INFORMAL WORKERS: UNIVERSAL & OCCUPATIONAL HEALTH COVERAGE

Transcription

1 INFORMAL WORKERS: UNIVERSAL & OCCUPATIONAL HEALTH COVERAGE MARTY CHEN HARVARD UNIVERSITY WIEGO NETWORK IOM WORKSHOP JULY 29, 2014

2 REMARKS My remarks will be in 4 parts: Informal Employment o Definition o Data Informal Workers, Universal Health & Occupational Health o Risks o Barriers Illustrative Cases: findings from 2012 study in 10 cities o Home-Based Workers o Street Vendors o Waste Pickers The Way Forward o Key Issues o Different Models

3 INFORMAL SECTOR, INFORMAL EMPLOYMENT, INFORMAL ECONOMY There are three related official statistical terms and definitions which are often used imprecisely and interchangeably by analysts and observers: informal sector refers to the production and employment that takes place in unincorporated enterprises that might also be unregistered or small (1993 International Conference of Labour Statisticians) informal employment refers to employment without social protection (i.e. without employer contributions) both inside and outside the informal sector: i.e., for informal enterprises, formal enterprises, or households (2003 International Conference of Labour Statisticians) informal economy refers to all units, activities, and workers so defined and the output from them (2002 International Labour Organization). In sum, the informal economy is the diversified set of economic activities, enterprises and workers that are not regulated by the state and do not have employment-based social protection; and the output from them.

4 INFORMAL EMPLOYMENT: 2003 International Conference of Labour Statisticians Self-Employed in Informal Enterprises (i.e. unincorporated enterprises that may also be unregistered and/or small) o o o o employers own account operators unpaid contributing family workers members of informal producer cooperatives Wage Workers in Informal Jobs (i.e. jobs without employmentlinked social protection) o o o informal employees of informal enterprises informal employees of formal firms domestic workers hired by individuals/households without employer contributions

5 THE INFORMAL WORKFORCE Around the world, the informal workforce includes those who work: On Streets or In Open Spaces: street vendors push-cart vendors waste collectors roadside barbers construction workers In Fields, Pastures, and Forests: small farmers agricultural laborers shepherds forest gatherers In Hotels, Restaurants, Offices: cleaners/janitors dishwashers helpers In Small Workshops: scrap metal recyclers shoe makers weavers garment makers and embroiderers paper-bag makers In Unregulated Factories: garment makers shoe makers fireworks/match makers At Home: garment makers embroiderers shoemakers artisans or craft producers assemblers of electronic parts

6 INFORMAL EMPLOYMENT AS % OF NON-AGRICULTURAL EMPLOYMENT Average & Range by Regions South Asia: 82% 62% in Sri Lanka to 84% in India Sub-Saharan Africa: 66% 33% in South Africa to 82% in Mali East and Southeast Asia: 65% 42% in Thailand to 73% in Indonesia Latin America: 51% 40% in Uruguay to 75% in Bolivia Middle East and North Africa: 45% 31% in Turkey to 57% in West Bank & Gaza Source: Vanek et al. WIEGO Working Paper No. 2, 2014

7 SEGMENTATION OF INFORMAL EMPLOYMENT: BY SEX, AVERAGE EARNINGS, AND POVERTY RISK Poverty Risk Average Earnings Segmentation by Sex Low High Employers Predominantly Men Informal Wage Workers: Regular Own Account Operators Men and Women Inf ormal Wage Workers: Casual Industrial Outworkers/Homeworkers Predominantly Women High Low Unpaid Family Workers

8 INFORMAL WORKERS, UNIVERSAL HEALTH & OCCUPATIONAL HEALTH RISKS Relative to Formal Workers greater exposure to health risks, especially occupational health risks due to living & working environment less protection against loss of income associated with health risks due to lack of paid sick leave less protection against costs of health risks due to lack of employer contributions to health insurance + limited access to universal health coverage

9 INFORMAL WORKERS, UNIVERSAL HEALTH & OCCUPATIONAL HEALTH BARRIERS Relative to Formal Workers less access de jure to health insurance and health services, including occupational health services - due to inappropriate design of services/systems that do not take into account the specific realities of informal work (e.g. high incidence of selfemployment & occupation-specific risks) less access de facto to health insurance and health services, including occupational health services, to which they are entitled - due to lack of knowledge of their entitlements, less ability to negotiate the bureaucracy, and leakages and blockages in health insurance and health services

10 ILLUSTRATIVE CASE # 1 HOME-BASED WORKERS RISKS nature of work: musculoskeletal stress + exposure to toxic substances + psychological stress (irregular work and earnings & inflation) place of work (=home): small cramped space + poor ventilation BARRIERS isolation & lack of organization lack of knowledge about preventive health measures & health entitlements + lack of bargaining power limited time & mobility limited ability to negotiate bureaucracy (especially for women) lack of recognition lack of integration & targeting in health insurance + health services Source: Chen Informal Economy Monitoring Study: Home-Based Worker Sector Report. WIEGO.

11 ILLUSTRATIVE CASE # 2 STREET VENDORS RISKS nature of work: musculoskeletal stress (from transporting goods & sitting, standing, moving) + physical abuse by police + psychological stress (fear of evictions and confiscation of goods & irregular work and earnings & inflation) place of work: exposure to the elements & pollution + lack of water & sanitation BARRIERS lack of organization lack of knowledge about preventive health measures & health entitlements + lack of bargaining power limited time limited ability to negotiate bureaucracy lack of recognition lack of integration & targeting in health insurance + health services Source: Roever Informal Economy Monitoring Study: Street Vendors Sector Report. WIEGO.

12 ILLUSTRATIVE CASE # 3 WASTE PICKERS RISKS nature of work: musculoskeletal stress (sorting & transporting goods) + exposure to (hazardous waste materials & psychological stress (harassment by authorities and public, irregular work and earnings, inflation) place of work: exposure to the elements & pollution & toxic/dangerous waste + lack of water & sanitation + risk of accidents (especially at dumpsites) BARRIERS lack of organization lack of knowledge about preventive health measures & health entitlements + lack of bargaining power limited time limited ability to negotiate bureaucracy & markets lack of recognition lack of integration & targeting in health insurance + health services Source: Dias and Samson Informal Economy Monitoring Study: Waste Pickers Sector Report. WIEGO.

13 THE WAY FORWARD: KEY ISSUES Universal Health Coverage o what services? o what about promotive & preventive health? o how financed? taxes and/or contributions/premiums? o who provides insurance? whether regulated? for tertiary care only? o who provides services? whether regulated? any caps on expenditures? Occupational Health o need to reform system to take into account different places of work & different types of occupational health risks o need for reformed system to be sector-specific: taking into account nature of work & place of work of different sectors/occupations of informal workers

14 THE WAY FORWARD: WHICH MODEL? Services o Promotive, preventive, curative, rehabilitative o Primary, secondary, tertiary o Occupational health & safety: appropriate to specific risks & workplaces of different groups of informal workers o Essential medicines: free or subsidized Financing o Taxes: progressive vs. regressive o Payroll deductions: employer + employee contributions o Individual contributions: voluntary, involuntary, subsidized Insurance o Government-run o Private for-profit: regulated or non-regulated o Private non-profit: regulated or non-regulated o Cooperatives: owned by informal workers Provision o Primary health care centers o Government hospitals and doctors o Private doctors: paid by government o Private for-profit hospitals and doctors: contracted in vs. independent, regulated vs. non-regulated o Private non-profit hospitals: contracted in vs. independent, regulated vs. nonregulated o Public-private partnerships, including organizations of informal workers o Community health workers

15 THANK YOU!