Inequalities in health and access to social security for informal workers in Latin America, Africa and Asia project

This initiative was established as a second phase of Project Inequalities in Health, Labour and Access to Informal Workers Social Security in Latin America, now oriented in the regions of Africa and Asia. The main objective of the project is to develop a baseline of information regarding the access of informal workers to health systems and social security to augment the data collected in Latin America during the first phase of the project, with the objective of generating a global baseline information on these key issues for decision makers. This second phase is currently under development by FLACSO-Chile supported the Rockefeler (Grant 2013 THS 321) Foundation.


Among its objectives, the project aims to:

  • Develop a baseline to identify knowledge gaps and contribute to a better understanding of the health of informal workers and their access to health systems and social security in each country. To achieve this goal, the first step is to develop a typology which allows selecting representative countries in each region and that will be part of the project in each region.

  • Identify interventions, programs or policies that have “shocked” or have the ability to replicate in different regions.

  • Identify actors develop actions to influence policy.

  • To fulfill these objectives, we have identified three types of actors with different roles in the project: first, each team developing the local study; second, regional partners and coordinating regional work; and third, FLACSO-Chile as the coordinating institution globally. The following diagram shows the various roles and functions of each actor.


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Developing a Regional Typology

Through the review of available information, we will seek to classify the different countries in each region, in order to select those who will participate in the study.

What do we look?

Develop, based on the available information, a classification of countries in each region in groups through which represent the different realities in terms of informality, health system organization, income levels, social development, among others. This will allow us to select the countries conducting case studies representing the reality of each region and the different groups to then carry out a comparative analysis between them and test hypotheses which can be explained by the diversity of contexts and realities.

How do we do?

To develop the typology, were selected following key domains to form representative groups of countries in each region: coverage of the health system, extent of informality coverage social security system, financial coverage of the health system, economic liberalization, including other.

Milestones and Products area

April, 2014: Typology completed in Africa and Asia (selected to conduct the case study countries).

Component Case Studies

It aims to learn the reality of informal workers and the gaps they face in accessing health and social security from the systematization of information from six African and six Asian countries, in order to make comparisons with the information gathered in the case studies for Latin America in the first phase of the project.

What do we look?

Analyze the informal workers access to health and social security, conditions of employment and work and relationship with the characteristics of different countries in terms of economic structure, labor market and health care systems, pensions and social security.

How do we do?

For the development of case studies will be conducted Desk Review process using secondary sources such as reports from national and international organizations, non-governmental organizations (NGOs), surveys, among others.

The work for this component will be developed by Regional Partners in Africa and Asia, country teams in each region and by FLACSO-Chile team.

Milestones and Products acreages

September 2014: Reports on six case studies in each region.
November 2014: Reports of comparative case studies for each region.
March 2015: Report compared inter-regional case studies.

Qualitative Research Component

From the rising of qualitative information is sought to know the perception of informal workers about their working conditions, employment, access to health and social security.

What do we look?

Additional information and further for each National Base Line, incorporating the perspective of informal workers on barriers to access to health and social systems security facing the measures to be taken to address these barriers, their employment and working conditions and state of health at national, regional and inter-regional level.

Such studies will also contribute to regional overview of working conditions, employment, health and barriers faced by informal workers, especially emphasizing the heterogeneity of the informal in each of the regions workers.

How do we do?

Identifying different groups of workers in each region to allow represent the heterogeneity of informal workers in each case.
Selecting domains to study in each country and group of informal workers: working conditions, employment and health of informal workers and / or barriers to health.
Apply various qualitative methodologies for collecting and analyzing information
The work for this component will be developed by Regional Partners in Africa and Asia, country teams in each region and by FLACSO-Chile team.

Milestones and Products Area

September 2014: Six qualitative studies in each region.
December 2014: Regional Report on qualitative research.
March 2015: inter-regional Qualitative Report.

Component Informality and Health Indicators

Effective collection and analysis of quantitative information, we will seek to establish a line of comparable basis across countries and regions on informality and various aspects of the health of workers / informal workers.

What do we look?

Conducting secondary analysis of data from selected surveys that are comparable for each of the participating countries, with the aim of proposing a set of key indicators on informal work, health and access to health of informal workers, which it can be tracked and monitored over time from national surveys conducted regularly.

How do we do?

First, conducting a detailed review of existing surveys in selected countries for each region, taking into account their specific characteristics and methodological contents.

Second, comparing the contents and variables in the different surveys to proceed with the development of comparable indicators among them.

Third, carrying out secondary analysis of data from two or three surveys for each country selected to generate information on the incidence of informality, informal health workers, and access to health and social protection in each case.

Finally, a minimum set of key indicators on these issues for tracking and monitoring in each country will be identified.

The work for this component will be developed by Regional Partners in Africa and Asia, country teams in each region and by FLACSO-Chile team.

Milestones and Products area

June 2014: completion of the review process and selection of surveys for each country.

June-August 2014: construction of informality and health indicators based on different selected surveys.

December 2014: final selection of key indicators comparable across countries and regions of the study.

Mapping Actors and Promising Interventions

The aim is to identify key actors and promising interventions in Asia, Africa and Latin America. This, so that they can be taken as examples to solve some of the many problems facing informal workers regarding health and social protection. Also, identification of these actors and interventions may allow for future partnerships, both domestically and internationally, building the context for national and international organizations to develop the most promising interventions.

What are we looking for?

Identify agents of change and positive experiences that might be relevant to or reducing gaps faced by informal workers when not to access or health and social protection.

How do we do?

The partners in Africa and Asia to search for and identify the actors and promising interventions in the area of ​​informal work and access to health and social protection, according to a methodology agreed by / as experts in different regions. The search will be performed for all countries of the region. FLACSO-Chile will search for actors and interventions in Latin America.

Each regional partner will develop a report to inform actors and interventions identified, using an agreed methodology.

FLACSO-Chile gather all interventions and actors identified by regional partners and build a global report.

Once you have identified all interventions and all players at the discretion of promising, a platform available to all / as / as interested / as experiences and identify these actors construct different purposes.

Milestones and Products Area

July 2014: start the mapping process in Africa, Asia and Latin America.
August 2014: the mapping process concludes in Africa, Asia and Latin America and the regional report is completed.
September 2014: global report is built.
October 2014: building a database that integrates the information provided by the different regions is concluded.

Monitoring progress in labor markets, health systems and their relation to health inequities. Taxonomy and Typology for Latin America

The second step in the process of monitoring labor markets, health systems, and their relationship with health inequities consists of a classification process of the countries of the region around these dimensions. This will take place in the first instance, a taxonomy of countries in the region and beyond, a typology of them based on a theoretical model that considered the relationship between these dimensions.

What do we look?

Observe the relationship between the characteristics of labor markets, with emphasis on informal employment, and characteristics of health systems, with the results and inequalities in health workers in the region. The development of this model will serve, first, to have a classification of countries in the region according to these structural features, and the other as an analytical framework that will feed the analysis process to be developed in other areas .

How do we do?

A job classification of countries in the region will take place in two stages. The first is the development of a taxonomy of the countries of the region around these three dimensions. It aims to have a first approach to the process of classification, while delivering supplies to support the work done in other areas. The second stage involves the development of a typology of labor markets, health systems and health outcomes, which will take into the base type of work performed by labor markets and Montaner Chung (2010), but incorporating the emphasis on informal employment, as well as the specificities of the region.

Milestones and Products area

June: Taxonomy of Latin America
September: Theoretical model of the relationship between labor markets, with emphasis on informality, health systems and health outcomes.
January: Typology of Latin American countries based on the theoretical model developed.

Research Group

Project Coordination

Dra. Orielle Solar H.

Medical Doctor, holds a Master´s in Public Health and a Master´s in Environmental Sciences. Researcher with Flasco Chile, coordinating the Work, Employment, and Health Equality Program (TEES).

Dr. Solar is an Adjunct Professor of the Dr. Salvador Allende School of Public Health of the Universidad de Chile Medical School and a Collaborator in the GRED-EMCONET Group (Grup de Recerca en Desigualtats en Salut y Employment Conditions Knowledge Network) of the Universitat Pompeu Fabra in Barcelona. She worked as reseracher in the Center for Research on Inner City Health at St. Michael's Hospital of the University of Toronto in Ontario, Canada during 2010, and she coordinated the investigative team that developed the National Survey of Employment Conditions, Work, and Equity for the Ministry of Health of Chile. From 2004 to 2007, she worked for the World Health Organization in Geneva in the Department of Equity, Poverty, and Social Determinants of Health and was a member of the Technical Secretariat of the WHO Commission on Social Determinants of Health. Dr. Solar was Head of the Department of Occupational Health and Environmental Pollution of the Public Health Institute of Chile (2002 – 2004) and the Deputy Director of Medical Health Services (1998 – 2002). She also serves as an international consultant in the areas of social determinants of health, access equity, employment conditions, intersectorality, and general health policies. Currently, she integrates the Presidential Commission on Health Reform for Chile.

Principal Investigators

Pamela Bernales Baksai

Psychologist, with a Master of Anthropology and Development from Universidad de Chile. In 2006, Ms. Bernales interned with the WHO Department of Equity, Poverty and Social Determinants of Geneva. Since then, she has carried out investigations in the areas of precarious labor and workers' health, social construction of risk and the labor market, social determinants of health, intercultural health, and social participation. She was part of the investigative team in charge of designing and analyzing the first National Survey of Employment Conditions, Work, and Equity of the Chilean Ministry of Health and Ministry of Labor.

Ms. Bernales is an academic of the Master of Applied Systematic Social Analysis and the Master of Clinical Psychology, both of the Social Sciences Department of Universidad de Chile.

Her investigative interests center on the Latin American labor market, informal work, inequalities in employment conditions and access to social protection, and its effects on the well-being of workers and on their family environment.

Patricio Tonelli

Historian from the Universitá degli Studi di Bologna, Italy, Ph.D in History, Politics, and the Representation of Collective Interests in the Italian and international society  from the Universitá degli Studi di Teramo,  Italy.

Dr. Tonelli has studied topics related to the Italian and European Union movements and their strategies concerning occupational health. He is the Academic Coordinator of the Master of International Labor Policies and Labor Relations program of Universidad Central de Chile and Universitá degli Studi di Bologna in Italy. Additionally, Dr. Tonelli is an investigator with Fundación SOL in the area of labor trends, with a particular interest in union training.

María José González

Political Scientist and Master (c) of Public Health of Universidad de Chile, with a diploma in Quantitative Methods for Social Investigations.

Ms. González served as an advisor in the cabinet of the Sub-Secretary of Public Health of the Ministry of Health of Chile. She worked as a researcher for the School of Public Health of Universidad Mayor, focusing on data analysis for the first National Survey of Employment, Work, and Health in Chile (ENETS), and has collaborated on numerous investigative projects concerning the health of workers.

Her research interests are related to employment and working conditions and their impact on health inequalities, from a gender perspective.

Denise Lama Feliú

Political Scientist from California State University-Long Beach, United States and holds a Master’s Degree in World Politics, from the University of Helsinki,  Finland. She has mostly worked in the design, implementation and monitoring of programs related with women’s economic empowerment, human rights of women youth volunteerism and labor market. For example, she worked as a National Program Officer for the Working Women and Female Heads of Household Program and as the Entrepreneurship Program Coordinator in the Women’s National Service of Chile. Ms. Lama also interned  with MADRE, an international human rights organization for women in New York, United States and for Pro Mujer, an international organization for microcredit for women in Bolivia.

In addition, she also interned at the Permanent Mission of Chile to the United Nations in New York and in the Latin American and Programs Division of the United Nations Volunteer Program, of UNDP in its headquarters in Germany.

Her research interests include the international influence in the design of domestic programs and public policies, the role of civil society in decision making processes and on gaps in the labor market faced by women, informal workers and migrants.

Andrea Cárdenas

Commercial Engineer and Master´s in Economics and Public Policy, University Adolfo Ibáñez. In 2010 he was an assistant in research dedicated to update a thesis on returns to schooling on wages. In 2012, she participated in research on the implementation of the minimum wage in Fundación Sol, and independent research organizationl. Her research interests are based in the area of ​​public policy and social security

Amalia Valdés

Sociologist at the Catholic University of Chile (PUC).

Currently, she is a student in the Diploma Program on Qualitative Methods for Social Sciences in the Diego Portales University.She has conducted research on adaptation mechanisms of detainees in the San Joaquin Prison.

Matías González

Sociologist from Universidad Católica  Certification Workshop on citizen participation, published as one of the researchers DECIDED Foundation. Certification Workshop for VRI UC experts on native forest in the Araucania and its relationship with local communities, as part of the " Chilean forest between modernity and tradition: an ethnographic approach to knowledge and environmental values ​​in region IX" 

Daniel Perez

Sociologist from Pontificia Universidad Católica de Chile, the Master’s candidate of the Social Science program at Universidad de Chile.

Mr. Perez has worked evaluating public policies related to gender and ethnicity. For example, he evaluated the Baseline Assessment Program of the Comprehensive Development of Honduran Indigenous Peoples group of the Honduran Social Investment Fund and IDB and was commissioned by Mexico City's Council of Evaluation of Social Development to assess their "Gender Equality Policy".

Vicente Alamos

Sociologist from Pontificia Universidad Católica de Chile and currently a student in the Master’s Program in Political Science from Universidad de Chile. He has participated in research projects related with ethnicity, politics and cultural conflicts in Chile and Bolivia. His research interests are politics of Sociology and qualitative research methodology.

Alejandra Vives

Medical Doctor by Universidad de Chile, with a specialty in Public Health by Pontificia Universidad Católica de Chile, and Master of Public Health and PhD by Universitat Pompeu Fabra in Barcelona.

Dr.Vives is currently Asistant Professor at the Department of Public Health in Pontificia Universidad Católica de Chile and researcher with GREDS-EMCONET (Health inequalities Research Group - Employment Conditions Network) at Universitat Pompeu Fabra in Barcelona.

Her main research interests focus on the social determinants of health and health inequalities, particularly regarding employment and working conditions.


Research Associate

Carles Muntaner

Professor of Nursing, Public Health and Psychiatry at the University of Toronto, Canada. Member of its Institute of Global Health Equity and Innovation. As a founding member of the Greds/Emconet research group he is also affiliated with the Universitat Pompeu Fabra, Barcelona. He is associate researcher at the Center for Research in Inner City Health (CRICH) at St Michaels Hospital in Toronto and adjunct professor with the Department of Mental Health, at Johns Hopkins University School of Public Health in Baltimore.

In the field of research, he has conducted extensive studies, relying mostly on primary data collection studies among workers in the US, the European Union, Latin America, Asia and Western Africa, with a focus on social inequalities in health. His research agenda has involved studies of immigrants, employment conditions and health services inequities in Europe and North America; psychosocial work environment and employment relations as a risk factor for mental disorders; the measurement of social class as property relations and managerial domination; the effects of neighborhood and workplace contexts on health, and realist approaches of class, racism, sexism, migration, the psychosocial work environment, income inequality and social cohesion in public health. Lastly his research has focused on macro-social determinants of health and on integrating politics, welfare state and labor markets as determinants of population health.

He has been developed several empirical studies published in different journals like American Journal of Epidemiology, American Journal of Public Health, Social Science and Medicine, among others. He has served as consultant for the WHO/PAHO and worked with governments in Latin America, including Chile and Venezuela. He participated in the “Marmot Review” and the review on social determinants and the health divide in the WHO European region. He co-chaired the Employment Conditions Network (EMCONET) of the WHO Commission on Social Determinants of Health.

Clelia Vallebuona

Medical Doctor, from Universidad de Chile, and holds a Master ‘s  in  Public Health, with a focus on Occupational Health, from the School of Public Health of Universidad de Chile.
Dr. Vallebuona worked in the Non-communicable Disease Surveillance and Epidemiology Research Department and was in charge of non-communicable disease surveillance issues such as the National Monitoring of Acute Pesticide Poisoning program and the Population Cancer Registry for the Ministry of Health of Chile.

Her research interests are related to workers' health and employment conditions, labor and social security, assessing impacts on workers' health and quality of life, access and quality of workers' social security in the active and passive stages of work, and impact of work on the development of population health problems.

Technical and administrative assistance

Paulina Godoy

Veterinarian at the University of Chile and a Masters in Economics of Agrifood System at the Catholic University of Milan. Experience in local, national and international in the areas of planning and evaluation, institutional modernization and international cooperation institutions.

Participating Institutions and collaborators

Universidad Javeriana de Colombia

  • Román Vega -
  • Jairo Luna -
  • Jaime Ramirez -


The impact of health insurance schemes for the informal sector in low and middle income countries

Subject: Trabajo Informal
Author(s): World Bank | Publication date: 2013

Eslabones de la Desigualdad

Subject: Desigualdad Social
Author(s): Cepal | Publication date: 2012

Protección Social Inclusiva en América Latina

Subject: Protección Social
Author(s): Cecchini-Martínez | Publication date: 2011

Primera Encuesta Nacional de Empleo, Trabajo y Salud 2009

Subject: Condiciones de trabajo
Author(s): Solar O., Bernales P., Sembler C., Vallebuona C., Ibáñez C. | Publication date: 2009

Calendar of Activities

Seminar Reviewing the available evidence

The reality of labor informality in Latin America and the challenges workers face to access health and social protection.

Date: 14 y 15 de marzo, 2013
Place: Auditorio de la Organización Internacional del Trabajo (OIT). Av. Dag Hammarskjöld N°3177, Vitacura.
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Seminar Conditions of Collective Action. Some bridges with struggles for social protection

FLACSO Chile, in the framework of the Health Disparities, Access to Work and Social Security in informal workers in Latin America, is pleased to invite you to attend the conference "Conditions of Collective Action. Some bridges with struggles for social protection "which dictate the Belgian Professor Guy Bajoit. Registrations are open through our website Contact section.

Date: 12 de junio, 2013
Place: Auditorio FLACSO Chile
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Seminar Informal work in Latin America: Inequalities in access to health and social security systems

FLACSO Chile, through its program of Labor, Employment, Equity and Health, is pleased to make the Regional Meeting: "Informal work in Latin America: inequalities in access to health and social security systems" to be held on September 25 and 26 in the Prebisch Auditorium ECLAC.

The workshop has the following objectives

1 Discuss the origin and maintenance of informal work in Latin America.

2 Discuss the methodologies used for the measurement of informality and new proposals have been developed to address this phenomenon.

3 Analyze the heterogeneity that occurs between informal workers in Latin America and its relationship with the principal axes of social inequality.

4 Discuss the barriers faced by informal workers to access health and social security and the proposals that have been developed for confrontation.

5 Discuss the challenges present in the study of inequalities in access to health and social security for informal workers in different contexts.

For more information please enter here.

Date: 25 y 26 de Septiembre, 2013
Place: Auditorio Raúl Prebisch, CEPAL.
Download Invitation »