Date: 11/03/2004
Source: Ministry of Health
Title: M Tshabalala-Msimang: Gugulethu community health workers certificate ceremony


SPEECH BY THE MINISTER OF HEALTH, MANTO TSHABALALA-MSIMANG, AT THE HAND OVER OF CERTIFICATES TO COMMUNITY HEALTH WORKERS, GUGULETHU, CAPE TOWN, 11 March 2004

It is indeed an honour and privilege for me to join you at this special ceremony. This is my second day here in Gugulethu. Yesterday, I spent the whole day here. I visited Gugulethu Day Hospital where I interacted with patients and staff in order to understand some of the challenges facing them. I also interacted with the rest of the community before meeting some of the community health workers in the afternoon.

It is important that as we celebrate our ten years of democracy, we acknowledge our dear sisters and brothers who are committed to serve our communities, even under difficult circumstances.

The African National Congress (ANC) Health Plan emphasised amongst other things that "Community health workers can play a unique role in promoting health and improving health services, provided they have effective support and referral structures and receive on-going training"

It is clear that, even before we were in government, we already understood the enormity of the task ahead of us. We knew that, in order to extend health care services to all of our people, community health workers would have to play a pivotal role. In pursuit of this vision we convened a lekgotla of community health workers from around the country to create a policy framework for the functioning of this cadre of health workers in Durban in October last year.

We discussed the Extended Public Works Programme, which is co-ordinated by the Department of Public Works, the Community Development Worker Programme co-ordinated by the Department of Provincial and Local Government and the Community Care Worker model within the Department of Social Development. The main aim of interrogating these models was to ensure that we moved in the same direction as different government departments. Community health workers attending the lekgotla made significant inputs into the framework for community health workers as adopted by Minmec late last year. We subsequently nominated national and provincial community health worker champions to further co-ordinate the implementation of these recommendations.

Comrades and colleagues, it has been a long road, it has been a difficult road, but together we have held hands to get to where we are now. I am proud to inform you that last month we were able to launch the Community Health Worker Programme at a national level.

The concept of community health worker is driven by five imperatives:
* The President's articulation of a people's contract to create work and fight poverty
* Government's commitment to improve service delivery
* The national human resource and skills development strategies
* The increasing complexity of the burden of diseases and poverty-related challenges
* The increasing need for health promotion activities, community and home-based care.

The Department of Health sees this cadre of health workers as community-based generalist health workers. They should combine competencies in health promotion, disease prevention, primary health care and health-resource networking as well as co-ordination.

This programme also links to the President's initiative of community development workers. It is a partnership between government and non-governmental organisations (NGOs). The Department of Health will provide grants to NGOs who would than employ community health workers. Community health workers will be employed by organisations in civil society and will not be government employees.

These health workers should work in their local communities and visit households. They should interact with community members, determine what health or other services are needed and co-ordinate efforts to make these services available.

Mechanisms are being put in place to ensure community involvement in the recruitment and selection of community health workers. Where single purpose health supporters like (Directly Observed Treatment Strategy) DOTS supporters for tuberculosis and lay counsellors for HIV and AIDS operate, community health workers will increase their efficiency by co-ordinating these activities and interactions with communities.

Programme Director, I urge your indulgence in dealing with an issue that has led to some confusion around the role of volunteers. It is important to stress that, despite formalisation of the community health worker sector, there is still a need for volunteers.

Volunteers are people who render their services without an expectation of payment or reward. With human resources being one of the scarcest resources especially in rural and peri-urban areas, we need the support of volunteers to render health services. We want to commend these men and women for their spirit of selflessness and patriotism and urge them to continue supporting the provision of health and other government services.

Turning back to the subject at hand, one area of concern highlighted by community health workers during the Durban Lekgotla, was the vast disparities between the stipends paid within and between provinces. It is for this reason that, in the policy framework, we recommend that all community health workers in the country should receive a minimum stipend of R1000 a month. Although it is humble, this stipend will invigorate community health workers to continue rendering this crucial service.

In conclusion, let me indicate that there were a number of issues raised by both patients and staff that I met at Gugulethu Day Hospital. I have learnt that a few staff members were not satisfied with the amount of time they were afforded to raise issues affecting them.

I have asked these health professionals to write to me as soon as possible about these issues. I will meet my colleague Health MEC, Piet Meyer, to discuss as to how they can be addressed because health is responsibility of both the provincial and national department.

There were a number of things raised. Community members were worried about waiting times, cleanliness of the facility and some challenges in accessing medicines. Staff raised such issues as shortage of personnel and poor patient information system. One thing that touched me was to see patient records being filed manually because all computers at the administration section were broken. In fact I was told that this situation has existed for a long time.

I have tried to check as to how we can urgently addressed the challenges around patient information system because it poses a serious threat to continued care of patients and follow up consultation. It is actually one of the factors that increase patient waiting times as accessing of patient files takes longer or they are lost altogether.

I have a pleasure to inform you that we have been able to get two laptop computers for the hospital administration section. These computers should be delivered to the hospital by Tuesday next week because appropriate software is still being installed. These computers are part of 50 computers we are getting from Digital Partnership. We will be giving most of them to clinics in order to strengthen the district health information system.

We have never claimed that improving health services is going to be easy. All of us in the health sector, including health professionals in our facilities, need to continuously seek creative solutions to the challenges facing us. As Government, we are committed to provide leadership and play stewardship role. We are also investing the limited resources we have in enhancing the quality of care because we are determined to improve the lives of our people.

Thank you.

Issued by: Ministry of Health
11 March 2004