Partner Care Arrangements and Older Europeans' Well-Being: Variations by Gender and Context

Across Europe, partners are often primary caregivers to older adults with care needs. Yet, a variety of partner care arrangements may arise. Little is known about the interrelations between partners’ care arrangements, (potential) caregivers’ gender, and the context in which care is embedded. We use 2015 SHARE data from 17 countries on 3,465 couples aged 50+ where one partner receives care. We examine how life satisfaction and depressive symptoms of (potential) caregivers vary across five care arrangements: solo-care; shared formal; shared informal; outsourced formal; and outsourced informal. We explore heterogeneity by gender and across four contexts: Northern, Western, Southern, and Eastern Europe. Outsourcing partners’ care to formal or informal providers is linked with higher well-being among Northern and Western European women, but with lower well-being among women in Southern Europe, where traditional female caregiving responsibilities are stronger. Among men, outsourcing partner care is linked to higher well-being regardless of context.

Engaging Informal Private Health Care Providers for TB Case Detection: Experiences from RIPEND Project in India

Background. Informal (unqualified) health care providers are an important source of medical care for persons with presumptive TB (PPTB) in India. A project (titled RIPEND) was implemented to engage informal providers for the identification of PPTBs and TB patients in 4 districts of Telangana State, India, during October 2018-December 2019 project period. Engagement involved sensitizing the informal providers about TB, providing them financial incentives to identify PPTBs, and linking these PPTBs to diagnostic and treatment services provided by the Government of India’s National TB Elimination Programme. Objectives. To describe (a) the characteristics of the informal providers, along with their self-reported practices on TB diagnosis, treatment, and challenges encountered by the RIPEND project staff in engaging them in the project and (b) the outputs and outcomes of this engagement. Methods. We used a combination of one-on-one interviews with informal providers, group interviews with RIPEND project staff, and secondary analysis of data available within the project’s recording and reporting systems. Results. A total of 555 informal providers were actively engaged under the project. The majority (87%) had a nonmedicine-related graduate degree and had been providing medical care for more than 10 years. Most (95%) were aware that a cough for 2 weeks or more is a symptom of pulmonary TB and that such patients should be referred for sputum-smear microscopy at a government health facility. Challenges in engaging the informal providers included motivating them to participate in the study, suboptimal mobile usage for referral services, and delays in providing financial incentives to them for referring PPTBs. During the project period (October 2018-December 2019), 8342 PPTBs were identified of which 1003 TB patients were detected and linked to TB treatment services. Conclusion. This project showed that engaging informal providers is feasible and that a large number of PPTB and TB patients can be identified through this effort. The Government of India should consider engaging informal providers for the early diagnosis of TB to reduce the missing TB cases in the country.

The prominent role of informal medicine vendors despite health insurance: a weekly diaries study in rural Nigeria

In sub-Saharan Africa, accessibility to affordable quality care is often poor and health expenditures are mostly paid out of pocket. Health insurance, protecting individuals from out-of-pocket health expenses, has been put forward as a means of enhancing universal health coverage. We explored the utilization of different types of healthcare providers and the factors associated with provider choice by insurance status in rural Nigeria. We analysed year-long weekly health diaries on illnesses and injuries (health episodes) for a sample of 920 individuals with access to a private subsidized health insurance programme. The weekly diaries capture not only catastrophic events but also less severe events that are likely underreported in surveys with longer recall periods. Individuals had insurance coverage during 34% of the 1761 reported health episodes, and they consulted a healthcare provider in 90% of the episodes. Multivariable multinomial logistic regression analyses showed that insurance coverage was associated with significantly higher utilization of formal health care: individuals consulted upgraded insurance programme facilities in 20% of insured episodes compared with 3% of uninsured episodes. Nonetheless, regardless of insurance status, most consultations involved an informal provider visit, with informal providers encompassing 73 and 78% of all consultations among insured and uninsured episodes, respectively, and individuals spending 54% of total annual out-of-pocket health expenditures at such providers. Given the high frequency at which individuals consult informal providers, their position within both the primary healthcare system and health insurance schemes should be reconsidered to reach universal health coverage.

Innovation and Financial Inclusion in Kenya Innovation and Financial Inclusion in Kenya

This chapter analyzes the role of financial innovation and mobile phone technologies to financial inclusion in Kenya. In order to do so, a case study on M-PESA is conducted, the leading mobile service of money transfers in Africa, which is offered by Safaricom. M-PESA services are cheap and easy to use in comparison to other formal and informal providers of financial services. It solves two different problems in Kenya: customers do not have to travel anymore long distances to reach financial services and more people can afford them. As result and in line with the literature, this chapter suggests that M-PESA services can be considered a type of disruptive innovation that promotes financial inclusion and wealth growth in Kenya.

Empty stocks and loose paper: Governing access to medicines through informality in Northern India

Based upon research in the state of Bihar, India, this article argues that informal access to medicines in Northern India is a core element of the government of healthcare. Informal providers such as unlicensed village doctors and unlicensed drug sellers play a major role in access to medicines in Bihar, in the particular context of the dismantling of public procurement services. Building on recent works in the socio-anthropology of pharmaceuticals, the article shows the importance of taking into account the political economy of drugs in India, in order to understand local problems of access more fully. If informal providers occupy such an important position in the government of healthcare in India, this is partly due to the shaping of healthcare as access to drugs on health markets. Elaborating the argument from interviews with health professionals and patients, the article first shows the situation of public healthcare and public procurement in Bihar; then it presents the role of informal medicine providers; lastly, it shows how patients deal with the fact that they live in a ‘pharmaceutical world’ where access to health equates with access to medicines.

Healthcare seeking patterns of families of infants with circumcision-related morbidities from two population-based cohort studies in Ghana

ObjectiveThis study assessed healthcare seeking patterns of families of infants with circumcision-related morbidities and families of infants with acute illnesses in rural Ghana.DesignTwo population-based cohort studies.SettingBrong Ahafo Region of central rural Ghana.ParticipantsA total of 22 955 infants enrolled in a large population-based trial (Neovita trial) from 16 August 2010 to 7 November 2011 and 3141 infants in a circumcision study from 21 May 2012 to 31 December 2012.Primary outcomeCare seeking for circumcision-related morbidities and acute illnesses unrelated to circumcision.ResultsTwo hundred and thirty (8.1%) infants from the circumcision study had circumcision-related morbidities and 6265 (27.3%) infants from the Neovita study had acute illnesses unrelated to circumcision. A much lower proportion (35, 15.2%) of families of infants with circumcision-related morbidities sought healthcare compared with families of infants with acute illnesses in the Neovita study (5520, 88.1%). More families sought care from formal providers (24, 69%) compared with informal providers (11, 31%) for circumcision-related morbidities. There were no obvious determinants of care seeking for acute illnesses or circumcision-related morbidities in the population.ConclusionsGovernment and non-government organisations need to improve awareness about the complications and care seeking needed for circumcision-related morbidities.

Innovation and Financial Inclusion in Kenya Innovation and Financial Inclusion in Kenya

This chapter analyzes the role of financial innovation and mobile phone technologies to financial inclusion in Kenya. In order to do so, a case study on M-PESA is conducted, the leading mobile service of money transfers in Africa, which is offered by Safaricom. M-PESA services are cheap and easy to use in comparison to other formal and informal providers of financial services. It solves two different problems in Kenya: customers do not have to travel anymore long distances to reach financial services and more people can afford them. As result and in line with the literature, this chapter suggests that M-PESA services can be considered a type of disruptive innovation that promotes financial inclusion and wealth growth in Kenya.