Health Vulnerabilities of Informal Workers

Health Vulnerabilities of Informal Workers
May 2013

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Problem Statement and Key Messages
Informal workers face substantial risks and vulnerabilities due to insecurity surrounding their employment status and
lack of control of the conditions of their employment. In addition, informal workers have limited access to affordable and
appropriate health care for themselves and their families, and they may not seek care if they have insecure legal status,
or due to the potential expense or loss of income. The combination of high vulnerabilities and inadequate social
protections (including insufficient access to affordable health services) results in high incidences of injury, illness,
susceptibility to chronic diseases and poverty.
Key Messages
1. Informal employment is often invisible, as workers are mostly
excluded from national labor laws and regulations, social
protections, and high‐level discussions. As a result, they fall
through the cracks in systems, including most UHC schemes,
that serve formal workers on the one hand and unemployed on
the other.
2. Employment insecurity and inadequate health care are
common to all informal workers and increase health
vulnerabilities; specific health issues vary in prevalence among
informal workers because of differential working conditions,
exposures and health risks.
3. Over 700 million informal workers live in extreme poverty, and
often cannot bear the financial and/or opportunity costs of
receiving health services and losing a day’s work.
4. Women make up the largest proportion of the most vulnerable
informal workers due to a combination of factors: they occupy
the lowest paying informal jobs, maternal health needs are not
met by employment conditions, and working conditions often
subject them not only to bodily harm but also psychological and
sexual abuse.
5. No one‐size‐fits all solution will address the geographic, health,
and occupational differences among informal workers. Some
countries (esp. in Asia and Latin America) are addressing health
care accessibility via national or tailored insurance. In Asia, Latin
America, and (less so) Africa, countries have devised worker‐specific
programs, particularly in urban areas.
6. Opportunities for engagement on health and informal workers
issues include population‐level or worker‐level efforts.
Scattered funding and variable interests have led to a patchwork
of policies and programs focused on national interest or type of
worker. Often the health vulnerabilities of informal workers are
addressed as one small component within a broad range of
activities.
7. The invisible nature of informal work results from and
contributes to the dearth of systematic data. Informal workers
are not “seen” so are not counted – limiting estimates of scale
and scope, and exacerbating the practice of overlooking this
population and their needs. Similarly, systematic health data
generally does not designate employment status and reveals
very little about specific “heath vulnerabilities.”

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Definitions of Key Terms
Term Definition
The ILO’s Informal
Employment
Definition
All remunerative work that is not recognized, regulated, or protected by existing legal or regulatory frameworks
and non‐remunerative work undertaken in an income‐producing enterprise. Unlike formal employment, informal
jobs are not subject to national labor legislation, income taxation, social protection, or certain benefits (advance
notice of dismissal, severance pay, paid annual or sick leave, maternity leave, retirement/pension, etc.).
Informal Worker An individual engaged in informal employment.
Informal Sector Self‐employment or small businesses not subject to regulation or taxation. People can be informally employed in
the formal sector and formally employed in the informal sector.
OHS Occupational Health and Safety – policies and programs that address the working conditions.
Employment
Conditions
The formal or informal conditions of an employer‐employee relationship involving labor regulations, and
employment‐based social protection (e.g., hours, pay or compensation, time‐off, and benefits).
Working Conditions Workplace and physical conditions of work, including repetitive or stressful motions required to perform work;
materials, chemicals, and hazards with which workers come into contact and provision of protective gear and
training; and the space, building, location, street, or place where work is performed.
Non‐Wage Workers Workers who are not paid a salary or minimum wage, e.g., employers; owners/operators of small informal
enterprises; self‐employed and own‐account workers – example: street vendors; and unpaid family workers.
Wage Workers Workers employed by other people, paid by the hour or piece/job. Examples: domestic workers, home‐based
workers, temporary and part‐time workers, migrant workers, unregistered workers, and casual workers without a
fixed employer.
Informal Workers
Included in Search
Agricultural, construction, domestic, home‐based, manufacturing, transportation workers, and street vendors and
waste pickers. Migrant workers are included within these occupational categories.
Population‐level
Approach or Worker‐level
Approach
Activities may be conducted at the population level (e.g., for all informal workers; national health insurance and
international guidelines) or at the worker‐specific level (e.g., subsets of informal workers; providing some types of
workers access to local health care or micro‐insurance coverage for health issues, or extending corporate benefits
to informal workers in the formal sector).

Problem Assessment
• Informal workers number 1.8 billion (60% of the global workforce) and comprise a diverse population in terms of type of occupation, and social
and legal status. They face greater job insecurity and stress than workers who are formally employed, and they have little to no access to
affordable, quality health care. These conditions increase informal worker vulnerability to poor health, injury and illness. Furthermore, working
conditions are often unsafe and unhealthy.
• Accessing health care requires leaving work, which reduces the income of informal workers and adds health care expenses. However, most
informal workers have few resources – more than one‐third receive <$1.25/day for their labor.
• Informal worker vulnerability is exacerbated by political systems that do not recognize them, global economic conditions that hurt the formal
sector, national economic systems that see informal work as a drain on resources, inconvenient and underfunded health systems,
poor education and training systems, and socio‐cultural norms that permit gender discrimination.
Dynamism Assessment
• Two dynamic approaches that are gaining momentum to address the problem are: a) creating access to health care via insurance, with the goal
of Universal Health Coverage (UHC) and b) partnering with grassroots efforts to strengthen outreach and access to primary care.
• Regional progress varies. Asia has been proactive and Latin America fairly successful in designing strategies and bridging grassroots and
government partners. Though pockets of progress in implementing UHC exist, dynamism is lower in Africa.
• Barriers to success include prohibitive expenses for informal workers, governments and providers; and efforts that do not account for the highly
differential health needs of informal workers. Limited data and evaluation are also problematic.
Landscape Assessment
• Gaps in health care and coverage are partially addressed through a project‐level patchwork of activities and programs, funded by the public and
private sector, multilateral institutions, and philanthropic donors. In addition to limited multilateral efforts, grassroots organizations (e.g., WIEGO
and SEWA) are working to reduce the “invisibility” of some subsets of informal workers.
Impact Assessment
• Expanding access to health care for all informal workers (e.g., through the expansion of UHC) and building local capacity to help a subset of
informal workers are dynamic activity spaces with substantial challenges to scaling up. The first option does not ensure that informal workers will
use the services and the second would only serve a small fraction of informal workers. Both options require partnerships for sustainability.
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Executive Summary

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What is the scale and scope of the problem?
Why is the problem pressing?
Scale: Why It Is Important Scope: Global Relevance
Informal workers are a large group. Growth is expected to continue in the
next 50 years because of economic conditions globally.
• They total more than a billion in developing countries and 1.8 billion
worldwide, or 60% of the world’s working population, per OECD.
• Of new jobs created in developing countries, most are in informal
employment.
• The proportion of informal workers is higher (>40%) in developing than
in high‐income countries (~5%),and accounts for a greater proportion of
GDP (25‐60% of GDP in developing countries and 5% or less in high‐income
countries).
• The informal sector is a crucial “sparkplug for the engine of
development” worldwide – better employment conditions translate to
higher productivity and a greater contribution to the economy.
Informal workers are susceptible to health problems due to poor
employment conditions and inadequate access to health care. Many
types of informal workers face unsafe or poor working conditions.
• 700 million informal workers live in extreme poverty (<US$1.25/day),
contributing to their vulnerability to poor health.
• Informal workers face poor employment conditions: excessive hours; no
sick time; high stress and insecurity; no health or social protection.
• 70‐90% of informal workers have no or few benefits, according to
several studies and organizations working with informal workers.
• Informal workers face poor working conditions: physical overexertion or
repetitive motion; high risk of injuries, exposure to toxins, violence and
sexual assault; and limited access to training and protective gear.
The informal economy is a major force in Asia, Africa and Latin
America. Estimates derived from World Bank, OECD and ILO data:
• East and South Asia: 1.26 billion informal workers (67% of the
workforce); 705 million in agriculture, 552 million in non‐agriculture.
• Latin America: 178 million informal workers (63% of workforce);
64 million in agriculture and 114 million in non‐agriculture.
• Sub‐Saharan Africa: 152 million Informal workers (45% of the
workforce); 63 million in agriculture, 98 million in non‐agriculture.
Types of informal workers vary in global prevalence.
• With >950 million, agricultural workers are the largest type of
informal worker, followed by >170 million home‐based workers.
• Construction, domestic, and manufacturing workers each include
>50 million informal workers, as does street vendors. Waste pickers
and transportation workers are each <50 million.
• Of the >215 million migrant workers, most engage in informal work,
adding legal complexities to health and other measures.
Penetration of health insurance and social protection is low among
informal workers, even with national health insurance.
• SE Asia and UHC – Vietnam & Indonesia: many informal workers not
covered. India & Bangladesh – low coverage.
• Workers in Africa, rural women and casual workers are the least
likely to have insurance against work accidents or injury.
• In Latin America, on average 35% in informal work categories have
access to health systems compared to 60% of workers.
Informal workers are poorer and more vulnerable than formal workers, experiencing higher rates of injury
and illness because of insecure and unhealthy employment conditions and inadequate health care.

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Informal Worker Summary: Estimated Scale
Regional estimates of informal workers indicate that Asia has the largest number of informal workers,
about 7‐times more than in Latin America and 8.4‐times more than in Africa.
# in Millions
Type of Informal Worker Global Asia Africa Latin America
20
66
>50
37
960
22
170‐330
78
50‐130
3
13
27
12
89‐177
27‐71
63
53
705
2
5‐14
2
17‐34
5
1
63
4
8
6‐16
13
20‐41
20
Agricultural Workers
Construction Workers
Domestic Workers
Home‐based Workers
Manufacturing Workers
Street Vendors
Transportation Workers
Most numbers are estimated based on R4D calculations with data from World Bank and ILO/WIEGO datasets. Bars with a gray
background represent only the 32 countries reporting in the ILO/WIEGO database.
64
Waste Pickers

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What is the impact on the lives of poor or
vulnerable people?
Impact on the Lives of the Poor or Vulnerable
Informal employment is associated with increased levels of illness and injury because informal workers are exposed to greater health risk due
to poorer work‐ or occupation‐related conditions as compared to formally employed workers.
• Many workplaces are unsafe – resulting in illness and injury: Nearly half of all wage workers in Bangladesh and Latin America reported unsafe
workplace conditions, while more than 60% of the informal women workers in India reported physical weakness due to poor working and
living conditions. In South Africa, the incidence of work injury was 7.2 times higher in the informal versus formal sector; in the Philippines,
>50% of non‐fatal injuries are incurred by self‐employed informal workers. In addition, children may suffer direct health issues from parent’s
work, e.g., lead poisoning due to home‐based battery manufacturing and asthma among street vendors‘ children who go to work with their
parents.
• Some workers are particularly at‐risk: Older and younger populations are most vulnerable and most affected by ill‐health. Migrant workers
often engage in agricultural and domestic work, which have high health risks. Disaggregated informal workers, e.g., domestic and home‐based
workers, most of whom are women with high health risks, are harder to reach with health services.
A key driver of poorer health among informal workers is inadequate access to health care and coverage, which combined with higher health
risks increase vulnerability, particularly for migrant workers, who may also face legal obstacles and are least likely to seek services.
• Inadequate access to health insurance: Only about one‐third of domestic workers and non‐wage workers have health insurance in Latin
America, compared with three‐fourths of salaries workers in private organizations with 6 or more employees and 90% of salaried public
workers. In Ecuador, Mexico, Panama, and Peru, access to healthcare diminishes according the number of workers in a business (small
businesses tend to be informal); in businesses with 100 or more employees health coverage is close to 90% vs. 15% in businesses with 1‐5
workers.
• More restrictions on women for general and work‐related health conditions: Lower incomes , disaggregated workplaces and lack of power
restrict access to care beyond insurance coverage. Many female informal workers are unable to leave work for basic health care, maternity
leave or prenatal care, or mental health services, despite facing increased health concerns, such as physical and sexual abuse.
Illness and injuries create hardship among families due to loss of income and expenses incurred in the course of treatment – particularly for
chronic or debilitating conditions; yet delaying care also has costs related to an increasing severity of conditions requiring more expensive
care.
• Many informal workers have few resources: In India, about 80% of the informal workers are poor; in Cambodia, >55% are below poverty line.
• Occupational injuries are costly to families: Street vendors in Ghana reported that work‐related injuries (e.g., chronic back and joint injuries
from repeated motions , dehydration and infection) could cost 2‐6 weeks of income. In India, 92% of survey respondents noted loss of income
due to illness, 17% lost their job, and 57% lost up to 10 days pay. In Bangladesh, poor families lost about a months’ wages/year due to illness.
Due to insecure employment conditions, informal workers’ families face financial hardship.

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Informal Worker Summary: Health‐related Issues
Differential health‐related issues are important to consider when framing an intervention or setting
priorities, as they suggest mechanisms and level of commitment required.
Type of
Informal Worker
# of Serious
Health Issues
Severity of
Health Risks
Social
Protection
Migrant
Workers
Domestic Workers
Home‐basedWorkers
Street Vendors
Waste Pickers
Risk of Death, Serious Over Half Insured Significant Subgroup
Injury or Disease
Risk of Acute Illness or Few Insured Some Reported
High Proportion of
Workers Affected
Few Workers Affected Chronic Non‐fatal Conditions
Very Few to None
Very Few Insured Reported Few or Un‐severe
Occupational Health Issues
Very Few Workers
Affected
1Aggregation: How physically grouped the workers are as a proxy for how easy it might be to reach them with either a health care intervention or to organize/mobilize.

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What are the root causes at play? What systems
failures are causing or exacerbating the problem?
Poor access to health care as well as gender and economic inequalities are particularly detrimental to the
health of informal workers – they limit a person’s ability to mitigate the impact of health risks.
System Failures: Underlying constraints that exacerbate the vulnerability of informal workers
Health System
Low government health
care expenditure, an
infrastructure skewed to
urban areas, and
inadequate UHC
implementation limit
system accessibility for
informal workers.
Economic System
Formal sector policies
often do not include
informal workers, who
may be seen as sources of
public expense not
revenue, as they do not
pay taxes and have low
income levels.
Political System
Informal workers are
often invisible, thus
marginalizing them in
policy making. They often
are not empowered to
raise their profile and
advocate and fight for
their rights.
Education System
Lack of adequate
education and training
makes a large portion of
the workforce depend on
low‐skilled jobs with little
room for negotiating
better employment
conditions.
Socio‐cultural
System
Cultural norms and
practices may include
restrictions that hinder
access to opportunities,
particularly for women
who face discrimination.
Root Causes: Main drivers that directly contribute to vulnerability
Gender Inequalities
A high proportion of women in home‐based
work, domestic work and unpaid family labor,
coupled with poor employment conditions
and lower earnings for women compared to
men, increase women’s health vulnerabilities.
Economic Inequalities
Poor economic conditions, limited access to
capital or other assets for micro‐ and small‐business
owners, and limited access to
educational and formal sector opportunities
inhibit informal worker economic growth.
Poor Health Care Access & Coverage
Urban‐concentrated health infrastructure,
low focus on primary and preventive
healthcare, poor quality of services, and
poor insurance coverage and use make for
unsatisfactory health outcomes.
Inadequate Regulatory Support
Social protection regulations are not
effectively designed to suit the needs of
informal workers; lack of awareness among
workers about the regulations is due to
limited marketing and outreach initiatives.
Disorganized Networks
Informal workers may have social and family
but limited occupational ties – problematic
particularly for workers in disaggregated
locations. Further limits the voice and
opportunities contacts for informal workers.
Excess Unskilled Labor
Lack of employment opportunities and low
levels of skills training, combined with a
large and growing population, forces large
numbers workers to take jobs characterized
by poor employment conditions.

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What are the relevant
gender dimensions of the problem?
Women are over‐represented in lower income occupations (e.g.,
home‐based and domestic workers) and under‐represented in
the higher income strata (e.g., employers of other workers).
Women Men Proportion of
84 63 65 65 58 48
100
0
Africa Asia Latin America
non‐agricultural
workers
informally
employed
Women in
the Informal Workforce
Estimated
# Women % Women
Agricultural workers 413 million >40%
Home‐based workers >136 million >80%
Domestic workers 28 million >50%
Manufacturing workers 26 million >33%
Construction workers 13 million 12%
Transportation workers 2 million 5%
Women’s unique health needs are not met | The type of work affects women’s health | Women have fewer options and resources
• The importance of maternity benefits: women in
informal work remain in their jobs until labor pains
start and return to work soon after delivery. Such
behavior not only endangers the health of the
women but also their lives and the lives of their
unborn or newborn child. Access to primary care
services is essential.
• Domestic workers are vulnerable to physical,
psychological, and sexual abuse, as they are
isolated, work very long hours, and get little
pay, especially migrant workers. They face
increased risk for asthma and other respiratory
problems associated with the regular use of
toxic cleaning agents, and injuries due to heavy
lifting.
• Women tend to be concentrated in the most
informal and insecure jobs within the agricultural
sector and receive the lowest pay. In the
agricultural sector, in Chile, 53% of temporary
workers but only 5% of permanent workers are
women; in South Africa, 69% of temporary or
casual workers are women compared to 26% in
permanent employment.
• Homeworkers have reported reproductive health
problems including ovary‐related problems,
abdominal pain, miscarriage from working paddle
driven machines, disturbance of fetal position
during pregnancy from excessive sitting
(sometimes leading to need for C‐section), and lack
of antenatal care services.
• Physical labor exposes women to many
debilitating health conditions that have long‐term
consequences. Manufacturing, food
processing, and the garment industry workers
are at risk of repetitive use injury of hands and
feet, lung disease, hearing loss, accidents, and
exposure to biological hazards. Agricultural
workers have reported muscular, psychological,
stomach, eye, and skin problems. Female street
vendors (mainly those over age 40) reported
illness and injury, e.g., burns, cuts, headaches,
and musculoskeletal problems.
• Women are prevalent in home‐based work
because it allows women to simultaneously care
for children and homes, and addresses cultural
limits to women’s mobility. Exposure to hazards in
the home are disproportionate because they also
affect children and can potentially cause life‐long
impacts.
• Pesticide poisonings disproportionately affect
women due to their higher levels of body fat and
have been documented to produce birth/
reproductive defects.
• Women’s concentration in insecure employment
makes them targets of sexual harassment by
supervisors responsible for renewing contracts.

Activities to secure access to health and address employment insecurities for informal workers are based in
part upon perspectives on the role and permanence of the informal sector. All four perspectives have a
following, are being applied in developing countries, and are based in promoting equity for informal workers.
“The formal sector is optimal; efforts should be made to translate it to the informal sector.”
This view is based on a good governance model of economic efficiency in which businesses conform
to OHS regulations and provide some employer‐based benefits, including health insurance or access
to health care. This view considers the informal sector a temporary state and is prominent among
multilaterals (e.g., ILO, The World Bank, OECD) and among traditional economists.
“Benefits and policies for the informal sector should be designed by the workers, who understand
their needs and the existing barriers to access to health care.” Workers have organized via trade
unions, community groups, NGOs, and other forums to promote health and safety. Benefits may also
include housing supplements, care for older family members, maternal and child health, and food
security. This approach is promoted by organizations like WIEGO, SEWA, HomeNet, and StreetNet.
“Improving health and accessibility for all includes informal workers and their families.” By
focusing on health affordability and improved infrastructure, governments can ensure that informal
workers do not “fall through the cracks.” This approach includes insurance schemes to work toward
UHC; enhanced clinics and training for work‐related care; and expanded access to primary care. This
approach is used by governments (e.g., India and Thailand) to meet health needs.
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What are the prevailing perspectives
on this problem?
The context is important in determining which approach (or combination of approaches) will be
most effective in meeting the needs of informal workers. Some of the most interesting actions
seem to be arising when partners work together across approaches.
The
“Drive to Formalize”
Approach
The
“From the Bottom Up”
Approach
The
“Health for All”
Approach
The
“Rights Based”
Approach
“Focus on improving health rights and protection of informal workers.” NGOs and international
research organizations have been actively involved in demanding recognition of the right to health
and improving employment conditions for informal workers. This approach, promoted by academics
and international organizations, uses research and policy advocacy, and international conventions
(e.g., the Universal Declaration of Human Rights) to promote health access.

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What has and has not worked?
Past efforts have taken many forms, including provision of health insurance, to increase the resources of
informal workers and promote regulations to improve safety.
What Has Not Worked What Has Worked
Some government‐mandated programs to provide health
insurance have not worked well because they do not meet
the needs of informal workers. India’s Rashtriya Swasthya
Bima Yojana (RSBY), national insurance program (2008),
provided publicly subsidized care and secured private
insurance via a competitive process. Early results show that
services focused less on commonly needed preventive care
and OHS, and more on costly but less needed services such
as surgery.
Efforts to
Prevent
Ill Health
Efforts to
Improve
Work
Security
Many national Occupational Health and Safety policies do
not include the informal sector. This may avoid burdening
informal businesses or protect employers but it puts
informal workers in high‐risk situations, e.g., lack of bars on
windows resulted in fatal falls of domestic workers.
Extending schemes designed for formal workers to cover
informal workers without understanding the needs of the
informal workers has mostly led to poor uptake. Ethical
trade initiatives to lead to improvements in health and
safety conditions are rarely directly tied to poorer
workers. Two examples in Chile and South Africa
(horticulture industry), and Thailand and Philippines
(garment industry) show that efforts to curb the industry
were more directed toward buyers than workers – there
was little effect on informal workers.
Customized and well‐designed schemes that incentivized
registration. In Thailand, registration for voluntary health insurance
under Social Security Law was re‐designed for informal workers by
adjusting the contribution payments and modifying risks covered.
Collective action by informal workers can lead to not only specific
actions but also a voice. SEWA has been influential on national
commissions and meetings on health, UHC, and support services (e.g.,
child care). Kagad Kach Patra Kashtakari Panchayat (KKPKP, Indian
waste pickers’ trade union) and South Africa’s Asiye eTafuleni are
designing carts that are easier to maneuver and lighter to pull.
Efforts to
Improve
Access to
Health Care
Targeted programs/policies can be effective in achieving specific
goals by focusing on local authorities and including informal
workers. Example: In 2009, the Indian government enacted a national
urban policy (Street Vendors Bill) that allowed state/municipal
authorities to provide preventive and curative health coverage.
Programs that highlight health priorities of informal workers can be
successful. HomeNet Thailand played an active role in the national
commission leading to the “30 baht health insurance scheme,”
subsequently UHC with 99% population coverage. UHC scheme in
Thailand was implemented with support of multiple stake‐holders
(NGOs, community, private organizations, public officials, and
informal worker representatives), resulting in better coverage, greater
commitment to success and higher rates of acceptance of the scheme.
The unique employment and working conditions of informal workers require their participation in developing and
implementing solutions – top‐down, one‐size‐fits all solutions generally fail to account for such factors.

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2) Dynamism Assessment
Purpose
• The Dynamism Assessment aims to identify the primary opportunities that could be catalyzed to address
the problem. It also aims to identify emerging issues and future trends that could influence these
opportunities, and the potential risks or uncertainties that could inhibit transformative change.
Key Findings
• Partnerships among actors – e.g., government, private funders, worker‐led organizations, NGOs, and
private insurance companies – have focused on population‐level (national insurance/UHC) or worker‐specific
(smaller, tailored) programs, contributing to scattered and geographically oriented progress.
• The most dynamic forces are: a) the growth of partnership models to foster programs/policies, b) an
increasing awareness of informal worker health issues among informal worker groups and external
actors, and c) the acceptance of UHC as a goal to promote health for all. The level of activity (window of
opportunity vs. tipping point) is country‐specific.
• Focus on the health and health vulnerabilities of informal workers is often part of broader programmatic
work that includes education, child care, economic and components that contribute to quality of life.
• Several grassroots organizations are addressing informal worker health needs, but usually not as a stand
alone focal issue. Health‐based organizations often do not track people by employment status, so their
level of engagement with informal workers is often difficult to gauge.
• Emerging trends include a) addressing economic systems failures through coordination among national
and international institutions, and b) promising advances in the use of technology for communication and
information‐sharing could facilitate identifying/tracking informal workers.
• Greater coordination of health and employment data collection efforts is needed to identify health needs
and access patterns, and to reduce the level of uncertainty about the scale and scope of these issues.

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What forces are creating windows of opportunity?
Forces Contributing to Dynamism
Areas of Dynamism
Population‐level Forces
• Bilateral and Multilateral Organizations: World Bank, Sida, DFID. These entities provide much of
the funding in the space, including for projects on informal workers, health systems, and health care.
In 2012, the World Bank increased funding on social protection and worker training – these
programs will include, but are not directed specifically to, informal workers.
• Multilateral Organizations: Decent Work Agenda (ILO, 1999) and Social Protection Floor (ILO/WHO,
2009/2012). These entities promote extending health and social protection to improve employment
and working conditions, with an emphasis on vulnerable (including informal) workers. These efforts
pressure governments to respond and they engage/motivate informal workers.
International bodies are now
accepting the role of the informal
workers and their health issues.
This opens the opportunity for high‐level
initiatives that provide a
framework for national and sub‐national
policies and standards.
Expansion of UHC is highlighting
what works and what does not
work. As countries expand and
evaluate UHC expansion, they learn
lessons about reaching the diverse
population of informal workers.
Groups that organize informal
workers are now promoting safety
and health; providing services or
increasing primary care access;
expanding insurance options, and
encouraging opportunities for
informal worker representation.
These efforts support informal
worker health by listening to their
needs.
Growing awareness of the health
issues of informal workers among
funders and other actors. The
greater the awareness, the greater
the possibility for new partners,
new funding and new ideas.
• National Governments. Most countries start by enrolling formal workers and easy‐to‐reach
populations, with informal workers added later. UHC results are mixed but lessons are being learned
about affordability, income insecurity, and services needed/wanted; evaluation will guide
refinement and expansion. Countries in intermediate stage: Ghana , Indonesia, Philippines, Rwanda
and Vietnam. Countries in early stage: India, Kenya, Mali, and Nigeria.
Worker‐level Forces
• Women‐focused Organizations: WIEGO, SEWA, and HomeNet Thailand. These organizations have
been effective in organizing women. They develop systems and processes designed for informal
workers, including better‐suited insurance schemes, tailored options for informal worker needs, a
market for health micro‐insurers and providers. WIEGO’s health work focuses OHS, e.g., in Thailand
(with HomeNet Thailand) and Tanzania for domestic workers. SEWA emphasizes health education,
treatment, preventive and primary care, and referrals to public hospitals and dispensaries.
• Other Worker Organizations: StreetNet International and others. These organizations work with
specific groups – e.g., StreetNet with street vendors to promote access to health care among other
benefits and to enact agreements for greater protection, such as in India, Ghana, and Nicaragua.
• Bill & Melinda Gates Foundation. The Foundation is a major funder of global health and also has
micro‐insurance and other relevant projects, e.g., they had a program to improve conditions of
waste pickers in urban environments but the scope was too broad to accomplish desired outcomes.
• Information exchange. Knowledge management is a current trend in global health, with mHealth
and K4Health and others leading the field and providing valuable health information to all. Though
these programs do not target informal workers, they are constantly evolving and adding new pieces.

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Informal Worker Summary: Momentum
Momentum is a multi‐faceted concept visualized through several parameters. As priorities for engagement
on informal worker health issues are set, the balancing of these parameters suggests activities and
interventions.
Type of
Informal Worker Attention1 Partners2 Funders3 Maturity4
Domestic Workers
Home‐basedWorkers
Street Vendors
Waste Pickers
New Literature & Media Several Active Organizations Several Active Funders Local, National,
International Work
New Literature OR Media A Few Active Organizations A Few Active Funders Local, National Work
Little Recent Activity No/Limited Potential No/Limited Potential Local Work
1Attention: Coverage of health issues in the media and in the peer‐reviewed or gray literature; 2Partners: Availability of actors from various sectors who could partner with RF on
projects; 3Funders: Relative number of funding organizations currently working on health issues for informal workers; 4Maturity: Level of progress of work related to informal workers,
with some types having only locally‐focused programs and others having national or international policies and programs on which to build.

International institutions and national
governments are recognizing informal workers
via standards, policies, and opportunities.
Building sustainability: Develop standards and
guidelines for national‐level programming and
policies that will reduce health vulnerabilities.
Engaging thought leaders: Promote forums for
discussion and development of innovative ways
of meeting informal worker needs.
Innovative financing: Work with governments
and private sector partners to develop and
implement investment mechanisms on health
access for informal workers and families.
Influencing partners: Support new actors and
engage existing health or informal worker
partners in developing new tools and funding.
16
What are the primary opportunities
that could address this problem?
There are multiple intervention points for various actors within each Area of Dynamism.
Organizing Grassroots –
Worker‐level Activity
Applying Large‐scale Insurance
Plans – Population‐level Activity
Acknowledging Informality –
Population‐level Activity
By engaging informal worker organizations,
grassroots organizing efforts have increased
access to health for informal workers.
Governments and private sector actors have
increased their activity in developing health
insurance that is affordable and appropriate.
Building coalitions: Make connections between
workers to identify priorities and develop
solutions that meet worker/family needs.
Building advocacy capacity: Educate workers
on using their voices to advance an agenda.
Developing a platform: Empower and influence
existing networks (e.g., mHealth and K4Health)
to promote health care and share knowledge.
Participating in research: Develop mechanisms
in which data can be collected and analyzed to
compile lessons learned and best practices.
Promoting preventive health care: Find ways to
dispense primary care near home or work.
Building evidence base: Develop ongoing
research protocols and collect data on health
and informal workers (baseline and annually).
Innovative financing: Work with private sector
partners to develop and implement financial
and investment mechanisms that fund health
access for informal workers and their families.
Implementing policies: Develop, support, and
apply affordable/appropriate UHC and health
insurance at national and community levels.
Dispensing grants: Fund NGOs, researchers,
and others to develop innovative approaches.
Fostering the Growing Awareness of Informal Workers –Worker‐level Activity
Greater knowledge and understanding of informal workers and their health vulnerabilities will inform discussions at all levels and bring about
increasing public pressure for meaningful action that will facilitate the development and implementation of new policies and programs.
Branding and marketing: Enhance positive
messages about informal workers to
engender general and government support .
Developing learning forums: Increase
learning and dialogue to generate new ideas
and engage partners at all levels.
Promoting effective communication and
knowledge‐sharing: Increase interaction of
informal workers via mobile technology.
Highlighted initiatives reflect the most dynamic opportunities for further exploration. Dynamism is determined based on size of potential impact on
poor/vulnerable and the opportunity for a donor to be uniquely additive or accelerating.

17
What potential tipping points are emerging?
Positive
Potential
Tipping
Points
(Actions &
events that
could catalyze
large‐scale
positive change)
Negative
Potential
Tipping
Points
(Thresholds
beyond which
there is no
going back)
Too Early
to Tell
(Potential
tipping points
that require
further
monitoring to
define and size)
Description What Would Have to Happen
to Reach This Tipping Point?
Established partnerships at the intersection between health and informal
worker issues provide an opportunity for further action.
• Population‐level – example: UHC underway in Ghana, India, Indonesia,
Kenya, Mali, Nigeria, Philippines, Rwanda, and Vietnam.
• Worker‐level – example: SEWA has provided health access for women
informal workers at clinics and hospitals in several cities in India.
• Population‐level action: Cooperation between public
sector agencies and with private sector and informal
worker input is needed for progress in countries.
• Worker‐level: Small‐scale progress can supplement
large scale efforts or provide interim solutions; trade
unions and other organizations can negotiate terms.
Increased attention to informal workers has raised their visibility,
generating political will to act and attention to specific occupations.
• Population‐level – ex.: Brazil’s World Cup‐related focus on street vendors.
• Worker‐level – example: Gates Foundation work with waste pickers.
• Attention by external actors can generate interest in
informal workers that could attract others to engage.
• Short‐term events/activities could become long‐term
with leadership from public and private sector actors.
The cost of providing health care and health access for the full range of
health issues (both general and work‐related) may derail efforts.
• Health care will have costs for everyone – governments, providers and
users. If costs are too large for any of these three groups, service provision
may fail – balancing everyone’s needs and resources is a key consideration.
• Programs require external funding sources , which
could limit operations and sustainability.
• Workers refuse to commit resources to a program.
• Providers are unable to meet the demand for services
or a to provide care at an affordable rate.
• Health insurance schemes implemented in countries (e.g., India) have not been well‐evaluated; research findings could steer the
next steps. Schemes that include informal workers need to determine whether health improved with improved access.
• Technology and accessing primary and preventive health and safety information. The availability of mobile devices and online
platforms has been effective in primary care programming; informal workers could benefit from the mHealth and K4Health models.
• Policies (e.g., Street Vendor Bill) initiated in the past five years to protect the health and safety of some informal workers have not
been well‐evaluated. Specific health outcomes and broader issues related to implementation of these policies need to be assessed.
• Private sector corporations and funders could catalyze expansion of activities, particularly health insurance options for informal
workers. Corporate involvement via CSR and in providing health insurance options, as in India’s RSBY program, require review.
• Leverage of existing health or economic structures. The Millennium Development Goals (MDGs) provided a framework for progress
on issues including health and poverty. Post‐MDG/post‐2015 framing may be useful, given informal workers’ vulnerabilities.

18
What are emerging issues and future trends that
could influence these opportunities?
Connecting the Economic and Social Agendas Willingness to Build on Prior/Current Efforts
Following the recent global economic downturn, international
organizations and nations realized the importance of balanced
reforms in support of economic growth, social stability, and health
coverage to address common global concern about and interest in
preventing or mitigating the impact of future “economic shocks.”
This led to:
• Promotion of the “social protection floor” agenda by the ILO
and WHO that brings informal workers into the framework.
• Increased openness by International Financial Institutions to
account for fiscal costs of universally extended minimum social
protection to the informal worker population.
• A re‐examination of labor services and links between economic
losses and poor Occupational Health and Safety standards with
the goal of providing insight into potential OHS policy.
Recognized higher profile of and appreciation of informal workers,
which has led to:
• An increased interest in building a strong fiscal revenue base
that invests in people and health, including informal workers.
• An increased understanding of informal employment in the
economy – e.g., the insecurity of informal workers’ ability to
contribute to the economy.
• Recognition of the need for rigorous and systematic global data
collection, and comparisons across countries and employment
status – esp. with regard to informal workers and benefits.
Over the past several years, many countries have implemented
efforts to reach a goal of Universal Health Coverage. With health
initiative implementation, many countries have made progress in
including informal workers in primary care and insurance plans:
• Integration of vertical programs led to progress in Argentina,
Brazil, Chile China, Ethiopia, Ghana, Rwanda, and Thailand.
• Countries in intermediate UHC reform: Ghana, Indonesia,
Philippines, Rwanda, and Vietnam; countries in early UHC
reform: India, Kenya, Mali, and Nigeria.
• Additional experiences with micro‐insurance schemes for health
and market prospects for health insurers and providers, and
targeted health provision for some informal workers.
• National legislation on financial support mechanisms and rights,
advanced by grassroots campaigns and gender‐focused groups.
Increased interaction and communication – e.g., on the
complementary roles of public and private sectors – between
countries, informal workers, and others has increased the
awareness of informal worker needs. Examples include:
• Communications tools (e.g., mobile phones, internet) to house
health information, access service availability, and registration.
• Enhanced impact of media and civil society action to promote
health and informal worker issues , such as organizing.
• Increased availability of technical support on health system
infrastructure from external sources and informal workers.
Recognizing Informal Workers in the Economy
Emergence of Support and Awareness

Population‐level Action: All parties (government, health care and insurance providers, and informal workers) have
limited resources and need to prioritize the services provided to keep costs in check.
• Informal workers tend to be poorer and less financially stable than formal workers. Voluntary systems have been
challenging because informal workers were not willing to contribute if services were inadequate or inconvenient.
• Providers prefer to focus on services that generate more income – e.g., India’s RSBY program reportedly promoted
surgery at the expense of primary care – to cover the health service and administrative costs of the program.
• Implementation may be undermined by systems failures, e.g., improving worker registration and the overall health
care system; governments faced with competing demands may not choose to invest in reaching informal workers.
Worker‐level Action: Informal workers’ have specific concerns – e.g., ability to leave work to access services,
occupation‐related injuries or illnesses, and income insecurity – added to general health issues.
• Informal workers do not usually have the ability to draw attention to their specific needs.
• Differential health needs of informal workers are not understood by other actors developing programs and policies.
19
What are potential risks or uncertainties?
Action on health issues for informal workers may be derailed or diminished if their needs are not considered and if
attention is not paid to the development and implementation processes.
HEALTH INSURANCE
PLANS THAT ARE TOO
COSTLY FOR
GOVERNMENTS,
PROVIDERS, AND/OR
INFORMAL WORKERS
POLICIES OR
PROGRAMS THAT DO
NOT REFLECT
INFORMAL WORKER
NEEDS/VOICES
RESEARCH RESULTS
ON CURRENT
INSURANCE SCHEMES
AND TARGETED
PROGRAMS
INFUSION OF
SUBSTANTIAL
FUNDING OR NEW
ACTORS FOR
SUSTAINABLE ACTION
Uncertainties
In one way or another, research findings will inform future action and lead to policies and programs that are more
effective in meeting the needs and adjusting for the resources of all actors. Rigorous and systematic assessment of
will provide insights into which components work and which do not.
• Population‐level: The insurance schemes implemented by governments have yet to be fully evaluated, which
limits the ability to determine how policies and programs could function more effectively and efficiently.
• Worker‐level: Operations or implementation research is often cut from programs or is not rigorously conducted,
which makes it difficult to determine the generalizability of a program to a different type of informal worker or to
different health issues faced by informal workers and their families.
One of the challenges in this space is the lack of large‐scale, sustained funding and attention – the result has been a
focus on national‐level insurance and smaller efforts for specific types of informal workers. Sustained or committed
action could provide opportunities for informal workers to get ahead, e.g.:
• Population‐level: Families balance multiple needs: health, nutrition, retirement and housing needs, etc.
• Population‐level: Insecurity and disempowerment restrict women in the workplace, particularly with regard to
wages and contract negotiations.
• Worker‐level: Education and skills training are not available to many informal workers.
Risks

20
3) Landscape Assessment
Purpose
The Landscape Assessment aims to identify the key players and opinion leaders in the field, what organizations
are doing innovative work, who provides funding, and the gaps in funding.
Key Findings
• Although there are technically many actors (e.g., various government agencies, NGOs, corporations, etc.)
around informal workers’ health, the funding support in the nexus is shallow and, except for strong support
from the grassroots organizations, commitment to informal workers is not high on many priority lists.
• Activity on informal worker health issues is not currently directed by a particular actor – some work is focused
on population‐level activities that benefit all informal workers, while other activities focus on
worker/occupation‐oriented activities. Most activities are limited in scale, scope and geographic reach.
• Funding levels directed to the health vulnerabilities of informal workers are nearly impossible to discern, as
generally projects are part of a larger portfolio and few programmatic funds support work on health
vulnerabilities. Similarly, national funding specifically directed to extending health insurance to the informal
worker population are subsumed within the overall health budget and thus not readily available.
• A few opinion leaders, particularly WIEGO and SEWA, link grassroots efforts with philanthropic organizations,
health insurance companies, multilateral and bilateral institutions, and local, regional, state and national
governments, with the goal of making “invisible” informal workers more readily apparent to policymakers.
• Differences in occupational health and health vulnerabilities of informal workers vary by workplace, type of
work, sector, and country. These gaps are addressed via a patchwork of policies, activities, and programs.
• Corporations and foundations are supporting, testing, and funding approaches that focus on specific worker
populations and different levels of intervention. This work creates opportunities to learn about what works.

21
The key players and opinion leaders at different levels engage in different types of activities – this is
important when selecting partners or planning engagement.
Key Activities Prominent Actors International National
Informal
Worker‐specific
Sub‐national
Research World Health Organization, International Labour
Organization, World Bank, Institute for the Study of Labor
Technical
Cooperation
World Health Organization, International Labour
Organization, World Bank
Agenda‐setting World Health Organization, International Labour
Organization, G20 Leadership Summit, 2013
Informal Unions
HomeNet Thailand, SEWA (Self Employed Women’s
Association), International Domestic Workers’ Network,
StreetNet International
Grassroots
Organizing
StreetNet International, SEWA (Self Employed Women’s
Association), WIEGO (Women in Informal Employment:
Globalizing and Organizing)
Policy and
Program Research
MoH (various), Abdul Latif Jameel Poverty Action Lab (J‐PAL),
United States Agency for International Development,
Department for International Development (UK), World Bank
Health Insurance
LIC’s extending UHC to informal workers (e.g., Ghana,
Indonesia, Rwanda, Vietnam, Philippines), MFI (e.g.,
ACODEP, BRAC, GRET), private firms (e.g., MicroEnsure, and
Zurich Bolivia Group)
CSR Interventions Mars Incorporated, Lipton, Starbucks Coffee Company,
Unilever
Health and
Technology/Design
Worker’s Unions , The Bill & Melinda Gates Foundation,
The Hershey Company
Who are the key players
and opinion leaders for informal workers?
Very Active
Diverse actors, many
projects: large scale
Active
Several actors, a range
of projects: mixed scale
Some Activity
A few actors and
projects: smaller scale
Little Activity
Some small projects:
small scale
Not Active
No projects identified

Who are the key players and opinion leaders in the
Many players are loosely engaged with informal workers’ health by addressing either health or
informal workers, but the nexus of these issues is largely neglected.
field?
National governments: Fund health systems, UHC activities, and national health insurance schemes. The
level of funding varies by country and some are only beginning to include informal workers.
Bilateral donors: CIDA, SIDA, DFID currently fund areas that related to the target of health vulnerabilities of
informal workers, though these projects may include minimal funding and attention to this specific topic.
22
Multilateral
Organizations
Global Networks,
Trade Unions and
Civil Society Orgs.
Programs: The Social Protection Floor escalates social protection for all, including informal worker health,
and unites the ILO and WHO around a new agenda. The ILO’s Decent Work Agenda addresses the health
and safety of workers and explicitly recognize informal workers; countries develop an action plan. The UN
Food and Agriculture Organization works with rural informal workers and unions on health issues.
Funders of health or informal workers: World Bank, ILO, UN WOMEN, the UK Community Fund
Global Networks: WIEGO, a global action‐research‐policy network seeks to improve the status of the
working poor in the informal economy, especially women. WIEGO’s social protection program focuses in
part on providing reproductive health services and compensation for work‐related accidents and injuries.
Informal Worker Trade Unions and Initiatives: Work on behalf of specific types of informal workers or to
achieve objectives. Examples: IDWN (domestic workers), StreetNet (street vendors), HomeNet (home‐based
workers), SEWA (women), and Worker Rights Consortium. Civil Society: Micro‐finance initiatives
offer loans and health micro‐insurance for health access – e.g., Cashpor, Grameen in Bangladesh, and NRSP
Microfinance Bank in Pakistan; meetings and skills trainings also discuss reproductive and other issues.
Funders and
Opinion Leaders
Foundations and Corporations: Bill & Melinda Gates Foundation, Ford Foundation, Packard Foundation;
Corporations: Mars Inc, Starbucks, Lipton, and Unilever, among others.
Thought/Opinion Leaders: Juan Somavia‐ ILO Director‐General who initiated the Decent Work Agenda;
SEWA Founder, Ela Bhatt who pioneered working women’s unionization in India and extended it globally,
WIEGO ‐ Martha Chen, Francie Lund, Vilma Santana bringing voice and visibility to women in informal work.
Governments and
Bilateral Donors
Population‐level Players
Worker‐level Players
Population‐ and Worker‐level Players

Informal Women Workers
Waste Pickers
Informal Workers
• $274M funds a broad array of programs, with a portion supporting health.
• AusAID and GIZ support work related to the health of informal worker
populations, such as informal workers' social protections, health insurance,
and health interventions, but did not report project‐level amounts.
• The ILO, UN WOMEN, IDRC, USAID, ADB, and IADB work in related areas of
informal sector social protection and occupational health and safety.
23
Who is providing funding in this space?
Funding Landscape: Key Observations – Foundation Support
• In 2008‐2012, four major philanthropic foundations* collectively funded
approximately $38 million (92% from the Gates Foundation) in projects related to
informal workers, of which a small fraction funded health activities.
• Funding is difficult to track because most foundations fund a larger program of
activities and do not map grants to “health vulnerabilities”. Determining the
specific amount for health of informal workers is particularly problematic.
• Z Zurich and Munich Re Foundations support micro‐insurance research, which may
include informal sector health products.
* Ford, Gates, Packard and Rockefeller Foundations
Funding Landscape: Key Observations – Public Sources, Bilateral and Multilateral Agencies
Funder, $M* 2009 $14M+
2010 2011 2012
CIDA 0 14 0 0
DFID 67 27 0 72
SIDA 1 0 1 1
World Bank 8 59 67 200
Total 75 100 68 274
*$ in Millions 2012 USD
$1.07 $0.80 Informal Settlements
$15.64
$20.69
Values in $M
Funding of health systems for informal workers and efforts to extend UHC to informal workers by national
governments is generally not separated from overall health system funding, so it is not readily available.
While funding for informal workers and for health overall may be significant, it seems very
little is currently focused on health vulnerabilities of informal workers.

24
Funders’ Perspectives
Matching funder goals with those of informal workers can yield new approaches to addressing health
issues for informal workers.
• Understanding how health insurance works with an informally employed population means figuring
out how to a) make it work, b) ensure its uptake and usage, and c) make it acceptable.
– The Gates Foundation, World Bank , ILO and DFID are interested in health insurance mechanisms.
– Despite service innovations, reaching informal workers remains a challenge; there is scant evidence of
improved health outcomes and reduced expenditures among those who use health insurance.
• Meeting informal workers in the middle to make progress on common health concerns.
– CSR activities deliver health services to workers where they work, which may reduce costs on all sides.
– Micro‐finance Institutions are packaging health services, insurance and education with loans and
other micro‐finance services.
– Most projects aim to assess vulnerabilities; provide better work, education and health; and
understand ways to extend social protection coverage – all of which require informal worker buy‐in.
• Recognizing the value of convening multiple‐stakeholders when it comes to solving community
problems – enhancing the capacity of informal workers to develop and apply practical skills.
– WIEGO is training market‐women to convene and enlist city officials in helping make public markets
(their workplaces) more sanitary and healthy.
– Participatory health research by the ILO and WHO among groups of informal workers increases
occupational safety and reduces workplace injuries using community self‐help techniques.
• Finding new ways to think about health for informal workers by thinking about how it relates to home
and opportunities for convenient delivery of health care services.
– Mapping informal slums, including the presence/absence of primary health care clinics, and
supporting self‐help initiatives to secure tenure, install toilets, and build houses.
– The National Street Vendor’s Association of India (NASVI), funded through member dues, helped bring
about a national policy recognizing a vendor’s right to livelihood and to occupy urban space.
Worker‐level Activity Population‐level Activity
Promoting Health
Insurance:
Evaluate What
Works and What
Doesn’t
Acknowledging
Informal Workers:
Corporations
Finding Ways to
Work with
Informal Workers
Organizing the
Grassroots:
Building the
Capacity of
Informal Workers
to Address Health
Raising
Awareness:
Bridging the Gap
between Health
and Home

25
What organizations are doing
innovative and/or high‐impact work?
Although we identified many existing interventions in the space, few organizations are doing highly innovative and impactful work
that is directly focused on the health vulnerabilities of informal workers . A sample is included below.
Microinsurance Innovation Facility: The Bill and Melinda Gates foundation partnered with the
ILO in 2007 to launch MiF with a $34 million grant. In its first five years, MiF studied and learned
from microinsurance innovators. It supported 67 grants to develop and test new
microinsurance products, models, and strategies; provided capacity‐building assistance to 57
individuals and organizations; gave academic research grants; helped build South‐South
Communities of Practice. MiF will now begin promoting good microinsurance practice and work
to dramatically expand low‐income market services. It will work to strengthen insurers and
widen the availability of better risk‐management practices.
Construction Worker Health and Safety: Between 2007 ‐2011, DFID funded a £300,000
($450,000) capacity building project among construction workers in Tanzania. Members of the
UK organization Engineers Against Poverty (EAP) led the project alongside Institution of
Engineers Tanzania (IET). A core group of men and women drawn from all the major stakeholder
organizations, including the Occupational Safety and Health Authority (OSHA) and the
Contractors Registration Board (CRB), in construction health and safety was trained.
Construction is a key area because of its high accident risk, and exposure to dust, noise,
vibration or chemicals. This core group then in turn trained their co‐workers and employees.
National Rural Support Program: In 2011, with additional investments from Acumen Fund, KfW,
and the International Finance Corporation, a traditional community‐based MFI in Pakistan was
transformed into a regulated Microfinance Bank. This will enable NRSP to access new sources of
finance and scale‐up its loan activity, which is focused on loans to low‐income clients and small
farmers across Pakistan. NRSP Microfinance Bank currently has more than 120,000 active
clients. The organization expects to reach nearly 625,000 borrowers over the next five years.

Coverage Drivers
centers in large emerging market economies in Asia and Sub‐Saharan Africa. Coverage is also driven by pressures on
governments to address health and safety protections for largely unskilled workers.
• In Southeast Asia, media coverage focused on household domestic workers, which are considered part of the
informal economy. Most are women. They are particularly vulnerable to violence and abuse by their employers, and
often work in fear of losing their jobs and deportation.
Gap Analysis
government services and protection. Media did not focus on the fact that high economic growth rates in many
developing countries are significant drivers of a growing, cheap, often informal work force, and did not highlight the
need for governments to work toward transitioning these workers into the formal economy.
• The problems of domestic workers in Asia received more media attention than other economic sectors where
26
Communications Audit
• Rural to urban migration: Coverage has been driven by increased migration of workers from rural areas to urban
• There was little media discussion of the unique problems of informal workers and their ability to demand greater
informal workers exist – such as urban transit systems, agriculture, construction, and mining.
Volume, Geography and Tone
• Key geographies were: China, India, Indonesia, Thailand, Nigeria, Kenya, and Ghana.
• Total volume over 10 years was approximately 1,500 relevant articles in both English and native language media.
• Social conversation over the past 12 months was modest, and led by journalists, development organizations, and
worker rights NGOs.
• Tone was neutral, with some criticism of the need for governments to adopt policies to better integrate informal
workers into the formal economy.

27
Communications Opportunity
Highlights from Coverage
• The unique problems of informal workers: Informal workers tend to be mobile, undereducated and low‐income
earners. This combination creates unique difficulties for government service providers to ensure provide health
services and worker safety. These populations lack the political clout to effectively advocate for safety and health
protections.
• Domestic workers: Across Southeast Asia, female domestic household helpers (maids) – who are defined as
informal workers – suffer from workplace abuses and insufficient healthcare coverage. They are not considered
“skilled workers,” and are highly susceptible to violence, exploitation, unpaid wages or other forms abuse from
employers.
• Healthcare access: Even though migrant workers may be allowed to access public healthcare facilities, reports
showed that they are at risk because they are hesitant to seek care due to language barriers, perceived or real
discrimination, fear of arrest for not having proper documents, or an inability to pay for healthcare. Consequently,
they often self‐medicate or wait to seek treatment until their illness is at a critical stage.
• Workplace safety: Media coverage highlighted the need to prevent workplace injuries and increase healthcare
coverage for informal workers. There were reports of high rates of injuries (such as hand and arm fractures) in
“black factories” in Guangdong and Shandong provinces in China. These black factories are highly mobile and bosses
can simply pick up and move their operations when injuries occur.
White Space Recommendation
• Media coverage of informal workers received extensive attention in China, India, and across Southeast Asia over the
past decade, where the trend of migrating workers has deeply impacted these emerging economies. However,
coverage in Sub‐Saharan Africa is just beginning, as economies across that region are just now beginning to
experience the impact of informal workers migrating from rural to urban areas.

28
5) Impact Assessment
Purpose
• The Impact Assessment presents an early view of the impact potential in this space, outlining how we
think change could happen based on the dynamism assessment, and using scenarios to illustrate different
impact ranges.
Key Findings
• Early work on potential impact in the space points to several areas that potentially could be catalyzed
given their current degrees of momentum to address the problem:
– Increasing informal worker access to preventative health care
– Making health care less costly for informal workers – reducing out‐of‐pocket costs and lost
income/job,
– Reducing gender disparities – participation of women in discussions and addressing health needs, and
– Building sustainability by improving policies, regulation, and funding mechanisms.
• The illustrative scenarios for impact assume a $100 million investment over 10 years with an impact goal
of: improved employment and working conditions that lead to better health outcomes for workers whose
livelihood depends on informal employment.
• Two potential scenarios for change are profiled, based on their current momentum, potential for
leadership and impact, and ability to address the high‐level outcomes:
– Universal Health Coverage – particularly working with countries with efforts underway,
– Grassroots organizing and partnerships – two examples: working with partners to facilitate the
development of health and social protection measures for informal workers, and an innovative
combination of health care training/provision and data collection.

29
How We Think Change Could Happen
Areas of Dynamism That Could be
Catalyzed Towards High‐level Outcomes
Informal workers are
preventing work injury and
illness by addressing risk,
e.g., street cart design
Trade unions and others are
using local care to reduce
job time lost and promote
occupational health
Community health workers
are providing primary
preventive care
Informal worker groups are
increasing access to health
care facilities
Informal worker groups are
providing support services,
like child care so women
can seek health care
Some government
insurance plans now
include informal workers
Partnerships (e.g., trade
unions, providers, funders)
are offering primary care to
the community
Groups of workers are
providing women‐specific
services
High‐level Outcomes That
Would be Required to
Achieve the Impact Goal
Healthier Workers:
Reduced need by informal workers for
health services
Greater Access to Care:
Improved access to convenient and
quality health care
Lower Costs from Illness:
Decreased income lost related to health
issues and health care seeking
Address Gender Disparities:
Reduced gender differences in access to
health and safety
IMPACT GOAL:
Improved
employment and
working conditions
that lead to better
health outcomes for
workers whose
livelihood depends
on informal
employment.
There are opportunities to provide health services to informal workers through both worker‐specific
level activities and population‐level activities.
Potential
Impact Goal
Improved Policy:
Improved policies and practices to assure
health and safety
International organizations
have started recognizing
informal workers, opening
social protection options
Governments are improving
laws covering informal
worker safety, e.g., street
vendors

30
Illustrative Scenarios for Impact
These scenarios present selected choices around which a potential development strategy could
be designed. They highlight options that focus on either all types of informal workers in a less direct but
more inclusive strategy, or on targeted subsets in a more direct intervention.
Universal Health Coverage has been rolled out in a number of
countries, with varying degrees of implementation and evaluation. A
number of activities at the population‐level could be scaled to reach
informal workers:
Occupation‐related issues could be covered, to address differential
health risks of informal workers. Primary care, such as access for
families and to preventive services (e.g., reproductive, maternal and
child, and general health), could improve the health outcomes of
informal workers and their families. Health care professionals could be
trained to identify and treat the types of conditions experienced by
informal workers. Gender issues, such as access to women’s health
could be addressed at the population‐level.
Potential Activities:
• Registration and enrollment of informal workers – this is
challenging – reluctance to formalize, cannot afford
premiums/fees, etc.
• Make use of mobile and online technologies to reach informal
workers within a country.
• Work with governments and other partners to evaluate current
efforts and then to pilot lessons learned and assess outcomes.
Options include: working with countries in the intermediate stage of
implementation, the early stages or those who have not started.
Organizing informal workers and expanding partnerships with other
actors has been used to bring the health focus work to informal
worker subgroups. A number of activities could be extended to
informal worker groups through increased organizing and partnerships:
Informal workers and their families could receive greater primary care,
particularly reproductive, maternal and child, and general health.
Occupational health risks could be addressed by training informal
workers in workplace health and safety and by increasing the number
of health care providers to identify and treat conditions of informal
work. New technology outreach efforts could increase worker access to
health services, potentially through mHealth or K4Health.
Potential Activities:
• Informal workers in urban or in rural settings may share some health
issues – e.g., access to facilities, environmental exposures –engaging
them where they work may be an option
• Training informal workers to be advocates for health care access.
• Increasing work‐related health care by training primary health care
providers to recognize symptoms, providing services and reporting on
best practices and scale/scope issues on a national level
Options include: working in a very active space (Asia), a moderately
active space (Latin America) or a relatively inactive space (Africa).
Scenario 1:
Population‐level
Scenario 2:
Informal Worker‐level

Affected Populations Possible Solution Spaces Vision of Scale
Indirect benefits to informal workers – informal
workers’ health‐care needs will be better
understood, improving program effectiveness.
Direct benefit to informal workers – increased
enrollment will improve health outcomes.
10‐year goal: survey 5% of informal workers (2
mil.); pilot/eval. new program: enroll up to 5
million; survey 1 million to evaluate program
Indirect benefit to informal workers – thousands
will have greater access to health information
resources.
Direct benefits – new trainers will increase
effectiveness of outreach.
10‐year goal: 15,000‐20,000 advocates trained;
active website reaching more informal workers.
31
Illustrative Scenarios for Impact
Vision of Scale
Population‐level: Universal Health Coverage
This affected population includes all types of
informal workers, urban and rural. The options
focus on registering informal workers and on
identifying what has worked in other countries
further along in the process.
Est. number of informal workers/country:
Work with governments and other partners to
register informal workers, including using
communications technology, in three African
countries that are in the early stages of
implementing UHC programming in their
countries: Kenya, Mali and Nigeria.
Work with governments and other partners to
evaluate mechanisms for applying UHC to
informal workers in an effort to enroll informal
workers in countries that are early in the
process: >90% enrolled – Thailand and Rwanda;
>50% enrolled – Philippines and Ghana; piloting
phase: TBD.
Work with local organizations and global groups
like WIEGO to mobilize rural women informal
workers to advocate for access to quality health
care. Develop training materials, using online
platforms and communications technologies.
Training includes: teaching advocacy methods
and building capacity to train trainers.
Work with local organizations, global groups like
WIEGO, and medical schools to train providers
and to provide treatment for work‐related
vulnerabilities, injuries and illnesses of urban
women informal workers. Develop mechanisms
to enable women to use health services, and
track and share information.
Worker‐level: Grassroots Organizing
This affected population includes subsets of the
total informal worker population ‐ women. For
the first option, Latin American women have
organized more in urban centers, but not as
much in rural settings. The second option
focuses more on urban women, who are
engaged in several occupations.
Est. number of female informal
workers/region:
• Latin American rural women: 10 million.
• Latin American urban women: 20 million.
Indirect benefit to informal workers – easier to
process into health insurance if registered.
Direct benefit to informal workers –able to
convey information on health during registration.
10‐year goal: register 50‐75% of informal
workers (15‐22 million people for all 3 countries).
Indirect benefit to informal workers – increased
capacity of health care system to address
informal worker needs.
Direct benefits – improved program design
increases the quality of care of informal workers.
10‐year goal: establish programs in 8‐10 medical
schools; reach 50% of population (10 million).
• Kenya: 7 million
• Mali: 1.2 million
• Nigeria: 23
million
• Thailand: 9.6 million
• Rwanda: 3 million
• Philippines: 15
million
• Ghana: 9.3 million

33
Appendix Outline
Content in the Appendix Slide
Number Summary of Content
Conceptual Framework 34 • Demonstrates relationship between employment conditions and health
vulnerabilities, with influencing factors included
Preliminary Theory of
Change
35‐36 • Detailed description of activities, inputs, outcomes and overall goal of the Search
as a Preliminary Theory of Change for a Potential Full Initiative in Execution
• Application of TOC to the population‐level and worker‐level
What is not known? 37 • Identification of key areas for additional research
Health Insurance
38‐40 • Describes the distinctions between UHC and micro‐insurance
• Describes the application of social and community health insurance
• Describes the current developments related to UHC in 9 countries
Organizations Doing
Innovative Work
41‐42 • Describes several organizations who are doing work in Asia
Trade Offs around Entry
Points and Momentum
43 • Graphic to assess potential intervention points’ momentum and relevance for
health vulnerabilities or occupational health and safety
Sources for Impact Scenarios 44‐45 • Documentation for developing the population‐ and worker‐level impact scenarios
Profile Summary Slides –
46‐53 • Describes the health problems, dynamism, landscape and impact experienced by
Type of Worker
eight types of informal workers
Profile Summary Slides –
Regions
54‐56 • Describes the health problems, dynamism, landscape and impact experienced in
Asia, Africa and Latin America
Profile Slides – Type of
Worker
57‐89 • More detailed information about the eight types of informal workers (agricultural,
construction, domestic, home‐based, manufacturing, and transportation workers,
and street vendors and waste pickers)
Profile Slides – Regions 90‐103 • More detailed information about the three regions – Africa, Asia, Latin America
Works Cited 104‐129 • References cited in the main slide deck (107‐121) and appendix (122‐132)

Social & Family
Networks
34
Proposed Theoretical Framework
Population‐level Action: Activities and Interventions
Adapted from Benach, Muntaner, Santana, 2007 to show primary relationships
Employment
Conditions
• Formal
• Informal
• Forced
• Unemployed
Working
Conditions
• Exposures
• Risks
• Injuries
• Illnesses
Behaviors,
Physical
Health and
Psychosocial
Factors
Material Deprivation and
Economic Inequalities
Health Systems
Health Coverage
Health
Inequalities
Labor
Market
Policies
• Social
Security
• Regulatory
Support
• Worker
Training
Political Power
Systems
• Governments
• Unions
• Internal
Conflict/War
Welfare
State Policies
• Social
Protection
Economic
Power Systems
• Markets
• Trade
Social, Cultural,
& Education
Power Systems
• Cultural Norms
• Discrimination
• Education
International
Forces
• Globalization
• Global Trade
• Global Health
• International
Regulations
• International
Agreements
• International
Standards
• External
Conflict/War
(migration)
Blue = Systems; Purple = Root Causes, Red = Main Relationship
Worker‐level Action: Activities and Interventions

35
Preliminary Theory of Change for a Potential Full Initiative in Execution
KEY ACTIVITIES OUTPUTS INTERMEDIATE OUTCOMES HIGH LEVEL OUTCOMES IMPACTS
Innovative health care
delivery mechanisms and
services are financed,
developed, tested and scaled
– monitoring and evaluation
components are included.
.
Healthier Workers:
Reduced need by
informal workers for
health services
Less Costly:
Decreased income lost
related to health issues
and health care seeking
IMPACT GOAL:
Improved health,
security, and quality
of life outcomes for
workers – and
families – whose
livelihood depends on
informal
employment.
Quality preventive health care
infrastructure available to informal
workers and their families
Provisions are made for informal
workers to have flexibility in work
day for food, hygiene, etc.
Lower the cost of services or
increase health coverage
Appropriate financial instruments
to compensate for income /job
loss
Decent wages enable informal
workers to afford quality health
care that meets their needs
New research identifies key
health vulnerabilities of
informal workers by
occupation.
Collective action platforms
supported and developed to
inform policy, advocate for
solutions, and redress
conflicts.
Innovative country‐level
policies are evaluated and
tweaked while best practice
is shared widely through
international issue networks.
Participatory action
research to
understand and
identify the causes of
vulnerability and
change levers in
communities of
informal workers
Capacity‐building for
collective action
networks of informal
workers and women
Advocacy and advising
with governments to
address the issue of
informal workers
comprehensively
Coordination between
health and informal
worker communities
to expand services to
informal workers
Development and
implementation of
equitable financing
mechanisms and
market oriented
interventions
Influencing funders,
local and international
NGOs, multilaterals
and government
agencies and
corporate actors to
address social
dimensions of
informal worker
health vulnerabilities
Working with private
sector actors to
develop flexible and
affordable options for
informal workers
Norms related to informal
workers continue to
legitimate their participation
in economic development.
Childcare and other support
services integrate with health care
Improved access to
convenient and quality
health care Competitive health markets to
improve quality, privacy, cultural
acceptability of health care
More field testing of UHC
take‐up enables innovative
program design to meet
informal workers needs.
Informal workers’ disease burden
is reduced to the level of formal
workers
Innovative policies recognize and
protect informal workers’ right to
make a decent living
INPUTS
INTERVENTION
Grants (research,
capacity, demo
projects)
Coalitions –
building
sustainable
partnerships
INNOVATION
New ways of
delivering health
services at work
and at home
New platforms
for knowledge
sharing and
collective action
Harnessing
technological
innovation to
achieve greater
efficiencies
Use new
technologies to
promote health
and health care
opportunities
INFLUENCE
Convening
Engaging and
developing
thought
leadership
Elevating non‐traditional
and
excluded voices
Communications
support among
partners
Branding and
marketing
Reduce the amount of time it takes
to get to and use care facilities by
locating services near work places
and/or near residences
Sustainable Steps:
Improved policies and
practices to assure health
Communities positively engage and safety
informal workers and actively
secure their livelihoods
International agreements
enable international
institutions to generate and
collect commensurable,
publicly available information
on informal workers.
Address Gender
Disparities:
Improve access to care
and promote health
Partnerships between
funders, NGOs, and other
actors develop to address
health and insecurity issues
of informal workers.

36
How do population‐level and worker‐level actions
lead to achieving the high‐level outcomes?
Examples of
Population‐level
Actions
Intervention Output
UHC enrollment field testing
implemented
Plans for financing and scale‐up
developed for health care delivery
mechanisms and services
Path to Outcomes – Illustrative
Improved access to
health care
Improved income security via
less income lost when
seeking/accessing health care
and safety
Country‐level policy best practice
shared via international networks
Health partnerships formed between
funders, NGOs, and other actors
Develop and test national models
Design innovative health programs to
meet the needs of informal workers
Policy on economic insecurity drafted
via changes in health policy
Lower the cost of services or increase
health coverage
Design financial instruments to
compensate for income/job loss
Examples of
Worker‐level
Actions
Key health vulnerabilities identified by
occupation for informal workers Improved access to
Delivery mechanisms implemented to
improve informal worker work‐related
health and access to services
health care
Improved access to care and
promoted health among
Provide a system of flexibility in work
day for food, hygiene, etc.
Locating services near work places
and/or near residences to improve
convenience
Convenience measures added to female informal workers
ensure that health care is appropriate
and accessible
Reduced need by informal
workers for health services
Reduce work‐related disease burden
to the level of formal workers
Ensure cultural acceptability of
health care
Provide quality preventive health
care to informal workers
Delivery mechanisms implemented to
improve informal worker general
health and access to services
Integrate childcare and other
support services with health care

37
What is not known?
The Need for Research
Linking Health and Employment Status Understanding Informal Employment
The relationship between informal economy/informal employment
and health issues (either related to the insecurity and vulnerability of
informal work or due to occupation‐specific health outcomes) are not
heavily studied or reported in the literature.
• Most of the available research is qualitative descriptive case studies
or community‐based surveys that compare informally to formally
hired workers. A more systematic data collection method is
needed.
• There is a need for the development of theoretical frameworks
showing the links and pathways that lead from employment
conditions to poor health outcomes. Explanatory models are
needed for guiding public health interventions and evaluation of
policy intervention.
• The full complexity of employment status – formal/informal,
temporary, self‐employed, multiple jobs, and so on – needs to be
incorporated into health databases to examine the associations
between work and health, and with other aspects of household
structure and functioning and family health issues.
• The differential analysis of health risks and outcomes experienced
by types of informal workers, stratified by geographic region and
gender, is essential to understand the links between informal
worker status and health.
The lack of official statistics related to informal workers, their
occupation‐specific distribution, and the uniqueness of
workplaces provide challenges for policy and programming
efforts, as the scale and scope of the population is not apparent.
• Data and statistical analyses that include the heterogeneity of
occupations, trades, job arrangements, and workplaces are
needed – the lack of these key measures impedes formative and
evaluation research.
• The lack of accepted standard definitions makes comparability
across studies or surveys difficult or impossible.
• Root causes, mechanisms, and multiple factors associated with
informal employment form a complex set of pathways that
require systematic measurement and analysis to determine
which are the most amenable to intervention.
• Employment status data are not always available or lack quality
in large demographic or health‐related databases., neither is a
sophisticated representation of social protection measures
available (or not available) to informal workers.
• The impact of technology, trade, globalization and other large‐scale
economic drivers on the growth of the informal
employment sector is not well understood.

38
Health Insurance
Health insurance offers a way of compensating an individual for the financial loss associated with
health expenditure by pooling the regular small payments of many individuals over time.
Universal Health Coverage Micro Insurance
A goal to ensure that “all people obtain the health services they need
without suffering financial hardship when paying for them” (WHO)
• Countries in intermediate reform: Ghana , Indonesia, Philippines,
Rwanda and Vietnam; Countries in early reform: India, Kenya, Mali and
Nigeria Other countries committed to UHC: Bangladesh, Brazil,
Columbia, China, Georgia, Jordan, Mexico and Thailand.
• UHC Inclusive of Informal Workers? According to the World Bank,
most countries have at least one scheme targeting vulnerable
populations, such as informal sector workers . However, inclusion of
the poor requires government subsidies to cover those unable to pay.
• UHC Schemes are found to “improve access and utilization of services”
may reduce Out of Pocket Expenditure, and show mixed evidence on
health impacts due to few, high quality studies.
Micro‐insurance is a financial protection service designed for low‐income
payers. It includes a wide range of products from crop and life insurance to
Health Microinsurance (HMI).
• Principally used in India: The ILO reports an estimated 40 million are
covered under HMI, principally in India.
• Includes of informal workers? Some HMI schemes specifically target
informal sectors workers as the unit of organization.
• Access to HMI Schemes is found to reduce “out‐of‐pocket health
expenses, especially for catastrophic health events, and improves access
to quality health care for those who are insured,” according to a ILO
report. However, little is known about household and health impacts of
MHI, and participation is voluntary; only those who can pay can benefit.
• Government‐sponsored health insurance.
• Managed at the community level either through a non‐governmental
organization (NGO), a local governmental
unit, or a private firm.
Community‐Based
Health Insurance
• Nationally mandated programs among formal workers
extended to informal sector on a voluntary basis
• Schemes involve some tax financing.
• Premiums well below actuarially fair price.
Social Health
Insurance
Community‐Based (CBHI) and Social Health Insurance (SHI) are the primary
instruments used to insure informal workers’ health in low‐and middle‐income
countries.
SHI and CBHI schemes are used alone or
in combination, depending on country
resources, health infrastructure, targeted
population, government support,
stability, and community organization
(among others).

39
Instruments:
Social and Community Health Insurance
Social Health Insurance Community‐based Health Insurance
Structure • National Health Insurance extended to informal workers.
• Compulsory enrollment.
• Contributions & benefits specified by law.
• Financing: Taxes and contributions.
• Initiated at village, district, or group level.
• Voluntary participation.
• Locally operated with varying levels of government support.
• Financing: Member contribution, some government subsidy.
Pros • Administrative structure may be shared with formal‐sector
Social Insurance.
• Premiums below actuarially fair price.
• Higher willingness to pay and trust due to social contract.
• Stable revenue, partly funded by taxes, and contributions.
• Community control ‐> more transparency, accountability,
services close to home.
• Premiums below actuarially fair price.
• Full scale‐up possible (over time, geography) with government
endorsement, subsidies, administration.
Cons • A reduced benefits package may be offered to informal
sector workers, or restrictions on providers limit quality of
coverage.
• Voluntary participation can lead to adverse selection.
• Small size and limited financial protection.
• Excludes some who cannot pay.
• Small, undiversified risk pools subject to shocks.
What Has
Worked or
Has Mixed
Results
Utilization ‐ does not always increase utilization. Different
utilization rates reported for the same large SHI in China and
Vietnam. Two studies report different results for Mexico.
Utilization may differ by outpatient and inpatient care.
MIXED
• Utilization ‐ does not always increase utilization – different
rates reported for same large SHI in China and Vietnam.
Two studies report different results for Mexico. Utilization
may differ by outpatient and inpatient care.
• Out of Pocket Expenditure ‐ OOP expenditure declined for
the insured in studies done in China, and Mexico; SHI
report more modest results than CBHIs.
Enrollment
• Better user understanding of insurance for higher enrollment.
• Higher levels of education and wealth increase enrollment .
• Trust in the insurer (i.e., an affiliation with a trusted MFI)
increases the chance an informal workers actually enroll in
health insurance.
Utilization – studies report a positive effect of insurance on
utilization more than for extended SHIs.
MIXED
• Out of Pocket Expenditure – CBHI studies reported greater
success, however using less rigorous study methods .
What Did
Not Work
Enrollment – uptake declines with distance to health clinic,
and with less awareness and trust in public programs.
Enrollment – distance to health facility, chronic illness, gender of
household head have no effect on insurance uptake rates.

40
Developing‐Country UHC
Ghana, India, Indonesia, Kenya, Mali, Nigeria the Philippines, Rwanda, and Vietnam have undertaken
national‐level reforms designed to implement UHC. All have developed ways of reaching informal sector
workers on a voluntary basis.
• Providing health insurance to informal sector workers is a particular problem because the conventional infrastructure for
collecting pre‐payments and delivering quality care breaks down with hard‐to‐reach populations.
• Ghana, Indonesia, the Philippines, Rwanda, and Vietnam are at the intermediate‐stage of making reforms, whereas India,
Kenya, Mali and Nigeria are in the early‐stages of reform.
• The percentage of the population enrolled varies widely from a high of 92% in Rwanda, to a low of 3% in Mali and Nigeria.
Country Program Targeted Population
Share of
population
enrolled (2012)
Ghana NHIS Entire population 54%
Indonesia BPJS Entire population 63%
Philippines PhilHealth Entire population 76%
Rwanda Mutuelles, RAMA, MMI Entire population 92%
Vietnam VSS Entire population 42%
India RSBY Individuals below poverty line 8%
Kenya NHIF Formal sector, expanding to informal sector 20%
Mali Mutuelles, RAMED, AMO Entire population 3%
Nigeria NHIS Civil servants expanding to informal sector 3%
Intermediate
Reform Stage
Early Reform
Stage
Source: Lagamarsino et. al. (2012)

What Organizations Are Doing Innovative
and/or High‐Impact Work – Health
41
Not many international organizations specifically work on health issues of informal workers. Local NGOs,
such as SEWA, BRAC, and Grameen, are involved in financing healthcare and making it affordable through
micro‐insurance schemes. While most of the interventions are not directed towards informal workers, they
do have an indirect impact on health affordability of informal workers as well.
Access Health is an international organization that provides research and advisory services to improve access to quality and
affordable health care for the poor in developing economies. They assess success and impact of current interventions in
health financing, health service delivery, and health technology space. Joint Learning Network is an initiative by them to
share and promote learning on universal health coverage across member countries. They have also worked in health
insurance evaluation and assessment of health PPP’s in India.
Micro Insurance Academy is a not‐for‐profit entity in India providing assistance to organizations that focus on micro‐insurance.
They provide research, training and advisory services to organizations implementing insurance schemes for low‐income
communities. Currently they are implementing a micro‐insurance project in India and assessing its impact, to
investigate aspects of successful implementation of the community based health insurance scheme.
Health remains an integral component of BRAC’s development intervention since its inception in 1972. The BRAC has
introduced a micro‐insurance scheme that provides subsidized services such as medical consultation, pathology testing and
medicines for an annual premium. BRAC targets poor and ultra poor in Bangladesh, and charges premium based on the
economic capacity of the individuals.
Best Case Practices:
SEWA is an Indian trade union registered for poor self‐employed women and a pioneer in the movement for organizing and
supporting informal workers. SEWA offers many services like micro‐finance, micro‐insurance, capacity building, etc. to help
informal women workers gain social and health security. One of their high impact interventions has been the insurance
scheme called VimoSEWA or SEWA Insurance, that provides composite package (health, life, assets, maternity) at an annual
premium of less than USD 3. The insurance started in 1992, has enrolled almost 2 million people in the span of twenty years,
with over 50000 claims processed.

What Organizations Are Doing Innovative
and/or High‐Impact Work – Employment
42
Several international organizations and networks aim to organize informal workers, protect their rights
and improve their employability in Asia. While improving health and safety conditions of informal
workers is one of key intervention areas, they do not exclusively focus on it.
Best Case Practices:
StreetNet is an alliance of street vendors formed in 2002, which works towards advocating and implementing social
protection for street vendors in different countries. They introduced the World Class Cities Campaign in India in 2009‐2010
to send out a message to the government about the inclusion of street vendors in the cities and also mobilizing street
vendors in a big way. The campaign was carried out in Delhi, Kolkata, Orissa, Tamil Nadu, and in Karnataka with the help of
NASVI. The campaign impacted street vendors and hawkers to understand their rights and help them affiliate to NASVI.
Governments also responded to the campaign, for example, the Tamil Nadu government started a survey of street vendors
and eventually registering them under Tamil Nadu Petty Shops and Street Vendors Welfare Board.
HomeNet Thailand has been consistently advocating for the better rights and protection of homeworkers in Thailand. The
organization considers social protection as one of the key demands for the home‐based workers. In 2001, they initiated a
pilot social protection scheme in Chiangmai. The homeworkers in the area began their health insurance scheme, with 110
members contributing their own fees. The organization has undertaken research studies to understand the need of social
security of workers. The organization has also worked extensively on Occupational Health and Safety by conducting
workshops and applying decent work conditions prescribed by ILO across work places within Thailand.
LabourNet, based out of Bangalore, India, seeks to provide job placement to workers from informal sectors, especially
construction and service sectors. They also provide services such as training, access to health insurance and bank account
to workers for a nominal membership fee. Currently, they have registered 44,000 workers for their services, provided
accident insurance to 39,000 workers, and health insurance to 1500 workers, provided training to 6300 workers and
registered about 20,000 workers with ConstructionWelfare Board.
Based out of Bangalore, India, Babajob seeks to help bring together informal workers and employers who provide them
with jobs. It is an online platform, with very easy to use features on a simple cellphone. It serves to break information
barriers at the touch of a button on a handset or at the click of a button.

Trade Offs Around Entry Points and Momentum
43
What problem does it address?
Skills
development
How much momentum does it have?
National
Regulation
Improved
primary
health care
system
Global
traded
industries
Organizing
workers
Informal
settlements
Informal
workplaces
Vulnerabilities
related to
informal
employment
Occupational
injury and
exposure
Increased
access to
care
Root cause
research
Evaluation
Informal research
worker
health
surveillance
Universal
Health Care
Micro
insurance
OHS worker
Design training
changes
Size = level of impact: population > community > individual

44
Population‐level Impact Scenario
Initiative/Study Description Impact
Extension of
Social Security
to the Informal
Economy
in Thailand
The Thai Social Security Office and the ILO cooperated to
extend social security to informal workers, through the
modifications of current schemes and the establishment
of new schemes, as appropriate.
Timeframe: 2004 – 2006 prep and planning; 2006 –
present implementation
GOAL: Expand voluntary health coverage to 20 million informal workers,
targeting individuals with 1) lack of official and legal status; 2) limited and
irregular incomes; 3) priority for social security; and 4) no employer.
ACTUAL: 6.9 mil insured persons in Dec 2002 (~11% of population). As of
2006, health insurance coverage was 97.8%. From 2002–05, outpatient
use and hospital admission rates increased annually by 4.3% and 2.2%.
Extension of
National Health
Insurance
Scheme in Ghana
Government of Ghana, with ILO tech. support, replaced
existing health schemes with National Health Insurance
Scheme to provide basic health‐care services via mutual
and private health insurance; to register, license and
regulate insurance; to accredit/monitor providers; and
to establish a National Health Insurance Fund.
Timeframe: Passed in 2003; Operational in Nov 2004
GOAL: aims to incorporate 50–60 per cent of the residents into NHIS in the
next five–ten years (from 2007)
ACTUAL: 47% of nat’l pop (10.3 of 22mil) registered as of June 2007. 20%
of those registered work in the informal sector (2 mil of 9 mil estimated
informal workers). By 2009, premium contributors = 4,132,783, or 29% of
total membership and about half of Ghana’s estimated informal sector
workforce. By 2012, 2012: 54% of national population is registered.
Enrolling
informal
workers: KaSAPI
PhilHealth
In 2005, Philippines PhilHealth launched KaSAPI initiative
to boost and sustain enrolment of informal workers, via
strategic partnerships with cooperatives, NGOs and rural
banks, many of which serve informal workers. Good
partnership between government and private sectors.
Timeframe: Launched in 2005, implementation ongoing
GOAL: Universal coverage, particularly targeting informal workers and
individuals in the 20‐60% income bracket (lower to lower‐middle)
ACTUAL: In 2004 42% of families had 1+ member with a Philheath card;
for the poorest 30% of families, it was only 28%. By 2006, had reached
79%, mostly those in formal employment. Coverage of 15.5 million
informal workers (45%). In 2009 there are 28,000 KaSAPI members.
Extension of
National Health
Coverage:
Rwanda
Muetelles
In 2010, the Rwanda Social Security Board set a coverage
goal of >70% of working population by 2015. Extending
coverage to informal sector via joint partnerships with
informal sector institutions, designing benefit packages
for informal sector, simplifying admin. procedures to
reduce compliance costs, and strengthening services.
Timeframe: Started in 2010, ongoing
GOAL: 1) extend coverage to >70% of workers by 2015; 2) increase overall
coverage from 7‐70% in 2015 via in informal workers; 3) ensure 95%
adhesion of all workers in organized groups in the informal sector by 2015.
ACTUAL: In 2009, 7% of >4 million workers were covered; >93%, mainly
informal sector, were not covered. By 2011, >200 cooperatives and
associations formed via informal sector mobilization. In one year, informal
sector coverage from 7% to 18%. National enrollment = 92% in 2012.
Registration of
workers:
LabourNet
LabourNet has nonprofit and for‐profit sections. Within
the Informal sector, LabourNet activities focus on the
construction and maintenance sectors: 1) link informal
sector workers with clients who need skilled workers; 2)
register migrant informal sector workers; 3) provide
workers access to services (accident insurance, bank
accounts, healthcare services, etc.)
Timeframe: Started in 2005, ongoing
GOAL: Reach out to 1 million workers by 2012 and open 36 worker
facilitation centers, extending operations to a new city in next four years.
ACTUAL: LabourNet has registered over 36,000 workers, including over
18,000 covered under accident insurance; opened 12,000 PNB bank
accounts, prepared 9 trade videos for training workers who normally are
averse to training, provided job information to 6,000 workers and directly
facilitated jobs for 3,000 workers. Suggesting sustainability and scalability,
LabourNet expanded from its pilot in Bangalore to Haryana government.

45
Worker‐level Impact Scenarios
Initiative/Study Description Impact
A participatory
approach to
health promotion
for informal
sector workers in
Thailand
Participatory Action Research with workers in four
local occupations in different regions. Qualitative
and quantitative data was collected from
questionnaires, industrial hygiene instruments,
group discussions. Results: participatory approach is
an effective tool for promoting informal sector
health safety.
GOAL: promote occupational health in the informal sector in Thailand by
using a participatory approach.
ACTUAL: Working conditions of the informal sector met necessary
standards after completing the participatory process. Also, the post‐test
average scores on 1) the occupational health and safety knowledge,
attitudes and behaviors measures and 2) the work practice improvement
measures were significantly higher than the pre‐test average scores.
Networking
Grassroots Efforts
to Improve Safety
and Health in
Informal Economy
Workplaces in Asia
From participatory training to improve safety and
health in Asia, ILO strengthened partnership efforts
with local people to improve safety and health of
informal workplaces via action‐oriented training
workshops in which workers and employers identify
priority safety and health actions.
Timeframe: 2005
ACTUAL: Workers and owners in the target informal economy workplaces
wanted to improve safety and health and needed support. They identified
safety and health priorities. Follow‐ups confirmed that many actions were
taken using low‐cost available materials. In Cambodia pilot, 414 home
workers trained in the first year. In Thailand, the training program spread
nationwide through the home workers’ networks. In Mongolia, trade union
members from different provinces trained as trainers.
Experience
Sharing &
Advocacy
Workshop
Workshop to share experiences of five organizations
implementing gender‐responsive policies and work
practices; train organizations in advocacy. Field
workers and management staff from each org. were
trained; >200 from local gov’t, employers, civil
society, academia and home‐based workers present.
Timeframe: January 2011, 2‐day training
GOAL: Train all labor market stakeholders including Government, Workers,
Employers, Media, and political leadership of Sialkot regarding the
significance of HBWs’ work and advocating for their due rights.
ACTUAL: Over 200 trained, including 10 partner staff, over 50 HBWs, more
than 20 from local government, and over 30 from media and academia.
Extending OHS
through primary
care in Thailand
With financial and tech. assistance from ILO, MoPH
trained PCU staff in basic OSH. PCUs target informal
workplaces and visit 1‐2X/mo. for: risk assessment ,
workplace improvement; work‐related and chronic
disease monitoring & educ.; provide safety equip.
Timeframe: 2004‐2005 pilot; Feb‐Nov 2007 model
expanded to informal workers economy at 8 PCUs
GOAL: Establish a national model to extend OHS services to all workers,
including informal workers, through primary care.
ACTUAL: Pilot project completed as planned. PCU staff experienced in OSH
services and promoting services. Pilot reached informal workers. A
workshop moved forward estab. a nationwide model for basic occupational
health services at PCUs in other provinces. Health volunteers have been
trained to work as service providers for primary health care in communities
SOLVE: Integrating
Health Promotion
into Workplace
OSH Policies
SOLVE : interactive educational program based on a
training of trainers method to develop policy and
action on workplace health promotion. Focus: policy
tools for workers and employers; preventive
programs, plans of action.
Timeframe: Implemented for the past ten years
GOAL: Focus on preventing psychosocial risks and promoting health and
wellbeing at work via policy design and action. Audience: managers,
supervisors, workers, occupational physicians and safety engineers with
interest in preventive programs. A secondary audience is policy‐makers and
government officials, workers' and employers' organizations with a direct
interest in this area.

46
Appendix Profile: Agriculture Workers
705 million
44% women
64 million
17% women
~1 billion informal workers globally
Largest Sector by Far, Moderate Participation of Women
Health Issues – Common and Potentially Severe
• High occupational hazards – Agriculture is one of the three most dangerous
occupations; according to the ILO at least 170,000 agricultural workers die every
year as a result of workplace accidents.
• Pesticide exposure – Affects 40,000 annually. Though developing countries
consume about 20% of the global production of pesticides, they experience about
70% of the total number of acute poisonings (1.1 million cases annually). Pesticide
poisonings disproportionately affect women due to their higher levels of body fat
(where pesticides accumulate) and have been documented to produce birth/
reproductive defects.
• Malnutrition, anemia, and maternal mortality rates are higher for plantation
workers in studies in South Asia.
• High levels of intestinal problems and sickness from a lack of clean drinking water
and unsanitary toilets.
• The spread of infectious diseases, such as TB, cholera, and STDs is linked to the
seasonal migration or workers.
• Agricultural workers are disproportionately poor; few can afford healthcare and
most have very small contributory capacity for insurance. Employers have little
incentive to supply health insurance to workers that only stay with them for a few
months out of the year.
63 million
47% women
Size: Nearly three quarters of the roughly 1.3 billion agricultural workers are informal,
making it by far the largest sector of informal workers. 75% of the world’s absolutely
poor (living on less than $1 per day) depend primarily on agriculture for their
livelihoods; agricultural workers, especially informal ones are among the occupational
groups with the highest incidence of poverty.
Gender: Participation of women varies. It is higher in areas with high rural to urban
migration of men. Women tend to be concentrated in the most informal and insecure
jobs within the agricultural sector. Female agricultural workers are particularly
vulnerable to insecure employment, long working hours, lack of health protections, and
being targets of sexual harassment by supervisors responsible for renewing contracts.
Geography: The majority are in Asia.
Attention and Momentum – Low to Moderate
• In the 2000s, countries began to recognize the need for extending labor
protections to seasonal and temporary agricultural workers. However,
national legislation is difficult to enforce due to administrative and labor
inspection deficiencies. Much existing legislation is outdated and relatively
ineffective.
• Some large international companies carry out voluntary initiatives to
improve health within the agricultural communities they work with. This is
a growing sector as new partnerships among actors within global value
chains (suppliers, agricultural enterprises, their employees/ unions, NGOs,
and governments) emerge.
• Global standards and monitoring systems (ETI Labor Standards, GLOBAL
GAP, SA8000) mostly target commercial farms. Some standards
incorporate worker health, safety, and welfare as an objective. Employers
are incentivized since compliance is increasingly important for accessing
export markets. Based on the ILO’s (2001) Safety and Health in
Agriculture Convention, the first international standards to guide
practices in agricultural workers’ health. Such codes have led to
improvements in safety training, sanitation, protective equipment, and
working hours.

47
Appendix Profile: Construction Workers
53 million
14% women
12 million
3% women
>66 million workers globally
Data from ILO/WIEGO database, 32 countries reporting (Asia=8; Africa=8; Latin America=16)
Moderate Size, Low Participation of Women
Health Issues – Common and Potentially Severe
• High incidence of injuries from accidents is the most common health risk,
resulting from unsafe work sites, and lack of appropriate protective equipment and
training. An estimated ¾ to all of informal construction workers are exposed to
occupational hazards. Accidents are so common that they are considered an
inevitable part of the work. WIEGO estimates 16‐18% of workers are injured in
south Asia each year. Workers bear responsibility for their health in the aftermath
of accidents.
• Chemical exposures are common and can cause metal poisoning, damage to the
central nervous system and liver, dermal and respiratory allergies, cancers and
reproductive disorders.
• Asbestos exposure is a serious risk and can cause cancer.
• Musculoskeletal injuries and disorders, including back injuries from carrying heavy
loads, and joint pain.
• Respiratory disease from inhaling dust.
• Poor living conditions for the many workers who also live on site include
overcrowding, poor sanitation, high prevalence of disease vectors such as rats and
mosquitoes, and continued exposure to construction dust, leading to water‐borne
disease, dengue fever, and respiratory problems.
1 million
3% women
Size: At least 66 million globally according to the ILO/WIEGO database, with some
estimates as many as double that. Both the number of informal construction workers
and the proportion of informality in the construction sector have increased over the
past 30 years.
Gender: Mostly men: 97% in Africa and Latin America and 86% in Asia (ILO/WIEGO
database). Some estimates have female engagement in India as high as 30% or 50% of
the informal construction laborforce. Women work at the lowest levels and do the most
unskilled work. There is widespread pay discrimination and some women are not paid
directly, instead working as part of a family unit.
Geography: The majority are in south Asia. Three quarters of the global construction
workforce is in developing countries, despite the fact that only one quarter of the
construction output resides there.
Attention and Momentum – Low to Moderate
Limited activities focus around OSH training, improved regulation, and
micro insurance.
• ILO’s on Work Improvement in Small Construction Sites produces training
materials and example photo books focused on decreasing workplace
hazards and reducing occupational injury and exposure.
• In Mongolia, trade union members provide OSH training using action
checklists and good example photos. Workers and managers collaborate
to develop practical improvement proposals.
• The Construction Industry Development Board in Malaysia is pioneering a
scheme requiring every construction worker to undergo a one‐day safety
and health course to obtain a “green card”, without which they cannot
enter work sites; contractors failing to send workers to training will be
blacklisted.
• There are a variety of micro insurance initiatives, including: the
Association of Construction and Informal Workers in the Philippines;
SEWA in India, working on accident insurance for female construction
workers; CUPPEC in Kathmandu; UMASIDA mutual health insurance
scheme for informal workers in Tanzania.

48
Appendix Profile: Domestic Workers
22 million
81% women
20 million
92% women
53 million workers globally
Moderate Size, Mostly Women
Health Issues – Moderate, with Risk of Severe Abuse
• Physical, sexual, and psychological abuse–WHO reports victims of sexual violence
are more likely to suffer from depression, eating disorders, STDs, and other
gynecological problems. Research in the UK found 18% of DWs have experienced
physical abuse, over 50% psychological abuse, and 3% sexual abuse. A study in
Thailand among DWsfrom Myanmar found 14% experienced unwanted physical
contact from an employer; for 1% this culminated in rape.
• Increased risk for asthma, chronic bronchitis, and other respiratory problems
associated with the regular use of toxic cleaning agents.
• Injuries due to heavy lifting.
• DWs have an annual incidence of non‐fatal work injuries of 7.3% compared to 5%
for the working population in general.
• Poor living conditions including inadequate sleeping arrangements and lack of
food.
• Working hours are long and unpredictable. Findings from occupational health
studies show that the long working hours, night working, & patterns of irregular
shifts have the greatest negative effect on workers’ health.
5 million
73% women
Size: According to ILO estimates, at least 53 million, totaling 3.6% of waged employment
worldwide. Much of the domestic work sector is informal and has grown rapidly over
the past 15 years, increasing by more than 19 million since 1995. The increasing
demand for domestic work is expected to continue as developing countries get richer
and more women work outside of the home.
Gender: Women account for 83% of domestic workers and outnumber men in every
region of the world. Globally, 7.5% of all female wage earners are domestic workers. In
2008, ILO reported that 37% of all female migrant workers were employed by
households. The ILO estimates an additional 15.5 million children are domestic workers
globally and more girls under 16 work domestically than any other kind of child labor.
Geography: Latin America and the Caribbean: 8% of total employment and 17% of
female employment; Asia/Pacific: 1% of total employment and 23% of female
employment; Africa: 1% of total employment and 23% of female employment.
Attention and Momentum –Moderate
No longer invisible and with policies on the books, domestic workers are
garnering attention and increasing levels of protection.
ILO’s 2011 Convention Concerning Decent Work For Domestic Workers
establishes global DW rights consistent with other workers. 4 countries have
ratified and many others are in the process of revising national legislation to
conform.
Bilateral contracts between migrant DW sending and receiving countries
are an emerging trend in the Middle East and Asia, and help regulate legal
protections of migrant DWs. However, enforcement mechanisms and
penalties are often weak.
Flexible Visas for Migrant Domestic Workers reduce the risk of DWs staying
in an abusive environment, however length of stay is often limited to prevent
permanent immigration.
In Vietnam and Uruguay, Regulation of third‐party recruitment agencies and
employers gives the gov’t the right to investigate working conditions of any
private household which employs a DW.
Some countries receiving large amounts of migrant DWs have established
protections for victims of domestic violence, such as shelters for abused
DWs in the Philippines.

49
Appendix Profile: Home‐based Workers
89‐177 mil
80% women
20‐41 mil
>50% women
170‐330 million workers globally
Second Largest Sector, High Participation of Women
Health Issues – Not as Severe, but Very Common
• Health problems from poor working conditions and postures, including: eye strain
and eyesight problems from low light and concentrating long hours on fine work;
joint, shoulder, and back pain from poor work posture, long sitting, cramped work
spaces, and continual bending; cough and bronchial problems from inhaling dusts
and poor ventilation
• Reproductive health problems including ovary related problems, abdominal pain
and miscarriage from working paddle driven machines, disturbance of fetal
position during pregnancy from excessive sitting (sometimes leading to need for C‐section),
lack of antenatal care.
• Exposure to workplace hazards due to lack of protective equipment and
workplace regulations, including: electric shocks, chemical exposure, dust and fiber
inhalation. Use of toxic materials exposes other members of the household even if
they are not involved in production.
• Limited time or money available for seeking health care due to long hours and
little pay, in addition to no health benefits from employer and no access to health
care initiates that are employer centered. Low price per piece also means that
other family members, particularly children, are often engaged to increase piece
production – thus exposing them to the occupational hazards as well.
17‐34 mil
~50% women
Size: Available statistics for developing countries suggest that over 10 per cent of non‐farm
workers in most countries and as high as 20‐25 per cent in some countries are
home‐based. Combined with data from the World Bank and ILO/WIEGO databases, this
yields an estimate of 170‐330 million workers, which is consistent with Mehrotta and
Biggeri’s estimate of 250 million.
Gender: The majority are women, often because homework allows them to combine
work with responsibilities of caring for children and the home, and don’t require women
to leave the home in areas where women’s mobility is restricted.
Geography: More than half of the total are in South Asia. Those in Asia and Latin
America are more often piece‐rate homeworkers, whereas in Africa they are more often
self‐employed in microenterprises.
Though dispersed and hidden, and therefore potentially difficult to organize
or serve, there has been notable momentum around home‐based workers.
• International standards like the 1996 ILO Convention on Home Work
have helped define the vulnerable parties and their needs.
• Worker organizing has been very active, led by groups like WIEGO, SEWA
in India, and HomeNet in South and Southeast Asia.
• National support mechanisms include India’s Worker Welfare Funds and
Bolivia’s program providing child and health services.
• OSH training initiatives seek to improve home work conditions, by
training workers, as in ILO’s Work Improvement for Safe Home program,
and providers, in Thailand’s Safe Work Program.
• Health worker outreach such as Save the Children’s partnership with the
Philippine MoH to train community health workers to collect data on and
provide OSH training to home‐based workers.
• Extension of health insurance protection, to include homeworkers in
national health insurance, as with the Philippines KaSAPI PhilHealth, or to
extend microinsurance to homeworkers, as with Grameen Bank and BRAC
in Bangladesh and HomeNet in Thailand.

50
Appendix Profile: Manufacturing Workers
63 million
30% women
13 million
50% women
One of the Largest Sectors, High Participation of Women
Health Issues –Moderate with Risk of Severe Accidents
• Exposure to high levels of dust, noise, and repetitive, stressful use of hands and
feet in textile factories often results in lung disease, hearing loss, and repetitive
strain injuries.
• Food manufacturing is associated with many repetitive strain injuries, a high
accident rate, and exposure to biological hazards.
• Carpal tunnel syndrome and hand and wrist tendonitis is common in factory
workers.
• Chemical exposure is common, specifically with goods like metal and plastics and
in the case of some dyes.
• A high proportion of homeworkers suffer health impacts of their work. Shoulder
pain and backache are the most commonly reported. Few homeworkers seek
treatment. Poor work environments are common. Family members are also
subject to occupational exposures.
• Incense making results in injury to the skin and eyes, and inhalation of toxins
which cause lung irritation and can lead to asthma.
• Poor factory conditions and employer practices can directly endanger workers’
health, as in the case of building collapses and factory fires.
2 million
22% women
Size: At least 80 million globally, though homeworkers are likely undercounted. The
number has grown over the past thirty years, as manufacturing boomed first in east
Asia, then southeast, then south Asia and Latin America, leading to increases in
manufacturing workers overall, and an increasing proportion of informal workers.
Gender: Women play a significant role in manufacturing; they make up more than a
third of manufacturing labor in some countries, and almost one‐half in some Asian
countries. Food processing and garment industry workers are predominantly women, as
well as most homeworkers.
Geography: Subcontracting, and thus informal manufacturing workers, is more
prevalent in middle income countries, such as east Asia and Latin America, but in lower
income countries, as in south Asia and sub Saharan Africa, it is becoming a more
common aspect of the domestic manufacturing market.
Attention and Momentum –Moderate to high
• Ethical Trade Initiatives and Corporate Social Responsibility – Some
apparel retailers and international food producers have voluntarily
adopted codes regarding ethical work practices and worker protections
that improve conditions for the workers in their supply chain, and can also
have a positive effect on business.
• Workplace training – ILO’s Work Improvement for Small Enterprises
program and Work Improvement for Safe Home program demonstrate
good work practices, help workers check available local solutions, and
plan and implement actions which will be useful for improving working
conditions and productivity.
• Regulation – ILO’s Better Factories Cambodia emphasizes the importance
of increased oversight and onsite inspection as important aspects of
factory safety.
• Social Protection – UMASIDA is an umbrella health insurance organization
for the informal economy in Dar es Salaam. The government of India
established Worker Welfare Funds for several categories of informal
workers, providing a variety of social protections, including access to
health facilities.

51
Appendix Profile: Street Vendors
27‐71 million
6‐16 million
50‐130 million workers globally
Size and Gender Participation Unclear, both Likely Moderate
Health Issues – Not as Severe, but Very Common
• Lack of proper sanitation infrastructure such as running water, toilets, and solid
waste removal systems.
• Accidents: Street vendors are exposed to market fires and, when occupying
roadsides, to traffic incidents, pollution and exposure to the elements.
• Pulmonary problems (bronchitis, asthma) from constant exposure to dust and
pollution. 30% of Indian venders have chronic respiratory problems.
• Eye‐related problems and blurry vision caused by dust and pollution.
• Strains and joint pains from inappropriate work posture and heavy lifting. 25% of
Indian street workers suffer from backache.
• Stress‐related diseases including migraine, hyper acidity, hyper tension and high
blood pressure.
• Stomach and liver problems including food poisoning from ingestion of food
prepared in areas with poor sanitation. 38% of Indian street vendors have stomach
problems and about 24% have liver problems.
• Malaria, transmitted by mosquitoes in stacked sacks of rubbish, blocked gutters
and stagnant puddles.
• Dehydration from continued exposure to sun and heat.
• Chronic headaches from car fumes, dust, and heat.
5‐14 million
Size: Estimates of street vendors vary widely. Some name street vendors as one of the
largest non‐ag sub‐groups of the informal workforce. The ILO reported the group as 2‐
9% of total nonagricultural labor in developing countries, and Jacques Charmes as 3‐8%.
Only a handful of countries have reported any actual counts for this sector. Statistics
likely undercount the number of street vendors as it is usually a secondary, seasonal,
temporary, or part‐time income‐generating activity and tends not to be reported in
labor force surveys.
Gender: Women represent 30%‐90% of street vendors, except in countries restricting
women’s mobility (e.g. India, Tunisia).
Geography: There is little country or regional level data.
Attention and Momentum –Moderate to High
• There has been increasing attention on street vendors recently, but little
of it is focused specifically on health outcomes or interventions targeting
their health.
• National and international initiatives are geared towards formulation of
policies allowing informal street vendors to access formalization in a more
inclusive way as street vending is illegal in most countries and perceived
as a nuisance.
• Street vendors associations are being developed at international, regional
and national levels in order to raise awareness, strengthen the voice and
bargaining capacity of informal workers, implement street vendor friendly
urban policies, and promote solidarity between organizations of street
vendors and hawkers.
• Though there is increasing awareness of the need to address urban
spaces, this focuses more around rights to safe living and working places,
and sanitation more broadly, rather than health in particular.

52
Appendix Profile: Transportation Workers
27 million
4% women
8 million
8% women
One of the Smaller Sectors, Low Participation of Women
Health Issues –Moderate with Risk of Severe Accidents
Transportation workers include not only drivers and conductors, but also supportive
workers, such as mechanics, fuel venders, porters, warehouse workers, cleaners,
guards, queue marshals, food venders, and touts, as well as fisheries workers in some
definitions. As a result, health impacts vary greatly. There is significantly more
information available about road transport workers than any other group, and much
of the following applies to them.
• Weak lungs, coughs, colds, rhinitis, headaches, and cancer, from inhalation of
pollution including carbon monoxide, sulfur oxide, volatile organic compounds,
toluene, and fine airborne particles.
• Back aches, overall muscle aches and pains, and sprains from lifting too heavy
objects, managing freight without appropriate equipment, and long exposure to
whole‐body vibration.
• Serious injury and death from traffic collisions, due in part to poor maintenance of
vehicles and roads; crowding of vehicles with passengers and freight; and lack of
adherence to safety regulations.
• Lack of protection from the elements including rain, sun, extreme temperatures.
• Fatigue and sleep deprivation from long and irregular hours and overnight work,
contributing to accident risk and exacerbating other health problems.
• HIV/AIDS exposure common among long distance truckers in Africa and parts of
Asia.
• Drug use common among overnight and long distance drivers.
• Hearing damage from prolonged loud noise exposure.
2 million
3% women
Size: : 37 million in the 32 countries included in the ILO/WIEGO database. Grew
substantially over the past two decades; likely to continue growing.
Gender: : The vast majority are men, though there is slightly higher female participation
in Latin America.
Geography: The majority are in Asia, with the largest groups in India, Pakistan, and the
Philippines.
Attention and Momentum – Low
Although some organizing has been done in this sector, little of it has focused
on health issues.
• A number of trade unions and worker associations have formed for
informal workers, or allowed informal workers to join. Though their
primary purpose is often to maintain or raise levels of income for their
members, a number have established basic social protection schemes,
such as micro insurance or mutual aid health schemes, as well as
campaigning for inclusion in state‐administered social protection
programs.
• There is an important role for national and local governments.
Government policy can increase transport worker income by reducing fuel
prices; raising fares; reducing taxes, duties, permit and registration fees;
and curbing extortion and harassment. Government regulations can
increase worker safety, by paying incentives to scrap older, unsafe
vehicles, banning leaded fuel, and passing laws requiring use of helmets
and other appropriate safety equipment. When regulations do already
exist, enforcement of the law is often weak.

53
Appendix Profile: Waste Pickers
13 million
3 million
20 million workers globally
One of Smallest Sectors, Women’s Participation Unclear
Size: 20 million informal waste pickers (about 1% of the urban population in developing
countries) is involved in informal scavenging.
Gender: Little information is available on gender repartition.
Geography: There is little country or regional level data.
Health Issues – Significant
• Accidents and injuries happen 10x more often for solid waste workers than for
the baseline population and as a result, solid waste workers have a up to 30%
higher mortality risk. The risks are greater for waste pickers working at open
dumps and landfills compared to street waste pickers. They are caused by dog
bites, moving trucks and exposure to toxic fumes.
• Informal waste pickers are faced with greater dangers than formal waste pickers
because their living and working environments often overlap: they live in informal
settlements, on the streets or at and on the landfill sites.
• Waste related safety hazards ‐ Waste is an ideal habitat for disease vectors (flies,
insects, rats) and can be contaminated by fecal bacteria or animal carcasses. Toxic
materials in waste expose pickers to high concentrations of pollutants. Sharp
objects (needles, nails, knives, broken glass) cause cuts during collection and
sorting. Exacerbated by a lack of safety equipment.
• Pulmonary problems (bronchitis, asthma) are 1.4‐ to‐2.6‐times more frequent for
solid waste workers than for the baseline population.
• Lacerations can lead to infections, such as tetanus, hepatitis or HIV.
• Strains and joint pains are twice as frequent for solid waste workers than for
baseline population.
• Dizziness, headaches and nausea, from exposure to emissions of methane, carbon
dioxide & monoxide.
• Risk of infections and parasites are 3 to 6 times higher for solid waste workers
than for the baseline population.
• Stomach problems such as acute diarrhea (linked to consumption of or contact
with waste foods) happens 10x more often for solid waste workers than for the
4 million
Attention and Momentum – High
Waste pickers have received increased attention recently. Much of this
attention has been focused in a few key areas:
• Raising group awareness .
• Legalizing and including informal waste pickers within the formal system
(e.g. India and Brazil).
• Suggestions from researchers to improve health conditions.
• Medical insurance initiatives, as in Pune, India, and the Philippines.
• Provision of safety equipment.
• Design of improved collection tools including carts.
International initiatives – IWPAR Project (Project for Informal Waste Pickers
And Recyclers organized by Enda) aims to promote the protection and
inclusion of popular collectors and recyclers of waste in Colombia, Ethiopia,
Madagascar and Vietnam and will last from 2011 to 2013.
National and regional initiatives include raising awareness for legal
recognition and integration of informal waste pickers.

54
Appendix Profile: Africa
Smallest of the Three Regions
Population: As many as 152 million informal workers (R4D calculation).
ILO/WIEGO reports 32 million informal workers in 8 countries. Estimates
place the share of non non‐agricultural employment in sub‐Saharan
Africa that is informal at 72‐80%.
Gender: About half of informal workers in sub‐Saharan Africa are
women. In the region 84% of women non‐agricultural workers are
informally employed compared to 63% of male non‐agricultural
workers, according to the International Poverty Centre in 2008. Most
women in the informal economy in Africa are either self‐employed or
unpaid workers in family enterprises, mostly working as own‐account
traders and producers or casual and subcontracted workers. Women are
under‐represented in high income activities and over‐represented in
low income activities such as subcontracted work.
Sector: Agriculture is the largest sector. Africa has less export
manufacturing than Asia and Latin America, though there are export
processing zones and domestic manufacturing is increasing. There are a
significant number of home‐based workers in Africa, who are generally
own account workers rather than piece rate workers.
Sectors of informal work
• Sub‐Saharan Africa has 11% of the world's population and 24% of the global disease
burden, but holds only 3% of the world's health workers.
• Few countries in sub‐Saharan Africa have free comprehensive health care services
available to citizens. In some places, state‐funded health care has completely
disappeared. In those that offer a limited service, there has been a steady
movement back towards a ‘user pays’ principle.
• In most low‐income developing countries, such as Tanzania, not more than 5‐15% of
the working population and their dependents are covered by statutory social
insurance, mainly for pensions and health.
• World Bank estimates the risk of fatal and non‐fatal occupational injury in the Sub‐
Saharan Africa economic region at five times higher than in Europe and North
America (non‐fatal: 160/1,000 workers; fatal: 21/100,000 workers).
# of workers
(R4D estimate)
# of workers
(WIEGO, from
8 countries)
% of
informal
work % women
Agriculture (not including
small scale farmers) 63 mil 13 mil 41% 47%
Home‐based workers 17‐34 mil ‐‐ 11%‐22% ~50%
Street Vendors 5‐14 mil ‐‐ 3%‐9% unknown
Domestic workers 5 mil ‐‐ 3% 73%
Waste Pickers 3 mil ‐‐ 2% unknown
Transportation 2 mil
16% of
WIEGO data 3%
Manufacturing 2 mil
15% of
WIEGO data 22%
Construction 1 mil
7% of
WIEGO data 3%
Health Issues
Attention and Momentum – Low
• The African experience has shown that, rather than create new
organizations, greater emphasis should be placed on respecting,
strengthening and developing organizations to which individuals have
freely decided to belong.
• The most successful programs in Africa have occurred when private
organizations use, adapt and take ownership of the methodology.
• Though there is not as much worker organizing as Asia, the WIEGO
database lists at least 190 informal economy associations in Africa,
including Member Based Organizations of the Poor (MBOPSs), Community
Based Organizations, cooperative, NGOs, and Trade Unions. A number of
these provide some form of micro health insurance, or advocate for
informal worker access to other health services.

55
Appendix Profile: Asia
Largest of the Three Regions
Population: Estimated 1.25 billion informal workers (70% of 1.8 billion
global informal workers), per World Bank with ILO/WIEGO. Asia has a
number of high population countries with high proportions of informal
labor, most notably India. Informal labor is differently categorized in
China, so estimates are likely low.
Gender: Women comprise 30‐50% of the non‐agricultural informal
workforce, except in India (150 million men, 35 million women or 19%)
and Pakistan (20 million men, 2 million women, or 9%). Informal
agricultural wage employment rate is 12‐40%; informal agricultural self‐employment
rate is 27‐52%. The vast majority of home‐based workers
are women.
Sector: Agriculture is the largest sector. Manufacturing is the second
largest, representative of a large export market in addition to domestic
manufacturing.
• Community based health insurance programs – Cambodia’s SKY program gives
access to primary care, emergency transportation, RX, etc. Targets populations not
covered by schemes for salaried employees; individuals need income to afford the
premiums. India’s SEWAVimo includes basic health programs for informal workers
who are SEWA members and health benefits including primary and maternity care.
• Universal health services – The Sri Lankan government provides universal health
services for all of its citizens, including informal.
• National health insurance – Thailand’s National Health Security Act in 2002
provides health insurance to the 25% of its population that did not qualify for
existing health schemes.
• Converge multiple programs – Laos combined 4 separate social health protection
schemes to reach universal coverage.
• Involve local gov’t – China’s central gov’t allows municipal gov’ts to grant informal
workers access to the basic health insurance program.
# of workers
(R4D
estimate)
# of workers
(WIEGO, from
8 countries)
% of
informal
work % women
Agriculture 705 mil 372 mil 56% 44%
Home‐based workers 89‐177 mil ‐‐ 7%‐14% 80%
Manufacturing 63 mil
15% of
WIEGO data 30%
Construction 53 mil
7% of WIEGO
data 14%
16% of
WIEGO data 4%
Approaches to Health Coverage
Attention and Momentum – High
• This region has seen the most momentum around informal workers.
There is more data from Asia than any other region, more worker groups,
and more interventions.
• Recently, the large manufacturing sector in south Asia has gotten
renewed attention following a series of devastating factory fires and
collapses in Bangladesh.
• Worker organizations have been extremely active in Asia bringing
attention to the informal sector. These include WIEGO and SEWA based in
India, as well as HomeNet, StreetNet, LaborNet and others.
• The ILO office in Southeast Asia has been particularly active around
worker training in occupational safety and health and worker organizing
and networking.
• Although there is much attention in this region, the vast scope of the
informal sector means there is still much that is unaddressed.

56
Appendix Profile: Latin America
Largest of the Three Regions
Population: Estimated 178 million informal workers (R4D calculation).
ILO/WIEGO reports 145 million informal workers (over 60% of total
employment in Latin America), in 16 countries reporting. Informality as
a proportion of total employment varies: Below 40% in Uruguay,
Panama, Costa Rica, Chile; 55‐65% in Brazil, Mexico, Argentina, and over
65% in Venezuela, El Salvador, Guatemala, Nicaragua, Ecuador,
Paraguay, Peru, Bolivia.
Gender: More women (53.7%) than men (47.8%) work in the informal
sector. Domestic workers alone account for 17.4% (18 million) of total
female employment. The percentage of women employed in the
informal sector increases dramatically as income bracket decreases.
Sector: Agriculture is the largest sector.
• In Latin America, around 35% of workers in categories which are
generally informal have access to health systems compared to 60%
of workers on average.
• Access to healthcare diminishes according the number of workers
in a business (small businesses tend to be informal). In businesses
with 100 or more employees health coverage is close to 90% vs. in
businesses with 1‐5 workers it is 15% (data from Ecuador, Mexico,
Panama, and Peru 2009).
• Only about one third of domestic workers and independent and
family workers have health insurance in Latin America, compared
with 3/4 of salaries workers in private organizations with 6 or more
employees, and 90% of salaried public workers.
• Informal workers are most covered by UHC schemes in Costa Rica,
Cuba (publicly funded), and a mix of public and private institutions
in Uruguay, Brazil, and Chile.
# of workers
(R4D estimate)
# of workers
(WIEGO, from
16 countries)
% of
informal
work % women
Agriculture 64 mil 52 mil 36% 17%
Home‐based workers 20‐41 mil ‐‐ 11%‐23% >50%
Manufacturing 13 mil
14% of
WIEGO data 50%
Construction 12 mil
12% of
WIEGO data 3%
8% of
WIEGO data 8%
Health Coverage
Extension of health coverage to informal workers – Caja de Seguro Social (Costa Rica) and
EsSalud (Peru) are contributory national initiatives created in 2010 offering health coverage
for independent workers and their families, includes benefits such as outpatient care,
hospitalization, emergencies, medications, and co‐pays for exams. Financed by voluntary
contributions from workers based on number of dependents.
Microinsurance – In Nicaragua the government extended its national health insurance plan
to informal workers via MFIs through a pilot among street‐vendors. Financed by voluntary
contributions as flat monthly installments of $15, with a two month premium of $171.
Mutelles are mechanisms of collective savings, where funds are managed autonomously by
a community of workers, often through unions or collectives. Associacion Mutua del Campo
created in 2000 in Nicaragua includes dental coverage and family co‐pays for medication
and is financed through shared contributions between employers and workers.
Community based health insurance – Obra Social de Vendedores Ambulantes de la
Republica de Argentina (street vendors), OSMU Trenque Lauquen (Argentina): Created in
1992 at the municipal level to benefit community members without health coverage, OSMU
is financed through a combination of contributions from members, the municipality, and
worker organizations representing its beneficiaries.

57
Agricultural Workers: Introduction
Number and Distribution of Agricultural Workers
• Definition: Waged agricultural workers (40%) labor in crop fields, orchards, glasshouses, livestock units, and primary processing facilities to produce
the world’s food and fibers. They may work on anything from a small farm to a large industrialized plantation. They do not own or rent the land they
work and are oftentimes temporary or seasonal workers. Self‐employed farmers (60%) own or rent the land they work and are oftentimes permanent
workers. The majority are informal small‐scale farmers. (WIEGO)
• Population: Roughly 1.3 billion agricultural workers – ~960 million informal; in most developing regions over 70% is informal. 75% of the world’s
absolutely poor (living on less than $1 per day) live in rural areas and depend primarily on agriculture for their livelihoods; agricultural workers‐especially
informal ones‐ are among the occupational groups with the highest incidence of poverty. (WIEGO, ILO 2003)
• Geography: Asia: 705 million informal agricultural workers (373 million in ILO/WIEGO database countries, representing 72% of all agricultural
workers, 56% of informal employment, and 38% of total employment). Latin America: 64 million informal agricultural workers (52 million in
ILO/WIEGO database countries, representing 81% of all agricultural workers, 36% of informal employment, and 23% of total employment). Africa: 63
million informal agricultural workers (13 million in ILO/WIEGO database countries), representing 38% of all agricultural workers, 41% of informal
employment, and 19% of total employment). (R4D calculations based on WB and ILO/WIEGO databases)
Categories of Informal Employment:
Most agricultural workers are either seasonal, temporary, or
contracted out by third party agencies. Many agricultural workers
who work for formal enterprises are still considered informal and may
work only part of the year, for multiple employers, or as migrants. In
North America, estimates put the number of migrant agricultural
workers (most from Mexico) at approximately 5 million, or almost 75%
of all agricultural workers in the U.S. Social protection is particularly
complex since employers have little incentive to supply non‐permanent
workers with coverage. For workers who own their own
land, the majority are small‐scale farmers who are considered
informal by the informal nature of their business. Most rely on unpaid
family labor, the most informal type of employment. As a result, the
majority of agricultural workers do not have labor contracts and
regulations are difficult. (ILO 2003, Barrientos 2002, WIEGO)
Continuum of Horticultural Employment
“Extending Social Protection to Informal Workers in the Horticulture Global Value Chain” (Barrientos 2002)

58
Agricultural Workers: Problem Assessment
The informal agricultural sector involves high levels of job insecurity and health risks combined with low
levels of income and social protection – a bad combination for workers.
Root Causes and System Failures
• Much of the agricultural sector is comprised of temporary
or casual workers. This is because the majority of
agricultural work is seasonal by nature, concentrated
around growing seasons which may only last a few months,
depending upon the product. For instance the coffee
harvesting season in Rwanda is only 4 or 5 months per year.
(WIEGO 2011)
• The effects of globalization have increased pressure on
developing countries to boost productivity while volatile
global markets have increased the flexibility of labor in
export‐driven sectors.
• Women tend to be concentrated in the most informal and
insecure jobs within the agricultural sector. In Chile, for
instance, 53% of temporary workers compared to 5% of
permanent workers are female. And unpaid family labor
accounts for 20% of women’s informal employment in
Ghana, 34% in India, and 85% in Egypt. (WIEGO, ILO 2003)
• Increasingly prevalent, particularly in Latin America, is the
use of contract labor and migrant labor through third‐party
recruitment agencies. Such contractors become responsible
for the employment conditions and wages of their workers,
thus removing the responsibility from employers. (WIEGO)
• Oftentimes labor contractors take advantage of seasonal
unemployment within peasant communities by providing
their recruits with advance payments. (ILO 2003)
• Few agricultural workers are entitled to labor contracts, social
protections, or health benefits and most struggle to make a living due
to insecure employment and piece‐meal wages. According to the ILO,
likely not much more than 5% of the world’s 1.3 billion agricultural
workers have access to systems for labor inspection and less than a
quarter have access to social protection. Barrientos (2009) and Oxfam
(2004) found that the majority of migrant workers on export pineapple
farms in Ghana and laborers on Chilean fruit farms did not have written
contracts.
• Countries are relaxing their labor laws in export‐driven sectors to
become more competitive on a global level. For instance, a 2002
Colombian labor reform negatively impacted workers in the export
flower industry by lengthening the work day, cutting overtime pay, and
introducing more flexible contracts.
• Female agricultural workers are particularly vulnerable to insecure
employment, long working hours, and lack of health protections.
Studies have also found women’s concentration in insecure
employment makes them targets of sexual harassment by supervisors
responsible for renewing contracts. (WIEGO 2011, Smith 2005, Oxfam
2004)
• Because third‐party agencies are generally more difficult to monitor
than stationary employers, they pose an additional challenge to the
extension of labor standards or social protections.
• Forced labor and exploitation arising from workers indebted to labor
contractors is problematic. An estimated 200,000 people work under
forced labor conditions in Brazil. Bonded labor also exists in South Asia
and Africa. (ILO)

Agriculture is one of the three most dangerous occupations‐ according to the ILO at least 170,000 agricultural workers die every year as
a result of workplace accidents; 40,000 are from exposure to pesticides. However, most of these deaths are preventable. The need for
developing countries to boost productivity has spurred greater intensity of production and the increasing use of toxic agrochemicals in
fertilizers and pesticides. Both of these developments have negatively impacted workers’ health. For instance, while developing countries
consume about 20% of the global production of pesticides, they experience about 70% of the total number of acute poisonings (1.1
million cases annually). Pesticide poisonings disproportionately affect women due to their higher levels of body fat (where pesticides
accumulate) and have been documented to produce birth/ reproductive defects. Although international standards on the use of
agrochemicals are now available, the challenge lies in monitoring their application in practice‐ particularly among informal workers, many
of which are ill‐trained, lack protective clothing, or cannot read labels. (ILO 2003, WIEGO 2011)
59
Agricultural Workers:
Problem Assessment – Health Issues
High
Occupational
Hazards
Excessively
Long Hours
Disease Bred
from Poor
Living and
Working
Conditions
Lack of Health
Insurance and
Benefits
Because of the short, labor‐intensive harvesting seasons, working hours are generally excessive and overtime, though often
compulsory, is inadequately compensated. In the U.S. at the height of harvesting season, tomato pickers (the majority of which are
migrants) work up to 11 hours a day 7 days a week without overtime because U.S. federal law excludes them from this right. Oxfam (2004)
similarly found tight shipping deadlines for fruit pack houses in South Africa led up to 8 hours of overtime paid at normal hourly rates.
Oftentimes agricultural workers only find out about overtime the day of. Short‐notice overtime work proves particularly problematic for
women who must incur extra costs to make alternative childcare arrangements or leave children at home unsupervised. Because
agricultural work is arduous by nature, long hours with limited rest can contribute to exhaustion among other health problems in this
sector. (Oxfam 2004, Smith 2004, WIEGO 2011)
Working conditions and pay for agricultural workers decline as informality increases. Barrientos (2003) found that in South African apple
farms and packhouses, permanent workers had the best working conditions followed by seasonal workers, with contract and migrant
workers at the bottom. Since many large‐scale commercial plantation workers actually live on the farms they work‐ often with their
families, health issues arise from overcrowded, unsanitary living conditions and poor nutrition. Health data from South Asian countries
consistently shows malnutrition, anemia, and maternal mortality rates are higher for plantation workers than the general population. Lack
of clean drinking water and toilets also leads to high levels of intestinal problems and sickness. Also problematic is the spread of infectious
diseases, such as TB, cholera, and STDs. In sub‐Saharan Africa the spread of HIV/ AIDS which is linked to the seasonal migration of workers
has caused pandemics on some plantations . A recent study of commercial farms in Kenya for instance revealed disproportionately high
levels of HIV among agricultural workers. (ILO 2003, WIEGO, World Bank 2002)
Although farming is one of the most dangerous sectors, agricultural workers are one of the least protected occupational groups. Social
protection where it does exist usually applies to permanent workers, leaving the non‐permanent majority vulnerable. Because agricultural
workers are disproportionately poor, few can afford healthcare on their own and most have very small contributory capacity for insurance.
Yet, employers have little incentive to supply health insurance or benefits to workers that only stay with them for 4 months out of the year.
The combination of seasonality, flexibility, and informality of agricultural labor creates a challenge in providing these workers with health
insurance. Even when seasonal or temporary workers are legally entitled to benefits, in practice employers only recognize these rights for
permanent employees. For instance, a study among South African fruit growers found that female seasonal workers did not receive the
paid sick leave or maternity leave they were entitled to. And, although Rwandan law mandates employers register all workers with the
national Social Security Fund, which covers the costs of occupational injuries and diseases, in practice very few workers in the seasonal
coffee and tea sectors are covered. (World Bank 2002, Oxfam 2004, ILO 2003, IFAD 2010)

60
National Action
Agricultural Workers: Dynamism Assessment
In the 2000s, countries began to recognize the need for extending labor
protections to seasonal and temporary agricultural workers.
• Chile’s Plan Nacional helps small‐holder raspberry farmers comply with
global labor standards. Chile requires employers to issue written labor
contracts for temporary workers and make payroll contributions to social
insurance programs when employed through third‐party contractors.
• India (Maharashtra sugar cane cutters) and Argentina – in both cases
inclusion of informal agricultural workers into public health insurance
plans was facilitated by pressure from local unions. In Argentina, the
farmers’ union UATRE worked with government to create National
Registry for Agricultural Workers and Employers (RENATRE) that included
informal temporary workers and migrants. (ILO 2003)
Risks: National legislation is difficult to enforce due to administrative and
labor inspection deficiencies – e.g., in South Asia, the ILO found social
security provisions for plantation workers are generally in place but most
legislation is outdated and relatively ineffective. (ILO 2003, World Bank 2002)
Global Market Codes and Labor Standards
Corporate Social Responsibility Initiatives
Some large international companies carry out voluntary initiatives to
improve health within the agricultural communities in which they work. This
is a growing sector as new partnerships among actors within global value
chains (suppliers, agricultural enterprises, their employees/ unions, NGOs,
and governments) emerge. Such initiatives can increase productivity,
enhance brand reputation and create company loyalty among farmers.
Examples of successful programs include the Chiquita Code of Conduct,
which established minimum labor standards and freedom of association for
all company owned farms in Central America and Colombia. The code
resulted from negotiations among Chiquita, the IUF, and the regional
banana union. In Indonesia, Starbucks partners with Save the
Global standards and monitoring systems (ETI Labor Standards, GLOBAL
GAP, SA8000) mostly target commercial farms. Some standards incorporate
health – e.g., GLOBAL GAP standards include proper sanitation facilities and
pest control; standards for tea growers include worker health, safety, and
welfare as an objective. Employers are incentivized since compliance is
increasingly important for accessing export markets. Based on the ILO’s
(2001) Safety and Health in Agriculture Convention, the first international
standards to guide practices in agricultural workers’ health, including a right
to health insurance against occupational injuries and diseases and training
in chemical use, election of a safety representative, and the right to stop
working under hazardous conditions. Such codes have led to improvements
in safety training, sanitation, protective equipment, and working hours of
agricultural worker in developing regions. (World Bank 2002, ILO 2003)
• Risks: International standards cover permanent workers in formal
enterprises the most and informal contract or migrant workers the least.
National governments have largely been unable to implement or enforce
the ILO standards regarding social protection schemes. (ILO 2003, World Bank
2002)
Children to improve children’s health and education in coffee‐growing
communities , doubling vaccination rates, improving health among workers,
and quadrupling the number of community health posts. Other programs:
Mars, Inc. (Ghana and Côte d’Ivoire), British American Tobacco
(Bangladesh), Unilever (Kenya), and Dunavant (Zambia). (ILO 2003, Rachel’s notes)
• Risks: Research on voluntary corporate codes from Kenya, South Africa,
and Zambia suggests the assumption of permanent employment and
limited informal seasonal sector reach. Many only address specific health
issues – e.g., limited housing improvements, childcare and access to
clinics. Suppliers may be too removed from employees; worker
representation in negotiations and effective monitoring is crucial. (World
Bank 2002)

61
Agricultural Workers: Landscape Assessment
International Regional Funders
Fair‐trade certified networks
among countries
CLAC (Latin America)
African Fair Trade Network
(AFN)
Advocacy groups and
researchers, standard‐setters,
NGOs, and multi‐nationals
ILO (STEP), World Bank, EU,
ECLAC, WHO, ISSA, WIEGO,
GLOBAL GAP, IUF, SAI, FHI
360, Ethical Trade Initiative
Multi‐nationals‐ ex:
Starbucks, Chiquita, Unilever,
various supermarkets (UK)
Funders of Value Chain
Projects in Agriculture
DFID (UK), USAID, FAO (UN),
ITC, Gates Foundation (WIEGO)
Other Funders of Health
Related Projects
WIEGO, MNE suppliers of
agricultural exports (Ex:
Mars Inc., Starbucks,
Unilever), World Bank,
UNESCO, World Cocoa
Foundation, CIDA
State
Grassroots movements and
unions representing
agricultural workers
NUPAWU (Uganda)
UATRE (Argentina)
SEWA (India)
CONTAG (Brazil)
Kuapa Kokoo (Ghana)
Among others…
Gaps in Funding and Knowledge
• Under‐capitalization in agriculture by national governments – A 2008 study of Africa found only 19% of countries had met their 2003
goal of dedicating more than 10% of national expenditure to agriculture. (Economic Report on Africa 2009)
• Lack of research specifically focusing on the link between health and working environments of informal agricultural workers –
Although the link between occupational hazards, health, and pesticide use has been established, little is know about longer term, less
easily observable conditions, such as mental illness and muscular problems, which tend to go undiagnosed as work‐related.
• Few Value‐Chain Analyses address informal employees within formal enterprises – Most target only small‐holder farmers, or
entrepreneurs rather than informal employees. (WIEGO 2011)
• Lack of established research on the shifting forms of migrant and contract agricultural labor.

Longer term, less observable illnesses
among AWs are properly diagnosed as
occupation‐tied and treated as such.
Better monitoring of pesticide use
and global standards by national labor
inspectors or corporate suppliers.
62
Agricultural Workers – Impact Assessment
Health vulnerabilities suggest four high‐level outcomes to prioritize.
Healthier Workers:
Reduced need by
health services
Improved access to
health care
Improved Policy:
and safety
The issue of unpaid family labor is
addressed by national legislation and
women gain right to jointly held land.
Governments, employers, NGOs, or
other actors establish policies to deal
with seasonal unemployment within
the agricultural sector.
Minimum health and safety
standards are set and enforced.
Forced labor and exploitation of
migrant or seasonal AWs reduced.
Informal AWs and families receive
better housing, sanitation & water
and reducing incidence of infectious
disease and intestinal problems.
Seasonal, temporary, and migrant
AWs and small‐holders are
incorporated into national labor
legislation; employers and third‐party
agencies are monitored.
OUTPUTS INTERMEDIATE OUTCOMES HIGH LEVEL OUTCOME
More affordable and conveniently
located health insurance options
increase health coverage for
informal agricultural workers and
their families.
CSR and national initiatives provide
access to childcare and clinics in
rural areas; perhaps through
community health posts or roaming
health care.
Occupation‐tied insurance is not
linked to just one employer or a
specific number of days worked in
a row; is expanded include
seasonal workers who may switch
between employers. Special
insurance provisions are created
for small‐holder farmers.
All employers and employees sign a
contract at the start of employment
and a national registry of all AWs is
created to guarantee access to
publicly provided health care.
AWs are better able to afford
medical attention and female
workers are less disadvantaged by
temporary employment status.
CSR initiatives are more efficient,
comply with international health
codes, and reflect workers’ needs.
The links between health and informal
agricultural work is better established
by researchers.
Investment in the living conditions
of AWs (on‐site or in community),
particularly migrants and seasonal
workers on large‐scale plantations.
All employers and employees sign a
contract at the start of employment,
guaranteeing a minimum wage based
on hours worked, rather than in‐kind
pay. Overtime is non‐compulsory and
properly rewarded. Sick days/
maternity leave is provided.
The gains to partnerships among
actors in global value supply chains
(private companies, governments,
NGOs, and employees/unions) are
realized.
Corporate and international labor
codes are extended to include non‐permanent
AWs and incorporate
health and safety as a priority.
Small‐holder farmers incorporated
into fair trade agreements.
Health and safety education is
brought to rural communities
(existent projects target pesticide use,
HIV/ AIDS, and malaria).

Number and Distribution of informal construction workers
• Definition: Unregistered workers, including masons, carpenters, steel benders, small‐scale plumbers, house‐wiring electricians, carpenters, and unskilled laborers,
who are mostly male, aged between 20 and 40, and are mostly school dropouts, often working on a piece‐rate or daily basis. (Rinehart 2004)
• Population: 66 million in the 32 countries included in the ILO/WIEGO database. ILO estimated over 110 million total construction jobs in 2001, of which the
majority are informal, BWI estimated up to 180 million construction jobs worldwide in 2006, mostly informal. More than 2/3 of all construction workers are
informal (Pais 2002; Wells and Jason 2010; WIEGO) Both the number of informal construction workers and the proportion of informality in the construction sector
have increased over the past 30 years. (WIEGO; Wells 2007; Wells 2001; Wells and Jason 2010)
• Gender: Mostly men: 97% in Africa and Latin America and 86% in Asia (ILO/WIEGO database). Some estimates have female engagement in India as high as 30% or
50% of the informal construction laborforce. (Wells 2001; WIEGO) Women work at the lowest levels and do the most unskilled work, mostly head‐loaders carrying
bricks, cement, sand, and water; other unskilled jobs such as digging earth and breaking stones; or some semi‐skilled work like plastering or concrete mixing. (Wells
2001; Jhabvala and Kanbur 2004) There is widespread pay discrimination and some women are not paid directly, instead working as part of a family unit on a piece‐rate
• Geography: The majority are in south Asia. According to the ILO/WIEGO database, India has the most with 43 million, followed by Brazil (4.6 mil), Vietnam (2.9 mil),
and Mexico (2.7 mil). ¾ of the global construction workforce is in developing countries, despite the fact that only ¼ of the construction output resides there. (Wells
2001)
POPULATION* TOTAL Asia Africa Latin Am.
# of informal construction
workers 66 mil 53 mil 1 mil 12 mil
% of construction workers
86 %
90%
59%
73%
that are informal
(out of 76.6mil)
(out of 58.8mil)
(out of 1.8mil)
(out of 16.0mil)
% of all informal workers
that are construction
workers
16.5%
(out of 399 mil)
18%
(out of 292 mil)
7%
(out of 14 mil)
12%
(out of 93 mil)
% of informal construction
workers that are female
12%
(8 mi)
14%
(7.6 mil)
3%
(.04 mil)
3%
(.32 mil)
*Data from ILO/WIEGO database on Informal workers. Asia = 8 countries: China, India, Indonesia, Pakistan,
Philippines, Sri Lanka, Thailand, Vietnam. Africa = 8 countries: Cote d’Ivoire, Liberia, Mauritius, Namibia, South Africa,
Tanzania, Uganda, Zambia. Latin America = 16 countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Dominican
Republic, Ecuador, El Salvador, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela.
63
Construction Workers: Introduction
basis. (WIEGO; Wells 2001; Jhabvala and Kanbur 2004)
• High incidence of injuries from accidents is the most common
health risk, resulting from unsafe work sites, and lack of
appropriate protective equipment and training. The ILO reports
that 70% of these accidents are foreseeable and preventable.
• Chemical exposures are common and can cause metal poisoning,
damage to the central nervous system and liver, dermal and
respiratory allergies, cancers and reproductive disorders.
• Asbestos exposure is a serious risk and can cause cancer.
• Musculoskeletal injuries and disorders, including back injuries
from carrying heavy loads, and joint pain.
• Respiratory disease from inhaling dust.
• Poor living conditions impact health including water‐borne
disease, dengue fever, and respiratory problems.
International Labor Organization; local and national worker groups and trade unions, such as Tanzania Association of Informal
Construction Workers, Philippines’ Association of Construction and Informal Workers, India’s National Federation of Construction
Labour, The Central Union of Painters, Plumbers, Electro and Construction Workers‐Nepal, SEWA; some governments, such as India
(national, and Kerala state), Malaysia.
Health Issues
Actors in the Space

Construction Workers: Problem Assessment
Over the past 30 years, explosions in population and infrastructure have fueled an expansion of the construction
sector. Simultaneously, growing international competition in construction, including multinational companies with
large and efficient infrastructures, has pushed bidders to compress labor costs and lead to a rise in subcontracting. As
a result, there has been a shift from formal to informal labor, with a substantial increase in the temporary use of
informal workers through intermediaries or small firms, particularly in developing countries. Informality has become
the new norm, encompassing more than 2/3 of all constructions workers.
Subcontracting blurs and diffuses responsibility for working conditions and workers’ health. The key motivation in the
shift to informal labor is the desire to lower costs, which impacts workers’ health through reduced wages, longer
hours, less training, failure to provide safety equipment or coverage for accidents, and poorer working and living
conditions, and means workers do not receive health benefits and are not covered by legal or social protections.
Informal workers fall outside of government protections and firms using informal labor often also fail to comply with
regulations. Workers in precarious jobs of short duration also leads to lower union density.
64
Informalization of the
construction workforce
How informality impacts
health
Low pay, and irregular income means fewer funds available for health expenditures. Informal workers generally earn
less than minimum wage, and income is irregular. As a result, many can’t even afford to buy into state health
insurance schemes when they are eligible. They have no employer provided benefits, and declining union participation
excludes them from union provided benefits as well.
Barriers to care
The Impact of informal construction work on health
Informalization has pushed construction workers out of social
protection and diffused responsibility, at the cost of workers’ health.
Injuries from accidents are so common that they are considered an inevitable part of the work. WIEGO estimates 16‐
18% of informal construction workers are injured in south Asia each year. Occupational exposure is also common, to
chemicals, dusts, and asbestos. These exposures can can cause metal poisoning, damage to the central nervous
system and liver, dermal and respiratory allergies, reproductive disorders, and cancer. Musculoskeletal injuries and
disorders are common, including back injuries from carrying heavy loads, and joint pain, as well as respiratory disease
from inhaling dust. The poor living conditions can lead to water‐borne disease, dengue fever, and respiratory
problems.
Common health problems
Although most construction accidents are preventable, informal workers receive inadequate training and protective
equipment. Lack of awareness among the workers as well as the absence of regulation lead to high incidence of
occupational injuries and exposures. Accidents on construction sites are very common and the workers have to bear
responsibility for their health in the aftermath of accidents. It is estimated that ¾ to all of informal construction
workers are exposed to occupational hazards. Many workers also live on site, frequently in poor conditions including
overcrowding, poor sanitation, high prevalence of disease vectors such as rats and mosquitoes, and continued
exposure to construction dust.
High risks, little protection

65
Construction Workers: Dynamism Assessment
Current Interventions Potential Interventions
• Require bidders to include costs for worker protections and health, or take
the costs of health and safety measures out of competition by including
them in the prime costs of a competitively tendered contract.
• Ratify and implement the Safety and Health in Construction Convention,
1988 (No. 167), and the Asbestos Convention, 1986 (No. 162).
• Establish, or enforce compliance with existing, occupational safety and
health legislation, and have a single government agency responsible for the
administration and enforcement of policy.
• Require registration of labor intermediaries.
• Occupational safety and health management by contractors should be
monitored on‐site.
• Use legislation to define accountabilities, supplemented by succinct
regulations and industry‐led codes of practice or guidelines.
• Enact legal provisions allowing workers to remove themselves from
hazardous or dangerous work conditions without risk of dismissal.
• Provide protection for workers to unionize.
Challenges
• Short term, scattered, and unrecorded work yields few reliable data. Lack of
insurance means that accident reports are not filed, making it difficult to get
good statistics on occupational injury as well.
• While many countries have safety and health legislation pertinent to
construction, compliance and enforcement are sometimes lacking or
minimal, particularly for informal sites. Government administration and
enforcement are also fragmented.
• When social protections are theoretically available, such as voluntary
membership in a government scheme, construction workers often don’t
know about them or are too poor to access them.
• ILO’s program on Work Improvement in Small Construction Sites produces
training materials and example photo books focused on decreasing workplace
hazards and reducing occupational injury and exposure. Trainings have been
conducted in several countries.
• India has a Worker’s Welfare Fund for construction which registers workers
and includes them in welfare schemes such as health insurance.
• In Mongolia, trade union members provide OSH training using action checklists
and good example photos. Workers and managers collaborate to develop
practical improvement proposals.
• In Vietnam, low cost improvements carried out to address occupational
hazards were coupled with development of company safety and health policies
based on risk‐assessments carried out jointly by workers and managers. The
effort succeeded due to employer buy in and ILO technical support.
• The Association of Construction and Informal Workers in the Philippines
provides members who are current with their dues grants to address
immediate needs in times of hospitalization, disability, or death.
• SEWA, in India, is working on an accident insurance scheme for female
construction workers.
• The Construction Industry Development Board in Malaysia is pioneering a
scheme to make every construction worker undergo a one‐day safety and
health induction course, after which he is issued with a “green card”. Those
without the card would be barred from entering work sites while contractors
who fail to send their workers to the training will be blacklisted.
• In Nepal, CUPPEC established a health cooperative in Kathmandu, with
members making small monthly contributions for subsidized health care for
themselves and one dependent. They organize in the urban areas by targeting
the communities where construction workers are living.
• UMASIDA is a mutual health insurance scheme for informal workers in
Tanzania, based on joint research by the ILO and Muhimbili University.
Members and their immediate families are entitled to all primary health‐care
services at a scheme selected private health‐care provider.

66
Construction Workers: Impact Assessment
Root causes that drive health vulnerabilities among informal workers suggest four high‐level outcomes
to prioritize for a potential Rockefeller Foundation initiative.
Healthier Workers:
Reduced need by
health services
Improved access to
health care
Sustainable Steps:
practices to assure
health and safety
• Ensure adequate OSH
training for workers, and
provision of protective
equipment.
• Monitor occupational safety
and health management by
contractors including on‐site
inspection.
• Enact legal provisions
allowing workers to remove
themselves from hazardous
work conditions without risk
of dismissal.
• Improve worker living
conditions.
• Ensure informal workers are
eligible for national social
protections where available.
• Support trade union and
worker association
negotiations for member
access to affordable health
services.
• Have mobile clinics or
community outreach workers
visit sites where workers live.
• Conduct education and
outreach to ensure workers
are informed of available
health care.
• Provide accident protection or
disability insurance through
national schemes or worker
groups.
• Underwrite group health
insurance schemes provided
by worker associations to
ensure viability.
• Erase cost of entry for
informal workers into national
health insurance schemes.
• Hold employers responsible
for medical costs associated
with occupational injuries and
exposures.
• Require inclusion of OSH costs
in contracts, or take the costs
out of competition by
including them in the prime
costs of a competitively
tendered contract.
• Encourage states to ratify and
implement the Safety and
Health in Construction
Convention and the Asbestos
Convention, and establish or
enforce OSH legislation, with a
single government agency
responsible for enforcement.
• Require registration of labor
intermediaries.

67
Number and Distribution of Domestic Workers
Advocacy groups, researchers
informing the debate and
organizations that link and
strengthen movement:
• ILO
• WHO
• WIEGO
• International Trade Union
Confederation
• International Domestic
Workers’ Network
• Human Rights Watch
• Amnesty International
Domestic Workers: Introduction and Landscape
• Definition: Domestic workers work in the private households of others, performing a range of domestic services. Women are concentrated in
cleaning and child‐care, while men tend to have higher paying jobs as gardeners, drivers, and security guards. WIEGO
• Population: According to ILO estimates, at least 52.6 million, totaling 3.6% of waged employment worldwide. Much of the domestic work
sector is informal and has grown rapidly over the past 15 years, increasing by more than 19 million since 1995. The increasing demand for
domestic work is expected to continue as developing countries get richer and more women work outside of the home. ILO
• Gender: Women account for 83% of domestic workers and outnumber men in every region of the world. Globally, 7.5% of all female wage
earners are domestic workers – several are migrants. In 2008, 37% of all female migrant workers were employed by households. ILO
• Child Labor: The ILO estimates an additional 15.5 million children are employed as domestic workers globally and more girls under 16 engaged
in domestic work than any other kind of child labor. (ILO 2013, WIEGO, Anti‐Slavery Int.)
• Geography: Latin America and the Caribbean – 7.6% of total employment and 17.4% (18 million) of total female employment. Asia and the
Pacific‐ 1.2% of total employment and 2.5% (17.5 million) of total female employment. Africa‐ 1.4% of total employment and 2.5% (3.8 million)
of total female employment. Middle East‐ 5.6% of total employment and 20.5% (1.3 million) of total female employment. ILO
Actors in the Space: Funders include UN Women, WIEGO, Ford Foundation
International
Regional
Ties individual grassroots
movements, NGOs, unions, etc.
together to form regional
associations:
• CONLACTRAHO – Latin
America
• Asian Domestic Workers
Network
Sources: WIEGO, Bonner 2010, ITUC
National
Grassroots movements
representing domestic workers
and providing services on the
ground:
• Namibia Domestic Allied
Workers’ Union
• Federation of Asian
Domestic Workers’ Unions
(FADWU) – Hong Kong
• SEWA – India
• SADSAWU – South Africa
• FENATRAD – Brazil
Migrant DWs
NGOs offer help with visas,
emergency assistance, and
accessing healthcare abroad:
• HOME‐ Singapore
• Kalayaan – United Kingdom
Community based
organizations:
• Association of Philippine
Migrant Workers – Belgium
Regional organizations:
• Asian Migrant Domestic
Workers’ Alliance

Domestic Workers:
68
Physical, Sexual
and
Psychological
Abuse
Excessively
Long Hours
Poor Working
and Living
Conditions
Lack of Health
Insurance and
Benefits
DWs have limited access to protections – even migrants in high‐income countries.
Research linking domestic workers and health on a global level are lacking, but several case studies exist. Kalayaan, an NGO which
works with MDWs in the UK, found 18% of their registered workers to have experienced physical abuse, over 50% psychological
abuse, and 3% sexual abuse. A study in Thailand among MDWs from Myanmar found 14% experienced unwanted physical contact
from an employer; for 1% this culminated in rape. WHO reports victims of sexual violence are more likely to suffer from depression,
eating disorders, STDs, and other gynecological problems. (Kayalaan 2008, WHO, ILO 2013).
Working hours globally are long and unpredictable for DWs, particularly in Asia. In Nepal and Indonesia domestic workers average
52 hour weeks, Malaysia 66 hours, and Thailand 58 hours. No upper limit on regular weekly working hours exists for 56% of the
world’s domestic workers. Findings from occupational health studies show that the long working hours, night working, and patterns
of irregular shifts domestic work entails have the greatest negative effect on workers’ health. For live‐in domestics, the divide
between work and rest is blurred; children and pregnant women are especially vulnerable. (ILO 2013)
Many live‐in DWs face poor living conditions‐ including inadequate sleeping arrangements and lack of food. Over 40% of DWs
registered with Kalayaan in 2006 were not allowed regular meals and/or their own bed. Some DWs are paid so little they cannot
afford adequate food for their families. In the US, 23% of DWs (many of whom migrated from developing regions) are paid below
the state minimum wage; 20% reported not having enough money to buy food in the previous month. DWs also face health risks
on the job, esp. increased risk for asthma, chronic bronchitis, and other respiratory problems associated with the regular use of toxic
cleaning agents, and injuries due to heavy lifting. DWs have an annual incidence of non‐fatal work injuries of 7.3% compared to 5%
for the working population in general. In the US, 23% of workers who had been fired from a domestic job said the reason was
complaining about unsafe working conditions. Since 2000, 75 maids in Singapore have fallen to their deaths in high rises while
trying to clean the outside of a window. The government tried to ban this practice but faced too much resistance. (Home Economics,
Kalayaan 2008, ILO 2013, Smith 2011)
Most DWs do not receive health insurance and some are not granted sick days‐ or are afraid to take them fearing they will lose their
job. This varies by country and is largely dependent on the good will of the employer. Some DWs interviewed in Indonesia were not
allowed to seek medical attention when they were ill; those who were could not afford hospitalization or medication. Globally, 44%
of female DWs, compared to 47% of male domestic workers and 64% of the total urban workforce, contribute to pension and/or
health schemes; 36% of women employed in private households globally have no legal entitlement to maternity leave. This varies
among regions: in Asia ¾ of DWs lack the right to take maternity leave . Micro‐insurance tends to be inexpensive, immediately
available, and relies on scalable partnerships. Naya Jeevan (Pakistan), which partners with 10 multinational companies, reaches DWs
through employers. When privately provided micro‐insurance relies on employers to buy in, as skeptics of DomestiCare (South
Africa), argue there is no tangible incentive for employers to support it. Public insurance models mandate that employers make
compulsory payments into state subsidized funds. In Uruguay and Argentina employees are provided with health insurance, social
security, maternity and sick leave. (WIEGO, ILO 2013, Amnesty Int. 2007)

69
• Because their work is done in the private sphere, domestic workers are among
the most invisible groups within the informal economy. Labor laws and
regulations generally miss them and where labor standards do exist, they
oftentimes remain un‐enforceable in the private setting of an employer’s home.
• It is difficult to count domestic workers, since most remain unregistered, and
even more difficult to assess their specific health needs on a global level.
• The employer‐employee relationship is unequal, exacerbated by social
inequalities embedded in society. An employer’s social status outside of the home
may erode the power of domestic workers (who are oftentimes poor and from
marginalized communities) to negotiate and enforce contracts.
• Women are subject to gender discrimination, prejudice, and stereotyping in
relation to work, which is undervalued and regarded as low status.
• Migrant domestic workers (MDWs) are the invisible of the invisible because their
legal status as migrants is oftentimes linked to their employers. Many are recruited
by exploitative third‐party agencies which do little to inform them of their rights or
ensure safe working conditions. (Kalayaan 2008, WHO)
Domestic Workers:
Problem Assessment – Causes and Systems
Root Causes and System Failures
• Domestic workers are highly susceptible to exploitation from
employers, either through physical violence, withholding of
wages, or poor working conditions. Live‐in domestic workers
are especially vulnerable since most depend upon their
employers for food and shelter. (WIEGO, Kalayaan 2008)
• As a result domestic workers suffer from a range of “decent
work deficits.” The proportion with labor contracts or social
protections is very low compared to other occupations. In a
recent study in Indonesia, none of the domestic workers
interviewed received a written contract and in Latin America
only 20% do. (Amnesty Int, ILO, Tokman)
• MDWs are particularly vulnerable to abuse since employers,
may take advantage of their status as migrants by seizing
passports and using them as forced labor. This subgroup
requires special attention. (Kalayaan 2008, WHO)
National Labor Standards
Geared towards DWs
Third‐party Regulation
and Enforcement
Special Policies for
Migrant DWs
Better Provision of Health
Insurance and Benefits
• National legislation regarding
maximum working hours, minimum
rest/ vacation, ban of dangerous
chores/materials, and minimum
wage (per ILO).
• For live‐in DWs, standards should
include a bed and nutritious food
supply.
• DWs should be explicitly included
under domestic violence/ sexual
abuse laws; authorities should be
trained to deal with this group.
• A formal contract between
employee and employer.
• A third party (NGO, national labor
division, or even an existent
recruitment agency ) could play a
monitoring/regulatory role and
serve as a formal mechanism for
filing worker complaints.
• Giving DWs a way to voice
grievances allows for targeted
inspection and removal from
dangerous situations.
• Key protection for MDWs is a visa,
as legal status is not linked to an
employer. Allows MDWs to leave
abusive employer without
deportation if they find work in
another household.
• MDWs should be covered under
labor standards of host country or
contract between countries.
• MDWs should have access to a
third‐party agency that can assist
with accessing healthcare.
• Most DWs with health insurance are
covered under universal insurance
schemes; emerging efforts are to
provide DWs with occupation‐tied
micro‐insurance initiatives in which
the employer contribute small
monthly payments to private insurers.
• Challenges: incentives for employers
to buy into the plan and ensuring that
DWs can afford it.
• DWs need access to maternity leave,
and compensated sick days.

• In June 2011, the ILO adopted the Convention Concerning Decent Work
For Domestic Workers. This is the first set of international labor standards
geared specifically towards domestic workers. The standards establish
that DWs globally have the same basic labor rights as other workers –
limits on hours, a weekly rest of 24 consecutive hours, clear information
on terms and conditions of employment, freedom of association.
• 4 countries (Uruguay, the Philippines, Mauritius, and Italy) have ratified;
becomes legally binding Sept. 2013.
• Dozens of other countries are currently in the process of revising national
legislation to conform to these recommendations. (ILO 2011, ILO 2013).
70
Domestic Workers: Dynamism Assessment
No longer invisible and with policies on the books, domestic workers are garnering attention. There are
windows of opportunity on all levels, but potential risks to consider.
National Action International‐level Action
Regulation of Third‐Party Recruitment Agencies and Employers
In Vietnam and Uruguay the labor code gives the government the
right to investigate the working conditions of any private household
which employs a domestic worker. (Daily Star, WIEGO) Risks: There is a
belief that labor standards cannot be applied to the private sphere,
which is the general risk with any regulation of domestic work.
Protections for Victims of Domestic Violence
Some countries, particularly those receiving large amounts of
MDWs, have set up shelters for abused domestic workers (e.g., the
Philippines). In Indonesia, The Domestic Violence Act mandates that
victims of domestic violence be provided with health care and are
taken to a government‐sponsored crisis center or shelter. (HRW,
Amnesty Int.) Risks: Crisis centers in Indonesia are only in major cities .
Many DWs did not know services existed. Cases of domestic violence
are difficult to prove, and sex before marriage may viewed as taboo.
Incorporating Domestic Workers into National Labor Laws
More national governments are granting DWs basic labor rights and
legal protections. In Argentina a new law will give DWs fairer wage
terms, a maximum 48 hour work week, and maternity leave. In Brazil
an amendment ensures DWs receive the same benefits as other
workers. Since the ILO Convention on Decent Work for Domestic
Workers was adopted, Venezuela, Bahrain, Spain, the Philippines,
Thailand, and Singapore have passed new laws improving DWs’ labor
and social rights. Legislative reforms have also begun in Namibia,
Chile, and the US. (The Argentina Independent, WIEGO, HRW, IDWN) Risks: Most
families who benefit from DW have political clout in society while
DWs are poor, un‐organized, or migrants . (CNN)
Bilateral Action
Bilateral Contracts Between MDW Sending and Receiving Countries
• Emerging trend in the Middle East/ Asia of bilateral/multi‐lateral contracts
to regulate legal protections of migrant DWs: Indonesia and Malaysia; Sri
Lanka and the UAE; Sri Lanka, Indonesia, and Jordan; and the Philippines
with several countries. Risks: Most bilateral agreements of this kind have
weak protections and unclear enforcement mechanisms or penalties. (HRW)
Flexible Visas for Migrant Domestic Workers
• The UK (with a push from Kalayaan) passed the Overseas Domestic
Workers’ Visa, which allows MDWs to change employers if they continue
to work in a private household. Most MDWs emigrate to richer countries
to send wages back home as remittances, so they have a strong incentive
to retain their legal status as migrants. Flexible work visas reduce the risk
of staying in an abusive environment. Risks: To limit immigration, the UK
reverted to 6month visitors’ visas; this is a problem, esp. in Singapore and
Malaysia, where workers are on 2‐year visas linked to a single employer.

The link between domestic work and
health is established on a global
level. Individual nations and NGOs
share best practices, allowing them
to better address the health needs of
their domestic workers.
71
Domestic Workers: Impact Assessment
Health vulnerabilities among domestic workers suggest four high‐level outcomes to prioritize.
Healthier Workers:
Reduced need by
Improved access to
health services
health care
Improved Policy:
and safety
Individual countries ensure DWs are
covered under national labor
legislation, following ILO Decent
Work standards
Domestic workers are prevented
from performing dangerous chores
or using toxic materials. Limits on
weekly working hours and
adequate time off.
Live‐in DWs receive adequate
sleeping quarters and food.
Forced labor and trafficking among
migrant domestic workers is
reduced.
Domestic violence and sexual
assault are reduced. Migrant DWs
can more easily escape dangerous
households.
Targeted policies for migrant DWs,
such as flexible workers’ visas tied
to employment status rather than a
single employer.
HIGH LEVEL
OUTCOMES
INTERMEDIATE
OUTCOMES
OUTPUTS
Safe houses for victims of domestic
violence are accessible to domestic
workers and MDWs have access to
healthcare abroad.
More affordable and conveniently
located health insurance options
increase coverage for domestic
workers and their families.
Innovative insurance models
geared towards domestic workers
are studied and best practices
adopted‐ ex. How to incentivize
employers to buy in or scale up to
limit expenses?
Increase special support services
for MDWs via third party agencies
(such as Kalayaan) which provide
assistance with accessing
healthcare in their new country
and serve as shelters for workers
in abusive homes.
Domestic workers receive
compensated sick days and
maternity leave as per ILO decent
work standards.
Minimum wage and overtime paid at
regular intervals assured though
direct deposits into a bank account
or similar instrument.
Domestic workers in abusive
households have a forum to voice
their concerns. Exploitative
recruitment agencies and employers
are punished.
DWs’ rights and awareness are
furthered at the international level,
helping reduce the stigma attached
to domestic work.
Third‐ party regulation of DWs
through a formal contract, complaint
system, and monitoring of targeted
households.
Individual countries ensure DWs are
protected under national labor and
domestic violence legislation,
following ILO Decent Work
standards.
Employers and employees sign a
contract at the start of employment,
guaranteeing a minimum wage based
on hours worked, rather than in‐kind
payments. New research identifies key health
vulnerabilities of DWs (esp. child,
live‐in, and migrant workers) and
how organizations on the ground are
currently addressing them.

• Definition: Home‐based workers are informal workers who carry out work for the market, either contractually or on their own account; within their
homes, surrounding grounds, or other premises apart from their employer. (Sudarshan and Sinha 2001; Sinha 2006, WIEGO, ILO 1996)
• Population: 100 million and growing. (Sinha 2006, ILO 2011, Sudarshan and Jhabvala 2009)
• Gender: The majority are women: ~50%in Africa, over 50% in Latin America, and 80% in South Asia. (Sudarshan and Sinha 2001, ILO 2011, Charmes 1997,
Hiralal 2010)**
• Geography: Over 50 million, more than half of the total, are in South Asia. Those in Asia and Latin America are more often piece‐rate homeworkers,
72
Home‐based Workers: Introduction and Landscape
whereas in Africa they are more often self‐employed in microenterprises. (WIEGO, ILO 2011, Sudarsha and Jhabvala 2009, Chen et al 2002, Hiralal 2010)
Health Issues
• Health problems from poor working conditions and
postures, including: eye strain and eyesight
problems; joint, shoulder, and back pain;
reproductive health problems; cough and bronchial
problems.
• Exposure to workplace hazards due to lack of
protective equipment and workplace regulations,
including: electric shocks, chemical exposure, dust
and fiber inhalation.
• Limited time or money available for seeking health
care due to long hours and little pay, in addition to
no health benefits from employer and no access to
health care initiates that are employer centered.
Policies, Programs and Interventions
• International standards like the 1996 ILO Convention on Home Work have helped
define the the vulnerable parties and their needs.
• National support mechanisms include India’s Beedi Workers Welfare Fund which
reimburses workers for health procedures and Bolivia’s program providing home‐based
• Multilaterals: International Labor Organization (ILO); World Health
Organization (WHO)
• Regional and national networks: Women in Informal Employment:
Globalizing and Organizing (WIEGO); HomeNet South Asia, HomeNet
Southeast Asia; Self Employed Women's Association (SEWA)
• Active governments: India, Pakistan, Thailand, the Philippines, Bolivia
child care for informal workers, including access to health services.
• Occupational safety and health initiatives seek to improve home work conditions,
including by training workers, as in ILO’s Work Improvement for Safe Home training
program, and providers, in Thailand’s Safe Work Program.
• Health worker outreach such as Save the Children’s partnership with the Philippine
Ministry of Health to train community volunteer health workers to target home‐based
workers, collecting data and providing OSH training.
• Extension of health insurance protection, to include homeworkers in national
health insurance, as with the Philippines KaSAPI PhilHealth, or to extend
microinsurance to homeworkers, as Grameen Bank and BRAC have done in
Bangladesh and HomeNet Thailand did in Chiang Mai.
Number and Distribution of Home‐based Workers
Health Issues and Responses
• NGOs: Save the Children (SC); Bangladesh Rural Advancement
Committee (BRAC), Grameen Bank, Japan International Labour
Foundation (JILAF); Rahnuna Family Planning Association of Pakistan;
Thardeep Rural Development Program
• Donors: ILO, WHO, Ford Foundation, Canada’s International
Development Research Centre, World Bank, UNDP, UN Women
Actors in the Space

73
Home‐based Workers: Problem Assessment
Liberalization and globalization push productivity and supply driven economic development, resulting in sub‐contract
competition at the cost of working conditions and worker protection. Particularly in Asia and Latin
America, homeworkers are prevalent in export industries, whose complicated supply chains make it easier to
hide bad working conditions. Lack of formal sector jobs , unemployment compensation and social protections
drive poor workers to home‐based work despite substandard work conditions and little pay.
Home‐based workers fall outside employment regulations and worker protections, e.g., OHS requirements. They
work long hours in poor conditions, e.g., too little light, cramped work spaces, unhealthy work postures,
inadequate ventilation, and lack of protective equipment. They have no employer‐provided health benefits and
are excluded from health schemes that require access through an employer. Long work hours imposed by
inadequate pay and preexisting poverty make it difficult to take time or limited household resources to access
care. The relative isolation of home‐based workers makes it difficult for them to organize or have bargaining
power which could pressure employers or authorities.
Global economics
drive the rise in
home‐based work
Poor conditions lead to
significant health
problems and little
health care
Access to care is very difficult for home‐based workers and their dependents – delays in accessing care can
exacerbate health issues. Untreated conditions can worsen or become chronic, causing life‐long impairment,
and impacting work ability, decreasing income and further restricting work opportunities and access to care.
Maternal health impacts child health; the majority of home‐based workers are female and have children at
home. Conditions/exposures experienced as a child impair short‐ and long‐term health.
Impact of health
problems
The Impact of Home‐based Work on Health
The rise of home‐based work is tied to global economics, but
impacts the health of individual workers and their families.
Health problems are routinely reported in surveys of home‐based workers, many of them chronic. Research
by the ILO, HomeNet South Asia, and WIEGO report the most common health problems as:
• Eye strain and eyesight problems from low light and concentrating long hours on fine work.
• Joint, shoulder, and back pain from poor work posture, long sitting, cramped work space, and continual bending.
• Reproductive health problems including ovary related problems, abdominal pain and miscarriage from working
paddle driven machines, disturbance of fetal position during pregnancy from excessive sitting (sometimes leading to
need for C‐section), lack of antenatal care.
• Field specific injuries, such as electric shocks, chemical exposure, hand problems, coughs and bronchial problems
from inhaling dusts and powders.
Health problems related to poverty, rather than work conditions, are also reported, including malnutrition
and anemia from insufficient food intake and tuberculosis from crowded living quarters.
Health problems are
common and varied

74
Home‐based Workers: Dynamism Assessment
Though challenges exist, there is a strong foundation to build from in seeking to address the needs of
home‐based workers.
Perspectives and Ways Forward Opportunities
• Three approaches to improving home‐based worker health:
– Ensure home‐based workers have access to health care.
– Minimize their occupational risks and health impacts.
– Deem the health and safety risks of this work as being too high
to be acceptable and change business practices or laws and
regulations to prevent it.
• Success will require working across sectors. Though clear links
between work and health are seen, tackling the issue calls for
looking beyond the immediate work context, and for looking for
synergy between development and social protection approaches.
(Sudarshan and Sinha 2011; Sudarshan and Jhabvala 2009)
• Importance of participation. The participatory approach is an
effective tool for encouraging workers to participate in improving
the quality of their own lives. Home‐based workers working
together is essential to create better working conditions.
(Manothum and Rukijkanpanich 2010; Rinehart 2004)
• Social responsibility of business in labor protection. Large
employers and their subcontractors should be involved in
protection schemes for homeworkers. When supply chains have
been made visible, consumers have been successfully engaged in
holding companies accountable for worker conditions. (Rinehart
2004; Chen, Jhabvala, and Lund 2002)
• Utilize existing institutions. Instead of creating new parallel
structures, existing ones, such as trade unions, training institutions,
or health facilities, should be utilized and strengthened for better
outreach to the target communities. (ILO 2011)
• Advocacy efforts by groups such as WIEGO and HomeNet have increased
awareness of the size, importance, and problems of the informal economy
generally, and home‐based workers specifically.
• ILO and WHO have developed extensive tools for training on occupational
safety and health and implementing experience that can be built upon.
• A number of countries are currently developing universal health coverage
which can provide access to home‐based workers, and can build in
strategies to ensure these workers are included.
• Surveys of women in health micro‐insurance schemes show relatively high
demand for maternity care. Promotion of schemes that offer maternity
care and/or cash benefits could therefore be a first step towards a more
comprehensive intervention package, and a way to promote improvement
in other aspects of working and employment conditions. (Rinehart 2004)
Challenges
• There is a lack of good data on home‐based workers, and in particular on
the health effects of home‐based work. The ‘place of work’ variable is not
included in many labor force or population surveys, and there are
variations in the definition of home‐based workers in existing data.
• Home‐based workers are isolated and can be hard to find or organize.
• Extreme poverty of many home‐based workers, and their position at the
bottom of the value chain, make it hard to contribute to schemes.
• The global economic forces driving the increase in home‐based work are
beyond the reach of most interventions.

75
Home‐based Workers: Impact Assessment
Root causes that drive health vulnerabilities among informal workers suggest
four high‐level outcomes to prioritize for a potential Rockefeller Foundation initiative.
Healthier Workers:
Reduced need by
health services
1. Preventive health
2. Work‐related flexibility
for food, hygiene, etc.
Improved access to
health care
1. Improve access: location
and hours, etc.
2. Improve quality issues
1. Reduce risk of income/job
loss when using care
2. Reduce cost of care
Sustainable Steps:
practices to assure
health and safety
1. Support services
2. Policies to recognize
informal workers
• Provide primary care
services, esp. maternal,
newborn, child and
reproductive health issues.
• Improve the quality of food
available to home‐based
workers.
• Ensure home‐based workers
have adequate protective
gear or equipment for their
work and for their families
who may be exposed.
• Develop convenient service
delivery ‐ may need to deliver
home‐based care.
• Ensure that home‐based
workers have access to
trained personnel (esp. for
vision, repetitive motions,
etc.), diagnostics and
treatment.
• Use technology to promote
excellence in medical record
documentation.
• Develop protections against
job loss for time taken to seek
health care.
• Implement insurance or other
mechanisms for work‐related
health issues (e.g., vision,
ergonomics, etc.).
• Promote costs of
treatment/equipment,
including eyeglasses, physical
therapy, medication, etc. to
alleviate symptoms.
• Increase the visibility of home‐based
workers and their
health concerns through
awareness‐raising campaigns.
• Promote child care programs
to assist mothers who need to
seek health care.
• Support policies that enable
an upgrade of facilities
(homes) to reduce health
problems and to meet OHS
regulations.

Number and Distribution of informal Manufacturing Workers
• Definition: Informal manufacturers generally work in labor‐intensive consumer goods industries such as garments, footwear, toys, handicrafts, and consumer electronics.
Tiered networks of contractors make finished goods for foreign buyers. Some informal manufacturing workers are employed in factories or workshops, generally with fewer
than 100 workers, and as many as half or more are homeworkers. Together they form the bottom layer of international value chains. Manufacturing homeworkers receive
raw material from a contractor or intermediary and follow strict instructions to produce a good that is marketed by others. In many countries, the garment industry is the
largest sector employer in manufacturing; it has a particularly high proportion of homeworkers.
• Population: There are at least 75 million in the 32 countries included in the ILO/WIEGO database. Because a large portion are homeworkers, and the database numbers for
some countries may only include factory based workers, this is likely a significant underestimate. The number of informal manufacturing workers has grown over the past
thirty years, as manufacturing boomed first in east Asia, then southeast, then south Asia and Latin America, leading to increases in manufacturing workers overall, and an
increasing proportion of informal workers.
• Gender: Women play a significant role in manufacturing; they make up more than a third of the manufacturing labor force in some countries, and almost one‐half in some
Asian countries. The food processing and garment industry workers are predominantly women, and most homeworkers are women. As production becomes more technical,
however, men squeeze women out and take the more skilled jobs. Factories tend to hire women before they are married or pregnant, and let them go when they are.
Homeworkers are often also balancing household work and child care.
income countries, as in south Asia and sub Saharan Africa, subcontracting is becoming a more common aspect of the domestic manufacturing market as well. The
manufacturing boom in Asia led directly to an expansion in informal workers, whereas in Latin America workers were pushed from formal to informal employment as
companies strove to maintain internationally competitive prices. In only a few African economies is subcontracting from formal to informal sector enterprises widely found.
Manufacturing homework is common and found in both rural and urban areas in Asia. It is less common in Latin America, and only in the cities. In Africa there is little
manufacturing homework. In Asia, manufacturing homework households tend to cluster, based on the kinds of goods they produce.
76
Manufacturing Workers: Introduction
• Geography: Subcontracting, and thus informal manufacturing workers, is more prevalent in middle income countries, such as east Asia and Latin America, but in lower
*Data from ILO/WIEGO database on Informal workers. Because such a high proportion of informal manufacturing workers are
homeworkers, which are difficult to count, these are likely underestimates. Asia = 8 countries: China, India, Indonesia, Pakistan,
Philippines, Sri Lanka, Thailand, Vietnam. Africa = 8 countries: Cote d’Ivoire, Liberia, Mauritius, Namibia, South Africa, Tanzania, Uganda,
Zambia. Latin America = 16 countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador,
Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela.
• Exposure to high levels of dust, noise, and repetitive, stressful use of
hands and feet in textile factories often results in lung disease,
hearing loss, and repetitive strain injuries.
• Food manufacturing is associated with many repetitive strain
injuries, a high accident rate, and exposure to biological hazards.
• Carpal tunnel syndrome and hand and wrist tendonitis is common in
factory workers.
• Chemical exposure is common, specifically with goods like metal
products and plastic boats and in the case of some dyes.
• A high proportion of homeworkers suffer health impacts of their
work. Shoulder pain and backache are the most commonly reported.
Few homeworkers seek treatment.
• Incense making results in injury to the skin and eyes, and inhalation
of toxins which cause lung irritation and can lead to asthma.
• Poor factory conditions can directly endanger workers’ health, as in
the case of factory fires.
POPULATION* TOTAL Asia Africa Latin Am.
# of informal manufacturing
% of manufacturing workers
60%
67%
51%
42%
that are informal
(out of 129 mil)
(out of 94 mil)
(out of 4 mil)
(out of 31 mil)
that are manufacturing
workers
20%
(out of 399 mil)
21%
(out of 292 mil)
15%
(out of 14 mil)
14%
(out of 93 mil)
% of informal manufacturing
34%
(26 mil)
30%
(19 mil)
22%
(.45 mil)
50%
(6.5 mil)
Health Issues

77
Manufacturing Workers: Health impacts
Homeworkers
• An empirical analysis of factors affecting women homeworker’s health in
India and Pakistan concluded that overall health status was more
associated with poverty, rather than their work.
• The exception was Incense making, which was found to have a negative
effect on health. It involves exposure to toxic chemicals, normally
handled with bare hands, leading to discoloring and injury to the skin.
Workers inhaled dust and toxins causing irritation in the upper
respiratory tract that resulted in asthma in many cases. In none of the
cases treatment sought, despite awareness of the health problem.
(Mehrotra and Biggeri 2002)
• In the same study, 48% of homeworkers reported health problems due
to work. In all sectors some 30 to 71 per cent of homeworkers faced
work related health problems. Shoulder pain and backache were the
most commonly cited problems. (Mehrotra and Biggeri 2002)
• Homeworkers are generally subject to poor environmental conditions,
sometimes hazardous occupations or processes, poor lighting and
ventilation, non‐availability of safety devices, exposure to toxic
substances, dangerous gases, and postural and spinal disorders.
(Mehrotra and Biggeri 2002)
• Homeworkers rarely have appropriate protective equipment and may
be unaware of safety measures. (WIEGO)
• Low price per piece means that other family members, particularly
children, are often engaged to increase piece production – thus exposing
them to the occupational hazards as well. (WIEGO)
• Use of toxic materials exposes other members of the household even if
they are not involved in production.
• Health risks for homeworkers, and consequently their families, in the
garment industry include repetitive strain, dust from cloth pieces and, in
the case of some dyes, exposure to poisonous chemicals. (WIEGO)
Factory‐based Workers
• Textile factories expose workers to high levels of dust, noise, and repetitive, stressful
use of hands and feet, which often results in lung disease, hearing loss, and repetitive
strain injuries. (Goldman and Hatch 2000)
• Food manufacturing is associated with many repetitive strain injuries, high accident
rate, and exposure to biological hazards. (Goldman and Hatch 2000)
• Manufacturing is one of the highest risk sectors for occupational hazards, and ¾ to all
of manufacturing workers may be exposed. (Benach et al 2007)
• Use of factory machinery or improperly sized tools can results in carpal tunnel
syndrome and hand and wrist tendonitis. (WHO 2006)
• Chemical exposure is common, specifically with goods like metal products and plastic
boats and in the case of some dyes. (Benach et al 2007)
• Irregular work availability, and therefore income, fluctuating with buyer driven
demand, as well as long and irregular working hours. (WIEGO)
• Many informal workers work in unregulated factories that do not meet industry code,
illegally constructed and lacking proper fire safety measures such as fire extinguishers
and emergency exits, which can results in devastating factory fires.
– In Bangladesh in Nov 2012, 120 workers were killed at a Tazreen Fashions factory
making clothes for several European brands.
– Fire at a Smart Export Garments factory in Jan 2013 killed 7.
– More than 700 people have died in Bangladesh factories since 2005, mostly in the
garment industry. (Business Insider)
– Since Nov 2012, Bangladesh has also experienced 18 other nonfatal factory fires.
(New York Times)
• The mass fainting of workers has become a regular occurrence in garment and shoe
factories in Cambodia, affecting dozens to several hundred workers at a time, with
2,400 workers fainting in 2011 alone. (Merk 2012)
– Investigations identified several contributory factors: inadequate ventilation;
noxious chemicals; low blood sugar; malnutrition; dehydration; food poisoning; long
working days; and mass hysteria.
• Export Processing Zones are often associated with poor work environments and work
practices, including un‐paid overtime work, inhuman working hours and deficient
health and safety. In some factories workers are locked into the workplace during
working hours, and workers have died in fires while being locked in. Poor ventilation,
failure to provide medical attention, and lack of proper accommodation are other
examples of EPZs employment practices. (Benach et al)

Manufacturing Workers: Interventions
• ILO’s Work Improvement for Small Enterprises (WISE) program relies on the initiative of the local people, entrepreneurs
and workers. They are guided to look at good local examples, check available local solutions, plan and implement actions
which will be useful for improving working conditions and productivity.
• ILO’s Work Improvement for Safe Home (WISH) program responds to the immediate needs of homeworkers and
provides them with practical, easy‐to‐implement ideas to improve their safety, health and working conditions. These
improvements will also contribute to higher productivity and efficiency of their work and promote active participation
and cooperation of home workers in the same workplace or in the same community.
• Increased oversight, and in particular onsite inspections, are an important aspect of factory safety.
• Publishing compliance with indicators, at the factory level, including the naming on clients, encourages unwilling
manufacturers and buyers to address health‐threatening violations.
• ILO’s Better Factories Cambodia project seeks to improve working conditions of factories in Cambodia and compliance
with international labor standards. Manufacturers must participate in order to earn an export license. Factory monitoring
is key and factories must sign an MOU allowing full access to ILO monitors, of premises, documents, and interaction with
workers. BFC has produced “Good practice sheets” and comic books on other topics, such as health.
78
• Social protections can reduce the financial shocks of an injury or health event, which can devastate an entire family,
by providing access to affordable health care.
• UMASIDA is an umbrella health insurance organization for the informal economy in Dar es Salaam, whose main
objective is to provide health care to all its members and their families on an insurance basis.
• The government of India established Worker Welfare Funds for several categories of informal workers, providing a
variety of social protections, including access to health facilities. Among the adult women workers, those covered by
the funds are much more likely to seek health care.
Voluntary
Codes of
Conduct
Workplace
Training
Regulation
Social
Protection
• Some apparel retailers have voluntarily adopted codes regarding ethical work practices and worker protections that
improve conditions for the workers in their supply chain, which can an have a positive effect on the business as well.
• The Ethical Trading Initiative is a tri‐partite membership organization made up of companies, NGOs and Trade Unions.
Member companies are required to adopt the ETI Base Code, which is derived from core International Labor Standards,
and to commit to ensuring compliance with the Base Code throughout their supply chains.
Current interventions to improve the health of informal manufacturing
workers are of several distinct types.

79
Manufacturing Workers: Impact Assessment
Healthier Workers:
Reduced need by
health services
Improved access to
health care
Sustainable Steps:
practices to assure
health and safety
• Regulate and inspect
factories to improve
working conditions.
• Provide training to workers
and employers on safer
working practices.
• Ensure provision and use of
appropriate protective
equipment.
• Provide mobile health
services at factory sites, or
in EPZs.
• Use outreach workers to
link workers with existing
care facilities.
• Increase community clinics
in areas accessible to home‐based
workers.
• Flex hours at community
health clinics.
• Ensure informal workers can
access and afford entry into
existing national schemes.
• Hold employers liable for
costs associated with work
place injuries and health
impacts.
• Compensate workers for
wages lost while seeking
care.
• Hold international
companies responsible for
conditions all the way down
the value chain of their
products.
• Publicize level of compliance
with international labor
standards.
• Require EPZs to meet
international labor
standards.

80
Street Vendors: Introduction and Landscape
Definition and Overview of Street Vendors
• Definition: Street vendors constitute an heterogeneous group.
– They sell goods and services in public places without a permanent or legal built‐up structure from which to sell. In many countries,
they are relocated to public markets that are privately owned and converted to off‐street markets.
– Street vendors can be non‐mobile or mobile (use of cars, bicycles etc.).
• Population:
– Along with home‐based workers, street vendors are the largest sub‐group of the informal workforce. Both groups represent 10‐25%
of non‐agricultural workforce in developing countries and >5% of total workforce in developed countries.
– Statistics likely undercount the number of street vendors: street vending is usually a secondary, seasonal, temporary, or part‐time
income‐generating activity and tends not to be reported in labour force surveys by fear of sanctions.
• Gender: Women represent 30%‐90% of street vendors, except in countries restricting women’s mobility (e.g. India, Tunisia).
Key international organizations
Major national & regional organizations
Kenya South Africa India
Health Issues
Working Environment Medical Condition
• Harassment from officials
(including payoffs) diminish the
funds available to address health
issues.
• Lack of proper sanitation
infrastructure.
• Roadside and fire incidents.
Policies and Programs
• Strengthening street vendors’
voice and bargaining capacity.
• Implementing street vendor
friendly urban policies.
• Pulmonary, stomach‐ and liver‐related
problems.
• Strains and joint pains.
• Headaches, eye infections and
stress‐related diseases.
• Dehydration and malaria.
• Micro‐insurance (VimoSEWA)
• New concepts introduced in
Ghana (SSNIT) on contributions
and collaterals.

81
Street Vendors:
Working
Conditions
Main Diseases
and Medical
Conditions
• Harassment from official forces: street vendors lead a precarious existence, facing the threat of fines,
confiscation of goods, eviction and destruction of their property. In Mumbai, each street vendor pays 15 to
20% of his daily income (that consequently cannot be used for health purposes) as bribes to local police.
• Lack of proper sanitation infrastructure such as running water, toilets, and solid waste removal systems. In
Johannesburg, 52% of interviewed street vendors reported not to be comfortable with their working
environment, for reasons ranging from lack of shelter and dirt (34%), noise (26%) and having to clean the
area themselves (24%).
• Accidents: Street vendors are exposed to market fires and, when occupying roadsides, to traffic incidents,
pollution and exposure to the elements.
• Long working hours: frequently 11 hours a day.
Pulmonary problems
(bronchitis, asthma):
• Constant exposure to
dust and pollution.
• 30% of Indian street
workers have chronic
respiratory problems.
Strains and joint pains:
• Inappropriate work
posture and heavy
lifting.
workers suffer from
backache. Dehydratation:
Malaria:
Mosquitoes in stacked
sacks of rubbish, blocked
gutters and stagnant
puddles.
Exposure to sun and
heat.
Chronic headaches:
From car fumes, dust,
heat.
Eye‐related problems:
Blurry vision caused by
dust and pollution.
Stomach‐ and liver‐related
problems:
• Food poisoning:
ingestion of food
prepared in areas with
poor sanitation.
vendors have stomach
problems and about
24% have liver
problems.
Stress‐related diseases
Migraine, hyper acidity,
hyper tension and high
blood pressure.

82
Street Workers: Dynamism Assessment
National and International Initiatives Health Insurance Initiatives
Geared towards formulation of policies allowing informal street
vendors to access formalisation in a more inclusive way as street
vending is illegal in most countries and perceived as a nuisance.
National initiatives:
India’s National Policy on Urban street vendors (2009) aims to:
• Promoting access of street vendors to such services as credit, skill
development, housing, social security and capacity building.
• Putting an end to bribery, evictions, harassment .
• Giving street vendors a legal status and vending zones in urban
planning.
• Promoting organizations of street vendors and their participation
to urban policies (via Town Vending Committees).
• Its implementation since 2004 has been weak and uneven.
Initiatives at international and regional levels:
Street vendors associations are being developed at international,
regional and national levels in order to :
• Raise awareness.
• Strengthen the voice and bargaining capacity of informal workers.
• Implement street vendor friendly urban policies.
• Promote solidarity between organizations of street vendors and
hawkers.
Failure of governments in implementing an efficient health insurance and
social protection to informal workers in general:
Ghana: National Health Insurance Scheme (2003)
• NHIS is a hybrid of the social and community based health insurance
models. It extends social protection to informal workers.
• But the World Bank predicts it will go bankrupt in 2013. NHIS premium
cannot be afforded by most informal workers and Ghanian healthcare
expenses remain dominated by out‐of‐pocket payments.
Thailand: Universal Coverage Scheme or "30 baht scheme" (2001)
The service is financed by general tax revenue with minimal co‐payment of
30 baht. But it is considered of low quality by its beneficiaries.
Successful initiatives and/or promising ideas:
India: VimoSEWA micro‐insurance (1992) implemented by membership‐based
organization SEWA
• Coverage for life, asset loss, widowhood, personal accident, sickness and
maternity benefits is not restricted to SEWA members: it was extended
to children and husbands of members in 2002 and 2003.
• Out‐of‐pocket payments to be later reimbursed by Vimo SEWA.
Ghana: SSNIT Informal Sector Fund (2008) relies on interesting financing
concepts for contributions and collaterals
• Voluntary contributory fully funded personal pension scheme designed
for 15y‐59y informal workers in formal sector establishments.
• Contribution rates are not fixed but based on members’ preference and
ability, on the occurance that suits them most.
• Members can use their contributions as partial collateral to secure credit
from approved financial institutions.

83
Transportation Workers: Introduction
Number and Distribution of informal transportation workers
• Definition: Informal workers in the transport of passengers, goods and freight, by road, rail, boat, and air. This includes not only workers conducting
the transportation, such as drivers and conductors, but also supportive workers, such as mechanics, fuel venders, packers, loaders, porters,
warehouse workers, cleaners, guards, clerks, queue marshals, food venders, and touts. Some definitions also include fisheries workers.
• Population: 37 million in the 32 countries included in the ILO/WIEGO database. Grew substantially over the past two decades; likely to continue
growing. (ILO/WIEGO database; Bonner 2006)
• Gender: The vast majority are men: 97% in Africa and Asia and 92% in Latin America. (ILO/WIEGO database)
• Geography: The majority are in Asia. India has the most with 17.5 million, followed by Pakistan and the Philippines with just over 2 million each.
Brazil, Colombia, Mexico, and Vietnam also have more than one million each. (ILO/WIEGO database)
Data from ILO/WIEGO database on Informal workers.
Asia = 8 countries: China, India, Indonesia, Pakistan, Philippines, Sri Lanka, Thailand, Vietnam.
Africa = 8 countries: Cote d’Ivoire, Liberia, Mauritius, Namibia, South Africa, Tanzania, Uganda, Zambia.
Latin America = 16 countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador,
Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela.
International bodies: International Transport Workers' Federation; International
Transport Forum (within OECD); International Labor Organization (ILO)
National or local transport workers unions that include informal workers: Pakistan
Transport Workers’ Federation; All‐Sindh Private Bus Transport Workers’ Union; Bus
Driver and Motor Taxis Association of Zambia; Kenya Long Distance Truck Drivers’ Union;
Jatiya Rickshaw Shramik League; Syndicat National des Travailleurs des Transports
Routiers (SNTTRS); Syndicat National des Zemidjan du Benin (Synazeb)
There is significantly more information available about
road transport workers than any other group, and much of
the following applies to them.
• Weak lungs, coughs, colds, rhinitis, headaches, and
cancer, from inhalation of pollution including carbon
monoxide, sulfur oxide, volatile organic compounds,
toluene, and fine airborne particles.
• Back aches, overall muscle aches and pains, and
sprains from lifting too heavy objects, managing freight
without appropriate equipment, and long exposure to
whole‐body vibration.
• Hearing damage from prolonged loud noise exposure
• Serious injury and death from traffic collisions.
• Lack of protection from the elements including rain,
sun, extreme temperatures.
• Fatigue and sleep deprivation from long and irregular
hours and overnight work, contributing to accident risk
and exacerbating other health problems.
• HIV/AIDS exposure common among long distance
truckers in Africa and parts of Asia.
• Drug use common among overnight and long distance
drivers.
POPULATION TOTAL Asia Africa Latin Am.
# of informal transport
% of all transport workers
61%
67%
38%
56%
that are informal
(out of 59 mil)
(out of 39.7 mil)
(out of 6.1 mil)
(out of 13.5 mil)
that are transport workers
9%
(out of 399 mil)
9%
(out of 292 mil)
16%
(out of 14.2 mil)
8%
(out of 93 mil)
% of informal transport
5%
(1.8 million)
4%
(1.1 mil)
3%
(.06 mil)
8%
(.61 mil)
Health Issues
Actors in the Space

84
Transportation Workers: Problem Assessment
• Low wages – Most net $1‐4 dollars a day. (WIEGO)
• Irregular income – often hired by the day or by the job,
or pay is contingent on that day’s business.
• Debt – sometimes half of daily pay given for vehicle lease
fee.
• Long working hours – 16‐20 hours/day commonly
reported. (Cervero 2000; Bonner 2006; ILO 1989)
• Irregular working hours – often required to work for long
stretches, or overnight.
• No time off or sick days.
• Poor maintenance of vehicles and roads.
• Crowding of vehicles with passengers and freight.
• Lack of adherence to safety regulations.
• Workers live in extreme poverty and cannot
afford health care, or to buy into health
insurance schemes.
• Inadequate equipment for lifting and handling freight.
• Long exposure to whole‐body vibration.
• Inhalation of fumes – exhaust from from adulterated
fuel and 2‐stroke engines causes pollution including
carbon monoxide, sulfur oxide, volatile organic
compounds, toluene, and fine airborne particles.
• Lead exposure from fuel.
Urbanization and
Privatization Led to Increase
in Informal Transport Work
Weak Regulation and
Strong Competition Lead to
Poor Working Conditions
Informal Transportation Work
Has Direct and Indirect
Impacts on Health
Over the past quarter century, liberal
economic policies have pulled workers
to urban centers in the global south,
requiring transportation for both an
expanded urban workforce and
increased production and export.
Overburdened public systems were
then subject to structural adjustment
programs pushing deregulation and
privatization of public transportation.
The inability to meet demand, and
fragmentation and outsourcing
following privatization caused the state
run bus and rail services to effectively
collapse in many developing countries.
This fueled a transition from formal to
informal transportation work, spurred
on by rising unemployment and rates of
urban poverty, and pushed workers out
of social protection and union
organization.
Though some work informally to avoid
registration or taxation, for increased
flexibility, or because of tradition, the
vast majority of informal transportation
workers do so due to deep poverty and
a lack of alternatives, choosing to work
informally in order to survive. Informal
transport workers are among the
poorest of the working poor.
• Inadequate or absent social protection – no pensions,
healthcare, disability grants, unemployment, maternity
benefits, and accident/life insurance coverage.
• No time to access health care when needed.
• Fatigue and sleep deprivation increase risk of
accidents.
• Drug addiction common among overnight and
long distance drivers.
• Increased road collisions
• Increased injury when collision occurs.
• Musculoskeletal injury including back aches,
overall muscle aches and pains, and sprains.
• One incident of ill health or accident can mean
disaster for the entire family.
• Chronic respiratory diseases, reductions in
pulmonary function, lung cancer.
• Headaches
• Circulatory impairments
• HIV/AIDS exposure high amongst long distance
truckers.
• Hearing loss
• Exposure to the elements – lack of protection against
rain, sun, heat.
• Prolonged exposure to loud noise.
Among the poorest of the working poor, transportation workers struggle to survive while
facing significant health risks in their work and without social protections.

85
Transportation Workers: Landscape and Dynamism
Trade Unions and Worker Associations Role for Governments
• There is an important role for national and local governments.
• In some cases, as in the Philippines, informal employment is protected legally,
but enforcement of the law is weak and often non‐existent.
• Government can help workers overcome the barriers to enrollment in existing
national social protection.
• Government policy can increased transport worker income by reducing fuel
prices; raising fares; reducing government taxes, duties, and permit and
registration fees; and curbing extortion and harassment.
• Government regulations can increase worker safety, by paying incentives to
scrap older, unsafe vehicles and passing laws requiring helmets for
passengers and drivers and other appropriate safety equipment.
• Government may decide to phase out some forms of informal transport, but
would need to ensure compensation and alternative livelihoods are provided.
Brazil – Health Family Program – a new strategy of prevention and health
promotion that covers informal workers. (Santana and Loomis)
Challenges
• There is a lack of reliable, comparative data. Much of what is available is
about road transport workers; far less is available for other subsets.
• The trade unions seem to be the only groups engaged on the issue.
• When social protections are theoretically available, such as voluntary
membership in a government scheme, transportation workers are often too
poor to access them. In the Philippines, for example, only 42% of families had
a member who had joined the social insurance program, and only 28% of the
families in the poorest 30% had; in Kingston, Jamaica, only 3% of minibus
drivers had health insurance; very few informal transport workers have joined
the national pension scheme in Zambia. (Pascual 2006; Cervero 2000; Bonner 2006)
• Root causes such as increasing urbanization and manufacturing, the collapse
of public transportation, and poverty, are difficult to address.
• A number of trade unions and worker associations have formed for
informal workers, or allowed informal workers to join.
• Though their primary purpose is often to maintain or raise levels of
income for their members, a number have established basic social
protection schemes, such as micro insurance or mutual aid health
schemes, as well as campaigning for inclusion in state‐administered
social protection programs.
– The Pakistan Transport Workers’ Federation, and The All‐Sindh
Private Bus Transport Workers’ Union, maintain small funds
collected from union dues, to assist members in times of crisis,
such as illness, injury or death.
– Syndicat National des Zemidjan du Benin‐Synazeb (Synazeb) pays
drivers a grant in the case of road accidents to cover health care or
vehicle repair costs, if the driver is up to date with his union dues.
A branch level mutual health savings covers 80% of the cost of
treatment at health care centers where the union has an
agreement. However, these structures are facing severe financial
problems because of the large number of accidents.
– The Syndicat National des Travailleurs des Transports Routiers
(SNTTRS) in West Africa is currently working with the ILO to
develop a health scheme for members and their families.
– In Benin the Social Security Mutual Insurance Fund of the Informal
Workers of Cotonou provides informal workers with health
coverage, pension, and disability insurance, managed jointly by the
state and several unions and workers’ organizations. However, it
has low membership emphasizing the need for unions to ensure
their members are aware of the fund and encourage them to join.
– The Jatiya Rickshaw Shramik League negotiates with municipal
authorities get free access to medical facilities for its members.

86
Transportation Workers: Impact Assessment
Healthier Workers:
Reduced need by
health services
Improved access to
health care
Sustainable Steps:
practices to assure
health and safety
• Promote respirator use for
drivers exposed to pollution.
• End use of leaded fuel.
• Lower fuel costs to reduce
use of adulterated fuel.
• Incentivize removal of old,
poorly maintained vehicles .
• Pass and enforce laws
promoting worker and
passenger safety, such as
wearing helmets.
• Crack down on unsafe
driving practices.
• Ensure informal workers are
eligible for national social
protections where available.
• Support trade union and
worker association
negotiations for member
access to affordable health
services.
• Provide medical care at
transportation hubs, such as
ITF/ILO collaboration to run
wellness centers with free
medical services.
• Provide accident protection or
disability insurance through
national schemes or worker
groups.
• Underwrite group health
insurance schemes provided
by worker associations to
ensure viability.
• Erase cost of entry for
informal workers into national
health insurance schemes.
• Strengthen public
transportation systems to
promote shift back to formal
transportation work, and
ensure public transportation
meets the needs of other
informal workers who often
rely on informal
transportation.
• Hold large companies
accountable for worker
conditions in subcontracted
transportation services.

87
Waste Pickers: Introduction and Landscape
Definition and Overview of Waste Pickers
• Definition:
– Waste pickers are split into different categories and have limited common interests: itinerant waste buyers, street waste pickers,
municipal waste collectors, dump pickers, waste recyclers etc. They constitute the lowest social level of society.
– The informal waste management sector saves cities about 15‐20% of waste management budget: it reduces the amount of waste
cities would otherwise have to collect and dispose of. Most of the avoided costs concern waste collection: the informal sector
performs c. 50‐100% of waste collection in most cities in developing countries at no cost to the city budget.
• Population:
– 20 million informal waste pickers (about 1% of the urban population in developing countries) is involved in informal scavenging
– Children waste pickers (e.g., 45,000 in Brazil) are particularly exposed to health issues.
• Gender: Little information is available on gender repartition.
Key International Organizations
Major National and Regional Organizations
South America Asia
Health Issues
Working Conditions
Policies and Programs
• Raising group awareness.
• Legalizing and including informal
waste pickers within the formal
system (e.g., India and Brazil).
Medical Conditions
Higher vulnerability of informal
waste pickers to:
• Waste‐related safety hazards and
vectors of diseases.
• Accidents and injuries.
• Unhygenic working conditions.
• Headaches, pulmonary, eye and
stomach‐related problems.
• Accidents.
• Lacerations and cuts.
• Strains and joint pains.
• Infections and parasites.
• Suggestions from researchers to
improve health conditions.
• Medical insurance initiatives in
Pune (India) and the Philippines.

88
Waste Pickers:
Problem Assessment – Health issues
• Waste is an ideal habitat for disease vectors (flies, insects, rats) and poses a risk of infection because it is
combined with rainwater and contains faecal bacteria/ animal carcasses.
• Different types of waste can be hazardous, include toxic materials and expose waste pickers to high
concentrations of pollutants (via direct contact, inhalation, consumption of waste food): e.g., Hospital or
industrial waste.
• Sharp objects (needles, nails, knives, broken glass etc) cause cuts during collection and sorting.
Working
Conditions
Waste‐related
Safety Hazards
Main Diseases
and Medical
Conditions
• Unhygienic and difficult working conditions: long working hours (12 hours a day) combined with the absence
of protective gear, sanitary service, shelter/warehouse to protect from rainwater, health care or social benefits.
• Accidents and injuries happen 10x more often for solid waste workers than for the baseline population and as
a result, solid waste workers have a up to 30% higher mortality risk. The risks are greater for waste pickers
working at open dumps and landfills compared to street waste pickers. They are caused by dog bites, moving
trucks and exposure to toxic fumes.
• Informal waste pickers are faced with greater dangers than formal waste pickers because their living and
working environments often overlap: they live in informal settlements, on the streets or at and on the landfill
sites.
Pulmonary problems
(bronchitis, asthma):
1.4‐ to‐2.6‐times more
frequent for solid waste
workers than for the
Strains and joint pains:
twice as frequent for
solid waste workers
than for baseline
population.
Dizziness, headaches
and nausea:
Exposure to emissions
of methane, carbon
dioxide & monoxide.
Laceration‐related
issues can lead to
infections, such as
tetanus, hepatitis, or
HIV.
Eye‐related problems:
conjunctivitis and
blurred vision (due to
dust and fumes).
Risk of infections and
parasites:
3‐ to 6‐times higher for
solid waste workers
than for the baseline
population.
Stomach‐related
problems:
acute diarrhoea (linked
to consumption of or
contact with waste
foods) happens 10x
more often for solid
waste workers than for
the baseline population.

89
Waste Pickers: Dynamism Assessment
Inclusion and Legalization Health Initiatives
International initiatives
IWPAR Project (Project for Informal Waste Pickers And Recyclers
organized by Enda) aims to promote the protection and inclusion of
popular collectors and recyclers of waste in Colombia, Ethiopia,
Madagascar and Vietnam and will last from 2011 to 2013.
National and regional initiatives: raising awareness for legal
recognition and integration of informal waste pickers
Recognizing the legal status of informal waste workers
• India: The National Environment Policy (2006) and The National
Action Plan for Climate Change (2009) recognize the legal status
of the informal sector in waste collection and recycling. They aim
at enhancing informal workers’ access to institutional finance and
relevant technologies.
• Brazil: The National Solid Waste Policy (2010) institutes a number
of mechanisms to support cooperatives and municipalities that
integrate informal workers into solid waste systems.
• Brazil and Colombia have the largest and best established
national movements of waste pickers (MNCR, MNRP) in South
America while Peru and Chile are only beginning to organize.
Providing informal waste workers with identity cards to help with
social acceptance and recognition.
Many informal waste workers are immigrants or do not have any
official identity document. This personal insecurity and subsequent
harassment by police or officials can be reduced by the provision of
identity cards, e.g. Project for the Empowerment of Waste Pickers by
the Women’s University in Pune.
Researchers’ suggestions to improve the health status and working
conditions of waste pickers:
• Providing protective equipment (gloves, clothing, boots and face masks),
clean drinking water and sanitation facilities near the working place.
• Registering all waste pickers and encourage participation in a regular
vaccination and health examination program.
• Establishing micro‐insurance as a solution for specific health and pension
systems.
• Encouraging the separation of hazardous materials from municipal
wastes within the population.
Medical insurance schemes
India: Implementation of a scheme for medical insurance for all registered
waste pickers by the Pune Municipal Corporation:
• Payment of health insurance premiums for KKPKP members to New India
Assurance Company in recognition of their financial and environmental
contribution by the Pune municipality.
• Reimbursement of hospitalisation costs of up to Rs.5000 by the insurance
company.
Philippines: The Comprehensive Integrated Delivery of Social Services
(CIDSS) is a program of the Department of Social Welfare and Development
that provides assistance to informal workers including waste pickers.

Informal Employment in 12 Countries Reporting
(ILO & WIEGO)
90
Informal Worker Profile – Africa
Employment in Millions, 12 Countries* Reporting (ILO & WIEGO)
Wage workers
28%
Number and Distribution of informal Workers in Africa
40
35
30
25
20
15
10
5
Contributing
family workers
10%
Non‐wage
workers
62%
Appendix
Non‐Agricultural Informal Employment in
12 Countries Reporting
(ILO & WIEGO)
Population:
• As many as 152 million informal workers. (R4D calculation)
ILO/WIEGO estimates 32 million informal workers (2% of 1.8 billion
global informal workers), 45% of the total workforce, or 53% of the
non‐agricultural workforce, from the 12 countries reporting.
• In 2002 ILO estimated that the informal economy is 72% of non‐agricultural
employment in sub‐Saharan Africa.
• Benach et al estimate the informal share of Africa’s non‐agricultural
workforce at 80%.
• In 1990, UNDP estimated a total African workforce of 235 million.
Gender:
• In ILO/WIEGO reporting countries, women comprise 27‐52% of the
non‐agricultural informal wage workforce and 31‐67% of the non‐agricultural
informal self‐employed workforce.
• Informal agricultural wage employment rate is 3‐48%; informal
agricultural self‐employment rate is 25‐58%.
• In sub‐Saharan Africa 84% of women non‐agricultural workers are
informally employed compared to 63% of male non‐agricultural
workers, according to the International Poverty Centre in 2008.
• Most women in the informal economy in Africa are either self‐employed
or unpaid workers in family enterprises, mostly working
as own‐account traders and producers or casual and subcontracted
workers.
• Women are under‐represented in high income activities and over‐represented
in low income activities such as subcontracted work.
Agriculture Non Agriculture Combined
Formal employment 22 17 39
Informal employment 13 19 32
Total employment 35 36 71
*Lesotho, Liberia, Madagascar, Mali, South Africa, Tanzania, Uganda, Zambia, Namibia, Côte d'Ivoire,
Mauritius, Zimbabwe
(numbers in millions)
Formal
Sector
Informal
Sector
Formal Employment 17 .5
Informal Employment 5 14
13
7 7
2 1 2
22
9
3
2 1
4
0
Informal employment
Formal employment2
Leading sectors of informal work # of workers
% of informal
work
Agriculture (not including small scale
farmers) 13 mil 41%
Domestic workers 5 mil 16%
Uncertain,
Home‐based workers
but high

91
The Informal Economy in Africa
Background Characteristics
• The idea of informal employment developed in context of Africa. It has
always been the dominant portion of the economies of most African
countries. It remains the main response to Africa’s continued weak
development and integration into the global economy. In most African
countries formal private wage employment accounts for a small fraction
of total employment, often well below 10%. (Heintz 2009; Schurman et
al 2012)
• Though Asia has seen a substantial increase in exports, other world
regions have hardly increased their export participation or have not
increased it at all. Despite increasing global trade, the benefits have
been very unequally distributed with investment flows concentrated in
a handful of countries. Most poor countries, including most in sub‐
Saharan Africa, have been marginalized from investments, resulting in
competition for a small share of the market, driving down trade returns
and leading to labor market concessions. Increasing debt further
reduces development opportunities. (Benach et al 2007)
• Though global GDP has increased, incomes have declined in sub‐Saharan
Africa, and there are widening disparities in wealth and economic
opportunity. (Lowenson 2001) In all regions, the total number of
working poor at the US$1 level declined between 2001 and 2006 except
in Sub‐Saharan Africa where it increased by 14 million. In 2006 sub‐
Saharan Africa had the highest share in working poverty, with 8 out of
10 women and men living on less than $2 a day with their families.
(Benach et al 2007)
• A pilot survey in Dar es Salaam found that the common roots of many
working and employment conditions problems related to poverty,
insecurity of land tenure, poor education, lack of institutional support
and weak organization. (Rinehart 2004)
• Workers in Africa’s informal economy are characterized by having lower education
and literacy levels compared to the formal sector; by earning much lower wages (44
to 84 %); by working longer hours; and by employing higher proportions of women
and children. (Schurman et al 2012)
• Informal employment accounts for a significantly larger share of total employment
than does formal employment. Though there is notable heterogeneity between
African countries, in most, employment is characterized by a relatively small share of
private industrial employment, a dominance of agricultural employment, and
widespread self‐employment is informal, non‐agricultural enterprises. (Heintz 2009)
• South Africa is a particular exception; informal self‐employment and agricultural
employment are less important than other African countries, it has more wage than
self employed agricultural jobs, and more wage jobs are in the private sector than in
the public. The unemployed do not enter informal employment very quickly. (Heintz
2009)
• In African countries, earnings are typically lowest and poverty rates are highest in
agricultural work. In non‐agricultural informal employment, both wage and self‐employment,
earnings are higher than in agricultural employment, but lower than in
formal employment. (Heintz 2009)
• Child labor remains both pervasive and concentrated in the informal economy of
developing countries in Africa. In some countries more than 50% of children (5 to
14 years old) are workers (Togo, Niger, Guinea‐Bissau, Cameron, Central African
Republic, and Chad), and more than 30% in others. (Benach et al 2007)
• Home‐based workers in Africa are mainly self‐employed in microenterprise, rather
than piece rate workers like their counterparts in Latin America and Asia. (Hiralal
2010; Heintz 2009)
• The informal economy in Africa is dominated by retail trade related activities. Even
formal distributors and manufacturers use informal workers to expand their markets
to low income groups. The informal economy is estimated as contributing 55% to
the GDP of sub‐Saharan African countries, including agriculture (60% without South
Africa and Botswana). (Schurman et al 2012)

92
The Health of Informal Workers
Health Impacts Common Few Health Protections
• World Bank estimates the risk of fatal and non‐fatal occupational injury in the Sub‐Saharan Africa
economic region at five times higher than in Europe and North America (non‐fatal: 160/1,000
workers; fatal: 21/100,000 workers). (Benach et al 2007) Estimates of the burden of occupational
disease suggest that reporting systems in southern Africa probably underestimate the real
burden of occupational disease 50 fold. (Lowenson 2001)
• Informal‐sector risks include poor work organization, poor access to clean water and sanitation,
ergonomic hazards, hazardous hand‐tools, and exposure to dusts and chemicals. Surveys of
informal‐sector workers have fund occupational injury and mortality rates similar to those in the
formal sector, but higher rates of occupational illness. (Lowenson 2001)
• The most significant share of nonwage labor is in agriculture. Studies indicate that injury from
farm implements and draught animals, musculoskeletal injury from long hours with poor work
postures, and agrochemical exposures are common. (Lowenson 1999)
• Export Processing Zones (EPZs) have been associated with high levels of machine‐related
accidents, dusts, noise, poor ventilation, and exposure to toxic chemicals. In the young women
who often work in EPZs, the stress can affect reproductive health, leading to miscarriage,
problems with pregnancies, and poor fetal health. (Lowenson 2001)
• Although new technologies and production processes are benefitting industrialized countries,
liberalized trade has led to the transfer to less developed countries of obsolete and hazardous
technologies, chemicals, processes and waste, including asbestos and pesticides no longer
produced or used in industrialized countries. (Lowenson 2001)
• Occupational risks also spill over to non‐employed populations, through air and water pollution,
and transmission of communicable diseases. Sexually transmitted infections including HIV/AIDS,
for example, are more prevalent in communities along transport routes, or surrounding major
development projects. (Lowenson 2001)
• In sub‐Saharan Africa the spread of HIV/ AIDS is linked to the seasonal migration of workers. A
recent study of commercial farms in Kenya revealed disproportionately high levels of HIV among
agricultural workers. (ILO 2003, WIEGO, World Bank 2002). HIV/AIDS exposure is also common
among long distance truckers in Africa.
• Sub‐Saharan Africa has 11% of the world's
population and 24% of the global disease
burden, but holds only 3% of the world's
health workers. (Benach et al 2007)
• Few countries in sub‐Saharan Africa have free
comprehensive health care services available
to citizens. In some places, state‐funded health
care has completely disappeared. In those that
offer a limited service, there has been a steady
movement back towards a ‘user pays’
principle. Despite common perceptions to the
contrary, the cost of traditional healers is often
as expensive as formal medical care. In
addition, health care services have been
overwhelmed by the high incidence of
HIV/AIDS. (Xaba et al 2002)
• In most low‐income developing countries, such
as Tanzania, not more than 5‐15% of the
working population and their dependents are
covered by statutory social insurance, mainly
for pensions and health. (Xaba et al 2002)
• In Africa unions have never represented a
large proportion of the working population,
unlike in the developed economies. They have
largely focused on defending and advancing
wage employment and those employed in the
formal economy, rather than securing social
protections. (Schurman et al 2012)

Current strategies and insights from previous initiatives are shaping the next health interventions for Africa’s
informal workers.
93
Strategies
Lessons Learned So Far Broadcasting Health
• The African experience has shown that, rather than create new
organizations, greater emphasis should be placed on respecting,
strengthening and developing organizations to which individuals have
freely decided to belong. (Rinehart 2004)
• The most successful programs in Africa have occurred when private
organizations use, adapt and take ownership of the methodology.
(Rinehart 2004)
• Health micro‐insurance schemes that offer maternity care and/or cash
benefits may be ideal groups through which other aspects of working
and employment conditions can be promoted, particularly for industries
or occupations with high prevalence of chemical exposures or physical
stress, which may adversely affect the pregnant mothers and their
unborn children. (Rinehart 2004)
• There are two fundamental requirements for setting up self‐financed
social insurance schemes: the existence of an association based on trust;
and an administration that is capable of collecting contributions and
paying benefits. (Xaba et al 2002)
• Rather than compartmentalizing projects by development discipline,
such as working conditions, decent work, job quality, social protection,
education, poverty, nutrition, etc., all aspects must be addressed in a
concerted effort, to have truly significant impact. (Rinehart 2004;
Moghalu 2002)
• Social protection systems cannot confront all of the health problems
from insecure, hazardous and low‐quality jobs – instead attention
should focus on the source of the hazard. (Loweson 2001)
• In Uganda and Ghana, research suggested that radio was by far the most
common communication medium used by small enterprise workers, and a large
percentage of potential listeners were willing to participate in a call‐in radio
show if it covered issues central to their business situation. A radio program was
developed and aired twice weekly, with caller participation. In part, the program
emphasizes the link between a safe and healthy work environment and a
competitive and growing business. Featured topics on working conditions have
included: safety for people working in restaurants and kitchens; prevention of
chemical burns and chemical poisoning when handling paint, fertilizers,
pesticides, glues and other hazardous chemical substances; and safety tips for
mechanics.
Worker Groups and Trade Unions
• The WIEGO database lists at least 190 informal economy associations in Africa,
including Member Based Organizations of the Poor (MBOPSs), Community Based
Organizations, cooperative, NGOs, and Trade Unions.
• StreetNet, an international street vendor alliance, has a south Africa chapter.
• The Self‐Employed Women’s Union, in Durban, South Africa, organizes women
working in the survivalist sectors of the economy.
• The Syndicat National des Zemidjan du Benin‐Synazeb pays drivers a grant in the
case of road accidents to cover health and runs a mutual health savings program
that covers 80% of the cost of treatment at health care centers where the union
has an agreement.
• The Syndicat National des Travailleurs des Transports Routiers in West Africa is
working with the ILO to develop a health scheme for members and their families.
• In Benin the Social Security Mutual Insurance Fund of the Informal Workers of
Cotonou provides informal workers with health coverage managed jointly by the
state and several unions and workers’ organizations.
• Tanzania Association of Informal Construction Workers provides micro insurance.

94
Approaches to Health Care in Tanzania
Program Description of Program Results for Informal Workers
• Registered workers were required to contribute in
advance, before they were allowed to receive
medical care.
• This NGO registers workers in the informal sector in
member groups and provides health services, helps
groups improve occupational health conditions, and
form health and safety committee.
• Forming worker groups give them more voice in
making positive changes to their working conditions
and family health situations.
• The scheme could not be sustained since, to
most Tanzanians, the concept of paying for
medical care when one is not yet sick was
new – and it still is.
• There is an increased use of health and
safety facilities among participants.
• Fifty‐four per cent of the groups have
established health and safety committees .
• There is an increased availability of
community health providers among
participating groups.
ILO prepaid scheme
Tanzanian Occupational
Health Service (TOHS)
UMASIDA Health
Insurance Scheme
• Umbrella health insurance organization for the
informal economy in Dar es Salaam.
• It provides health care to all its members and their
families on an insurance basis as well as
occupational safety and health measures.
• This program could be incorporated into
state level pilots of the universal
coverage program and could help to
address the accessibility of primary care.
• Launched by ILO in 1994. The objective of the
project was to improve health and safety standards
through the introduction of simple low‐cost
measures for the improvement of informal sector
working and living conditions and the reduction of
diseases and accidents.
Interdepartmental
Project on the Informal
Sector (INTERDEP)
• It covered ten business clusters,
encouraged the formation and training of
safety and health committees within the
micro‐enterprises in each cluster and the
training of one of the members of the
committee as a First‐Aider.
Within a country, several efforts may need to converge to provide health care for informal
workers, particularly to address primary health care needs.

95
World Bank Social Protection Strategy
The heterogeneity of economies in Africa will require varied approaches.
• In 2012, the World Bank announced a new ten‐year strategy to support the development of social protection systems in Africa.
• The vision is to help governments build country‐owned national social protection systems. This strategy was informed by numerous
consultations with governments and civil society in Africa. It presents a unified vision for social protection and informs the choice of
instruments, financing mechanisms and institutional arrangements for social protection. The Strategy will be implemented by
leveraging partnerships, knowledge, and the World Bank’s financing instruments.

Employment in Millions, 8 Countries Reporting (ILO & WIEGO)
Agriculture Non Agriculture Combined*
96
Appendix
Informal Worker Profile – Asia
Number and Distribution of informal worker in Asia
• Population: Estimated 1.25 billion informal workers (70% of 1.8 billion
global informal workers), per World Bank with ILO/WIEGO.
• Gender: Women comprise 30‐50% of the non‐agricultural informal
workforce, except in India (150 million men, 35 million women or 19%)
and Pakistan (20 million men, 2 million women, or 9%). Informal
agricultural wage employment rate is 12‐40%; informal agricultural
self‐employment rate is 27‐52%.
Types of Workers
* Countries: China, India, Indonesia, Pakistan, Philippines, Sri Lanka, Vietnam, Thailand.
Non‐Agricultural Informal Employment
in 8 Countries Reporting
Non‐wage
workers
49%
Wage
workers
42%
Contributing
family
workers
9%
(ILO & WIEGO)
(numbers in millions)
Formal
Sector
Informal
Sector
Formal Employment 169 8
Non‐Agricultural Informal Employment in 8 Countries Reporting
(ILO & WIEGO)
600
500
400
300
200
100
0
Number of workers (in millions)
Total Employment
Formal Employment
Informal Employment
Actors in the Space – Combining Prevailing Perspectives and Approaches to Promote Health for Informal Workers
Example of Program The “drive to formalize’ approach The “from the bottom up” approach The “expanded coverage “ approach
Thailand’s Social Protection Floor ILO (concept of social protection floor) HomeNet and 8 other networks Ministry of Health
India’s Decentralized Oversight Protection of Livelihood and Regulation
of Street Vending Bill
StreetNet, civil society organizations Local authorities
Indonesia’s Constitutional Plans National Social Security Law 3% of income from informal workers Community‐level micro insurance

97
Spotlight on Asia’s Programs
Asia has been an active region in developing national‐level programs for informal workers’ health.
Social Protection Floor in Thailand Decentralized Oversight in India
Building on policy momentum, Thailand passed the National
Health Security Act in 2002 to provide health insurance to the 25%
of its population that did not qualify for existing health schemes.
• Programs for private employees and civil servants excluded
informal workers (about half of the uncovered population).
• Combined two existing schemes targeting the poor.
• Funded through general taxation and free of cost to beneficiaries;
• Provides general health services to individuals not covered by the
government’s other insurance programs and requires users to
register with local primary care units.
• Compulsory participation in the program and national level
communication campaigns are important ways to reach informal
workers; Thailand has successfully covered 98% of its population.
• The Universal Coverage Scheme moves the country towards
establishing what the ILO calls a “social protection floor,” which
guarantees minimum social services and financial protection.
• Although it does not focus on occupational health risks, it helps
address the health needs of informal workers by bringing down
barriers to accessing healthcare. Programs that address
occupational health risks for informal workers could be added.
• Assessment of effectiveness found it has reduced health‐related
impoverishment among those employed in the informal sector.
• Pilot initiative: primary care units visited local informal
workplaces, assessed the health risks, delivered health education,
provided safety equipment, and followed‐up with advice and
feedback.
• Primary care units refer users working in the informal sector to
targeted health programs during registration.
Street vending is a common informal profession; in Delhi alone there are
an estimated 200,000 street vendors. The Protection of Livelihood and
Regulation of Street Vending Bill has two key health‐related components.
• All street vendors register with the local authorities and obtain an
identity card, which ensures a dedicated space for their operations and a
way the health program can track down the vendor.
• Government authorities can extend credit, insurance, and welfare
programs to street vendors. Civil society groups can use this language to
advocate for the provision of health care to street vendors.
Constitutional Coverage in Indonesia
The Constitution grants every citizen the right to social security—sets the
stage for health coverage for all; National Social Security Law requires
insurance and pensions managed by a coordinating entity .
• Rolling out health insurance to cover the entire population, though poor
formal sector workers have benefitted the most from expansions;
• In 2006, the Jamsostek program (one of the country’s insurance
schemes) extended coverage to the informal sector – “self employed”
workers:
– Pilot informal workers program for individuals earning at least
minimum wage; user contributions are set at 3% of income.
– ILO recommends a new scheme for informal workers since program is
employer‐based and eligibility is linked to number of employees, etc.;
– Informal workers skeptical of government plans and unwilling to pay
premiums; covers work‐related injury (hard to verify in informal
work).
• ILO recommends a system of micro insurance operating at the
community level to reach informal sector.

98
Approaches to Health Coverage
Sri Lanka: The government provides universal health services for all of its citizens, which includes informal workers,
who continue to have significant health needs, especially the elderly who are more likely to work long hours in the
informal sector (formal sector mandates retirement at 60). Sri Lanka has a large voluntary public sector insurance
scheme for farmers and fishermen, who belong to the informal sector, that focuses on pensions, disability
payments, and other non‐health social security. One scheme provides up to 1500 rupees a year for hospitalization
costs.
Laos: Aiming to combine four separate social health protection schemes to reach universal coverage. District‐level
informal workers reached by community based health insurance (CBHI) schemes, promoted for the informal sector
for its affordability for families, capitated payments to local contracted hospitals, and coverage of family members.
Donors are helping the Ministry with Health Equity Funds leveraged to buy membership into CBHI programs for
poor families. Challenges in scaling up: lack of adequately trained staff at the village level to launch new programs
and user contribution requirement is voluntary but deters informal workers.
China: 140 million informal sector workers largely lack health insurance. The central government allows municipal
governments to grant informal workers access to the basic health insurance program but does not require it; many
municipalities do not offer or have high eligibility criteria (e.g., residence in a permanent registered household).
Studies suggest informal workers are willing to pay to join the basic health scheme, but subsidies are needed to
cover costs. There is room for policy action on the health of informal workers, similar to China’s mandated
informal worker sign up for the central public or collective pension scheme.
Community‐based
Health
Insurance
Programs
Universal
Health Services
Converge
Multiple
Programs
Municipal
Government
Role
Cambodia: SKY program, which was piloted in 2 districts, expanded to 6; gives poor access to primary care,
emergency transportation, RX, etc. Targets populations not covered by schemes for salaried employees; individuals
need income to afford the premiums. No unified coverage scheme yet, but the country is moving in this direction
and hopes to eventually fully cover informal workers. There are similar community based schemes operating in 18
districts.
Countries often can expand existing policies or consolidate existing programs to provide
health coverage or services to informal worker communities.

99
Challenge of Health Care in India
Program Description of Program Goals and Results for
• Central and state governments cover the
majority of beneficiary premium costs.
• User pays 30 rupees for 30,000 rupees of
hospital coverage annually.
• Insurance companies and state level ministries
of labor and employment implement village
level enrollment campaigns.
• Emphasis on the poor makes it a potential
resource for workers in the informal sector.
• Provide more basic health programs to informal
workers who are SEWA members.
• An insurance program covering life, assets, and
some health benefits including primary and
maternity care.
• In 2008 the scheme covered 194,000 people.
Informal Workers
• Increased health care use across all poor
groups, incl. informal workers.
• Significant flaws in suitability.
• Overemphasizes hospital care, under‐emphasizes
preventative care and
occupational health and safety.
• Informal workers have a greater need
for frequent outpatient care visits to
(work‐related chronic conditions).
• Similar programs starting that use
similar model: on a smaller scale a
waste pickers’ union in Pune,
Maharasthra has launched a health
insurance scheme for its members.
In 2008 India’s Ministry
of Labor launched
Rashtriya Swasthya
Bima Yojana (RSBY) for
families living below
the poverty line
In 1992, Self Employed
Women’s Association
(SEWA) launched
SEWAVimo for members
(New) Ministry of Health
and Family Welfare and
the Planning
Commission of India
• Develop and implement own agenda to reach
universal health coverage.
• Emphasizes primary care, access to free
medicines, and public provision of services.
• Strong and targeted advocacy considerations
around effective outreach to informal workers
• This program could be incorporated
into state level pilots of the universal
coverage program and could help to
address the accessibility of primary
care.
Within a country, several efforts may need to converge to provide health care for informal
workers, particularly to address primary health care needs.

Appendix
Informal Worker Profile – Latin America
Employment in Millions, 16 Countries Reporting (ILO & WIEGO database)
Formal Employment
Informal Employment
100
Number and Distribution of informal workers in Latin America
• Population: Estimated 178 million informal workers (R4D
calculation). ILO/WIEGO reports 145 million informal workers (over
60% of total employment in Latin America), in 16 countries
reporting.
• Gender: : More women (53.7%) than men (47.8%) work in the
informal sector. Domestic workers alone account for 17.4% (18
million) of total female employment. The percentage of women
employed in the informal sector increases dramatically as income
bracket decreases. (ILO/ WIEGO database, OIT 2011)
Agriculture Non Agriculture Combined*
* Countries: Argentina, Bolivia, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, El
Salvador, Honduras, Mexica, Nicaragua, Panama, Paraguay, Peru, Uruguay, Venezuela.
Informal
Employment in 16
Countries
Reporting
(ILO & WIEGO)
(numbers in millions‐ not
including agriculture)
Formal
Sector
Informal
Sector
Formal Employment 71 1
Informal Employment in
16 Countries Reporting
(ILO & WIEGO)
12
52
34 16
26
34
18
4 6
13 12 8
70
60
50
40
30
20
10
0
Relatively Low Incidence (Below 50%) Average Incidence (55%‐65%) High Incidence (over 65%)
Uruguay, Panama, Costa Rica, Chile (below 40%) Brazil, Mexico, Argentina Venezuela, El Salvador, Guatemala,
Nicaragua, Ecuador, Paraguay, Peru, Bolivia
29%
13%
58%
wage workers
contributing
family workers
non‐wage
workers
Types of Workers
The distribution of informal employment in Latin America varies across countries. (Tokman 2008)

Health Coverage of Latin America’s Informal Sector
40% of workers in Latin America do not receive health services as a result of their employment relationship.
Total
Salaried public workers
Salaried private workers in
organizations with 5 or fewer workers
Salaried private workers in
organizations with 6 or more workers
Independent and family workers
Domestic Workers
Informal
Prone
category
0.00% 20.00% 40.00% 60.00% 80.00% 100.00%
101
Informal Prone Categories
Have the Fewest Workers with Health insurance
Survey of Latin American working urban population with health insurance
(2010, 12 countries):
Data From: Presentation by FLACSO Chile and the Rockefeller Foundation: March 11, 2013
• 35% of workers in categories which are generally informal have access
to health systems compared to 60% of workers on average.
• Ecuador, Mexico, Panama, and Peru (2009)‐ Found in companies with
100 workers or more the health insurance coverage is about 90% vs. in
organizations with between 1 and 5 workers it is 15%.
• Poverty tied to informality produces even lower levels of coverage‐
Among heads of households in the lowest income brackets (1st and 2nd
quintiles), informal workers are least likely to have access to social
protection (81.6% lack insurance). Informal workers in quintile 5 are
seven times more likely to have social security than those in quintile 1.
Informal workers are most covered by UHC schemes in
Costa Rica, Cuba (publicly funded), and a mix of public and
private institutions in Uruguay, Brazil, and Chile. (Tokman 2008)
Brazil Family Health Teams‐ government funded FHTs
consist of a general doctor, nurse, dentist, and community
health agent. Each team is responsible for covering primary
health as well as OSH services for 800‐1000 families‐specifically
targeting informal sector workers who lack
insurance. (WHO 2011)
Chile’s Dual System‐ coverage of primary health is high due
to a public/ private network of insurance. The National
Health Insurance Fund (covers 68% of the population),
private insurance (18%), and non‐profits all provide options
for health coverage. A public health program is being
developed to integrate OSH and PHC in order to better serve
the informal sector. (WHO 2011)
• Over half of wage workers are employed either without contracts
or under atypical contracts, ranging from 21% in Argentina to 74%
in Bolivia. (Tokman 2008)
• 19% of workers without contracts are covered by social security,
compared to 80.4% of workers with written contracts. (Tokman 2008
• In 2005, average income in the formal sector was 80% higher than
the informal sector. Employers in formal firms with more than 5
employees earn 2.2 times more than employers of micro
enterprises and 7 times more than the self‐employed. (Tokman 2008)

Latin America: Enforcing Labor Rights and Health
Standards
102
Examples of Interventions by Sector
Bolivia, Venezuela, and Brazil. Along with violent political clashes over
extraction rights, indigenous land rights, and pollution, mining in itself is one
of the top three most dangerous occupations. The working conditions of
informal miners are very poor – there is a high incidence of respiratory
disease, mercury poisonings, and injuries. Treatment for occupational related
injuries is limited because of lack of access to health facilities. During the
1980s and 1990s, UNESCO, UNEP, and the World Bank invested heavily in the
informal mining sector. However, after finding little could be done to
formalize the sector, development agencies reduced funding in the 2000s.
(World Politics Review 2010, ELLA)
Chile’s Plan Nacíonal helps small‐holder raspberry farmers comply with
global labor standards. Chile requires employers to issue written labor
contracts for temporary workers and make payroll contributions to social
insurance programs when workers are employed through third‐party
contractors. Argentina – inclusion of informal agricultural workers into public
health insurance plans was facilitated by pressure from local unions. In
Argentina, the farmers’ union UATRE worked with government to create the
National Registry for Agricultural Workers and Employers (RENATRE) that
included informal temporary workers and migrants. The Chiquita Code of
Conduct, established minimum labor standards and freedom of association
for all company owned farms in Central America and Colombia. The code
resulted from negotiations among Chiquita, the IUF, and the regional banana
union. (ILO 2003)
Waste Pickers
Brazil and Colombia have the largest and best established national
movements of waste pickers (MNCR, MNRP) in South America while Peru
and Chile are only beginning to organize. In Brazil, The National Solid Waste
Policy (2010) institutes a number of mechanisms to support cooperatives and
municipalities that integrate informal workers into solid waste disposal
systems. (Information from appendix: Worker Profile slides)
Domestic Workers
More Latin American countries are granting domestic workers’ basic labor
rights and legal protections via national legislation. In Argentina a new law
will give domestic workers fairer wage terms, a maximum 48 hour work
week, and maternity leave. In Brazil a recently passed amendment
ensures DWs receive the same benefits as other workers. Since the ILO
Convention on Decent Work for Domestic Workers was adopted,
Venezuela and Uruguay (the first country to ratify the convention) have
also passed new laws improving domestic workers’ labor and social rights.
Legislative reforms have begun in Chile as well. (The Argentina Independent,
WIEGO, HRW, IDWN)
In Uruguay where employers are legally required to register their workers
with the Banco de Prevision Social (BPS Social Welfare Bank), their
employees are provided with health insurance, social security, maternity
and sick leave. The BPS recorded a 110% increase in domestic workers
receiving sick leave between 2004 and 2010. A similar mandate in
Argentina relied on an intense outreach campaign and income tax
deduction to garner employers’ support. One year after the program
began, the number of domestic workers covered under social security
increased from 5.5% to 12%. Pros: Because these programs are
mandatory and subsidized by the state, employers have an incentive to
actually make contributions. Cons: For informal‐prone sectors, it is easy
for employers to evade even mandatory contributions. Of the 43% of
evaders, which the BPS deemed “difficult to capture,” 70% were in the
domestic sector. (BPS, El Pais, ILO 2011)
Miners
Although affecting a smaller share of the population, informal small‐scale
and illegal mining has a long history of hazardous working conditions and
extortion in Latin America. Peru’s informal miners’ union Fenamarpe
estimates up to 300,000 informal miners exist nationwide. Large informal
mining populations appear throughout the Andes in Colombia,

Latin America: Approaches for Extending Health Coverage
to the Informal Sector
Interventions to increase health coverage among Latin America’s informal sector fall into two categories:
Public Policies and Worker‐led Initiatives.
Health insurance linked to private companies, in which members of a particular working group define their priority needs. Ex:
Seguro Facultativo de Salud (Nicaragua): In 2007, the government extended its national health insurance plan to informal
workers via MFIs through a pilot among street‐vendors. Financed by voluntary contributions as flat monthly installments of
$15, with a two month premium of $171. Results: Subsidies brought informal sector workers into the program but did not
contribute to long term retention; deterrents included the high premium relative to low income levels, time/ convenience
costs, and lack of information. In Nicaragua, those with higher income and education levels were more likely to buy into the
plan. (FLACSO 2013, CHMI Profile, Poverty Action Lab)
Mechanisms of collective savings, whereby funds are managed autonomously by a community of workers, oftentimes through
unions or collectives. Ex: Mutua de Salud Urbana Nicagagua, AMUTRABA‐ Asociacion Mutual para los trabajadores de Bateyes
(sugar refinery workers), Associacion Mutua del Campo Nicaragua: Created in 2000 to assist agricultural workers and their
families; includes a health plan covering dentist visits and family co‐pays for medication. The fund is financed through shared
contributions between employers and workers. Results: As of 2009, 4,565 workers are affiliated and 6,009 have benefitted.
(FLACSO 2013)
103
Through CBHI, workers’ organizations are associated with a particular micro‐insurance model and membership is voluntary.
The workers’ organization acts as mediator of the private insurance company, with municipalities sometimes playing a
regulatory role. EX: Obra Social de Vendedores Ambulantes de la Republica de Argentina (street vendors), OSMU Trenque
Lauquen (Argentina): Created in 1992 at the municipal level to benefit community members without health coverage;
includes hospitalizations, exams, and medications. OSMU is financed through a combination of contributions from members,
the municipality, and worker organizations representing its beneficiaries. Results: 18,000 members are affiliated. (FLACSO 2013)
Extension of
Public Health
Coverage to
Informal
Workers
Microinsurance
Mutuelles
Community‐based
Health
Insurance
The passage of public health schemes by governments has been linked to pressure from workers’ organizations, but many
laws extending rights to informal workers do not translate to increased coverage in practice. The low level of expectations
about health and insurance among Latin America’s informal sector act as a strong barrier. Ex: Caja de Seguro Social (Costa
Rica) and EsSalud (Peru): Contributory national initiative created in 2010 offering health coverage for independent workers
and their families, includes benefits such as outpatient care, hospitalization, emergencies, medications, and co‐pays for exams.
Financed by voluntary contributions from workers based on number of dependents. Results: Has 23,000 members so far and
unlike the free public insurance model (SIS), EsSalud provides better quality and access to healthcare. In 2009, 70.5% of formal
workers were covered by EsSalud compared to 9.3% of informal workers. 35.9% of informal workers were covered by SIS.
(FLACSO 2013, ECLAC 2013)

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108
SCALE AND SCOPE CONT’D
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109
DYNAMISM
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110
DYNAMISM CONT’D
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• Unni, Jeemol, and Uma Rani. Social Protection for Informal Workers: Insecurities, Instruments and Institutional Mechanisms. Working Paper.
eSocialSciences, 2009. http://ideas.repec.org/p/ess/wpaper/id1920.html.

111
DYNAMISM CONT’D
• http://wiego.org/
• http://www.sewa.org/About_Us.asp
• http://www.streetnet.org.za/
• http://www.homenetsouthasia.net/; http://www.homenetseasia.org/
• http://www.ilo.org/public/english/bureau/program/dwcp/
• http://www.worldbank.org/
• http://www.sida.se/English/
• https://www.gov.uk/government/organisations/department‐for‐international‐development
• http://www.who.int/en/
• http://www.oecd.org/
• http://www.gatesfoundation.org/
• http://www.mhealthalliance.org/
• http://www.un.org/millenniumgoals/

LANDSCAPE
• “2005 World Summit Outcome: Resolution Adopted by the General Assembly.” In 2005 World Summit Outcome, Sixtieth Session:38. Agenda Items 46 and
112
120. New York, 2005. http://daccess‐dds‐ny.un.org/doc/UNDOC/GEN/N05/487/60/PDF/N0548760.pdf?OpenElement.
• 2007Annual Report. Annual Report. Cambridge, MA: WIEGO, 2007. http://wiego.org/sites/wiego.org/files/reports/files/WIEGO_Annual_Report_2011‐
2012.pdf.
• “A Handbook on HIV/AIDS for Labour and Factory Inspectors.” International Labour Organization, February 2005.
http://www.ilo.org/wcmsp5/groups/public/‐‐‐ed_protect/‐‐‐protrav/‐‐‐safework/documents/instructionalmaterial/wcms_110151.pdf.
• Acharya, Arnab, and Sukumar Vellakkal. Impact of National Health Insurance for the Poor and the Informal Sector in Low‐ and Middle‐income Countries,
n.d.
• Acharya,, Arnab, Sukumar Vellakkal, Fiona Taylor, Edoardo Masset, Ambika Satija, Margaret Burke, and Shah Ebrahim. Impact of National Health Insurance
for the Poor and the Informal Sector in Low‐ and Middle‐income Countries. Systematic Review. London: EPPI‐Centre, Social Science Research Unit, Institute
of Education, University of London, n.d. http://www.dfid.gov.uk/r4d/PDF/Outputs/SystematicReviews/Health‐insurance‐2012Acharya‐report.pdf.
• “Action for Health Initiatives, Inc. (ACHIEVE).” Action for Health Initiatives, Inc. (ACHIEVE), 2013. http://www.achieve.org.ph/.
• Aggarwal, Surinder. Tackling Social and Economic Determinants of Health Through Women Empowerment The SEWA Case Study. Draft. New Delhi: WHO‐SEARO.
Accessed May 9, 2013. http://www.who.int/social_determinants/resources/isa_sewa_ind.pdf.
• Annual Report April 2010 – March 2011. Annual Report. Cambridge, MA: WIEGO, 2011.
http://wiego.org/sites/wiego.org/files/reports/files/WIEGO_Annual_Report_2011‐2012.pdf.
• Annual Report April 2009 – March 2010. Annual Report. Cambridge, MA: WIEGO, 2010.
• Annual Report January 08 – March 09. Annual Report. Cambridge, MA: WIEGO, 2009.
• Bacchetta, Marc, Ekkehard Ernst, and Juana P. Bustamante. Globalization and Informal Jobs in Developing Countries. Switzerland: Joint WTO and ILO
publication, 2009.
• Behrman, Jere, David Robalino, and Rita Almeida. The Right Skills for the Job? Rethinking Training Policies for Workers. The World Bank, January 1, 2012.
http://documents.worldbank.org/curated/en/2012/01/16489532/right‐skills‐job‐rethinking‐training‐policies‐workers.
• “Bicao Investment Care Administration Organization (BICAO) | Center for Health Market Innovations (CHMI).” Center for Health Market Innovations
(CHMI), September 27, 2011. http://healthmarketinnovations.org/program/bicao‐investment‐care‐administration‐organization‐bicao.

LANDSCAPE CONT’D
• Building and strengthening health and wellness activities for the Sustainable Tree Crops Program (STCP) in Ghana and Côte d’Ivoire. Final Report. Ghana:
113
Family Health International, January 30, 2009. http://www.candyusa.com/files/FHI_Final_Report_Sept_2008.pdf.
• Building Better Lives Together: 2011 Annual Report. Annual Report. Seattle, WA: Bill and Melinda Gates Foundation. Accessed May 9, 2013.
http://www.gatesfoundation.org/~/media/gfo/documents/annual%20reports/2011gates%20foundation%20annual%20report.pdf.
• “Canadian International Development Agency.” Project Browser. Accessed May 9, 2013. http://www.acdi‐cida.gc.ca/home.
• Cho, Yoonyoung. Informality and Protection from Health Shocks: Lessons from Yemen. World Bank, December 2010.
http://www.iza.org/conference_files/worldb2011/cho_y2150.pdf.
• Clark, Phoebe. Assessment of Social Accountability Standards: Light Manufacturing Small and Medium‐sized Enterprises, November 2007.
http://pdf.usaid.gov/pdf_docs/PNADP612.pdf.
• Decent Work and the Informal Economy: Sixth Item on the Agenda. 90th Session International Labour Conference. Geneva: International Labour Office,
2002. http://www.ilo.org/wcmsp5/groups/public/‐‐‐ed_norm/‐‐‐relconf/‐‐‐reloff/documents/meetingdocument/wcms_078849.pdf.
• Deshingkar, Priya. Extending Labour Inspections to the Informal Sector and Agriculture. Working Paper. Chronic Poverty Research Centre. London:
Overseas Development Institute, November 2009. http://www.dfid.gov.uk/r4d/PDF/Outputs/ChronicPoverty_RC/WP154‐Deshingkar.pdf.
• “DFID Projects Database.” Bilateral Agency. DFID. Accessed May 9, 2013. http://projects.dfid.gov.uk/.
• “Dutch Foreign Ministry.” Documents and Grants. Accessed March 13, 2013. http://www.government.nl/issues/development‐cooperation/documents‐and‐
publications/parliamentary‐documents/2012/01/12/new‐focus‐of‐dutch‐development‐policy.html.
• “Educating Cocoa Farmers Through Mobile Phones.” NCA Journal 1, no. Fall 2011 (2011). http://www.candyusa.com/files/NCAJSustainabilityHershey.pdf.
• Fact Sheet on Youth Reproductive Health Policy ‐ Sustainable Livelihood Programs and HIV/AIDS. Fact Sheet. Washington, DC: Health Policy Initiative, Task
Order 1, Futures Group, November 2009. http://pdf.usaid.gov/pdf_docs/PNADR399.pdf.
• Frye, Isobel. Extending Social Security to Developing Countries: Particular Emphasis on Healthcare and Informal Economy Workers. Literature Review.
Discussion Paper. Global Union Research Network, October 2005. http://www.gurn.info/en/discussion‐papers/healthcare05.pdf.

114
LANDSCAPE CONT’D
• “Fundacion FACES | Center for Health Market Innovations (CHMI).” Center for Health Market Innovations (CHMI), September 27, 2011.
http://healthmarketinnovations.org/program/fundacion‐faces.
• Van Ginneken, Wouter. “Social Security for the Informal Sector: A New Challenge for the Developing Countries.” International Social Security Review 52,
no. 1 (1999): 49–69. doi:10.1111/1468‐246X.00033.
• “GIZ:” AID Agency website. Deutsche Gesellschaft Für Internationale Zusammenarbeit (GIZ). Accessed May 9, 2013.
http://www.giz.de/en/aboutgiz/profile.html.
• “Globalising Decent Work.” Accessed May 9, 2013. http://www.solidar.org/Globalising‐Decent‐Work.html.
• Heintz, James. Employment, Poverty, and Inclusive Development in Africa: Policy Choices in the Context of Widespread Informality. Revised Draft. Political
Economy Research Institute University of Massachusetts, Amherst, March 2009.
http://www.peri.umass.edu/fileadmin/pdf/conference_papers/khan/Heintz_chapter_PEA_volume_Mar_5.doc.
• “Helping smallholder farmers | Sustainable living | Unilever Global.” Unilever, 2013. http://www.unilever.com/sustainable‐living/
betterlivelihoods/farmers/.
• “Hershey`s CocoaLink Mobile Phone Program Delivers 100,000 Farmer and Family Messages During First Year in Ghana | Reuters.” Reuters, August 6,
2012. http://www.reuters.com/article/2012/08/06/idUS137424+06‐Aug‐2012+BW20120806.
• HIV/AIDS Mainstreaming Guideline into Rural Capacity Building Project. Ethiopia: Ethiopian Ministry of Health, February 2009.
http://www.moa.gov.et/sites/default/files/HIV%20AIDS%20mainstreaming%20guideline.doc.
• “ILO and Today′s Global Challenges (Part 2: 1999‐) 1999.” UN Agency Website. International Labour Organization. Accessed May 9, 2013.
http://www.ilo.org/public/english/support/lib/century/index6.htm.
• “Improving Access of Migrant and Mobile Populations to HIV Services in the Caribbean.” Pan Caribbean Partnership Against HIV and AIDS, 2012.
http://www.pancap.org/en/migrant‐population.html.
• “Institute for the Study of Labour.” Research Institute. Accessed May 9, 2013. http://www.iza.org/en/webcontent/index_html.
• International Labor Organization. Statistical Update on Employment in the Informal Economy. Department of Statistics. Geneva: International Labor
Organization, June 2011. http://www.ilo.org/wcmsp5/groups/public/‐‐‐dgreports/‐‐‐stat/documents/presentation/wcms_157467.pdf.
• Intervention with Microfinance for AIDS and Gender Equity (IMAGE) Study. Case Study. Reducing Intimate Partner Violence. Global Violence Prevention,
2011. http://www.aidstar‐one.com/promising_practices_database/g3ps/intervention_microfinance_aids_and_gender_equity_image_study.

LANDSCAPE CONT’D
• Jain, Saranga, Margaret Greene, Zayid Douglas, Myra Betron, and Katherine Fritz. Earning Their Way to Healthier Lives—Mulheres Primero (Women First):
115
Health and Legal Training Combined with Income Opportunities Helps Rural Mozambican Women Mitigate HIV Risk. Case Study Series. Arlington, VA:
AIDSTAR‐One, October 2011. http://www.aidstar‐one.com/focus_areas/gender/resources/case_study_series/mozambique_women_first.
• Kawakami, T. “Networking Grassroots Efforts to Improve Safety and Health in Informal Economy Workplaces in Asia.” Industrial Health 44, no. 1 (January
2006): 42–7.
• Kogi, K. “Advances in Participatory Occupational Health Aimed at Good Practices in Small Enterprises and the Informal Sector.” Industrial Health 44, no. 1
(January 2006): 31–4.
• Labor Market Programs. Africa Social Protection Policy Briefs. World Bank, December 2012.
http://siteresources.worldbank.org/INTAFRICA/Resources/social‐protection‐policy‐brief‐labor‐EN‐2012.pdf.
• Lund, Francie. “Social Protection and the Informal Economy: Linkages and Good Practices for Poverty Reduction and Empowerment *.” In Promoting Pro‐
Poor Growth: Social Protection, 69–88. OECD, 2009. http://wiego.org/sites/wiego.org/files/publications/files/Lund‐Soc‐Protection‐Linkages.pdf.
• Lund, Francie, and Anna Marriot. Occupational Health and Safety of the Poorest. Research Report. School of Development Studies Research Report.
Durban: University of KwaZulu‐Natal, April 2011. www.sds.ukzn.zc.za/files/RR%2088%20Lund.pdf.
• Mahatma Gandhi National Rural Employment Gurantee Act. Accessed February 13, 2013. http://nrega.nic.in/netnrega/home.aspx.
• Making Health Financing Work for Poor People in Tanzania: A Health Financing Policy Note. World Bank, September 9, 2011.
http://www.who.int/providingforhealth/countries/WB_TanzaniaHealthFinancingPolicyNoteFinal.pdf.
• MANAGING RISK, PROMOTING GROWTH Developing Systems for Social Protection in Africa. The World Bank. Accessed April 24, 2013.
http://siteresources.worldbank.org/INTAFRICA/Resources/social‐protection‐strategy‐summary‐2012.pdf.
• Managing Risk, Promoting Growth: Developing Systems for Social Protection in Africa. The World Bank, June 2012.
http://siteresources.worldbank.org/INTAFRICA/Resources/social‐protection‐full‐report‐EN‐2012.pdf.
• “Market Vendors AIDS Project (MAVAP) | Center for Health Market Innovations (CHMI).” Center for Health Market Innovations (CHMI), July 11, 2012.
http://healthmarketinnovations.org/program/market‐vendors‐aids‐project‐mavap.
• Mars Partnership for African Cocoa‐Communities of Tomorrow (iMPACT). Ghana: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 2011.
http://hespa.net/sites/hespa.net/files/mars‐gtz‐impact‐en.pdf.
• “MicroInsurance Innovation Facility.” International Labour Organization. Accessed May 9, 2013.
http://www.ilo.org/public/english/employment/mifacility/.

116
LANDSCAPE CONT’D
• Microinsurance Innovation Facility: Protecting the Working Poor. Annual Report 2012. Geneva: Microinsurance Innovation Facility, Social Finance
Programme – Employment Sector, International Labour Office, 2013.
http://www.ilo.org/public/english/employment/mifacility/download/annual/annualreport2012_en.pdf.
• MILES to Go: A Quest for An Operational Labor Market Paradigm for Developing Countries. Draft. Social Protection & Labor Sector, The World Bank,
January 21, 2008. http://siteresources.worldbank.org/INTLM/Resources/390041‐1212776476091/5078455‐
1267646113835/MILESThequestoperationalLMparadigm_Jan212008.pdf.
• “Ministry of Foreign Affairs, Norway.” Ministry of Foreign Affairs. Accessed March 13, 2013. http://www.regjeringen.no/en/dep/ud/selected‐topics/
development_cooperation.html?id=1159.
• “Multi Donor Trust Fund: Labour Markets, Job‐Creation and Economic Growth.” World Bank. Accessed May 9, 2013.
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALPROTECTION/EXTLM/0,,contentMDK:22512466~menuPK:7010971~pagePK:148956~piP
K:216618~theSitePK:390615,00.html.
• “Multi Donor Trust Fund: MILES Framework.” World Bank. Accessed May 9, 2013.
http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTSOCIALPROTECTION/EXTLM/0,,contentMDK:22512466~menuPK:7010971~pagePK:148956~piP
K:216618~theSitePK:390615,00.html.
• “Munich Re Foundation.” Microinsurance. Accessed May 9, 2013. http://www.munichre‐foundation.org/home.html.
• Munshi, Kaivan. “Networks in the Modern Economy: Mexican Migrants in the U. S. Labor Market.” The Quarterly Journal of Economics 118, no. 2 (May 1,
2003): 549–599. doi:10.1162/003355303321675455.
• “Network of WHO Collaborating Centres in Occupational Health.” WHO collaborating centres database. World Health Organization. Accessed May 9, 2013.
http://www.who.int/occupational_health/network/en/.
• “NRSP Microfinance Bank Limited.” NRSP Bank. Accessed May 9, 2013. http://www.nrspbank.com/.
• “OECD.StatExtracts: Creditor Reporting System.” Database query system. Accessed May 9, 2013. http://stats.oecd.org/Index.aspx?datasetcode=CRS1.
• Okello, Francis O., and Juliet Ighure. HIV/AIDS and the Workplace: A Qualitative Assessment of the Ghana Port and Harbor Communities for an HIV/AIDS
Workplace Program. Ghana: Commercial Market Strategies, Abt Associates, February 2004.
http://www.abtassociates.com/reports/ES_Ghana_PH_Research_Report.pdf.
• Park, H., E. Ha, J. Kim, H. Jung, and D. Paek. “Occupational Health Services for Small‐scale Enterprises in Korea.” Ind Health 40, no. 1 (2002): 1–6.
• “Pathfinder International: Bangladesh NGO Service Delivery Program.” Pathfinder International, 2012. http://www.pathfind.org/our‐work/projects/ngo‐service‐
delivery‐program‐bangladesh.html.

117
LANDSCAPE CONT’D
• Pereira, Javier. Decent Work and the Millennium Development Goals: A Promising Partnership. SOLIDAR, September 2010.
http://www.solidar.org/IMG/pdf/gn2010report_dw_mdg.pdf.
• “PhilHealth KaSAPI (Kalusugang Sigurado at Abot‐Kaya sa PhilHealth Insurance) | Center for Health Market Innovations (CHMI).” Center for Health Market
Innovations (CHMI), May 30, 2012. http://healthmarketinnovations.org/program/philhealth‐kasapi‐kalusugang‐sigurado‐at‐abot‐kaya‐sa‐philhealth‐insurance.
• Pierre, Jennifer, and Soniaa David. A Case Study of CSR Fueling Health Service Provision in Ghana. Ghana: International Institute of Tropical Agriculture‐
Sustainable Tree Crops Program, 2010. http://www.ilcafrica.com/directory/documents/Health%20Increased%20access%20to%20health.pdf.
• Preker, Alexander S., Guy Carrin, David Dror, Jakab Melitta, William Hsiao, and Dyna Arhin‐Tenkorand. Effectiveness of Community Health Financing in
Meeting the Cost of Illness. Health, Nutrition and Population (HNP) Discussion Paper. Washington D.C.: World Bank, February 2002.
• “Realising Social Protection and Decent Work for All.” Global Network. Accessed May 9, 2013. http://www.theglobalnetwork.net/uploads/files/en/GN‐Materials/
GN_DFID%20Project%20leaflet_Oct2010.pdf.
• “Rockefeller Foundation.” Foundation Website with searchable database of grants. Recent Grants. Accessed May 9, 2013.
http://www.rockefellerfoundation.org/.
• “Rural Capacity Building Project.” World Bank, 2013. http://www.worldbank.org/projects/P079275?lang=en.
• “Safety Nets: Public Works.” Policy Brief. Africa Social Protection Policy Briefs. Accessed May 9, 2013.
http://siteresources.worldbank.org/INTAFRICA/Resources/social‐protection‐policy‐brief‐safety‐nets‐public‐EN‐2012.pdf.
• Sankaran, Kamala, and Roopa Madhav. Informal Economy: Law and Policy Demands Lessons from the WIEGO India Pilot Study. USAID, February 2012.
http://www.solidaritycenter.org/files/infecon_wiego_law_and_informal_economy.pdf.
• Santana, V. S., and Ribeiro, F. S. N. “Occupational Cancer Burden in Developing Countries and the Problem of Informal Workers.” Environmental Health: A
Global Access Science Source 10, no. 1 (2011).
• SEWA Joins Forces with the ILO to Help Informal Sector Workers Move Out of Poverty. Stories of Empowerment. Geneva, Switzerland: ILO‐SEWA‐OECD.
Accessed May 9, 2013. http://www.oecd.org/dac/povertyreduction/48869455.pdf.
• “Smallholder Farmers Rural Radio.” SmallHolders Foundation, 2012. http://smallholdersfoundation.org/sfrrf.php.
• “Social Protection Floors for Social Justice and a Fair Globalization.” Vol. ILC.101/IV/1. Geneva: International Labour Office, 2012.

118
LANDSCAPE CONT’D
• The World Bank’s Africa Social Protection Strategy 2012‐2022. Overview. Human Development Africa, The World Bank, 2012.
• Thomas, Duncan, and Elizabeth Frankenberg. “Health, Nutrition and Prosperity: a Microeconomic Perspective.” Bulletin of the World Health Organization
80, no. 2 (2002): 106–113.
• Thornton, Rebecca, L., Laurel E. Hatt, Erica M. Field, Mursaleena Islam, Freddy Solis Diaz, and Martha Azucena Gonzalez. “Social Security Health Insurance
for the Informal Sector in Nicaragua: A Randomized Evaluation.” Health Economics 19 (June 2010): 181–206.
• “UN Women.” UN Website. United Nations Entity for Gender Equality and the Empowerment of Women. Accessed May 9, 2013.
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• Utting, Peter. “Regulating Business Via Multistakeholder Initiatives: A Preliminary Assessment.” In Voluntary Approaches to Corporate Responsibility:
Readings and a Resource Guide. Geneva, Switzerland: UN Non‐Governmental Liaison Service (NGLS) and UNRISD, 2002.
http://www.unrisd.org/80256B3C005BCCF9/(httpAuxPages)/35F2BD0379CB6647C1256CE6002B70AA/$file/uttngls.pdf.
• WIEGO Annual Report 2011‐2012. Annual Report. Cambridge, MA: WIEGO, 2012.
• Workers’ Health: Global Plan of Action. Agenda Iterm 12.13. Sixtieth World Health Assembly: WHO, May 23, 2007.
http://www.who.int/occupational_health/WHO_health_assembly_en_web.pdf.
• http://www.ilo.org/public/english/employment/mifacility/
• http://www.engineersagainstpoverty.org/viewitem.cfm?cit_id=382658
• http://nrsp.org.pk/

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UNIVERSAL HEALTH COVERAGE
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PROFILES: AGRICULTURE WORKERS
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Development Studies, 2006. http://www.ethicaltrade.org/sites/default/files/resources/Impact%20assessment%202c%20safrica.pdf.
• Barrientos, Stephanie, A. Kritzinger, G. Muller, P. Rossouw, N. Termine, N. Tregurtha, and N. Vink. The Global Value Chain and Changing Employment
Relations in South African Fruit: Summary of Findings., 2003. http://www.inti.gov.ar/cadenasdevalor/Draft4summaryofreport.pdf.
• Chan, Man ‐ Kwun. Review of Value Chain Analyses in the Commodities and Horticulture Sectors Roles, Constraints and Opportunities for Informal
Workers. WIEGO: Women In Informal Employment: Globalizing and Organizing (WIEGO), July 2011.
http://wiego.org/sites/wiego.org/files/resources/files/Chan_Value_Chain_Analyses_Report.pdf.
• “Database On Informal Employment.” New Enhanced Database on Informal Employment Produced by the ILO in Partnership with WIEGO, April 30, 2012.
http://www.ilo.org/global/statistics‐and‐databases/WCMS_179795/lang‐‐en/index.htm.
• “Decent Work in Agriculture.” In Background Paper. Geneva, Switzerland: International Labor Organization, 2003.
http://www.ilo.org/wcmsp5/groups/public/‐‐‐ed_dialogue/‐‐‐sector/documents/publication/wcms_161567.pdf.
• “Ethical Trading Initiative‐ About ETI.” Ethical Trading Initiative‐ Respect for Workers Worldwide, 2013. http://www.ethicaltrade.org/about‐eti.
• “Helping smallholder farmers | Sustainable living | Unilever Global.” Unilever, 2013. http://www.unilever.com/sustainable‐living/
betterlivelihoods/farmers/.
• Mars Partnership for African Cocoa‐Communities of Tomorrow (iMPACT). Ghana: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), 2011.
http://hespa.net/sites/hespa.net/files/mars‐gtz‐impact‐en.pdf.
• “Occupational Groups‐ Smallholder Farmers.” Women in Informal Employment: Globalizing and Organizing (WIEGO), n.d. http://wiego.org/informal‐economy/
occupational‐groups/smallholder‐farmers.

121
PROFILES: AGRICULTURE WORKERS CONT’D
• Trading Away Our Rights: Women Working in Global Supply Chains. Oxford: Oxfam International. Oxford: Oxfam International: Oxfam, 2004.
www.oxfam.org.uk/resources/papers/downloads/trading_rights.pdf.
PROFILES: CONSTRUCTION WORKERS
• “ACIW ‐ Association of Construction and Informal Workers.” Accessed April 12, 2013. http://www.aciw.org.ph/services_damayan.html.
• Benach, Joan, Carles Muntaner, Vilma Santana, and F. Chairs. “Employment Conditions and Health Inequalities.” Final Report to the WHO Commission
on Social Determinants of Health (CSDH) Employment Conditions Knowledge Network (EMCONET). Geneva: WHO (2007).
• “Construction Workers in the Informal Economy | WIEGO.” Accessed April 12, 2013. http://wiego.org/informal‐economy/occupational‐groups/
construction‐workers.
• International Labor Organization. Note on the Proceedings of the Tripartite Meeting on The Construction Industry in the Twenty‐First Century: Its Image,
Employment Prospects and Skill Requirements, 2001. http://wiego.org/publications/note‐proceedings‐tripartite‐meeting‐construction‐industry‐twenty‐first‐
century‐its‐imag.
• Jason, Arthur. Informal Construction Workers in Dar Es Salaam, Tanzania. Working paper, February 1, 2007.
http://www.ilo.org/sector/Resources/publications/WCMS_160790/lang‐‐en/index.htm.
• Jha, Kishore K. “Informal Labour in the Construction Industry in Nepal.” ILO Sectoral Activities Programme Working Paper 187 (September 2002).
• Jhabvala, Renana, and Ravi Kanbur. “12 Globalization and Economic Reform as Seen from the Ground: SEWA’s Experience in India.” India’s Emerging
Economy: Performance and Prospects in the 1990s and Beyond (2004): 293.
• Kawakami, Tsuyoshi (ed ). “Good Practices in Safety, Health and Working Conditions: Home Workers, Farmers and Construction Workers in Cambodia,
Mongolia, and Thailand.” Publication, January 1, 2006. http://www.ilo.org/asia/whatwedo/publications/WCMS_BK_PB_311_EN/lang‐‐en/index.htm.
• Mitullah, Winnie V., and Isabella Njeri Wachira. “Informal Labour in the Construction Industry in Kenya: A Case Study of Nairobi.” ILO Sectoral Activities
Programme Working Paper 204 (2003).
• Pais, Jesim. “Casualisation of Urban Labour Force.” Economic and Political Weekly (February 16, 2002). http://www.epw.in/special‐articles/
casualisation‐urban‐labour‐force.html.
• Research on Skill Formation, Enhancement and Refinement of Informal Sector Workers. CHF International. Accessed April 9, 2013.
http://www.graam.org.in/sites/graam.org.in/files/Report%20on%20Construction%20workers‐final1.pdf.

122
PROFILES: CONSTRUCTION WORKERS CONT’D
• Rinehart, Richard D. Designing Programmes to Improve Working and Employment Conditions in the Informal Economy: A Literature Review.
International Labour Organization, 2004. http://www.oit.org/wcmsp5/groups/public/‐‐‐ed_protect/‐‐‐protrav/‐‐‐
• Unni, Jeemol, and Uma Rani. Social Protection for Informal Workers: Insecurities, Instruments and Institutional Mechanisms. Working Paper.
eSocialSciences, 2009. http://ideas.repec.org/p/ess/wpaper/id1920.html.
• Wells, Jill. “Informality in the Construction Sector in Developing Countries.” Construction Management & Economics 25, no. 1 (2007): 87–93.
• ———. The Construction Industry in the Twenty‐first Century: Its Image, Employment Prospects and Skill Requirements. Geneva: International Labor
Organization, 2001. http://www.ilo.org/public/english/standards/relm/gb/docs/gb283/pdf/tmcitn.pdf.
• Wells, Jill, and Arthur Jason. “Employment Relationships and Organizing Strategies in the Informal Construction Sector.” African Studies Quarterly 11,
no. 2 & 3 (Spring 2010): 107–124.
PROFILES: DOMESTIC WORKERS
• “100th ILO Annual Conference Decides to Bring an Estimated 53 to 100 Million Domestic Workers Worldwide Under the Realm of Labour Standards.”
International Labor Organization Press Release. June 16, 2011. http://www.ilo.org/ilc/ILCSessions/100thSession/media‐centre/press‐releases/
WCMS_157891/lang‐‐en/index.htm.
• Bonner, Chris. “Domestic Workers Around the World: Organising for Empowerment.” Cape Town, South Africa: Women In Informal Employment:
Globalizing and Organizing (WIEGO), 2010. http://www.dwrp.org.za/images/stories/DWRP_Research/chris_bonner.pdf.
• Burnham, Linda, and Nik Theodore. Home Economics: The Invisible and Unregulated World of Domestic Work. New York, NY: National Domestic
Workers Alliance, 2012. http://www.domesticworkers.org/pdfs/HomeEconomicsEnglish.pdf.
• “Decent Work for Domestic Workers.” Report IV:119. Geneva, Switzerland: International Labor Organization, 2010.
http://www.ilo.org/wcmsp5/groups/public/‐‐‐ed_norm/‐‐‐relconf/documents/meetingdocument/wcms_104700.pdf.
• Domestic Workers Across the World: Global and Regional Statistics and the Extent of Legal Protection. Geneva: International Labour Office, January
2013. http://www.ilo.org/wcmsp5/groups/public/‐‐‐dgreports/‐‐‐dcomm/‐‐‐publ/documents/publication/wcms_173363.pdf.
• “Domestic Workers in the Informal Economy | WIEGO.” WIEGO. Accessed May 3, 2013. http://wiego.org/informal‐economy/occupational‐groups/
domestic‐workers#size.

123
PROFILES: DOMESTIC WORKERS CONT’D
• “Informal Economy Occupational Groups: Domestic Workers.” WIEGO, n.d. http://wiego.org/informal‐economy/occupational‐groups/domestic‐workers.
• Mkize, Vuyo. “Cheap Health Care for Domestic Workers.” IOL News. February 26, 2013. http://www.iol.co.za/news/south‐africa/cheap‐health‐care‐for‐domestic‐
workers‐1.1476918#.UYBow6kpvIq.
• “Naya Jeevan‐ Lessons from the Project.” Microinsurance Innovation Facility, n.d. http://www.microinsurancefacility.org/en/grantee/ig/naya‐jeevan#
group‐lessons‐from‐the‐project.
• Neisloss, Liz. “Call for Action as Singapore Maids Fall to Their Deaths.” CNN, May 24, 2012. http://edition.cnn.com/2012/05/23/world/asia/singapore‐maids‐
deaths/index.html.
• “Partners of Domestic Worker Organizations.” International Domestic Workers’ Network, n.d. http://www.idwn.info/content/partners‐domestic‐worker‐
organizations.
• “Programs‐ Naya Jeevan.” Center for Health Market Innovations (CHMI), March 15, 2013. http://healthmarketinnovations.org/program/naya‐jeevan.
• Smith, Peggie. “The Pitfalls of Home: Protecting the Health and Safety of Paid Domestics.” Canadian Journal of Women & the Law Washington
University in St. Louis Legal Studies Research Paper No. 11–03–03 (March 1, 2011): 40.
• Varia, Nisha. “A Victory Against Modern Day Slavery.” Article. Human Rights Watch, December 1, 2012. http://www.hrw.org/news/2012/12/01/victory‐against‐
modern‐day‐slavery.
• “Violence Against Women‐ Intimate Partner and Sexual Violence Against Women.” World Health Organization, November 2012.
http://www.who.int/mediacentre/factsheets/fs239/en/index.html.
PROFILES: HOME‐BASED WORKERS

124
PROFILES: HOME‐BASED WORKERS CONT’D
• “Convention C177 ‐ Home Work Convention, 1996 (No. 177).” Accessed April 22, 2013.
http://www.ilo.org/dyn/normlex/en/f?p=1000:12100:0::NO::P12100_INSTRUMENT_ID:312322.
• Hiralal, Kalpana. “The ‘Invisible’ Workers of the Informal Economy–A Case Study of Home‐based Workers in Kwazulu/Natal, South Africa.” J Soc Sci 23,
no. 1 (2010): 29–37.
• “Home‐Based Workers | WIEGO.” Accessed April 22, 2013. http://wiego.org/informal‐economy/occupational‐groups/home‐based‐workers.
• ILO, UN Women and Baidari. “Report on Experience Sharing and Advocacy Workshop: Integrated Support Programme to Home Based Workers.” Book,
April 15, 2011. http://www.ilo.org/islamabad/whatwedo/publications/WCMS_155223/lang‐‐en/index.htm.
• Manothum, Aniruth, and Jittra Rukijkanpanich. “A Participatory Approach to Health Promotion for Informal Sector Workers in Thailand.” Journal of
Injury and Violence Research 2, no. 2 (July 1, 2010): 111–120. doi:10.5249/jivr.v2i2.36.
• Sinha, Shalini. Rights of Home‐based Workers. New Delhi, India: National Human Rights Commission, 2006. http://www.bhrc.bih.nic.in/Docs/Home‐based‐
Workers.pdf.
• Sudarshan, Ratna M., and Renana Jhabvala. “Social Protection for Home‐Based Women Workers in South Asia: Learning from Action and Research”
(2009). http://dspace.cigilibrary.org/jspui/handle/123456789/21078.
• Sudarshan, Ratna M., and Shalini Sinha. “Making Home‐Based Work Visible: A Review of Evidence from South Asia” (2011).
http://wiego.org/sites/wiego.org/files/publications/files/Sudarshan_WIEGO_WP19.pdf.
PROFILE: MANUFACTURING WORKERS

125
PROFILE: MANUFACTURING WORKERS CONT’D
• “Garment Workers ‐ Conditions, Statistics, Challenges and Research | WIEGO.” Accessed April 15, 2013. http://wiego.org/informal‐economy/
occupational‐groups/garment‐workers.
• Goldman, Marlene B., and Maureen C. Hatch. Women & Health. Gulf Professional Publishing, 2000.
• Manik, Julfikar Ali, and Jim Yardley. “Bangladesh Factory, Site of Fatal Fire, Made Western Brands.” The New York Times, January 27, 2013, sec. World /
Asia Pacific. http://www.nytimes.com/2013/01/28/world/asia/bangladesh‐factory‐site‐of‐fatal‐fire‐made‐western‐brands.html.
• Mehrotra, Santosh, and Mario Biggeri. Social Protection in the Informal Economy: Home Based Women Workers and Outsourced Manufacturing in Asia.
InnocentiWorking Paper No.97. Florence: UNICEF Innocenti Research Centre, December 2002.
http://www.researchgate.net/publication/24139993_Is_EFA_Affordable_Estimating_the_Global_Minimum_Cost_of_’Education_for_All’/file/79e41512
2362a9441e.pdf.
• Merk, Jeroen. 10 Years of the Better Factories Cambodia Project. Clean Clothes Campaign and Community Legal Education Centre, 2012.
http://www.clec.org.kh/web/images/Resources/Res_CCC‐CLEC‐BetterFactories‐Eng‐Final1346726534.pdf.
• Messing, Karen, and Piroska Ostlin. “Gender Equality, Work and Health: A Review of the Evidence.” World Health Organization, 2006.
• “Wal‐Mart And Sears Don’t Plan To Pay Victims Of A Bangladesh Factory Fire That Killed 120.” Business Insider. Accessed April 18, 2013.
http://www.businessinsider.com/wal‐marts‐bangladesh‐factory‐fire‐2013‐4.
PROFILE: STREET VENDORS
• Alfers, Laura. Occupational Health & Safety for Market and Street Traders in Accra and Takoradi, Ghana. WIEGO, 2009.
http://www.inclusivecities.org/wp‐content/uploads/2012/07/OHS_Street_Traders_Final.pdf.
• Ross, MH, WM Pick, and Y Dada. “The Reproductive and Occupational Health of Women Street Vendors in Johannesburg, South Africa.” Department of
Community Health and WHO Collaborating Centre for Urban Health, University of the Witwatersrand (Parktown, South Africa) (n.d.).
http://www.ncbi.nlm.nih.gov/pubmed/11824925.
• Saha, Debdulal. Conditions of “Decent Working Life” of Street Vendors in Mumbai. Tata Institute of Social Sciences, n.d.
http://www.ilo.org/legacy/english/protection/travail/pdf/rdwpaper27c.pdf.

126
PROFILE: STREET VENDORS CONT’D
• Sekar, Helen. Vulnerabilities and Insecurities of Informal Sector Workers ‐ A Study of Street Vendors. V.V Giri National Labour Institute, NOIDA, n.d.
http://www.vvgnli.org/sites/default/files/publication_files/Vulnerabilities%20and%20Insecurities%20of%20Informal%20Sector%20Workers%20A%20St
udy%20of%20Street%20Vendors.pdf.
• Sinha, Shalini, and Sally Roever. India’s National Policy on Urban Street Vendors. WIEGO, 2011.
http://wiego.org/sites/wiego.org/files/publications/files/Sinha_WIEGO_PB2.pdf.
• Skinner, Caroline. Street Trade in Africa: A Review. WIEGO, 2008. http://wiego.org/sites/wiego.org/files/publications/files/Skinner_WIEGO_WP5.pdf.
PROFILE: TRANSPORTATION WORKERS
• Bonner, Chris. Organising Informal Transport Workers. Overview Report. International Transport Workers’ Federation, 2006.
http://wiego.org/publications/organising‐informal‐transport‐workers.
• Cervero, Robert. Informal Transport in the Developing World. UN Habitat, 2000.
• Hisam, Zeenat. “Collective Care Arrangements in the Informal Labour Market: Road Transport Workers in Pakistan.” Economic and Political Weekly
(2006): 2099–2106.
• Krueger, Gerald P. Health and Wellness Programs for Commercial Drivers. Vol. 15. Transportation Research Board National Research, 2007.
http://books.google.com/books?hl=en&lr=&id=oXkZwE8lCHgC&oi=fnd&pg=PA1&dq=%22Edward+Johnson,+Director,+Applied+Science+Directorate,+N
ational+Aeronautics+and+Space+Administration,+John+C.+Stennis+Space+Center,%22+%22and+Wellness%22+%22(FMCSA)+was+established+within+t
he+Department+of+Transportation+on%22+&ots=3hqRU2p3mF&sig=EjWtnMc3LO4eYjwFG1AYpeThUWM.
• Making a Difference ‐ Women Transport Workers in the 21st Century. International Transport Workers’ Federation. Accessed April 4, 2013.
http://www.itfcongress2010.org/files/extranet/‐2/24694/10Eng‐%2042C_14_WTWC_2_Annex%202%20%5BITF%20Women%20‐
%20Making%20a%20Differe..pdf.
• Pascual, Clarence. Organising Informal Transport Workers: A Case Study of the National Transport Workers’ Union Philippines | WIEGO. International
Transport Workers’ Federation, 2006. http://wiego.org/publications/organising‐informal‐transport‐workers‐case‐study‐national‐transport‐workers%
E2%80%99‐union‐phil.
• Schurman, Susan, Adrienne Eaton, Rebecca Gumbrell‐McCormick, Richard Hyman, Camille DiLeo, Gilma Madrid Berroterán, Sahra Ryklief, Mihai Varga,
and Verna Viajar. Organizing Workers in the Informal Economy. Cape Town, South Africa: Solidarity Center, December 2011.

127
PROFILE: TRANSPORTATION WORKERS CONT’D
• “Transport Workers | WIEGO.” Accessed April 22, 2013. http://wiego.org/informal‐economy/occupational‐groups/transport‐workers.
PROFILE: WASTE PICKERS
• Dias, Sonia Maria. Waste & Citizenship Forums ‐ Achievements and Limitations. Solid waste, health and the Millennium Development Goals. Kolkata,
India, 2006. http://www.cwgnet.net/prarticle.2006‐01‐27.9445210332/prarticle.2006‐01‐27.0949657238/prarticleblocklist.2006‐01‐
27.1370579427/skatdocumentation.2006‐01‐27.0903224148/file.
• Poschen, Peter, Ana Lucía Iturriza, and Xinxing Li. Working Towards Sustainable Development: Opportunities for Decent Work and Social Inclusion in a
Green Economy. ILO, 2012. http://www.oitcinterfor.org/sites/default/files/file_publicacion/wcms_181836.pdf.
• Samarth, Ujwala. Occupational Health of Waste Pickers in Pune: KKPKP and SWaCH Members Push for Health Rights. KKPKP, n.d.
http://www.mfcindia.org/main/bgpapers/bgpapers2013/am/bgpap2013Vv.pdf.
• Solid Waste Management in the World’s Cities. UN Habitat, 2010. http://www.wsscc.org/resources/resource‐publications/solid‐waste‐management‐worlds‐
cities‐2010.
PROFILES: AFRICA
• Heintz, James. Employment, Poverty, and Inclusive Development in Africa: Policy Choices in the Context of Widespread Informality. Revised Draft.
Political Economy Research Institute University of Massachusetts, Amherst, March 5, 2009.
http://www.peri.umass.edu/fileadmin/pdf/conference_papers/khan/Heintz_chapter_PEA_volume_Mar_5.doc.
• Hiralal, Kalpana. “The ‘Invisible’ Workers of the Informal Economy–A Case Study of Home‐based Workers in Kwazulu/Natal, South Africa.” J Soc Sci 23,
no. 1 (2010): 29–37.
• Loewenson, Rene. “Assessment of the Health Impact of Occupational Risk in Africa: Current Situation and Methodological Issues.” Epidemiology 10, no.
5 (1999): 632.
• Loewenson, Rene. “Globalization and Occupational Health: a Perspective from Southern Africa.” Bulletin of the World Health Organization 79, no. 9
(2001): 863–868.

128
PROFILES: AFRICA CONT’D
• MANAGING RISK, PROMOTING GROWTH Developing Systems for Social Protection in Africa. The World Bank. Accessed April 24, 2013.
• Schurman, Susan, Adrienne Eaton, Rebecca Gumbrell‐McCormick, Richard Hyman, Camille DiLeo, Gilma Madrid Berroterán, Sahra Ryklief, Mihai Varga,
and Verna Viajar. Organizing Workers in the Informal Economy. Cape Town, South Africa: Solidarity Center, December 2011.
• Xaba, Jantjie, Pat Horn, and Shirin Motala. The Informal Sector in Sub‐Saharan Africa. Working Paper on the Informal Economy. Geneva: International
Labor Office, 2002. http://www.ilo.int/wcmsp5/groups/public/@ed_emp/documents/publication/wcms_122204.pdf.
PROFILES: ASIA
• Casanova‐Dorotan, Florencia G. Informal Economy Budget Analysis in Philippines and Quezon City. WIEGO, 2010.
http://wiego.org/sites/wiego.org/files/publications/files/Casanova‐Dorotan_WIEGO_WP12.pdf.
• Nirathron, Narumol, and Kamolthip Chamkajang. A Review of Barriers in Access to Health Services for Selected Vulnerable Groups: Case Studies from
Thailand. Thammasat University, Thailand, n.d. http://cop.mdgasiapacific.org/files/cop/7/Thailand.pdf.
• Pina, Patricia, Tim Kotin, Vicky Hausman, and Edwin Macharia. Skills for Employability: The Informal Economy. Innovative Secondary Education for Skill
Enhancement (ISESE). Results For Development, May 7, 2012.
http://www.resultsfordevelopment.org/sites/resultsfordevelopment.org/files/resources/Skills%20for%20Employability%20in%20the%20Informal%20E
conomy.pdf.
• Profile of the Informal Sector. Congressional Planning and Budget Department House of Representatives (Philippines), November 2009.
http://www.congress.gov.ph/download/cpbd/fnf_112008_profsector.pdf.
• Ranson, Kent, Tara Sina, Mirai Chatterjee, Akash Acharya, Ami Bhavsar, Saul S. Morris, and Anne J. Mills. “Making Health Insurance Work for the Poor:
Learning from the Self‐Employed Women’s Association’s (SEWA) Community‐based Health Insurance Scheme in India.” Elsevier. Social Science &
Medicine (2005): 14.
• De la Rosa, Jennifer, and Xenia Scheil‐Adlung. Enabling Transition to Formalization Through Providing Access to Health Care: The Examples of Thailand
d h h // l / / / bl/ d / l /d / d / df

129
PROFILES: ASIA CONT’D
• Saha, Debdulal. Conditions of “Decent Working Life” of Street Vendors in Mumbai. Tata Institute of Social Sciences, n.d.
http://www.ilo.org/legacy/english/protection/travail/pdf/rdwpaper27c.pdf.
PROFILES: LATIN AMERICA
• Chen, Marty. “THE INFORMAL ECONOMY IN LATIN AMERICA: A GLOBAL PERSPECTIVE.” Monterrey, Mexico, May 22, 2008.
http://wiego.org/sites/wiego.org/files/resources/files/Chen_Presentation_Monterrey%20Conference_May_16_08.pdf.
• Ivanov, Ivan D. “Scaling Up Access to Essential Interventions And Basic Services For Occupational Health Through Integrated Primary Health Care.” In
Background Document. The Hague, Netherlands: World Health Organization, 2011.
• Lavigne, Milena. Social Protection Systems in Latin America and the Caribbean‐ Peru. Project Documents Collection. Santiago, Chile: Economic Comission
for Latin America and the Caribbean (ECLAC), January 2013. http://www.eclac.cl/publicaciones/xml/5/49105/SPS_Peru_ing.pdf.
• SMALL‐SCALE AND INFORMAL MINING: A BIG PROBLEM FOR LATIN AMERICAN STATES. Policy Brief‐ Economic Development. Evidence and Lessons from
Latin America (ELLA). GRADE, Practical Action Consulting, UK Aid, n.d.
http://ella.practicalaction.org/sites/default/files/121129_ECO_ExtIndConMan_BRIEF4.pdf.
ORGANIZATIONS ARE DOING INNOVATIVE AND/OR HIGH IMPACT WORK
• http://accessh.org/
• http://www.sewa.org
• http://www.microinsuranceacademy.org/
• http://www.brac.net/
• http://www.streetnet.org.za/
• http://www.homenetthailand.org/
• http://labournet.in/
• http://www.babajob.com/

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