CIVICUS discusses recent protests by South African health workers with doctor and global health advocate Zolelwa Sifumba.
Dr Sifumba’s advocacy for a more compassionate healthcare system is rooted in her personal experience. Early in her career, she contracted drug-resistant tuberculosis (TB) after being exposed at work, facing 18 months of gruelling treatment and psychological struggle. This reshaped her understanding of the disease and the problems of the public health system, and led her to join TB Proof, an organisation that raises awareness of the risks of TB for healthcare workers. Her advocacy raised awareness and led students to demand proper protection in high-risk environments.
How have your personal experiences influenced your understanding of the South African public health system?
My personal experiences have really shaped my understanding of the public health system and its challenges. When I was studying medicine at the University of Cape Town, I had to deal with some mental health issues that showed me how little was being said about this in the medical field. Because of this, my firsthand experiences with the public health system were pretty chaotic.
At the hospital where I worked, not enough attention was paid to infection control for diseases like TB. TB patients were not properly isolated, which meant that health workers and other patients were at risk of catching the disease. In my fourth year, I was diagnosed with multidrug-resistant TB.
I didn’t access the public health system at all for my mental health issues; I was seen in private. But I needed the public health system when I got TB, and it was chaos. I had to go to the clinic daily and wait in long lines while I needed to get back to school. I was seen by overworked, uncaring staff who paid little attention to side effects and told me I wasn’t allowed to cry there. There weren’t any functional support groups, and I had to fight for doctors to give me a bulk quantity of pills so I didn’t have to go every day. I had to pay to get a port inserted to avoid the pain of daily injections. On top of the emotional burden, the financial burden was too much to bear.
Dealing with the public health system as a patient opened my eyes. I fortunately received lots of support, advice and encouragement from TB Proof, an organisation founded by health workers who had experienced TB. At first I was a bit hesitant, but I eventually decided to speak publicly about my experience. I realised my voice could help raise awareness and drive change.
Through TB Proof, I became an advocate and activist. I shared my story at medical schools, conferences and various forums, highlighting the realities of TB and the systemic problems of the health sector. The lack of social support, the stigma associated with TB and the inadequacies of the public health system became the focus of my activism. I realised systemic changes were needed to protect patients and health workers alike. My advocacy included fighting for better infection control measures and the inclusion of TB education in medical curricula.
Over the past decade, I’ve helped to raise awareness and make some progress in the fight against TB, locally and internationally. But there’s still a lot more to do.
I am now setting up an organisation focused on health trainees, students and workers. My concern is systemic change in the health sector.
What are healthcare workers protesting about, and how has the government responded?
The recent protests by healthcare workers have been about employment issues. South African healthcare workers face a lot of challenges, including a lack of job opportunities for newly graduated doctors and other medical professionals. After completing their mandatory internships and community service, many struggle to find permanent positions due to budget cuts and frozen posts in the Department of Health. This has led to high rates of unemployment among healthcare workers, causing financial strain as they often have significant debt and responsibilities.
Medical graduates, including doctors, pharmacists and physiotherapists, have been protesting against the lack of job openings, inadequate staffing and insufficient government support. Protests have taken place in several regions, including the Eastern Cape, Gauteng and KwaZulu-Natal, with healthcare workers marching to government buildings to demand action.
In response to the protests, the government has announced the creation of some new posts. However, the number of positions made available has been insufficient to meet the demand. The inadequate response has only exacerbated frustration.
Other challenges faced by healthcare workers include poor working conditions, inadequate support to cope with emotional and psychological stress, exposure to disease without adequate protection and lack of training in soft skills. Intense workloads and emotional stress often lead to burnout, depression, anxiety and even suicidal ideation, and systemic support is often unavailable. The working environment is further complicated by bullying and harassment. The competitive nature of the sector, combined with long hours and high levels of stress, contributes to a toxic atmosphere.
While the protests have drawn some attention to the employment crisis in healthcare, these wider systemic issues have remained unaddressed. More comprehensive reforms are needed to ensure the wellbeing of healthcare workers and the effective functioning of the public health system in South Africa.
What changes should South Africa’s new government make to the healthcare system?
It’s essential to prioritise the experiences and needs of healthcare workers. Firstly, the government should actively engage with healthcare workers and listen to their experiences and ideas. Their insights are invaluable in shaping effective policies.
A critical area requiring attention is psychological and social support for healthcare workers. Comprehensive, mandated support must be integrated into the healthcare training syllabus, teaching healthcare workers to identify their emotional responses and needs, and how to seek support. The goal is to create a system where healthcare workers can proactively address their wellbeing.
Commitment and research are essential to identify the challenges facing healthcare workers. Comprehensive national research should be conducted independently to gather data on issues affecting health workers.
It is also essential to create safe spaces for health workers to share their experiences and seek help without fear of judgement or repercussions.
What is When Healers Connect and how could it change the healthcare environment?
When Healers Connect is an initiative that aims to provide such spaces. It aims to foster connections between healthcare workers, create a supportive community, provide safe spaces, refer people to therapy if needed and offer other forms of support to healthcare workers in need.
It also aims to better prepare healthcare trainees and students for the challenges they will face in their careers by addressing the psychological impact of patient care and providing training on how to deal with difficult situations. Through comprehensive training and support, it aims to equip healthcare workers with the tools they need to succeed in their careers.
The initiative calls for action to support and invest in the health and wellbeing of health workers. Governments and health institutions around the world should conduct research, implement supportive policies and provide funding and resources for initiatives such as When Healers Connect.
Investment in the wellbeing of healthcare workers is crucial to strengthening healthcare systems. Healthy and supported healthcare workers are better able to provide quality care to patients, ultimately leading to better health outcomes.
How have you worked with the Global Fund?
I’ve had the privilege of working extensively with the Global Fund, an international organisation that secures investment to fight the world’s deadliest infectious diseases: HIV, malaria and TB. I contributed to their Faces of the Fight campaign, which aims to humanise the fight against these diseases. As a TB survivor, I shared my story alongside HIV and malaria advocates.
The Global Fund channels funding to organisations working on the ground to ensure resources are used effectively. My involvement included attending the Sixth Replenishment Conference, where world leaders and philanthropists pledged financial support. I was honoured to speak at this event, which helped secure significant funding.
My work with the Global Fund has been impactful and rewarding. But I’d also like to address the often-overlooked issue of fair compensation for activists. There’s a need for proper recognition and payment for activists who make significant contributions to global health initiatives. Advocacy and the sharing of personal stories are critical to driving change but are often not adequately rewarded.
Civic space in South Africa is rated ‘obstructed’ by the CIVICUS Monitor.
