On Racialized, Gendered, Precarious Work: Struggles of Community Health Workers During the National Health Insurance Pilot Program in the Tshwane District, South Africa

Abstract

The infrastructure of precarious work is racialized and gendered, affecting disenfranchised Black women who carry the burden of low paid caregiving within the healthcare system. In South Africa, Community Health Workers, predominantly Black women from marginalized communities, have been vital in providing primary healthcare services at home, amidst widespread barriers to healthcare access for many Black South Africans, exacerbated by unemployment, poverty, and inadequate infrastructure. The objective of this paper is to demonstrate how the experiences of Community Health Workers during the National Health Insurance pilot program in the Tshwane District speak to the racialized and gendered nature of precarious work. Through qualitative research involving in-depth interviews and focus group discussions with Community Health Workers, Outreach Team Leaders, District Managers, and policymakers, findings reveal that Community Health Workers were subjected to exploitative contracts and poor conditions while delivering services in communities forgotten by the State. The humanity of Community Health Workers in this study reflects the intersecting oppressive systems of race and gender that continue to define the life of a disposable Black worker in post-apartheid South Africa. The paper urges the South African government to reform the precarious conditions of Community Health Workers by offering secure, full-time employment with decent wages, improved working conditions, and addressing the socio-economic challenges of the communities they serve. If these propositions are not met, the National Health Insurance Bill, which hopes to move the country toward universal health coverage, will institutionalize underpaid community healthcare giving, continuing the marginalization and exploitation of poor Black women.