ANALYSIS O F FINDINGS
5.3 THE POOR TENDING TO THE POOR
to help participants develop the skills needed to control their own lives, make informed decisions and to work for social change.
governments to relegate women to low-paid, part-time jobs. In the situation of the caregivers who are now employed, the work at the clinic is temporary and they are only paid R600 a month, which is only adequate to buy them cosmetics.
Barnett & Whiteside (2002) recognise that the policies on community care are attractive to politicians because they control the costs of care borne by the state, however they do not take into account the opportunity costs for women in terms of income lost. This also explains the reasons why the payment of stipends to women caregivers to compensate for loss of earnings has been a matter of some debate among policy makers. I argue that the issue of payment for voluntary services is a moral and ethical one in the face of dire poverty in South Africa. In cases where women's labour is not reimbursed financially, levels of motivation are affected negatively as it is demonstrated in caregivers in the study. It was reported in the previous chapter that the withdrawal of a stipend of R100 a month resulted in some of them losing interest in their work as voluntary caregivers. I therefore argue that policy makers, planners and other development workers need to consider some financial reward for caregivers and avoid romanticizing CHBC as the best model when it relies on cheap and free labour.
Privileging one set of needs over another
The study has demonstrated a tension between the needs of PLWHA and the needs of those who care for them. The tendency is to address the needs of the sick without recognizing those of caregivers. However, the study showed that many women voluntary caregivers are as needy as the beneficiaries of care. The study revealed that the duties of voluntary caregivers include encouraging PLWHA who are still not at the final stages of the disease to get involved in growing vegetables. The purpose is twofold: it is for PLWHA to feed themselves and their families and also to earn extra money by selling surplus produce. When an evaluation is done on the needs of PLWHA, service providers need to realize that some of their needs reflect those of their caregivers. Many volunteers are also poor, therefore, it would seem unethical to expect them to go to sick people's homes and help to grow their gardens, from which they could also benefit. This reality demonstrates one of the injustices that caregivers are confronted with. Their rights and needs are usually overlooked while the rights of
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PLWHA and their families are taken into account. As one caregiver remarked that they take food parcels to the homes of the sick people, while she also wishes to take a parcel home. These observations make it clear that the needs and rights of the sick person in the field of CHBC seem to be considered more important that the needs and rights of the caregiver.
Surprisingly, the government continues to hold a strong belief that communities are capable of providing home-based care for the terminally ill. The former KZN Health Minister indicated in no uncertain terms that the fight against HIV and AIDS would not be won in the hospitals but in the community with home-based care (Leeman, 2003). However, there is a danger in assuming that communities and families are capable of providing care without assistance from the government. Often, people tend to blame themselves for the social ills that affect them, and for their failure in meeting set standards, in this case the objectives of CHBC. Conscientization aims at enabling people to make the connection between their personal actions and the wider cultural, economic and political context, as Brookfield (1987) has argued.
Caregiving as invisible labour
The study has clearly demonstrated the meaningful contribution that caregivers are making in society to alleviate the cost associated with caring for the terminally ill.
However, as indicated in the study, their contribution to the fight against HIV and AIDS seems insignificant, ignored, and less appreciated. The current focus in the fight against HIV and AIDS is on scientific research, treatment, policies, etc - and the people who always get the credit are in such selected fields. However, the caregivers play a key role in service delivery at the local community, and without their effectiveness and availability there will be no implementation. Therefore, there is a need to ask whose work is valued and whose goes unrecognized? A challenge for policy makers, service providers and various stakeholders is to increase their support of volunteers by taking their needs seriously and give them the recognition they so rightly deserve.
Interestingly, regardless of the lack of recognition of caregivers in the public domain, the respondents in this study indicated that some of their motivation comes from the
fact that their contributions are acknowledged and appreciated in the local homes where they offer CHBC.