Health Impact of Occupational Risks in the Informal Sector in ZimbabweChapter 4Issues and conclusions arising from the survey |
The rates of injury, illness and mortality reported in this survey signify the presence of occupational risks and a negative health burden that is not factored into national assessments of and programmes in occupational health and safety. The annual mortality rate due to work related causes of 12,49 / 100 000 is half that reported in the formal sector, but given the small sample size for this estimate and the potential for a healthy worker effect it is possible that mortality rates are equivalent to those in the formal sector.
| As one entry point into the informal sector there is a strong case for making ALL work related fatalities reportable within 24 hours to NSSA, including those in the informal sector, and for an inquiry into every fatality. This would also serve to raise the profile of occupational health in the sector. |
The reported annual rates of injury and illness in the informal sector of 131 injuries / 1 000 workers and 116 illnesses / 1 000 workers exceed those in the formal sector by a factor of 10 in the case of injury and of about 100 in the case of illness. The distribution of injury between sectors correlates significantly with formal sector rates, with an excess in manufacturing. Illness rates are higher in the agricultural and service sectors. The similar pattern of illness as in the formal sector, the similarity between the ratio of illness and injury to that prevailing in countries with better reporting systems and the fact that under-reporting of injury and illness in the formal sector is widely suspected signals that the rates found in the informal sector may be closer to the real picture of health impacts than what is formally reported to NSSA. In particular, the survey found high levels of musculoskeletal and respiratory illness which are already thought to be significantly under-detected in formal systems.
| The data strongly indicates a need for a surveyed assessment of occupational injury and illness in ALL sectors of employment, to obtain a more accurate assessment of the health burden of occupational risks. As has been done in other countries, a specific module on this can be developed for the integrated household survey. |
Nineteen percent (19%) of injuries, or 24,8 injuries per 1 000 workers, resulted in some form of permanent disability. In fact while the disability led to job transfer in about one fifth of cases, it did not lead to job loss, indicating that while functional impairment was present it was not high. Of the 19% of workers who should have been covered by workers compensation only one case was reported and none were compensated. This indicates a serious shortfall in the enforcement of SI 68 1990 in informal sector workers.
| For coverage with workers compensation (WCIF) to be improved, it is suggested that WCIF be linked with other forms of credit and insurance in the sector. To qualify for government and other credit schemes for example, proof of subscription to WCIF should be shown, and assistance be given in ensuring such coverage. In addition, given the lack of accurate data and the need for a simplified system of coverage it is suggested that in the initial years a flat rate annual payment per worker be levied on informal sector operators. |
The pattern of reported morbidity is similar to that reported by workers in formal sector surveys (ZCTU 1992), ie injury, particularly eye injury, crushings and superficial injuries, respiratory disorders and musculoskeletal disorders. These relate to the common pattern of poor work organisation, ergonomic hazards (poor work posture and loads), hazardous handtools and exposure to dusts and chemicals, primarily pesticides, traffic fumes and solvents. In addition stomach problems are commonly reported, probably linked with the poor hygiene due to lack of accessible clean water and safe sanitation. The pattern of risks and health outcomes is shown in Figure 4.1 overleaf.
FIGURE 4.1: PATTERN OF OCCUPATIONAL RISKS AND INJURY/ILLNESS IN THE INFORMAL SECTOR
| It is proposed that the greater share of the health burden of occupational risks could be addressed by improving hygiene, ergonomics, work organisation and handtool safety, and by focusing on reducing risk of exposure to solvents and pesticides. In addition, general control of vehicle exhaust fumes would reduce exposure of informal workers operating at bus terminals. |
How can such controls be effected?
| Given the extremely low use of PPE, it is suggested that the route of controls using PPE may not be effective in the informal sector. The major occupational risks call for design stage changes in the siting, layout, design of work stations in and design of equipment for the sector. |
The issue of improved technology for the sector has been raised in other fora, including in the Government of Zimbabwe development plan (ZIMPREST). A national programme towards this end could usefully include safety aspects in the technology design. Kogi (1989), for example, provides useful examples of low cost technology designs for small enterprises. In addition, worksite layout in investments in factory shells should include an adequate ratio of hygiene facilities, allocation of sites should consider clustering of similar work processes and worksite design should incorporate ergonomic features for work benches/ platforms and seats as well as housekeeping features such as passageways, storage facilities and emergency exits. Maintenance of these facilities should be a community service using levies paid by the operators for licenses.
The specific problem of chemical exposures requires a focused information programme on safe handling of chemicals, their risks and health effects, in particular focusing on the commonly used solvents (urban) and pesticides (rural). Simplified safety data sheets for the most common chemicals in use produced in the vernacular with appropriate advice on risk reduction, first aid and health impacts should be available to informal sector operators. As noted earlier the literacy rates are high in this sector and this can be tapped for wide dissemination of relevant information. As the work pace is sporadic, less pressurised work times could be used to read and discuss such information sheets.
The survey has highlighted features of informal sector work that would need to be taken into account in any occupational health intervention. While few workplaces were licensed, even fewer home based workplaces were licensed, making it difficult to reach them through formal systems. New players may have roles in ensuring worksite safety, including landlords. Many workers are self employed, and even for those in employment contracts, the employer is often not present indicating that formal sector approaches that work through employers may not be relevant or effective.
This is further reinforced by the fact that workplaces have a low density of workers. Employees are often mobile and work in public places that are not officially delineated as workplaces. Formal skills levels are low, even if literacy rates are high, much skills and experience being acquired through informal exchange of experience and expertise. There is a high level of female participation in the sector, with women sharing their production work with domestic work, and while working hours may be long, work is not always intense.
It is therefore difficult to establish traditional systems of promotion, dissemination of information, inspection and monitoring in small enterprises, and alternative approaches to occupational health development are needed.
These features imply that community based approaches linked to
primary health care systems may be more successful than formal 'workplace'
approaches. Such approaches would need to link
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The Bali Statement of the government of Indonesia at the recent October 1997 ICOH meeting on occupational health in the informal sector proposed that the primary health care approach which accommodates preventive, promotive, curative and rehabilitative measures with involvement of workers and a multidisciplinary / intersectoral support system is an appropriate and cost effective strategy to improve OHS in the informal sector. To this end the statement calls for
The disaggregation of the sector must be overcome and collective systems of management developed. For example, the provision by local authorities of appropriate shelters and work stations at agreed sites with proper toilet, water, electrical, ventilation, telephone and other facilities could provide a framework for information and support services on equipment, chemicals and safe work practices and easy access to the necessary spare parts and protective equipment. Such serviced work areas would also allow easier monitoring of environmental waste.
These approaches would need to link with other programmes aimed at the more general problems of access to infrastructures, capital resources, skills and decision making in the small enterprise sector (GoZ 1997). Approaches to dealing with these include removal of bureaucratic and regulatory impediments, promoting the role of local authorities, providing relevant information to the sector, promoting flows of financial resources and credit to the sector, linking large and small enterprises and promoting skills development through entrepreneurial outreach programmes (GoZ 1997). It has been noted that such programmes would also need to promote and support the development of participatory institutions with full involvement of informal sector participants or their representatives. Such organisations would equally be important in monitoring compliance with health, environmental, employment and quality standards (Mhone 1996).
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