Universal health coverage (UHC) has been recognized by the World Health Organization as a key element in reducing social inequality and a critical component of sustainable development and poverty reduction. In most of the world UHC is sought through a combination of public and private-sector health care systems. In most low- and middle-income countries health systems are evolving to increasingly rely on the private sector because the public sector lacks the infrastructure and staff to meet all health care needs. With growing individual assets available for private-sector expenditure, patients often seek better access to technology, staff, and medicines. However, in low-income countries nearly 50 percent of health care financing is out-of-pocket. With the expected increase in the overall fraction of care provided through the private sector, these expenditures can be financially catastrophic for individuals in the informal workforce.

In the global workforce of approximately 3 billion people, only 10 to 15 percent are estimated to have some type of access to occupational health services. The informal workforce is growing worldwide, and the degree to which its occupational health needs are satisfied depends on the capabilities of the general health care system. In July 2014, the Institute of Medicine held a workshop on approaches to universal health coverage and occupational health and safety for informal sector workers in developing countries. This report summarizes the presentations and discussions from this workshop. Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries identifies best practices and lessons learned for the informal workforce in developing countries in the financing of health care with respect to health care delivery models that are especially suitable to meeting a population's needs for a variety of occupational health issues, including the prevention of or mitigation of hazardous risks and the costs of providing medical and rehabilitation services and other benefits to various types of workers within this population. These experiences and lessons learned may be useful for stakeholders in moving the discussions, policies, and mechanisms forward to increase equitable access to quality health services without financial hardship for the informal workforce.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• PLANNING COMMITTEE ON APPROACHES TO UNIVERSAL HEALTH COVERAGE AND OCCUPATIONAL HEALTH AND SAFETY FOR THE INFORMAL WORKFORCE IN DEVELOPING COUNTRIES
• FORUM ON PUBLIC–PRIVATE PARTNERSHIPS FOR GLOBAL HEALTH AND SAFETY
• Reviewers
• Acknowledgments
• Acronyms
• 1. Introduction
  • OPERATIONAL DEFINITIONS FOR THIS WORKSHOP
  • ORGANIZATION OF THE REPORT
• 2. Universal Health Coverage and Occupational Health and Safety Issues for the Informal Workforce
  • THE INFORMAL WORKFORCE
    Marty Chen.
  • UNIVERSAL HEALTH COVERAGE: FRAMEWORKS FOR DISCUSSION
    Robert Emrey.
  • UNIVERSAL HEALTH COVERAGE AND THE INFORMAL WORKFORCE
    Peter Berman.
  • UNIVERSAL HEALTH COVERAGE, INFORMALITY, AND WORKERS' HEALTH
    Ivan Ivanov.
  • PARTNERSHIPS AS A MECHANISM FOR PROGRESS
    Victor Dzau.
  • UNIVERSAL HEALTH COVERAGE AND OCCUPATIONAL HEALTH AND SAFETY FOR INFORMAL WORKERS: A VIEW FROM INDIA
    Mirai Chatterjee.
  • DISCUSSION
• 3. Mapping Solutions to Universal Health Coverage Inclusive of the Informal Workforce
  • ROLES OF GLOBAL EMPLOYERS IN UNIVERSAL HEALTH COVERAGE
    Lorna Friedman.
  • THE ROLE OF EMPLOYERS IN COVERAGE AND OCCUPATIONAL HEALTH: A PERSPECTIVE FROM THE U.S. EXPERIENCE
    Marleece Barber.
  • EFFORTS TO MAP THE INFORMAL WORKFORCE AND HEALTH COVERAGE IN LATIN AMERICA
    Orielle Solar.
  • DISCUSSION
• 4. Responding to Work-Related Health Needs of Informal Sector Workers
  • PRIMARY-CARE BASED INTERVENTIONS FOR INFORMAL SECTOR WORKERS
    Ivan Ivanov.
  • RESPONDING TO THE WORK-RELATED NEEDS OF INFORMAL SECTOR WORKERS IN LATIN AMERICA
    Julietta Rodriguez-Guzman.
  • THE INTERNATIONAL LABOUR ORGANIZATION'S APPROACH AND GOOD PRACTICES FOR OCCUPATIONAL SAFETY AND HEALTH FOR INFORMAL WORKERS
    Yuka Ujita.
  • A PERSPECTIVE FROM THE UNITED STATES
    John Howard.
• 5. Select Country Experiences
  • BRAZIL: BUILDING THE NATIONAL OCCUPATIONAL HEALTH SERVICES NETWORK: AN EXPERIENCE WITH UNIVERSAL HEALTH CARE PROVISION
    Vilma Santana.
  • INDIA: INEQUITIES IN FINANCING, COVERAGE, AND UTILIZATION OF HEALTH CARE BY INFORMAL SECTOR WORKERS
    Charu Garg.
  • INDONESIA: THE EFFECTIVENESS OF OCCUPATIONAL HEALTH INTERVENTIONS FOR THE INFORMAL SECTOR AND OPTIONS FOR DELIVERY
    Hanifa Denny.
  • SOUTH AFRICA: SERVICES TO WORKERS IN THE INFORMAL ECONOMY
    Barry Kistnasamy.
  • SOUTH AFRICA: OCCUPATIONAL HEALTH AND SAFETY: TOWARD THE INCLUSION OF INFORMAL WORKERS
    Francie Lund.
  • SOUTH AFRICA AND GHANA: LINKING OCCUPATIONAL HEALTH AND UNIVERSAL HEALTH COVERAGE
    Laura Alfers.
  • THAILAND: UNIVERSAL HEALTH COVERAGE SYSTEM AND INFORMAL WORKERS
    Somsak Chunharas.
  • THAILAND: OCCUPATIONAL HEALTH SERVICES DELIVERY FOR INFORMAL WORKERS AND FINANCIAL RESOURCES
    Orrapan Untimanon.
  • THAILAND: EXPERIENCES FROM A PILOT PROJECT ON OCCUPATIONAL SAFETY AND HEALTH PROMOTION FOR INFORMAL WORKERS
    Poonsap Tulaphan.
  • ZAMBIA: PUBLIC–PRIVATE PARTNERSHIPS IN HEALTH
    Karen Sichinga.
• 6. Closing Remarks
  • A PERSPECTIVE FROM THE ROCKEFELLER FOUNDATION
    Michael Myers.
• References
• APPENDIXES
  • Appendix A. Workshop Agenda
  • Appendix B. Speaker Biographical Sketches

Rapporteur: Rachel M. Taylor.

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2016. Approaches to universal health coverage and occupational health and safety for the informal workforce in developing countries: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21747.