S Selao: Community health worker summit

16 March 2007

Community Health Workers
Representatives of non-governmental organisations (NGOs)
Representatives from the private sector
Officials from the Department
Ladies and gentlemen

Firstly, I would like to take this opportunity to congratulate our Community
Health Workers on the very important work that they are doing to assist
government in preventing diseases, promoting healthy lifestyles and caring for
the chronic and terminally ill.

Due to personal circumstances, I was unable to attend the recently held
Community Health Worker Recognition Awards Ceremony, but I would like you to
know that my physical absence was by no means a reflection of my attitude
towards you.

With your daily tasks entailing visiting communities and households,
engaging with community members, determining what health requirements are
needed and co-ordinating these services to be available, you play a critical
role in the health chain.

So know that your work does not go unnoticed. Your constant exposure to
great human need surely takes its toll, and in response I can only issue words
of admiration. It is indeed a noble job that you are doing and for that I thank
you.

Now the time has come to take community health service delivery to another
level and through your deliberations at this summit you should remain focused
so that we can begin to close the gaps that still exist in the health care
sector.

The province has now progressed from an early HIV epidemic into one of which
the full impact of morbidity is beginning to be felt. At the same time, the
health system is becoming massively overburdened.

The disease burden will increase substantially over the next few years, as
more of the population becomes symptomatic, requiring numerous hospital
admissions and primary health care consultation.

As community teams, you have taken up a place in the health sector and you
are tackling the challenges of HIV, AIDS, Sexually Transmitted Infections and
tuberculosis (TB), but the health sector itself is also faced with a number of
challenges of its own.

We must recognise that we have limited health care resources such as
insufficient medical and nursing staff, and increasing demands by other
patients who have curable conditions which need to be managed in hospitals.

There is also the limited amount of resources for treatment and drugs, as
well as the cost of institutional care and the shortage of hospital beds.

As more people become ill with AIDS-related diseases and other chronic
conditions, many are not able to stay in hospitals and home has become a more
appropriate place for care. However, it is important that we avoid the
misconception that home-based care is intended to be "second class care" or
"cheap care".

This is not the case, as you have shown that commonly occurring diseases can
be effectively managed at home, and that institutionalised care is not always
the most appropriate care for many problems.

Focus has also shifted from recovery to quality of life because while people
with AIDS may have a limited prognosis, with the right advice and support, they
can still have a good quality of life for a long time to come.

However, one of the main challenges facing home-based-care programmes, is
fear or mistrust of caregivers.

Hence the need to keep patients’ HIV status secret. This is very important
because as you know, the disease is unfortunately still heavily stigmatised,
and revealing a patient’s status can lead to the community rejecting not only
the patient but their whole family. We even know of situations where people are
known to have died from AIDS without disclosing their status, simply to protect
their children from being shunned by the community.

This must not happen. It is therefore necessary to consider how best to
provide care for people with diseases and their families.

As caregivers, it is also imperative that you lead by example.

This should not only be seen in your decision to abstain or to condomise,
but also in your conscious decision to get tested and to know your own status.
However, this is not to say that you should disclose your status if you are not
ready.

One of the challenges of home-based care is that the HIV and AIDS epidemic
will decrease the caregiver pool. I hope you respond to this challenge with a
determination that will prove this gloomy assumption to be wrong. And so I urge
you again to get tested.

If you are HIV negative, make it your goal to stay negative. If you are
positive, accept your status and then live positively. You know better than
anyone that with proper care, there are many years to still to be enjoyed and
to still to make a difference.

Sometimes you might think you are not making a difference, but in fact you
are the very epitome of our State Presidents articulation of Government’s
commitment to getting closer to communities and serving them better.

As you find yourselves amidst large scale, face-to-face contact, you are
seen to be a compassionate and energetic presence in the communities.

Masibambisane – you are caring for our communities, in spite of the
obstacles that continue to present themselves.

It is so that your social environment may be restricted due to set beliefs,
customs, local conflicts and even inappropriate housing.

In fact, only last week I visited a TB patient in Ganspan, whose
impoverished and poorly ventilated residence served as a reminder to me of the
harsh conditions that you so often have to work under.

You are constantly at risk of being exposed to physical illness such as TB.
Then there is also the emotional and physical strain experienced by caregivers,
the uncertainty about the duration of the situation and possible dependency of
the client on you, emotions such as rejection, anger and grieving; and
exhaustive care tasks.

Yet, you achieve direct communication with a human touch, on a mass scale,
within relatively short time-frames, and in doing so you are strengthening the
nation’s commitment to strengthen participation of its people in development of
civil society in general.

You are reaching individuals and marginal groups who miss out on health and
social services and receive very little information.

You are foot soldiers, but you are not merely foot soldiers who unthinkingly
repeat predetermined messages to a set number of people. Instead you are self
directed teams, who know their communities and use their judgment in planning
and executing local campaigns.

I encourage you now to put your acquired skills to use, to use your judgment
wisely and, when the time comes, to execute the plans that you make today and
tomorrow, with a confidence and determination that won’t back down for
anything.

This is so that our very first Community Health Worker Summit will result in
actions that will ensure that the burden of the HIV epidemic is decreased, and
that the ability of the health system to cope with provisions of adequate care
and support activities is increased.

Let me remind you once again that Community Based Organisations and
Community Health Workers are critical partners in the successful implementation
of government programmes and are also a support base for the nation’s strategic
HIV and AIDS plan.

Thus, let us not underestimate the power of clean water, soap, essential
medicines, a willing heart and caring hands to improve matters here in the
Northern Cape.

I thank you

Issued by: Department of Health, Northern Cape Provincial Government
16 March 2007