Linking Occupational Health & UHC in Ghana and South Africa

Transcription

1 Linking Occupational Health & UHC in Ghana and South Africa Laura Alfers WIEGO Presentation prepared for the Institute of Medicine Workshop on Universal Health Care and the Informal Workforce th July 2014 Washington DC Photo credits: Laura Alfers, Dorcas Ansah, Richard Dobson, Tasmi Quarsi

2 The Informal Workforce: Ghana & South Africa Ghana: Over 90 percent of the workforce are informally employed. Biggest sector is in agriculture, but significant numbers work in the urban non-agricultural sector (37.4 percent of the workforce). Self-employed, own-account workers make up the largest single share of non-agricultural employment (27.4 percent of the workforce and 37.5 percent of the female workforce). South Africa: Approximately 33 percent of the workforce are informally employed. Biggest sectors of the informal economy are in private households and informal trade. - Heintz, 2005 More than street vendors identified by the Quarterly Labour Force Survey. - Budlender, 2011

3 National Health Systems in Ghana & South Africa UHC = National Health Insurance Schemes

4 Ghana NHIS: Barriers to access for informal workers: 1. Cost of premiums. 2. Administrative chaos on the ground. 3. Lack of adequate information. 4. Long waiting periods for NHIS members at health facilities.

5 But what gets left out?

6

7 All of these places are informal workplaces which are hazardous to the health of informal workers. All of them are controlled by municipalities. Health insurance schemes do not address this source of ill-health.

8 Institutional Mismatches Ministry of Local Govt. Ministry of Health Ministry of Labour Municipalities Environmental Health Waste Management Urban Infrastructure

9 The Accra Health & Safety Platform The basic principles: Health & safety institutions need reform in order to meet the needs of informal workers Reforming institutions and regulations is a long and difficult process. The first step towards reform is to build and sustain more positive relationships between those who govern and those who are governed. This can only be done when spaces are created where these relationships can be built in an even handed manner.

10 Activities Building a platform for informal workers to engage with municipal institutions: Representatives from the Ghana Health Services (Occupational & Environmental Health Unit), the Accra Metropolitan Assembly Fire Department, as well as waste management and environmental health services. Included capacity building of worker organizations so that they were able to articulate to their problems and concerns appropriately and in a strategic manner. Results of the engagements with local government: Waste management committees Fire extinguishers Drain clearance

11

12 The Phephanathi Platform Phase 1: Formation of risk management committees in each market. Training: Fire Safety First Aid Basic understanding of workplace hazards Hazard mapping and urban design process: Experimenting with crowd mapping technology Developing basic emergency plans and installing basic infrastructure Formation of the Warwick Junction Central Risk Management Committee: Trader representatives Local government representatives Occupational and public health experts

13

14

15 The future: Linking our platforms to other health systems Precedent for this set in Ghana: 2000 Kayayei registered at subsidised rate on NHIS. NHIS organised a second registration drive on their own initiative. About to start small monitoring study after Year 1.

16 Phephanathi Phase 2: Partnering with universities who have specific knowledge: Ergonomics specialists Occupational hygiene specialists Worker s health education specialists Facilitating health and hygiene mentorship systems amongst sellers of cooked food and promoting healthy street food in Durban. Running health diagnostic camps in the Warwick Junction area. Thinking through further urban design solutions.

17 Thank You! More info at: