Join Oxfam South Africa (OZA), Young Nurses Indaba Trade Union (YNITU), Nation Union of Public Service & Allied Workers (NUPSAW), National Union of Care Workers of South Africa (NOCWOSA), Treatment Action Campaign (TAC), South African Federation of Trade Unions (SAFTU) as we stand in solidarity with healthcare workers. #Care4Carers.

Oxfam South Africa, in collaboration with the Young Nurses Indaba Trade Union (YNITU), have released new research The Right to Dignified Healthcare Work, a Right to Dignified Health Care for All, which finds that unfair labour practices and the poor treatment of healthcare workers has compromised the quality of health care and left us with a healthcare system ill-prepared for shocks such as the COVID-19 pandemic

The South African healthcare system hangs on the edge of a cliff. A profit-seeking private healthcare sector, combined with underinvestment in an unaccountable public healthcare sector and gaps in labour policy, has driven unfair practices in the South African healthcare sector.

The health sector has been a site of catastrophic understaffing, stagnating salaries and jobs stripped of security, predictability, benefits such as health care, and a minimum number of guaranteed working hours. We have seen shortages of personal protective equipment (PPEs), medication and equipment. The healthcare workforce is on its knees from overwork, exhaustion, hyper stress, and mental health difficulties.

For decades, this system has worked to break the backs of the mostly black womxn healthcare workforce. In this tale of a two-tiered health care system, healthcare workers, particularly nurses and community healthcare workers, have borne the brunt of unfair treatment. This has compromised the quality of care given to patients.

Women are the backbone of our economies and society

The study finds that those in the healthcare profession are underpaid for the amount of work and hours they put in. Nurses can work excessive hours of up to 24 hours without a break.

It’s important to remember that nursing, community healthcare work and unpaid care work are culturally and socially viewed as “feminine” sectors. Therefore, womxn in general and black womxn in particular are overrepresented in the sector, owing to the system of patriarchy and racism. In South Africa, the number of womxn in the overall population is about 51.2%, yet womxn make up 90.1% of nurses. To be a “feminine sector”, however, is to be invisibilised, unrecognised, hypersexualised, undervalued, unrepresented and unappreciated.

The COVID-19 pandemic has woken us up to the cold reality that these so-called feminine sectors are in fact “essential services”. While the pandemic brought life to a standstill for many across the world, it intensified life for a brigade of womxn on farms, in food retail, in unpaid care, our homes and in nursing and community healthcare work, to name a few. These womxn have been life support for society, providing food and care to secure our collective right to life in the pandemic.

When will the collective #Care4Carers? When will we act on the realisation that community healthcare workers, who are risking their own lives to save our lives by tracing, testing and monitoring the virus, are amongst the most exploited? Their work helps to contain the pandemic, but they do not get medical aid for themselves and their households, earn a meagre R3500 a month if they are lucky, and are hardly ever reimbursed for transport when carrying out their work.

They are the foot soldiers charged with resuscitating a society and economy on the brink of collapse, by helping to contain the virus. Derided as “volunteers” despite their long working hours, they are at the mercy of criminals as they do their community visits, subjected to insecure contracts, and excluded from protections such as the Compensation for Occupation and Injury Disease Act (COIDA) which gives relief to someone harmed in the line of duty, a highly likely event given their responsibilities and circumstances. 

Today we ask, what will be done for the nurses? The backbone of South Africa’s national health system, they represent 77% of the public sector’s human resources for health care. Chronic understaffing in our healthcare sector and the reduction in admin staff has left them overworked, overstretched and unable to fully carry out care duties because of increasing administrative duties. Frozen salaries and ever-increasing labour brokering have left them for broke without labour protections. They have been forced into debt to subsidise low pay and they take up piece jobs or moonlighting to make ends meet. The private healthcare sector, on the other side, has exploited loopholes in labour law, such as using labour brokers to avoid filling vacancies and paying competitive salaries. 

Premeditated acts of injustice by the healthcare system

These are premeditated acts of injustice - the result of an austerity government that, for the past eight years, has cut budgets for healthcare and banned hiring nurses despite the healthcare needs. Those healthcare workers being recruited in response to the COVID-19 pandemic are likely to be left out in the cold and out of work once surge capacity is no longer needed, as they have been employed under short term contracts. Combined with poor governance, these acts have left patients and healthcare workers stranded, in a state of tension and hampered by low medical supplies and equipment.

Unequal and elitist healthcare system

The ever more expensive South African private healthcare system is available only to 16.4% of the population. We see that 72.9% of the White population has access to medical schemes, compared to only 9.9% of the Black population. Thus, private healthcare facilities exclude most of the Black population. 

This profit-driven private healthcare sector has been financially supported all the while through medical tax credits (a tax rebate for those paying to a medical aid) that serve a few. This combination has resulted in unequal resource distribution within the system. In the public sector, one nurse serves 200 patients and one community health worker serves 101 households; meanwhile 70% of the country’s doctors are in the private sector. 

It is no coincidence that the huge gains made by shareholders and CEOs before the Covid-19 pandemic coincided with increased job insecurity. Netcare, Life Group and Mediclinic have collectively paid out R 19 billion to shareholders of these three companies combined, while collecting net profit of R11 billion from 2016-2019.

Towards quality universal access to health care, free at the point of access

In the midst and the wake of the crisis, we must all stand in solidarity with nurses and community healthcare workers, and call for an end to the injustice and inequality they experience. Our report demonstrates a link between healthcare workers’ poor working conditions, and the poor quality of healthcare available in the country.

Ultimately, quality sustainable healthcare can only be achieved through decommodifying services, public investment on infrastructure and the health labour force to guarantee staffing levels, living wages, and dignified working conditions. Any successful strategy for the future of South African health care, and responsiveness to this pandemic, has to strengthen frontline health workers, restoring the dignity of their work to work towards a quality, universal, people-centred, resilient healthcare system that is responsive to the needs of communities and free at the point of access

We therefore ask the public to stand in solidarity with the healthcare workers. Join our campaigns and stand with us as we demand that now is the time to #Care4Carers.

Signed by

Oxfam South Africa (OZA),

Young Nurses Indaba Trade Union (YNITU),

Nation Union of Public Service & Allied Workers (NUPSAW),

National Union of Care Workers of South Africa (NOCWOSA), 

Treatment Action Campaign (TAC)

South African Federation of Trade Unions (SAFTU)

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