“By doing my job I am taking the clinic to the community”
-Philippi-based Community Care Worker
The July strikes and subsequent arrest of community health workers in the Free State have focused attention on the role of community-based workers in South Africa’s health system. This type of health worker is critical to the success of TB and HIV programmes.
In his recent budget vote speech, Health Minister Aaron Motsoaledi said that as of January next year antiretrovirals (ARVs) are to be rolled out earlier– at a CD4 count of 500 (as opposed to 350). This means more people will be on treatment. Yet success in fighting HIV as well as TB does not stop at access to and availability of treatment. Additionally, people who start treatment must continue to take TB medication for at least six months, or in the case of ARVs, for the rest of their lives. With clinics overwhelmed by the need to diagnose and start patients on medication, the difficult task of keeping patients in care and walking the journey of treatment with them falls to a different cadre of health workers – community care workers.
Community care workers (CCWs) are tasked with supporting members of their community who are living with HIV and/or TB. They do so weekly and focus on giving adherence support (monitoring whether clients are taking their medication through counting pills), making referrals for social services, and screening other households members. Their function is especially important when there is insufficient social support in the home and a lack of knowledge about TB and HIV. With busy clinic health workers who may not speak the language of the patient, community care workers can become the main source of health information for a patient and a critical link to the health facility.
TB/HIV Care Association employs a total of 243 community care workers in the Western Cape, the majority of whom are women. Being a community care worker is not an easy job. Because these women must walk around the community visiting their patients, they are at risk. Many experience varying degrees of gender-based violence while doing their work. Like other health workers, CCWs are also at increased risk of contracting TB.
As an indispensable part of South Africa’s current and future health system, it is TB/HIV Care’s position that community-based workers should be acknowledged, properly supported and trained, and adequately compensated for their work.