Inequalities are built into the city’s contract system, say leaders of nonprofits

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The pandemic sparked discussions about fairness in various directions, but for essential workers on the front lines of healthcare, few inequities were as glaring as those impacting their own wallets: non-profit workers. lucrative earn significantly less than their urban counterparts.

For months, contact tracers for nonprofits have been paid less than their counterparts employed in the city, said Dr Monique LeSarre, executive director of the Rafiki Coalition, which hired and trained workers to perform community contact tracing at Bayview Hunters Point. It’s an injustice she had grown used to: Even skilled professionals, like therapists and social workers who work for a nonprofit, she said, often make less than half of those. who occupy the same position as a city employee.

While LeSarre’s contact tracers have finally secured an hourly rate comparable to that of city workers, much remains to be done in the rates the city uses to contract with nonprofits, which have since assumed. long a large part of the city’s social work.

Dr Hillary Kunins, the city’s new director of behavioral health services, mentioned the inequalities and the resulting understaffing in nonprofits when she answered questions at Cafe Manny earlier this this month. “The challenges for the workforce, before they even hit the pay gap… are huge,” she said, “in my experience this is a national problem as well as a problem. here in this high cost city. “

Changes, she said, are long overdue. LeSarre said the inequalities are indicative of the chronic undervaluation of community organizations. It also sounds like racism, she said.

LeSarre compared the inequalities between city workers and nonprofit workers to the ‘sharecropper experience’, referring to how this labor system exploited sharecroppers, especially former slave black workers. after the civil war.

Additionally, the city’s contract approval process and cost-based reimbursement model often mean that nonprofits don’t get paid until their work has already started.

“You’re asking nonprofits to provide money that we don’t even have and for which we aren’t even paid enough. … We are often in the hole doing work that the city cannot or does not want to do, ”said Le Sarre.

Delays can have disastrous consequences for organizations left unfinished, especially those working in underserved communities. “I know of several large black agencies in the city that have been suspended for over a year with uncertified contracts, and they have to absorb the costs,” LeSarre said.

As the city celebrates how it reaches its diverse communities with essential services through nonprofits, nonprofit professionals have said the city is simultaneously tapping into their cheaper workforce.

Dr Mary Ann Jones, CEO of Westside Community Services, agreed with LeSarre.

Nonprofits, which now do much of the city’s social work, are not reimbursed at a rate that covers their true costs, Jones said.

“What ends up happening is you have a structural deficit because you can’t meet your contractual goals because you can’t fill those positions all the time. And so you end up seeing nonprofits shutting down or ending up on the corrective action list or the high concern list of the government. [city] comptroller’s office… these are all part of the structured system, ”she said.

LeSarre said she wanted to continue pushing for parity that brings nonprofits into the system rather than relying on the city’s one-off good graces (such as with contact tracing).

Lower salaries mean that nonprofits are also entering a competitive position with the city. They find and train community workers, then the city steps in with much higher paying full-time jobs.

“You can’t contract if you can’t keep the positions filled if they recruit people, and we’ve shown them where the people are [are]”Jones said.

She said half of Westside’s clinical staff are recruited by the SF Department of Public Health and about 25 percent go to Kaiser.

Jones and LeSarre have lots of ideas on what needs to change – “a complete overhaul of the health care system so that it is more transparent in working with nonprofits,” LeSarre said.

“But it’s not just the financial part,” she said, “it’s the practical part of the assessment, like recognizing our full partnership and expertise.”

She said the city seems to be trying to say ‘you are a fair partner, you are the experts, you are leading the way’, but she is not sure they really mean it.

What both would like to see is an agreed-upon salary system used by nonprofits and the city.

“If we could just get an agreement that people should do this tariff, then the city would have to create contracts that reflect those tariffs,” she said. LeSarre confirmed that parity will be part of the recommendations of the working group on the implementation of the FS in mental health of which she is a member. “If you count across town it’s gonna be millions [of dollars] trying to put people on par with city workers, ”she said.

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