After months of non-payment, lay counsellors vital to government's ambitious target of testing 15 million South Africans for HIV by April 2011, are threatening to walk out of voluntary counselling and testing (VCT) clinics.
Lay counsellors in at least two of South Africa's nine provinces - Eastern Cape and Gauteng - said they had gone for as long as five months without receiving their government stipends for providing pre- and post-test counselling as part of the national testing drive.
"Even a gardener knows that every month [his employer] will pay him," said Martha Busana, a counsellor in Johannesburg. "We are going to picket until we get our money."
Counsellors in Gauteng also said they were required to work longer hours without additional pay, and asked to sign temporary contracts with local NGOs, whom they claim are mismanaging the payment of their stipends.
Counsellors from eastern and western Johannesburg - known as the East and West Rand - and its largest township, Soweto, plan to march to the capital, Pretoria, on 19 August to deliver a list of demands to the national health department.
Lucky Mokone, who has been a VCT counsellor for 10 years and is one of the march organizers, said they would demand back-pay and permanent employment contracts with the Department of Health.
A dry season
Government contracted NGOs to ad minister payment of counsellors' monthly US$200 stipends for their work at government clinics in order to meet the anticipated increased demand for testing following the April launch of the national VCT campaign.
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Lorna Fisher, project manager at Persevere Until Something Happens (PUSH), one such NGO based on the West Rand, told IRIN/PlusNews that her organization had become stuck in a cycle of delayed payments to counsellors since an initial transfer of funds from the Gauteng Department of Health and Social Development arrived three months late.
"When [the money] came in July I paid back the months I owed counsellors, but then I'm empty again," she told IRIN/PlusNews. "It is like a dry season for the counsellors because it is sort of like they get paid quarterly - it's a breach of contract."
A spokesperson for the Gauteng Department of Health and Social Development, Mandla Sidu, told IRIN/PlusNews that his department struggled to get payment requests from NGOs on time, but that all of them had now been paid in full. However, Fisher said PUSH was still waiting for money from government to pay counsellors.
While many counsellors are working for no pay, they also allege that others are being paid for not working. Mokone claimed that a number of counsellors who had either moved to another clinic or quit had not been removed from NGO books and were still receiving stipends.
Fisher said PUSH and other NGOs contracted by the health department lacked the resources to remove 'ghost' counsellors from their systems. "I don't know who's at work today," she told IRIN/PlusNews. "I depend on the clinic manager and the district coordinators to make sure the person [counsellor] signs in at the clinic."
The Budget and Expenditure Monitoring Forum (BEMF), a coalition of civil society organizations tracking government health expenditure, pointed out that although provincial HIV and AIDS budgets provided for VCT, there was not enough money to support the considerable scale-up in testing services demanded by the national campaign.
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"This worthwhile campaign is another example of the need for government to allocate sufficient funds to its programmes, so that they may be properly implemented," the BEMF noted in the minutes of its June meeting.
"At present it is arguably yet another 'unfunded mandate'. Given the importance of this campaign, and the expectations it has created, it would be tragic if it were to fail due to lack of money."
New regulations passed in July allows lay counsellors actually conduct finger-prick HIV tests - a job that was previously reserved for the country's scarce registered nurses. With the new regulations, the role of lay cousellors in the national VCT campaign is likely to become even more important.
No pay, no test, no food
Nokhwezi Hoboyi, an East Rand district coordinator for the AIDS lobby group, Treatment Action Campaign, said they had received reports of disgruntled counsellors not coming to clinics, and of people wanting to be tested for HIV being turned away.
Most of the counsellors are still at work, but those who have not been paid for months are struggling to cope. "We love this job because we are helping people; we have that passion - that's why we've been doing this for years," said East Rand counsellor Enid Zulu*, adding that she and many other lay counsellors were HIV-positive themselves.
"I'm an adherence counsellor, and adherence counselling must be very thorough, but how can I counsel someone to take their medication and eat if I am also hungry?"
*Not her real name