A/HRC/20/15 informal street vendors initiated by local governments 22 and various efforts to extend social health insurance coverage in the informal sector.23 A number of interventions tailored to the needs of specific industries have also been implemented. 24 19. There are additional means by which States can address the right to health in the informal sector. These include social health insurance schemes tailored to address the sector-specific health risks faced by workers throughout the informal economy; occupational health service provision at work sites; and primary health care interventions designed to educate and train workers about occupational health. The obligation to fully realize the right to occupational health for workers in the informal economy falls directly on States. In some instances, this may require formalization through the introduction or extension of occupational health regulations in the informal economy. Where this is not possible or feasible, States should then take all necessary steps (short of those that would eliminate these jobs) to mitigate harm stemming from such employment. B. Obligation to formulate, implement, monitor and evaluate effective laws and policies towards realizing the right to occupational health 20. The obligation to fulfil the right to health requires States to formulate and implement a national health policy towards realizing the right to health. General comment No. 14 of the Committee on Economic, Social and Cultural Rights explains that it is a core obligation to formulate, implement and periodically review a coherent national policy to minimize the risk of occupational accidents and diseases, as well as to provide a coherent national policy on occupational safety and health services (para. 36). ILO conventions on occupational safety and health and on occupational health services call on States to do the same. General comment No. 14 states that a national policy on occupational health, amongst other things, should include the identification, determination, authorization and control of dangerous materials, equipment, substances, agents and work processes; the provision of health information to workers and the provision, if needed, of adequate protective clothing and equipment; and the enforcement of laws and regulations through adequate inspection (para. 36, ftn. 25). Participation 21. The right to health requires the participation of those affected in all decision-making processes affecting their health during the formulation, implementation, monitoring and evaluation of all health laws and policies. This means that workers must participate in the formulation, implementation, monitoring and evaluation of laws and policies affecting their occupational health. While established trade unions must also participate fully in this process, in some instances, they may not adequately represent the interests of some 22 23 24 8 improving safety, health and working conditions in informal economy workplaces - Experiences of Cambodia, Thailand and Viet Nam” (ILO Subregional Office East Asia, Bangkok, 2007) p. 2. See Tsuyoshi Kawakami, “Participatory approaches to improving safety, health and working conditions in informal economy workplaces,” p. 3; Francie Lund and Anna Marriott, Occupational Health and Safety and the Poorest, Research Report No. 88, School of Development Studies, Durban, South Africa, April 2011, p. 19. Inke Mathauer, Jean-Olivier Schmidt and Maurice Wenyaa, “Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand,” International Journal of Health Planning and Management, vol. 23, No. 1 (January/March 2008), pp. 51–68; Rebecca Thornton and others, “Social security health insurance for the informal sector in Nicaragua: A randomized evaluation,” Health Economics, vol. 19 (2010), pp. 181-206. See Francie Lund and Anna Marriott, Occupational Health and Safety and the Poorest.