A virtual roundtable titled 'Health Insurance for RMG Workers in Bangladesh: Designing Policy and Management Structure' was organized on 18 August 2021. It was jointly organized by the Health Economics Unit of the Ministry of Health and Family Welfare, Institute of Health Economics of the University of Dhaka, BRAC Urban Development Programme, and SNV Bangladesh. The Daily Prothom Alo was the media partner. An excerpt of the discussion is published here.
Health Insurance for RMG Workers in Bangladesh: Designing Policy and Management Structure
Organised by: Health Economics Unit of the Ministry of Health and Family Welfare, Institute of Health Economics of the University of Dhaka, BRAC Urban Development Programme, SNV Bangladesh.
Media partner: The Daily Prothom Alo
1. Mujibul Haque, MP: Chairman, Parliamentary Standing Committee on Ministry of Labour and Employment
2. Dr. Mohd. Shahadat Hossain Mahmud, Director General (Additional Secretary), Health Economics Unit, Ministry of Health and Family Welfare
3. Selina Akhter, Director General, Central Fund, Ministry of Labour and Employment
4. A.K Azad Chowdhury, President, Bangladesh Diabetic Association (BADAS)
5. Dr. Md. Liakath Ali, Director, Climate Change Programme, BRAC and BRAC International, & Urban Development Programme, BRAC
6. Syed Abdul Hamid, Professor, Institute of Health Economics, University of Dhaka
7. Dr. Md. Nurul Amin, Director-Research (Deputy Secretary), Health Economics Unit, Ministry of Health and Family Welfare
8. Farhtheeba Rahat Khan: Team Leader, RMG Inclusive Business Programmes, SNV
9. Nasrin Sultana, PhD, Professor & Director, Institute of Health Economics, University of Dhaka
10. Syful Alam Mallick, Manager (Compliance), South Asia, Auchan International
11. ANM Saifuddin: Chairman, Standing Committee on ILO & Labour, BGMEA
12. Mohammad Hatem, Vice President, BKMEA
13. M. Jalalul Azim, MD & CEO, Pragati Life Insurance Ltd.
14. Rezaul Haque, RMG Health Insurance Programme, Gonoshasthaya Kendra
15. Sirajul Islam Rony, President, Bangladesh Garments Workers League; and Member, TCC Committee (RMG)
16. Abdul Qayyum: Associate Editor, The Daily Prothom Alo
17. Firoz Chowdhury: Assistant Editor, The Daily Prothom Alo
The RMG industry in Bangladesh created huge employment opportunities for women. The RMG workers are significantly contributing to national development. Providing the RMG workers with health insurance is necessary. Productivity increases if the workers stay healthy which ultimately benefits the owners. Health insurance for the RMG workers is necessary for the sake of workers, industries, and the overall development of the country.
I thank the Health Economics Unit (HEU) of the Ministry of Health and Family Welfare, Institute of Health Economics of the University of Dhaka, SNV, and BRAC for considering and discussing this issue. I hope the expert discussants will provide the necessary advice and directions in this regard. And the present condition of the female workers will improve if those guidelines can be realised.
Dr. Syed Abdul Hamid
The ready-made garment sector is the key sector that earns foreign currency for the country. This promising sector has created employment opportunities for about 4.2 million people, especially for women. Many development organizations and NGOs have been piloting 'Health insurance for the RMG workers.’
Studies show that health insurance makes getting treatment for RMG workers easier and improves their health while minimizing personal expenses. Health insurance also decreases the volume of sick leaves that ultimately increases production in the factories. Most of the pilot projects are going to end soon but no guidelines have been formulated to carry on these projects in the future. And monitoring the management, source of funds, health benefit packages, regulation, and compliance is necessary to realize health insurance in a broader context. Participation of the workers, owners, government, and relevant others is also necessary.
A 20-year strategy was prepared in 2012 to finance the health sector that proposed to establish a national health security office. Establishing the strategy will ease implementing health insurance on a broader scale which will take time in the context of Bangladesh.
Therefore, it is necessary to continue the existing pilot projects and establish an interim body that can be named 'Social Health Insurance Management Unit (SHIMU)', to bring all workers under health coverage. The unit will be primarily responsible for applying the knowledge and experiences gathered from the ongoing pilot projects and taking preparations necessary to bring garment workers under health insurance coverage. This includes coordinating with partners, formulating health benefits packages, selecting insurance companies or TPA, etc. This entity will also supervise collecting and managing scheme funds, inspecting the whole scheme and controlling its quality, and settling complaints. It can be directed under an administrative body and a steering committee.
Thus, formulating a working committee to establish 'Social Health Insurance Management Unit (SHIMU)' is necessary. This working committee can include representatives from the Ministry of Labour and Employment, Central Fund, Ministry of Finance, Ministry of Health and Family Welfare, Health Economics Unit, Institute of Health Economics of the University of Dhaka, FBCCI, BGMEA, BKMEA, Trade Union and other organizations concerned.
Health insurance is performing well in countries like South Korea, Thailand, and the Philippines. However, it took them time to reach there. South Korea took around 40 years starting back in 1963. Ghana, Thailand, and the Philippines also took a long time. In the Bangladesh context, initiating health insurance coverage for all wage earners is difficult, so at least we can start in the RMG sector by establishing 'SHIMU'.
M. Jalalul Azim
We started and successfully continued our pilot projects with SNV to provide the workers' health benefits in three factories and have included a few more factories now. If the government, BGMEA, and BKMEA provide support, we can expand this project. If we want to provide the garment workers’ health coverage, something like 'SHIMU' will be very effective. The proposal for establishing 'SHIMU' discussed here is a timely call.
Syful Alam Mallick
Auchan has been working in the garment sector for 25 years in Bangladesh. We have a foundation. Now we are working with Gonoshasthaya Kendra and BADAS with the target to bring 25 thousand workers under health coverage. Our experience from these two pilot projects is positive. We are also working to make these projects sustainable. The proposal for establishing 'SHIMU' from the experiences of these projects is very realistic. We have to outline a national guideline for that.
Dr. Rezaul Haque
We will need a national institute to provide health insurance to garment workers. Without this, coordinated service cannot be provided. It can be named 'SHIMU' or something else. But the government has to be involved somehow. We have created a platform for this purpose including Gonoshasthaya Kendra, Health Economics Unit of the Ministry of Labour and Employment, Institute of Health Economics of the University of Dhaka, BRAC, and SNV. We are trying to formulate a national guideline. All have to come forward in this regard.
Sirajul Islam Rony
Garment workers do not have health security, which requires a fair health service policy. The RNG sector has been developed a lot and now we have to work to ensure improved living status for the workers.
Some factories have doctors but the number is insufficient. We are working with SNV and other NGOs. We have understood the importance of health insurance for the workers. The Central Fund has been established with help from the government, where up to BDT 100,000 is being given to those who became disabled in accidents. The workers are constantly suffering from health problems. Such health coverage will be of great benefit to a huge number of workers. Workers and the Central Fund can be working in a coordinated way. Others can also contribute, but demand for health insurance should not be delayed anymore.
RMG is a major sector among the 42 sectors of Bangladesh. The Central Fund has been formed with the support of Mujibul Haque MP. The Central Fund policy states the health coverage of the stakeholders. But my question is, why do we talk about only the garment sector and not the others? Legally and as per compliance, we have to ensure health services at all factories. Not all can afford such services and for them, there are many health centers in Dhaka and Chattogram. We run a hospital in Chattogram. Many workers of this formal sector are getting health services. However, around 7 crore informal workers are deprived of any government or non-government support for healthcare. We have to think about ensuring health services for all workers.
I have been involved in the garment sector for a very long time. We always have to struggle with insurers’ harassment. Group insurance was introduced in the RMG sector after the Rana Plaza incident. We have had a very bitter experience with insurance with some private insurance companies. They were not realising insurance claims against the death of 300 workers. We tried with BGMEA and BKMEA but we have not received the money for 115 dead workers yet for very silly reasons. The issue of health insurance is addressed in the eighth five-year plan. Workers are receiving health services from the Central Fund. So, I do not know what the necessity of establishing ‘SHIMU’ now is. But we will not object if the government wants to do that.
AK Azad Khan
We launched a micro health insurance programme, inspired by one of my Swiss friends. The Insurance Academy of Switzerland provided support in this regard. We provided year-long health services within BDT 500 except for a few special cases. We managed to cut down the expense by encouraging the prevention of diseases and promoting healthcare. There was a challenge that the workers could not manage time to receive healthcare services from their offices. We devised a plan to make it happen during their lunch and leisure time. 15% VAT is added whenever the commercial insurance companies are involved in micro health insurance that becomes a burden over the programme. So, the government should waive the VAT here.
Farhtheeba Rahat Khan
We started working with three organizations. We have brought around 30 thousand workers under insurance. Many of us have negative experiences with insurance companies. We have to consider this and devise a plan to include garment workers in the scheme. A few companies have directed pilot projects and many of these workers could receive health services during this pandemic. This is a positive example. An effective guideline should be formulated from these experiences.
We will need a guideline if we want to bring all workers under health coverage. I specially request BGMEA and BKMEA to consider this seriously. This cannot be done without their support. The workers do not care for themselves as they care about their children and families. We worked with some factories and now they have become able to take care of themselves. We want all factories to come under the same umbrella. I request BGMEA and BKMEA to support us so that we can help you.
Mujibul Haque MP
I think health insurance should be there for not only the garment workers but also workers from all sectors. Medicine, leather, and other industries are contributing to earning foreign currencies from their positions. Why will there be only workers of the BGMEA for any kind of experiment and not from other sectors?
There is a provision of 5% profit sharing in the labour act. The garment industry was outside of it then. We asked them to do something in this regard and then they started sharing 0.03% profit and the workers are getting advantage of it. Workers from many sectors are not getting any benefits at all and I think we should think about them also.
Mass people do not trust the insurance companies of this country. When I was the minister of the Ministry of Labour and Employment, 100 workers died in a fire. I am also a lawyer. We submitted all necessary papers to the insurance company, sat with the owner of the company and authorities from the garment sector. But we have not received any amount against the claims for the dead workers yet. The insurance companies always try to avoid their liabilities using the loopholes of the law. If there is any proposal to the government regarding health insurance for the workers, I will be there with it. There has been a proposal for establishing 'SHIMU'. I agree with it. But whatever we do, we have to do it without the private insurance companies. It can be done directly from the Central Fund.
Md. Nurul Amin
We are implementing Shasthyo Surokhsha Karmasuchi (SSK) in 3 upazilas of Tangail. We are also trying to expand the programme to the remaining 9 upazilas of Tangail and in Dhaka. There have been many challenges and we are constantly learning from this. Many countries of the world learned through this process and then implemented health insurance. Poor patients admitted to the government hospitals in the three upazilas are provided with medicine, health check-up facilities and treatment for 78 diseases through SSK. We are also working to chalk out how to provide such facilities to those who are not admitted patients. SSK Cell of the Health Economics Unit is constituted of 5-6 officials. The initiative has already been taken to increase the capability of the Shasthyo Surokhsha Karmasuchi.
Many other countries have a specialized organization at the national level for this purpose. There must be one such in our country as well. Some are saying that it will take time. This is why we have to start now. This can be started by establishing 'Social Health Insurance Management Unit (SHIMU)'. A legal structure is necessary to form a national body. We have drafted the 'Health Protection Act' and taken steps to pass it.
Dr. Md. Liakath Ali
BRAC has been working on health insurance for 5-6 years. We have both positive and negative experiences. But I think we have to formulate a health coverage policy for the workers having everybody on board. We want to provide our support in this regard. We, the government, and the RMG sector are connected through the network. We already have an agreement with the BGMEA to work on health insurance for RMG workers. No one is against health insurance. But getting all sectors under this facility has been discussed. This can be considered. We want to do this transparently. We all can have discussions about that. There is no secrecy. If the government wants this for all, that will be even better. But we have to start at some point and I think it can be the garment sector.
The Central Fund was founded under the Ministry of Labour and Employment in 2016-17 for the welfare of garment workers. Financial benefits are provided to the workers under BGMEA and BKMEA facing death or physical disability, and for the education of their children. Health insurance and group insurance are there in what we do. But we could not initiate health insurance. At present, we are giving financial grants. BGMEA and BKMEA provide us information in a specified form and we provide aid after thorough scrutiny. We lack a workforce in this regard and this is a challenge. I got here four months back. I have been working sincerely from the beginning.
If we cannot address the claims quickly, then it becomes hard to achieve our goal. I feel that we should know the number of both formal and informal sector workers. 'SHIMU' has been proposed. There are many things here to discuss. We have to keep in mind many issues like implementation, coordinating, and making it sustainable.
Dr. Mohd. Shahadt Hossain Mahmud
We are sincere enough to implement the initiative taken here today. Government policy, funds, skill development, and logistic support will be needed for that. We will be able to work with the Central Fund if all these are ensured. No country in the world was able to bring all the workers under healthcare services at once. We have to start at some point. More than 80% of the revenue of export comes from the garment sector where 4.2 million workers are involved. We are now in the second position globally in exporting garments. There has been a change in the industry in China. We can achieve the first position if we want to. So, garment workers come to the focus whenever we think of something to do for the workers. I do not think that there will be any opposing opinions to what we have discussed here today. Health insurance for garment workers is necessary for the sake of national development. Most of the RMG workers are female. If this sector develops, women's empowerment will increase and male-female discrimination will decline. We are thinking of health insurance for the whole population.
We have working experience from Tangail through the Health Economics Unit. The Institute of Health Economics of the University of Dhaka conducted its research. The Central Fund is working for the welfare of the RMG workers. We can start working together now to keep health insurance going for this sector and then expand its coverage. The proposed working committee can be formed with the Central Fund. I have shared my opinion here as my responsibility being the Director-General of the Health Economics Unit.
RMG is the main sector earning foreign currency. Health insurance for the workers in this sector is crucial. We believe something good can be done in this regard if the government, BGMEA, BKMEA, and all concerned work together. I thank you all on behalf of the daily Prothom Alo for participating in the discussion today.
A national organization should be established for ensuring health insurance. But 'Social Health Insurance Management Unit (SHIMU)' can be formed as an interim body. Health Economics Unit and Central Fund can jointly form a working committee as the first step.
A national policy should be formulated for initiating health insurance for the workers.
This policy can be formulated by the participation of experts from the Health Economics Unit of the Ministry of Health and Family Welfare, Central Fund of the Ministry of Labour and Employment, Institute of Health Economics of the University of Dhaka, BRAC, Gonoshasthaya Kendra, Diabetic Association of Bangladesh, and SNV utilizing experiences from the successful pilot projects.
Health insurance for the workers of other sectors along with RMG should be considered as well.