Taking health to the RMG workers

Every morning literally millions of garment factory workers stream to work, the majority of them women. They are the drivers of Bangladesh’s economy, especially the force behind the country’s export growth.

The country's labour-intensive apparel industry has about four million workers employed in around 5,400 factories. And at least 70 per cent of these workers are women.

Unfortunately, while the country has made strides in the health sector, with a lot of impressive statistics being tossed around, these women have almost no access to healthcare services. They work six days a week, often working overtime. Both financial and time constraints are barriers for them to accessing basic healthcare services.

While on an individual level this lack of proper healthcare affects these hard working women, it impacts the industry as a whole. If a worker is not physically or mentally fit, she cannot give her best. So both from a humanitarian angle and from the economic aspect, access to health services is essential for these women.

However, this has been a long neglected area. While some factories do have medical facilities, these factories are limited in number and the facilities are often perfunctory.

In 2012, a television report about the collapse of a readymade garment factory building in Bangladesh that killed a large number of workers, prompted the Bangladeshi physician Ruhul Abid to come up with the concept of HAEFA (Health and Education for All). Using his previous experience as a primary care physician in the tea plantations, he designed a plan to screen and link factory workers for common non-communicable diseases.

Basically founded by Ruhul Abid of Brown University and Rosemary Duda of Harvard Medical School, HAEFA first started providing the services to the RMG workers in Bangladesh in 2013.

Since then, HAEFA has provided healthcare to more than 8,000 RMG workers and 1,200 rickshaw-pullers. In 2016, Brown University Global Health and HAEFA developed a paperless, portable, electronic medical record (EMR) system and used that to perform medical check up for 5,776 RMG workers in Sripur/Mawna, Gazipur, Savar and rickshaw pullers in Dhaka for diseases such as hypertension, diabetes, anaemia, asthma, high-risk pregnancy and tuberculosis (TB).

The project, ‘Novel Workplace NCD (non-communicable disease) and ID (infectious disease) Screening for Garment Factory Female Workers using EMR’, is being implemented by HAEFA and Brown University.

This is initially a one-year project, from 1 April 2018 to 31 March 2019, to be extended further if successful. The first three months have focused on preparation, recruitment of medical team members, training, and garment factory selection.

Abid says, “We are starting the first health screening under this project on 25 June this year and will continue for the next 10 months. If the project is successful, HAEFA will be eligible to apply for a larger project for three years to cover 50,000-100,000 RMG (readymade garment) factory workers for annual health screening and treatment of chronic diseases.”

Elaborating on the project, he says, “In brief, the basic concept of this project is to provide access for the RMG workers to quality healthcare services. We propose and are working towards achieving a system where all industrial workers will have Universal Health Coverage (UHC) under the SDG (sustainable development goals) programmes of Bangladesh. UHC is number 3 of SDG 2030. Most NGOs work in the slums cannot access the four million RMG workers as they are not available in the slum until late evening.”

Under this project, HAEFA, in collaboration with the the Bangladesh government’s Directorate General of Health Services (DGHS) and owners of several garment factories, will provide medical check-up to 9,000 factory workers.

HAEFA will also introduce cervical cancer screening using digital technology for the garment factory workers for the first time.

This is significant as cervical cancer is the second (after breast cancer) cause of deaths of women in Bangladesh.

The project will also ensure that the diagnosed cases of hypertension, diabetes tuberculosis, cervical cancer, etc, receive continued treatment from the nearby government upazila/district health centres, BRAC centres, BIRDEM, nearby pharmacies where HAEFA-designated physicians and health workers will be available.

The project will also work to raise health, feminine hygiene and nutrition awareness among the factory workers by organising workshops at the factories and discussions with the factory management.

Funded by Grand Challenges Canada, the project has scheduled health screening in seven garment factories in Sripur, Gazipur, Savar and Dhaka. It may extend its programmes to other factories and regions in Bangladesh.

HAEFA has its country office in Dhaka and a medical team consisting of physicians, public health experts, nurses, midwives, health workers and IT experts.

Since October 2017, HAEFA’s 22-member medical team has been operating in two Rohingya camps of Kutapalong and Balukhali. It has provided free treatment to over 31,000 Rohingya and local host community patients.