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PARAGUAY: Health Insurance for All (Registered) Domestics

Natalia Ruiz Díaz

ASUNCION, Sep 17 2009 (IPS) - It took 42 years for social security health care coverage for domestics to extend beyond the limits of the Paraguayan capital.

The measure adopted by the social security institute, the Instituto de Previsión Social, could potentially benefit some 290,000 people – mainly women – working in domestic service throughout this impoverished landlocked South American country of 6.1 million, as well as their families.

“This is a huge stride forward which will help improve the living conditions of domestics in Paraguay,” the president of the Association of Domestic Service Workers (AESD), Solana Meza, told IPS.

The challenge now is to get employers to register their domestics with the social security system, which very few have done.

Although health care coverage is obligatory for formal sector workers under Paraguay’s labour code, only as of this week do all domestic workers have a right to health insurance – 42 years after the inclusion of that stipulation in the social security institute’s charter in 1967.

Domestic workers were not covered when the Instituto de Previsión Social was established in 1943. That situation began to change when a special system for health insurance for domestics went into effect in Asunción in 1967. The aim was to gradually expand it to the whole country. But that never happened.

The social security institute’s health care insurance covers maternity, non work-related illness, work-related illness and accidents, surgery, dental care, medication, hospitalisation and a disability subsidy.

A 1987 law expanded health coverage to the worker’s family for maternity, illness and accidents.

“But although this was already in force in Asunción, people didn’t know about it – especially not women from rural areas, who make up a majority of domestics here,” said Meza. Most employers do not register their domestics with the social security institute and pay the monthly contribution of around 10 dollars, and the domestics, for their part, are largely unaware of their rights.

Domestics account for roughly 10 percent of the economically active population of 2.9 million in Paraguay, and 93 percent of them – 213,000 – are women. (Male domestic workers are mainly gardeners and drivers.)

But only three percent – 6,000 – are registered with the social security institute, and only 2,500 actually make use of its services.

Domestic work is the leading occupation of women in Paraguay, accounting for one out of five women who are employed. Fifty-seven percent of domestics are between the ages of 15 and 29, while 70 percent have only partial primary school education or no formal schooling at all, according to the General Statistics, Surveys and Census Office.

Most domestics are young, impoverished Guaraní-speaking women from rural areas with little to no education.

In Paraguay, around 95 percent of the population is of mixed indigenous and Spanish descent, and both Spanish and Guaraní are official languages. But Guaraní-speakers with a limited education often suffer discrimination.

Carmen Frutos, the director of the Instituto de Previsión Social, said the expansion of health insurance to all domestics is a major step towards reducing inequalities in this country.

“Paraguay has the lowest rate of health and social security coverage in the Americas, but we mean to start changing that with measures like the ones we have adopted for domestic workers,” she told IPS. That is one of the aims of the government of centre-left President Fernando Lugo, who took office in August 2008.

“With the expansion of the system, a large part of the health care for domestics will be subsidised, and they will have access to medical attention above and beyond the bare minimum. But they will not have access to a retirement pension or to coverage for complex medical cases,” she explained.

Complete social security coverage for domestics would require a modification of the current legislation, because domestic employment is deemed to have special characteristics, and is thus regulated differently than other kinds of jobs.

The minimum monthly salary for domestics – most of whom are live-in, and thus receive room and board – is set at 40 percent of the minimum wage for other workers, which stands at around 285 dollars today.

And although they have the right to the “aguinaldo” – a month’s bonus salary paid to all workers – they do not receive the family allowances that the governments pays to the rest of the country’s registered workers.

The family allowance is five percent of the minimum monthly salary for each dependent child under the age of 17 living with the beneficiary.

Meza said that achieving the same minimum wage as other workers is one of the AESD’s main goals, along with paid vacation time and maternity leave for the women who do much of the cooking, cleaning and child-rearing for so many middle-class and wealthy Paraguayan families.

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