South Africa: Confusion Over Healthcare Worker Contracts in the Eastern Cape

Thousands of healthcare contract workers in the Eastern Cape Department of Health face an uncertain future over the continued extension of their contracts. This follows two conflicting decisions on ending contracts of workers roped in February last year to help in the fight against COVID-19 in the province.

How it happened

The department went on a hiring spree of healthcare workers last year to boost the numbers of frontline workers deployed to different health facilities across the province in response to the COVID-19 pandemic.

Initially, the contracts were meant to end in March this year. However, a new circular was sent in March following a public outcry about the termination of the contracts at a time when healthcare workers were sorely needed for the COVID-19 response. This prompted the provincial government to source an additional R400 million to fund the renewal of the contracts until the end of June 2021.

On 21 June, the Buffalo City Metro was the first district to send out an internal circular to personnel managers as a reminder that contracts would not be renewed after it ends at the end of June.

However, the provincial health department’s newly appointed Acting Superintendent-General, Mahlubandile Qwase then made an about-turn a week later and ordered all circulars and notices issued must be retracted “with immediate effect”.

Qwase wrote to health department and facility managers on June 28, informing them the department is attending to administrative matters relating to the extension of contracts for 2 949 COVID-19 and community healthcare workers who are currently on three months contract extensions ending June 30.

“All managers and supervisors are hereby notified to and instructed not to terminate these workers’ contracts, nor to issue them with notices of termination until such time that the accounting officer indicates as such. All circulars and notices already served to be retracted with immediate effect,” he wrote.

‘The department needs us as much as we need employment’

One community healthcare worker from East London affected by this, tells Spotlight “the whole thing of these contracts is confusing”. She did not want to be named out of fear it may jeopardise her future employment prospects.

“After we received our contracts, we served the department wholeheartedly risking our lives throughout the peak of the pandemic and now we are told we don’t have a job. The same officials who had told us that we are losing our jobs, now told us we might get an extension of our contracts. This is traumatic to go to work in the morning not knowing that by the end of the day you are about to lose your job. We are hoping this time they will give us permanent employment because the department needs us as much as we need employment. I don’t know where my next meal will come from if the department decides to dump us,” she says.

Eastern Cape provincial chairperson of the Treatment Action Campaign, Thembisile Nongampula says now it is the wrong time to talk about terminating contracts of healthcare workers as the province is heading towards a third wave.

“Terminating contracts at this juncture will be a wrong move because those workers are most needed to assist in combating the third wave which is almost here. Five provinces, including the Eastern Cape, are affected by the Delta variant, meaning the department needs all the help they can get. We have constantly warned the department on numerous occasions that failing to employ enough [healthcare] workers will result in other workers being overworked. Health MEC Nomakhosazana Meth must do justice to the community and public health, which is on the edge of collapsing. They should strive to absorb these workers,” says Nongampula.

Meanwhile, the National Education Health and Allied Workers’ Union (Nehawu) provincial secretary Mlungiseleli Ncapayi said the department’s latest decision is a victory for workers.

“While the department halts the termination of contract workers it is not clear how long the extension is but we are happy that the department is coming to its senses. We have been pushing for this because we are faced with a third wave in the middle of winter,” he said.

“We want the department to employ all of them permanently and stop using the money [meant] for human resources to settle legal claims. The senior managers need to be accountable for shortages of staff caused by the exorbitant medico-legal claims. We don’t want our people to suffer because the department had budget constraints due to poor management. We can change MECs every now and then but if there is something wrong with the management nothing will be proper in that department. We need serious investigation towards the department managers, said Ncapayi.

Eastern Cape legislature rebukes health department

Early in June before the notices on employment contracts were issued, the provincial legislature’s health portfolio committee tabled its report on the provincial department’s budget vote criticising the department for failing to fill hundreds of critical vacancies left by healthcare workers who had left due to various reasons including death and retirement, among others.

According to the report, there were vacancies left by 307 frontline healthcare workers who succumbed to COVID-19 during the first and second waves. The committee noted in the report that staff shortages coupled with accruals associated with employment benefits are “an indication of the department’s unwillingness to appropriately cater for its employees”. “Continuous contract extensions,” the report states, “is tantamount to unfair labour practices” and shows inefficiencies in the department’s capacity. The committee recommended that the department “strives to work with minimum staff at the administration level whilst maintaining and redirecting other human resources to service delivery platforms”.

When Spotlight asked the committee chair Mxolisi Dimaza about the latest developments with the contract workers, he said the issue is now with the Premier’s office. “We understand he advised that their contracts must be extended. We also understand that the department is busy with recruitment of those 307 critical workers. When there are those actions we are happy as the legislature but after three months, the committee will go to those affected hospitals to check if the posts are filled,” he said.

“If the vacancies are not filled, our responsibility is to find out why posts are not filled because in our report we made it clear that the critical posts must be filled as soon as possible. To us as the committee, at the hospital level all workers are critical. Vacancies of cleaners are critical just like doctors and nurses vacancies.”

Eastern Cape health department responds

Eastern Cape Department of Health spokesperson Sizwe Kupelo tells Spotlight for now the department will employ over 80 healthcare workers to help plug the gap.

According to him, the recruitment processes are at “an advanced stage for the 86 frontline workers”. “These are professional nurses, enrolment nurses, and assistant nurses. They will be placed on a needs basis with clinics and hospitals in desperate need of more workers. The employment of these nurses comes as COVID-19 active cases continue to rise in the province, so having more of our dedicated frontline workers on the frontline is a good move that will save many lives,” says Kupelo.