Social Protection Measures Research Articles

Assessing social protection influence on health status in the European Union.

Health status and access to healthcare services are crucial factors that directly impact the well-being of individuals and societies. In the European Union (EU), social protection measures are significant in supporting citizens' health and providing access to healthcare resources. This study investigates the relationship between social protection and health status in EU countries. We collected data from Eurostat on the EU member states' health status, healthcare expenditure, and social protection expenditure. The paper used structural equation modeling (SEM) and cluster analysis to analyze the complex interplay among these variables. Findings revealed a strong positive correlation between EU countries' social protection expenditure and healthcare status. Higher social protection spending was associated with improved access to healthcare services and facilities. Moreover, the analysis showed that countries with higher social protection expenditure tended to exhibit better overall health status indicators among their populations. The results suggest that adequate social protection expenditure positively influences health status in the European Union. By investing in robust social protection programs, governments can enhance citizens' access to healthcare services and resources, ultimately leading to improved health outcomes. These findings underscore the importance of prioritizing social protection policies to address health disparities and promote public health in the EU.

Aging Population in Vietnam: Challenges, Implications, and Policy Recommendations

Objectives: This paper aimed to critically examine challenges of Vietnam in addressing its aging population, highlighting its status as the third fastest aging nation in ASEAN, after Singapore and Thailand. The primary goals are to grasp the impending demographic shift and offer recommendations for policymakers. Design: This study is a comprehensive review providing insights into the aging situation in Vietnam. It focused on short and long-term strategies to tackle challenges posed by the rapidly growing older adult population. It contextualized the aging issue in its socio-economic landscape. The review spanned 2020 to 2050, outlining the expected transformation in the population aged 65 years or above. Setting(s): The study has focused on Vietnam’s aging population by consolidating the secondary data sources. Participants: The study is a secondary data and hence various secondary sources have been used to analyze the data of this study. Interventions: There are no interventions used in this study. Outcome measures: Anticipated changes in the percentage of the population aged 65 years or above serve as outcome measures. This commentary projects an increase from nearly 7% in 2020 to 14% by 2035, tripling to 21% by 2050, indicating the magnitude of the aging challenge in Vietnam. Results: The present review proposes recommendations to address the aging issue, including boosting the skilled workforce, investing in technology and research and development (R&D), enhancing human capital, promoting international migration, creating additional funding opportunities, and introducing social protection measures. The results section encapsulates these suggested strategies as potential solutions to identified challenges. Conclusions: Vietnam faces a significant aging challenge with a rapid increase in the older adult population. This commentary advocates for a proactive approach by policymakers. The recommended strategies, both short and long-term, aim to mitigate economic and social challenges associated with an aging population. The conclusion stresses the importance of timely and effective policy measures to ensure sustainable development amid demographic changes in Vietnam.

Psychiatric rehabilitation in routine Indian mental health practice: A review of social protections for persons with mental health conditions.

An estimated 200 million Indians have mental health conditions - a sizeable proportion of them requiring psychiatric rehabilitation services. The numbers of mental health professionals are abysmally low. Early psycho-social rehabilitation interventions can improve functional outcomes, reducing disability. Psycho-social interventions have been made possible with the shift away from medical and charity models of disability to the establishment of social protections for vulnerable groups. The authors have undertaken a narrative review of all the social protection measures that can be explained to persons affected by mental health conditions and their family members. A larger tabulation is provided as an appendix to this article that has details of all the social protection measures across the states and union territories of India. This tabulation can be useful as a one-stop reference for every mental health practitioner in India toward informing persons affected by mental health conditions and their family members about how recovery journeys can be advanced. The data have been compiled after extensive searches of official government websites, information brochures, and even relevant legal provisions. For almost all the social protection measures provided by the central or state government, a disability certificate is a prerequisite. Rehabilitation today is a collaborative process aimed at community re-integration. In the absence of specialized services like those of clinical psychologists, vocational trainers, and psychiatric social workers, the psychiatrist becomes the sole point of contact. Motivated community members, recovered services users, and family members can aid mental health professionals by disseminating this knowledge further.

A Study of Internal Working Female Migrants in Kochi City, Kerala

As migration is dominated by men, with women comprising either residual or dependent followers, its gender dimensions are rarely addressed in literature in India. The decision to migrate of women is often highly influenced by intra-household gender relations and hierarchies. They often migrate out of concerns of household poverty or to ensure family survival through remittances as supplementary income. In this context, the paper attempts to study the socio-economic background, and working and living conditions of working female migrants in Kochi city. It also examines the reasons for their migration, benefits received and the problems faced at work in the city. The paper is based on primary data collected from 184 female migrants working in urban informal labour market of Kochi city, Kerala State, during January to April 2023. The findings of the study revealed all the sample migrant women to be engaged in informal sector, owing to their low education and skill. While their push factors for migration were poverty and debt at native home, the pull factors to Kochi city included more regular employment and better income. They are largely self-employed and work as domestic help or street vendors. They work for hours longer than prescribed under minimum work hours, besides lacking social protection measures. Their perceived problems at work were low wages, work not regular and longer working hours. The major benefits of migrant family in Kerala were better employment and income, infrastructure and children’s education. The Lorenz curve shows that there is a significant decline in the income inequality among migrant households with the additional income earned by the female migrants. The study recommends the need for local language mediators, to help the migrants benefit from the State’s migrant workers welfare schemes.

Inclusive or exclusive? Examining the dynamics of social protection in Saudi Arabia

This article provides an analysis of social protection responses to the pandemic in Saudi Arabia with a focus on policies targeted at migrant workers. Using data from multiple pandemic-era policy tracking databases and other resources, we use a descriptive case study through the lens of comparative welfare regime theory to include a comprehensive set of social protection and labor market measures. We found that, in sum, the Saudi government expansively scaled up its social protection system in response to COVID-19 with 86 implemented social protection measures. Labor market policies in the form of wage subsidies, labor regulations, and activation measures were the most prevalent type of social protection responses used by the Saudi government, complemented by social assistance measures in the form of cash transfers, food, vouchers, utility, and financial obligation support. Social insurance measures such as paid sick leave, healthcare insurance, unemployment insurance schemes, and social security contributions were the least adopted. Despite its expansions, the Saudi social protection system continued to largely neglect non-citizens and migrant workers. Saudi social protection system must pivot toward the full inclusion of non-citizens and migrant workers. COVID-19 has highlighted systemic gaps in Saudi social protection systems. It has magnified some of the country’s critical social protection challenges, which can inform future crisis response and the development of social protection systems.

Shock-Responsive Social Protection for Displaced Persons in the IGAD Region: Lessons from COVID -19 Compounding Risks

Large-scale disasters and shocks are becoming increasingly frequent, protracted and complex. Social protection system is a potentially effective mechanism in reducing the impacts of these risks on vulnerable households and to build their resilience. The need for social protection for migrants during crisis came into sharp focus during the COVID - 19 pandemic. The study used in-depth desk review from secondary sources complemented with key informant interviews from four countries - Ethiopia, Kenya, Uganda and Somalia. The findings show that IGAD Member States with less - developed social protection systems such as Somalia were poorly prepared and struggled to launch rapid and effective social protection responses to COVID - triggered hardship to cover migrants. Unlike non-migrants who were registered as additional beneficiaries on national cash transfer programmes, many migrants lacked similar social protection in the duration of lockdown. In view of complex future shocks in the context of a changing climate, states are strongly encouraged to strengthen their social protection measures to be shock-responsive by reforming their laws, strengthening collaboration, develop data sharing protocols and information management system and linkages to early warning systems to trigger swift transfer of resources in the event of a crisis. This study offers lessons that will inform future inclusive policy responses on social protection for migrants during crises. 

U prilog snižavanja starosne granice krivične odgovornosti - drugačiji pogled na "večitu dilemu"

The journal Crimen 3/2023 published an article entitled "Lowering the age limit of criminal responsibility: an eternal dilemma?" in which the author presents arguments against this solution. The aim of this analysis is to provide the opposite arguments, in favor of lowering the minimum age of criminal responsibility, so that the reader can make his judgment based on the pro and contra argumentation. Opponents of lowering the minimum age of criminal responsibility (MACR) mostly refer to the argument of "accepted international standards" as well as to the humane, altruistic statement that children perpetrators of criminal offenses are most often victims of poor socio-economic conditions that "force them into crime", so that they should not be punished, but that they should be helped. In the first part of the paper are analysed international standards and MACR in European and non-European countries. We are proving that international standards regarding MACR does not exists, but MACR is different in different countries. The structure of juvenile crime in Serbia is analysed in the second part. Statistical data show that juvenile crime in recent years is increasingly violent and brutal, what confirm the thesis that MACR should be lowered. The third part of the paper deals with juveniles sanctions. They are relatively mild and do not differ much from the measures of social protection, except that they are not imposed by social services but by judicial authorities, whose authority can only act encouragingly and frighteningly on the child to stop with criminal behaviour. In this sense, we do not see that lowering the MACR would drastically "deteriorate" the position of children, except that perhaps the fear of "criminal responsibility" would deter them from committing criminal offenses. In the end, we deal with the psycho-physical (in)maturity of children starting from the premise that we should not only observe the protection and interests of the child perpetrator, but also the protection and interests of the child victims and victims in general, who feel powerless in a system in which they cannot achieve material or moral satisfaction. Statistics show that the most common victims of juvenile crime are other children, and protection of the childperpetrator in such cases means neglection of the child-victim. The law cannot and should not be only "particularly human", neither for the sake of abstract "humanity" turn an eye to concrete crimes. The issue of lowering the age of criminal responsibility below 14 should be considered because this limit was set at another time and for minors who had a completely different lifestyle and who committed mostly property crimes. Having in mind all that, we advocate that MACR should be reduced to 12 years for all or alternatively only for violent crimes, and in terms of "criminally irresponsible" children, some form of parental criminal responsibility should be introduced. Because the child, by birth itself becomes a legal subject, and the consequences of his actions or the pain inflicted on the victim cannot be attributed to "force majeure", but exclusively to their guilt or the guilt of their parents.

SWOT Analysis on The Views of Midwives Assigned in The Delivery Room About The Effects of The Covid-19 Pandemic: A Qualitative Study

Objective: The aim of this study is to examine the experiences of midwives working in the maternity ward during the COVID-19 pandemic by SWOT analysis.
 Materials and Methods: A descriptive qualitative study reported following the COREQ guidelines. For the purposes of this study, 40 midwives working in the delivery room throughout the pandemic were interviewed. Research data were collected using a Personal Information Form (PIF) and a SWOT analysis interview form. One-on-one and indepth telephone interviews were conducted with the midwives. All interviews were recorded with the consent of the midwives. Collected data were transcribed and a content analysis was carried out using the MAQDA 2020 program.
 Results: Data collected in the study were categorized under four main themes as “Strengths”, “Weaknesses”, “Opportunities” and “Threats”.
 Conclusion: Midwives worked under difficult conditions during pandemi, so they were extremely tired and worn out. Midwives who could not go home during this difficult period gave psychological warfare because they were separated from their families. In addition, they thought that they could not provide adequate care and support to pregnant women at the time of delivery within the framework of social distance protection measures. This made them feel professionally inadequate.
 Bangladesh Journal of Medical Science Vol. 23 No. 01 January’24 Page : 150-159

Reimagining the Social During the Covid-19 Pandemic: Scientific Denialism, Brazilian Diplomacy and the ‘Virus of Communism'

Examining the circulation of scientific statements during the Covid-19 pandemic in Brazil from an STSperspective, the article argues that the denialism espoused by the far-right diplomatic circles oftheJair Bolsonaro administration must be understood in light of the disputes, which the virus revived, over different forms of imagining the social. Iexamine how the very reality of Covid-19 and the socioeconomic crisis to which it gave rise, urging governments to adopt social protection measures and strong forms of international cooperation, became the object of intense disputes between representatives of the so-called ‘anti-globalism’in Brazil’sdiplomatic institutions

Social protection of the population in rural areas

The goal of the research is to characterize the impact of social protection measures on rural households. A broad description of the current literature on social protection measures rationalizes the choice of methods for this article. Methods of dialectical, analysis and synthesis, comparison, analogy, abstract-logical, monographic, economic-statistical methods were used. The current trends in the implementation of social protection of the population in rural areas are revealed. The core of the analysis is that social protection of the population is a necessary component of the economy, so reforms in this area should be effective both in the short and long term. It is noted that Kazakhstan is constantly improving the legislative framework in the field of social policy. The factors affecting the transformation of social protection are outlined. Measures of social protection of rural population are evaluated. Direct and indirect relationship between the social sphere and socio-economic development of society is characterized. It is revealed that various practices of digitalization of social sphere have become actively implemented in rural areas. These are online counseling, video counseling, web-based programs, virtual reality for the rehabilitation of persons with disabilities. There is an active transition from the declarative nature of social services to the digital space. The authors conclude that social protection brings social benefits, contributing to the sustainable development of rural areas.

Informality, Food Insecurity and Intra-Household Resource Allocation: Evidence from Pakistan

The significance of employment in alleviating household poverty and enhancing overall well-being is widely acknowledged. In Pakistan, even with the notable growth in agricultural production, the country struggles with significant levels of food insecurity, affecting approximately 20.3 percent of the population, as indicated by a 2019 global report. This research investigates the impact of informal employment on the Food Insecurity Experience Scale (FIES) and the distribution of resources within households, including categories such as food, non-food items, education, and health. Utilizing data from the Household Integrated Economic Survey (HIES) conducted in 2018-19, fractional response and ordered logit models were employed to analyze the influence of informal employment on resource allocation across various categories and household food insecurity. The findings indicated that households headed by individuals in informal employment typically allocate a more significant portion of their budget to food and health than those in formal employment. Moreover, the impact of informal employment on non-food expenses appears limited, and households with informal workers demonstrate reduced spending on education compared to their formal counterparts. Additionally, the study highlights a higher probability of severe or moderate food insecurity levels in households headed by individuals in informal employment. Comprehending employment and household welfare dynamics necessitates a thorough understanding of intra-household dynamics. This research contributes valuable insights for policymakers, aiding in identifying critical areas for expanding social protection measures for informal workers.

Features of social protection by implementing the right to disconnect

The article examines the realisation of the right to disconnect in the framework of workers’ social protection. The study explores different approaches to the definition of a new right. The right to disconnect is analysed on the basis of targeting and universality of social protection, soft and hard measures, the components of the new right, which include workers’ opportunity, employers’ responsibility, communication between employers and workers, protection from adverse consequences. The legal acts that serve as a foundation of the right to disconnect create a separate work pattern of teleworkers, which affects the formation of the targeting approach to social protection. The regulation of the right to disconnect introduced in European Social Partner framework agreement on digitalisation and European Parliament resolution of 21 January 2021 with recommendations to the Commission on the right to disconnect gives a more universal approach. The Resolution acknowledges the right to disconnect as a fundamental right and proposes hard regulatory and technological measures to ensure observation of work and rest periods. The agreement is based on the change in corporate culture. It is revealed that nowadays the right to disconnect serves as the only project aimed at regulating digital working relations in the framework of social protection of remote workers, however R2D can be limited by a narrow category of teleworkers. Debates over the right to disconnect touch upon the issue of the effectiveness of social dialogue in the context of adaptation to digital work organisation, as well as the possibility of keeping binary understanding of work and rest periods.

Planning with a gender lens: A gender analysis of pandemic preparedness plans from eight countries in Africa

BackgroundHealth planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa. MethodsMulti-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis. ResultsAll plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries. ConclusionsThe plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

Features of the occupational prevalence in health workers in the Republic of Bashkortostan over 2017–2022

Introduction. The labour of health workers (HW) is associated with the impact of adverse factors of various nature including chemical, physical, biological, high neuro-emotional stress, physical activity. All these factors, high workload, round-the-clock working with night shifts, unpredictability of the state of health and responsibility for the life of the patient, high olccupational activity, constant psycho-emotional and intellectual stress make the labour of HW to be a complex and responsible type of human activity. Over recent (2020–2021) years, due to the emergence of a highly contagious Covid-19 viral infection, health workers have been in direct contact with patients.
 Objective. To determine the features of occupational morbidity among the HR in the Republic of Bashkortostan over 2017–2022 including the COVID-19 pandemic.
 Materials and methods. Data on occupational diseases in HW over 2017–2022 were studied on the base of the materials of the Republican Center for Occupational Pathology of the Ufa Scientific Research Institute of Occupational Medicine and Human Ecology. There were evaluated reports of the final diagnosis of an occupational disease, acts of investigation of occupational diseases, sanitary and hygienic characteristics of working conditions, a consolidated annual report on the activities of the Center.
 Results. The level of occupational morbidity increased from 0.6‱ in 2017 to 5,6‱ during 2021, i.e. increased by 9.3 times. The nosological, gender, age, occupational and experience structure of morbidity has changed. In 88.8% of cases, the diagnosis of an acute occupational disease due to coronavirus infection was established posthumously: in 2020 – 100%, in 2021 – 86.3%. There were 0.72 deaths from this infection per 1,000 health workers.
 Conclusions. To preserve the health and occupational longevity of HW, especially in the context of an epidemiological rise in infectious diseases, it is necessary to strengthen priority measures for primary and secondary prevention, provide personal protective equipment, strengthen disinfection measures, establish a special regime of work and rest, and other preventive and social protection measures.

The social protection aspect of the subjective assessment of the material security of large and foster families: the results of a comparative qualitative study

Modern demographic trends in the field of fertility have led to increased state attention in recent years to issues of social protection of motherhood and childhood, social support for families with children. This trend has resulted in a significant increase in the list and volume of social benefits and other social benefits, and an increase in the number of their recipients. The issue of evaluating the effectiveness of measures taken by the state is becoming increasingly relevant, not only from the standpoint of quantitative statistical indicators, but also by studying the opinion of beneficiaries. The article presents the results of a study aimed at determining subjective assessments of the material security of families with children in connection with their receipt of social protection and support measures. The object of the study is families with children belonging to the categories of large and foster families. By the method of in-depth qualitative interviews, representatives of households of 10 large families and 10 foster families living in large and small cities of the Irkutsk region were interviewed. The author has revealed significant differences in assessments between representatives of different categories of families with children. Large families express dissatisfaction with the following positions: the availability and amount of social benefits; the amount of benefits and the complexity of obtaining them. In conditions of dependence of social benefits on the size of the per capita income of family members, the status of having many children ceases to play a social protection role, not being a significant factor in ensuring the material well-being of the family. On the contrary, foster families note: a significant increase in the amount of payments for the maintenance of foster children and the remuneration of foster parents; an increase in the list and volume of additional social support measures. These measures have made it possible to increase the level of financial security of foster families. Foster parents expressed the need to take into account the needs of foster children not only of a minimal nature, but also related to their development, health maintenance, and additional education. The results obtained made it possible to formulate approaches to solving problems of a social protection nature of the considered categories of families with children. For foster families, it is important to gradually expand measures of social support for foster children based on monitoring needs. In relation to large families, it is necessary to radically change the social protection mechanisms based on the recognition of the status of having many children, which gives the right to receive additional social guarantees.

The concept and system of functions of social protection for judges in Ukraine

The article aims to clarify a comprehensive understanding of social protection functions for judges in Ukraine. It explores the concept and system of these functions, which constitute an integral part of social relations and processes aimed at ensuring an appropriate level of social security for judges. The application of social protection measures by authorized subjects of social law reflects the socio-legal, democratic, and economic nature of the state's development, highlighting the significance of social protection for judges in guaranteeing their independence and the independence of the judiciary in Ukraine. Through a critical analysis of various scholarly perspectives on the structure of social protection functions, the article establishes that the system of social protection functions for judges consists of three main groups. The first group comprises the basic functions that encompass the primary areas of social protection for the population. These functions contribute to normalizing social security levels for different segments of society, taking into account the state's socioeconomic development. Key functions within this group include economic, social, political, demographic, and informational functions. The second group of functions pertains to judges as professional public servants. These functions encompass organizational, preventive, restorative, compensatory, adaptive-stimulating, social protection, and social rehabilitation functions. They recognize the specific needs and vulnerabilities of judges in their roles as employees and aim to provide the necessary support to ensure their well-being and effective performance. The third group of functions arises from the main functions of social protection and contributes to the comprehensive implementation of social protection for judges in Ukraine. These functions encompass control and prevention, innovation, ideological, and commitment, and they further enhance judges' social protection effectiveness and scope. In conclusion, the article summarizes the findings of the study, shedding light on the concept and system of functions of social protection for judges in Ukraine.

THE ROLE OF PUBLIC POLICY IN ENSURING PUBLIC HEALTH

A healthy population is the key to the long-term development and existence of any state. Therefore, one of the important tasks of the state is the development and implementation of relevant policies aimed at maintaining and strengthening the health of all segments of the population. The purpose of this study was to determine the role, influence and instruments of public policy for the preservation and promotion of public health. During the study, a retrospective analysis of the literature data, as well as the legal framework of Ukraine in the field of maintaining the health of the population, was performed. Adequate policies that may have an impact on the health of the population are implemented through ensuring the population's access to medical care; social protection measures; education and through economic aspects. The mechanism for implementing policies to ensure public health includes institutions and organizations that form the policy and interaction of all participants to implement policies, as well as regulatory and legal documents through which these initiatives are actually implemented. Today Ukraine is in difficult social and economic conditions. There is a negative trend in the health of the population. However, despite this, Ukraine implements policies to preserve and improve the health of the population by joining the global process of achieving the Sustainable Development Goals; adoption of the Law of Ukraine “On the system of public health”, which is aimed at protecting and strengthening the health of the population, preventing diseases, improving the quality and increasing life expectancy, ensuring the sanitary and epidemic well-being of the population; development of regulatory documents on priority areas for the development of the healthcare sector for the period up to 2025.

Livelihood support for caregivers of children with developmental disabilities: findings from a scoping review and stakeholder survey

Purpose Poverty amongst families with a child with disability adversely impacts child and family quality of life. We aimed to identify existing approaches to livelihood support for caregivers of children with developmental disabilities in low- and middle-income countries. Methods This mixed-method study incorporated a scoping literature review and online stakeholder survey. We utilised the World Health Organization community-based rehabilitation (CBR) matrix as a guiding framework for knowledge synthesis and descriptively analysed the included articles and survey responses. Results We included 11 peer-reviewed publications, 6 grey literature articles, and 49 survey responses from stakeholders working in 22 countries. Identified programmes reported direct and indirect strategies for livelihood support targeting multiple elements of the CBR matrix; particularly skills development, access to social protection measures, and self-employment; frequently in collaboration with specialist partners, and as one component of a wider intervention. Self-help groups were also common. No publications examined effectiveness of livelihood support approaches in mitigating poverty, with most describing observational studies at small scale. Conclusion Whilst stakeholders describe a variety of direct and indirect approaches to livelihood support for caregivers of children with disabilities, there is a lack of published literature on content, process, and impact to inform future programme development and delivery.

Household costs incurred when seeking and receiving paediatric tuberculosis services: a survey in Cameroon and Kenya

Background Elimination of catastrophic costs due to tuberculosis (TB) is one of the three targets of the World Health Organization (WHO) End TB Strategy. Limited data have yet been reported on the costs experienced by households of children receiving TB services. We quantified the economic impact on households with children seeking and receiving TB services during the Catalyzing Pediatric TB Innovations (CaP-TB) project in Cameroon and Kenya. Methods Within the INPUT stepped-wedge cluster-randomised study evaluating the effect of CaP-TB integration of TB services in paediatric entry points, we designed a cross-sectional facility-based survey with retrospective data collection using a standardised questionnaire adapted from the WHO Global taskforce on TB patient cost generic survey instrument. Caregivers of children receiving TB services (screening, diagnosis and treatment of drug-sensitive TB) during the CaP-TB project were interviewed between November 2020 and June 2021. Direct medical, direct non-medical, and indirect costs for TB services were analysed following WHO Global taskforce recommendations. We used the human capital and output-based approaches to estimating income loss. All costs are presented in 2021 US dollars. Results A total of 56 caregivers representing their households (Cameroon, 26, and Kenya, 30) were interviewed. The median household costs for TB services, estimated using the human capital approach, were $255 (IQR; $130-631) in Cameroon and $120 ($65-236) in Kenya. The main cost drivers across both countries were direct non-medical costs (transportation and food), 52%; and medical costs, 34%. Approximately 50% of households reported experiencing dissavings (taking a loan, or selling an asset) to deal with costs related to TB disease. Using a threshold of 20% of annual household income, 50% (95%CI; 37-63%) of households experienced catastrophic costs when using the human capital approach; (46% (95%CI; 29-65%) in Cameroon and 53% (95%CI; 36-70%) in Kenya). Estimated costs and incidence of catastrophic costs increased when using the output-based approach in a sensitivity analysis. Conclusions Accessing and receiving TB services for children results in high levels of cost to households, despite the provision of free TB services. Strategies to reduce costs for TB services for children need to address social protection measures or explore decentralisation. Registration: https://clinicaltrials.gov/ct2/show/NCT03862261.

Challenging the formality bias: The organization of informal work, working relations, and collective agency in Kenya and Tanzania

AbstractMotivationFormal social protection systems, such as health insurance and representation, are often biased in favour of formal workers, thereby excluding most of the world's working population who make a living in the informal economy.PurposeThe article extends existing critiques of formality bias by investigating the reality of work for people in the informal economy in Kenya and Tanzania and analysing related social protection challenges. Specifically, we look at: (1) the governance of work; (2) the organization of work relations; and (3) collective agency. In terms of social protection, we focus on formal and informal forms of social insurance and representation.Methods and approachWe draw on interview and survey data from people working in micro trading, transport, and construction in Nairobi and Kisumu in Kenya, and Dar es Salaam and Dodoma in Tanzania. A total of 1,462 workers were surveyed and 24 focus group discussions were held with such workers. Interviews were conducted with 120 key informants: leaders and members of informal workers' associations in the three sectors, as well as representatives of authorities, trade unions, and business associations. Data were collected from June 2018 to December 2019.FindingsFormal social insurance and representation do not fit the real experience of most people working in the informal economy. They have been modelled on and designed to support workers in formal standard employment relations. At the same time, informal workers' associations play important roles in meeting—albeit inadequately—the social insurance and representational needs of their members.Policy implicationsMeaningful engagement with the reality of work and collective agency in the informal economy is necessary to inform more appropriate policies and measures to provide informal workers with appropriate social protection measures, particularly social insurance and representation. Their reality should not have to conform to an inadequate model; rather, the model should fit their reality.