Western Cape Community Health Workers Demand Permanent Jobs as Province Retains NPO Model

For eight years, Salaama Abrahams has been on the frontlines of community healthcare, visiting vulnerable patients at home, providing palliative care, and offering vital tuberculosis and HIV support. Yet every March, she faces the same agonizing uncertainty: will her contract be renewed?

Abrahams is one of thousands of community health workers (CHWs) in the Western Cape caught in an annual cycle of fixed-term employment. Despite carrying heavy responsibilities, these workers remain employed through contracted non-profit organizations (NPOs) rather than the provincial government.

“We work like permanent employees and serve our communities every day, but we do not receive the same security and benefits,” Abrahams said.

Her daily duties include antenatal and postnatal care, HIV testing and counseling, TB awareness, and health education at local schools. As a member of the National Union of Public Service and Allied Workers (NUPSAW), she points out that CHWs miss out on standard employment benefits such as medical aid and pension funds.

“Permanent employment would give me and my family more stability,” she explained. “It would allow me to plan for the future without always worrying about whether my contract will be renewed.”

Union Challenges Provincial NPO Model

NUPSAW is pushing for community health workers to be directly integrated into government departments, arguing that community-based care is an ongoing, essential public healthcare service.

Vuyani Shwane, NUPSAW’s provincial office manager, noted that expectations of direct integration grew across the country following a landmark Labour Court ruling. However, he argued that the Western Cape has lagged behind other provinces by continuing to outsource these roles to third-party NPOs.

According to NUPSAW estimates, approximately 3,700 community health workers operate under the Western Cape model, 1,843 with matric qualifications and 1,857 without. Shwane stated that NUPSAW represents close to 2,800 of these workers in the province (figures provided by the union and not independently verified).

Department Stands by NPO Framework

Responding to National Citizen, the Western Cape Department of Health and Wellness clarified that CHWs are directly employed and managed by contracted NPOs, while the department provides funding and service oversight.

“There is currently no policy decision to employ community health workers directly as permanent employees of the Western Cape Government,” the department stated.

The department emphasized that employment conditions and benefits remain the responsibility of the respective NPO employers, though it noted that constructive engagement with organized labor, including NUPSAW, remains ongoing.

The province maintains that the NPO model provides an effective, community-rooted approach to primary healthcare delivery, a stance that leaves workers like Abrahams asking for more than just annual contracts.

“We are asking for recognition of the work we do,” Abrahams said. “And for the opportunity to have a secure and dignified future.”