Access to health is also about people in it: the Health workforce

Access to health isn't simply about infrastructure, hospitals and medication, it is also about the nurses, doctors and other health practitioners that are a part of it. A key advice for the WHO Workforce 2030 and the actors working on it would be to move away from focusing on the instrumentalist, utilitarian role of the health workforce in economic growth and labour markets, and rather emphasise the intrinsic value of a competent workforce in improving health outcomes and reducing health inequalities.


The migration of health professionals is at the junction of the right to mobility, right to health and the right to decent work. It is about finding an acceptable compromise between the rights and obligations of migrant workers, employers and governments based on sound research findings

Illustration: Thailand
Thailand has four decades of experience with strategies for solving the inequitable distribution of human resources for health (HRH) between urban and rural areas. There are four key components in these strategies: (1) Development of rural health infrastructure. (2) Educational strategies including rural recruitment, training and hometown placement. (3) Professional-replacement strategies such as training in basic medical care capacities for rural health personnel. (4) Financial strategies such as a compulsory public service, incentives for working in rural services, payback for tuition fees by rural public work, reform of the health care financing system to Universal Coverage Health Scheme.

Quotes on access to health

Health protection is central to decent work and must be a reality for all.
Guy Ryder, Director-General, ILO

Universal health coverage is one of the most powerful social equalizers among all policy options.
Dr Margaret Chan, Director-General, World Health Organization

Where is the right to health enshrined?

Health is a fundamental human right that is indispensable for the exercise of other human rights. It is enshrined in several instruments, like the Universal Declaration of Human Rights of 1948 (Art.25) and in the International Covenant on Economic, Social and Cultural Rights of 1966.

For the World Health Organisation (WHO), the right to health contains both freedoms and rights: the right to control one’s own health and one’s own body (for example sexual and reproductive rights) and the right to physical integrity (for example the right not to be subject to torture and not to be subject to any medical experimentation without consent); the right to access a health protection system which guarantees equal possibilities to all to enjoy the best possible state of health.
The key to health is a functional health care system i.e. one that is available, accessible and acceptable to all without any form of discrimination and of high quality.

According to ILO Recommendation 202 on social protection floors, the minimum requirements in the area of social protection must include:
• basic income security (especially in cases of sickness, unemployment, maternity or disability).
• access to a nationally defined set of goods and services, constituting essential health care and including maternity care, that meets the following criteria:

• Availability: the facilities, goods, public health programmes and health care services are functional and in sufficient supply.
• Accessibility: the facilities, goods and health care services are accessible to all without any form of discrimination. Accessibility is made up of four interdependent dimensions: non-discrimination, physical accessibility, economic accessibility or being sufficiently affordable, accessibility of information.
• Acceptability: all facilities, goods and services in the domain of health care must respect medical and appropriate ethics from a cultural point of view, in other words, should respect the culture of individuals, minorities, people and communities, be receptive to the specific requirements linked to sex and stages of life and must be designed so as to respect confidentiality and improve people’s state of health.
• Quality: as well as having to be acceptable from a cultural point of view, installations, goods and services in the domain of health care must also be scientifically and medically appropriate and of a high quality.

W-Connect on Health: editorial

On the 12th of December, the International Day for Universal Health Coverage, the Asia Network on Right to Social Protection presents this thematic edition of W-Connect on Access to Health. A high quality health care system is one of the pillars of social protection and is a necessary condition for a global population with better health. This third 2016 W-Connect newsletter starts by detailing what access to health means and refers to some of the relevant legal international instruments. While many of the World Solidarity partners in Asia focus on labour rights, some work on the access to health, like the two in charge of the editorial oversight of this edition: Gonoshasthaya Kendra (GK) in Bangladesh and the Alliance of Health Workers (AHW) in the Philippines. Women and adolescents have their specific health needs, as demonstrated by the article from AREDS in India. The 1st of October is also the International Day for older people and 2016 is the year to take a Stand Against Ageism, so we look at what came out of the exchanges between GK in Bangladesh and OKRA in Belgium regarding elderly. In another article, Social Protection is also linked to disaster risk reduction and climate change. It is calculated that we could’ve built up health systems in West Africa at one third of the Ebola response cost.
Building on the dossier “Health, a commodity” from the Belgian campaign Social Protection for All, this edition also lists the areas in which demands are being formulated by the WSM supported Asia Network on the Right to Social Protection.

Bruno Deceukelier, WSM Asia Coordinator 

Dr Kadir, GK Bangladesh

Angela, AHW Philippines

Stop the Killings!

Pensioenen, veilige werkomgevingen, toegankelijke gezondheidszorg, moederschapsverlof, kortom: Sociale Bescherming. In vele landen in het Zuiden is dit geen vanzelfsprekendheid. Activisten en sociale organisaties die opkomen voor de uitbouw van een inclusief systeem van Sociale Bescherming zijn vaak het slachtoffer van repressie. Om hun strijd in de kijker te plaatsen, organiseert het campagneplatform Stop The Killings dit jaar samen met de campagne Sociale Bescherming een actiedag op 8 december in Brussel aan Brussel-Centraal!

Neem deel aan de actie & stuur een brief naar de betrokken ambassades hier!
Participez à l'action & envoyez une lettre aux ambassades concernées ici!

Les pensions, un environnement de travail sûr, des soins de santé accessibles, le congé de maternité, bref: la Protection Sociale. Dans de nombreux pays du Sud, elle est loin d'être une évidence. Les activistes et organisations sociales qui se battent pour mettre en place un système inclusif de Protection Sociale sont souvent victimes de répression.

Afin de mettre en lumière leur lutte, la plate-forme de campagne Stop The Killings organise cette année, en collaboration avec la campagne Protection Sociale, une journée d'action le 8 décembre.

WSM and partners lobby at the ILO Asia Pacific Regional meeting (ILO AP RM)

The 16th Asia and the Pacific Regional Meeting reviewed progress made towards building a future with Decent Work since the 15th Asia and the Pacific Regional Meeting (held in Japan in 2011). From 6 till 9th of December 2016, ILO brought together 351 delegates from Asia and Pacific governments, employers' and workers' groups. Delegates discuss the future of work and emerging challenges and consider policies that can strengthen sustainable development, job creation and social justice in their region.Out of 50 member states invited, 37 members and one Territory attended. A total of 351 participants attended, the highest level of the last four regional meetings. The meeting was composed of 72 government delegates, 34 Employers' advisers delegates and 34 Workers' Delegates. Women represent 28% of the total delegates.

This is an increase compared to the last ILO AP RM in 2011, when it was 20,4% but still below the benchmark set of 30% and beyond, for real gender parity, as called for by the Director-General. The meeting finished by adopting the Bali Declaration.

WSM and IYCW also attended and supported some participants and interventions, in line with the political agendas established by the Asia Network on the Right to Social Protection. The goal was that members of the Steering Committee understand the functioning of the ILO and its Asia Pacific Regional Meeting and lobbies successfully for the inclusion of certain issues in the final conclusions.

The Members of the Steering Committee attending were Father Chetan (India), Leizyl (YCW ASPAC), Sister Sulistri (Indonesia), Ath Thorn (Cambodia), Ganesh Niroula (Nepal) and Ramesh Badal (Nepal). Andy from the International YCW also attended. For WSM, Jeroen, Bart, Francina, Bruno and Bismo attended. In the following posts on this blog, we publish some of the interventions, as well as some interviews made to evaluate their participation.

Attending the ILO AP RM: Sullistri, KSBSI, Indonesia

In this meeting, I can bring forward certain positions and influence the policies on Asia and Pacific level. We promote also the women participation and attention to gender. We can also create links with the National Decent Work programmes in Indonesia.

In my intervention, I focused on the environment and the palm oil sector, which is a big issue in Indonesia. We need a just transition, so that workers do no suffer. Climate change is also mentioned in the SDG, and so we plead for involvement of social dialogue, and include indigenous people and environmental NGOs. The Free Trade Agreements are also part of my intervention, which should include social elements and workers’ rights.

Attending the ILO AP RM: Francina, WSM South Coordinator

I wanted to come to learn more about the trade union dynamics and the process of the ILO. As WSM closely works with labour standards, it is important for me to know what is being debated on regional and global level. In the context of WSM’s work on Social protection, our partners contribute to job creation by offering vocational skills to members.

During this ILO meeting, the aspect of skills was put in a larger context, linking it to multinationals, the importance of new technologies and young workers. Also the social dialogue was very relevant, because workers facing problems on the work floor have to first turn to the first step of social dialogue, the bipartite plant level, before the government is brought in. Also that many states have not yet ratified some of the core conventions was revealing, like India hasn’t ratified freedom of association (ILC87) or collective bargaining (ILC98).

Attending the ILO AP RM: Ganesh Niroula, NTUC, Nepal

Very interesting to witness the tripartite dialogue, hearing what is being raised by all three parties per country. We can learn from good practices and lapses, so situations can improve for workers and productivity as well. We also learn about the situation of decent work and issues in Asia and the Pacific.

Many issues are raised, like the strike in South Korea and the brutal repression by government, or the unfriendly trade union reforms in India or Indonesia and diluting union policies. Certain governments aren’t providing space to organize or to do collective bargaining. For instance, in Nepal, legal strikes aren’t banned, but the Industrial Act passed in this year, specifies certain sectors that prohibit strikes completely. This legislation is stricter, because it prohibits strikes in a larger way than the essential services act, which wasn’t applied too strictly. The Nepali trade unions have filed a case before ILO regarding this legislation.

Through the two interventions from the Nepali workers’ joint representative, Ramesh, which were agreed upon beforehand between trade unions in the JTUCC, we were able to share what is the situation in Nepal regarding labour migration and skills. The employment agenda is discussed here and linked to productivity. Nepal has high unemployment and low productivity. By discussing here with policy makers and employers and learning on these topics, we hope to improve these two aspects.

Attending the ILO AP RM: Leizyl, YCW ASPAC

The meeting was different from what I expected, like the original way to organize the participation, through the panel discussions, which bring together different views from various countries and is more dynamic. However, I feel it really lacks interventions from the grass-root level. For the YCW and myself, this helps to understand the issues that the ILO tackles, like Global Supply Chain, labour migration and decent work, from the perspective of young workers. Every year, we also attend the ILC in Geneva, so this is very relevant. For us, this is not only a moment to lobby for our demands, but also the networking aspect is important. For instance, during this meeting we met a representative from the Singapore trade union, and since we would like to also extend our work there, they offered their assistance to facilitate the start up. Labour migration is an issue that stood out, because after our YCW International council, the YCW provides specific input, but our analysis is still not very clear. In Europe, the focus is currently more on refugees, but here in Asia, the context is different and labour migration is more important for young workers.  The Global Supply Chain is in our opinion is part of the major causes of precarious work, like flexibility and outsourcing. The intervention from the government delegate from the Philippines indicated to me that they want to end contractualization, which is an important demand for us. If I could have made an intervention, it would have been on social protection for young and migrant workers, because this is a right that is currently not respected in most of the Asia Pacific countries.

Attending the ILO AP RM: Father Chetan, NDWF, India

For me, it was the first time to attend, so it was a learning process, which helps us understand the issues better. We also witness the continental dynamics and issues that are being debatted, like labour migration, where they go deeper into recruitment issues, social protection in hosting and sending countries etc. Even though no binding instrument comes out of it, I do feel some government delegates will take certain issues back to their national level and initiate some efforts. India in my perspective will not be among these, as their delegation seemed to simply pretend all is going well, the government is doing so much and there are no major problems. This is regrettable. I also appreciated better the importance of the issue of Freedom of Association, which I understand now is a vital prerequisite for social dialogue and collective bargaining.

Attending ILO AP RM: Ath Thorn, CLC - Cambodia

It is interesting for us to attend, to know more about the priorities of the Asia Pacific Labour movement. We learn about the situation of decent work in each country. We see how sometimes the employers’ or government group try to limit our efforts, even though we are supposed to all work together for decent work. Their delegates often pretend everything is fine, while there are many labour issues and violations. Only 14 states among 47 Asia Pacific have ratified the 8 ILO core conventions.

Can Cambodian partners file complaints at the ILO?

Life and work has been complicated in Cambodia in the past years, both for workers and for trade unions (see post here and here on Cambodia minimum wage struggle). ACV-CSC, ACV-CSC METEA and WSM have been supporting since many years the Cambodian Labour Federation (CLC) and the Coalition of Cambodian Apparel Workers Democratic Union (C.CAWDU), the largest independent federation in the textile sector in Cambodia affiliated to CLC. In the last years, CLC and C.CAWDU have demonstrated their strength and capacity to organise and mobilise workers, to negotiate agreements with individual companies and to launch (inter)national campaigns when needed. They are strongly valued by all key international stakeholders (ITUC, IndustriAll, UNI, CCC and several other labour rights organisations) for their independence.



However, many challenges remain for CLC-C.CAWDU. They requested from ACV-CSC and WSM to complement their (reactive) urgent appeal work with a more proactive strategy. Understanding the ILO’s work with regards to developing and supervising the effective implementation of international labour standards (ILS), is one of the key areas in which CLC-C.CAWDU wanted capacity strengthening.

Thirty five members of CLC, C.CAWDU and other affiliates delegated their leadership and the staff of the legal department took part in this training and looked at the ILO supervisory system, gathered data by interviews of garment workers and field visits and practiced by drafting complaints and campaigns for the Clean Clothes Campaign. It met with a 84% satisfaction rate and participants felt their expectations were largely met, promising to apply this knowledge and to share it with other members.

1 Million kilometers for Clean Sports Clothes, handed to Bioracer

© Mine Dalemans

A team of valiant KWB and World Solidarity cyclers hands over 1 million bike kilometers to Limburg cycling gear company Bioracer, together with a request to make Clean Cycling Clothes  a reality. ‘Clean’ stands for respect for the human and labor rights of the workers making cycling gear. The CEO of the company receives the activists and listens to their questions. Read the account below.