The past few decades have seen a significant increase in urbanization in low and middle income countries. The vast majority of those moving to and living in cities rarely find employment in the formal sector, thereby giving rise to the new and continued norm of informality.
Research supported by The Rockefeller Foundation has found that informal workers make up as many as 80 percent of the working population in South East Asia, and 67 percent in several African countries. The numbers do not lie—not only are many 21st century economies driven by those working in the informal sector, they are the very engines of growing cities and new economic activity. Which begs the question—if indeed informal workers are a significant majority of the adult working population, how are social services reforming and reorienting themselves to ensure that this economic mother lode is protected?
Informal workers make up as many as 80 percent of the working population in South East Asia, and 67 percent in several African countries.
Our work over the past year has highlighted the challenges that this invisible population faces in protecting their health. The International Labor Organization (ILO), defines informal workers as those who are not covered by any social protection measures such as health insurance or welfare programs. Existing survey instruments do not capture data on the size of the informal worker population, which is the first of many hurdles in trying to understand and address their health challenges.
Informal workers run the gamut of construction workers building roads, dams and towering office blocks, to food and market traders who feed the populations of those cities, garment workers who clothe us globally, and transport workers who move goods across regions; and yet despite differences in work sectors and geographical locations, many informal workers face the startlingly similar challenges when it comes to protecting, promoting and addressing their health—the very asset that enables them to be productive labour units.
For today’s urban based informal workers the new ‘last mile’ is no longer a geographical one but one that is typified by somewhat ‘softer’ issues such as the monetary value of their time, and thus the very real loss they face when this time needs to be sacrificed for care seeking. It’s also characterized by the disconnections they face from information on existing locations for care at relevant times and appropriate financing options both in terms of insurance and in terms of micro-costs that enable one to reach healthcare delivery points. All of these elements deeply determine the probability of informal workers seeking care when and if they need it. As a result many easily treatable conditions are turned into critical ones.
As we build and embed the concept of resilient communities it is time to develop new options for how healthcare should be delivered in an informal, highly urbanized, technology dependent world. Understanding and uncovering the limitations this population faces in accessing care will allow the building blocks needed to develop new options to cross this divide.
We understand that as countries aim towards positive economic and social growth paths, it is time to start reorienting health systems to the needs and realities of this invisible and vulnerable population.