PurposeThe purpose of this paper is to establish the main factors influencing willingness to pay for health insurance and pension schemes among informal workers in low- and middle-income countries (LMICs). Historically, informal economy workers have been excluded from social protection coverage. There is a growing need, interest and policy discourse in LMICs to extend social security to informal economy workers. However, little is known about informal workers' willingness to pay (WTP) for social security services in different LMIC settings.Design/methodology/approachThe authors conducted a systematic review and searched five databases from 1987 to 2017. Included papers focused on “social security”, “social insurance”, “pension”, “informal economy”, “informal sector” and “informal workers” in LMICs. Authors conducted independent data appraisal and data extraction. A total of 1790 papers were identified. After exclusion, 34 papers were included in the analysis. Given the heterogeneous results, the authors performed a narrative synthesis to consolidate the findings of the different studies.FindingsIn total, 34 studies from 17 countries were included in the review, out of which 23 studies focused on health insurance, 7 studies on pension schemes and 4 studies on social security in general. The study showed that income and trust were associated with WTP for both health insurance and pension schemes. In addition, family size, age, education and residential area were common factors for both forms of social security. For health insurance, experience of sickness, attitude and presence of medical doctors as well as distance from the healthcare facility all played a role in determining WTP. For pension schemes, low and flexible contribution rates, benefit package, government subsidies and quality of administration of the schemes influenced enrolment and contributions.Research limitations/implicationsMore evidence is needed for WTP for pensions among informal workers.Practical implicationsThe findings show that socio-economic differences, scheme-type (health or pension) and level of trust influence WTP for health insurance or pension among informal sector workers. The review results suggest that the factors influencing WTP for health insurance and pensions interplay in a complex web of relations. More evidence is needed on WTP for pensions among informal workers.Social implicationsFurther studies are particularly needed on the interrelationship of the influences to WTP, including gender issues, access barriers and socioeconomic factors, among program design issues for social security.Originality/valueThis paper is based on a systematic review methodology and contributes to the discourse on extending social security to informal economy workers based on evidence from various countries.

There is growing interest to extend social protection coverage to people working in the informal economy. This interest has risen through the realization that the right to social protection is not yet a reality for 71 per cent of the world's population (International Labour Organization 2017). In the Asia and Pacific region, for example, only 38.9 per cent of the population are effectively covered by at least one social protection cash benefit compared to 67.6 per cent in the Americas; while Africa has only 17.8 per cent of the population covered (International Labour Organization 2017). Access to social protection is still a challenge, more so for the informal sector, who are not poor enough to qualify for social transfer schemes and not rich enough to participate in existing contributory schemes (OECD 2019).Recent experience with the COVID-19 crisis, especially in low-and middle-income countries, has exposed the fractured labour market and social protection systems that do not cover the 'missing middle' (Rutkowski 2020). Lock-downs that characterized responses to the COVID-19 pandemic meant permanent or temporal loss of work and income for some people in the informal economy. In the North, lock-downs meant that taxis lost 80 per cent of customers, but neighbouring sector food delivery increased (Svynarenko and Perkiö 2020), suggesting that not all informal sectors suffered equally. In some countries, restaurant workers, street vendors and domestic workers could not report for work while farmers in rural areas experienced low sales of their farm produce due to restrictions in movement (ActionAid 2020). At the same time, unpaid care work increased due to closure of schools and other facilities.Governments responded differently when it came to mitigating social-economic challenges caused by the COVID-19 crisis. Reports suggest that cash transfers were being adapted to the COVID-19 response. Administrative adaptations such as flexibility in the time of collection took place in Algeria, while home delivery of cash for seniors was implemented in Armenia (Allahoum et al. 2020). At the same time, Egypt, for example, increased benefits among pre-existing programmes. However, most people remained uncovered by social protection programmes leaving them vulnerable to various shocks. Therefore, extending social protection coverage to the informal economy, including to agricultural workers, presents an opportunity to reduce poverty and vulnerability.This chapter examines contributory social protection coverage, for informal economy workers, including the agricultural sector focusing on alternatives for contributory schemes for this population. In Section 22.3 we discuss the characteristics of the informal economy. Section 22.4 shows the magnitude of informal economy workers across the globe, and Section 22.5 highlights challenges in coverage extension for this group. Section 22.6 presents policy options for extending coverage and argues for an integrated approach comprising tax-financed social transfers, contributory social i...

With many countries experiencing high prevalence rates of HIV scaling up ART, it is vital to assess quality assurance in health facilities accredited to provide these HIV and AIDS-related services. Reviewed literature indicates that there are limited studies in Zambia on the capacity of accredited health care facilities to provide effective HIV/AIDS related services. Using data from a large ethnographic qualitative study in a resource poor rural setting in Zambia, this paper assesses quality assurance in health facilities to providing HIV/AIDS services in a remote rural setting. Findings show that although HIV and AIDS related services were available at the remote rural health facility of Chivuna, the services provided did not meet the WHO minimum guidelines/standards on the provision of such services. Therefore, there is need for such facilities to be adequately equipped in all the departments of ART delivery so as to ensure effective delivery of these services and universal access.

With the enactment of Statutory Instrument No. 72 (2019), Zambia is extending pension coverage to workers in the informal economy. We present evidence on the experiences and perspectives of domestic workers and bus and taxi drivers regarding pension scheme coverage in Zambia. We use data generated through interviews and focus group discussions. The analysis shows that pension schemes, as conventionally designed for formal economy employees, are not compatible with the values, beliefs and needs of informal economy workers, and pension coverage was not a priority for them. As a form of social innovation, extending access to pension coverage had a lower relative advantage and lacked incentives to attract informal economy workers. We propose a member-centred framework for initiating the extension of social security coverage to informal economy workers.

Zambia embarked on an ambitious plan to extend the pension scheme to informal economy workers traditionally excluded from the scheme, including small-scale farmers. Estimates suggest that there are at least 1.5 million small-scale farms in Zambia, and that over 80 per cent of the rural population depends on agriculture-related activities (Central Statistical Office Zambia 2015). This case study presents and analyses the ongoing initiative to extend pension schemes to small-scale farmers in Zambia. SOCIAL PROTECTION IN ZAMBIAZambia has no overarching legal framework to support comprehensive provision of social protection, including pensions. This situation is worsened by the lack of recognition of the economic, social and cultural rights in the constitution (Ministry of Community Development Mother and Child Health 2014). Consequently, citizens are not guaranteed social protection despite most being vulnerable to social and economic risks, as reports show that over 54 per cent of the population lives in poverty (Central Statistical Office Zambia 2018).Despite the lack of a unified legal framework, existing laws support contributory social security. It is mandatory for all formally employed individuals (currently about 15 per cent of the labour force) to contribute to one of the three public schemes: (1) the Public Service Pension Fund, (2) the Local Authority Superannuation Fund; or (3) the National Pension Scheme. The National Pension Scheme Authority (NAPSA) is responsible for extending coverage to those in informal employment and it provides three principal benefits: retirement, invalidity and survivors (NAPSA 2019) and a funeral grant. Additionally, the Workers' Compensation Act, No. 10 of 1999 establishes the Workers Compensation Fund, administered by the Workers Compensation Fund Control Board. This institution provides for a wide range of benefits including life pension or lump-sum invalidity payments to workers with static or permanent injuries or diseases, widow's or widower's monthly pensions, child allowances, reimbursement of medical expenses incurred by employers on treatment and hospitalisation of injured or disabled workers (Phe Goursat and Pellerano 2016).