The Western Cape Department of Health & Wellness has no plans to comply with a 2025 Labour Court ruling that community health workers (CHWs) must be absorbed into the formal health workforce, saying that its current model is sustainable and effective.
This comes as African Union leaders highlighted the urgency of employing more CHWs, and their critical role in the continent’s health sector.
Health-e News, reports that CHWs have functioned as contractual workers for years, with no pension benefits, and with most of them hired by non-profit organisations and contracted by various health departments.
However, last year the court ruled that they must be absorbed into provincial departments’ formal labour force, where they would earn salaries and qualify for a pension.
But the Western Cape is not planning on changing its relationship with CHWs.
“Over the years we have built strong partnerships with NPOs that recruit and employ the community health workers, ensuring services are tailored to the needs of the neighbourhoods they know best,” Maret Lesch, a spokesperson for the provincial health department told Health-e News.
According to Lesch, this model has been effective, and the province will continue to partner with the NPOs.
“We appreciate the vital contributions of every community health worker and will continue working with our partners to ensure they perform their roles with the respect and support they deserve,” Lesch added.
Partnering organisations
Nobuntu Mfengwana (53), a CHW in Cape Town working for Philani Nutrition Centre, one of the NPOs contracted by the department, has been working for different organisations since 2012, gaining extensive experience over the years. She earns R4 900 monthly, which she said is not enough to meet the basic needs of her family of nine.
Mfengwana added that their their workload often exceeds their official duties, yet the Health Department does not seem to value their efforts. Over the past 14 years of service, she has had to reapply for her job every year.
Philani Nutrition Centre did not respond to queries.
Cynthia Tikwayo, who started doing community healthcare service in 2011, works at Michael Mapongwana Clinic in Khayelitsha, working for TB HIV Care, earning a stipend of R3 700 a month.
“The stipends are determined by the Western Cape Department of Health and Wellness, and are in line with the national minimum wage stipulations,” said TB HIV Care spokesperson Aziel Gangerdine.
He added that they haven’t received any complaints from employees regarding working conditions, but that internal processes were in place for all staff to raise concerns.
Mobilisation of CHWs
Tikwayo is calling on workers in the province to unite and organise, instead of boycotting strikes organised by competing unions. “Unions representing the CHWs are politically competing, and I wish this could come to an end. The workers are divided because of the politics within the unions,” she said.
She believes that the department will, at some point, permanently employ the CHWs.
In his 2025/26 budget speech, Health Minister Dr Aaron Motsoaledi said R1.4bn had been set aside for the permanent employment of 27 000 community health workers.
The National Department of Health didn’t respond to queries about the approach being adopted by the Western Cape.
AU reiterates call for CHWs
Meanwhile, in Addis Ababa this week African Union (AU) Ministers of Health and Finance and Heads of Delegation called for urgent and sustained investment in Africa’s health workforce, highlighting the goal to build a 2m-strong CHW workforce by 2030.
The appeal was made at a High-Level Side Event during the 39th AU Assembly, co-organised with the Africa CDC and the AU Commission.
Leaders said the investment is critical to strengthen Africa’s health security and sovereignty and accelerate progress toward universal health coverage.
They highlighted the essential role of community health workers and strong immunisation systems, warning that Africa’s severe workforce shortage threatens outbreak detection and basic health services.
Despite the more than 1m CHWs now deployed, coverage remains well below global benchmarks, and most programmes still lack stable domestic financing.
The meeting underscored the strong economic returns of investing in health workers and urged countries to prioritise workforce financing, protect frontline spending, and use AU accountability tools.
Despite carrying more than 25% of the global disease burden, Africa faces a severe shortage of health workers, with the WHO projecting a shortfall of more than 6m health workers by 2030.
Leaders concluded by endorsing a declaration committing to accelerated investment in Africa’s health workforce.
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Failed bid to have 47,000 community health workers made permanent employees
Thousands of KZN community health workers finally employed full-time