Informal workers form a large percentage of the global working force. According to estimates by the Organization for Economic Cooperation and Development (OECD), they total more than a billion in developing countries and 1.8 billion worldwide, or 60% of the world’s working population. Of new jobs created in developing countries, most are in informal employment. The informal sector is thus a crucial component of development worldwide. Ensuring better employment conditions for them will translate to higher productivity and a greater contribution to the economy. Informal workers are susceptible to health problems due to the poor employment conditions and inadequate access to health care. Many types of informal workers face unsafe or poor working conditions hence accessing health care requires leaving work, which reduces the income and adds to health care expenses. However, most informal workers have few resources which makes it harder for them to access these facilities.
The Rockefeller Foundation puts the number of informal workers who live in extreme poverty, at 700 million people contributing to their vulnerability to poor health. Most informal workers have few resources, which makes accessing health care a challenge as it requires leaving work, which reduces their income and adds health care expenses. Some of the common problems that Informal workers face include poor working conditions high risk of injuries, exposure to toxins, limited access to training and protective gear, excessive working hours, no sick time, high stress and job insecurity and no health or social protection.
From the Kenyan perspective fifty-six per cent of the Kenyan population are poor by the World Bank definition, namely living on one dollar or less a day per capita. According to the national health accounts from the Ministry of Health, more than a third of the poor who were ill did not seek care, compared with only 15% of the rich. Fifty-two per cent of poor households cited financial difficulties as the principal reason for not accessing health care. Furthermore, 7.7% of poor households were faced with catastrophic health expenditure, i.e. out-of-pocket payments exceeding 40% of disposable household income. Expanding access to health care for the informal sector and the poor is therefore an important objective of the Kenyan health sector strategy.
The National Health Insurance Fund (NHIF) has set itself an ambitious target of recruiting 12 million Kenyans in the informal sector as it moves to roll out the second phase of its mass recruitment drive. It has so far recruited 3.5 million people from the formal sector and a further 2.5 million in the informal sector and is now planning to expand the membership. The drive is hinged on recent roll out of an ‘affordable’ care package which allows informal sector workers to contribute KSh500 monthly or KSh6,000 per year. This initiative, if properly executed will go a long way in ensuring that the development goal of attaining universal access to healthcare is met. Such initiatives need to be replicated, expanded and scaled up to ensure that the majority of workers, who fall under the informal economy access adequate healthcare.
Informal Economy Analyst