‘It’s in our veins’: caring natures and material motivations of community health workers in contexts of economic marginalisation

Abstract

Khayelitsha, an economically marginal peri-urban settlement in Cape Town, is home to a number of 'flagship' public health interventions aimed at HIV/AIDS and TB. Alongside these high-profile, foreign donor-driven treatment and care programmes are a plethora of NGOs that provide a wide range of community-based carework. Some of these organisations are large, well-funded and wellconnected globally, while others are run by a few unemployed women responding to care needs in their neighbourhoods. This article explores the ways that community health workers (CHWs) who work for these organisations understand and speak about their involvement in carework as volunteers, employees or managers of community-based care organisations. Many CHWs framed their work through discourses of gender, religion or culture ('African-ness'). They also described forms of material or economic benefits of providing carework, but many were concerned that these might be seen as existing in tension with more socially accepted, altruistic motivations for care. We explore here how CHWs narrate and understand their roles and motivations as carers and members of a resource-constrained community.

Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa

“…The finding that supervisors derive intrinsic motivation from being promoted to the position of supervisor provides support for the finding of previous studies among CHWs that show that the hope of acquiring skills and the need to pursue career paths within the health system are key motivations for CHWs in South Africa [10, 11, 17]. Most of the supervisors had only high school education when they enrolled as CHWs.…”

“…Currently, the South African Department of Health (DOH) is piloting a reform of the PHC system. A key element of this reform is the incorporation of CHWs into the formal health care system as part of ward-based outreach teams that will facilitate access to health care services in households in marginalized communities across the country [6, 11]. Given the central role that CBOs play in the delivery of health care services to marginalized communities, one would expect CHWs and supervisors working in CBOs to play a critical role in the new PHC initiative.…”

“…An important factor influencing motivation among CHWs and the sustainability of CHW programmes, as demonstrated by several studies, is the management and supervision of CHWs [14–16]. Research has found that the main factors motivating CHWs are altruism, religious and moral obligations, the prospects of paid employment in the health and social services sector, previous experience with HIV and AIDS in the family, and the wish to avoid idleness [10, 11, 17]. Studies have also identified supervision as a key factor influencing retention among CHWs [18, 19].…”

Paid staff or volunteers – does it make a difference? The impact of staffing on child outcomes for children attending community-based programmes in South Africa and Malawi

“…In most cases, CHWs in low-income contexts are poor and usually female [57,58]. Expecting economically marginalised women to provide health and welfare services to others, without remuneration, has been argued to amount to labour exploitation [24,59]. Swartz and Colvin [59] suggest that the lack of payment is reflective of a broader, gendered, and structural lack of recognition of the female workforce.…”

“…Expecting economically marginalised women to provide health and welfare services to others, without remuneration, has been argued to amount to labour exploitation [24,59]. Swartz and Colvin [59] suggest that the lack of payment is reflective of a broader, gendered, and structural lack of recognition of the female workforce. The requirement of a fair wage and a secure livelihood is the leading philosophical argument in favour of a paid workforce [7,14].…”