Addressing the health needs of economically disempowered people

In Bangladesh the majority of the population lives on less than $1 per day, with multiple health hazards affecting the quality of their lives. In order for them to live up to their full potential, it is very important to have access to basic health needs. At SNV, we support people to develop their own capabilities and to gain access to services and opportunities needed to live a healthy, productive and fulfilling life. In Bangladesh, we address Sexual Reproductive Health Rights (SRHR) at a large scale through our Working with Women project. We also work on occupational health and safety (OHS) as part of our Pro-poor market-based solutions for faecal sludge management (FSM) programme.

The Ready Made Garment (RMG) industry in Bangladesh, employs about 3.5 million female workers who often suffer from health issues such as malnutrition, communicable diseases and pregnancy complications. Incorrect use of family planning materials, reproductive infections and diseases do not only have dire consequences for women but also negatively impact the productivity of the RMG industry. These female garment workers suffer greatly due to the lack of available, affordable, and accessible products.

Samira Khatun, who works as a helper in Rizvi Fashions Ltd., says “After getting treatment from the Institute of Allergy and Clinical Immunology of Bangladesh (IACIB), my health has improved tremendously. I am performing better with regard to my regular work at the factory and I have not suffered from any major health difficulties since. I am also taking injections every three months, as a family planning method after getting advice from the counselor at the center.”

With support from the Dutch Embassy, SNV in Bangladesh is promoting SRHR through inclusive business (IB) practices within the RMG industry. One of the IB models, entitled GROW, works with Kumudini Hospital with a focus on strengthening facilities inside the factories, and providing SRHR services and products to the female factory workers. A gender sensitive SRHR corner has been established in the hospital to make female workers feel more comfortable. Kumudini has established networks with private manufacturers for procuring SRHR products at subsidized rates. A newly introduced dedicated ambulance service for the workers ensures easy access to referred services from the factory to the hospital.

The POWER model provides female garment workers of the factory Towel Tex Limited with SRHR services and support for victims of violence. The factory has established a referral linkage with the Apollo Clinic, to ensure better SRHR awareness, counselling and services. To ensure effective access to the services, management sensitization trainings are being conducted throughout the project period along with sensitizing the community on violence against women.

MANUSH is another inclusive business model where SRHR services and support to the mental health victims for Shomahar Sweaters Limited workers is ensured. This initiative has been taken exclusively for the female garment workers with a view to support the development of para-counsellors, for them to provide mental health counselling support. The curriculum integrates knowledge of the body, SRHR and gender, with psychological and social well-being for developing para-counsellors. The referral linkage of female workers for this model is also with Apollo Clinic. Orientation programmes for the factory workers on mental health and SRHR issues and services are an integral part of the model.

While SRHR of women working in factories is the prime focus of the Working with Women project, an important component of our FSM programme –funded by the Bill & Melinda Gates Foundation– is improving the health and safety and working conditions of septic tank emptiers in Bangladesh. Despite being aware to some extent of the dangers associated with their work, the majority of sludge emptiers in Bangladesh work without personal protective equipment such as gloves, masks or boots and do not take safety precautions while emptying tanks and pits. Most emptiers work at night to avoid objections from neighbors, while many also drink locally produced alcohol while working; both of which may further increase the chances of injury and accidents.

There is a clear legal and social obligation to create a favorable and healthy environment for workers engaged in FSM. OHS is also a key indicator in the maintenance of labor standards and the Bangladesh Labor Act 2006, specifically citing the responsibility of bodies including government departments and the private sector in ensuring OHS. However, the health and safety of workers involved in FSM remains broadly ignored, and water and sanitation campaigns have failed to sufficiently address - the rights of workers in the sanitation service chain.

Apart from supporting local governments in providing sustainable city-wide sanitation services, the FSM programme has directly taken part in developing OHS guidelines. We have provided training to sludge emptiers and supervisors/managers and other workers from sludge treatment plants in three southern cities. We have also ensured certification for emptiers, created pictorial manuals and compiled listings of all the emptiers in the three cities.

Results show that better health standards help achieve better productivity, and as such more income for employers, and the nation as a whole as well. According to a 2015 WHO report, though, 400 million people around the world still lack access to essential health services. As we pledge to celebrate World Health Day, let’s focus our efforts on those people who still have a long way to go in terms of access to basic health care and needs.