This report comes as South Africa’s Minister of Health pledges to formalise and employ 27,000 community health workers (CHWs) — a major victory after decades of struggle for recognition — though nearly 20,000 CHWs remain precariously employed. It examines the history, challenges, and policy failures shaping the CHW sector, rooted in apartheid-era inequalities, donor dependence, and austerity. Despite being the backbone of primary healthcare, CHWs continue to face insecure contracts, poor pay, limited rights, and unsafe conditions. The report calls for systemic reform through insourcing CHWs into the Department of Health, standardising roles and training, improving resourcing and supervision, and aligning national laws with ILO and WHO standards to ensure dignity, equity, and effective healthcare delivery.

The report has four main goals.

It has four goals:

1. Describe the past and current context in which community health workers operate.

2. Analyse the key community health workers’ challenges.

3. Review existing policies to ensure compliance with fundamental ILO rights and WHO guidelines.

4. Offer suggestions for better CHW alignment with international best practices.