A day in the life of two GK paramedics caring for the elderly in Bangladesh

Follow a day in the lives of two paramedics from Gonoshasthaya Kendra (GK) in Bangladesh. 


From the early morning on the GK campus in Savar, their day starts with the community work done in the fields by all GK staff.  Then they get dressed for work and their visits, have breakfast and set out on their iconic bicycles, after receiving their assignments.
Most elderly people are not economically solvent and depend on their family or relatives. Many elderly also have various kind of illnesses and aches. GK provides primary care services for the elderly at their doorstep, services such as: checking blood pressure, personal hygiene, nail cutting, etc.  Those cases needing more attention are brought to the GK hospitals, for services like physiotherapy, or prescribing affordable medication if necessary.
All this is done for GK with a rights based approach, since elderly have equal right for health care services. 

UN High-Level Meeting on Universal Health Coverage

In exactly one week, leaders of the world’s nations will gather for the UN High-Level Meeting on Universal Health Coverage. After months of tough negotiations, they have reached consensus on a political declaration – which you can read here – that will be adopted on Monday, 23 September.  

The response, as expected, has been mixed. On one hand, the extensive document touches on many core messages and important issues, including mentions of migration and SRHR that were debated until the end. At the same time, weakened or murky language in places will make it easier to loosely interpret the fundamental principles of UHC: equity, social justice and the right of every single person to get the quality health services they need without financial hardship.

One thing is certain: whether you feel skeptical, optimistic or fired up, this is probably the largest global spotlight on universal health coverage to date, and another unanimous pledge that leaders will be on the hook for. We cannot afford not to speak up for what we believe and demand the urgent actions we need to see.

That’s why UHC Coalition, UHC2030 and the Civil Society Engagement Mechanism are teaming up for a 7-day Twitter Storm running from tomorrow, 17 September until the High-Level Meeting, with one focus theme per day:

·       Tuesday, 17 Sept: Leave No One Behind

·       Wednesday, 18 Sept: Commit to Gender Equality & Women’s Rights, including SRHR

·       Thursday, 19 Sept: Invest More, Invest Better

·       Friday, 20 Sept: Uphold Quality of Care

·       Saturday, 21 Sept: Regulate & Legislate

·       Sunday, 22 Sept: Move Together

·       Monday, 23 Sept: Ensure Political Leadership Beyond Health

More resources to join the Twitter storm can be found in today’s edition of UHC2030’s newsletter. As always, UHC Coalition will be tweeting from @UHC_Day, along with @UHC2030 and @CSOs4UHC, and you can join and follow the conversation with #HealthForAll, #HLMUHC and #Asks4UHC.

                                                                                                                     

UN meetings and resolutions are always only as transformative as we make them. It’s up to us to hold leaders accountable in our countries and communities once they have signed on the dotted line.

India passes two of the four proposed and controversial labour codes, with dire consequences for workers, especially informal

From the Working Peoples Charter:
On July 4, the Economic Survey argued that a higher national minimum wage is central to addressing inequality and widespread poverty in the country. A couple of weeks later, the government of India trashed its own analysis by proposing a “starvation wage” of Rs. 178 a day. The Central government hit the nadir with a minimum wage hike of Rs. 2! Experts allege that it is a precursor of what is in store for millions of workers as the cabinet passed two of the four proposed labour codes – Code on Wages as well as the Code on Occupational Safety, Health and Working Conditions.

 Working people are a national asset - undermining their well-being is the biggest anti-national act. Need based Minimum Wage should be guided by Supreme Court jurisprudence laid down in Raptacos case, which is based on principles and test laid down by judiciary, and if any committee, any advisory board decided below this, has to give reason and recommendation.

The two codes were tabled for discussion yesterday by Sri. Santosh Gangwar, Minister of Labour and Employment. With this the Parliament has struck the proverbial hammer on the fate of millions of workers, robbing them of the possibility of decent work and wages, omitting the principles of determining minimum wages, an equal workplace and avenues for access to justice. Primarily driven by the interests of the industry, this predatory piece of legislation is all set to alter the labour protection landscape in India beyond repair and reclaim. It clearly shows that there is a clear drive to `informalise the formal` or `levelling down` which has been central to the overall architecture of the emerging labour regime.

This predatory piece of legislation is all set to alter the labour protection landscape in India beyond repair and reclaim.  With this the Parliament strikes the proverbial hammer on the fate of millions of workers, robbing them of the possibility of decent work and wages, an equal workplace and all avenues for access to justice.

Putting an end to contractualization in Philippines

Contractualization, while in most cases illegal, is a commonly used practice in Philippino companies to give workers temporary employment for just less than 6 months preventing them to be regularized. Short-term contract workers do not have the same benefits as regularized workers, such as social security, health insurance (Philhealth), unpaid leaves, a 13th month bonus. Moreover, contractual workers will be less eager to become a union member as they risk not having their contract renewed. While the Philippino president had vowed to phase out contractualization and has signed an executive order to that end, in reality the practices of labour-only contracting and job contracting are still omnipresent in Philippino companies. 

KMU decided to focus their campaign against contractualization on mass filings for regularization, which appeared to be much more effective than individual legal aid to the workers. Contractual workers would file a document to the Department of Labour and Employment that they want their company to be investigated on compliance with the regulations on contractual work and security of tenure and that they want to be regularized as permanent workers. The lists that were filed contained some 2.900 to 3.000 companies with 300.000 workers which could be up for regularization. In some cases (Coca Cola, Magnolia), several hundreds of workers managed to become permanent workers, while others were not granted such status.

Due to the attention that was given to the campaign against contractualization, the All Workers’ Unity (an alliance of labour centers advocating for a national minimum wage and for an end to contractualization), could not make substantial progress on the demand for higher minimum wages. 

Act against the privatization of public hospitals in the Philippines

Political, economic and social context

In 2018, the political situation in the Philippines still deteriorated in comparison to the previous year, as the Philippino government, under the guise of an all-out war against drug lords and terrorists, continued its crackdown on civil society organisations, human and labour rights activists and indigenous people. The martial law which was imposed in Mindanao in 2017 was extended to the whole region of Visayas and to Bicol (as the so-called ‘State of Lawlessness’), raising concerns that soon it will cover the whole of the Philippino territory. Heavy military operations have also been expanding, while military officials have been placed in key government positions. 

Social activism, mobilization and organising of workers becomes increasingly difficult and dangerous, due to a climate of indiscriminate violence and extrajudicial killings. The administration passed the Tax Reform for Acceleration and Inclusion Act (TRAIN), which sparked a lot of protest from progressive labour and pro-poor organisations, as the excise tax on oil products contributed to the rise of inflation in 2018 (up to 6,7% in October 2018). The tax reform and subsequent sharp rise in the price of basic commodities affected mostly poor workers who have to get by on a daily minimum wage (in Manila) of 512 pesos (±8,2 euro).

Medical staff in Manila hospital

"My name is Rose Ann. I have been employed as a laboratory technician grade 1 for four years now but by training am a medical technologist. While I was applying for a better suited and paid position of medical technologist 2, I was charged with a case to pay 35.000PHP (600€) for some spilled reagent. The Alliance of Health Workers’ union in our hospital met with the head of the laboratory and found out that the chief of the department wanted to give the position I was applying for to his niece, who was still had to pass her final exams. It seems he didn’t want to give me, the current laboratory technician, the position but he wanted to wait for his niece to pass the board exam and give it to her.AHW filed a complaint and notified the director of this potential abuse, and four of us health workers got promoted to medical technologist grade 2. The hospital also acquitted me of the 35.000PHP, determining the real cause was a malfunctioning of the machine indicator, while I had correctly followed the Standard Operating Procedure."

Act against the privatization of public hospitals, health facilities and health services

In three hospitals, AHW could negotiate an ‘end-of-the-year-incentive’ of 25.000 pesos (±430 euro). In two other hospitals, 475 health workers – nurses as well as administrative staff – could be regularized.

Health workers and their organizations, among which the Alliance of Health Workers, obtained a (small) success in the House of Representatives with the passing of the ‘Act prohibiting the privatization and corporatization of public hospitals, public health facilities and public health services’ which states that “the State has to ensure the protection and promotion of the right to health of the people and to make essential goods, health and other services available to all people at affordable cost”. No public hospital, health facility or health service shall be privatized and 90% of total bed capacity in public hospitals has to be allocated to indigent/poor patients. However, the law can only be enacted when a similar bill is being introduced and passed in the Senate.

Nepal to start guaranteeing employment

Over 100,000 unemployed people are set to get paid work as part of the Prime Minister Employment Programme (PMEP), the new Nepal wage-employment scheme launched in February 2019 that aims to provide minimum days of work for unemployed citizens. While starting up in 2019, the programme has calculated that a minimum 30 days of work can be ensured to a total of 106,872 people this fiscal year. However, the goal is to provide minimum 100 days of work for unemployed citizens of the working age (18 to 59 years). The government plans to provide citizens with guaranteed sustenance equal to half of the agreed upon wage for 100 days, should it fail to provide employment. “They can repair playground or schools, do plantation, work for dam and canal building,” said Prakash Dahal, the programme chief and joint secretary at the Ministry of Labour, Employment and Social Security. Most jobs available seem to be in the construction sector.

The government plans to collect information on the unemployed through the newly set-up Employment Service Centres, which have been created in all 753 local units of the country. The centres are supposed to have information, through an online database, on locally available jobs, and can match registered job seekers to suitable employment.


Coordination among the three levels of government is crucial for an effective implementation of the scheme to provide jobs for the poor and unemployed sections of the society. A minimum amount of R300,000 to maximum Rs10 million has been sent to all the local units for implementation of the scheme. The amount for each local unit has been distributed after calculating three factors—number of households with poverty, the total population of the local unit, and its remoteness. Local, provincial and federal governments have started signing tripartite agreements for the implementation of the Prime Minister Employment Programme. This is linked to an ambitious plan to create 500,000 jobs in the next fiscal year.

Every year nearly 500,000 workers enter the job market and end up jobless in the country, and more than 4,3 million Nepali have chosen to migrate abroad. Youth unemployment rate is estimated at 35.8 percent.

Internationalising elderly: exchanges in Bangladesh and Belgium lead to elderly clubs set up by GK

GK has also been exchanging since 2016 with OKRA, a Belgian member organisation of WSM for, by and with elderly, regarding the ageing population and the implications this has for social protection.

Dr Kadir: “This reflection and activities have made many changes inside GK. While we already treated many elderly through our health outreach, we are now switching this to a movement for and by the elderly, which is a major difference. The exchanges and joint statements from GK and OKRA for instance on the International Day for Elderly prompted us to think globally but act locally. GK has initiated ten elderly clubs that gather at least monthly and offer a space for elderly to get health advice, but more importantly to interact and feel less alone.  They can talk about the current political situation, meet with authorities and demand the pensions elderly should be entitled to, and also do sport activities at their level of comfort. The clubs also annually organize elderly festivals, which are important to have the rest of the village think about how elderly are treated and to ensure they are respected. Besides loneliness however, the main fear of these elderly is that they feel they are a burden for the rest of the family. Many Bangladeshi move from the rural areas to the city or even abroad, so the traditional care system for elderly is collapsing. Hence, we are also looking into possibilities of income generating activities these elderly clubs can set up."

Philippines in numbers in 2018: Main results

Labour standards:
Health workers: In 2018 the AHW reached out to some 110.920 health workers and Philippino patients (of which 54 % women and 51% young people). Through social media and campaign materials some 100.000 health workers  were informed about the issues of public sector health workers, such as contractualization and privatization of hospitals. In four hospitals, a new collective negotiations agreement has been ratified with another hospital, negotiations are ongoing, potentially creating better union rights for 5.127 health workers. Bill n°7437 prohibiting the privatization of public hospitals and public health services was passed in the House of Representatives.
Young workers: In 5 locations (Manila, Negros, Ilo-ilo, Cebu, Camarines Norte) 1.488 young people (young workers, students, of which 39 % women) were organized and trained by the YCW on basic labour rights, contractualization, the TRAIN – law, social and economic problems of youth and how to overcome them.
National minimum wage and social protection for workers in the private sector: Trade union confederation KMU raised the awareness of 44.298 Philippino workers (of which 49% women and 49% young people) on the need for a national minimum wage and the end to contractualization. 1.062 workers, some of them working in expert-processing zones or multinational companies,  participated in different activities: basic training, mobilizations, legal assistance.
Joint advocacy: The three WSM partner organisations are key partners in the All Workers’ Unity, an alliance of different labour centers who are advocating for a national minimum wage of 16.000PHP/month in the public sector, 750PHP/day in the private sector and against contractualization. In 2018, the campaign of the alliance reached some 40.000 workers (of which 25% women and 30% young workers).

Partner organizations in the Philippines: AHW (Alliance of Health Workers’ unions), KMU (trade union confederation), YCW Philippines (young workers’ organisation), Philippines Synergy network (core organisations of the AWU – All Workers’ Unity)
Budget 2018: 75.627,76 euro
Donor: DGD, LBC-NVK
Program: 2017-2021

Indonesia in numbers in 2018: Main results of the programme

Minimum wage and wage scale structure:
- 1.163.435 staff and members of KSBSI (of which 41 % women and 50% young people) were involved in awareness raising activities, trainings and advocacy actions to inform the workers  and to give advocacy on the system to set the annual minimum wage, the level of the minimum wage and the implementation of the new wage scale structure.
- Garment workers: In 2018 GARTEKS, the garment federation of KSBSI, has organized and raised the capacity on labour rights and the Freedom of Association Protocol in the garment sector for 2.631 garment workers (of which 55% women and 63% young people). This included legal assistance and grievance handling. In the process GARTEKS could affiliate 1.750 new members.
- Migrant workers: SBMI reached out to 2.963 people (of which 66% women and 62% young people) by raising the capacity of SBMI trainers to assist the migrant workers and by handling migrant workers’ grievance cases in 10 provinces over Indonesia.
- Social security:70.651 staff and members of KSBSI (of which 35% women and 63% young people) were given  training on the Indonesian health insurance system, the social security for workers (working accident scheme, death insurance, pension) and the state of affairs with regards to the concrete implementation of these different schemes by  the companies and by the Indonesian government.
- Advocacy in synergy: Through training and advocacy actions KSBSI and SBMI involved 10.850 migrant workers and politicians (of which 12% women and 8% young people) in their efforts to explain the Indonesian Migrant Workers’ Act (Law 2017/n°18) and to negotiate the implementation of local regulations for migrant workers. Village- or district-level regulations were adopted in two provinces (Lampung and West-Kalimantan).

Partner organizations in Indonesia: K-SBSI (trade union confederation), GARTEKS (garment union federation), SBMI (migrant workers’ union), Indonesia Synergy network
Budget 2018 : 125.000 euro
Donors: DGD, ACV-CSC BIE, LBC-NVK
Programme: 2017-2021

Improvements in 2018 for the new Indonesian Social Security

2018 saw the further implementation of the reformed National Social Security System and the expansion of the social security coverage, including the health insurance. At multiple moments KSBSI invited officials from the Health Insurance Body and the Social Security Body to discuss the various difficulties with the implementation of the different schemes, such as the contributions to be paid by employers and by workers. Nevertheless there were some breakthroughs:

• hospitals are now obliged to accept any patient and to ask for reimbursement for the expenses from the Health Insurance Body rather than from the patients themselves. 
• The policy on ‘Coordination of Benefits’ between the public social security and private company schemes has been clarified now.

Indonesian migrant workers get access to the regular social security schemes
The new Indonesian Migrant Workers’ Law for which the partner organisations advocated came into effect in November 2018. This law gives more and better protection to Indonesian migrant workers going abroad to work, mainly by making placement, recruitment and protection of migrant workers a responsibility of the state. A new regulation stipulates that migrant workers can have access now to the regular work accident scheme, the death insurance and to old age insurance (a kind of retirement savings). The actions of KSBSI and SBMI in 2018 focused on the dissemination of the new law to the migrant workers and on the negotiation of and advocacy for village level and district level regulations,  needed to execute the law.

Negotiating wages in Indonesia

South Sumatra is one of the regions where the development of KSBSI is quite strong, with 5 federations who have a total of 15.210 members. The monthly provincial minimum wage in South Sumatra in 2018 was 2.600.000 Rupiah (± 165 euro) and increased to 2.800.000 Rupiah ((± 176 euro)  in January 2019. In Indonesia, the majority of workers receive wages that are composed of the provincial minimum wage and a fixed allowance. This means that there is no difference in wages between workers who have a work experience of less than one year and wages of workers who have a tenure of more than one year. To increase the income of workers in South Sumatra, KSBSI is very serious in advocating for increases in provincial minimum wages. With the existence of a wage scale structure, it is expected that there will be an increase in wages and there will be rewards for workers who work more than one year. This year there are 12 companies that have handed over the structure of the wage scale to the South Sumatra labour agency.

Mr. Ali Hanafiah was born in Palembang, on 8 July 1969. He graduated from STIH Sumpah Pemuda University in 2010. He is the regional coordinator of KSBSI in South Sumatra. Before he was the chairperson of KSBSI at plant level for 2 years and chairperson of the branch board of NIKEUBA (KSBSI’s service sector federation) for 12 years.  Currently he is a member of the provincial wage council and vice chairperson of the tripartite social dialogue at province level as a representative for the workers.

Political, economic and social context
In 2018 Indonesia’s economic growth tended to be stable at about 5%. Increasing religious sentiment, abused by Islamic fundamentalists, stirred up fears that conservative parties would claim victory in the regional elections, thus also influencing the national elections in April 2019. Identity and religious politics risk to divert attention from the agenda of economic development, prosperity and social welfare that is being promoted by the current Indonesian administration under President Joko Widodo. On 28 September an earthquake and tsunami hit Palu and Donggala in Central Sulawesi, killing 2.113 and injuring 4.612 people. Both KSBSI and SBMI provided immediate assistance to their members in the area and the families who became victim of the tsunami.

Minimum wages, wage scale structure and social security
Since presidential regulation 2015/n°78 was adopted, yearly minimum wages in Indonesia (set at provincial or district level) can only be increased by inflation and growth of gross domestic product. Based on those two criteria the growth of the provincial minimum wage for 2019 was fixed at 8,03%. While KSBSI is not in favour of Regulation 2015/78, as it prevents the trade unions from fully freely negotiating minimum wages such as foreseen by the ILO Minimum Wage Convention, it does not believe that in the current political constellation the regulation can be overturned in the short term. Currently KSBSI focuses in its training for local union leaders, activists and members on the implementation of the wage scale structure, as October 2017 was the deadline for companies to register their wage structure at the Labour Department. However, most Indonesian employers are still not aware about their obligation to determine a structure and scale of wages in the company taking into account the class, position, period of employment, education level and competence of the employees. Seen the limitations that have been imposed to the regular minimum wage negotiations, the trade unions see the wage scale structure regulation as a way to differentiate wages at company level, so that at least at plant level it will be possible to still negotiate higher wages. The workers should be informed of the wage scale structure in their company.

India in numbers in 2018: over 730.000 Indians were reached through...

For labour standards:

• Over 450.000 people (53% women and 33% youth) are better aware of their labour rights through campaigns and outreach.
• Trade unions organized over 80.000 workers (70% women and 38% youth).
• Over 12.000 people, 90% women and 50% youth, received basic training in labour standards, social security and health. 
• Over 11.000 Indians, 85% women and 40% young workers, received advanced training (of leaders or of Trainers).
• 655 workers, almost all women and 60% young workers, benefited from legal assistance .
• Advocacy: Over 135.000 people (55% women and 32% young workers) were mobilized at grassroots level (ex. demonstrations, petitions…)

India Partners: CWM-I, AREDS, NDWM, NDWF, CFTUI Budget 2018: 260.843euro
Donor: DGD, Brussels Region, Province of West Flanders
Programme: 2017-2021

Mumbai construction workers share their challenges

During a meeting with 15 male construction workers in Mumbai, they shared some of their challenges.

With only one of them born in Mumbai, all the others had moved from the country side looking for work and half goes back home for over three months a year. This is very typical for workers in the informal sector, with people working half the year on fields and half in construction, mostly getting paid per day in both sectors. One said: “I started working in 1994 and have never had a longer term contract, so I don’t get any pension now that I am too old. My daughters support me, working as domestic workers, though one of them is handicapped.” Nine of the 15 started working before they were 18 years old, several before they were 14 as helpers and one even started when he was eight years. Though the legal minimum wage for them is fixed at 25.000INR or 320EUR, nine of them make less. Only one is not a day worker: “I used to work in a garment factory, where I made 18.000INR or 230EUR monthly, but after the union demanded an increase of pay, the management closed the factory and relocated it to another state.” Daily wages are low and women make at least 20% less. “In part, it is also because there are still many cases of bonded labour, people who are in debt and so agree to work for less, which drives down the wages.” All of them were in debt, not to banks but to small private moneylenders who often charge exorbitant interest rates. “We have no access to social welfare schemes, because you have to be a registered worker for at least 90 days at the same company, and so day workers like ourselves are effectively excluded.” 

These stories illustrate why the five WSM India partners focus on a decent living income for the informal sector, especially for three sectors: the domestic, agriculture and construction workers.

Prevention is better than the cure (AREDS)

I have been working as a health worker with AREDS for the past 18 years. I have two daughters and my husband works in a trade union sector with AREDS for unorganized workers. I started the work because of the support from my husband. My husband believes that, if you approach things with a positive state of mind, we can change things, we can do great things. That positive energy pushed me to go work in the same field. Now, I work with pregnant women. I try to ensure continuous follow up and a trust relationship with each family. We’re not there just for one or two months, we follow the same family for over five years. It means we sort of become members of that family. I provide classes to the adolescent girls, where we talk about diseases and hygiene and sexual and reproductive health. Here, there is still a tradition that says that women can’t go outside if they are menstruating or be in a group. So there are still many misconceptions to educate people about. – Dhanalakshmi, AREDS

Access to health is one of the two priority areas for AREDS in the south of India and it believes prevention is very important. Almost 3.800 people (78% women and 80% adolescents) attended sessions on basic health, hygiene and reproductive health issues. While developing alternatives on a local level, AREDS increased awareness in 2018 of over 8.000 members on preventive health practices, water and environment sanitation, breast feeding, organic food growing and consumption, and on the uses of native medicines.