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Financial support for this activity was provided by Air Products; Anheuser-Busch InBev; Becton, Dickinson & Company; The Bill & Melinda Gates Foundation; CARE USA; Catholic Health Association of the United States; e-Development International; Estée Lauder Companies; ExxonMobil; Fogarty International Center of the National Institutes of Health; Fondation Mèrieux USA; GE; Global Health Innovative Technology Fund; Johnson & Johnson; Lockheed Martin Corporation; Medtronic; Merck; Novartis Foundation; PATH; PepsiCo; Pfizer Inc.; Procter & Gamble Co.; The Rockefeller Foundation; Takeda Pharmaceuticals; United Nations Foundation; University of Notre Dame; UPS Foundation; U.S. Agency for International Development; U.S. Department of Health and Human Services Office for Global Affairs; U.S. Department of State/Office of the Global AIDS Coordinator; U.S. Food and Drug Administration; Verizon Foundation; and The Vitality Group. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-37406-4
International Standard Book Number-10: 0-309-37406-5
Digital Object Identifier: 10.17226/21747

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

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

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PLANNING COMMITTEE ON APPROACHES TO UNIVERSAL HEALTH COVERAGE AND OCCUPATIONAL HEALTH AND SAFETY FOR THE INFORMAL WORKFORCE IN DEVELOPING COUNTRIES¹

CLARION JOHNSON (Chair), Private Consultant, ExxonMobil (retired)

MARLEECE BARBER, Director of Health and Wellness, Chief Medical Officer, Lockheed Martin

PETER BERMAN, Professor of the Practice of Global Health Systems and Economics, Director, GHP (Global Health and Population) Educational Initiatives, Harvard School of Public Health

PAURVI BHATT, Senior Director for Global Access, Medtronic Philanthropy

MARTHA CHEN, Lecturer in Public Policy, Harvard Kennedy School; Affiliated Professor, Harvard Graduate School of Design; International Coordinator, Women in Informal Employment: Globalizing and Organizing

IVAN D. IVANOV, Team Leader, Workers’ Health, Department of Public Health, Environmental and Social Determinants of Health, World Health Organization

KATHERINE TAYLOR, Research Professor, Director of Operations, Interim Director of Global Health Training, Eck Institute for Global Health, University of Notre Dame

__________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

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FORUM ON PUBLIC–PRIVATE PARTNERSHIPS FOR GLOBAL HEALTH AND SAFETY¹

JO IVEY BOUFFORD (Co-Chair), President, New York Academy of Medicine

CLARION JOHNSON (Co-Chair), Private Consultant, ExxonMobil

ANN AERTS, Head, Novartis Foundation (from January 2016)

TARA ACHARYA, Senior Director, Strategic Nutrition Risks in Global R&D, PepsiCo (until April 2016)

SIR GEORGE ALLEYNE, Director Emeritus, Pan American Health Organization Chancellor, University of the West Indies

RAJESH ANANDAN, Senior Vice President, Strategic Partnerships and UNICEF Ventures, U.S. Fund for UNICEF

MARLEECE BARBER, Director of Health and Wellness and Chief Medical Officer, Lockheed Martin Corporation

DEBORAH L. BIRX, Ambassador-at-Large; U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy (from November 2015)

SIMON BLAND, Director, New York Liaison Office, UNAIDS

ROBERT BOLLINGER, Professor of Medicine, Public Health and Nursing, Johns Hopkins University School of Medicine

KIM C. BUSH, Director, Life Sciences Partnerships, Global Health Program, The Bill & Melinda Gates Foundation

GARY M. COHEN, Executive Vice President and President, Global Health and Development, Becton, Dickinson & Company

BRENDA D. COLATRELLA, Executive Director, Corporate Responsibility, President, Merck Foundation, Merck

BRUCE COMPTON, Senior Director of International Outreach, Catholic Health Association of the United States

PATRICIA DALY, Senior Director, Save the Children

PATRICIA J. GARCIA, Dean, School of Public Health, Cayetano Heredia University

HELENE D. GAYLE, President and Chief Executive Officer, CARE USA (until July 2015)

ELAINE GIBBONS, Executive Director, Corporate Engagement, PATH

ROGER GLASS, Director, Fogarty International Center

LOUISE GRESHAM, President and Chief Executive Officer, Fondation Mèrieux USA (until January 2015)

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.

RICHARD GUERRANT, Thomas H. Hunter Professor of International Medicine, University of Virginia

TREVOR GUNN, Vice President, International Relations, Medtronic

JESSICA HERZSTEIN, Member, U.S. Preventive Services Task Force

BEN HOFFMAN, Chief Medical Officer, GE Energy

REZA JAFARI, Chairman and CEO, e-Development International (from January 2016)

JAMES JONES, Manager, Community Investment Programs, ExxonMobil

ALLISON TUMMON KAMPHUIS, Leader, Children’s Safe Drinking Water Program Social Sustainability, Procter & Gamble Co.

ROSE STUCKEY KIRK, President, Verizon Foundation

SEEMA KUMAR, Vice President, Global R&D Communications, Johnson & Johnson

AMBASSADOR JOHN E. LANGE, Senior Fellow, Global Health Diplomacy, United Nations Foundation

NANCY MAHON, Senior Vice President, Global Philanthropy and Corporate Citizenship, Estée Lauder Companies

LAUREN MARKS, Director, Private Sector Engagement, Office of the Global AIDS Coordinator, U.S. Department of State (until May 2015)

EDUARDO MARTINEZ, President, UPS Foundation

MICHAEL MYERS, Managing Director, The Rockefeller Foundation

REGINA RABINOVICH, ExxonMobil Malaria Scholar in Residence, Harvard School of Public Health

SCOTT C. RATZAN, Vice President, Global Corporate Affairs, Anheuser-Busch InBev

B. T. SLINGSBY, Chief Executive Officer and Executive Director, Global Health Innovative Technology Fund

KATHERINE TAYLOR, Research Professor, Director of Operations, Eck Institute for Global Health, University of Notre Dame

WENDY TAYLOR, Director, Center for Accelerating Innovation and Impact, U.S. Agency for International Development

MARY LOU VALDEZ, Associate Commissioner for International Programs, Director, Office of International Programs, U.S. Food and Drug Administration

JACK WATTERS, Vice President for External Medical Affairs, Pfizer (until July 2015)

HOLLY WONG, Principal Deputy Assistant Secretary for Global Affairs, U.S. Department of Health and Human Services

DEREK YACH, Chief Health Officer, The Vitality Group

TADATAKA “TACHI” YAMADA, Venture Partner, Frazier Healthcare Partners

IOM Staff

RACHEL TAYLOR, Program Officer

FRANCIS AMANKWAH, Research Associate (from January 2016)

PRIYANKA NALAMADA, Research Assistant (from March 2015)

KIMBERLY SCOTT, Senior Program Officer (until May 2015)

ANGELA CHRISTIAN, Program Associate (until January 2015)

AUDREY GROCE, Senior Program Assistant (until September 2014)

FAYE HILLMAN, Financial Associate

PATRICK KELLEY, Director, Board on Global Health

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Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

Deena L. Buford, ExxonMobil Corporation

Somsak Chunharas, National Health Foundation

Hanifa M. Denny, Diponegoro University

K. Srinath Reddy, Public Health Foundation of India

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Georges C. Benjamin, American Public Health Association. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteur and the institution.

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Acknowledgments

The National Academies of Sciences, Engineering, and Medicine’s Forum on Public–Private Partnerships for Global Health and Safety (PPP Forum) has been established to illuminate opportunities that strengthen the role of public–private partnerships (PPPs) in meeting the health and safety needs of individuals and communities around the globe. The forum seeks to foster a collaborative community of multisectoral health and safety leaders to leverage the strengths of varying sectors and multiple disciplines to yield benefits for global health and safety. Achieving global health will not only improve the health and well-being of individuals, but also contribute to the strengthening of families and communities, to international security, to economic productivity, and to other elements of social well-being. Progress toward global health is inherently multisectoral and more effective when sectors work synergistically based on the ever better discovery and implementation of best practices. Critical sectors for achieving global health include diverse elements of government, a wide range of academic disciplines, multinational companies of virtually all types, foundations willing to pursue high-yielding investments for mutual aims, nongovernmental organizations that play key roles in policy development and implementation, and other elements of civil society. Bringing together such a collection of stakeholders for innovation and action is a challenge at which the Institute of Medicine (IOM) of the Academies excels.

By regularly gathering and learning from leaders of diverse, exemplary, and innovative entities as described above, the forum focuses on

catalyzing more effective global health initiatives that capitalize on the complementary assets and motivations of the sectors involved. The concept of PPPs to advance global health is well established, and various other groups offer convening activities to develop and share relevant knowledge. This forum, however, seeks to uniquely add value to complement many of those efforts. The membership is committed to engaging the expertise of its members and broader groups of stakeholders, its resources, and its networks to identify opportunities to catalyze partnerships; to elaborate norms that protect the interests of those partnered and those served; to capture and share best insights, evidence, and practices for decision making and resource allocation for partnerships; and to foster innovations that may increase efficiencies and equitable access to effective care.

A number of individuals contributed to the development of this workshop and report. These include a number of staff members from the IOM and the Academies: Marton Cavani, Angela Christian, Greta Gorman, Audrey Groce, Faye Hillman, Patrick Kelley, Sarah Kelley, Priyanka Nalamada, Jose Portillo, Patsy Powell, Bettina Ritter, Kimberly Scott, Rachel Taylor, and Julie Wiltshire.

The planning committee contributed several hours of service to develop and execute the agenda, with the guidance of forum membership. Reviewers also provided thoughtful remarks in reading the draft manuscript. Finally, these efforts would not be possible without the work of the forum membership itself, an esteemed body of individuals dedicated to the concept that violence is preventable.

The overall successful functioning of the PPP Forum and its activities depends on the generosity of its sponsors. Financial support for the PPP Forum is provided by Air Products; Anheuser-Busch InBev; Becton, Dickinson & Company; The Bill & Melinda Gates Foundation; CARE USA; Catholic Health Association of the United States; e-Development International; Estée Lauder Companies; ExxonMobil; Fogarty International Center of the National Institutes of Health; Fondation Mèrieux USA; GE; Global Health Innovative Technology Fund; Johnson & Johnson; Lockheed Martin Corporation; Medtronic; Merck; Novartis Foundation; PATH; PepsiCo; Pfizer Inc.; Procter & Gamble Co.; The Rockefeller Foundation; Takeda Pharmaceuticals; United Nations Foundation; University of Notre Dame; UPS Foundation; U.S. Agency for International Development; U.S. Department of Health and Human Services Office for Global Affairs; U.S. Department of State/Office of the Global AIDS Coordinator; U.S. Food and Drug Administration; Verizon Foundation; and The Vitality Group.

Contents

ACRONYMS

1 INTRODUCTION

Operational Definitions for This Workshop

Organization of the Report

2 UNIVERSAL HEALTH COVERAGE AND OCCUPATIONAL HEALTH AND SAFETY ISSUES FOR THE INFORMAL WORKFORCE

The Informal Workforce

Universal Health Coverage: Frameworks for Discussion

Universal Health Coverage and the Informal Workforce

Universal Health Coverage, Informality, and Workers’ Health

Partnerships as a Mechanism for Progress

Universal Health Coverage and Occupational Health and Safety for Informal Workers: A View from India

Discussion

3 MAPPING SOLUTIONS TO UNIVERSAL HEALTH COVERAGE INCLUSIVE OF THE INFORMAL WORKFORCE

Roles of Global Employers in Universal Health Coverage

The Role of Employers in Coverage and Occupational Health: A Perspective from the U.S. Experience

Efforts to Map the Informal Workforce and Health Coverage in Latin America

Discussion

4 RESPONDING TO WORK-RELATED HEALTH NEEDS OF INFORMAL SECTOR WORKERS

Primary-Care Based Interventions for Informal Sector Workers

Responding to the Work-Related Needs of Informal Sector Workers in Latin America

The International Labour Organization’s Approach and Good Practices for Occupational Safety and Health for Informal Workers

A Perspective from the United States

5 SELECT COUNTRY EXPERIENCES

BRAZIL: Building the National Occupational Health Services Network: An Experience with Universal Health Care Provision

INDIA: Inequities in Financing, Coverage, and Utilization of Health Care by Informal Sector Workers

INDONESIA: The Effectiveness of Occupational Health Interventions for the Informal Sector and Options for Delivery

SOUTH AFRICA: Services to Workers in the Informal Economy

SOUTH AFRICA: Occupational Health and Safety: Toward the Inclusion of Informal Workers

SOUTH AFRICA AND GHANA: Linking Occupational Health and Universal Health Coverage

THAILAND: Universal Health Coverage System and Informal Workers

THAILAND: Occupational Health Services Delivery for Informal Workers and Financial Resources

THAILAND: Experiences from a Pilot Project on Occupational Safety and Health Promotion for Informal Workers

ZAMBIA: Public–Private Partnerships in Health

6 CLOSING REMARKS

A Perspective from The Rockefeller Foundation

REFERENCES

APPENDIXES

A WORKSHOP AGENDA

B SPEAKER BIOGRRAPHICAL SKETCHES

Acronyms

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