The health department has apologised to the public for the disruption to some health services in the Ndlambe municipal area. Since Wednesday, staff have been locked out and patients turned away from five clinics in Port Alfred and Bathurst in protest at the department’s failure to absorb all community health workers (CHWs) and lay counsellors. In a statement, the department said it had issued an ultimatum instructing employees to return to work.
This week, patients arriving at Port Alfred’s four clinics, as well as the Bathurst Clinic in Nolukhanyo, were turned away and professional staff were locked out. Patients needing chronic medication were advised to go to the outpatients department at Port Alfred Hospital, where they faced a long wait.
“This is something the government started, and they must fix this mess!” said a Station Hill resident who relies on the Station Hill clinic for his chronic medicine and general health care. He spoke on condition of anonymity.
“It’s unfair for people who can’t afford expensive medical aids, or even just to buy their medicine, that they sit without their medicine.
“I am sympathetic to the community health workers: they are doing most of the work, especially when it comes to home visits. But this is unfair to patients. They must rather go to the offices where those health officials are and not take out their frustration on poor people,” he said.
Commenting on Talk of the Town’s Facebook post about the stoppage, Olwam Makasi said, “An elderly couple left the farm at 6 to get to Nolukhanyo clinic [this] morning – a 13km walk, shame baya bhenza utuVi abanye Abantu Kodwa yitoni evalisayo.”
Zimkhitha Khofi responded, “I know and I feel the pain of the elderly people…. but how should the workers work so that their grievances are heard? It’s been years since community health workers were not hired… The one who is really hurting the people is the government, not the workers… instead of insulting them on Facebook, we should stand up and help them so that this can be brought to an end.”
What is the stoppage about?
The LRA allows fixed-term contracts longer than three months if there is a justifiable reason, and the employee’s earnings are below a certain threshold. In a 2021 Public Health and Social Development Sectoral Bargaining Council mediation, the health department justified the CHWs’ recurring longer fixed term contracts by saying their positions were funded by an external source for a limited period. In addition, the contracts had been drawn up through collective bargaining with unions. The commissioner arbitrated in favour of the health department.
In January 2025, after a successful review application by the National Education, Health and Allied Workers Union (Nehawu), the Johannesburg Labour Court said the CHWs’ salaries might be funded by a different type of grant, but like all government funding it came from the same source: the national treasury. The 2021 ruling was set aside and the employment contracts of the listed CHWs were deemed permanent.
The Public Servants Association (PSA) hailed the ruling, In a media statement soon after the PSA said, “For over a decade, CHWs have worked under recurring fixed-term contracts with no job security or benefits. They have played an essential role in the healthcare system, especially in underserved communities, where they deliver critical services such as health education, maternal and child health, and chronic-disease management.
“Despite their immense contributions, CHWs have been deprived of basic worker rights, including the ability to access financing and healthcare owing to their short-term contract status. Many have been unable to afford medical aid, pensions, or insurance, leaving them vulnerable.”
Short lived
But the celebration was short-lived, as the health department announced it would only be employing CHWs with Grade 12. This, and what CHWs consider to be slow progress on executing the court order, is what prompted this week’s stoppages.
In a telephone interview with Talk of the Town, Nehawu provincial secretary Mlungiseli Ncapayi said after all provinces had been directed to verify how many CHWs they had, the Eastern Cape submitted 2500.
“But the the Eastern Cape has has 5000 CHWs,” said Ncapayi.
“For us, it makes no sense. We have people who served as CHWs for 18 years before being reassigned as lay counsellors [i.e. because of lacking matric]. Now, because for the past two or three years they’ve been working as lay counsellors instead of CHWs, they’re not eligible to be absorbed.
“There’s no difference between CHWs and lay counsellors in terms of the service they provide. We see this as discrimination.”
Also concerning, Ncapayi said, was that of the 2500 names submitted by the health department for absorption, 289 of those were people who had reached the age of 65 and were due to retire according to the department’s policies. He said Nehawu was pushing for the health department to find the money to absorb both CHWs and lay counsellors.
“We also secured pay top-ups that would be backdated for both CHWs and lay counsellors,” he said.
‘The department has to listen’
CHWs who had gathered at Nkewenkwezi Clinic on Friday said they had been fighting for proper employment for more than a decade.
“Some of us have been working as CHWs for about 15 years,” said the group’s spokesperson who spoke on condition of anonymity. “Some are the right age to retire – but they will leave with no pension and no having received no employee benefits for all that time.”
The current iteration of CHWs was introduced to South Africa in 2011.
Talk for the Town asked the CHW if she was aware that elderly and other vulnerable people who couldn’t afford private health care were struggling to get their chronic medication.
She said, “We know it’s not right: these are our people.
“But what about our rights? We have been tolerating this for many years without a way forward. This way, the department has to listen and they will come to us.
“We want to work, even now – but our rights also matter,” the CHW said.
EFF PR councillor Xolisa Runeli vowed to support the Ndlambe CHWs as they pursue their cause. He said, “The government has failed them, and it has been years.”
Affront to dignity
In a recent statement, the PSA slammed the exclusion of those without matric.
“These veteran workers have carried the provincial health system through multiple public-health crises, proving their competence, clinical intuition, and community trust under precarious contract conditions.
“To now implement a rigid academic requirement for an entry-level position that these workers have already mastered through many years of frontline service is illogical and an affront to their dignity,” the PSA said.
The PSA also condemned what it said were discriminatory appointments based on the age of workers.
“The PSA has observed a trend where senior, more experienced Community Health Workers are being marginalised in favour of younger applicants. This approach ignores the fundamental principle of recognition of prior learning. In a professional healthcare environment, 15 years of uninterrupted field experience should be regarded as a qualification far superior to a theoretical certificate.”
Ultimatum
In a statement issued earlier this week, the Sarah Baartman District of the Eastern Cape Department of Health said it wished to inform the public that some health services in facilities within the Ndlambe Local Municipality, including Port Alfred Hospital and surrounding clinics, had been affected by the work stoppage.
“The Department has formally engaged with the affected individuals and has issued an ultimatum in terms of the Labour Relations Act 66 of 1995, instructing employees participating in the unprotected work stoppage to return to work,” spokesperson Siyanda Manana said.
“The concerns raised by the affected workers relate primarily to matters regarding the permanent appointment of Community Health Workers and Lay Councillors. The Department acknowledges these concerns and remains committed to addressing them through the appropriate consultation and labour relations processes.”
The Department apologised to communities for the inconvenience and disruption.
“Every effort is being made by management to ensure that critical services continue and that the matter is resolved as soon as possible,” Manana said.
In the interim, management was implementing measures to minimise the impact on patients and to ensure that urgent and emergency health services remained available.
“Community members are requested to remain patient while the Department works to stabilise services,” Manana said. “The Department appreciates the cooperation and understanding of the public during this period.”
maclennans@talkofthetown.co.za
