Walking the Talk - VSO

have no time for other sources of income to feed theirchildren and themselves. 196Secondary care providers’ right to be paidA survey in southern Africa in 2005 identified sevendifferent models of care services across the region,ranging “from the very basic community-driven modelwhich is reliant on home visits by volunteers, to the fullycomprehensive care model which provides a wholespectrum of medical, psychological and spiritual care.” 197The more comprehensive models, like Bwafwano homebasedcare in Zambia, provide good support for womencare providers, such as training and some form of pay.However, currently, many home-based care organisationsuse large numbers of what are collectively termed‘volunteers’ to provide secondary home-based care, whoreceive little or no remuneration at all.Volunteers are an immensely valuable and importantpart of society, especially in communities seriouslyaffected by HIV and AIDS. They will continue to providean essential part of the response to HIV and AIDS.However, because most secondary care providers arewomen, and women’s work is routinely undervaluedwithin societies, the term ‘volunteer’ in this context hasbeen expanded and applied incorrectly to include allwomen within the formal economy who provide care tomembers of their community, but who receive little or notraining or recompense for the work they do.The UN defines volunteering as having threeessential characteristics:“First, the activity should not be undertakenprimarily for financial reward… Second, theactivity should be undertaken voluntarily,according to an individual’s own free-will…Third, the activity should be of benefit tosomeone other than the volunteer, or to societyat large, although it is recognised thatvolunteering brings significant benefit to thevolunteer as well.” 198Some secondary care providers have the resources tovolunteer their time and thus meet the UN definition of avolunteer. However, most secondary care providers canonly be called ‘volunteers’ because they currently workwithout pay. These are non-volunteer secondary careproviders because it is not necessarily the case thatthey do not want (or have) the right to be paid, or thatthey are willing to be made poorer for the work they do.Many secondary care providers are not willingvolunteers in this respect and, as the epidemic worsensin their communities, many secondary care providershave too many people to care for and little or no time tomake an alternative living. With the many extra costs ofproviding care, this means that many secondary careproviders plunge into deeper levels of poverty.Secondary care providers, therefore, should no longerbe referred to as volunteers unless they explicitly andwillingly meet the UN criteria above.The situation is complicated by the fact that definitionsof volunteering vary around the world. For example, insouthern Africa, the concept of ubuntu, which reflects astrong community spirit and sense of responsibility tosupport other members of the community, means manypoor and unpaid women secondary care providers feela strong motivation and experience it as a source ofpride in being referred to as ‘volunteers’. Research toexplore and understand the differing national andregional varying definitions of volunteering is neededinstead of universally applying largely westerndefinitions. This research can only really take place at anational level with the active participation of careproviders whom it most affects. Only then can cleardistinctions be made between volunteering and workthat should be recognised as paid employment.Secondary care providers should have the right tochoose to be a volunteer or a paid worker, a choice thatis currently denied them.Until now, many governments have regardedcommunity care as a ‘cost-effective response’ to thecrisis – women’s free labour saving money for the healthsystem. This short-sighted, needs-driven approachignores secondary care providers’ right to earn a livingfrom their work. It is nothing more than the exploitationof unpaid labour. Given the cycle of deprivation itcreates, it is both unsustainable and a false economy.The realisation of the call for secondary care providers tobe recognised and remunerated as workers will beprogressive. The transition will need the involvement andsupport of secondary care-providers and all 'dutybearers'responsible for the rights of secondary careproviders, including community-based organisations,NGOs, governments, donors and multilateral institutions.Some countries have begun to address the lack ofremuneration given to secondary care providers byintroducing legislation to ensure they are paid. InMozambique, for example, the government legislatedthat care providers receive 60% of the minimum wage(the current minimum salary is £26). 199 However, thesewages/stipends are still very low, and as such reinforcethe low valuation of women’s work in society. In mostcases it is insufficient to sustain a woman or her familyand so forces her to seek alternative income generation.44 Walking the talk putting women's rights at the heart of the HIV and AIDS response