South Africa: Cry for Help for Caregivers

Late payment of the small monthly stipend that the Health Department provides to volunteer caregivers threatens to undermine the system, experts say. Among South Africa's nearly 39,000 community caregivers, 57 percent work in critical HIV and TB fields such as testing, treatment adherence, and home-based care.

The Health Department contracts with 1,636 nonprofit organizations through which the caregivers volunteer. In fiscal 2007-08, the department allocated 62 million rand (US $6.5 million) for organizations working against HIV/AIDS and TB. However, late payments by the department leave many caregivers without a stipend.

"They call it the dry season of government funding," said Denise Hunt, executive director of the AIDS Consortium. "Year after year, a few months in, government ceases to pay the grant to the organizations. Sometimes the counselors don't get paid for four months."

Some caregivers are unable to afford transportation to work, while others work with the hope of receiving back pay.

"Caregivers are exploited; you find that people are paid 500 or 600 rand a month [US $62-75]," said S'khumbuzo Maphumulo, an attorney with the AIDS Law Project. "They call it a stipend but it's just a way for government to get cheap labor." "The majority should be considered as employees, not volunteers, because they meet all the requirements of our labor laws in this regard," Maphumulo added.

Counselors are a key part of the mother-to-child HIV prevention program, said Dr. Vivian Black of Witwatersrand University. "They provide the pre- and post-test counseling," she said. "Without counseling we can't test for HIV." If caregivers are not paid and fail to report to work, clinics have to ask people to return some other time for testing, she said.

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