‘It’s in our veins’: caring natures and material motivations of community health workers in contexts of economic marginalisation

Abstract

Khayelitsha, an economically marginal peri-urban settlement in Cape Town, is home to a number of ‘flagship’ public health interventions aimed at HIV/AIDS and TB. Alongside these high-profile, foreign donor-driven treatment and care programmes are a plethora of NGOs that provide a wide range of community-based carework. Some of these organisations are large, well funded and well connected globally, while others are run by a few unemployed women responding to care needs in their neighbourhoods. This article explores the ways that community health workers (CHWs) who work for these organisations understand and speak about their involvement in carework as volunteers, employees or managers of community-based care organisations. Many CHWs framed their work through discourses of gender, religion or culture (‘African-ness’). They also described forms of material or economic benefits of providing carework, but many were concerned that these might be seen as existing in tension with more socially accepted, altruistic motivations for care. We explore here how CHWs narrate and understand their roles and motivations as carers and members of a resource-constrained community.

Keywords:

• community health worker
• South Africa
• motivation
• ethnography
• ubuntu
• care

Acknowledgements

Alison Swartz wrote the first version of this piece, under the supervision of Christopher J. Colvin, for the completion of her Master of Public Health at the University of Cape Town. Alison Swartz and Christopher J. Colvin worked together closely to further develop this piece for publication. We are grateful to all those we worked with in Town Two, Khayelitsha. A special thanks is due to Monwabisi Maqogi who consistently guided and supported this research.

Funding

Time to work on this paper was partially supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award # R24HD077976. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.