As the world’s population increases, it is now more imperative than ever that people have access to quality healthcare services. Health insurance is a critical component of a stable and secure healthcare system, offering protection against the cost of medical treatment. Today, nearly 19-24 million people worldwide earn their livelihoods through collecting and recycling waste and 80% of waste pickers operate within the informal economy. However, for many informal workers, including waste pickers, accessing such health insurance coverage remains a significant hurdle. Waste pickers, who play a decisive role in managing waste and recycling in our communities, often face grating working conditions and limited resources, which heightens their struggle to secure adequate health coverage.
The daily work done by waste pickers exposes them to several health risks, such as musculoskeletal disorders arising from the heavy waste luggage they carry and the long distances they have to walk in search of recyclables, respiratory associated health problems as a result of being exposed to dirty air from landfills, cuts and injuries from the recyclables they have collected and the list goes on and on. Despite the immense contribution, they continue to contribute in curbing the escalating waste challenge, this group remains neglected when it comes to accessing quality health services, further putting their life and safety at risk.
The severity of the problem in accessing health insurance among waste pickers varies from place to place, but the underlying truth remains that waste pickers have limited access to it. To understand the magnanimity of the problem, TakaNiAjira Foundation undertook a comprehensive survey among waste pickers in 8 regions in Tanzania mainland and Zanzibar Island, the survey catered to gain insights on several issues relating to waste pickers, one being health insurance coverage.
Overview of Waste Pickers’ Health Financing
Waste pickers’ health financing refers to the mechanisms used to ensure waste pickers, who are informal workers with limited access to healthcare, can afford and receive health services. Since the nature of the work they perform exposes them to various health risks, including injuries, infections, and respiratory issues, these individuals must have health insurance coverage.
This survey involved 269 waste pickers from across various backgrounds in Tanzania mainland and Zanzibar. In Tanzania mainland the regions that were covered are Dar es Salaam, Dodoma, Tanga, Mwanza, Iringa, Mbeya, Arusha and Kilimanjaro.
Concerning health financing, the survey focused on understanding the financier of waste pickers when they needed health services. The results indicated that 238 waste pickers (88%) financed themselves, 23 waste pickers (8.5%) depended on relatives, 3 waste pickers (1.1%) relied on friends and 5 waste pickers (1.8%) had health insurance. Most waste pickers who finance themselves (88%) noted that they often must cover health costs out-of-pocket, which is a substantial burden given their typically low and unstable incomes. Additionally, data on waste pickers who depend on relatives and friends, suggest that waste pickers usually turn for financial help when health issues arise but this support is not widespread.
The low percentage of waste pickers covered by health insurance (1.8%) indicates a significant gap in access to health protection leaving the vast majority without a safety net. The lack of insurance coverage contributes to the financial vulnerability of waste pickers, as they are often unable to afford the necessary medical care or preventive services.
While waste pickers in Tanzania face significant challenges in accessing health insurance as depicted by the findings of this survey, these issues are not unique to the region. Across the globe, informal workers, whether in Latin America, Asia, or Africa, encounter similar barriers. For instance, a study done on Safai Sathis (waste pickers) in India, indicated health insurance coverage was below 5%, with high cost of insurance premiums, lack of awareness and bureaucratic hurdles being some of the underlying reasons accounting for the small insurance coverage.
Comparative Analysis: Lessons from Other Countries
Can technology be leveraged to extend health insurance to marginalized groups such as waste pickers and improve their livelihoods? SOSO Care in Nigeria is showing us yes it can. SOSO Care which is a health fintech is enabling waste pickers to access micro health insurance and gain points on food stamps in exchange for recyclable waste as health premiums. Such an initiative is touching the lives of numerous waste pickers in Nigeria ensuring that their efforts towards environmental sustainability do not go in vain.
Challenges in Accessing Health Insurance
Waste pickers, who are central to managing waste in many communities, confront significant challenges when trying to access health insurance. These difficulties are a result of larger systemic issues that prevent them from obtaining the necessary healthcare coverage. The barriers they face stem from economic constraints, a lack of information, and bureaucratic hurdles.
Lack of Awareness: One of the significant obstacles that waste pickers face is their limited awareness of health insurance options. Many in this profession are not well-informed about the advantages of health insurance or the various programs available to them. This lack of knowledge hinders them from actively seeking and enrolling in insurance plans that could offer crucial health security. Without access to accurate information and guidance, waste pickers are unable to comprehend the complexities of health insurance and the potentially life-changing benefits it could provide.
Financial Constraints: Financial obstacles play a critical role in the struggles that waste pickers face when trying to secure health insurance. These individuals, who already contend with low and inconsistent incomes, often find the costs of insurance premiums, deductibles, and co-payments to be unmanageable. Even when reasonably priced insurance options are accessible, the immediate financial strain of paying premiums may outweigh the perceived long-term benefits, prompting many to opt out of coverage altogether. This financial burden further increases their susceptibility to health issues and medical expenses.
Inadequate Coverage: The current health insurance options often do not adequately address the specific needs of waste pickers. As a result, the available coverage plans may not be designed to accommodate the particular challenges they face in their work or the health risks they encounter. This leads to gaps in the services covered or results in high out-of-pocket costs for essential treatments. Additionally, the complexity of insurance policies and the absence of tailored options for informal workers contribute to their reluctance or inability to obtain the coverage they need.
Administrative Hurdles: When waste pickers seek to obtain health insurance, they often encounter complex bureaucratic hurdles, such as intricate application processes and eligibility criteria that are hard to comprehend without assistance. These challenges may dissuade individuals from pursuing insurance, particularly when they lack the necessary support or resources to navigate the system effectively.
Recommendations for Improvement
Taking into consideration the significant contribution that waste pickers have in the waste management ecosystem, interventions must be taken to address the issue of lack of health insurance coverage among them. To address the significant challenges faced by waste pickers in accessing health insurance, a range of targeted recommendations can be implemented. These recommendations are but not limited to;
Policy Changes and Subsidies: Governments and policymakers should consider implementing policies that provide financial subsidies or incentives for health insurance specifically for informal workers like waste pickers. Subsidies could reduce the cost of premiums and make insurance more affordable. Additionally, creating policies that mandate insurance coverage for all workers, including those in informal sectors, could ensure broader and more inclusive health protection.
Tailored Insurance Products: Insurance providers should develop health insurance plans that are specifically tailored to the needs of waste pickers and other informal workers. These plans should account for the unique risks and health conditions associated with waste picking, offering comprehensive coverage at affordable rates. Simplified insurance products with fewer exclusions and lower premiums could make it easier for waste pickers to obtain and maintain coverage.
Streamlined Application Processes: Simplifying the application and enrollment processes for health insurance can help overcome administrative barriers. Insurance providers and government agencies should work together to create user-friendly application procedures, minimize bureaucratic red tape, and provide assistance to individuals who need help navigating the system. Mobile applications and online platforms could also be utilized to facilitate easier access and management of insurance coverage.
Community-Based Support Systems: Strengthening community-based support systems can help waste pickers access health insurance and healthcare services. Establishing partnerships between local organizations, NGOs, and insurance providers can facilitate the creation of community health funds or cooperative insurance schemes that pool resources and offer coverage at reduced rates. These support systems can provide a safety net and financial assistance to waste pickers, helping them manage health costs more effectively.
TakaNiAjira Foundation firmly believes that the global efforts to address the growing waste challenge must not overlook the vital role played by waste pickers. This essential group is central to the solution, and as such, targeted interventions must be made to ensure they have access to health insurance services. By prioritizing their well-being, we can create a more equitable and effective approach to waste management, ultimately benefiting both the environment and society as a whole.
