Enhancing Access to HIV Testing and Social Protection for Workers in the Informal Economy in Kenya

Under the Voluntary Counselling and Testing for Workers’ Initiative - the VCT@WORK Initiative - the ILO in Kenya has developed an innovative programme of enhancing access to HIV testing amongst workers in the informal economy; and facilitating their access to national social protection schemes.

News | 25 April 2017

HIV prevalence in Kenya is at 5.9 per cent. Maximum infections are in the most productive age group of 15-49 years. Prevalence amongst women (6.5 per cent) is higher than men (4.7 per cent). One out of five new HIV infections is among young women (15-24).

 

Over 50 per cent of people living with HIV (PLHIV) do not know their HIV status.

 

The informal economy in Kenya accounts for 83% of the workforce. Workers in the informal economy are hardly covered by the social protection programmes. Both the National Social Security Fund (NSSF) and the National Hospital Insurance Fund (NHIF) cover over 3 million workers but around 90 per cent of these are workers in the formal sector.  

The ILO contributes to HIV and AIDS and social protection in Kenya through the Joint UN Team on HIV and AIDS and the UN Development Assistance Framework (UNDAF) outcome group on social protection.

Under the Voluntary Counselling and Testing for Workers’ Initiative - the VCT@WORK Initiative - the ILO in Kenya has developed an innovative programme of enhancing access to HIV testing amongst workers in the informal economy; and facilitating their access to national social protection schemes.

 

The approach primarily covers truck drivers, small traders/artisans and other informal economy workers such as young women working in hair and beauty salons, who find it difficult to visit the HIV testing centres as well as NHIF and NSSF to access social protection schemes. This is primarily due to lack of information and the fact that visits to access services results in the loss of daily wages for them. Partnerships between the world of work actors and NHIF and NSSF have been established. Onsite enrolment of workers to NHIF is being made during HIV testing and awareness events.

Salient features of the strategy:

For reaching out to truckers, the ILO is partnering with the Central Organization of Trade Unions in Kenya (COTU-K), Kenya Long Distance Truck Drivers', Allied Workers' Union/Highway Community Health Resource Centre and Swedish Workplace HIV/AIDS Programme. This partnership provides voluntary HIV testing and counselling services along the Northern transport corridor (Mombasa to Busia). Hotspots for sex workers have been identified where onsite HIV testing and counselling (HTC) is provided.

 

For hair and beauty salon workers, the ILO is partnering with the Kenya Union of Hair and Beauty Salon Workers, an affiliate of COTU-K and the AIDS Healthcare Foundation. Union officials have been trained on HIV management at the workplace.  Onsite integrated health/HIV testing and counselling (HTC) services are provided in workplaces, along with awareness on the benefits of enrolling with the National Hospital Insurance Fund (NHIF).The union also mobilizes workers to become members of the Savings and Credit Cooperative (SACCO), encouraging them to save a portion of their income.

 

The Federation of Kenya Employers, through its Clustered HIV Enterprise Programmes (CHEP) Networks in Mombasa, Uasin Gishu and Laikipa Counties, reaches out to their member companies to scale up the HIV response at their workplace and beyond. VCT@WORK initiatives are organized targeting the informal economy workers from the Jua kali sector (small traders and artisans) with an integrated component of social protection. Officials of NHIF and NSSF from the specific counties are invited to sensitize workers on the importance of enrolling with the schemes. Wherever possible, workers are provided support for the onsite registration in NHIF.  

 

Results:

Between July 2013 and December 2016:

Ø  Over 74,000 workers (44,000 male and 30,200 female), majority being in the informal economy, took the HIV test. Over 1000 found HIV positive were referred to access treatment and social protection. 

Ø  Over 10,500 male and 8,000 female informal economy workers were enrolled with NHIF. Over 6,000 male and 5,100 female informal economy workers were enrolled with NSSF through different HIV testing events.

Ø  Around 500 hair and beauty salon workers have become members of the Savings and Credit Cooperative (SACCO).  

 

Lessons Learned:

Integration of HIV, health services and social protection helps reduce stigma and discrimination.

Onsite HIV testing and enrolment into social protection schemes enhances the uptake of HIV services and coverage of social protection programmes amongst informal economy workers.

Trade unions have a significant role in reducing HIV-related stigma and discrimination and enhancing the uptake of HIV testing, treatment and support not only in formal but also in informal workplaces.

Social protection provides income security for PLHIV and informal economy workers and enables them to access HIV services.

Engagement of trade union leaders, employers/informal business association leaders and local administrations is essential to effectively reach out  to workers in the informal economy.

Awareness is the key.  Workers in the informal economy are generally not aware of the benefits of social protection schemes, and the process of enrolling in them. Likewise, they are not aware about the benefits of timely HIV testing. Peer education can play a key role in promoting the uptake of services.

Next Steps:

Building on the positive experience and partnerships that have been established, the ILO is expanding the VCT@WORK Initiative in other high and medium burden counties.

Under the UNDAF outcome on social protection, the ILO is scaling up the integration of HIV and social protection in more counties targeting workers from formal as well as informal economy.