As we look ahead to rebuilding our country following the devastation caused by Covid-19, our country must reflect on the importance of the cadre of workers that was at the frontlines of containing this pandemic.
Community health workers are the best “first responders” to countries’ health crises. In South Africa, they have played a vital role in curbing HIV and tuberculosis. Over the past two years, they have put their own lives at risk, bravely entering homes and screening people for Covid-19 and connecting those who were affected to their nearest facilities in addition to their everyday duties.
This past week the world celebrated World Health Worker Week (4-8 April) under the theme “build the health workforce back better”. If South Africa is to have a fair chance at withstanding future health crises and, more importantly, reducing our high burden of stunting, this is precisely what we will need to do for our community health worker workforce – which stands at just over 50 000 people.
Stunting is a condition arising from chronic malnutrition in the early years of life and affects the physical and cognitive development of young children. More than a quarter of children under five in South Africa are affected by it. As the people best placed to tackle this challenge head-on, community health workers visit the homes of pregnant women and young children to monitor their health and ensure that they are connected to quality healthcare where they live.
Community health workers are our best chance at eliminating stunting as they make important health interventions in the first 1 000 days of children’s lives, when their growth and development is happening at a rapid pace. This is the period between a child’s conception and their second birthday and when children are most vulnerable to stunting.
Through their daily duties, which include monitoring children’s growth, administering Vitamin A and referring pregnant women to healthcare facilities for antenatal care, community health workers protect children in vulnerable communities from a condition that can lead to poor school performance and ultimately unemployment in adulthood, as well as a susceptibility to chronic diseases such as hypertension and diabetes.
To pregnant mothers, community health workers are a well of information on raising healthy babies. They provide advice regarding the nutritional and emotional needs of babies during pregnancy and after birth. They also support new mothers to exclusively breastfeed for six months – a crucial preventative measure against stunting. Community health workers are thus a formidable weapon against stunting and countries that have recorded declines in stunting are proof of this. Brazil, for example, enjoyed improved maternal and child health thanks to the efforts of community health workers. Children were weighed more frequently, and exclusive breastfeeding increased.
With adequate support and better working conditions, community health workers can help South Africa attain the prosperity that would follow improved child health and a stunting-free future. Their employment status remains precarious, however, as they must renew their contracts annually and they are often not adequately resources with the tools and personal protective equipment necessary to do their jobs safely.
In recent years, the government has taken commendable steps towards formally recognising the work of community health workers as important by remunerating them at the minimum wage level but more still needs to be done for them to be supported to perform their duties optimally.
Our government must seize the opportunity to reimagine and rebuild a stronger community health worker workforce that the Word Health Worker Week provides.
“Building back this workforce better” will require them to be trained and equipped to better serve the most vulnerable people in our communities. It is also only fair that they be offered full employment given the demands of their work. Community health workers are a vital part of our health system, and it is time that our government prioritise them.