Outreach workers. Photo by Mike Kai Chen

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.

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"Annie" is originally from Nebraska, where she found her calling to journalism as editor of her high school newsletter. Before returning to the field, she studied peace and political science in the Balkans, taught elementary and middle school, and worked as an epidemiologist during the COVID-19 pandemic. Follow her on Twitter @anlancheney.

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  1. Yet another excellent argument against outsourcing what should be government functions to unaccountable private nonprofit corporations for the express purpose of relieving the public sector of the burdens of paying people equitably for social services work.

    We don’t need equity in pay at city funded nonprofits, we need to eliminate the outsourcing to nonprofits and replace that with public sector employees paid good wages and benefits providing public services.

    But that would freeze up billions in political patronage dollars and allow for a budget process that was not just desperate nonprofits begging for add backs, so that ain’t gonna happen.

  2. Glad to hear the City is doing, or paying for, some manner of contact tracing, which is probably a job that CBOs should do as they, ostensibly, are closer to neighborhoods were they work. There’s a much larger, longer story though. Contracting out city services to nonprofits began in the late 70s as a response to what was then billed as an urban fiscal crisis. Rather than raise additional revenue (say by taxing the big downtown corporations, or at least making banks pay property tax), the City chose to cut spending. As always, labor represented the highest and most flexible cost. In 1976 the City tried to get public unions to accept a lower raise, or no raise. The unions went on strike and won their raises. In response, successive local administrations emphasized cutting government spending on social services (including healthcare). Since the public sector was one of the biggest sources, if not the biggest source at the time, of employment for racial minorities and women, they were the ones who bore the brunt of the job cuts (over time the rest of us were forced to bear reduced city services). In addition to automation (replacing human street sweepers with mechanical for example) the City contracted out to private (non union) firms to replace low-level workers like janitors at SFGH, and to a constellation of nonprofits, some which had been around for years, and others which sprung up to receive the dollars. Paying nonprofits to do the work of the City lowered the bill in many ways, but one of the biggest was the savings in labor costs, as the nonprofit employees were not unionized. Nonprofits also competed against each other for contracts (keeping the cost down), and were able to stick around by getting philanthropic dollars as well as City funds. The dysfunction of DPH (which would have been totally lost without UCSF, the LTF and the many sacrifices of healthcare workers) and the almost comic corruption in DPW and DBI are testimonies to a forty year hollowing out the public sector.

    1. Mr. Rabine – You hit the nail on the head.

      But, the city gets what it pays for. I’ve been forced to work with non-profits who win RFP’s in San Francisco. I’ve found their staff to be – more often than not – incompetent. At this point, non-profits survive by bending their knee to local politicians and winning favor with people in the hallways of City Hall. It’s just another layer of this city’s corruption.

  3. Non-profits generally come about to fill a need. True grassroots organizing. Those that manage to survive do so by learning the ropes, hounding politicians, grants, etc. They continue to survive because they continue to fill a need that is not addressed because those served are poor, BIPOC, addicts, mentally disabled, or disabled. Those people that most want to forget about, pretend they don’t exist. The bone is thrown to pay lip-service and keep the lid on.

  4. This story is a joke. You make it sound like the city only employs white people.SF employees are made up of a mix of races and genders that mirrors the city’s population.

    To be hired: city employees must meet minimum qualification criteria, take a civil service examination, and usually be subject to a panel interview just to rank on an eligible hiring list. This list can include dozens or hundreds of names for one or a handful of positions.

    Non-profit staff usually just needs to apply for a job and can be selected at the discretion of a Director.

    There is a reason why it takes years for someone to get a city job. It’s really hard and a process that most people don’t want to deal with. If someone wants to work for the city, all the jobs are published online: apply.

    That being said, non-profits masquerade themselves as agency’s doing good for the people of San Francisco, but they are usually just shill groups that provide city politicians allies that they can call upon when they need “community support”. I’m looking at you: Calle 24, Urban Alchemy, Coalition On Homelessness, Project Homeless, SF Tenant’s Rights Association, Chinese Youth Center, Together SF, Larkin Street Youth Services, and SF Parks Alliance.

    This is nothing more than a push to funnel more tax payer dollars to SF’s non-profit INC.

    Do better Mission Local. I expect this lazy journalism from the Chronicle, y’all are better than that.

    1. You must not work providing the needs of the community. It’s always easy to speak from the outside looking in. In such a divided environment, we need people that are willing to work together not tear each other down.

      1. I’d put my resume up against anyone in terms of how their work helps make San Francisco a better place to live. You must work at a non profit.

      2. You’re not “in the trenches,” at best you’re treading water. Most likely, you’re not providing enough services to make a dent in the increasing need for support.

    2. Amen, it takes guts to stand up against the vocal. There are way too many non-profits, non-profits overseeing non-profits and another layer over them to ensure the non-profits are getting what they want. Just so the politicians can get the local vote they want. I say audit all the non-profits, do they do what their mission statement says, how well are they doing, is there redundancy?

    3. The order and length of the City’s hiring process is somewhat misrepresented in this comment. You must meet minimum qualifications, then you take a standardized test (usually ~2 months after submitting application, at least within my agency), and if you pass that test, you’re on a ranked eligibility list which can, yes, have hundreds of people on it. Those on the list (especially those toward the top third/half of it) will be called to interviews, and the candidates are selected from the interviews.

      The process takes about 6 months, though I’ve seen it take less (like 3-4) or more (~1 year). Except during COVID, I’ve never known it to take multiple years, and that only happened because we had a budget freeze during much of 2020. The City’s hiring process is long and confusing in comparison with many (it could really use some improvement!), but it’s not as grueling as what you described.

      The reason permanent City workers have a livable(ish) wage and good benefits is thanks to the tireless advocacy of our unions. I know all the union reps in my agency and they work really hard, in the job and in the union. Non-profit workers are rarely(?) unionized, and the City takes advantage of that.

      1. Three month turnaround to hire a new employee?! That’s laughable. What department do you work for? You’ve got to be in the real trenches. I’ve sat in on Director level HR meetings related to department hiring. DHR did an audit, pre COVID, and the average turnaround time for a new hire – from the point of a position being approved to the first day of hire starting – is 1.5 years.

        You’re right about the unions and position salary. The collective bargaining process makes it easier to negotiate a decent living for employees. They also make it infuriating when unions defend/represent underperforming employees to keep their jobs, when they should be fired. You ever try to fire a permanent employee? It takes 3 – 5 years.

    4. I’m surprised by your description of certain local non-profits as “shills” who don’t do any work in the community. Larkin Street Youth Center is an especially surprising choice given that they seem to do a huge amount of community work (far more than advocacy work).

      Also, the statement about racism was made by the Director a non-profit (Rafiki Coalition) that specifically works with Black communities in San Francisco (and has since 1986, apparently). Most (all?) of the staff are Black, and the implication is that the Director is talking about her organization and other longtime organizations that are paid by the City to do community work that the City didn’t initiate, but aren’t paid those decent City wages.

      Quoting someone who says that the City’s policies are racist isn’t the same as the journalist stating it as fact. It doesn’t make the article “a joke,” it means the journalist did their job.

      1. Larkin Street Youth? They’re far from an honorable organization. They’re currently facing a few lawsuits from former employees: https://www.ebar.com/news/latest_news//304901

        If a statement is wrong, a journalist shouldn’t give it legs with an article. I’ve already given you reasons why non-profit employees get paid less from a hiring standpoint. I could write about the RFP process that non-profits start with the city for contracts and how it relates to the non-profit employees pay or the wage disparity of Director level positions at non-profits versus boots on the ground at non profits… but if you want to drink Monique LeSarre’s Kool-aid and believe her at her word, far be it from me to put educate you.

    5. There are plenty of Non-Profits that are DOING the WORK on the ground. Some have been operating supporting community through the pandemic. Come to Potrero Hill meet some of us for yourself. We are resident that started our own non-profit and have been doing the work. For a few years we did the work with no funding at all.

  5. So true. I was a counselor and case manager for a local non-profit for years and the low pay was very demoralizing, not to mention hard to live on.
    Reckoning with the pay disparity for City sub-contractors is long overdue and I applaud Jones and LeSarre’s efforts in this direction.

  6. Sounds like the nonprofits need to negotiate better for themselves. Don’t do the work if you don’t like the pay. Tell them, no, we will do it for 20% more or not so it at all. If you are not willing to walk away, you will always be taken advantage of.

    1. This is very hard for non profits that have been around for a long time and we’re at one point comparable. Really hard to walk away from a 20,30,40 or even 50 year agency because things don’t match up any longer.

    2. The problem is that the contracts are put out for competitive bidding, so they have the non-profits fighting each other instead of negotiating with The City.

      The City puts out a request for proposal and it goes out to bid and the lowest bid usually wins. The contracts range from 2-5 years and the budget is fixed, so, if health insurance goes up, the non-profits have no recourse to negotiate and have to eat the margin.