Effects of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers

OBJECTIVES

This study aims to evaluated the effectiveness of participatory action-oriented training (PAOT) intervention for hypertension management among intercity van drivers.

MATERIAL AND METHODS

This quasi-experimental study applied concept and process of participatory actionoriented training and self-management to guide the development of the intervention addressing improvement in hypertension management behaviors. A total of 104 intercity van drivers with uncontrolled hypertension in Thailand were recruited to participate in this program. The intervention group (N = 52) received PAOT program, while the control group (N = 52) received conventional program. Data on hypertension management behaviors, and blood pressure were measured at baseline, 1 month and 3 months after intervention.

RESULTS

At 3 months after intervention, hypertension management behavior, and systolic blood pressure were significantly different between 2 groups (p < 0.05).

CONCLUSIONS

This PAOT was found to be feasible and could potentially improve hypertension management, and blood pressure level of intercity van drivers. The program should be applied in further studies with other workplaces in both formal and informal sectors with different characteristics and other health issues. Int J Occup Med Environ Health. 2024;37(2).

Status of occupational health and safety in the informal sectors in Tanzania: the case of stone quarrying and soil brickmaking

Objectives. The informal economy in Tanzania, as in many other developing countries, presents numerous workplace safety issues. This study was conducted in stone quarrying (SQ) and soil brickmaking (SBM) sites to assess workers' awareness and perceptions of safety practices, identify common workplace risks and hazards, and evaluate challenges hindering the implementation of workplace safety culture. Methods. A total of 173 workers responded to a semi-structured questionnaire and 15 workers were interviewed. Data were summarized using Stata (version 15). Results. More than 95% of the SQ and SBM workers were exposed to ergonomic hazards and related health risks, due to low awareness (90%) and unavailable leadership structures (>96%) for enforcing and overseeing the implementation of workplace occupational health and safety (OHS) regulations. Conclusion. Due to the lack of regulation and oversight, workers in the informal sector in Tanzania often face hazardous conditions that put their health and safety at risk. Workers use self-intuitions, observations, injuries and near miss incidences to improvise control measures and minimize hazardous risks. This study provides baseline information that can be used for evidence-based decision-making and policy formulation to safeguard workers' safety and health in the informal sectors of Tanzania.

Impacts of unconditional cash transfers on health care utilisation in informal sector households in Togo

BACKGROUND

Most Togolese population earns their income from informal sector, and they are very often exposed to health outcomes. Cash transfers impact healthcare utilization by improving household's social capital, socio-economic status, lifestyle choice, and physical health. The aim of this paper was to analyse the impact of unconditional cash transfers on health care utilisation in informal sector households.

METHODS

We used the propensity-score method to compare health care utilisation by households that received cash transfers from nonbeneficiary households and simulated a potential confounder to assess the robustness of the impacts of the estimated treatment (i.e., cash transfer). Data were obtained from a national survey that covered 1405 households.

RESULTS

The results show that women benefited the most from cash transfers (73.1%). Our estimates indicate that health care utilisation increased by 28.3% among workers in the informal sectors who benefited from unconditional cash transfers compared to nonbeneficiaries. The greatest impact was found on agriculture households with an increase by 31.3% in the health care utilisation. In general, cash transfer beneficiaries are more likely to use public health centres; there was an increase in public health facility attendance of 21.3%.

CONCLUSIONS

Cash transfers are a valuable social protection instrument that improve health care utilisation of populations in the informal sector. Policymakers could use cash transfer as the infusion of income and/or assets that may impact health outcomes. Cash transfers are an opportunity to alleviate barriers of access to health care by older people. Future research must examine impact of cash transfer on health of vulnerable groups such as older people, children, and people with disabilities.

Workplace concentrations of particulate matter and noise levels among stone quarry and soil brick-making workers in Tanzania

This study was conducted in 15 artisanal stone quarries (SQ) and 22 soil brick-making (SBM) sites. Specific objectives were to: (i) quantify ambient concentrations of suspended particulate matter (PM) and gaseous pollutants and noise levels at SQ and SBM workplaces; (ii) critically evaluate the potential workplace hazards, and risk factors; and (iii) analyze potential health risks to workers. Gaseous pollutants, PM, and noise levels were measured by using portable digital devices. Social demographic information of 150 workers across the study sites was collected using a questionnaire. Quantitative data were summarized and exploratorily analyzed using Stata software. This study revealed that fuel burning in the SBM releases SPM up to 10-fold and CO gas up to 14-fold above the WHO-recommended time-weighted average exposure concentrations of 16.6 µg/m3 and 0.3 mg/m3, respectively. On average hitting with a pickax in SQ areas released noise levels of about 81.01 ± 6.8 dB[A]. Overall, the SQ and SBM workers were exposed to low concentrations of PM and noise levels when the measurements were taken. Long working hours for repetitive activities in hot-sunny (27.1 ± 2.3 °C) and low outdoor humidity 23 ± 1.5%, potentially increase epidemiological risks to vulnerable individuals and enhance worker exposures to inhalable PMs. Although workplace noise exposure below the regulatory threshold of 85 dB[A] may not cause immediate hearing damage, it can have a significant impact on workers' hearing health, cognitive performance, psychological well-being, and overall productivity. This study provides an overview of workplace conditions rather than an accurate representation of the actual worker exposure levels because personal breathing zone sampling devices were not used. This study provides baseline information for further research and can be used for evidence-based decision-making and policy formulation to safeguard worker safety and health in SQ and SBM sites in Tanzania.

Exploring the concepts of decent work through the lens of SDG 8: addressing challenges and inadequacies

Promoting decent work and sustainable economic growth within the framework of Sustainable Development Goal 8 (SDG 8) entails addressing gender inequality, the consequences of market economies, and the role of the informal sector while also considering environmental sustainability. Research on SDG 8 remains limited, often adopting an appraisal perspective, and the concept of decent work within this goal remains relatively unexplored. Additionally, the focus on the challenges and inadequacies of achieving sustainable economic growth through decent work in the context of SDG 8 is insufficient, resulting in significant knowledge gaps. To contribute to filling these gaps, this paper adopts a descriptive and critical review perspective, systematically analyzing 108 journal papers and reports to investigate the concept of decent work within SDG 8. The research addresses the challenges and inadequacies related to decent work embedded in SDG 8. The review reveals that while progress has been made in tackling gender inequality in the labor market, gender bias, income discrepancies, and underrepresentation of women in senior positions persist, hindering inclusive and sustainable economic growth, full and productive employment, and decent work for all - SDG 8. Moreover, SDG 8's focus on inclusive and sustainable development falls short of effectively addressing market economies' structural disparities, insecure working conditions, and exploitative labor practices. Additionally, support for informal sector workers, who lack essential rights such as legal protection and social security, remains insufficient. Ecological destruction is sometimes an unintended consequence of purely market-based labor markets with an emphasis on economic growth, with SDG 8 lacking sufficient integration of environmental sustainability in its framework. The novelty of this study comes from its in-depth, critical, and policy-focused analysis of the ideas around decent employment in the context of SDG 8. The findings underscore the importance of providing fair, safe, and secure employment opportunities to support economic growth and development while upholding workers' rights. In conclusion, we emphasize the crucial role of promoting decent work and sustainable growth in achieving SDG 8's overall objectives, as it directly impacts other SDGs.

Mandatory health insurance for the informal sector in Tanzania-has it worked anywhere!

Many countries in sub-Saharan Africa are struggling to expand voluntary health insurance schemes to raise finances toward achieving universal health coverage. With more than three-quarters of the population without any insurance, the government of Tanzania has unsuccessfully tried to pass a Bill proposing a mandatory, nationwide scheme to cover the large and diverse informal sector. The Bill proposed an annual premium of ∼150 USD for a household of six or 65 USD per person. Studies in Tanzania and Kenya have shown that the majority of people in the informal sector are unwilling and unable to pay premiums as low as 4 USD, mostly due to poverty. Mandatory health insurance for the informal sector is not common in this region, mostly because it is difficult to enforce. Successful insurance schemes have included significant subsidies from tax revenues. Tanzania should not seek to raise funds for health through an unenforceable insurance scheme but rather should consider a largely tax-funded scheme for the informal sector. Contributions through low-cost voluntary schemes can enhance social contracts, reduce out-of-pocket expenditure, and promote efficient utilization. In addition, progressive health taxes should be imposed on harmful products (tobacco, alcohol, sugary drinks, etc.) to raise more funds while addressing the increasing burden of non-communicable diseases. Furthermore, efficiency in the use of scarce health resources should be promoted through realistic prioritization of public services, the use of Health Technology Assessment, and strategic purchasing.

Determinants of retirement of formal and informal sector workers in Mexico: the role of health and economic security

OBJECTIVE

We examine the socioeconomic and health drivers of retirement decisions and compare these determinants between formal and informal sector workers in Mexico.

MATERIALS AND METHODS

Using data from the Mexican Health and Aging Study 2012 and 2015, we estimate conditional probit models of retirement using sociodemographic, health, health care utilization, health insurance, private pensions, and social security systems covariates. The Institutional Review Board at the University of Southern California reviewed and approved the research (IRB # UP-15-00023).

RESULTS

We find that the social security systems are an important determinant for retirement age for formal sector workers. The informal sector workers, who lack access to retirement benefits of the social security system, make retirement decisions mainly based on health and access to health insurance through social security.

CONCLUSION

Despite the lack of access to social security benefits, informal sector workers do not respond strongly to socioeconomic factors in determining the timing of retirement. Strengthening access to better health care services could improve health, extend working lives, and promote healthy aging for workers in the informal sector.

Factors affecting access to healthcare for young people in the informal sector in developing countries: a systematic review

Background

Young people are increasingly seeking employment in the informal sector due to increasing global unemployment. However, the precarious nature of work in the informal sectors, coupled with the high risk of occupational hazards, calls for a greater need for effective healthcare for informal sector workers, particularly young people. In addressing the health vulnerabilities of informal workers, systematic data on the determinants of health is a persistent challenge. Therefore, the objective of this systematic review was to identify and summarise the existing factors that affect access to healthcare among young people from the informal sector.

Methods

We searched six data databases (PubMed, Web of Science, Scopus, ProQuest, Crossref, and Google Scholar), which was followed by hand searching. Then we screened the identified literature using review-specific inclusion/exclusion criteria, extracted data from the included studies and assessed study quality. Then we presented the results in narrative form, though meta-analysis was not possible due to heterogeneity in the study design.

Results

After the screening, we retrieved 14 studies. The majority were cross-sectional surveys and were conducted in Asia (n = 9); four were conducted in Africa, and one in South America. Samples ranged in size from 120 to 2,726. The synthesised results demonstrate that problems of affordability, availability, accessibility, and acceptability of healthcare were barriers to young informal workers seeking healthcare. We found social networks and health insurance as facilitators of access for this group of people.

Conclusion

To date, this is the most comprehensive review of the evidence on access to healthcare for young people in the informal sector. Our study finding highlights the key gaps in knowledge where future research could further illuminate the mechanisms through which social networks and the determinants of access to healthcare could influence the health and well-being of young people and thus inform policy development.

The informal economy as a provider of assistive technology: lessons from Indonesia and Sierra Leone

Promoting the use of assistive technology (AT) is crucial for the health and well-being of users, but there is a huge global problem of unmet need for AT. In this context informal (unregulated) providers of AT play a significant role of meeting AT user need, particularly in less-resourced settings. This study draws on research into formal and informal AT provision in low-income urban communities in Indonesia and Sierra Leone to explore the potential of informal providers in addressing unmet need. Specifically, it looks at the different performance of formal and informal providers regarding the availability and the adequacy of AT that they provide. The study concludes by proposing further research into the scope for coproduction of AT between formal and informal providers.

Consumer Demand for Milk and the Informal Dairy Sector Amidst COVID-19 in Nairobi, Kenya

Background

The coronavirus disease 2019 (COVID-19) pandemic has had large negative effects on countries' economies and individual well-being throughout the world, particularly in low- and middle-income countries. Pandemic-related changes in behavior and government restrictions in Kenya may have negatively affected food supply chains and household food access; however, the empirical evidence is currently limited.

Objectives

The study explored changes in informal milk markets, dairy consumption, and food insecurity among low-income households in urban and periurban Nairobi, Kenya, following the start of the COVID-19 pandemic in the country.

Methods

Baseline data on milk sales and consumption were collected in late 2019 from dairy vendors operating in the informal sector and their dairy customers. We conducted 2 longitudinal telephone surveys with the same study participants in July and September-October 2020, respectively.

Results

At the first follow-up, the volume of milk sold by informal vendors had dropped by 30% compared with their baseline level, and the volume of milk from informal markets consumed by households decreased by 23%. By the second follow-up, the volume of milk sold and consumed had recovered somewhat but remained lower than the volume observed 1 y prior in the same season. Large reductions in the consumption of other animal-sourced products were also observed. The rate of food insecurity increased by 16 and 11 percentage points in the first and second follow-up periods, respectively, compared with baseline.

Conclusions

The evidence, therefore, suggests that the timing of the pandemic and the related restrictions were associated with a decrease in the supply and consumption of milk from informal markets in Nairobi and a decrease in the food security of periurban consumers.

Formal and informal solid waste management in Kutaisi, Georgia: A status quo report based on material flow analysis

The goal of this study is a qualitative and quantitative evaluation of processes and flows within the solid waste management (WM) system in Kutaisi, Georgia, and the wider Imereti region. The applied methodology based upon data collected through customized questionnaires enabled both the formal and informal sectors (IS) to be characterized. Moreover, waste composition studies in the region's rural and semi-urban areas revealed that the share of recyclables is higher in urban areas and commercial centres. A material flow analysis was used to transparently consolidate the collected data, showing that dumping and landfilling still play a major role within the Georgian WM system. The total amount of waste landfilled on 'Nikea' landfill in 2019 equals 58,000 tonnes year^-1, from where around 55,500 tonnes year^-1 is formally collected municipal solid waste, and 2,503 tonnes year^-1 is commercial and industrial waste. According to the findings, the size of the IS in Kutaisi is 0.07-0.15% of the city's population, whose supposed cumulative income is estimated GEL 0.57-1.13 million (EUR 180-360 thousand) in 2019. Informally collected recyclables are estimated 870-1,750 tonnes year^-1, comprising 6-11% of recyclables landfilled in Kutaisi in 2019. The study provides a basis for decision-makers. Replicating the applied methodologies and approaches to create this sound database could support the WM system across whole Georgia. The study further reveals the importance of the need to stop neglecting the IS and recognizes the importance of its role in the WM system of Kutaisi and the wider Imereti region, respectively.

Tax obsessions: Taxpayer registration and the "informal sector" in sub-Saharan Africa

MOTIVATION

There are three puzzling features of sub-Saharan African tax systems: tax administrations maintain records on vast numbers of small enterprises that actually provide no revenue; they continually invest resources into registering even more of these "unproductive taxpayers"; and discussions about taxing small enterprises are framed by the ambiguous, misleading concept of the "informal sector."

PURPOSE

To make sense of these separate puzzling practices and narratives by exploring the synergies between them, and the broader organizational and political interests that they serve.

METHODS AND APPROACH

There is little statistical or sociological information on the functioning of national tax administrations in sub-Saharan Africa. The analysis is based on the results of recent research; along with a thorough search for useful data; my own extensive interactions with African tax administrators and relevant international organizations; and a sensitivity to the political dimensions of taxation.

FINDINGS

The three features of tax systems that are individually puzzling make sense when examined holistically. The continual drive to register more taxpayers provides an unduly favourable impression of the extent of policy and managerial efforts to collect more revenue. The informal sector narrative locates the apparent cause of revenue scarcity in the alleged undertaxation of small enterprises and poorer people, and thus helps divert attention from failures adequately to tax more privileged Africans and larger enterprises.

POLICY IMPLICATIONS

Be very wary of claims that it would be a good idea to invest resources in registering large numbers of new taxpayers in sub-Saharan Africa. Try to avoid using the term "informal sector" when discussing issues of tax policy and administration-it is confusing and diversionary.

Do working and living conditions influence brick-kiln productivity? Evidence from Nepal

The brick-kiln (BK) sector in Nepal is largely an informal sector. This study investigated the influence of working and living conditions (WLCs) in BKs on productivity at two levels - BK level and workers' level - using primary data collected from 781 workers and 80 BK entrepreneurs in 12 districts of Nepal. WLCs were assessed based on the provision of nine amenities to workers at BKs. Correlation and regression analyses revealed that WLCs have a positive influence on both BK level as well as workers' level productivity. Moreover, large BKs with better investment in zig-zag technology and mechanization are more likely to spend on improving WLCs than small BKs, who are reluctant to invest in WLCs due mainly to a lack of financial resources. The study suggests an integrated approach emphasizing equally improved WLCs and cleaner technology in the BK sector to transform it into a healthier and socio-environmentally responsible industry.

Exploring heterogeneity of national health insurance scheme enrolment among persons in the informal sector

The Ghanaian government began implementing the National Health Insurance Scheme (NHIS) in 2005, anchored on the universal health coverage principle. However, informal sector workers contribute to the low enrolment into the scheme. This paper examines the factors that influence enrolment status in Ghana's NHIS among individuals in the informal sector. The study employed the fixed-effects logit model, using the Ghana Socioeconomic Panel Survey datasets. The findings revealed that gender, age, education, marital status, household size, physical activity, income, savings and subjective social welfare determine enrolment decisions of persons in the informal sector. Drivers of NHIS enrolment for male and female household heads were secondary education and household size. Heterogeneously, age, Junior High School education, married, physical activity, subjective social welfare and savings influenced only male-headed households' enrolment status. The study shows differences in enrolment status among rural and urban residents, as age, education, marital status, household size, and physical activity influenced rural residents, while for urban inhabitants', savings determined their NHIS enrolment decisions. However, gender, obesity, income and subjective social welfare predicted enrolment decisions for rural and urban residents. Finally, two variables, gender (male) and physical activity predicted the NHIS enrolment decision among the poor, whereas subjective social welfare and savings influenced the wealthiest enrolment decisions. For Ghana to achieve the Sustainable Development Goals of universal health coverage, the study recommends enhanced public education on NHIS benefits among informal workers to promote enrolment.

Application of a 'Recycling Exchange' instrument to compensate waste pickers in Brazil via a first payment for urban environmental services programme

This article presents an approach to compensate waste pickers in the informal sector of Minas Gerais state, Brazil, via a Payment for Urban Environmental Services (PUES) instrument, called 'Recycling Exchange'. The aim is to evaluate the effects of this instrument on the amount of waste diverted from landfill and reintroduced into the production chain, and to increase recognition of waste pickers' contributions to the state's economy. It was found that the 'Recycling Exchange' met the fundamental objectives of a PUES: the double social and economic benefits of the social inclusion of waste pickers in the execution of the public policy for solid waste management, and inducing (in the case of glass), ensuring and stabilising (plastic and paper) continuity of the activity of selling recyclables in times of wide price fluctuations for these recyclables. The instrument enhanced the provision of this environmental service and the positive externalities associated with recycling.

Fiscal stimulus packages to COVID-19: The role of informality

In this paper, we use a novel cross-country dataset to investigate the relationship between the prevalence of the shadow economy and fiscal policy responses to the economic crisis induced by the pandemic. The finding is that countries with a relatively larger shadow economy before the pandemic have adopted a smaller fiscal policy package. The results are robust to different econometric specifications, including an instrumental variable estimation. This reinforces the wider literature that countries (especially those with larger shadow economies) generally follow a procyclical policy as opposed to the optimal and countercyclical one.

Source separation in municipal solid waste management: Practical means to its success in Asian cities

Source separation plays a pivotal role in sustainable and integrated Municipal Solid Waste Management (MSWM) and in achieving a circular economy in Asia. However, it is still not an official practice, and many cities continue to utilise open dumping, involving receiving mixed waste without pre-treatment. This paper, therefore, examines the advantages of source separation of MSW and explores the main factors for success in the planning and implementation of official source separation programmes in cities in Asia. Analysis of the results for two case studies in India and Japan could be used to strengthen capacities of policymakers in designing and implementing official source separation systems to facilitate material recovery and achieve sustainable development in Asia.

The Great Lockdown in the Wake of COVID-19 and Its Implications: Lessons for Low and Middle-Income Countries

Concern for public health has been growing with the increasing volume of cases of COVID-19 in India. To combat this pandemic, India has implemented nationwide lockdowns, and unlocking phases continue with certain restrictions in different parts of the country. The lockdown has required people to adopt social-distance measures to minimize contacts in order to reduce the risks of additional infection. Nevertheless, the lockdown has already impacted economic activities and other dimensions of the health of individuals and society. Although many countries have helped their people through advanced welfare protection networks and numerous support aids, several emerging economies face specific difficulties to adapt to the pandemic due to vulnerable communities and scarce resources. However, certain lower-income countries need more rigorous analysis to implement more effective strategies to combat COVID-19. Accordingly, the current systematic review addresses the impacts of the COVID-19 pandemic and lockdowns in India in relation to health and the economy. This work also provides further information on health inequalities, eco-nomic and social disparities in the country due to the COVID-19 pandemic and lockdowns and also contributes pragmatic suggestions for overcoming these challenges. These observations will be useful to the relevant local and national officials for improving and adopting novel strategies to face lockdown challenges.

Health care payment practice, perception and awareness of national health insurance scheme by market women in Enugu Metropolis South-East Nigeria

Introduction

health insurance is in the fore front of health financing and achievement of universal health coverage for all. It provides a means of coping with some of the risks faced by individuals in achieving optimal healthcare. Women are vital in the family especially when it comes to the health of their children. We therefore set out in this study to assess the healthcare payment method of women in the informal sector and their awareness of the National health insurance scheme (NHIS) in Nigeria.

Methods

the study was a cross sectional descriptive survey involving women traders who were aged 18 years and above. Three hundred and fifty-three (353) womens were recruited using semi-structured interviewer questionnaire and data was analyzed using SPSS version 22.

Results

the prevalence of awareness of NHIS among the women was 57.5% and educational status was contributor to awareness of the scheme. Also, only 9.9% of the women were registered under the NHIS and out of pocket payment for healthcare was practiced by as much as 88.7% of the respondents. Most respondents had poor perception about the scheme with 60% believing that the government cannot be trusted to keep its end of the bargain with regards to the NHIS.

Conclusion

the need for awareness of the NHIS especially in the informal sector for women is brought to fore. The policy -makers should take into account how women in informal sectors should be captured to enrol in the NHIS in order to expand its coverage and this enrolment should be compulsory.

High Prevalence of SARS-CoV-2 in an Indigenous Community of the Colombian Amazon Region

Introduction. COVID-19 is a pathology caused by the SARS-CoV-2 virus. The World Health Organization (WHO) has reported more than 225 million cases and 4.5 million deaths worldwide. Objective: To describe the seropositivity, spatial distribution, and clinical and sociodemographic variables of SARS-CoV-2 in a community of the Colombian Amazon region. Methods. In December 2020, a cross-sectional observational study was carried out in a population located in the Colombian Amazon in the municipality of Mitú. Sociodemographic and clinical data were taken. Besides, 589 blood samples were taken, and an antibody detection was carried out with an ELISA and a recombinant protein N antigen of SARS-CoV-2. Results. A seropositivity of 57.6% was observed. The highest proportion of the infection is located in inter-municipal transport zones. The bivariate analysis did not show differences in the SARS-CoV-2 infection rate concerning the variables sex, age range, and the presence of comorbidities (p > 0.05). The bivariate and multivariate analysis showed that being symptomatic and presenting neurological manifestations of the upper respiratory tract are clinical variables associated with SARS-CoV-2 infection (p < 0.05). One of the causes of this virus’s high spread in this community could be that 53.3% of the people were asymptomatic. Conclusions. Our data showed a high burden and transmission of SARS-CoV-2 in the indigenous community. This could be linked to cultural behaviors and the high infection rate in asymptomatic patients.

Comparison of knowledge of occupational hazards of lead exposure and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria

INTRODUCTION

occupational practices continuously exposes workers to hazards of lead. This study aimed to compare the knowledge of occupational hazards associated with lead exposure, and blood lead estimation among roadside and organized panel beaters in Enugu metropolis, Nigeria.

METHODS

this was a cross-sectional study. Multistage sampling method was used to select 428 panel beaters in Enugu metropolis. Samples were analyzed using Atomic Absorption Spectrometer at 283.3 wavelengths. Data were entered and analyzed using Statistical Package for Social Science 20. Comparative analysis were done using chi - square, T-test, Mann-Whitney U-test, Kruskal-Wallis test, logistic regression and level of significance was set at 5%.

RESULTS

the majority of respondents on both roadside (59.8%) and organized (73.4%) sectors had poor knowledge of hazards of lead exposure. The difference was significant using χ² (P<0.05). The median blood lead levels were 3.0µg|dl and 16.0µg|dl for roadside and organized panel beaters respectively. The difference was significant with Mann-Whitney U test (P<0.001). The prevalence of elevated blood lead at 10µg|dl were 36.9% (roadside sector) and 64.5% (organized sector). The duration of working hours (OR = 4.34, CI = 1.729 - 10.338) was found to be the predictor of elevated blood lead levels.

CONCLUSION

there were general poor knowledge of hazards of lead exposure and high prevalence of elevated lead levels which were more among organized panel beaters. Advocacy on standard organizational structures that support improved occupational health practices is needed and routine outreach by research institutions for health education and safety training.

Forgotten Contributors in the Brick Sector in Nepal

Brick making in Nepal is an informal sector that is still highly labor intensive. It employs transient workers who are extremely marginalized and exposed to poor working and living conditions. This study assesses the working and living conditions of male and female brick workers and their children and looks to address the main issues and challenges to promote decent living and working conditions in the brick factories through action research. A rapid needs assessment was conducted to take stock of the working and living conditions of male and female workers across five provinces in Nepal. Subsequently, selected pilot interventions through stakeholder consultations were initiated to address these issues and challenges. There are a host of challenges faced by these workers in the factories, with the main issues being occupational health and safety and childcare/education for workers’ children. The study suggests that the working and living conditions of the workers can be improved by incentivizing the brick entrepreneurs to invest in them, thus creating a more productive workforce. Moreover, the findings from the pilot interventions can help in the design of effective solutions.

Executive Function among Chilean Shellfish Divers: A Cross-Sectional Study Considering Working and Health Conditions in Artisanal Fishing

Knowledge about professional diving-related risk factors for reduced executive function is limited. We therefore evaluated the association between decompression illness and executive functioning among artisanal divers in southern Chile. The cross-sectional study included 104 male divers and 58 male non-diving fishermen from two fishing communities. Divers self-reported frequency and severity of symptoms of decompression illness. Executive function was evaluated by perseverative responses and perseverative errors in the Wisconsin Card Sorting Test. Age, alcohol consumption, and symptoms of depression were a-priori defined as potential confounders and included in linear regression models. Comparing divers and non-divers, no differences in the executive function were found. Among divers, 75% reported a history of at least mild decompression sickness. Higher frequency and severity of symptoms of decompression illness were associated with reduced executive function. Therefore, intervention strategies for artisanal divers should focus on prevention of decompression illness.

Opportunities and challenges in reducing personal inhalation exposure to air pollution among electronic waste recovery workers in Ghana

BACKGROUND

Informal sector electronic waste (e-waste) recovery produces toxic emissions resulting from burning e-waste to recover valuable metals.

OBJECTIVES

To identify high-risk worker groups by measuring relative levels of personal inhalation exposure to particulate matter (PM) of fine (≤2.5 µm) and coarse (2.5-10 µm) fractions (PM2.5 and PM2.5-10, respectively) across work activities among e-waste workers, and to assess how wind conditions modify levels of PM by activity and site location.

METHODS

At the Agbogbloshie e-waste site, 170 partial-shift PM samples and time-activity data were collected from participants (N = 105) enrolled in the GeoHealth cohort study. Personal sampling included continuous measures of size-specific PM from the worker's breathing zone and time-activity derived from wearable cameras. Linear mixed models were used to estimate changes in personal PM2.5 and PM2.5-10 associated with activities and evaluate effect modification by wind conditions.

RESULTS

Mean (±standard deviation) personal PM2.5 and PM2.5-10 concentrations were 80 (±  81) and 123 (± 139) µg m-3 , respectively. The adjusted mean PM2.5 concentration for burning e-waste was 88 µg m-3 , a 28% increase above concentrations during non-recovery activities (such as eating). Transportation-related and burning activities were associated with the highest PM2.5-10 concentrations. Frequent changes in wind direction were associated with higher PM2.5 concentrations when burning, and high wind speeds with higher PM2.5-10 concentrations when dismantling e-waste downwind of the burning zone.

The financing need for expanding paid maternity leave to support breastfeeding in the informal sector in the Philippines

In low- and middle-income countries, almost three-fourths of women in the labour force lack maternity protection. In the Philippines, current laws do not guarantee paid maternity leave to workers in the informal economy. A non-contributory maternity cash transfer to informal sector workers could be used to promote social equity and economic productivity and could provide health benefits by helping mothers meet their breastfeeding goals. The objective of the study is to provide a realistic cost estimate and to assess the financial feasibility of implementing a publicly financed, non-contributory maternity cash transfer programme to the informal sector in the Philippines. Using a costing framework developed in Mexico, the study estimated the annual cost of a maternity cash transfer programme. The methodology estimated the unit cost of the programme, the incremental coverage of maternity leave and expected number of enrollees. Different unit and incremental costs assumptions were used to provide a range of scenarios. Administrative costs for running the programme were included in the analysis. The annual financing need of implementing maternity cash transfer programme in the Philippines ranges from a minimum scenario of USD42 million (14-week maternity cash transfer) to a more ideal scenario of USD309 million (26-week maternity cash transfer). The latter is financially feasible as it is equivalent to less than 0.1% of the country's gross domestic product substantially lower than the share cost of not breastfeeding (0.7%). The annual cost of the programme is only 10% of the total cost of the largest conditional cash transfer programme.

Understanding family-based health insurance enrolment among informal sector workers in a rural district of Vietnam: Adverse selection and key determinants

Background: Challenges remain in the implementation of family-based health insurance (FHI) - the key strategy for achieving universal health coverage in Vietnam. Objectives: To explore the experiences of and factors influencing enrolment in FHI among informal sector workers (ISW) in a rural district in Vietnam. Methods: A cross-sectional study was conducted from January to June 2016 in Tien Du, a rural district in Bac Ninh province. Secondary data were extracted from provincial social insurance databases to identify the rate of FHI among ISW in the district. Qualitative data were collected from 55 participants: 20 semi-structured in-depth interviews (IDI) and 6 focus group discussions (FGD). Data were transcribed verbatim. Thematic analysis was conducted. Results: Only 25.1% of ISW had FHI. Those individuals with FHI tended to be older or already experiencing health problems or have 'risky' jobs. The key determinants of adverse selection from different levels included: individual, family and health system. Conclusions: Low health insurance uptake remains an issue for ISW. Policy makers should consider raising awareness of FHI and improve the quality of primary health services, simplify the procedures of enrolment and claim for ISW. Additional government premium subsidy is required to increase FHI enrolment among ISW.

Micronutrient Status of Electronic Waste Recyclers at Agbogbloshie, Ghana

Growing evidence suggests that micronutrient status is adversely impacted by toxic metals (e.g., cadmium, lead, and arsenic) exposures; however, the micronutrient status of e-waste recyclers who are amongst the highest metal-exposed groups is not known. This study, therefore, assessed the micronutrient status of e-waste recyclers using dietary information (2-day 24-h recall survey) and biomarker data (whole blood and urine) among 151 participants (100 e-waste recyclers at Agbogbloshie and 51 controls at Madina Zongo from the Accra region, Ghana) in March 2017. Biomarker levels of iron (Fe), calcium (Ca), magnesium (Mg), selenium (Se), zinc (Zn) and copper (Cu) were analyzed by the ICP-MS. Linear regression models were used to assess associations ofwork-related factors and sociodemographic characteristics with micronutrient intake, blood, and urine micronutrient levels. The results showed that apart from Fe and Zn, e-waste recyclers at Agbogbloshie did not meet the day-to-day dietary requirements for Ca, Cu, Se, and Mg intake. Except for the low levels of Mg and Fe detected in blood of e-waste recyclers, all other micronutrients measured in both blood and urine of both groups fell within their reference range. Exposure to biomass burning was associated with lower blood levels of Fe, Mg, and Zn among the e-waste recyclers. Further, among e-waste recyclers, significant relationships were found between the number of years spent recycling e-waste and urinary Ca and Cu excretion. Given that, some dietary and blood levels of micronutrients were below their reference ranges, the implementation of evidence-based nutrition strategies remains necessary among e-waste recyclers to reduce their risk of becoming malnourished.

Living situation of family caregivers of persons with spinal cord injury

OBJECTIVE

To describe the living situation of family caregivers of persons with spinal cord injury.

DESIGN

Cross-sectional questionnaire.

SUBJECTS

Primary family caregivers of persons with chronic spinal cord injury in Switzerland.

METHODS

Cross-sectional study of family caregivers of persons with spinal cord injury. For comparison, the study population was matched to family care-givers of persons dealing with long-term health conditions in the general population, using a propensity-score based algorithm.

RESULTS

A total of 717 family caregivers participat-ed in the survey (35% response rate). Participants were mostly female (72%), mean age 57 years, and had spent approximately 13 years caring for their relative. A mean of 21 h/week was spent providing care and assistance. The vast majority of family care-givers reported coping well with their situation. However, support from public services was deemed inadequate. Compared with family caregivers in the general population, family caregivers of persons with spinal cord injury performed more caring tasks and reported a slightly lower quality of life.

CONCLUSION

Family caregivers of persons with spinal cord injury are self-reliant to cope with their situation, but report discontent with public support ser-vices. The healthcare system could provide alternative support measures, such as direct financial compensation.

Occupational Health of Agricultural Women Workers in India

Background:

Women in Agriculture form a significant portion of the productive work force in Indian economy. Occupational Health is a vital component of nation's infrastructure and it focuses on the physical, mental and social well being of workers. In India, Occupational Heath among agricultural women is a public health issue which needs immediate attention.

Objectives:

To study the association between health and agriculture, the occupational hazards and health problems faced by agricultural women workers and the related policy provisions in India.

Methods:

An extensive literature review and data search were done using online search engines, peer reviewed articles and the reports of various departments of Government of India.

Results:

The result reveals that Occupational health hazards have a direct impact on the physical and mental health of women workers.

Conclusion:

Implementation of social security and welfare measures by the Government for the agricultural women could enhance the health of women workers.

Occupational Exposure to Fine Particulate Matter (PM4 and PM2.5) during Hand-Made Cookware Operation: Personal, Indoor and Outdoor Levels

(1) Exposure of informal artisanal cookware makers to fine particles has not yet been characterized. The aim of this study was to characterize occupational exposure to fine particulate matter (PM4 and PM2.5) levels and fine particulate matter (PM2.5) elemental components; (2) Artisanal cookware makers were recruited from five cookware making sites. Exposure to fine particulate matter was measured for 17 male participants. SidePak personal aerosol monitors (AM520) were used to measure personal exposure to PM4, while a DustTrak monitor and an E-sampler were used to assess indoor and outdoor PM2.5 levels, respectively. A questionnaire was administered to capture information on demographic characteristics. The chemical characterization of indoor and outdoor PM2.5 filter mass was conducted using Wavelength Dispersive X-ray Fluorescence. Time series record of 15-min averages for indoor and outdoor PM2.5 levels were assessed; (3) The median (range) was 124 µg/m3 (23-100,000), 64 µg/m3 (1-6097) and 12 µg/m3 (4-1178), respectively, for personal PM4, indoor and outdoor PM2.5. The highest levels for many of the elemental components of PM2.5 were found in the outdoor PM2.5 filter mass and (4). The information generated during this study may assist in extending occupational health and safety strategies to artisanal cookware makers and developing targeted prevention initiatives.

Derivation of Time-Activity Data Using Wearable Cameras and Measures of Personal Inhalation Exposure among Workers at an Informal Electronic-Waste Recovery Site in Ghana

OBJECTIVES

Approximately 2 billion workers globally are employed in informal settings, which are characterized by substantial risk from hazardous exposures and varying job tasks and schedules. Existing methods for identifying occupational hazards must be adapted for unregulated and challenging work environments. We designed and applied a method for objectively deriving time-activity patterns from wearable camera data and matched images with continuous measurements of personal inhalation exposure to size-specific particulate matter (PM) among workers at an informal electronic-waste (e-waste) recovery site.

METHODS

One hundred and forty-two workers at the Agbogbloshie e-waste site in Accra, Ghana, wore sampling backpacks equipped with wearable cameras and real-time particle monitors during a total of 171 shifts. Self-reported recall of time-activity (30-min resolution) was collected during the end of shift interviews. Images (N = 35,588) and simultaneously measured PM2.5 were collected each minute and processed to identify activities established through worker interviews, observation, and existing literature. Descriptive statistics were generated for activity types, frequencies, and associated PM2.5 exposures. A kappa statistic measured agreement between self-reported and image-based time-activity data.

RESULTS

Based on image-based time-activity patterns, workers primarily dismantled, sorted/loaded, burned, and transported e-waste materials for metal recovery with high variability in activity duration. Image-based and self-reported time-activity data had poor agreement (kappa = 0.17). Most measured exposures (90%) exceeded the World Health Organization (WHO) 24-h ambient PM2.5 target of 25 µg m-3. The average on-site PM2.5 was 81 µg m-3 (SD: 94). PM2.5 levels were highest during burning, sorting/loading and dismantling (203, 89, 83 µg m-3, respectively). PM2.5 exposure during long periods of non-work-related activities also exceeded the WHO standard in 88% of measured data.

CONCLUSIONS

In complex, informal work environments, wearable cameras can improve occupational exposure assessments and, in conjunction with monitoring equipment, identify activities associated with high exposures to workplace hazards by providing high-resolution time-activity data.

Factors associated with patient payments exceeding National Health Insurance fees and out-of-pocket payments in Lao PDR

BACKGROUND

Attaining universal health coverage is a target in the Sustainable Development Goals. In Lao PDR, to achieve universal health coverage, the government is implementing a national insurance scheme, initially targeting the informal sector.

OBJECTIVE

The purpose was to assess: i) the percentage of NHI patients who paid above the scheduled amount, based on individual billing payment; and ii) the factors related to overpayment.

METHODS

Descriptive cross-sectional study based on a structured questionnaire administered at health facilities in face-to-face interviews with 1,850 patients in six provinces.

RESULTS

All 1,850 participants worked in the informal sector. Of these, 78.8% of respondents (77.9% of in-patients; 79.5% of out-patients) made co-payments or were exempted from. Factors associated with in-patients paying above the scheduled fee were living in the province and district (OR = 2.8; 95%CI 1.2 to 6.3); not having documents with them (OR = 21.2; 95%CI 5.6 to 80.3); or not having documents (OR: 7.8; 95% CI 2.1 to 28.6). Significant factors associated with additional costs for out-patients were level of facility used at the provincial hospital (OR:1.4; 95% CI 1.1 to 1.9); older age (OR = 2.2; 95%CI 1.5 to 3.1); living in the province and district (OR = 2.3; 95%CI 1.5 to 3.7); living more than 5 km from the facility (OR = 1.4; 95%CI 1.1 to 1.9); buying medicine or supplies outside of the health facility (OR: 5.6; 95% CI 3.1 to 10.2); not bringing documents (OR:9.1; 95% CI 6.1 to 13.5), not having the right documents (OR: 8.9; 95% CI 5.4 to 14.8).

CONCLUSIONS

A number of patients paid above scheduled fee rates, which may deter people from utilising services when needing them. There is a need for increased understanding of the benefits of the national insurance scheme among patients and healthcare staff.

Demolition waste recycling in China: New evidence from a demolition project for highway development

China's rapid urbanization has led to rising construction and demolition waste (C&DW) amid a quoted recycling rate of only about 10%. Previous studies on C&DW recycling in China have focused on lack of awareness, weak regulation, limited markets for recycled products, and immature recycling technology. This paper investigates the recycling rate of demolition waste (DW) through a case study of the demolition process in a highway project in Taixing, Jiangsu Province, and data collected through analyses of past documents, field observations, and interviews with key stakeholders to provide contrary evidence that the recycling rate is much higher than reported. The reason for the discrepancy is that the reported recycling rate did not include the efforts of a myriad of relocated residents, small construction businesses, informal recycling establishments, developers, and road construction contractors. Proper estimation of the DW recycling rate in China should consider these efforts, especially from the informal sector.

Courses on Basic Occupational Safety and Health: A Train-the-Trainer Educational Program for Rural Areas of Latin America

Integrating basic occupational health services into primary care is encouraged by the Pan American Health Organization. However, concrete initiatives are still scarce. We aimed to develop a training program focusing on prevention of occupational risks for primary healthcare professionals. This train-the-trainer program was piloted at four universities in Chile and Peru. Occupational health or primary healthcare lecturers formed a team with representative(s) of one rural primary healthcare center connected to their university (N_participants = 15). Training started with a workshop on participatory diagnosis of working conditions. Once teams had conducted the participatory diagnosis in the rural communities, they designed in a second course an active teaching intervention. The intervention was targeted at the main occupational health problem of the community. After implementation of the intervention, teams evaluated the program. Evaluation results were very positive with an overall score of 9.7 out of 10. Teams reported that the methodology enabled them to visualize hazardous working conditions. They also stated that the training improved their abilities for problem analysis and preventive actions. Aspects like time constraints and difficult geographical access were mentioned as challenges. In summary, addressing occupational health in primary care through targeted training modules is feasible, but long-term health outcomes need to be evaluated.

Willingness to pay for Community Health Insurance among taxi drivers in Kampala City, Uganda: a contingent evaluation

BACKGROUND

Community Health Insurance (CHI) schemes have improved the utilization of health services by reducing out-of-pocket payments (OOP). This study assessed income quintiles for taxi drivers and the minimum amount of premium a driver would be willing to pay for a CHI scheme in Kampala City, Uganda.

METHODS

A cross-sectional study design using contingent evaluation was employed to gather primary data on willingness to pay (WTP). The respondents were 312 randomly and 9 purposively selected key informants. Qualitative data were analyzed using conceptual content analysis while quantitative data were analyzed using MS Excel 2016 to generate the relationship of socio-demographic variables and WTP.

RESULTS

Close to a half (47.9%) of the respondents earn above UGX 500,000 per month (fifth quintile), followed by 24.5% earning a monthly average of UGX 300,001-500,000 and the rest (27.5%) earn less. Households in the fourth and fifth quintiles (38.4% and 20%, respectively) are more willing to join and pay for CHI. A majority of the respondents (29.9%) are willing to pay UGX, 6,001-10,000 while 22.3% are willing to pay between UGX 11,001 and UGX 20,000 and 23.2% reported willing to pay between UGX 20,001 and UGX 50,000 per person per month. Only 18.8% of the respondents recorded WTP at least UGX 5,000 and 5.8% reported being able to pay above UGX 50,000 per month (1 USD=UGX 3,500). Reasons expressed for WTP included perceived benefits such as development of health care infrastructure, risk protection, and reduced household expenditures. Reasons for not willing to pay included corruption, mistrust, inadequate information about the scheme, and low involvement of the members.

CONCLUSION

There is a possibility of embracing the scheme by the taxi drivers and the rest of the informal sector of Uganda if the health sector creates adequate awareness.

Reducing agate dust exposure in Khambhat, India: Protective practices, barriers, and opportunities

AIMS

Agate workers in Khambhat, India and their community members are exposed to high levels of silica dust and related diseases. Use of effective prevention practices remains low, prompting the need for effective interventions which increase the uptake of and investment in prevention practices. We sought: (a) to describe knowledge, self-efficacy, and practices among a population of workers, their family members, and neighbors involved in or located close to agate processing; and (b) to explore which factors are related to use of prevention practices and willingness to invest in new dust control technologies.

METHODS

A community survey was conducted to measure demographics, occupation and financial factors, knowledge, prevention practices, barriers, risk perceptions, and efficacy beliefs. Descriptive statistics were used and, among agate workers, hierarchical logistic regression explored predictors of prevention practice use and willingness to invest.

RESULTS

Among 1120 respondents, approximately 44%, 35%, and 8% of workers, family members, and neighbors used prevention practices, respectively. Knowledge and risk perceptions were generally high, where efficacy beliefs were low. Workers who had high levels of education, worked at home, and had high efficacy beliefs were more likely to report using prevention practices and being willing to invest. Barriers to prevention practice use included financial barriers, and beliefs that prevention is ineffective and health is not at risk.

CONCLUSIONS

Interventions and future research should be designed to engage the community to improve preventive behavior, and implement affordable and effective dust control interventions in the agate industry.

Costing a Maternity Leave Cash Transfer to Support Breastfeeding Among Informally Employed Mexican Women

BACKGROUND

Investing in maternity protection for working women is an important social equity mechanism. Addressing the maternity leave needs of women employed in the informal sector economy should be a priority as more than half of women in Latin America, South Asia, and sub-Saharan Africa are employed in this sector.

OBJECTIVE

To develop a costing methodology framework to assess the financial feasibility, at the national level, of implementing a maternity cash transfer for informally employed women.

METHODS

A World Bank costing methodology was adapted for estimating the financial need to establish a maternity cash transfer benefit. The methodology estimates the cash transfer's unitary cost, the incremental coverage of the policy in terms of time, the weighted population to be covered, and the administrative costs. The 6-step methodology uses employment and sociodemographic data that are available in many countries through employment and demographic surveys and the population census. The methodology was tested with data for Mexico assuming different cash transfer unitary costs and the benefit's time coverage.

RESULTS

The methodological framework estimated that the annual financial needs of setting up a maternity cash transfer for informally working women in Mexico ranges between US$87 million and US$280 million.

CONCLUSIONS

A pragmatic methodology for assessing the costs of maternity cash transfer for informally employed women was developed. In the case of Mexico, the maternity cash transfer for women in the informal sector is financially feasible.

Does the Informal Sector in Kenya Have Financial Potential to Sustainably Prepay for Health Care? Implications for Financing Universal Health Coverage in Low-Income Settings

Kenya currently lacks evidence on whether income in the informal sector is sustainable and predictable and therefore able to support financing of universal health coverage (UHC). This article demonstrates the financial potential of informal sector entities to sustainably finance UHC in Kenya. Data were collected using a standardized questionnaire on the following topics: nature and sustainability of informal sector entities, indicators of financial potential, and socioeconomic status. Both descriptive and multivariate analyses were used. The findings indicate that income in the informal sector is generally low although investors in health/medical, stationery, entertainment, manufacturing and craft as well as transportation tend to have higher and more consistent incomes than most others in both sites. Mean monthly incomes ranged from 16.7 USD (lowest) to 786.5 USD (highest). The urban informal sector recorded higher mean monthly incomes of 195.8 USD compared to 77.9 USD in the rural area (P < 0.001). The most sustainable entities in the urban area included stationery (67%), repair and maintenance (50%), food vending (49%), shopkeeping (48%), and clothing and beauty products (43%). Farming (90%), manufacturing and craft (86%), and health/medical (100%) were the most sustainable in the rural area. Key predictors of sustainable informal sector entities include monthly expenditure patterns, gender, marital status, household structure, number of employees in an entity, and land ownership in the rural area and number of entities owned. Informal sector entities are mostly unsustainable, meaning that the majority of premium contributors will not be consistent in payment and will likely to require subsidies.

Improving food safety in the informal sector: nine years later

Introduction: Foodborne disease is a major public health problem in poor countries, but we lack effective, sustainable and scalable approaches that work in the traditional, informal markets where most fresh, risky food is sold. A promising intervention is working with informal sector vendors to provide: a) training and technologies; b) an enabling environment; c) motivation for behaviour change.

Materials and methods: We present a long-term follow-up of pilot project in one of the largest abattoirs and meat markets in Nigeria. An evaluation shortly after implementation found the intervention was acceptable, cost-effective and resulted in safer meat.  The follow-up nine years later using mixed methods: qualitative surveys and microbiological tests.

Results and Discussion: The policy environment had become disabling, partly as a result of authorities attempts to move butchers to a modern, hygienic but more distant abattoir. This was resisted by the butchers. Authorities revoked the license for Bodija market and stopped providing services. Matters escalated and forceful attempts to remove butchers resulted in deaths followed by riots. Meat safety deteriorated.

Conclusion: The case study shows the importance of an enabling environment and need for stakeholder collaboration in attempting to improve food safety in the traditional sector.

Perceived and Manifested Health Problems among Informal E-waste Handlers: A Scoping Review

E-waste being hazardous in nature demands scientific management thereby protecting and safeguarding the health of the workers. A major chunk of e-waste ends up in informal sectors where crude methods are employed thereby risking the health of workers. The current scoping review, Based on Arksey and O'Malley's framework was done to explore the available literature to summarize the perceived and manifested health problems among informal e-waste workers. A literature search was done in three databases namely PubMed, Web of Science and ScienceDirect between 1/01/2010 and 1/01/2018. All the titles and abstracts were scrutinized to include only those studies on the basis of health symptoms/problems among workers. Health problems, thus explored, were categorized into five broad categories- physical injuries, respiratory, skin, musculoskeletal, and other general health problems. Major factors which could be related to health problems were job designation, age, non-usage of personal protective equipment, exposure to dust, and hazardous chemicals.

Organic Waste Buyback as a Viable Method to Enhance Sustainable Municipal Solid Waste Management in Developing Countries

Many developing countries have inadequate Municipal Solid Waste (MSW) management systems due to lack of not only the awareness, technologies, finances, but also a proper governance that is able to enforce and monitor the regulations. Not all the solutions practiced by and in developed countries fit to the developing country contexts. The local conditions and limitations must always be taken into account when proposing waste management options for developing countries. The excessively high organic waste fraction in MSW and relatively inexpensive labor markets available in developing countries are two of the strengths that have not yet been utilized fully. This manuscript is an attempt to point out the benefits we receive from the above two strengths if we establish organic waste buyback programs. This can only become successful if we find solutions to: (1) collect source-separated organic waste, and then (2) find stable markets for the products made from organic waste. Compost or biogas could be the best bet developing countries can consider as products. However, there must be some policy interventions to support buyback programs at the waste collection stage as well as at the product marketing stage. Implementation of such organic waste buyback centers that can offer some incentives can indirectly motivate residents to do source separation. This will in turn also help promote more recycling, as any waste bin that has no organics in it is much easier for anyone (e.g., waste pickers) to look for other recyclables. Developing country settings such as the Green Container composting program in Cajicá, Colombia, and buyback centers in South Africa that are presented later in the manuscript are thought to be the places where the concept can be implemented with little effort. The environment, economy, and society are considered to be the three dimensions (or pillars) of sustainability. Interestingly, the organic waste buyback centers solution has positive implications on all three aspects of sustainability. Thus, it also supports the 2030 Agenda of the United Nations (UN), by making specific contributions to the Sustainable Development Goals (SDGs) such as zero hunger (SDG 2), affordable and clean energy (SDG 7), climate action (SDG 13), clean water and sanitation (SDG 6), and sustainable cities and communities (SDG 11).

Priorities and Challenges Accessing Health Care Among Female Migrants

Women’s ability to access health care requires access to and control of resources as well as the ability to make personal health decisions. Female migrants may experience additional challenges in accessing health care due to marginalization and vulnerability resulting from both their gender and their migrant status. Rural-to-urban migrant women working in the informal sector, such as Ghana’s head porters (kayayei), experience exclusion from the health system, risk of being uninsured, and poor health outcomes. Kayayei’s survival needs (eg, food, water) and a need to provide for their families can mean that migrant kayayei avoid health care expenses for illnesses or injuries. To ensure equal access to health care for migrant and non-migrant populations, health insurance is crucial. Yet, improving access to health care and service uptake requires more than health insurance. Incorporating culturally appropriate care into the provision of health services, or even developing specific migrant-friendly health services, could improve health service uptake and health awareness among migrants. Public health systems should also take account of migrants’ financial situations and priorities in the design and delivery of health services.

Family-Based Health Insurance for Informal Sector Workers in Vietnam: Why Does Enrolment Remain Low?

Providing financial protection to the whole population is a top health policy priority of many countries. However, expanding social health insurance coverage to the "informal sector worker" is a challenge in many developing countries. This study analyzed the reasons for the limited coverage of health insurance for informal sector workers. Direct interviews were carried out with 391 uninsured households in Vietnam, followed by in-depth interviews with 11 key stakeholders. The study offers several possible explanations for the low enrollment in family-based health insurance scheme at both the demand and supply sides, such as inability to pay the premium, lack of information, perceived poor quality of primary health care services, and complicated enrollment procedures. The study suggests that a partial government subsidy and improvement in the quality of primary health care are crucial strategies for health insurance expansion for the informal sector workers and their families.

Family-Based Social Health Insurance for Informal Workers in Vietnam: Willingness to Pay and Its Determinants

The study aimed to assess willingness to pay for family-based social health insurance and its determining factors among informal workers in Vietnam. A double-bounded dichotomous choice approach was used to elicit the willingness to pay of 391 heads of uninsured households. The study indicates that 48.8% of 391 uninsured households were willing to pay for family-based health insurance. The households were willing to pay about 921.9 thousand Vietnamese dongs per household per year (US$42). The factors that significantly affected willingness to pay were household income, number of uninsured members in a household, and sickness of the household head. The study suggests that a feasible premium for family-based health insurance supported by government subsidy, along with attention to the quality improvements of health services, could be an effective means to increase coverage among the informal sector workers.

Household waste and health risks affecting waste pickers and the environment in low- and middle-income countries

Household waste has evolved into a core urban challenge, with increased quantities of waste being generated and with more complex material compositions, often containing toxic and hazardous elements. Critical systems theory understands cities as urban metabolisms, with different material and energy flows, highlighting the circularity in production, consumption, and discard. Waste pickers in low- and medium-income countries work on dumps and landfills, sifting through highly contaminated household waste and are exposed to health hazards. This paper discusses the risk factors, hazards, and vulnerabilities waste pickers are exposed to during collection and separation of recyclables, based on the review of literature on waste and environmental health and on findings from participatory research with waste pickers conducted in Brazil. We take a social and environmental justice perspective and identify the vulnerabilities and waste-borne hazards of household waste, associated with these workers, their communities, watersheds, and the environment. Household waste, although not always per se toxic or hazardous, can become a hazard if not collected or inadequately managed. Those communities where household waste is not collected or waste collection is insufficient are the most critical places. Informal and organized waste pickers, municipal or private waste collectors/workers, small waste traders and sometimes residents, particularly small children, may be considered vulnerable if exposed to waste-borne hazards. The results include recommendations to address household waste-borne hazards and vulnerabilities, according to waste workers involved in this research.

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria

BACKGROUND

As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria.

METHODS

Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records.

RESULTS

Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan.

CONCLUSIONS

Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs.

The influence of customer-medicine seller transactional dynamics on childhood diarrhoea management: a qualitative study in Ghana

In 2004, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) jointly revised the recommended treatment for acute paediatric diarrhoea to specify supplementing reduced osmolarity oral rehydration salts (ORS) with zinc. In many countries, however, a significant knowledge-practice gap persists in appropriate diarrhoea management among private healthcare providers. For example, the United States Agency for International Development (USAID)-funded Strengthening Health Outcomes through the Private Sector (SHOPS) project recently demonstrated that over-the-counter medicine sellers (MS) in Ghana recommended inappropriate diarrhoea treatments, despite their demonstrated knowledge of appropriate treatment protocols. To explore and explain these results, we conducted 26 focus groups with MS and their customers using an indirect elicitation approach, presenting simulated drug shop transaction scenarios for each group to analyze and discuss. Through inductive and deductive data analysis, we found that the pattern of customer-MS interactions within the transactional context plays a critical role in shaping dispensing outcomes, not only in diarrhoea management but in other contexts as well. MS who engaged and negotiated with their customers were better able to introduce and promote the appropriate diarrhoea treatment protocol. Several factors hinder optimal interactions. Although MS in fact serve as frontline medical providers, they lack the perceived status of a clinician. Moreover, the need to maintain their customer base creates a power imbalance that favours accommodating customer requests and discourages educational interaction. Finally, many MS lack a complete understanding of the recommended treatment, limiting their ability to educate and negotiate. These findings have important implications for efforts to position community-level private providers to improve outcomes across a number of health areas; the study recommends three broad approaches related to training design, marketing, and professional linkages. More generally, behaviour change initiatives should recognize the potential impact of provider interaction dynamics in facilitating or impeding desired health outcomes.

Extending voluntary health insurance to the informal sector: experiences and expectations of the informal sector in Kenya

Background: Kenya has made a policy decision to use contributory health insurance as one of its key pre-payment health financing mechanisms. The National Hospital Insurance Fund (NHIF) is the main health insurer in Kenya. While the NHIF has hitherto focused its efforts on providing health insurance coverage to individuals in the formal sector, it has recently broadened its focus to include individuals in the informal sector. This paper provides an analysis of the perceptions, and experiences of informal sector individuals in Kenya with regard to enrolment with the NHIF. Methods: We collected data through key informant interviews (39) in two purposefully selected counties. Study participants were drawn from healthcare facilities contracted by the NHIF, and current, former, and prospective informal sector members. We analyzed data using a grounded approach. Results: Participants felt that the NHIF provided inadequate information about the registration and membership processes as well as benefit entitlements. There was variable and inconsistent communication by the NHIF. There was also variance between the official benefit package and the actual benefits received by members. The NHIF registration requirements and processes presented an administrative barrier to obtaining membership. The NHIF premium level and contribution mechanism presents a financial barrier to current and prospective members. Healthcare providers discriminated against NHIF members compared to cash-payers or private insurance holders. Conclusions: The NHIF could improve enrolment and retention of informal sector individuals by; 1) using communication strategies that are effective at reaching the informal sector, 2) improving the affordability of the premium rates, 3) simplifying the enrolment requirements and process, and 4) strengthening accountability mechanisms between itself and healthcare facilities to ensure that enrolled members receive the benefits that they are entitled to, and that client experience at healthcare facilities are satisfactory.

Occupational health and safety issues in the informal economic segment of Pakistan: a survey of construction sites

This research covers the current status of occupational health and safety (OHS)-related practices in the informal construction segment of Pakistan. Data were collected, through interviews, from 316 construction sites employing 3577 workers. The results of the study reveal that both employers and workers lack knowledge of OHS laws/standards and no practices of this nature are enacted at these construction sites. Alarmingly, work-related accidents, whenever they happen, are not given due attention and there is no formal injury-report system. The informal construction industry employs a huge portion of the informal workforce, and lack of OHS happens at tremendous human cost. These research findings may thus play their role in strengthening the case for reforms in the sector. This study, if properly utilized, may also enable employers of the sector by increasing their knowledge about OHS practices and, as a result, trying to offer safer environments for their workers.

Health Risks Awareness of Electronic Waste Workers in the Informal Sector in Nigeria

Insight into the health risk awareness levels of e-waste workers is important as it may offer opportunities for better e-waste recycling management strategies to reduce the health effects of informal e-waste recycling. Therefore, this study assessed the knowledge, attitude, and practices associated with occupational health risk awareness of e-waste workers compared with a control group (butchers) in the informal sector in Nigeria. A cross-sectional study was used to assess health risk awareness of 279 e-waste workers (repairers and dismantlers) and 221 butchers from the informal sector in three locations in Nigeria in 2015. A questionnaire was used to obtain information on socio-demographic backgrounds, occupational history, knowledge, attitude, and work practices. The data was analysed using Analysis of Variance. The three job designations had significantly different knowledge, attitude, and practice mean scores (p = 0.000), with butchers consistently having the highest mean scores. Only 43% of e-waste workers could mention one or more Personal Protective Equipment needed for their job compared with 70% of the butchers. The health risk awareness level of the e-waste workers was significantly lower compared with their counterparts in the same informal sector. A positive correlation existed between the workers’ knowledge and their attitude and practice. Therefore, increasing the workers’ knowledge may decrease risky practices.