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The deadly factory fire at Rana Plaza five years ago this week sparked global outrage about workers’ safety. The incident in Bangladesh prompted discussion on national and international levels. But it is not just at these levels that health and safety can be addressed. Many local governments wield the power and position to play important roles in ensuring workers in their cities – including the highly diverse informal workforce – have the protections in place to live healthy and safe lives.
Local government is, conceptually and actually, closer to the urban poor than other levels of government. The goods and services it provides (often in partnership with others) have an impact on workers’ health and safety. However, in few countries are local governments the main providers of health care, in the narrow sense of provision of clinics and hospitals. On this Workers Health Day, we wish to highlight the additional vital roles that local governments can play in influencing the “social determinants of health” – such as water, sanitation, storage and street lighting. Improving where informal workers live and work can have a transformative effect on their health and safety, as well. The examples below provide ideas big and small for how local governments can make their cities into places where everyone is properly protected.
Watch a video that tells the stories of informal workers and the difficulties they face in accessing health services.
Healthier workplaces in diverse spaces
More than half of the world’s population now live in towns and cities. Urban managers face the tension between managing public space, and allowing existing and newly arriving residents access to economic space in which people can secure livelihoods. This space may itself be public, such as roads and pavements, or owned by the private formal sector, like Rana Plaza, or be in people’s private homes – as when (typically) women do contracted piece-rate work out of their own homes. The municipality can have a health-related role to play in all of these work places.
Interventions can start at the simplest level. In Delhi’s informal settlements, women work hunched over for long hours every day on the floor, causing a variety of health aches and pains. Some roll incense sticks; some use primus stoves to cook meals for local residents; yet others use the floor for kite-making. To improve the situation for these women, a housing trust, in cooperation with the municipality, prioritized levelling the floors of the houses. In all these cases, the leveling of the floor, or the introduction of a low table to enable equipment to be placed above floor height, led to health improvements. The women reported less lower backache, reduced fire hazards, and greater productivity. Multiple objectives were achieved with these simple, low-cost interventions.
Read more about WIEGO’s Social Protection Programme.
Samnvay Tocharoen works in a small factory producing bronze silverware, a traditional Thai craft. The work poses a number of occupational health and safety issues, which the group, as members of HomeNet Thailand, have been addressing. Their long-time work in this area led to the introduction of the Universal Healthcare Coverage Scheme in Thailand in 2001, which provides unprecedented health coverage to all informal workers, including home-based workers in Thailand. Photo: Paula Bronstein/Getty Images Reportage.
Simplifying processes for busy, poor workers
For informal workers, Illness, accidents and disability tend to be high, while access to health services tends to be low. Informal workers rate health care as a high priority. They are made poorer by health expenditures. Neither the work that they do nor the injuries they suffer are properly reported: an industrial outworker who gets burned packing fireworks in her home; a street vendor hit by a vehicle when crossing a busy street; a waste picker who cuts her hands while picking glass for recycling.
In countries with very different quality of health services (India and Thailand) informal workers expressed similar needs for health interventions (as did workers in South Africa). Their chief barrier of access to health was registration: they had to register at a health facility near to where they lived, as opposed to near where they worked.
The solution, of course, should not be registration at one or the other – health systems should make it possible to register at both, thus at one stroke enabling women to combine more conveniently their work and family-care roles.
Another welcomed intervention, through organizations of informal workers, are community-based health workers whose chief role is to assist informal workers in navigating the complicated bureaucratic procedures of the health systems. Furthermore, some organizations have organized large-scale diagnostic health screenings. These are done with the willing help of volunteer doctors, nurses, pharmacists and others, and take health services close to where people work. For informal workers, time spent seeking out health services is income foregone.
Read “Universal Health Coverage: An Informal Worker Perspective.”
Giving informal workers a say in municipal discussions
However big or small the intervention, workers themselves should be included to ensure municipal decisions are actually meeting their diverse needs. New platforms for inclusion of informal workers in negotiations about working conditions are beginning to emerge across the Global South. Finding out what works best and in which circumstances will assist informal workers in protecting and securing their own health; will enable city managers to better protect the health of the public; and can contribute to the ability of informal workers to secure their place in the city as workers.
Listen to Francie Lund discuss social protection for informal workers:
Read “Overcoming barriers and addressing gender dimensions in universal health coverage for informal workers: lessons from India and Thailand” by Martha Chen and Frances Lund, published in Social Protection for Informal Workers in Asia.
Read the August 2016 edition of New Solutions journal, which was co-edited by Frances Lund and focused entirely on health and safety for informal workers.
Download our recent report on how women informal workers are mobilizing for child care.
Featured photo: Ahmedabad, India: Feroza has honed her kite-making skills over the last 26 years. She makes 1,000 colorful kites a day for an average of 100 rupees from her small, dimly lit, two-room home. The work is repetitive and can cause body cramps and pains. She has attended trainings at the Self Employed Women's Association (SEWA), a trade union for poor, self-employed women in the informal sector, to improve her working environment, and now uses special tables and chairs to make the kites. Photo: Paula Bronstein/Getty Images Reportage.