Health-associated Cost of Urban Informal Industrial Sector: An Assessment Tool

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/233760775 Health-associated Cost of Urban Informal Industrial Sector: An Assessment Tool Conference Paper in Procedia - Social and Behavioral Sciences · June 2011 DOI: 10.1016/j.sbspro.2012.03.013 CITATIONS READS 3 79 4 authors, including: Anindrya Nastiti Indrawan Prabaharyaka 11 PUBLICATIONS 12 CITATIONS 3 PUBLICATIONS 3 CITATIONS Bandung Institute of Technology SEE PROFILE Monash University (South Africa) SEE PROFILE Dwina Roosmini Bandung Institute of Technology 14 PUBLICATIONS 18 CITATIONS SEE PROFILE All content following this page was uploaded by Anindrya Nastiti on 25 December 2016. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document and are linked to publications on ResearchGate, letting you access and read them immediately. Available online at www.sciencedirect.com Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 AcE-Bs 2011 Bandung ASEAN Conference on Environment-Behaviour Studies, Savoy Homann Bidakara Bandung Hotel, Bandung, Indonesia, 15-17 June 2011 Health-associated Cost of Urban Informal Industrial Sector: An Assessment Tool Anindrya Nastiti*, Indrawan Prabaharyaka, Dwina Roosmini & Tresna Dermawan Kunaefi Study Program of Environmental Engineering, Faculty of Civil and Environmental Engineering, Institut Teknologi Bandung, Jalan Ganeca 10, Bandung 40132, Indonesia Abstract Marginalized urban migrants thrive in informal economy, where health and safety are often neglected. Findings on previous studies have listed several informal characteristics; occupational injuries and diseases in informal setting; and components of health expenditure. This paper attempts to assess health-associated cost in informal industry through questionnaire containing basic information of respondent and household members, economic and occupational assessment. Different types of jobs surveyed, target population, biases from occupational/nonoccupational cost and household/individual expenditure, and validation method are challenges that must be addressed. This paper serves as policy-tool reference to improve the well-being of informal workers by improving nationwide workforce survey. 2011Published Publishedbyby Elsevier Selection andpeer-review peer-review under responsibility of Centre for Environment© 2012 Elsevier B.V.Ltd. Selection and/or under responsibility of Centre for Environment-Behaviour Studies(cE-Bs), Faculty of Architecture, Planning & Surveying, Teknologi MARA, Malaysia Behaviour Studies (cE-Bs), Faculty of Architecture, Planning &Universiti Surveying, Universiti Teknologi MARA, Malaysia Keywords: Urban informal sector; occupational health and safety; health expenditure * Corresponding author. Tel.: +62-222502647 ; fax: +62-222530704. E-mail address: anindrya@gmail.com 1877-0428 © 2012 Published by Elsevier B.V. Selection and/or peer-review under responsibility of Centre for Environment-Behaviour Studies(cE-Bs), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia doi:10.1016/j.sbspro.2012.03.013 Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 1. Introduction Up to the 1980s poverty was largely associated with rural areas; contrast with present dramatic increase in the numbers and proportion of the population living in urban areas, and a corresponding increase in the level of urban poverty. As a low-middle income country, Indonesia has a population of 238 million, and is undergoing a steady process of urbanization; its urban population increased from 14.8% in 1961 to 57.4% in 2010, and still growing (Kamaludin, 2004). This number is predicted to rise to 68.9% by 2030 (UN, 2005) and concentrated in the two most urbanized regions: Metro Jakarta and Greater Bandung. This rate may be faster than shown in official statistics (ILO, 2004). This situation had caused employment demand in cities to rise. Nevertheless, recognition of scarce earning opportunity in cities with their limited skills and capacity has pushed the marginalized migrants to thrive in informal economy, in situation where safety and health are often neglected. Share of urban informal sector in Asian countries ranged between 40-50 % of its workforce (Chattopadhyay, 2005). Growth of informal sector brings two contrary results based on its definition. One may define informal sector as a source of income for the poor, the basis of local entrepreneurship, and serves as affordable goods and service provider. It also considered as the sprite of slums, health risks, insecurity, and exploitation associated with the sector. Informal sector enterprises, especially those located in residential areas, pose real health hazards for the urban community, particularly for the urban poor in irregular settlements who least can afford the high cost of health care (Nwaka, 2005). Amid the height of economic crisis of 1997, the very first International Conference on Occupational Health and Safety in the Informal Sector made a statement about the national importance of informal workforces who represent the underprivileged and under-served working population. It is perceived that informal sector largely contributed to Indonesia’s economy. With the increasing share of informal activities in total employment, every country concerned with reducing poverty will aim to develop coverage for informal sector workers and their families. Social security, if properly managed, enhances productivity by providing healthcare, income security and social services (ILO, 2004). Nevertheless, informal sector statistics have not been regularly collected and have not been included in Indonesia’s official labour force statistics (Cuevas et al., 2009); thus to set up appropriate and effective policies is challenging. This study aims to summarize previous researches in informal sector and develop an assessment tools for defining informal sector, occupational health and safety behaviour and expenditure in informal setting. 2. Literature review 2.1. Definitions of informal sector Several studies attempted to define informal sectors, and they mostly distinguish it with formal sector from its legal definition and government recognition, which have neither legal status under existing legislation nor fall under the formal institutional regulation of any public sector bureau or administration (Tagnman, 2006). In addition, informal employment rely on social networks in order to gain, seek out and/or supply employment; use cultural and traditional means of support that are based on word of mouth; mutual trust, verbal agreements; sometimes serves as stop-gap solution in providing cheap labour; 100 % ‘on the job training’ for its apprentice (ILO, 2009). Other publication from ILO (2004) stated that, according to The Fifteenth International Conference of Labor Statisticians, informal sector enterprise is unincorporated enterprise with no complete sets of accounts available; owned and operated by individual/self-employed person or unpaid household members; not registered under national legislation including tax; and goods or service produced are meant for sale or barter. Some characteristics of 113 114 Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 informal jobs, compared with their formal counterparts, are absence of standard legislation, income taxation, and social protection; lower allowance; deprivation of benefits such as medical, sick leave, holiday leave, refreshment, food, insurance; longer working hours; informal recruitment; casual jobs with short duration of employment; jobs for which labour regulations are not applied, not enforced, or not complied with for any other reasons; generally poor working condition; low productivity; use of production methods that are often harmful to the environment; strong presence of women workers and, too often, child labour (ILO, 2009, ILO, 2004, and Baron, 2005). Economic Institute of Cambodia (2006) also states that business statistics, employment statistics, business registration and licensing, social security and labour protection, access to productive resources and small business associations are amongst factors that informal sector is lack of. Bocquier etc. al (2010) had identified vulnerability indicators among informal workers, which consist of contractual security, independent working, unfixed work location, casual job, unstable remuneration, underemployment, and instability of employment. The study also found out that informal sector offers higher earnings to more vulnerable jobs although it was not compensated for the poorest workers. Cuevas et al. (2009) classified ‘informal’ as informal selfemployment and informal wage employment. Under informal self-employment are employers in informal enterprises; own account workers in informal enterprises; unpaid family workers and members of informal producers’ cooperatives (Chen, 2006; in Cuevas et al. 2008). Informal wage employment includes employees without formal contracts, worker benefits or social protection who are employed either in formal or informal enterprises. He states that definitions are made in regard to the primary job or occupation, whereas a person can simultaneously have two or more jobs. 2.2. Health equity and health-associated expenditure It is acceptable that more than 80 percent of the world’s workforce in developing countries disproportionately shares in the global burden of occupational disease and injury, of both traditional and emerging hazards (Rosenstock, et al., 2006). The rate of fatal accidents in developing countries is four times higher than that in industrialized countries due to low literacy and poor safety and work training, rising exposure of fire and hazardous substances, musculoskeletal disorders, and stress-related health problems (Markkanen, 2004). These risks are higher in informal setting, due to lack of labor protection. The Department of Health, in collaboration with the World Health Organization, organized the “International Conference on Occupational Health and Safety in the Informal Sector” in Denpasar, Bali, Indonesia during 21-24 October 1997 (Department of Health, 1997; in Markkanen, 2004) pointed out that every worker has the right to OSH irrespective of the kind of an occupation or a size of an enterprise. It concluded that workers in the informal economy form an important segment of the workforce and their safety and health rights cannot be ignored. (Markkanen, 2004); and every worker has rights for fair and ethical employment, as well as social protection (Aprhorn et al, 2010). The Committee on Economic, Social and Cultural Rights has stated that the right to health requires that health and health care facilities, goods and services be available, accessible, acceptable and of good quality (Amnesty International, 2009). This means that: x A sufficient quantity of health facilities, trained professionals and essential medicines must be available. x Health facilities, goods, services and information on health must be physically and economically accessible (within easy reach and affordable) to everyone without discrimination. x Health facilities, goods, services and information must be acceptable, that is respect medical ethics, be culturally appropriate and sensitive to gender requirements. Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 x Health facilities, goods, services and information must also be scientifically and medically appropriate and of good quality. This requires, among other things, skilled medical personnel, scientifically approved and unexpired drugs and hospital equipment and adequate sanitation. The questions is, do health and health care facilities be available, accessible, acceptable, and in good quality for urban informal workers? According to ILO (2004), there are 550 million working poor that earning less than US$1 a day; consist of urban working poor, which mostly contribute in informal economy. Informal workers are vulnerable because they have little or no access to social protection and not covered by National Labor Code and therefore cannot rely on the Social Security Law for any of its benefits and protections (Economic Institute of Cambodia, 2006). They are exposed to sickness, disability, accidents and premature death, in addition to loss of the little assets they have due to their poor living and working condition, where there is, but not limited to, lack of clean water and sanitation, high flood exposure and fire risk, casual use of toxic substances, dehumanizing work methods, over density, accidents from using equipment (ILO, 2004, Patel, 2002, Arphorn et al, 2010). Even though they should receive attention from municipal government since these marginalized occasionally live in the heart of cities, health and safety protections are rare, causing health inequality to occur. These marginalized migrants receive low health care quality and emergency services without social protection in form of occupational insurance. This absence of social protection can make the smallest crisis to ruin them, such as injured head of household urges children from working, debt, or if there is nothing that can be done, the family will trap in chronic poverty (ILO, 2004). 3. Methodology Desktop study was conducted to gather information and findings from previous researches regarding informal sector and health-associated expenditure, and the results serves as the basis in formulating a questionnaire as assessment tools. 4. Results and discussions From 1967 to 1996, total and percentage of urban poor decreased gradually in Indonesia, but monetary crisis in Asian countries since 1997 had caused poverty to widely reappear, especially in urban area. In 1998, terminations of employments extensively occurred; causing thousands of ex-formal workers from low-income community became jobless, or thriving in non-formal sector, or migrate to their home villages (Kamaludin, 2004). This is one of factors that probably caused informal sector increased since 1998 in which economic and political crisis hit Indonesia hardest on the same year. Ever since, number of informal workers continued to increase (as shown in Fig. 1). Informal sector is considered as the last resort for the poor, especially when development fails to do so. Dewi and Mahmudin (2005) examined the role of street vendors, typical urban informal workers and possible bridging with formal sectors through relocation. Ali&Sakano (2009) studied informal recycling business in which ecological and economic contribution were measured. Muljarijadi and Thio (2008) valuated urban informal economic activities of flea market traders through willingness-to-pay survey. Common concluding remarks of those studies are the ability of informal sector in absorbing workforces which were unaccepted by formal sector, apparent contribution of informal economic activities to the whole urban economy, and linkage with poverty. Next, findings from previous studies of occupational safety and health (OSH) and health-associated expenditure will be presented, followed by development of questionnaire as an assessment tool. 115 116 Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 Fig. 1. Trend of informal workers (left) and informal entities (right) in five sectors other than agriculture in Indonesia based on work sectors from 1996 to 2004 are known to grown since economic crisis hit in 1998. Source: Data was taken from official website of Statistical Center Agency, www.bps.go.id, 2010 4.1. OSH hazards and risks in informal sector Inadequate safety and health standards and environmental hazards are particularly evident in the case of the informal sector. Majority of workers in the informal economy, which represents 60% of Indonesian working population (The Department of Health, Indonesia, Strategic Planning of Occupational Health Program 2002 – 2004, 2002, in Markkanen, 2004), are women and children working under poor working conditions and unregulated working hours. Replicating formal labour market, poor working environment and limited safety measures are part of strategy of micro enterprises to reduce operational cost of informal sector, and the issue is ranked in lower priority of work related problems compared to income and insecurity issues (Corrêa-Filho et al., 2010, Luebker, 2008). In fact, most of informal sector micro enterprises operate on locations which are not legally recognized for the purpose and with no right of ownership. In developing countries, in which informal economy thrives, official statistics on occupational injuries of informal workers remains unincorporated into national database; attributed to a lack of governmental interest in occupational health, poor data and data collection systems, and weak enforcement of health and safety regulations (Nuwayhid, 2004). Studies related with occupational injuries of informal workers have been done privately by academic institutions or international agencies. Loewenson (1998) summarized commonly perceived health risks in both urban manufacturing and rural agricultural areas as respiratory problems, eye problems, traumatic injury, musculoskeletal problems, backache, and muscle strain. Similar to this, Sutarjo (2007) suggested that most of the ergonomics problems are found in the informal sector in which muscle disorder symptoms in account for the most frequent complaints. Among automotive and machinery repair and metalwork sector of the urban informal economy in the Philippines, an array of hazards, including long working hours, poor housekeeping, inadequate welfare facilities, ventilation and lighting, poor work posture and work methods, chemical exposure, and inadequate provision on personnel protective equipment (PPE) have Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 been noted (Atienza, 2007). Nastiti et al (2010) also found that informal small-scale welders, as part of urban metal-working small industry, are exposed of higher level of manganese than non-welders. Homebased industries also bring many health hazards, not only for the workers, but also to the family. Typical hazards present in poor residential area that also serves as ‘industry’, are no adequate access to clean water and sanitation, mixed workplace and living place, poor lighting, overcrowding, lack of fire safety equipment and first aids kits, and obstructed emergency exits (Atienza, 2007). During the 1990s, Indonesia has undergone a period of rapid growth until 1997; which the number of work-related injuries tends to increase; and suffered subsequently from the financial crisis as mentioned before; which occupational safety and health becomes one of the first areas to be curtailed (Markkanen, 2004). It has been reported that workers in the informal economy in Indonesia suffer from malnutrition, parasitic diseases, asthma, skin allergies and cancers, chemical poisoning, food poisoning, musculoskeletal disorders, respiratory track problems, lymphoid and blood diseases, etc. Their work hazards include noise, vibration, heat stress, poor lighting, unsafe electrical wiring, exposure to dust and chemicals, and poor ergonomics (Joedoatmodjo, 1999; in Markkanen, 2004). Some health outcomes are found in most occupations, such as musculoskeletal disorders and sanitation-related health outcomes in informal industry environment. Nevertheless, some findings elaborated earlier indicate that safety and health hazards and risks are specific for each type of job, although. Therefore, assessment tools for informal sector must be adjustable according to type of jobs. 4.2. Health-associated expenditure Acs&Nichols (2005) elaborate non-food expenses in low-income working families into housing expense as the largest expenditure, out-of-pocket health expense, and childcare expense. In developing countries, the expenses sometimes are not necessarily to be expenditure. Sometimes the poor do not spend on housing, health and childcare, due to, for example, staying with family member; never seek for medical treatment when sick; and taking care of their own children. A ‘catastrophic’ health payment has traditionally been defined as costs for a treatment or illness as a proportion of income, with various studies choosing different cut-offs. For example, Su et al. (2006) offers cut-off values of catastrophic health payments to range between 5-20% of the total household income; and 40% of income remaining after subsistence needs have been met (Xu et al., 2003 in Su et al., 2006). The term, ‘catastrophic’ does not necessarily equal with expensive or high cost, considering available resources of poor household are spent for basic needs, and even small health cost can make the family to suffer (Su et al., 2006). Household usually has catastrophic health payment if has family member who suffers chronic disease, and headed by disabled or elderly person (Merlin, 2002, Xu et al., 2005; in Su et al., 2006). An alternative approach is to define payments as ‘catastrophic’ if they force households to reduce their consumption on items necessary for general well-being and economic security, or to take out loans; as coping strategies (Flores, 2008, in Nguyen et al, 2009). The expense for treatment of occupational injuries is high compared to income of informal workers (Alfers, 2006). Wobus&Olin (2002) had elaborated components of health expenditure into hospital inpatient services (room and board and all hospital diagnostic and laboratory expenses, and emergency room expenses incurred immediately prior to inpatient stays), hospital outpatient services (visits to both physicians and other medical providers seen in hospital outpatient departments), emergency room services (visits to medical providers seen in emergency rooms not resulting in a hospital admission).These expenses include payments for services covered under the basic facility charge and those for separately billed physician services. Moreover, the writers also suggested two other components of health cost, which are office-based medical provider services (visits to medical providers seen in office-based settings or clinics), and prescription medicines. Studies in Vietnam suggests a health care system that relies 117 118 Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 significantly on out-of-pocket payments exposes households to risks of high treatment costs (Nguyen et al., 2009). This study gathered household-level information regarding illness and treatment in the previous 12 months, including inpatient treatment (appointment/treatment for which the member stayed overnight in a health facility); outpatient treatment (appointment/treatment received at a health facility not requiring an overnight stay); and self-treatment (any means used to treat an illness that was not administered/prescribed by a health care professional); information on health costs; means of payment and coping strategies. This study revealed that health treatments force households to resort to detrimental coping strategies. The poor and near-poor households are particularly vulnerable, because health treatment costs account for a greater proportion of their total resources. Lost income and other indirect costs can comprise near half of the health payment burden for households in a Vietnamese rural commune. Loans and reduced food expenditure are major ways of funding costly inpatient and outpatient treatments, with poor households especially vulnerable to food reduction and a downward spiral of debt and intensifying poverty (Nguyen et al, 2009). Another one-year study in Burkina Faso, West Africa revealed that in area with no risk-pooling mechanism, as in Indonesia, out-of-pocket health expenditure is more than 50% of total health payment (WHO, 2005, in Su et al, 2006). This study only encompassed share of direct health expenditure in nonfood expenditure for seeking treatment, including drugs, consultation fees, hospital beds and services, transport and daily living cost for accompanying family members. The study resulted in factors affecting catastrophic expenditure are economic status, utilization of modern healthcare, number of illness episode. Major financial problems caused by occupational injuries for many poorer workers lead to two major health cost factors: direct and indirect cost. Many studies failed to include indirect cost for health aspect, therefore burden of indirect health cost, such as loss of income, loss of productivity, and lower life quality due to permanent disability, is remain overlooked. Burden of health-associated cost with informal economy is far from appreciated. Not also employees in formal sector in general have better income so appropriate health care is affordable, but they are also protected by companies’ health insurance and health and safety measures in their workplaces. 4.3. Statistical data availability and development of assessment tool Attempts in providing data in workforce had long been implemented through Indonesia’s Labor Force Survey or “Sakernas”, as a component of Statistics Indonesia’s system of household surveys. However, estimates are generated only for individual household members aged 15 years and older. Most importantly, Sakernas did not openly categorize formal and informal occupation status in the tabulation. This lack of informal data interpretations have led to minimum attention to informal sector employment. Moreover, Sakernas does not have sufficient questions for determining poverty status; therefore, it is hard to determine informality status based on wage approach (Cuevas et al., 2009). To validate these perceptions, comparative analysis of wages, benefits and working conditions between formal/informal workers by employment status can be undertaken. These results will be informative on the risks faced by informal workers and could also become the basis for designing appropriate social and legal protections for the informal workforce. Attempting to revise Sakernas, in 2009, under the Asian Development Bank’s regional technical assistance, Badan Pusat Statistik piloted Informal Sector Survey in two provinces, Yogyakarta and Banten, which incorporated expanded labour survey and identified Household Unincorporated Enterprises with some Market Production/HUEMs (BPS, 2009). The results of this survey showed that the labour market was dominated by informal employment, particularly in less developed areas. These results show that in terms of economic production, as measured by the GRDP, the share of the informal sector is much less than that of the formal sector. However, with regard to jobs, informal employment is a vital source of income to the employed population (BPS, 2010). Informal Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 Sector Survey (BPS, 2009) collected the data in two phases. First phase identified household/individual unit while second phase identified production unit as the subset of first phase results. The questionnaire included questions on work status, income, and expenditure which will be useful in developing health cost survey in informal sector. Considering the magnitude of informal sector as small-scale and household based, Joshi&Dahal (2008) summarized the procedural guidelines to assess such industries as follows: walk-through surveys, identification of hazards, sampling (exposure assessment), health assessment, occupational history, post sickness absence review, biological effect monitoring, and review of medical records. However, this guideline requires high cost and need to be developed furthermore to calculate statistical significance of the association between exposure and disease outcome. Important determinants of health care expenditure were illness rate, income level, family size, and education level (Satayavongthip, 2001). Arphorn et. al (2010) developed interview questionnaire for rubber tappers in Thailand to measure the impact of health and safety intervention into three parts, as follows: (1) Personal factors covering general details including age, sex, number of average daily working hours, number of sleeping hours, number years, and daily income (2) Costs for healthcare and the prevention of work-related accidents, injuries and illnesses (including training, personal protective equipment, exercise, supplementary food and herb, and annual medical check-up), and (3) Costs for treatment of work-related accidents, injuries and illnesses. The work-related accidents in third component of questionnaire are specific for rubber-tapping work, and include loss of income, self-care, and medical care. Mock et al. (2005) carried out a more detailed household survey of occupational injuries in Ghana which include annual incidence rates, injuries by occupational category, mechanism of injury, and out-ofpocket expenses, whether by modern practitioners or traditional healers, as part of the discussion. Survey was relied on self-reports by respondents which had tendency to underreport events that would be sensitive to discuss, such as intentional injury. Likewise, there would be a tendency to under-report minor injuries that occurred several months to a year before the interview. Thus, the rates reported were minimum estimates, with the real rates being higher. This study showed that occupational injuries had greater fatality rates than non-occupational injuries, and led to a much longer disability period and time off work. Health-associated cost is assessed through questionnaire, which is developed into three main parts: A. Basic Information (identity of respondent and household member), B. Economic and Occupational Assessment, and C. Working Condition and Occupational Injury. Using this questionnaire, researchers are able to predict health expenditure percentage to income, particularly for occupational injury. Developed questionnaire in this study is elaborated in Table 1 below. Table 1. Developed questionnaire framework A. Identity of respondent and household member B. Economic and Occupational Assessment C. Working Condition and Occupational Injury A.1 General information: gender; age; relationship; education; occupation; monthly income. B.1 Occupation Pattern: recruitment; work duration; work level; contractual aspect; working hours; working days; casual income; severances; work benefits (day-off, nutrition, medical); bank account; payment method; casual task. C.1 Workplace Condition: location; number of workers (including women and children); registration status and tax status of workplace. A.2 Migration history: place of birth; previous living places; reason for B.2 Household Income: monthly income from primary wage, overtime pay, secondary job, and family business; monthly income of C.2 Occupational Accident: frequency of accident; injured body parts; type of 119 120 Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 migration. own household member; remittances in. injury; task during accident. A.3 Health History: history of acute and chronic diseases of respondent; history of acute and chronic disease of family member; age of head of household. B.3 Household Expenditure: non-food expenditure (water, cooking fuel, transportation, electricity, solid waste management, communication, religious ritual, marriage, death, beauty, cigarette, recreational, business equipment, tax and contribution); food expenditure (including infant formula milk); others (education, clothes, electronic appliances, health); remittances out, expense on other family member. C.3 Health-expenditure and behaviour: day-loss; preference of medical facilities; information regarding drugs (selfprescription); transportation cost; inpatient cost (emergency room cost, prescription drugs cost, cost for household member attending in hospital, doctor cost); outpatient cost; follow-up treatment; sources of health information; loss of productivity; disability loss. The first part deals with basic information, such as ages and latest education, of each household member who currently reside in the same dwelling with the informal worker. This part also covers migration history, to identify whether respondent is a migrant and has local identification. Absence of official identification of present residency often complicates a settler to obtain appropriate health care or social protection. Part A also identifies health history of respondent and family member and age of head of household; factors affecting catastrophic health expenditure in a household. The second part aims to collect detailed household income and expenditure data under 30 days and 12 months recollection period. The third part gathers the condition of work place and occupational and non-occupational injury data as well as related direct and indirect cost under 12 months recollection period. Informality of respondent’s occupation is determined based on registration status of his workplace or business (in Part C), along with other identified characteristics of informal employment in Part B. Several challenges that must be addressed in designing an assessment tool are elaborated as follows; x First, OSHA hazards are specific for each type of jobs; and questionnaire must be adjusted according to type of jobs surveyed. Therefore, hazard and risk analysis must be conducted prior investigating health-associated cost. x Second, determining target population may be difficult since informal workers are rarely registered, and their work location are commonly scattered. x Third, bias from occupational and non-occupational cost and household and individual expenditure may be present. x Fourth, validation method must be determined to ensure reliability of result, using production cost of health services. x Fifth, the questionnaire is designed for household setting to identify coping strategy due to catastrophic health expenditure; but differentiating health expenditure for individual who works in informal sector and expenditure for family member may be confusing for respondent. 5. Conclusion While informal sector largely contributes to the economy of developing countries, such as Indonesia, it is unofficially recognized and rarely controlled. Else than unstable income, poor working conditions, and unregulated working hours, series of occupational and safety hazard pose a serious threat to the wellbeing of the workers, who are unprotected by formal means. This paper offers a framework in quantifying socio-economic parameters of informal employment. Data collection, in informal setting, faces different biases which potentially reduce the level of validation. Assessment tool in predicting associated health cost of occupational accident and injury in informal sector should be able to minimize those biases to which design of layout of questionnaire plays Anindrya Nastiti et al. / Procedia - Social and Behavioral Sciences 36 (2012) 112 – 122 an important role. The position of informal workers and socio-economic relationship in their household should be considered and integrated in the assessment. To minimize distraction and indisposition, the survey is designed to take place in workers’ residence. Considering the possibility of multiple income contributor and different expenditures for each household member, the survey should collects incorporated income and expenditure data of the whole members. Health associated costs should be detailed to specific units to unveil hidden costs. Household survey assists the recollection activity during the interview with informal workers with which household members will be able to corroborate the answers. This paper, including the assessment tool, is useful to improve nationwide workforce survey, such as Sakernas, by including associated cost of occupational health and safety elements. Furthermore, this paper is available as policy-tool reference to improve the well-being of informal workers. 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