Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries Workshop Summary (2016) / Chapter Skim
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5 Select Country Experiences
5 Select Country Experiences
Pages 63-88
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From page 63... ...
BRAZIL: BUILDING THE NATIONAL OCCUPATIONAL HEALTH SERVICES NETWORK: AN EXPERIENCE WITH UNIVERSAL HEALTH CARE PROVISION Vilma Santana, Federal University of Bahia, Brazil Vilma Santana from the Federal University of Bahia in Brazil described the experience of developing occupational health services (OHSs) in Brazil.
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This set of benefits is limited to registered workers who contribute 8 percent of their paychecks toward social insurance. The labor and employment ministry provides labor protection through the occupational health and safety authority, which carries out workplace inspections and various other safety-related measures.
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Santana noted that the centers provide occupational health and safety services which include clinical assistance, diagnosis, treatment, and recovery as well as workplace inspection, identification of hazards, and treatment of the hazards. Some examples of the activities that CERESTs carry out are health promotion and protection based on priorities drawn from local epidemiological data; education and community participation through workshops, rallies, and local health councils; and enhanced dialogue with social movements, labor unions, and organizations.
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From page 66... ...
The primary industries in which they are concentrated are agriculture, construction, shops and establishments, cigar manufacturing, waste management, food service, transportation, and home-based work. Some of the major occupational health problems that have been recognized are injuries due to accidents; chronic respiratory/lung diseases (asthma, chronic obstructive pulmonary disease, pneumoconiosis, and silicosis)
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30,000 for 11,000 Approx 11 MOLE + state Swasthya Bima across 27 states poverty line (BPL) a family of 5, lakhs nodal agency + Yojana (RSBY)
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, facilities insurer Rs. 50,000 100% budgetary buffer allocations NOTE: CHIS = Comprehensive Health Insurance Scheme; CM's= Chief Minister's; MOLE = Ministry of Labour and Employment; NA = not available; Rs = rupees; TPA =Third Party Administrator.
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From page 69... ...
To improve the benefits package design and better meet the needs of informal sector workers, Garg suggested that more robust data needs to be collected on the population characteristics and disease patterns of informal sector populations based on geographic locations, and more data is needed on the costs of services that are provided. She also stressed that more research needs to be conducted to illuminate the linkages between workers' health and productivity and changes in the gross domestic product.
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o Activities include health education, referral services, linkage with pub lic and private providers, occupational health and safety, low cost pharmacies, and a health insurance cooperative. o utcomes and impacts have included greater awareness, high cure O rates and reduction in default rates from a tuberculosis control pro gram, the availability of drugs at reduced rates, and the training of health workers and educators.
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Fifty percent of the budget is for the delivery of occupational health services to informal sector workers. Besides the spending by the central government, a discretionary spending budget has been made available to the provincial health offices.
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3. Occupational health risk mapping has been done by Director ate of Occupational Health together with some provincial health offices at selected provinces and workplaces, including informal sectors, home industries, and small-scale enterprises.
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However, the informal sector in South Africa still accounts for $30 billion, or 7.1 percent, of the South African gross domestic product. The largest portion of the informal economy is classified as retail (41.5 percent)
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Kistnasamy suggested that several elements are needed in order to move forward in implementing effective interventions to address the occupational health and safety needs of workers in the informal economy in South Africa: • Policy dialogue that is inclusive of political parties, ministries, organized labor, standing committees in parliament, relevant stakeholders, and the workers themselves • Ongoing discussions at multilateral, regional, national, and tech nical levels • An evidence base on the size and scope of the sector, its contribu tions to the economy, the risks and hazards that workers face, and existing interventions • Capacity building and training for health professionals • Surveillance that can create a loop from data to interventions • A networking strategy that includes discussions with informal workers on agendas for change • The promotion of safety, health, and environment activities • Universal coverage and financing for a national health insurance model that covers informal economy workers • Integration into the primary health care system SOUTH AFRICA: OCCUPATIONAL HEALTH AND SAFETY: TOWARD THE INCLUSION OF INFORMAL WORKERS Francie Lund, WIEGO Social Protection To open her remarks, Francie Lund from Women in Informal Employment: Globalizing and Organizing (WIEGO) Social Protection offered several lessons learned from her experiences and the work of WIEGO in addressing OHS for informal sector workers:
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Lund said that WIEGO is attempting to go further in finding ways to extend OHS to informal workers. Various forces of exclusion prevent informal sector workers from receiving OHS protections and benefits, Lund said, including a lack of recognition as workers and a lack of reliable statistics on informal work in labor force surveys.
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Lund described a 4-year occupational health project being carried out by WIEGO. The project is investigating the possibilities of an OHS discipline and practice that is more inclusive of informal workers, especially poorer working women.
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The street and market traders who were the focus of the project work in urban public spaces. In both Ghana and South Africa the move toward universal health coverage has resulted in a move toward national health insurance schemes.
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In collaboration with a local nongovernmental organization, Asiye eTafuleni, WIEGO helped to develop the Phephanathi Platform. The platform provides a basic institutional architectural framework in which a range of health interventions, including occupational health interventions, public health interventions, and urban health interventions, can be embedded.
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Then, starting in 1975, the government provided indigent cards for the poor that granted free health services at public sector facilities. In 1990 social security was established, with health insurance as an integral component for formal sector workers.
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SOURCES: Somsak Chunharas presentation to workshop, July 30, 2014; data from National Health Security Office.
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. Chunharas said that while universal health coverage in Thailand has helped to ensure that almost all informal workers in Thailand have health insurance, the preventive and promotive dimension has not been robust.
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SOURCES: Somsak Chunharas presentation to workshop, July 30, 2015; adapted from Tangcharoensathien et al., 2014. THAILAND: OCCUPATIONAL HEALTH SERVICES DELIVERY FOR INFORMAL WORKERS AND FINANCIAL RESOURCES Orrapan Untimanon, Ministry of Health, Thailand Orrapan Untimanon from the Ministry of Health in Thailand described access to occupational health services for informal workers in that country.
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Thus, Untimanon suggested that the specification of OHS intervention in a benefit package of universal care will be crucial to strengthen OHS for informal workers. THAILAND: EXPERIENCES FROM A PILOT PROJECT ON OCCUPATIONAL SAFETY AND HEALTH PROMOTION FOR INFORMAL WORKERS Poonsap Tulaphan, HomeNet Thailand Poonsap Tulaphan from HomeNet Thailand described a government pilot project for an occupational health scheme for informal workers in Thailand.
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At present with support from the National Health Security Office via a scheme called Promotion and Prevention for workers, HomeNet Thailand is implementing a pilot project to support OSH promotion. The objectives for the pilot are to provide OSH knowledge to and promote prevention activities among informal workers, to support informal workers in accessing the local health community fund, and to facilitate the implementation of OSH promotion activities by primary care units.
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• Subdistrict offices have exhibited an increasing interest in work ing with the working-age population. Regarding constraints, Tulaphan said that most hospitals lack staff with sufficient knowledge and skills on OSH promotion and there is no incentive to promote OSH through assessment standards for primary care units.
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729 591.2 483 162.3 NOTE: GDP = gross domestic product; IMF = International Monetary Fund ; MDG = Millennium Development Goal ; UNDP = United Nations Development Programme. SOURCE: Karen Sichinga presentation to workshop, July 30, 2014.
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. • Occupational health: Occupational disability, morbidity, and mortality are also major problems in Zambia.
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To address sustainability issues, CHAZ and other, similar organizations are encouraging dialogue with the government and the district health offices from the beginning of an initiative so that plans for sustainability will include all partners and be transparent. Sichinga concluded by saying that "public–private partnerships are the only way to sustainable development particularly in resource constrained countries like Zambia.
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