Community care policy at the intersection of HIV and unemployment crises in South Africa: paradoxes and paradigms.

Abstract

The community care sector is a major component of social protection systems in South Africa. However, despite considerable investment and policy attention on social protection in South Africa, the community care sector continues to face enormous challenges and pressures. On the one hand, government invests a significant amount in social spending and aims to honour its constitutional responsibilities towards improving the health and social welfare of the country. On the other hand, community-based care workers are socially and economically marginalised, and community care services remain fragmented and often inaccessible to those who need them most. This paper explores how elements of South African policy on the community care sector emerged historically out of policy responses to parallel social crises of HIV/AIDS and unemployment in the period 2000-10. We draw on the theories of John Kingdon (agenda setting) and Nancy Fraser (needs interpretation) as the lenses to analyse data from policy documents, published literature, and key informant interviews. We show the convergence and consolidation of policies across sectors in the study period into a community care sector characterised by competing and unresolved tensions: between constitutional promises of social and economic rights and enduring conceptualisations of social reproductive labour as feminised, devalued, and 'invisibilised' within the private, domestic sphere. This results in a community care sector that has limited effectiveness as an arm of the social protection system, and which continues to be plagued by the structural inequalities that characterise South African society.