Appendix A
Workshop Agenda
Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries July 29–30, 2014
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.
Approach: The workshop will examine the approaches, successes and challenges, and lessons learned in a purposeful selection of countries (primarily Brazil, Ghana, India, South Africa, and Thailand) to explore the topics of universal health coverage and occupational health and safety for the informal workforce in developing countries. With multisectoral presentations, exploration of the countries’ experiences may identify innovative approaches or opportunities for partnerships to improve equitable access to quality services to meet the needs of the informal workforce in resource-constrained countries. Many of the presentations also will describe the roles of the existing PPPs that are engaged in promoting universal health coverage and meeting the occupational health and safety needs for informal workers.
Workshop goal: To illuminate best practices and lessons learned for the informal workforce in developing countries: (1) in the financing of health care; (2) with respect to health care delivery models that are espe-
cially suitable to meet the population’s needs; and (3) for a variety of occupational health issues, including preventing or mitigating hazardous risks as well as the costs of providing medical and rehabilitation services and other benefits to various types of workers within this population. These best practices and lessons learned may be useful for stakeholders to move the discussions, policies, regulatory frameworks, political contexts, and mechanisms (including enhanced or new PPPs) forward to increase equitable access to quality health services without financial hardship for the informal workforce or workers in the informal sector, including prevention, curative, and rehabilitation services for injuries and illness due to occupational hazard exposure.
Context: Achieving universal access to quality care is an urgent global health priority today. Most of the world achieves this through a growing and dominant mix of public- and private-sector health care systems. Health systems in most low- and middle-income countries (LMICs) are evolving to increasingly use the private sector (e.g., health providers from different parts of the private sector, corporations, social enterprises, and philanthropy) because the public sector lacks the infrastructure and staff to meet all health care needs. With growing individual assets available for private-sector expenditure, patients often seek better access to technology, staff, and medicines. However, in the developing world about 40 to 70 percent of private sector expenditures are out of pocket. With the expected increase in the overall fraction of private-sector–provided care, these expenditures can be financially catastrophic for individuals in the informal workforce.
Occupational accidents, diseases, and fatalities create significant burdens globally in terms of human suffering and economic costs, which are estimated to be roughly 4 percent of gross national product globally. Occupational health and safety services, initially designed during the advent of industrialization, prevent and treat acute and chronic illness as well as injuries among the working population. The field is evolving in response to social, political, economic, and technological changes globally, but services are usually private entities and continue to be primarily financed by the employers and provide advice and carry out different interventions to protect workers from occupational health and safety risks. In the global workforce of approximately 3 billion people, only 10 to 15 percent are estimated to have some type of access to occupational health services. The informal workforce is growing worldwide, and meeting its occupational health needs rests on the capabilities of the general health care system. General health care practitioners often lack the skills and knowledge to address work-related health needs, which is one of the primary limitations to meeting the needs in most countries, although there are some encouraging examples for capacity enhancement and
building. In countries where the enforcement of occupational health and safety rules relies on labor inspection, such inspections are usually confined to formal workplaces and employment relations. In contrast, there are examples of public health systems in several developing countries that rely on enforcement of occupational health through public health law that is not conditioned by the nature of employment relations. Financing for universal quality care, as well as the models to best deliver care, including occupational health and safety services, often require innovative solutions, especially for the large fraction of workers who occupy what is variably defined as the informal sector in LMICs.
DAY 1 — JULY 29, 2014
8:30 a.m. | Registration (continental breakfast provided) |
9:15 a.m. |
Welcome and Introductions |
Patrick Kelley, Director, Boards on Global Health and African Sciences Academies Development, National Academies of Sciences, Engineering, and Medicine |
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9:30 a.m. |
Opening Remarks |
9:30 a.m. |
Victor Dzau, President, National Academy of Medicine |
9:45 a.m. |
Clarion Johnson, Co-Chair of PPP Forum and Chair of Workshop Planning Committee |
Keynote Addresses |
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10:00 a.m. |
Robert Emrey, U.S. Agency for International Development |
10:45 a.m. |
Mirai Chatterjee, Self Employed Women’s Association (India) (SEWA) |
11:30 a.m. |
BREAK |
I. Universal Health Coverage and Occupational Health and Safety Issues for the Informal Workforce
There are recommended packages of basic services for both universal health coverage and occupational health and safety, but when they are offered, it is usually though a mixed system of providers and payers. Many countries are grappling with the growing demand for providing
quality health services and equitable access while also protecting their most vulnerable citizens from financial catastrophe when services are needed. This is particularly salient when those in the informal workforce are excluded from health and social care driven by national or private contracts, national heath and labor regulations, and other protections for or on behalf of formal sector workers. Informal workers have commonly shared health needs with the formal sector, but they have additional unique occupational needs, hazards, and exposures. As countries seek to strengthen fragile or overburdened health systems or undergo comprehensive health system reform, more public and private stakeholders are engaged in the pragmatic dialogue about not only all aspects of health systems, including governance, financing, and service delivery, but also the issue of sustainability of quality services for the longer term. From a variety of perspectives, this session explores the common and unique health issues of informal workers and the short- and long-term individual and societal consequences for the informal workforce and sector when not covered adequately and sufficiently by national health and social protections efforts.
11:45 a.m. – 1:00 p.m. | |
Moderator: Ivan Ivanov, World Health Organization; Workshop Planning Committee Member |
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Martha Chen, Harvard Kennedy School; Harvard Graduate School of Design; Women in Informal Employment: Globalizing and Organizing (WIEGO); Workshop Planning Committee Member |
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1:00 p.m. |
Lunch (provided) |
II. Mapping Solutions to Universal Health Coverage Inclusive of the Informal Workforce
There are many different strategies for health care reform that ultimately affect health systems, particularly the provision and coverage of health services and their financing. Services are usually needed along the continuum of preventive, primary, secondary, and tertiary health care. The modalities for financing and their potential mixing can situate countries differently in terms of what services can be provided, by whom, and whether the actual or desired mix is sustainable. Another challenge is whether the services and the financing are inclusive of meeting the commonly shared and unique health needs of the informal workforce in
developing countries by achieving goals of social financial protection of informal workers around the world. This session will explore the different prioritization and allocation of services based on the available financial resources and different financing mechanisms utilized as well as the social protection and inclusion of the informal workforce.
1:45 – 3:45 p.m. | |
Moderator: David de Ferranti, Results for Development |
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Peter Berman, Harvard School of Public Health; Harvard University; Workshop Planning Committee Member |
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Lorna Friedman, Mercer |
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Marleece Barber, Lockheed Martin; Workshop Planning Committee Member |
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Orielle Solar, TEES Program, Chile (by videoconference) |
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3:45 p.m. |
BREAK |
III. Examination of Select Country Experiences of Universal Health Coverage, Part I
Many countries have the challenge of assurance in meeting the demands for the provision of quality health services to their varied populations. Through a purposeful sampling of countries and of diverse perspectives from the public and private sectors, this session explores the efforts of each country toward the achievement of universal health coverage specifically for the informal workforce. Presentations will also provide highlights of the involvement of PPPs in these efforts, as well as opportunities for enhanced or new partnerships to meet universal health coverage objectives that are inclusive of the health and social needs of the informal workforce and informal sector.
4:00 – 5:30 p.m. | |
Moderator: Paurvi Bhatt, Medtronic Philanthropy |
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Vilma Santana, Federal University of Bahia, Brazil |
Karen Sichinga, Churches Health Association of Zambia |
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Orrapan Untimanon, Ministry of Public Health, Thailand |
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5:30 p.m. |
ADJOURN WORKSHOP FOR THE DAY |
5:30 – 6:30 p.m. |
RECEPTION |
DAY 2 — JULY 30, 2014 |
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8:00 a.m. | Registration (continental breakfast provided) |
8:30 a.m. |
Recap of Day 1 and Preview of Content for Day 2 |
Martha Chen, Harvard Kennedy School; Harvard Graduate School of Design; WIEGO; Workshop Planning Committee Member |
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IV. Examination of Select Country Experiences of Universal Health Coverage, Part II |
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8:45 – 10:45 a.m. | |
Moderator: Paurvi Bhatt, Medtronic Philanthropy |
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Somsak Chunharas, National Health Foundation, Thailand |
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Barry Kistnasamy, Social Protection and Workers Compensation, Department of Health, South Africa |
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Mirai Chatterjee, SEWA |
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10:45 a.m. |
BREAK |
V. Responding to the Work-Related Health Needs of Informal Sector Workers, Part I
In addition to general health care, informal sector workers have some specific health needs to protect and promote their working capacity and to be protected from occupational health and safety hazards in their workplaces. How can these needs be met, and what are the most essential health services for this, and how much do they cost? What is the role of general health care providers (public and private) and non-health actors (workers and trade associations, local authorities) to protect and promote
the health of informal sector workers? What is the role of the corporate sector to protect and promote health of informal sector workers and to contribute to their health coverage? This session will highlight the lessons learned from country initiatives and the different policy options for extending health coverage and occupational health and safety to informal sector workers.
11:00 a.m. – 1:00 p.m. | |
Moderator: John Howard, U.S. National Institute for Occupational Safety and Health |
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Ivan Ivanov, World Health Organization; Workshop Planning Committee Member |
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Yuka Ujita, Labour Administration and Occupational Safety and Health, International Labour Organization |
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Charu Garg, Population, Health & Nutrition Research Program, Institute for Human Development, New Delhi, India |
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Laura Alfers, WIEGO |
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1:00 p.m. |
Lunch (provided) |
VI. Responding to the Work-Related Health Needs of Informal Sector Workers, Part II |
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2:00 – 4:00 p.m. |
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Moderator: John Howard, U.S. National Institute for Occupational Safety and Health |
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Francie Lund, School of Built Environment and Development Studies University of KwaZulu Natal, South Africa; WIEGO |
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Julietta Rodriguez-Guzman, Pan American Health Organization |
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Poonsap Tulaphan, HomeNet Thailand |
Hanifa Denny, Associate Professor, Diponegoro University, Indonesia |
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VII. The Way Forward |
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4:00 – 5:15 p.m. | |
Co-moderator: Clarion Johnson, Co-Chair of PPP Forum and Workshop Planning Committee |
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Co-moderator: Katherine Taylor, University of Notre Dame; PPP Forum and Workshop Planning Committee Co-Chair |
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Julietta Rodriguez-Guzman, Pan American Health Organization |
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Mirai Chatterjee, SEWA |
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Lorna Friedman, Mercer |
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Yuka Ujita, Labour Administration and Occupational Safety and Health, International Labour Organization |
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Robert Emrey, U.S. Agency for International Development |
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5:15 p.m. |
A Perspective from The Rockefeller Foundation |
Michael Myers, The Rockefeller Foundation |
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5:30 p.m. |
Adjournment of Workshop |
Clarion Johnson, Co-Chair of PPP Forum and Workshop Planning Committee |