International Journal of Social Security and Workers Compensation
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International Journal of Social Security and Workers Compensation |
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This paper examines workplace initiatives for the management of HIV and AIDS in Zimbabwe. The HIV and AIDS pandemic has been accepted as a workplace issue which warrants intervention from employers. This is a recognition of its negative impact on productivity at the workplace. The paper argues that national instruments have been developed by the Government of Zimbabwe to facilitate the management of HIV and AIDS at the workplace. The private sector has generally accepted the need to prevent and control the HIV and AIDS pandemic at the workplace in order to arrest its negative impact not only on their businesses but on the economy generally. However, the small and medium enterprises sector is lagging behind in the development of workplace policies and programs on HIV and AIDS. While Zimbabwe’s preventive programs have been successful, the same cannot be said of compensation, treatment and care arrangements. It is noted that Zimbabwe’s social security system is not responsive to the needs of those infected and affected by HIV and AIDS. The socioeconomic challenges facing the country have also undermined workplace initiatives for the management of HIV and AIDS.
Zimbabwe, with a population of about 11 million, had its first HIV and AIDS case in 1985. It is estimated that there are about 1.7 million people living with HIV and AIDS in Zimbabwe. The percentage of the workforce lost to AIDS is projected to reach 29 per cent by 2020.[1] The HIV prevalence rate within the 15–49 years age group peaked at 33.7 per cent in 2000 but dropped to 18.1 per cent in 2006 and to 15.6 per cent in 2007. ‘The declining trend is largely attributable to behavioural changes such as increased condom use in high-risk relationships and reduction in multiple sexual partners’.[2] Despite this marked decline in the HIV prevalence rate within the 15–49 years age group, Zimbabwe still ranks among the countries in southern Africa worst affected by the HIV and AIDS pandemic. Southern Africa is considered the epicentre of the HIV and AIDS pandemic. Higher prevalence rates within the 15–49 years age group are found in Botswana and Swaziland, with 30 per cent, and Lesotho with 23.5 per cent.[3]
When HIV and AIDS first emerged as a global phenomenon, it was perceived as a health problem. However, the social and economic consequences of the pandemic convinced world leaders and experts that it was also a social and economic problem. The social impact of HIV and AIDS in Zimbabwe has clearly demonstrated that it is a social problem. For instance, it is projected that by 2010, 34 per cent of all children in Zimbabwe will either be single or double orphans as a result of HIV and AIDS.[4] Currently, there are about one million orphans in Zimbabwe. The unprecedented rise in the number of orphans has resulted in the emergence of a new phenomenon of child-headed households. This is an indication that the established care arrangements are not able to cope with the pandemic.
Furthermore, life expectancy in Zimbabwe has declined sharply as a result of the HIV and AIDS pandemic. The projection is that in ‘2010, life expectancy in Zimbabwe will be 33 years (with AIDS) and 73 years (without AIDS)’.[5] The economic impact of HIV and AIDS is manifested through reduced savings and investments and, ultimately, a slowdown in economic growth.[6] In ‘those countries where national HIV and AIDS prevalence rates exceed 20%, annual gross domestic product growth has been estimated to drop by an average 2.6 percentage points’.[7]
In recognition of the consequences of HIV and AIDS, the Government of Zimbabwe formulated a National HIV and AIDS Policy in 1999 which has three major areas of focus, namely the prevention and control of HIV and AIDS, care of persons infected by HIV and AIDS and the mitigation of the impact of HIV and AIDS.[8] The policy emphasises a multisectoral approach to the pandemic. There is, thus, space for the involvement of government, the private sector, trade unions, voluntary organisations and communities.
Globally, HIV and AIDS are regarded as workplace issues because of their negative impact on the labour force and employers. The impact of the HIV and AIDS pandemic in Zimbabwe is not different from the rest of southern Africa in that it affects the most productive age group and is consequently undermining productivity at the workplace. It has been observed that ‘AIDS-related illnesses and deaths of workers affect employers both by increasing their costs and reducing revenues’.[9] The costs to employers arise because infected workers require regular treatment for opportunistic infections. There is also continuous recruitment and training which is necessitated by the frequent deaths and the need to replace lost skills. Costs are also incurred in providing funeral assistance to employees. Loss of revenue, on the other hand, is due to reduced productivity as a result of absenteeism at work and the use of inexperienced workers.
It is common for workers to absent themselves from work because of illness or the need to attend funerals of their relatives or friends. A study undertaken in Zimbabwe revealed that some small and medium enterprises (SMEs) lost about ‘9.7 days in the last 30 days prior to the survey’ due to absenteeism attributed to either attendance at funerals or illness.[10] Such a loss is more debilitating to SMEs since their operations are labour-intensive and their staff establishments are small. Thus the absence of a single worker can have an adverse effect on productivity and may ultimately affect the continuity of the business.
HIV and AIDS also impact negatively on the labour force itself. First, increased mortality as a result of HIV and AIDS causes a significant decline in the size of the population. For instance, the populations of Botswana, Namibia and Zimbabwe ‘are expected to be about 20 per cent smaller than they would have been by 2015.’[11] Second, HIV and AIDS exacerbate the problem of child labour as orphaned children try to support themselves. In the same vein, employers are forced to keep older workers beyond their retirement age in order to preserve skills and experience and assure the continuity of their business. For the infected workers, HIV and AIDS diminish their capacity to provide adequately for their families as they are forced to divert a significant proportion of their income to meet their health care needs.
The International Labour Organization (ILO) has recognised that HIV and AIDS are also workplace issues which warrant workplace responses. Consequently, it has devised the ILO Code of Practice on HIV and AIDS and the World of Work. This ILO Code calls for the recognition of HIV and AIDS as workplace issues and acknowledges the need for workplace responses to curb the spread of the disease. Therefore, the ILO Code calls on the private sector to contribute towards the prevention of HIV and AIDS through education and information, and to provide a safe environment for workers so that the workplace does not become a source of infection. Finally, the ILO Code provides for the right of workers and their families to access health services and other benefits.
The Southern African Development Community (SADC), of which Zimbabwe is a member, has also developed a Code of Conduct on HIV and AIDS and Employment (1997). The SADC Code is informed by the ILO Code and affirms the need to develop workplace prevention programs based on the involvement of both employers and employees. The SADC Code suggests that prevention programs should include education, promotion and distribution of condoms, management of sexually transmitted diseases, and the provision of counselling services. The strength of the SADC Code rests on the fact that it protects workers against discrimination on the basis of their HIV status and calls on employers to ensure that infected workers are entitled to sick leave provisions enjoyed by the rest of their employees.
Although the Government of Zimbabwe took a long time to recognise the need for workplace responses in the fight against HIV and AIDS, it eventually introduced Statutory Instrument 202 of 1998.[12] These regulations make it an offence for an employer to require HIV testing as a precondition for employment[13] or to terminate employment on account of one’s HIV status.[14] Furthermore, the statutory instrument requires employers to develop workplace policies and programs regarding HIV and AIDS.[15] The Government of Zimbabwe has also devised the Zimbabwe National Strategic Framework for the Private Sector Response to HIV and AIDS: 2007–2010, the overall goal of which is ‘to contribute to a reduction in the number of HIV infections as well as support national initiatives to achieve commitments toward the goal of universal access to HIV prevention, care, support and treatment by 2010’.[16]
Having examined the legal provisions, it is important now to examine some of the management responses from Zimbabwe’s private sector. It is noted that many employers have responded positively, acknowledging that it is in their interest to be involved in prevention, treatment and care programs.
However, some sectors, notably the small and medium enterprises sector are lagging behind. A study of the impact of HIV and AIDS on the SME sector in Zimbabwe revealed that ‘there was a general lack of workplace HIV and AIDS programs in the SME sector as 67% of them did not have anything in place’.[17] The same study revealed that no written policies on HIV and AIDS were found in 74 per cent of SMEs. The study attributed these gaps to lack of capacity on the part of SMEs to develop policies and programs. There also appears to be lack of appreciation of the benefits that can accrue to SMEs through mounting prevention programs.
While workplace programs are common in southern Africa, Zimbabwe’s position is unique in that it is experiencing serious macroeconomic problems because of its political problems and the resultant international isolation. Businesses are struggling to survive and can hardly afford to earmark resources for the prevention and treatment of HIV and AIDS. This is confirmed by Nyika Mahachi, the HIV and AIDS program advisor at the Zimbabwe AIDS Prevention Support Organisation, when he says that:
We are meeting real challenges in carrying out HIV and AIDS programmes at workplaces, and this inevitably comes from the macro-economic problems the country is going through.[18]
Workplace initiatives on prevention focus on information dissemination, education and promotion and distribution of condoms.[19] Information is disseminated through posters, printed material and drama and workplace prevention programs make use of peer education and voluntary counselling and testing. Workers also benefit from national prevention programs which use both the print and electronic media for the dissemination of information. It is generally accepted that HIV and AIDS awareness has increased as a result of workplace HIV and AIDS prevention programs. Success in the area of behaviour change is, however, mixed. Overall, prevention programs have begun to bear fruit. A study by Katzenstein et al (1998) revealed that there was a 34 per cent reduction in the rate of new HIV infections in 40 factories that participated in workplace programs.[20]
The reduction was attributed to the impact of a peer education program that was run alongside a voluntary counselling and testing program. Factories which did not have a peer education program did not show a reduction in new HIV infections. A study of a workplace HIV and AIDS prevention and support program at Tobacco Processors Zimbabwe also revealed that 92 per cent of the workers interviewed indicated that their source of information on HIV and AIDS was the workplace-based HIV and AIDS prevention program at their company.[21] The same study attributed the success of the program to the existence of counselling services at the workplace. The use of peer educators was also reported to have contributed to this success.
The issue of treatment is critical for the management and control of HIV and AIDS at the workplace. Whilst there is no law that compels employers to provide health care to their employees or assist them to access health care, employers are, however, encouraged to do so. A few employers, however, provide health care to their employees, thereby making it easier to treat and control opportunistic infections. Tobacco Processors Zimbabwe contracted a medical doctor to provide health care to workers free of charge.[22] Not surprisingly, workers identified this as a strength of the workplace-based HIV and AIDS prevention and support program as they were able to access health care of good quality which they would not have been able to afford on their own.
The bulk of employers, in particular the smaller ones, do not have clinics at the workplace. However, they allow their workers to join private medical aid schemes where both the employer and employees contribute. A few employers pay 100 per cent of the contributions but the majority share the contributions with their workers. However, membership to medical aid schemes is increasingly becoming meaningless as patients are often asked to pay cash first and claim from the medical aid scheme later. Furthermore, the out-of-pocket expenses that are paid in order to access medical care have become so burdensome that they are now a barrier to accessing health care. This impacts negatively on the management and control of HIV and AIDS.
The provision of anti-retroviral drugs is an important component of the treatment and care component. Whilst the government is not able to provide free anti-retroviral drugs, some employers have seen fit to assist their workers to access anti-retroviral drugs. Some of the employers meet the total cost whilst others subsidise the cost of anti-retroviral drugs. However, it should be pointed out that only a few employers are providing anti-retroviral drugs to their workers. Consequently, many infected workers have no access to anti-retroviral drugs. Such workers have to rely on other initiatives outside the workplace or they have to access the drugs on the open market where the cost is prohibitive. In the end, infected workers who are unable to access the drugs continue to fall prey to opportunistic infections, resulting in increased absenteeism at work. These workers will eventually die, resulting in a loss of skilled employees. Ultimately, employers must recruit and train new workers, thereby forcing them to incur additional costs.
As part of the support arrangements, employers often reassign infected workers to do lighter duties if they are unable to continue in their present positions on account of their health. This is often the case in large enterprises where it is possible to redeploy workers. Workers in SMEs are, however, disadvantaged as there is little room for the redeployment of workers. When the illness progresses to invalidity, infected workers are forced to withdraw from the workplace. This is the point at which most of them require home-based care. When this happens, the burden of care shifts from the employer to the family.
The issue of compensation in the context of HIV and AIDS is critical for the wellbeing of workers and their families. There are two social security schemes that provide protection to workers against exposure to risks or contingencies. These are the Pensions and Other Benefits Scheme and the Accident Prevention and Compensation Scheme, both administered by the National Social Security Authority.[23] The Accident Prevention and Compensation Scheme, which is funded through employers’ contributions, provides protection against work-related injuries and diseases. Thus workers who are injured at work or who contract diseases in the course of their duties are entitled to compensation from the National Social Security Authority. However, domestic workers and the self-employed are not covered.
AIDS is generally not considered as a work-related disease. There are few instances in which workers can contract HIV in the course of their duties. Consequently, the Accident Prevention and Workers Compensation Scheme does not normally provide compensation to workers who have HIV and AIDS.[24] There are a few categories of workers, such as nurses, who may claim compensation provided the procedures are adhered to. For instance, if a nurse suffers a needle prick, she must be tested immediately for HIV and AIDS to determine her status. If she is negative but eventually tests positive, the new status would be attributed to a work injury and only then can the nurse receive compensation. This procedure suggests that it is not easy to attribute HIV and AIDS to a work-related injury or disease.
Workers exposed to the risk of HIV and AIDS, even though not work-related, can claim invalidity benefit under the Pensions and Other Benefits Scheme. The Pensions and Other Benefits Scheme provides four benefits, namely retirement benefit, invalidity benefit, survivors benefit and a death grant.[25] In the context of HIV and AIDS, invalidity benefit is payable when members are no longer able to continue working on account of their health, suggesting progression to full-blown AIDS. This invalidity status is determined by a medical board.
Workers who have contributed for a minimum period of 10 years receive an invalidity pension whilst those who have contributed for less than 10 years receive an invalidity grant which is a one-off lump-sum payment.[26] Most workers who are HIV-positive find it difficult to satisfy the contribution requirement for an invalidity pension and, therefore, end up receiving a lump-sum payment. Consequently, such beneficiaries and their dependants are likely to suffer long periods of income insecurity. The biggest drawback, however, is that workers operating outside formal employment are not covered by these compensation arrangements.
Workplace initiatives have succeeded in creating awareness about the HIV and AIDS pandemic and are contributing towards the prevention of HIV and AIDS. Whilst some employers are involved in the treatment and care of infected workers, the majority of employers are not providing treatment and care to infected workers and their families. This is particularly true of SMEs which are constrained not only by the costs of running workplace HIV and AIDS programs but also by lack of capacity. The biggest challenge facing workplace HIV and AIDS programs is a lack of financial resources, given Zimbabwe’s deepening macroeconomic problems. Under this environment, it makes little sense for employers to provide funds for workplace HIV and AIDS programs when their businesses are on the brink of collapse. It is thus imperative for Zimbabwe to address its political and macroeconomic problems in order to create an enabling environment for sustainable workplace HIV and AIDS programs.
1. International Labour Organisation (ILO), HIV and AIDS: A Threat to Decent Work, Productivity and Development, ILO, Geneva, 2000.
2. ILO, An ILO Code of Practice on HIV and AIDS and the World of Work, ILO, Geneva, 2001.
3. Integrated Regional Information Networks (IRIN), Zimbabwe: Workplace AIDS Programmes Feel the Pinch (2007) <http://www.irinnews.org/report.aspx?ReportID=75459> at 23 February 2009.
4. Jackson, H, AIDS Africa: Continent in Crisis, SAFAIDS, Harare, 2002.
5. Kaseke, E, ‘HIV/AIDS and Social Protection: Towards Socio-economic Integration and Development in SADC — A Social Policy Perspective’ (Paper presented at the Conference on HIV/AIDS and Social Protection, Lusaka, 1–2 December 2003).
6. Moyo, G, Workplace-based HIV and AIDS Prevention and Support Programme: A Study at Tobacco Processors Zimbabwe (BSW Dissertation, University of Zimbabwe, 2001).
7. Southern African Development Community (SADC), SADC Code of Conduct on HIV and AIDS and Employment, SADC, Gaborone, 1997.
8. Southern Africa HIV and AIDS Information Dissemination Service (SAFAIDS), Children and AIDS: Fact Sheet, SAFAIDS, Harare, 2001.
9. United Nations Programme on HIV/AIDS (UNAIDS), HIV and AIDS, Human Resources and Sustainable Development, UNAIDS, Geneva, 2002.
10. Zimbabwe Labour Relations (HIV and AIDS) Regulations, 1998.
11. Zimbabwe, Government of, National HIV and AIDS Policy, Ministry of Health and Child Welfare, Harare, 1999.
12. Zimbabwe, Government of, Zimbabwe National Strategic Framework for the Private Sector response to HIV and AIDS — Responding to HIV and AIDS in the World of Work: 2007–2010, Government of Zimbabwe and ILO, Harare, 2007.
13. Zimbabwe, Government of and ILO, The Impact of HIV and AIDS on SME Sector in Zimbabwe, Government of Zimbabwe, ILO, Harare, 2006.
[*] DPhil, Professor of Social Work and Director, School of Social Work, University of Zimbabwe.
[1] United Nations Programme on HIV/AIDS (UNAIDS), HIV and AIDS, Human Resources and Sustainable Development, UNAIDS, Geneva, 2002.
[2] Government of Zimbabwe and International Labour Organization (ILO), The Impact of HIV and AIDS on SME Sector in Zimbabwe, Government of Zimbabwe, ILO, Harare, 2006 at iii.
[3] E Kaseke, ‘HIV/AIDS and Social Protection: Towards Socio-economic Integration and Development in SADC — A Social Policy Perspective’ (Paper presented at the Conference on HIV/AIDS and Social Protection, Lusaka, 1–2 December 2003).
[4] Southern Africa HIV and AIDS Information Dissemination Service (SAFAIDS), Children and AIDS: Fact Sheet, SAFAIDS, Harare, 2001.
[5] H Jackson, AIDS Africa: Continent in Crisis, SAFAIDS, Harare, 2002 at 15.
[6] ILO, HIV and AIDS: A Threat to Decent Work, Productivity and Development, ILO, Geneva, 2000.
[7] UNAIDS, HIV and AIDS, Human Resources and Sustainable Development, UNAIDS, Geneva, 2002 at 16.
[8] Government of Zimbabwe, National HIV and AIDS Policy, Ministry of Health and Child Welfare, Harare, 1999.
[9] ILO, HIV and AIDS: A Threat to Decent Work, Productivity and Development, ILO, Geneva, 2000 at 20.
[10] Government of Zimbabwe and International Labour Organization (ILO), The Impact of HIV and AIDS on SME Sector in Zimbabwe, Government of Zimbabwe, ILO, Harare, 2006 at 21.
[11] ILO, HIV and AIDS: A Threat to Decent Work, Productivity and Development, ILO, Geneva, 2000 at 14.
[12] Zimbabwe Labour Relations (HIV and AIDS) Regulations, 1998.
[13] Zimbabwe Labour Relations (HIV and AIDS) Regulations, 1998 s 4.
[14] Zimbabwe Labour Relations (HIV and AIDS) Regulations, 1998 s 6(1).
[15] Zimbabwe Labour Relations (HIV and AIDS) Regulations, 1998 s 3.
[16] Government of Zimbabwe, Zimbabwe National Strategic Framework for the Private Sector response to HIV and AIDS — Responding to HIV and AIDS in the World of Work: 2007–2010, Government of Zimbabwe and ILO, Harare, 2007 at 1.
[17] Government of Zimbabwe and International Labour Organization (ILO), The Impact of HIV and AIDS on SME Sector in Zimbabwe, Government of Zimbabwe, ILO, Harare, 2006 at 31.
[18] Integrated Regional Information Networks (IRIN), Zimbabwe: Workplace AIDS Programmes Feel the Pinch (2007) <http://www.irinnews.org/report.aspx?ReportID=75459> at 23 February 2009.
[19] Government of Zimbabwe, Zimbabwe National Strategic Framework for the private sector response to HIV and AIDS — Responding to HIV and AIDS in the World of Work: 2007–2010, Government of Zimbabwe and ILO, Harare, 2007.
[20] H Jackson, AIDS Africa: Continent in Crisis, SAFAIDS, Harare, 2002 at 330.
[21] G Moyo, Workplace-based HIV and AIDS Prevention and Support Programme: A Study at Tobacco Processors Zimbabwe (BSW Dissertation, University of Zimbabwe, 2001).
[22] Ibid.
[23] E Kaseke, ‘HIV/AIDS and Social Protection: Towards Socio-economic Integration and Development in SADC — A Social Policy Perspective’ (Paper presented at the Conference on HIV/AIDS and Social Protection, Lusaka, 1–2 December 2003).
[24] Ibid.
[25] Ibid.
[26] Ibid.
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