Health care access of informal waste recyclers in Johannesburg, South Africa

Kistan, Jesne; Ntlebi, Vusi; Made, Felix; Kootbodien, Tahira; Wilson, Kerry; Tlotleng, Nonhlanhla; Kgalamono, Spo; Mathee, Angela; Naicker, Nisha

doi:10.1371/journal.pone.0235173

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…Migrant undocumented workers may not feel welcome at health facilities [ 5 , 6 ]. Additionally, informal economy workers may have less access to occupational health education and services; resulting in less knowledge of hazards and their control, poor access to personal protective equipment, and low health services coverage [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

Naicker

Pega

Rees

et al. 2021

IJERPH

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Background: There are approximately two billion workers in the informal economy globally. Compared to workers in the formal economy, these workers are often marginalised with minimal or no benefits from occupational health and safety regulations, labour laws, social protection and/or health care. Thus, informal economy workers may have higher occupational health risks compared to their formal counterparts. Our objective was to systematically review and meta-analyse evidence on relative differences (or inequalities) in health services use and health outcomes among informal economy workers, compared with formal economy workers. Methods: We searched PubMed and EMBASE in March 2020 for studies published in 1999–2020. The eligible population was informal economy workers. The comparator was formal economy workers. The eligible outcomes were general and occupational health services use, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, depression, noise-induced hearing loss and respiratory infections. Two authors independently screened records, extracted data, assessed risk of bias with RoB-SPEO, and assessed quality of evidence with GRADE. Inverse variance meta-analyses were conducted with random effects. Results: Twelve studies with 1,637,297 participants from seven countries in four WHO regions (Africa, Americas, Eastern Mediterranean and Western Pacific) were included. Compared with formal economy workers, informal economy workers were found to be less likely to use any health services (odds ratio 0.89, 95% confidence interval 0.85–0.94, four studies, 195,667 participants, I2 89%, low quality of evidence) and more likely to have depression (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26,260 participants, I2 87%, low quality of evidence). We are very uncertain about the other outcomes (very-low quality of evidence). Conclusion: Informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for relative differences in the other eligible outcomes. Further research is warranted to strengthen the current body of evidence and needed to improve population health and reduce health inequalities among workers.

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Section: Introductionmentioning

confidence: 99%

Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

Naicker

Pega

Rees

et al. 2021

IJERPH

Self Cite

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“…Our study found that distance (no health facility nearby since a local hospital was moved), cost (have to take a taxi to nearest health facility), clinic times and queues (street vendors unable to wait for long as the operating times coincide with their trading times) are main challenges in accessing health care, showing consistency with findings of other studies. 22,40 Though condom provision at the workplace is not mandatory in South Africa, the HIV policies advocate that workplaces facilitate easy access to condoms for workers, as part of HIV primary prevention. 41 According to our findings more needs to be done for marketplace vendors to ensure that they have the suggested easy access to condoms.…”

Section: Discussionmentioning

confidence: 99%

HIV and TB Workplace Program for Street Vendors: A Situational Analysis

et al. 2021

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In South Africa, 15 percent of informal economy workers are street vendors. The organization of occupational health services in the country is fragmented and does not cover informal workers. Conditions of work make informal workers extremely vulnerable to human immunodeficiency virus (HIV) and tuberculosis (TB) exposure. In this study, a qualitative risk assessment was conducted among street vendors, followed by focus group discussions. Interpretation of data was according to major themes extracted from discussions. Workers are exposed to several occupational health hazards identified during the risk assessment. There is a lack of workplace HIV and TB services and overall poor access to healthcare. Street vendors, especially females, are at higher risk of HIV, due to gender inequalities. Comprehensive gender-sensitive training on occupational health and safety, HIV, and TB should be prioritized. To reach Universal Health Coverage and achieve the Sustainable Developmental Goals’ targets, the health system should improve services for informal economy workers.

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“…Against the backdrop of these risks, however, waste pickers have low health-seeking behaviour [ 25 , 40 ]. All informal workers suffer from a ‘no work no pay’ situation, and this can make waste pickers reluctant to seek medical attention for work-related injuries.…”

Section: Occupational Hazards In the Inner Citymentioning

confidence: 99%

Working with Waste: Hazards and Mitigation Strategies Used by Waste Pickers in the Inner City of Durban

Mlotshwa

Dayaram

Khanyile

et al. 2022

IJERPH

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Informal waste pickers in cities across the Global South divert significant amounts of tonnage from landfills. This diversion contributes towards a sustainable environment and better public health practices. Informal workers globally derive livelihoods from collecting, sorting, and selling recyclable waste. In South Africa, there is growing recognition of the valuable work that waste pickers carry out. Despite this, however, these informal workers remain largely unrecognised, are often stigmatised, and suffer from a lack of social protection linked to their work. This lack of recognition and protection creates specific occupational hazards for waste pickers. Using an ethnographic method, this study explores the physical and socio-psychological hazards that emerge from waste picking on the streets of the inner city of Durban, in South Africa. We found that the waste pickers, the majority of whom were women, developed mitigation strategies against these risks. A better understanding of how the occupational hazards of waste picking are shaped by the local context of working on the street enables the recognition of the knowledge waste pickers already hold regarding mitigation strategies. Insight into occupational hazards are important to consider if the municipal integration of waste pickers is to happen in a way that ensures access to social protections for these informal workers.

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Health care access of informal waste recyclers in Johannesburg, South Africa

Cited by 10 publications

References 14 publications

Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

HIV and TB Workplace Program for Street Vendors: A Situational Analysis

Working with Waste: Hazards and Mitigation Strategies Used by Waste Pickers in the Inner City of Durban

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