Access to healthcare services and products is a critical gap for the 4 million workers in Bangladesh's ready-made garment (RMG) sector, and particularly for women workers, who comprise approximately 80 percent of the workforce. Bangladeshi law requires factories with more than 300 workers to provide basic healthcare facilities and personnel, such as nurses and doctors. However, the current healthcare systems in RMG factories face a number of challenges in providing beneficial, relevant, and accessible services to workers.

With the support of UKaid, BSR conducted a gap assessment of onsite healthcare services and facilities in 10 RMG factories in Bangladesh from June to July 2014. We identified five gaps in the factories’ healthcare systems:

1. Nurses lack the skills and qualifications to perform their jobs. This includes a lack of formal medical education among some nurses or a mismatch between nurses’ training and workers’ health needs, such as counseling on personal hygiene and sexually transmitted infections.
2. Insufficient attention is given to health education and women’s health issues, even though the majority of workers in the factories are women.
3. Clinic facilities and processes need improvements, such as facility cleanliness, waste-disposal and other client-safety protocols, record-keeping, and publicly available information about hours and services.
4. Factories’ healthcare management systems must be strengthened. Although all of the factories had documented healthcare policies, communication and accountability mechanisms were often weak.
5. Health workers are insufficiently prepared to respond to emergencies. Worker-safety measures following the Rana Plaza tragedy have focused on infrastructural upgrades, while factories' health-response systems have lagged.

Workplace healthcare services can help fill gaps in Bangladesh’s weak health system. Given that the RMG sector represents 75 percent of Bangladesh’s exports, improving clinic operations and nurse competencies will strengthen the country’s economy, contributing to a more inclusive system and increasing productivity and profits.

There are a few ways to strengthen factory healthcare systems. For instance, factories and international buyers can invest in both people (appropriately trained nurses) and systems (maintaining sound clinic operations and stocking appropriate health and hygiene products). International buyers can incentivize this by including health-related indicators and clinic-assessment areas into factory audits—and ensuring that third-party monitors do the same. Furthermore, factories can develop standard policies related to health and well-being of their workforce, and appropriate channels to communicate these to all stakeholders.

Finally, collaborative initiatives that focus on health and safety, such as the Alliance for Bangladesh Worker Safety and Bangladesh Accord on Fire and Building Safety, should consider healthcare worker and systems development in their subsequent phases of activity.

Following our gap assessment, BSR and partners are designing a program to train currently employed nurses to better respond to the populations they serve in factories. We will also transform clinic-facility assessments into working plans for factories interested in upgrading their facilities. BSR will pilot both initiatives in 2015.

If you are interested in participating in this work, please contact getinvolved@herproject.org.