Applying social life cycle assessment in the informal recycling sector: Understanding challenges and limitations

The transition towards Circular Economy (CE) is a promising approach to sustainable development that may cause significant social impacts. Despite the benefits of CE initiatives, key players such as informal recyclers face serious social issues such as poverty, lack of social security, and discrimination. Although evaluating social impacts remains a considerable challenge, Social Life Cycle Assessment (SLCA) is recognized as a suitable methodology with a life cycle perspective. While most SLCA experiences are conducted in the formal sector, it is important to consider the informal sector, which plays a crucial role in developing countries. This article presents an analysis of SLCA studies in informal recycling settings in order to identify the challenges and adjustments required for informal settings. The analysis is based on a literature review and a documentary review of a pilot application of SLCA in the informal recycling system in Cuenca, Ecuador. The results show that SLCA requires adaptation to be applied in informal settings. There are particular challenges in delineating boundaries due to the fuzzy nature and variability of informal activities. Tasks such as establishing specific indicators, developing reference scales and data collection, require careful planning and active stakeholder participation. For instance, indicators regarding Fair Salary or Working hours were adapted based on best practices. Furthermore, tasks such as verifying and disseminating results should be included in interpretation phases to generate long-term impacts and influence behaviors. The study underscores SLCA's multidimensional view but highlights the need for further standardization and adaptation for informal sectors.

Understanding the interplay of occupational, public health, and climate-related risks for informal workers: A new framework with findings from Zimbabwe and India

Globally, there are 2 billion 'informal' workers, who lack access to social protection while facing profound health risks and socioeconomic exclusions. The informal economy has generated most jobs in Low and Middle-Income Countries (LMICs), but few studies have explored informal workers' complex health vulnerabilities, including in the face of climate change. This paper will discuss recent action-research in Indore (India), Harare, and Masvingo (Zimbabwe) with informal workers like vendors, waste-pickers, and urban farmers. We conducted qualitative interviews (N = 110 in India), focus group discussions (N = 207 in Zimbabwe), and a quantitative survey (N = 418 in Zimbabwe). Many informal workers live in informal settlements ('slums'), and we highlight the interrelated health risks at their homes and workplaces. We explore how climate-related threats-including heatwaves, drought, and floods-negatively affect informal workers' health and livelihoods. These challenges often have gender-inequitable impacts. We also analyse workers' individual and collective responses. We propose a comprehensive framework to reveal the drivers of health in the informal economy, and we complement this holistic approach with a new research agenda. Our framework highlights the socioeconomic, environmental, and political determinants of informal workers' health. We argue that informal workers may face difficult trade-offs, due to competing priorities in the face of climate change and other risks. Future interventions will need to recognise informal workers' array of risks and co-develop multifaceted solutions, thereby helping to avoid such impossible choices. We recommend holistic initiatives to foster health and climate resilience, as well as participatory action-research partnerships and qualitative, intersectional data-collection with informal workers.

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.

Exploring the impact of formal and informal finance on green innovation under the lens of carbon neutrality

In order to reduce environmental deterioration and promote sustainable growth, green innovation-which includes ecologically friendly technology and practices-has become a top priority of policymakers worldwide. This research investigates how formal and informal finance affects green innovation in highly polluted high, middle-, and low-income economies, using data spanning from 2007 to 2021. For analyzing the empirical link between formal finance, informal finance, and green innovation, we have employed the 2SLS and GMM estimation techniques. The primary estimates of the analysis suggest that formal and informal funding methods significantly impact environment-related technologies in high-income and middle- and low-income nations. Moreover, the GDP, carbon emissions, trade openness, human capital, research and development, financial stability, and digital finance are essential factors in promoting environment-related technologies in high-, middle-, and low-income nations, respectively. The policymakers in both groups of countries should foster collaboration between the formal and informal sectors to promote green innovations, which is essential for achieving sustainable development goals.

Impact of filtering face pieces (FFP3) respiratory protective mask usage on the respiratory functions of informal sector carpenters in Douala: a five-month before-after study

Introduction

informal sector carpenters in Douala, Cameroon, face potential risks to their respiratory health due to daily exposure to fine particles and wood dust. The study aims to demonstrate the importance of preventing respiratory problems in this population through regular use of filtering face pieces (FFP3) respiratory masks.

Methods

the before-after study involved 37 carpenters who wore FFP3 masks during their professional activities for five months. Spirometry measurements were taken before and after the intervention to assess changes in respiratory function.

Results

significant improvements were observed in forced vital capacity (FVC) 89.6 % to 95.0 % (p<0.000), forced expiratory volume in one second (FEV1) 88.1 % to 95.0 % (p<0.000), Tiffeneau index 82.4 to 84.9 (p<0.000), and peak expiratory flow (PEF) 6.7 l/s to 7.9 l/s (p<0.000) after mask usage, indicating enhanced lung function.

Conclusion

the regular use of FFP3 masks had a positive impact on the respiratory health of informal sector carpenters in Douala, enhancing lung function and reducing airway obstruction. The study highlights the importance of preventive measures to safeguard the respiratory well-being of workers exposed to occupational hazards. Spell out Greek characters (i.e: alpha, beta).

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.

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.

Environmental impact of e-waste management in Indian microscale informal sectors

Inappropriate e-waste processing in the informal sector is a serious issue in developing countries. Field investigations in microscale informal recycling sites have been performed to study the impact of hazardous metal(loid)s (released from e-waste dismantling) on the environment (water and soil). Eight hazardous metal(loid)s (Pb, Cd, Cu, Zn, As, Hg, Ni, and Cr) were primarily found in the monitored water and soil samples (Sangrampur, West Bengal) because of widespread informal e-waste handling and primitive processing. Elevated concentrations of Cd, Pb, As, Cu, and Cr were observed in pond water samples (0.04, 1.62, 0.03, 1.40, 1.74 mg/L respectively). These ponds, which are regularly used for e-waste handling/dismantling, are usually flooded during the monsoon season mixing with further larger water resources - posing a serious threat to public health. Enriched levels of Pb, Cd, Cu, and Zn were detected in collected soil samples, both top surface soil (Pb up to 2042.27 ± 206.80, Cd up to 25.90 ± 9.53, Cu up to 6967.30 ± 711.70, and Zn up to 657.10 ± 67.05 mg/Kg) and deeper subsurface soil (Pb, 419.70 ± 44.70; Cd, 18.34 ± 3.81; Cu, 3928.60 ± 356.40; and Zn, 134.40 ± 33.40 mg/Kg), compared to the levels of As, Hg, Ni, and Cr. Seasonal variation of soil metal(loid) content indicated that higher levels of most of the metal(loids) were detected in the pre-monsoon (Nov-May) season, possibly due to the monsoonal dilution effect, except for Pb and Cd. The results highlighted that the composition and the handling of e-waste were important factors affecting the metal(loid) concentrations. E-waste policy and legislation have great influence on the handling and disposal procedures. An improved e-waste management practice has been proposed to encourage eco-friendly and safe e-waste disposal. It is recommended that regulatory agencies and manufacturers should create a road map to convince the informal sector to develop a systematic approach towards a more standardized formal e-waste management practices at the microscale field level.

Confidence in the health system and health insurance enrollment among the informal sector population in Lusaka, Zambia

BACKGROUND

To improve equitable access to quality essential services and reduce financial hardship, low-and-middle-income countries are increasingly relying on prepayment strategies such as health insurance schemes. Among the informal sector population, confidence in the health system to provide effective treatment and trust in institutions can play an important role in health insurance enrollment. The objective of this study was to examine the extent to which confidence and trust affect enrollment into the recently introduced Zambia National Health insurance.

METHODS

We conducted a regionally representative cross-sectional household survey in Lusaka, Zambia collecting information on demographics, health expenditure, ratings of last health facility visit, health insurance status and confidence in the health system. We used multivariable logistic regression to assess the association between enrollment and confidence in the private and public health sector as well as trust in the government in general.

RESULTS

Of the 620 respondents interviewed, 70% were enrolled or planning to enroll in the health insurance. Only about one-fifth of respondents were very confident that they would receive effective care in the public health sector 'if they became sick tomorrow' while 48% were very confident in the private health sector. While confidence in the public system was only weakly associated with enrollment, confidence in the private health sector was strongly associated with enrollment (Adjusted odds ratio (AOR) 3.40 95% CI 1.73 - 6.68). No association was found between enrollment and trust in government or perceived government performance.

CONCLUSIONS

Our results suggest that confidence in the health system, particularly in the private health sector, is strongly associated with health insurance enrollment. Focusing on achieving high quality of care across all levels of the health system may be an effective strategy to increase enrollment in health insurance.

What inhibits the progress of early-career women in Karachi? Studying the effects of socio-spatial mobility barriers on women's employment

BACKGROUND

There is a widespread acceptance and shift towards sustainable, inclusive and smart mobility solutions around the world. However, in Karachi, poorly coordinated urban planning, lack of effective governance structure and investment in transport, has allowed the growth of an almost unregulated and ungovernable informal transport sector. Women are more severely affected by the poor service since men not only have more space allocated to them on public transport but also have the freedom to use alternative and cheaper private vehicles such as motorbikes and cycles. Poor representation of women in the transport sector further aggravates the situation.

OBJECTIVE

The paper aims to highlight the gender-disaggregated effects of poor transport design, provision and lack of personal agency on mobility, for emphasising the social and cultural attitudes faced by female employees. It argues that not integrating the gender-based disadvantages faced by women into planning, reinforces their disadvantaged position and force them to take complex trips.

METHODS

Scenario-based questions were designed for focus group discussion which covered not only the everyday mobility challenges but also their reactions to the potential solutions. For a gender-based comparative analysis, two separate focus group discussions were organised.

RESULTS

Adopting a sector-based mapping approach of the issues discussed in the groups helped understand the complexity of female user experience at various levels, starting from planning or discussing the trips with families, to making modal choices. It also helped to tease out the impact of these issues on their employment opportunities as early-career women.

CONCLUSION

The model proposed in this paper can help illustrate where changes can be made in the system considering the social aspects of transport.

Informal sector employment and the health outcomes of older workers in India

A large proportion of the older population in India constitutes an undeniable share of workforce after the retirement age. This stresses the need to understand the implications of working at older ages on health outcomes. The main objective of this study is to examine the variations in health outcomes by formal/informal sector of employment of older workers using the first wave of the Longitudinal Ageing Study in India. Using binary logistic regression models, the results of this study affirm that type of work does play a significant role in determining health outcomes even after controlling socio-economic, demographic, life-style behaviour, childhood health and work characteristics. The risk of Poor Cognitive Functioning (PCF) is high among informal workers, while formal workers suffer greatly from Chronic Health Conditions (CHC) and Functional Limitations (FL). Moreover, the risk of PCF and/or FL among formal workers increases with the increase in risk of CHC. Therefore, the present research study underscores the relevance of policies focusing on providing health and healthcare benefits by respective economic activity and socio-economic position of older workers.

Leveraging Innovative Financing Strategy to Increase Coverage and Resources Among Informal Sector for Social Health Insurance Within the Nigerian Context of Devolution: Evidence From Adoption Model Implementation

Background

Enrollment in sub-national social health insurance schemes (SSHIS) can be challenging in developing countries like Nigeria, particularly among people in the informal sector. This could be due to a lack of knowledge on its mode of operation and benefits, distrust in government, inimical religious and traditional beliefs, as well as constraining economic factors. A complementary and innovative financing strategy such as the philanthropist adoption model (ADM) could be beneficial in improving SSHIS coverage and financial resources among persons in the informal sector. The study provides new evidence on how ADM influenced health insurance coverage and resources within SSHIS among informal settings in Nigeria. It also highlights contextual factors influencing the implementation of ADM.

Methods

This study employed a mixed-methods case-study approach undertaken in Anambra State, Southeast Nigeria. Data were collected through in-depth interviews (n = 14), document review (n = 12), and quantitative (enrollment data) methods. The respondents were purposively selected based on their involvement with the implementation of the SSHIS. Data analysis for qualitative data was done using the manual thematic framework approach while descriptive analysis was performed for the quantitative data.

Results

The implementation of ADM was a valuable and effective strategy for improving knowledge, coverage, and resource mobilization (annual premium pool) within the SSHIS in the informal sector. The main enablers of the implementation of ADM include strong political will and commitment, wider stakeholders' consultation and collaboration, numerous public-spirited philanthropists, and legal institutionalization of health insurance. Other enablers include organizational factors like good teamwork among Anambra State Health Insurance Agency (ASHIA) staff, enabling work environment (incentives, supervision, office space), and experienced marketers in the agency. However, ADM had several barriers that affected its implementation—acceptability issues due to distrust for government and the health system, health systems barriers including substandard health facilities and equipment, and inimical cultural and religious beliefs about health insurance.

Conclusion

The study demonstrates a case for the implementation of innovative ADM as a strategy for enhancing SSHIS financial sustainability and coverage of persons in the informal sector. Hence, the strategy should be adopted in settings where philanthropy abounds for increasing access to quality healthcare delivery to poor beneficiaries toward achieving universal health coverage in developing countries.

Assessing data in the informal e-waste sector: The Agbogbloshie Scrapyard

The Old-Fadama-Scrapyard, better known as Agbogbloshie, is located in Accra, Ghana. Over the last 20 years, the area has developed into a large scrapyard, where the informal sector processes mainly electronic waste (e-waste) and scrap metals. However, unsafe treatment methods, such as the open burning of cables and foams, and the spilling of hazardous liquids onto the ground, cause environmental pollution and create health risks by releasing persistent organic pollutants (POPs) and heavy metals. There is a recognized lack in literature of data on e-waste mass and material flows due to the lack of applicable methods to measure e-waste quantities in an informally managed treatment system. However, to establish sustainable e-waste management, e-waste mass and material flow data are crucial prerequisites. Therefore, the material flow analysis (MFA) methodology is proposed as a means for data collection within a limited time frame in the informal e-waste recycling context. In this case study, mass and material flows of e-waste processed at Agbogbloshie were estimated using two different approaches: Firstly, the kind, measures, constitution of load and number of loaded entering and exiting vehicles was observed and documented, and second, to validate the data collected, the mass and material flow of e-waste treatment processes on site were observed and documented. The resulting annual mass flows range between 13,090 t/a and 17,094 t/a of e-waste. Based on the data for Ghana from the Global E-waste Monitor, an average of 15,092 t/a (approximately 39% of the Ghanaian e-waste generation) is treated in Agbogbloshie.

Women's experiences using drugs to induce abortion acquired in the informal sector in Colombia: qualitative interviews with users in Bogotá and the Coffee Axis

In 2006, abortion in Colombia was decriminalised under certain circumstances. Yet some women continue to avail themselves of ways to terminate pregnancies outside of the formal health system. In-depth interviews (IDIs) with women who acquired drugs outside of health facilities to terminate their pregnancies (n = 47) were conducted in Bogotá and the Coffee Axis in 2018. Respondents were recruited when they sought postabortion care at a health facility. This analysis examines women's experiences with medication acquired outside of the health system for a termination: how they obtained the medication, what they received, how they were instructed to use the pills, the symptoms they were told to expect, and their abortion experiences. Respondents purchased the drugs in drug stores, online, from street vendors, or through contacts in their social networks. Women who used online vendors more commonly received the minimum dose of misoprostol according to WHO guidelines to complete the abortion (800 mcg) and received more detailed instructions and information about what to expect than women who bought the drug elsewhere. Common instructions were to take the pills orally and vaginally; most women received incomplete information about what to expect. Most women seeking care did not have a complete abortion before coming to the health facility (they never started bleeding or had an incomplete abortion). Women still face multiple barriers to safe abortion in Colombia; policymakers should promote better awareness about legal abortion availability, access to quality medication and complete information about misoprostol use for women to terminate unwanted pregnancies safely.

Challenges in conducting epidemiological field studies evaluating associations between heat stress and renal health among workers in informal sectors: experiences from India

Well-designed Environmental Epidemiological Studies (EES) play a crucial role in quantifying the influence of environmental exposures and their associated risks on health in the wider population. They provide critical research evidence for identifying and developing interventions to avert adverse health consequences from those exposures. However, uncertainty and variability inherent to any field based EES could hinder the nature and magnitude of association between an exposure and health outcome. This is particularly pronounced in resource limited settings and resource-tight research projects. The present study evaluated the association between occupational heat stress and renal health among informal work sectors in India which had some significant challenges. Informal workers exposed to chronic occupational heat stress had significantly higher adverse renal health outcomes than the unexposed workers. Our field challenges included gaining access and permissions to conduct the study, participant recalls bias and attrition, accurately estimating exposures, confounding from causes of both exposure and disease, and to a large extent tight-funding. Though opportunities are abundant, we must ensure field conditions are optimized to attain study objectives. A keen understanding and sensitivity towards the cultural and work settings is essential for successful project completion. Based on our experiences, we provide strategies to adopt to improve fieldwork and provide recommendations to help overcome the field challenges and achieve better results for future EES studies in developing country settings.

Evaluation of models for household recycling behaviour in high-rise buildings: A Chinese case study in urban Guangzhou

Recycling strategies and waste management for the source separation of recyclables are still in their infancy in China and many other developing countries. Unlike formal recycling systems with strictly regulated management in high-income countries, waste management and recycling activities in low-income and middle-income countries are predominantly informal. Formal recycling systems often have very small amounts of recyclables in comparison to informal recycling systems. Considering the Chinese case of urban Guangzhou, where formal and informal recycling systems coexist, this study investigated household recycling behaviour and explored the sociodemographic and contextual factors that affect this behaviour. Based on data collected through questionnaire surveys and interviews, a model of the use of public recycling facilities (UPRF) and a model of the use of informal recycling sectors (UIRS) were evaluated using correlations and multiple regression analyses. The findings indicated that the use of public recycling facilities can be significantly predicted by the launch of a source separation scheme, the physical setting and satisfaction with public recycling facilities. The sociodemographic variables did not significantly predict the use of public recycling facilities but did significantly predict the use of informal recycling sectors. This study's findings have implications for researchers and policymakers and shed light on public designs for sustainability.

Assessing the functional relationship between the formal and informal waste systems: A case-study in Catalonia (Spain)

The present study draws from data collected with informal recyclers in the autonomous region of Catalonia in northeastern Spain. The purpose of the investigation is to determine the relationship between the formal and informal recycling sectors in Catalonia and determine how each of their activities impacts the other. From the case study in the city of Granollers, it was determined that from the spring of 2018 to the fall of 2019, the informal recyclers had the potential to collect roughly 44% of the cardboard in their geographical area, helping to meet the environmental goals of the region, but receiving no recognition for their work nor acknowledgement regarding their role in the waste management system. This investigation also analyzed the economic relationship between the formal and informal systems, and the effects that international events, such as China's National Sword policy, had on that relationship. It was determined that the embeddedness of waste systems and global waste markets affect not only the formal system, but their relationship with the informal system as well.

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.

Why did informal sector workers stop paying for health insurance in Indonesia? Exploring enrollees' ability and willingness to pay

Indonesia faces a growing informal sector in the wake of implementing a national social health insurance system-Jaminan Kesehatan Nasional (JKN)-that supersedes the vertical programmes historically tied to informal employment. Sustainably financing coverage for informal workers requires incentivising enrolment for those never insured and recovering enrolment among those who once paid but no longer do so. This study aims to assess the ability- and willingness-to-pay of informal sector workers who have stopped paying the JKN premium for at least six months, across districts of different fiscal capacity, and explore which factors shaped their willingness and ability to pay using qualitative interviews. Surveys were conducted for 1,709 respondents in 2016, and found that informal workers' average ability and willingness to pay fell below the national health insurance scheme's premium amount, even as many currently spend more than this on healthcare costs. There were large groups for whom the costs of the premium were prohibitive (38%) or, alternatively, they were both technically willing and able to pay (25%). As all individuals in the sample had once paid for insurance, their main reasons for lapsing were based on the uncertain income of informal workers and their changing needs. The study recommends a combination of strategies of targeting of subsidies, progressive premium setting, facilitating payment collection, incentivising insurance package upgrades and socialising the benefits of health insurance in informal worker communities.

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 the role of informal sector for sustainable development of municipal solid waste management system: A case study in Vietnam

Although the informal sector of waste collection has an important role in income diversification for the poor and contribution to waste recycling, this sector is still not recognised in any government official policies and is usually underestimated in the Mekong Delta of Vietnam. This paper employs a systems thinking approach to analyse the crucial roles of the informal sector in solid waste management (SWM) system in Vietnam. From a circular economy viewpoint, the flow diagram was built for the first time, which could integrate the actors and activities of the informal sector into a wider SWM system in Vietnam. The map focuses on analysing the contributions and activities of the informal sector, focusing on its roles and impacts on the recycling system. This paper then employed the systems thinking approach to further analyse the systematic problem of the informal sector. The analysis builds on the field survey including elements and key driving forces of the systems with 36 scrap dealers, 127 scrap buyers, and 760 households and in-depth interviews with experts in the Mekong Delta region, Vietnam. Based on the practices and experience in waste-related activities of informal sector, this sector should be integrated into the general waste management process. With the relevance of informal systems, the authorities could establish an effective waste recycling system, and improve the livelihoods and working conditions of those involved, especially the poor.

A model to rapidly assess informal electronic waste systems

Electronic waste (e-waste) policies have traditionally been based on extended producer responsibility (EPR) principles. In practice, EPR-based e-waste policies primarily involve the creation of regulated collection and recycling channels, with success tied to achieving high collection quotas. However, the majority of EPR programs, particularly those in the Global South, have achieved little success due to competition with the informal sector. Despite this, strikingly little is known of the scope and dynamics of informal e-waste flows and actors during the formulation of e-waste management policies. This study develops and pilots a replicable three-stage model for solid waste researchers, practitioners and policymakers to rapidly assess these informal e-waste systems. This model is demonstrated in Cuenca, Ecuador, and determined the destination of 50-80% of Cuenca's e-waste over a period of three days. The methods used and findings that emerge from this study offer a strategy to rapidly quantify and understand the dynamics of informal e-waste systems to inform EPR-based policies in ways that place informal recyclers at the core of e-waste management. This not only provides creative opportunities for formal systems to achieve e-waste collection quotas through partnerships with the informal sector, but offers a pathway to preserve the livelihoods of marginalized populations reliant on e-waste recycling and decrease environmental harm.

Prevalence of exclusive breastfeeding among mothers in the informal sector, Kampala Uganda

Exclusive breastfeeding (EBF) for the first six months of life is effective in preventing infant morbidity and mortality. However, 36% of Ugandan children below 6 months are not breastfed exclusively despite its active promotion. This study determined the prevalence and factors associated with exclusive breastfeeding among mothers working in the informal sector in Kampala district. A community based cross-sectional study targeting 428 interviews with mothers with children aged 0–5 months was conducted. Analysis was done using modified Poisson regression in Stata version 14. The prevalence of exclusive breastfeeding was 42.8%. The factors associated with exclusive breastfeeding included: attending antenatal care at least 4 times (APR = 1.24; 95% CI: 1.01–1.51), intention to exclusively breastfeed for 6 months (APR = 1.26; 95% CI: 1.01–1.57) or longer (APR = 1.38; 95% CI: 1.06–1.76), proper breastfeeding practices (APR = 4.12; 95% CI: 2.88–5.90), age of the infant (APR = 0.78; 95% CI: 0.65–0.94) and (APR = 0.48; 95% CI: 0.39–0.60) for children aged 2–3 and 4–5 months respectively and working in a lower position (APR = 0.68; 95% CI: 0.55–0.83). Mothers should be encouraged to attend antenatal care where they learn about the benefits of exclusive breastfeeding to children below 6 months hence enabling them to make informed decisions about exclusive breastfeeding. The government of Uganda should ensure maternity leave benefits of the employment act are enforced in the informal sector to allow women to practice EBF.

Antimicrobial Resistance Phenotype of Staphylococcus aureus and Escherichia coli Isolates Obtained from Meat in the Formal and Informal Sectors in South Africa

BACKGROUND

Foodborne diseases (FBD) caused by resistant pathogens are a global public health problem. One main driver of the increasing FBD incidence is the transfer of pathogenic organisms from animal guts to carcasses during processing and subsequent transfer from meat products to consumers.

METHODS

In this study, meat samples from abattoirs in the formal meat sector (FMS) (n = 140) and slaughter points in the informal meat sector (IMS) (n = 104) were collected for microbial detection and phenotypic AMR determination using polymerase chain reaction.

RESULTS

The antibiogram of Staphylococcus aureus isolates revealed that resistance to clindamycin (74.3%) and ampicillin (59.5%) was highest in the FMS, while resistance to penicillin (83.8%) and tetracycline (82.1%) was highest in the IMS. Escherichia coli isolates show significant resistance to chloramphenicol (90.7%) and tetracycline (82.3%) in the FMS. Likewise, resistance to tetracycline (92.3%) and sulfamethoxazole/trimethoprim (87.5%) was highest in the IMS. The multiple antibiotic resistance index (MARI) for S. aureus and E. coli ranged from 0.3 to 0.8 and 0.2 to 0.5, respectively.

CONCLUSION

This study suggests high-level contamination of meat with resistant pathogens and highlights the public health consequences associated with consuming such unhygienic products.

Recent evolution of the informal recycling sector in Argentina within the 'popular economy': Measuring its impact through a case study in Tandil (Buenos Aires)

The integration of the informal recycling sector into formal waste management systems is imperative to the implementation of the circular economy in the Global South. In Argentina, after the 2001 crisis, some large cities such as Buenos Aires greatly improved their informal recycling sector integration. In medium-size cities from the rest of the province, this was not the case. However, the formation of a national coalition between different sectors of what is now called the 'popular economy' forced the enactment, in the context of a new crisis, of a Social Emergency Law, which includes a Complementary Social Salary equivalent to half the minimum wage, among its main features. In this paper, we recap these recent changes and we use the InteRa framework in a case study to measure how, along with academic and civil society support actions, they influenced the informal recycling sector integration in an intermediate city of Buenos Aires province. Our results show that the inclusion of the informal recycling sector improved rapidly after the availability of the Complementary Social Salary. Nevertheless, we registered a hard-to-overcome stagnation in some indicators of the InteRa framework, related to the weak engagement of the local municipal government with the informal recycling sector. Importantly, the advent of the Complementary Social Salary was not reflected in any indicator because there is no specific action related to this aspect in the InteRa framework. This may give an insight into future methodology improvement.

Recent evolution of the informal recycling sector in Argentina within the 'popular economy': Measuring its impact through a case study in Tandil (Buenos Aires)

The integration of the informal recycling sector into formal waste management systems is imperative to the implementation of the circular economy in the Global South. In Argentina, after the 2001 crisis, some large cities such as Buenos Aires greatly improved their informal recycling sector integration. In medium-size cities from the rest of the province, this was not the case. However, the formation of a national coalition between different sectors of what is now called the 'popular economy' forced the enactment, in the context of a new crisis, of a Social Emergency Law, which includes a Complementary Social Salary equivalent to half the minimum wage, among its main features. In this paper, we recap these recent changes and we use the InteRa framework in a case study to measure how, along with academic and civil society support actions, they influenced the informal recycling sector integration in an intermediate city of Buenos Aires province. Our results show that the inclusion of the informal recycling sector improved rapidly after the availability of the Complementary Social Salary. Nevertheless, we registered a hard-to-overcome stagnation in some indicators of the InteRa framework, related to the weak engagement of the local municipal government with the informal recycling sector. Importantly, the advent of the Complementary Social Salary was not reflected in any indicator because there is no specific action related to this aspect in the InteRa framework. This may give an insight into future methodology improvement.

Physical environmental and occupational factors inducing work-related neck and shoulder pains among self-employed tailors of informal sectors in Ethiopia, 2019: results from a community based cross-sectional study

BACKGROUND

Musculoskeletal disorders (MSD) caused by occupational-related factors continue to place huge burdens on global workforces. Significant numbers of workers report potential adverse health outcomes related to the condition, such as physical injury, disability, and decline in quality of life. Occupational-related MSD also poses additional burdens to healthcare services and diminishes productivity at work. The condition usually worsens in informal sectors where the work environments are often poorly designed. This paper explored occupational and physical environmental factors that induce work-related neck and/or shoulder pains among self-employed tailors in Gondar city, Northwest Ethiopia.

METHODS

We conducted across-sectional survey from April to May 2019 on 422 tailors selected with systematic random sampling technique. Nordic Musculoskeletal questionnaire was used to measure pains in neck and/or shoulder, and the questionnaire was pretested and administered by interviewers. Work-related factors such as working posture, rest break, training in safety and health, and the availability of adjustable chairs at workplaces were assessed. The significance of associations was set at a < 0.05 p-value and adjusted odds ratios (AOR) with a confidence interval (CI) of 95% were used to determine strength of associations.

RESULTS

A total of 419 tailors participated with a response rate of 99.3%. The mean age and mean years of experience were 29.23 (SD ± 7.03) and 1.48 (SD ± 0.50) years, respectively. The study found that the prevalence of pain in either neck or shoulder or both sites in the last 12 months was 66.6% (N = 279) [95% CI (62.1, 71.1)]. Pains in shoulder and neck were observed in 72.1% (N = 302)[95% CI (67.8, 76.4)] and 68.3% (N = 286) [95% CI (64.0, 72.6)] of the interviewees, respectively. The majority, 78.1% (n = 218) of those with pains indicated they were prevented from doing normal daily activities. Work experience (AOR = 1.81), rest break (AOR = 2.13), awkward working posture (AOR = 2.60), prolonged sitting (AOR = 2.00) and inadequate light (AOR = 5.02) were significantly associated factors of neck and/ or shoulder pains.

CONCLUSION

Work-related neck and/or shoulder pain induced by physical factors of the work environment among self-employed tailors is pervasive in Ethiopia. Efforts to curb the condition, therefore, need to impalement diverse approaches addressing the physical environment and occupational factors. We also promote the integration of schemes for the effective use of rest breaks into health and safety programs in the workplace.

Gender-based market constraints to informal fish retailing: Evidence from analysis of variance and linear regression

Over the last decade, Egypt's aquaculture sector has expanded rapidly, which has contributed substantially to per capita fish supply, and the growth of domestic fish markets and employment across the aquaculture value chain. Despite the growing importance of aquaculture sector in Egyptian labour force, only a few studies have explored the livelihoods of Egypt's women and men fish retailers. Even fewer studies have examined gender-based market constraints experienced by these informal fish retailers. This study uses sex-disaggregated data collected in 2013 in three governorates of Lower Egypt to examine the economic and social constraints to scale of enterprises between women (n = 162) and men informal fish retailers (n = 183). Specifically, we employ linear regression method to determine the correlates of enterprise performance. We found that both women and men retailers in the informal fish market earn low profits and face livelihood insecurities. However, women's enterprise performance is significantly lower than that of men even after controlling for individual socio-economic and retailing characteristics. Specifically, the burden of unpaid household work and lack of support therein impedes women's ability to generate higher revenues. These findings strengthen the argument for investing in understanding how gender norms and attitudes affect livelihood options and outcomes. This leads to recommendations on gender-responsive interventions that engage with both men and women and enhance the bargaining power and collective voice of fish retailers.

Bi-objective design of household E-waste collection with public advertising and competition from informal sectors

The rapid expansion of technology, coupled with the falling prices of electronic products and their fast obsolescence, has resulted in a rapidly-growing amount of e-waste worldwide. Because of adverse effects on environment and public health, more and more countries and regions have begun to establish and operate public e-waste collection systems. In many developing countries, the low level of environmental awareness and the existence of informal sectors present obstacles to the success of such collection systems. This paper proposes to design a household e-waste collection network and launch a corresponding public service advertising campaign to counteract the informal recycling markets. The proposed mixed integer nonlinear program maximizes the amount of collected e-waste and minimizes overall costs of developing the network and its advertising campaign. A decomposition-based, multi-objective metaheuristic was developed to obtain the Pareto frontier. A case study based on the e-waste collection system in Changsha, China contextualizes the problem and developed methodology. Experiment results show that the cost of network construction and public advertising must be carefully balanced for limited budgets. The impact of residents' environmental awareness is also important to the collection effect. From a methodology perspective, this paper uses the Pareto analysis approach to study the design of household e-waste collection networks, with a supporting public service announcement campaign, in the presence of informal recycling markets. This paper also offers a policy design decision support tool to help regulators determine most workable policies that will balance the trade-offs between the two objectives.

Why Do Informal Sector Workers Not Pay the Premium Regularly? Evidence from the National Health Insurance System in Indonesia

BACKGROUND

The challenges of universal health coverage (UHC) in developing countries with a significant proportion of the labor force that works in the informal sector include administrative difficulties in recruiting, registering and collecting regular contributions in a cost-effective way. As most developing countries have a limited fiscal space to support the program in the long run, the fiscal sustainability of UHC, such as that in Indonesia, relies heavily on the contributions of its members. The failure of a large proportion of voluntary enrollees/self-enrolled members/informal sector workers (Peserta Mandiri/Pekerja Bukan Penerima Upah [PBPU] members) to pay their premiums may lead to the National Health Insurance System (NHIS) in Indonesia being unable to effectively deliver its services.

OBJECTIVE

This study aims at exploring the important factors that affect the compliance behavior of informal sector workers (PBPU members) in regularly paying their insurance premium. This analysis may be a basis for designing effective measures to encourage payment sustainability in informal sector workers in the NHIS.

METHOD

This study utilizes the survey data collected from three regional offices of the Indonesian Social Security Agency for Health (SSAH), which cover approximately 1210 PBPU members, to understand the relationship between members' characteristics and their compliance behavior regarding the premium payment. We applied an econometric analysis of a logit regression to statistically estimate which factors most affect their compliance behavior in paying the insurance premium.

RESULTS

This study reveals that almost 28% of PBPU members do not pay their insurance premiums in a sustainable way. Our logistic regression statistically confirms that the number of household members, financial hardship, membership in other social protection arrangements, and the utilization of health services are negatively correlated with the compliance rate of informal sector workers in paying their insurance premium. For instance, people who experience financial hardship tend to have a 7.7 percentage point lower probability of routinely paying the premium. In contrast, households that work in agricultural sectors and have income stability, the cost of inpatient care incurred before joining the NHIS, a comprehensive knowledge of the SSAH's services, and the availability of health professionals are all positively correlated with regular premium payment.

CONCLUSION

Although there is no single policy that can ensure that informal sector workers (PBPU members) regularly pay their premiums, this study recommends some policy interventions, including (1) flexibility in applying for a government subsidy for premiums (Penerima Bantuan Iuran [PBI]), especially for people who have financial hardship; (2) an intensive promotion of insurance literacy; (3) expanding the quantity and quality of healthcare services; and (4) tailor-made policies for ensuring the sustainability of premium payments for each regional division.

Recycling of scrap metal into artisanal cookware in the informal sector: A public health threat from multi metal exposure in South Africa

Recycling of scrap metal into artisanal cookware is widespread in poorly resourced countries. The aim of the study was to determine the risk of metal exposure from the use of artisanal cookware available in South Africa. Twenty cookware samples were purchased from local manufacturers and informal traders across South Africa. Aluminum and silicon concentrations were determined using XRF and the total content of 18 elements (Ag, As, Ba, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, Sb, Se, Sn, V and Zn) were evaluated using ICPMS. Leaching of metals from cut pieces of cookware over a 2-h period of boiling in a 3% acetic acid solution was repeated 3 times and revealed multi-metal migration that was compared to EU maximum permissible levels. The mean Al migration of 509 mg L^-1 was over 100 times the EU maximum permissible level allowed for cookware. Lead was detected in all samples with 11 (55%), 12 (60%) and 9 (45%) of samples being over the maximum EU permissible level (10 μg Pb L^-1) for 1st, 2nd and 3rd migrations respectively. The mean As migration concentrations in the first leaching event ranged from 0.23 to 24.1 μg L^-1 with four pots (20%) over the maximum EU permissible limit for As (2 μg L^-1). Notably, all four pots were well below the maximum EU permissible As limit by the 3rd migration. Cadmium and mercury were detected in each pot across all three migrations however the levels were relatively low. Transmission electron microscopy revealed dramatic changes in surface structure after leaching of cookware.

Global Statement on Air Pollution and Health: Opportunities for Africa

The editorial speaks to the Global Statement on Air Pollution and Health and How it may assist African countries to eliminate air pollution-related health impacts.

Solid waste management in informal urban neighbourhoods. Occupational safety and health practices among tricycle operators in Kumasi, Ghana

The study examines the nature of activities and assess knowledge on occupational safety and health (OS&H) risks and practices among solid waste collectors in two low-income informal neighbourhoods in Kumasi (Aboabo and Asawase). Using observations and semi-structured interviews with 83 participants and relevant institutions, the findings indicate that informal tricycle waste collectors provided spot-to-spot waste collection using improvised sirens to signal their arrival. Workers generally had low knowledge, expressed less about occupational health risks, and thus adopted less safe work practices. The study however showed significant differences between knowledge of health risks (p < 0.000, R = 0.83) and years of working experience (p < 0.01, R = 0.74) and adoption of safe practices. Workers who had knowledge the associated health risks of the activity and also have been in the activity for more than 2 years were more likely to use at least one PPE/PPC. The study recommends that targeted interventions to mitigate risks and improve the health and safety of workers require effective risk communication. The study concludes that insight into OS&H is important to offer opportunities for better waste management strategies in the informal urban areas.

Attending Informal Preschools and Daycare Centers Is a Risk Factor for Underweight, Stunting and Wasting in Children under the Age of Five Years in Underprivileged Communities in South Africa

The study objectives were to determine the nutritional status of children between the ages of 12–60 months and to establish the association between attending preschool and the prevalence of undernutrition. This was a cross-sectional survey conducted in health facilities in Tshwane district in South Africa, consisting of both a questionnaire and anthropometric measures of 1256 mothers and their children. Weight-for-age (WAZ), height-for age (HAZ) and BMI-for-age (BAZ) were calculated and bivariate and multivariable analysis was performed to establish association. The results showed that child-related factors, namely birthweight, age, gender, and attending preschool increased the risk of undernutrition. Children over the age of 24 months were likely to be stunted and underweight. Maternal education reduced the odds of underweight. Children who stayed at home had reduced odds of underweight and stunting. High birthweight reduced the odds of wasting and underweight. The risks for undernutrition are multifaceted, but children who attend preschool have an increased risk of undernutrition. The risk of undernutrition increased with age and coincided with the time of cessation of breast-feeding and attendance at daycare or preschool. The complementary role of quality childcare in preschools and daycare centers is vital in alleviating the problem of undernutrition in underprivileged communities.

An Integrated Approach for Delivering Current Astrobiology Research to the General Public

This article describes a multifaceted approach to delivering results from current research in astrobiology to visitors at Pacific Science Center, along with the evaluated results of the impact of the work. Content was delivered by (1) training scientists to communicate effectively with the public, (2) providing the trained scientists with venues to engage with the public, and (3) creating two Science on Sphere shows that highlight key tenants scientists are investigating, a hands-on activity to facilitate interactive learning, and a temporary exhibit that highlights current research on the topic. Evaluation of visitors who engaged with each element demonstrates that the content had a large impact on both the increase in knowledge of the visitors and the increase of interest in the topic.

Job hazards and respiratory symptoms in Hispanic female domestic cleaners

The occupational hazards and respiratory symptoms of domestic cleaners in USA are largely unknown. We conducted a cross-sectional study among 56 Hispanic female domestic cleaner on their health status and frequency of cleaning products used and tasks performed. While women used multi-use products (60.0%) and toilet bowl cleaners (51.8%) most days of the week, many (39.3%) reported not using personal protective equipment while cleaning. Itchy/watery eyes (61.8%) and itchy nose (56.4%) were the most frequently reported symptoms. A history of physician-diagnosed asthma was reported by 14.3% while 33.9% had symptoms of bronchial hyperresponsiveness (BHR). In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR symptoms and is potentially exposed to myriad occupational hazards. Further research exploring associations between products use, cleaning tasks and respiratory symptoms is warranted.

Why do they take the risk? A systematic review of the qualitative literature on informal sector abortions in settings where abortion is legal

BACKGROUND

Restrictive abortion laws are the single most important determinant of unsafe abortion, a major, yet preventable, global health issue. While reviews have been conducted on the extent of the phenomenon, no study has so far analysed the evidence of why women turn to informal sector providers when legal alternatives are available. This work provides a systematic review of the qualitative literature on informal sector abortion in setting where abortion is legal.

METHODS

We used the PRISMA guidelines to search Pubmed, Web of Science, Sciencedirect and Google Scholar databases between January and February 2018. 2794 documents in English and French were screened for eligibility against pre-determined inclusion and exclusion criteria. Articles investigating women's reasons for aborting in the informal sector in settings where abortion is legal were included. In total, sixteen articles were identified as eligible for this review. Findings were reported following the PRISMA guidelines.

RESULTS

The review highlights the diverse reasons women turn to the informal sector, as abortions outside of legal health facilities were reported to be a widespread and normalised practice in countries where legal abortion is provided. Women cited a range of reasons for aborting in the informal sector; these included fear of mistreatment by staff, long waiting lists, high costs, inability to fulfil regulations, privacy concerns and lack of awareness about the legality of abortion or where to procure a safe and legal abortion. Not only was unsafe abortion spoken of in terms of medical and physical safety, but also in terms of social and economic security.

CONCLUSION

The use of informal sector abortions (ISAs) is a widespread and normalised practice in many countries despite the liberalisation of abortion laws. Although ISAs are not inherently unsafe, the practice in a setting where it is illegal will increase the likelihood that women will not be given the necessary information, or that they will be punished. This study brings to the fore the diverse reasons why women opt to abort outside formal healthcare settings and their issues with provision of abortion services in legal contexts, providing an evidence base for future research and policies.

Home-based and informal work exposes the families to high levels of potentially toxic elements

The city of Limeira presents a relevant productive chain of jewelry and fashion jewelry, including a scenario of outsourcing informal home practices. It is highly complex to understand the potentially toxic elements (PTE: Cr, Mn, Ni, Cu, Zn, As, Cd, Sn, Sb, Hg, and Pb) exposures of the workers because this productive chain encompasses households. This study aimed to investigate the associations between blood PTE levels and informal work in the home environment. Fifty-two families divided into Exposed group (n = 112) and Control group (n = 53) were included. Families' blood (n = 165) and welder's breathing zone air samples (n = 9) were collected and PTEs concentrations were determined by ICP-MS. Questionnaires were applied to collect sociodemographic information and workplace details. Principal component analysis, Mann-Whitney test, cluster and a logistic regression analysis based on environment-wide association studies (EWAS) were carried out. Ni, Cu, Zn, Cd and Pb concentrations in the air samples were higher than occupational guidelines. Eighty percent of the workers were female, and 43.5% of those females then worked as welder. A significant difference was found for Pb concentration between the exposed and control group (p < 0.0001) and between sexes (p = 0.0046). For Cu (p < 0.0001) and Sb (p = 0.0434), differences were found between the sexes. The receiver operating characteristic of the EWAS was 0.80, providing evidence of a potential model to associate exposure levels and occupational factors. PTEs concentrations in the air samples raised concerns, particularly for children, who were in the same exposure scenario. Inadequate work conditions were observed in the houses, revealing the need of public actions to protect these families.

Standardized Questionnaire for the Measurement, Valuation, and Estimation of Costs of Informal Care Based on the Opportunity Cost and Proxy Good Method

Costs of informal care account for a significant component of total societal costs for many chronic and disabling illnesses. Yet, costs associated with the provision of informal care is seldom included in economic evaluations of new health technologies, increasing the risk of suboptimal decisions on the allocation of resources from the perspective of society. Our objective was to propose a standardized questionnaire for the measurement, valuation, and estimation of caregiver indirect (productivity) and informal care costs as separate mutually exclusive subsets of total costs in cost-of-illness studies and as an input to economic evaluations from the societal perspective. We developed a questionnaire for data collection and step-by-step analysis procedures for resource valuation and cost estimation. Data concerning absenteeism from work and time devoted to informal care were recorded using the recall method. Indirect (productivity) and paid informal care costs were valued and estimated according to the human-capital approach as the loss of production. Unpaid informal care costs were valued and estimated as the loss of leisure time quantified using the opportunity cost and proxy good method. The new questionnaire, titled the Caregiver Indirect and Informal Care Cost Assessment Questionnaire, contains 13 questions regarding caregiver current and previous work status, productivity, and the provision of informal care (stratified by time devoted to household activities, personal care, practical support, and emotional support). The proposed questionnaire should be helpful to inform the design, implementation, and execution of future cost-of-illness studies and economic evaluations from the perspective of society.

Health Assessment of Electronic Waste Workers in Chile: Participant Characterization

Little research has been done to evaluate the occupational health of electronic waste (e-waste) recycling workers in Latin America. The objective of this study was to complete comprehensive health evaluations on e-waste recycling workers in Chile and to compare those that work in informal (i.e., independent) to those that work in formal (i.e., established company) settings. A cross-sectional study in the summer of 2017 recruited 78 informal recycling workers from two cities and 15 formal e-waste recycling workers from a single recycling facility to assess exposures and health outcomes. Participants completed a health questionnaire and underwent a full health assessment. Herein, only health questionnaire data are reported. Participants were primarily male, middle-aged, married with children, and had worked in e-waste recycling for an average of 12 years. Participants generally reported good health status, and their prevalence of chronic diseases was comparable to national rates. Workers frequently reported exposures to several occupational stressors, including noise and insufficient income, as well as other mental health stressors. Occupational injuries were commonly reported and use of safety equipment was low. Only a few significant differences, generally of a rather small magnitude, were found between informal and formal workers. In conclusion, from survey data, we did not identify major risks to health among e-waste workers, and only minor differences between workers in informal and formal settings.

A critical analysis of purchasing arrangements in Kenya: the case of micro health insurance

BACKGROUND

Strategic purchasing can ensure that financial resources are used in a way that optimally enhances the attainment of health system goals. A number of low- and middle-income countries, including Kenya, have experimented with micro health insurance (MHIs) as a means to purchase health services for the informal sector. This study aimed to examine the purchasing practices of MHIs in Kenya.

METHODS

The study was guided by an analytical framework that compared purchasing practices of MHIs with the ideal actions for strategic purchasing along three pairs of principal-agent relationships (government-purchaser, purchaser-provider and citizen-purchaser). The study adopted a qualitative descriptive case study design with 2 MHIs as cases. Data were collected through document reviews (regulation, marketing materials, websites) and semi-structured interviews with key informants (n = 27).

RESULTS

The regulatory framework for MHIs did not adequately support strategic purchasing practice and was exacerbated by poor coordination between health and financial sectors. The MHIs strategically contracted health providers over whom they could exercise bargaining power, sometimes at the expense of quality. There were no clear channels for beneficiaries to provide timely feedback to the purchaser. MHIs premium payments were family-based, low-cost and offered limited benefits. Coverage was based on ability to pay, which may have excluded low-income households from membership.

CONCLUSIONS

Adequate policy, legal and regulatory frameworks that integrate MHIs into the broader health financing system and support strategic purchasing practices are required. The state departments responsible for finance and health should form coordinating structures that ensure that MHI's role in universal health coverage is owned across all relevant sectors, and that actors, such as regulators, perform in a coordinated manner. The frameworks should also seek to align purchasers' relationships with providers so that clear and consistent signals are received by providers from all purchasing mechanisms present within the health system.

New York City's Reuse Impact Calculator: Quantifying the zero waste impact of materials reuse

In 2015, the city of New York (NYC) introduced a plan to reduce the volume of collected solid waste by 90% by 2030 and envisioned the expansion of reuse opportunities as one of its main drivers. The assessment of the contributions from reuse initiatives to the advancement of waste prevention and waste reduction goals requires a quantitative understanding of the scope of reuse activities. The high population density in NYC and well-organised collection efforts by The City of New York Department of Sanitation (DSNY) (DSNY) have resulted in a structure that enables the informal sector to readily contribute and access the reuse market. Importantly, the scale of the operations in NYC enable the results found to be a model for other municipalities of similar size. This article presents the Reuse Impact Calculator, developed from the need to automate and quantify the environmental impact of product reuse by nonprofit enterprises in NYC. Specifically, we will explain the development process, show the novel characteristics of this calculator, describe the software in terms of data input, auto mapping functionality and calculations and present a case study to demonstrate the implementation of the Reuse Impact Calculator. This calculator is a dynamic and easily modifiable tool that converts diverse datasets to comparable conditions and allows the assessment of the impact of reuse organisations to waste prevention in NYC.

Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin

BACKGROUND

Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied.

METHODS

A cross-sectional study was carried out among 340 children's caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD.

RESULTS

Beyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169-0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest quintile. The caregivers age group 30-39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD.

CONCLUSION

This study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.