The pandemic has driven discussions on equity in a variety of directions, but for essential workers on the frontlines of health care, few inequities were as stark as one that impacts their own wallets: nonprofit workers earn decidedly less than their counterparts with a city job.
For months, contact tracers for nonprofits were paid less than their city-employed counterparts, said Dr. Monique LeSarre, executive director of the Rafiki Coalition, which hired and trained workers to do community contact tracing in Bayview Hunters Point. It’s an inequity she had grown accustomed to: even qualified professionals, like therapists and case workers who work for a nonprofit, she said, often make less than half of those holding the same position as a city employee.
While LeSarre’s contact tracers eventually got an hourly rate on par with city workers, much needs to be done in the rates the city uses to contract with nonprofits, which have long taken on much of the city’s social service work.
Dr. Hillary Kunins, the city’s new director of behavioral health services, mentioned the inequities and the resulting understaffing in nonprofits when she fielded questions at Manny’s cafe earlier this month. “The workforce challenges, even before getting to the salary differentials … 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 inequities are indicative of the chronic undervaluing of community-based organizations. It also looks like racism, she said.
LeSarre compared the inequities between city and nonprofit workers to “the sharecropper experience,” referencing how that labor system exploited tenant farmers, particularly formerly enslaved Black workers after the Civil War.
Moreover, the city’s contract approval process and cost-based reimbursement model often means that nonprofits aren’t paid until their work has already begun.
“You’re asking nonprofits to front money that we don’t even have and we’re not even paid enough for. … We’re often in the hole doing the work that the city can’t or won’t do,” Le Sarre said.
The delays can have disastrous consequences for the organizations left hanging, especially those working in underserved communities. “I know several large black agencies in the city who were left hanging for over a year with uncertified contracts, and they’re left absorbing the cost,” said LeSarre.
While the city celebrates how it reaches its diverse communities with critical services through nonprofits, nonprofit professionals said that the city is simultaneously exploiting their cheaper labor.
Dr. Mary Ann Jones, chief executive office of Westside Community Services, agreed with LeSarre.
Nonprofits, which now do much of the city’s social service work, aren’t being reimbursed at a rate that covers their true costs, said Jones.
“What ends up happening is that you have a structural deficit because you can’t meet your contractual goals because you can’t have these positions filled all the time. And so you end up having nonprofits go out of business or end up on the corrective action or the elevated concern list of the [city] controller’s office … these things are all part of the structured system,” she said.
LeSarre said she wants to continue pushing for parity that makes nonprofits part of the system rather than rely on the city’s one-off good graces (as with contact tracing).
Lower wages mean the nonprofits also get into a competitive position with the city. They find and train community workers, and then the city steps in with full-time jobs that pay substantially more.
“You can’t make your contracts if you can’t keep positions filled if they’re recruiting people, and we’ve showed them where the people [are],” said Jones.
She said half of Westside’s clinical staff are recruited by the SF Department of Public Health, and about another 25 percent go to Kaiser.
Jones and LeSarre have plenty of ideas about what needs to change – “a whole reworking of the system of care so that it’s more seamless in working with the nonprofits,” LeSarre said.
“But it’s not just the money part,” she said, “it’s the practice part of valuing, as in acknowledging our full partnership and expertise.”
She said the city seems to be trying to say “you are an equitable partner, you are the experts, you lead the way,” but she’s not sure they actually mean it.
What both would like to see is an agreed-upon salary system used by nonprofits and the city.
“If we can just get an agreement that people should be making this rate, then the city would have to create contracts that took into account those rates,” she said. LeSarre confirmed that parity will be part of the recommendations from the Mental Health SF implementation working group of which she is a member. “If you count across the city, that’s going to be millions [of dollars] trying to get folks up into parity with city employees,” she said.