Health Impact of Occupational Risks in the Informal Sector in ZimbabweExecutive Summary |
Assessment of the health impact of occupational risks is important for social recognition of these risks, to plan and facilitate adequate interventions for their prevention and to adequately manage the health burdens they cause. While the International Labour Organisation and World Health Organisation working with members states are compiling information on the health burdens of occupational risks, it has been raised that occupational health and safety information in the non wage or informal sector of employment is extremely limited. This is despite the fact that of the total labour force in Africa of approximately 235 million in 1990, the share of this labour force in informal sector employment ranged from 49-99%.
The report outlines information from the literature on the sector, the jobs and work environment problems it involves and documented information on occupational injury and illness. The review provides evidence that there is a significant level of reported risks and ill health in the informal sector. Despite this, there is no comprehensive monitoring of injury and illness rates in urban informal sectors.
The reported survey of occupational risks and health impacts in the informal sector in Zimbabwe was thus carried out in August / September 1997 to
The study population was drawn from urban home based enterprise and informal production sites, and peasant agriculture and rural informal sector production sites in Harare and Murewa respectively, covering a total of 1 585 respondents. The report details the methods and research instruments used. Informal sector employees were defined as those working in registered and licensed enterprise, employing less than 10 people, not covered by formal collective bargaining mechanisms and excluding full time students and unemployed people. The questionnaire for the survey was developed using existing surveys of occupational risks and injury, some linked to labour market and other household surveys.
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. It is proposed that 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 was 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 related closely to a reported 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 were commonly reported, probably linked with the reported poor hygiene due to lack of accessible clean water and safe sanitation.
Based on the work environment problems found, 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. Given that an extremely low use of PPE was found in the survey, 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, and it is suggested that technology interventions could usefully include safety aspects in the technology design; investments in factory shells to include an adequate ratio of hygiene facilities; allocation of sites to consider clustering of similar work processes and worksites to incorporate ergonomic features for work benches/ platforms and seats as well as housekeeping features such as passageways, storage facilities and emergency exits. It is further proposed that maintenance of these facilities be a community service using levies paid by the operators for licenses.
Chemical use was found to be widespread (in 40% of workers). The most common chemical risks were solvents in urban areas and pesticides in rural areas. These problems call for a focused information programme on safe handling of chemicals, their risks and health effects, in particular focusing on the commonly used solvents and pesticides. 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. Literacy rates were found to be high (97%) enabling wide dissemination of written information.
The survey 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 were found to have a low density of workers. Employees were often mobile and worked in public places that are not officially delineated as workplaces. Formal skills levels were low, even if literacy rates were high, much skills and experience being acquired through informal exchange of experience and expertise. There was a high level of female participation in the sector (54%), with women sharing their production work with domestic work. Working hours were significantly longer than formal sector statutory limits in the manufacturing sector.
The conditions of informal sector production make it difficult to establish traditional systems of promotion, dissemination of information, inspection and monitoring in small enterprises, calling for alternative approaches to occupational health development. It is suggested in the paper that community based approaches linked to primary health care systems may be more successful than formal 'workplace' approaches.
Such approaches would need to link
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 called for
The paper supports the view that 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.
It also raises that 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, in a manner that promotes and supports 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.
The research findings indicate a need for a wider national survey of occupational exposures and morbidity to more clearly identify from a less biased data source where attention should be directed to reduce the major causes of morbidity. Periodic collection of such data would provide policy makers with estimates of the burden and distribution of the health impacts of occupational risk, the progress towards reduction of that risk and the returns to their investments in occupational health practice. The report outlines possible questions for inclusion in such an occupational health survey. It is suggested that this inclusion of work related health outcomes in the national systematic assessment of public health in Zimbabwe is long overdue.
| [ Table of contents ] | [ List of papers ] |