Summary of a Roundtable Discussion on HIV/AIDS and Social Responsibility.
The third GSO roundtable on “HIV/AIDS and Social Responsibility” was convened at the ILO on 31 May and addressed the theme of “connecting with SMEs and the informal economy”. Participants from international organizations, governments, NGOs, trade associations, and individual companies shared their views and experiences and agreed to develop an action plan for outreach to people working in SMEs and the informal economy. This event benefited from the experiences of representatives from the employers’ associations of Lesotho, Namibia and Uganda. Various field studies and surveys were also brought into the discussion, along with information about recent initiatives organized or funded by the ILO, World Bank, UNDP, the Global Fund, bilateral donors and private donors.
In the countries that are suffering the most from the HIV/AIDS pandemic, the overwhelming majority of people afflicted with and most vulnerable to the disease are in the informal economy. At this roundtable, the focus was on SMEs and the informal economy in sub-Saharan Africa. The discussion covered the way that the outreach needs to be targeted to these groups, the challenges that are particularly applicable, approaches to capacity building, the role of multinational enterprises, and the issues of health insurance and legal reform.
Key findings show that there is a need to establish policies that are targeted to the circumstances of SMEs and the informal economy but that the policies also need to cover the full range of needs, including useful education and prevention strategies, practical and relevant non-discrimination strategies, information on how to access voluntary counseling and testing, realistic access to reliable and confidential treatment programmes, and viable options for care and support. All participants also emphasized the disproportionate presence of women working in SMEs and the informal economy and the urgency of developing strategies for women and their particular needs, especially for prevention and control of their own lives.
One major obstacle to reaching out to the SMEs and informal economy is the state of denial about the pandemic. The perception among the SMEs is that AIDS is a society problem, not a business problem. Even though these employers are experiencing high turnover, they do not incur a high cost in hiring new workers to replace the ones they lose. Also, the stigma of publicly acknowledging HIV/AIDS is severe, and there is even reluctance among some SMEs to promote condom use. Even where there is recognition that the losses do affect the business, the apparent costs of treatment and the difficulty of ensuring confidentiality are additional obstacles to action.
In spite of these obstacles, the urgency of promoting prevention strategies and encouraging people to seek testing and treatment calls for making the effort. The first challenge is to convince them to create the time to listen. One way of reaching the SMES is through integrating an HIV/AIDS component into other developmental tools, such as the “Improve Your Business” model or other general training programmes. Also, NGOs can play an important role in reaching the informal sector. Groups like the YWCA are especially well situated to use their existing programmes of education and empowerment to mobilize women, who are not likely to take time away from their stalls or other places of work, just to discuss HIV/AIDS.
In addition to information on prevention, voluntary counseling and testing is being promoted in many countries. Participants reported that there is a general willingness to test, but the question is asked what next? Drugs can’t be accessed so why test? Even if there is an external donor who is willing to fund the effort, whether this is a public or private donor, there is the concern about sustainability once that external funding comes to an end.
The message needs to include the certainty of treatment. One helpful development for effective outreach, therefore, has been bringing the prices of drugs lower. Some lower-priced drugs are being channeled through governments, while others are being made available through faith-based organizations – it doesn’t matter which vehicle is used. The question is how to include SMEs and informal sector organizations, as well as employer associations in these projects.
The participants noted that considerable resources have been mobilized through the Global Fund, the World Bank and bilateral donors to help cover the costs of treatment, but they agreed that it has been especially difficult to direct those resources to SMEs and the informal economy. For one thing, the private sector, no matter the size of the enterprise, is expected to be providing resources for the effort, not receiving them. Revised policies for co-investment and other participatory frameworks need to accommodate the limited resources of SMEs and the informal economy. For another, participants noted that both the labour and employer representatives and other workplace-oriented organizations have often been marginalized by the Country Coordinating Mechanisms (CCMs) because of their location and domination by Ministries of Health. The group noted that one could help SMEs and informal sector operators to organize themselves as NGOs in order to participate in the CCM process.
Delivering skills training for preparing credible project proposals is another important priority. Capacity building is in fact being done through programmes assisted by the ILO, the World Bank and UNAIDS. The MAP programme, for example, is working with groups on how to mobilize the private sector through national business coalitions. Private sector initiatives are receiving assistance in 17 Anglophone and 8 Francophone countries. There is an increased focus on involving SMEs and the informal sector.
The Role of MNEs
The group noted that most of the private sector programmes to fight HIV/AIDS in the workplace are in the big multinational companies, whose programmes tend to be company-specific. One approach for reaching smaller enterprises has been to promote MNE collaboration with SMEs. Companies like Coca Cola, Nestlé and Ford were among those mentioned by the group. The lesson they have learned is that the big companies have the expertise and the capacity to help others, but they can’t take the message to the SMEs or the communities at large on their own. In many instances, this is done through SME and informal sector organizations, often sector-specific such as truckdrivers or contractors or small retail shopowners. Some companies are also working with NGOs like the Red Cross or the YWCA to be effective.
Actual delivery of treatment for HIV/AIDS continues to be a problem in Africa because there is no good health structure. One proposal discussed by the group is to encourage private health care companies to fill the void. Private HMOs, for example, are creating a package of services that includes HIV/AIDS. It was argued that the extra amount that it costs to include HIV/AIDS treatment in an HMO is so token that it can be appealing. Another option involves joining together through associations of small employers to promote cost-effective measures, such as health care delivery by medical staff assistants. One avenue worth pursuing is to trace the ways the poor spend their money and analyse how it might be possible to connect their spending patterns to the purchase of premiums for health insurance.
The protection of rights is another concern, which depends on having an appropriate legal and political framework. The ILO has various conventions covering discrimination and occupational safety and health, but there are no ILO conventions on HIV/AIDS specifically. Another concern is that HIV/AIDS is not recognized as a workplace sickness. This is important for both prevention and treatment. Although such protections are by definition only relevant to the formal economy, they are nonetheless important for the spillover effect of interactions between the formal and informal sectors.
Conclusion and Next Steps
The group concluded that many innovative ideas and valuable experiences had been shared in the course of the exchange. In addition, there were other ideas and experiences in the previous two roundtables that had a direct bearing on the linkages to SMEs and the informal economy. The participants agreed that the next steps should include pulling these various ideas together into an action plan, with visible options for the group to consider. A small planning group should be convened in July from volunteers among the participants to develop a proposal for action. Then, in September the GSO could convene a programme to debate and adopt this action plan. There was broad consensus among the participants to proceed in this modified direction over the course of the next two scheduled dates in the GSO series.
Future dates include a planning group meeting on Tuesday, 19 July and a debate for an action plan directed to SMEs and the informal economy on Thursday, 15 September. Participants are also encouraged to hold the date of Thursday, 17 November for a follow-up roundtable.