A health worker gets her vaccination. Picture: ALON SKUY
A health worker gets her vaccination. Picture: ALON SKUY

The World Health Organisation (WHO) has fittingly designated 2021 as the International Year of Health and Care Workers. More than before the world has come to recognise the invaluable contribution of these frontline workers as they continue to place their own lives at risk to save those of others in the face of the Covid-19 pandemic.

In SA more than 40,000 of these selfless workers contracted the coronavirus in active duty, of whom about 2% have succumbed to the disease. The Sisonke programme to inoculate healthcare workers could not have come quickly enough, since these frontline workers are three to four times more exposed to the coronavirus than the general population.

Without the contingent of 28,000 community health workers undertaking door-to-door community screening and testing in the fight against this epidemic, not to mention the clinical care provided by the nurses in hospitals and makeshift wards, even more of the population would have been engulfed by Covid-19.  

Since about 90% of these health and care workers are women in SA, it behoves us on this year’s International Working Women’s Day to elevate into sharper focus the plight and challenges afflicting women workers in health and care work. We must also do so because in the wake of the tabling of the 2021 budget by finance minister Tito Mboweni, as part of the broader cadre of the public service these workers have been subjected to sustained and virulent abuses by neoliberal deplorables in government and the mainstream commentariat.

This elite has contrived to manufacture a consensus on the public service wage bill to shift the focus away from the more than R500bn that has been looted or laid to waste in corrupt deals between government and the private sector, involving senior officials, SOE executives and politicians on the one hand and infrastructure contractors, outsourcing companies and accounting firms on the other. Meanwhile, the lavish pay and benefits pertaining to those at the higher echelons of government — as politicians, judges, traditional leaders, executives and managers of entities, which are drawn from the same fiscus — is shrouded by the elite narrative of the bloated public service wage bill.

Amid these shocking cuts on vital items in public health spending, the Treasury is increasing allocations for consultants and outsourcing companies by 33% and 20% respectively in public health spending over the medium term

The auditor-general has been exposing the prevalent abject state of public finance management year after year to no avail. Yet since the first budget of the fifth administration presented by Pravin Gordhan in 2015, the narrative of a runaway public wage bill has been routinely peddled while formulaic economic policies continue to put the economy on a downward spiral through austerity measures. A simple logic is deliberately evaded; that if national output remains stagnant over such a protracted period, fixed allocations such as the compensation of employees will invariably inversely rise as a proportion of spending, amid declining revenue. Similarly, the debt-service costs, budget-deficit and the debt burden itself will rise in inverse proportion to the contracting output, as long as the superstition that reducing aggregate demand somehow leads to economic growth prevails.

Total public health spending contracted to a negligible average of 1.8% growth between 2012/2013 and 2019/2020, hence the Covid-19 pandemic laid bare the fragility of the public health-care system, and in the Eastern Cape it was overrun.

Over the medium term, public health is set to be subjected to at least an about 6% budget cut, which has chilling implications considering the other draconian austerity measures the Treasury announced.

The sixth administration of the ANC seeks to impose a wage freeze, measures to reduce headcounts, freeze certain posts, reverse pay progression and occupation-specific dispensation, as well as abolish some allowances and benefits. It is a cynical irony that the occupation-specific dispensations that were an initiative of government itself from 2007 amid the exodus of professionals because of poor pay and working conditions in the public service, is now blamed on healthcare workers and other professionals. Amid these shocking cuts on vital items in public health spending, the Treasury is increasing allocations for consultants and outsourcing companies by 33% and 20% respectively in public health spending over the medium term. This is likely to be replicated in other departments and SOEs that are also now dependent on the same fiscus for their operations.

Tragically, all of these austerity measures will severely impinge upon the livelihoods and the already dreadful working conditions experienced by nurses, doctors and other professionals in public health. This also means the intensification of psychological distress and further devastation of their wellbeing. Many of these women are highly indebted single parents, and are overwhelmed by unpaid household drudgeries. The WHO has recently found a 23% prevalence of depression and anxiety, and 39% prevalence of insomnia, during Covid among health-care professionals in 84 member states. In the SA public health sector the prevalence of these conditions is bound to be severe, and more so among care and health workers, who are often exposed to violence, rape and lack of transportation while eking out a survivalist livelihood.

Reactionary path

Care and health workers are the epitome of superexploited semiskilled labour, intersecting with gender and race, perpetrated by a neoliberal regime. The government says the foundation of the envisaged universal health coverage in terms of the National Health Insurance policy will be primary healthcare, in which such workers would be at the centre. Despite the adoption of the policy for nearly a decade now, these largely women workers remain precariously linked to the public healthcare system through casualised contracts or externalised to nongovernmental organisations, without any benefits. Paid “stipends” are generally worse than the starvation national minimum wage. Yet, like nurses, many of the care and health workers are already over 40 years of age and are subjected to long hours’ standing and walking, while working more than the maximum hours specified in the Basic Condition of Employment Act.

In declaring 2021 the International Year of Health and Care Workers, the WHO is calling on governments to “protect our health and care workers” and “invest in people who invest in us”. In this regard, based on the set out fiscal policy over the medium term, the SA government pivoted on a reactionary path, diametrically opposite to the course towards the realisation of the Sustainable Development Goals, especially goals 3, 5, 8; not least at the expense of working and unemployed women of this country.

However, this should not be surprising as already in 2018 under the UN Economic and Social Council the SA neoliberal regime had been called out. The 58th meeting of the Committee on Economic, Social and Cultural Rights adopted a report on concluding observations on SA, which the ANC government continues to ignore. Among others, the committee stated that:

  • The model of economic development pursued by the governing party in SA was insufficiently inclusive and called on it to reexamine its growth model to move towards a more inclusive development pathway.
  • It was concerned that government had “introduced austerity measures to relieve the debt level” and “that these measures have resulted in significant budget cuts in the health, education and other public service sectors”.
  • There is no composite index on the cost of living that provides the state party with a benchmark to adequately set the levels of social benefits consistent with the requirement to ensure an adequate standard of living for all.
  • The SA government should “prevent and mitigate the casualisation or externalisation of work in the formal economy”.

Our acute triple crises of unemployment, poverty and inequalities are largely borne by working and unemployed women in SA, amid a fragmented and inadequate system of social protection. In a deeply patriarchal society such as ours, reinforced by class and gender oppressions, it is no surprise that however invaluable an occupation might be socioeconomically, if it is dominated by women, as in health and care work, the exploitation is intense.

• Sapheta is general secretary of the National Education, Health and Allied Workers Union.

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