Approaches to UHC & OHS for the Informal Workforce in Developing Countries
Institute of Medicine, Washington DC
WIEGO and its partners from SEWA, HomeNet Thailand and the Federal University of Bahia attended the Institute of Medicine’s workshop on “Approaches to UHC & OHS for the Informal Workforce in Developing Countries.” The Institute is one of the National Academies of Science in the USA, and influential policy-focused NGO. This workshop was the first one to be held under the auspices of the IOM’s new Forum on Public-Private Partnerships for Global Health & Safety. The aim of the workshop was to examine approaches, successes and challenges in extending universal health coverage (UHC) and occupational health and safety (OHS) to informal workers in five countries: Brazil, Ghana, India, South Africa and Thailand, and to think further about how the PPP Forum could support these efforts. WIEGO’s international coordinator, Marty Chen, was a member of the workshop’s Planning Committee.
Presentations at the workshop from WIEGO and its partners included a keynote address by SEWA’s Director of Social Security and member of India’s High Level Expert Group on Universal Health Coverage, Mirai Chatterjee. She detailed the plans for India’s move towards UHC. Marty Chen provided important background information on the size and shape of the global informal economy, and the challenges this presents to mainstream principles and regulation of OHS. Francie Lund, WIEGO’s Social Protection Director spoke about the five year, five country OHS project. Partners in the project gave country presentations: Vilma Santana of the Institute for Collective Health at the Federal University of Bahia gave an overview of Brazil’s integration of worker’s health into the national health system.
Mirai Chatterjee, Poonsap Tulaphan of HomeNet Thailand and Laura Alfers of WIEGO gave presentations on some of the practical interventions that have been made in India, Thailand, Ghana and South Africa to extending general and occupational health services to informal workers.
Some of the key ideas that emerged from the workshop included the fact that the private sector should not be solely defined as businesses, but should also include non-governmental organizations and other social partners who could help to make health care more accessible to informal workers. It was, however, also stressed that businesses should play an important role in extending health services beyond their formal employees, to those who produce for them as informal workers, and to the wider communities in which they operate. Derek Yach of the Vitality Institute provided four reasons why this is important for companies: i) brand reputation and to avoid naming and shaming, particularly if suppliers work informally; ii) an investment in the future workforce; iii) an investment in the consumer base as informal workers are also consumers, and iv) “reverse innovation” at the bottom of the pyramid. WIEGO stressed that informal workers need a holistic model of healthcare, one which incorporates prevention as well as curative care, and this was why occupational health should be seen as an important aspect of universal health coverage. The workshop was held in a spirit of dialogue and cooperation, with strong consensus about the need for far better health-related statistics, and quantitative and qualitative research, about the informal workforce. Contentious “elephants in the room” were the different interpretations of what ‘universal health coverage’ actually means; the fact that private sector insurance for the working poor is not easily compatible with preventive health services; and that the extension of health services to informal workers was not only a matter of resources, but also of political will, and that the current dominant economic model of growth-oriented capitalism has done much to undermine the livelihoods and health of informal workers.
Mirai Chatterjee on the closing panel noted that:
- the informal economy had become more visible through this workshop
- there were areas where the private sector could concretely assist informal workers organisations; by giving support for the development of low cost tools and work processes; help with labour intensive training in body literacy; explore how to work together on a model for diagnostic camps
- WIEGO and its allies such as SEWA could learn from corporations who have been really innovative in the extension of general and occupational health services
Finally, she suggested that perhaps experiences from the Global South could have some lessons for the Global North as well. With regard to future collaboration with the IOM and its partners, Mirai suggested it could be constructive to have a separate convened meeting with a narrower focus on occupational health and safety, and that it might be good to convene forums in regions in which the IOM is active, such as India.
The workshop was considered highly successful, something that was attributed to the diversity of voices in the room – broader than that to which the IOM is usually accustomed. In addition to the informal worker organizations, these included large multinationals, government representatives, non-governmental organizations, including faith-based organisations, academics and international organizations such as the World Health Organization (WHO), the International Labour Organization (ILO) and the regional Pan-American Health Organization (PAHO).