Setting up an Occupational Health Service for the Informal Sector in South Africa

Introduction
The Informal sector accounts for 50% of the workforce in South Africa while the rest of Sub-Saharan Africa may have as many as 90% of its workers in the informal sector. The workers in the informal sector have little visibility, are not covered by occupational health or labour legislation and have no social protection or access to occupational health services. Occupational health professionals have no exposure to the informal sector and have minimal knowledge and experience of the occupational health interventions including the financing and sustainability of occupational health services for such workers.

Methods
A multisdisciplinary team from the NIOH has begun the initial assessment of the informal economy including its size, shape, scope and distribution of workers in a South African metropolitan authority working in partnership with a non-governmental organisation, local universities and associations of the informal workers. The assessment entails a review of the policy and legislative framework, the occupational hazards, the nature and types of occupational health interventions needed and the financing model for such interventions.

Results
Changes are needed to the policy and legislative framework to cover workers in the informal sector. The education and training of occupational health professionals is deficient with respect to their knowledge of the hazards faced by workers in the informal sector as well as the occupational health interventions that can create and sustain a safe and healthy 'workplace'.

Discussion
A crtical success factor is the need to build trust amongst the partners and the workers; develop innovative ways to deliver occupational health interventions and ensure the sustainability of interventions through policy and legislative reforms at national and local government levels. Experiential learning models will enhance the knowledge of workers and occupational health professionals in the assessment and mitigation of hazards, provision of surveillance and medical services for workers in the informal sector.