“Only God can thank you”: healthcare workers fight to get paid

Community health workers spend long hours protecting people in developing countries from diseases such as malaria, Covid-19 and HIV . But most receive little or no compensation.

On a given work day, Misra Yusuf can vaccinate a child against polio, inject a woman a long-acting medication. contraceptive, screen a man for tuberculosis, hang a mosquito net to protect a family from malaria and help dig a pit latrine. Over the past few years, she has administered some 10,000 coronavirus vaccines in her community in eastern Ethiopia. She also spotted and suppressed a measles epidemic.

She works much more than the 40 hours her contract requires her to do each week. For her work, the Ethiopian government pays her the equivalent of $90 a month.

“This payment is discouraging,” she said. “But I continue because I enjoy the work.”

Mrs. Yusuf is one of a legion of more than three million community health workers worldwide and part of a small minority who actually get paid. Eighty-six percent of community health workers in Africa go completely unpaid.

But now, spurred by frustrations that emerged during the Covid pandemic and connected by digital technologies that have reached even In remote areas, community health workers are organizing to fight for fair compensation. The movement is spreading across developing countries and echoes the union actions taken by women garment workers in many of these countries 40 years ago.

« Community health workers in some countries like Rwanda and Liberia treat half of malaria cases, making huge strides in curative care, promotional care and preventive care – and yet the vast majority of community health workers health communities around the world are not paid for or supported,” said Madeleine Ballard, executive director of the Community Health Impact Coalition, an advocacy group that helps with organizing and strategy. “It’s a gender issue, it’s a public health issue and it’s a work issue.”

The new pressure is starting to produce results . In Kenya, 100,000 community health workers recently began receiving stipends – $25 per month, paid by the government – ​​as a newly formalized group of health promoters. The victory followed a campaign, coordinated on WhatsApp, in which women posted photos of themselves doing their jobs on social media and used an app to learn strategies for lobbying politicians.

Margaret Odera, who formed the first WhatsApp group, said she relished the fact that she managed to help pregnant women in the Kenyan capital Nairobi , to protect their babies from HIV. But she was tired of being told for a decade that “only God can thank you” for your work.

“If you can pay a doctor to save a life, you can pay me," she said.

Praising cheap labor costs

ImageMs. Yusuf and colleagues promote vaccination and contraception options before deploying to provide door-to-door care.

For more than a billion people in low-income countries, community health workers provide the primary, and sometimes only, health care they receive during their lives. Health and aid organizations, such as the Bill & Melinda Gates Foundation; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and USAID, depend on workers to carry out programs that often have multi-million dollar budgets. Yet little or nothing in these budgets can be allocated to so-called last mile delivery.

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