For people in their 80s, night time is for sleeping. Not for 83-year-old Khem, a poor villager in Buri Ram province. Sleep is a luxury when a big fair in a city nearby means a chance for him to earn some coins from busking.
With a pair of small ching cymbals, his tunes, and a plastic cup to collect money, Khem earns about 100-200 baht a night at the fair. Not much. But for an old man without any means, every baht counts to survive his last days without much hunger.
Grandpa Khem is not the only street musician at the Red Cross Fair in Khon Kaen province. Most other street musicians are blind. Most have little education or none at all. All of them are among the most vulnerable groups in society.
How to give them better access to health care services and better quality of life? What kind of policies can best meet the needs of these informal workers who are often the poorest of the poor?
To answer these questions, the Thailand Research Development Institute (TDRI) interviewed informal workers in different occupations to find out about their specific situations and needs which vary from occupation to occupation and place to place.
According to the National Statistical Office, 54.3 % of the 37.5 million-strong workforce are informal workers. As a major part of the workforce, they are undeniably an important driving force of the Thai economy.
As informal workers, however, they suffer work insecurity, irregular income, hard work with low pay, and a lack of protection from the social security system. Consequently, many are vulnerable to extreme poverty.
Our interviews with 10 Khon Kaen street musicians shed light on the harsh life of people at the lowest rung in society and revealed many blind spots in the government’s education, public health and welfare policies which leave the poorest of the poor behind.
Nearly all of the interviewees are blind, illiterate, or — like Grandpa Khem — too old to do other work. Only one of them is of working age without any physical disability. It is clear; a combination of physical disabilities and a lack of education are the main causes of their extreme poverty. Sadly, any rehabilitation to redress their constraints is not possible due to their advancing age.
Without an education, they do not have any job options. Nearly all of them said they do not like singing and asking for money like this, but they have to do it to survive. Busking, they said, is open to people of all ages and all walks of life, allowing them to use their skills to make some money although the income is highly unstable.
Busking at fairs can bring them from 100 to 3,000 baht a day. As part of their job, they are constantly on the move, travelling to different fairs and festivals in various provinces across the country. Not staying in the same place for long robs them of access to public health welfare benefits as well as information about their rights. Some do not even know about the “gold cards” — the universal healthcare scheme that entitles them to free medical services. When sick, they then do not dare go to the hospital for medical treatment.
Most of them play down their health problems, saying that they are not serious so they do not need to go see the doctor. They have never had any medical check-ups and believe that they do not have any chronic diseases. When sick, most wait for the symptoms to disappear. When the pains persist, they just buy medicines over the counter.
Avoiding seeing the doctor may well be the effects of stigma. The feeling of shame and inferiority makes them avoid going into a formal setting for fear of being the target of contempt. They are also afraid of not having enough money to pay the doctor and the humiliation that goes with it. So even if the country has a universal healthcare system for the citizenry, the social vulnerability of the vagabond buskers prevents them from accessing the services they are entitled to.
When asked to rate on life satisfaction on the scale of one to 10, they gave a very low score, which is understandable. But this method needs a lot of explaining since most of the buskers do not understand the logic of numbers. Using numbers to gauge their feelings, then, may not give accurate results.
Despite the government’s several policies to help the poor, such as the state welfare card, our fieldwork shows that they often miss the very poor who need them most.
In the same vein, when the poor buskers are doing their work in the crowded streets or at various fairs, people in society still do not see them as a vulnerable group that needs to be rescued from being drowned in poverty.
Of the 10 buskers in the study, only three of them have state welfare cards. The rest do not, although they have over 14 people in their families to take care of. The evidence is clear; the state schemes to help the poor have largely failed to reach their target groups. Their scheme management is simply too inefficient.
The challenge is how to improve the system to help vulnerable groups in society better.
Most people with disabilities already receive monthly stipends from the government. But the money is too little to help them survive. Instead of making them dependent on the central government’s welfare money alone, the local governments should step in.
Local governments have more accurate information about the poor in their jurisdictions and they are closer to their constituents. They also have money to help the poorest of the poor in their areas. Ideally, the rich local governments should also intervene by allocating their surplus money to help the underprivileged in places where the other local governments face financial constraints.
Public health authorities should be proactive, reaching out to vulnerable groups instead of passively waiting for them to come to them. Mobile health services should be set up to give people with disabilities and the poor elderly easy access to health care.
This proactive approach could effectively prevent chronic diseases which are more costly to the health systems than preventive care. For starters, there should be mobile health services at fairs or community markets with a team making rounds to invite those who have not had check-ups to have free services at the mobile health units.
Many people with disabilities have work skills. Some buskers are very good singers. One of them is a sportsman and belongs to the Thai national team for the Paralympic Games. The government should have innovative policies to encourage companies to hire people with disabilities with work skills such as subsidising their salaries. This policy may generate low economic values, but it results in high social benefits.
The government should also compile a database of people with disabilities with work skills and liaise with the private sector to create more hirings. At present, there have been efforts in this direction, but they are still not enough to effectively help vulnerable people.
Our study once again highlights the significance of education and diverse work skills to prevent poverty in old age, especially for people with disabilities.
It is unrealistic, however, to expect someone like Grandpa Khem to learn new work skills in his 80s. As the country quickly enters an ageing society, it has become more urgent to provide social welfare protection to the elderly poor.
It is also important to prevent poverty from passing on from generation to generation. The government must strengthen social welfare benefits and safety nets so the young in vulnerable groups have access to education and occupational training.
The last thing Grandpa Khem wants is to see his grandchildren become just like him, struggling to survive by being vagabond musicians. “How could you be happy with a life like this?” he asked.
Worawan Chandoevwit, PhD, is an Associate Professor at the Faculty of Economics, Khon Kaen University, and an adviser for the Thailand Development Research Institute. Boondhariga Chonpitakwong is a researcher at Thailand Development Research Institute. Policy analyses from the TDRI appear in the Bangkok Post on alternate Wednesdays.
First Published: ฺBangkok Post on Wednesday, March 25, 2020