Diet Quality Among Mothers and Children in India: Roles of Social and Behavior Change Communication and Nutrition-Sensitive Social Protection Programs.

BACKGROUND: Limited evidence exists on determinants of maternal and child diet quality. OBJECTIVES: This study examined the role of social and behavior change communication (SBCC) and nutrition-sensitive social protection (NSSP) programs on maternal and child diet quality. METHODS: Data were from cross-sectional phone survey on 6627 Indian mothers that took place in late 2021. The Diet Quality Questionnaire (DQQ) was used to measure maternal and child diet quality, including minimum dietary diversity (MDD), dietary diversity scores (DDSs), noncommunicable disease (NCD)-protect and NCD-risk scores, adherence to dietary guidelines (All-5 and India-All-6), and unhealthy child feeding. Multivariate regression models were used to explore the association between diet indicators and coverage of SBCC and NSSP programs. RESULTS: Maternal and child diet quality was suboptimal, with more mothers (57%) achieving MDD than children (23%). SBCC was positively associated with healthy food consumption in children (odds ratio [OR]: 2.14 for MDD; ß: 0.60 for DDS and 0.54 for NCD-protect) and mothers (ß: 0.38 for DDS and 0.43 for NCD-protect). Cash transfers were associated with healthier diets in mothers (OR: 1.45 for MDD, 1.86 for All-5, and 2.14 for India-All-6; ß: 0.43 for DDS and 0.26 for NCD-protect), but less associations noted for children (ß: 0.14 for NCD-protect). Receiving food was associated not only with healthier diets in mothers (OR: 1.47 for MDD; ß: 0.27 for DDS and 0.33 for NCD-protect) and children (ß: 0.19 for DDS and 0.15 for NCD-protect) but also with unhealthy food in children (OR: 1.34). Exposure to multiple programs showed stronger associations with diet quality. CONCLUSIONS: SBCC has greater positive impact on child feeding than food and cash transfers, while cash has a stronger association with improved maternal diets. Food and cash are also associated with unhealthy food consumption. Our study underscores the importance of interventions that combine education, resource provision, and targeted support to promote maternal and child diet quality.

Social protection and the International Monetary Fund: promise versus performance.

BACKGROUND: Countries in the Global South are currently facing momentous economic and social challenges, including major debt service problems. As in previous periods of global financial instability, a growing number of countries have turned to the International Monetary Fund (IMF) for financial assistance. The organization has a long track-record of advocating for extensive fiscal consolidation-commonly known as 'austerity'-for its borrowers. However, in recent years, the IMF has announced major initiatives for ensuring that its loans support social spending, thus aiding countries in meeting their development targets and the Sustainable Development Goals. To assess this track record, we collected spending data on 21 loans signed in the 2020-2022 period, including from all their periodic reviews up to August 2023. RESULTS: We find that austerity measures remain a core part of the organization's mandated policies for its borrowers: 15 of the 21 countries studied here experience a decrease in fiscal space over the course of their IMF programs. Against this fiscal backdrop, social spending floors have failed to live up to their promise. There is no streamlined definition of these floors, thus rendering their application haphazard and inconsistent. But even on their own terms, these floors lack ambition: they often do not foresee trajectories of meaningful social spending increases over time, and, when they do, many of these gains are eaten up by soaring inflation. In addition, a third of social spending floors are not implemented-a much lower implementation rate from that for austerity conditions, which the IMF prioritizes. In several instances, where floors are implemented, they are not meaningfully exceeded, thus-in practice-acting as social spending ceilings. CONCLUSIONS: The IMF's lending programs are still heavily focused on austerity, and its strategy on social spending has not represented the sea-change that the organization advertised. At best, social spending floors act as damage control for the painful budget cuts: they are instruments of social amelioration, underpinned by principles of targeted assistance for highly disadvantaged groups. Alternative approaches rooted in principles of universalism can be employed to build up durable and resilient social protection systems.

Systematic review of cash plus or bundled interventions targeting adolescents in Africa to reduce HIV risk.

BACKGROUND: HIV remains a leading cause of death for adolescents and young people aged 10-24 years. HIV prevention requires multisectoral approaches that target adolescents and young people, addressing HIV risk pathways (e.g., transactional sex, gender-based violence, and school attendance) through bundled interventions that combine economic strengthening, health capabilities, and gender equality education. However, best practices are unknown because evidence on multisectoral programming targeted to adolescents and combining these components has not been systematically reviewed. METHODS: We conducted a systematic review to summarize the evidence on bundled interventions combining health and economic strengthening components for adolescents and young people and their effects on HIV/STI incidence and risk factors. We included studies from Africa published between 2005 and 2023, combining at least one economic strengthening and one health component, directed toward adolescents and young people aged 10-24 years. Included studies measured programmatic impacts on primary outcomes: HIV and STI incidence/prevalence; and mediators as secondary outcomes: sexual behaviours, sexual and reproductive health, school attendance, health-seeking behaviours, and violence. We conducted key word searches in PubMed, EMBASE, and Web of Science, imported titles/abstracts from the initial search, and reviewed them using the inclusion criteria. Full texts of selected articles were reviewed and information was extracted for analysis. Findings from the full texts identified were summarized. RESULTS: We reviewed 58 studies, including 43 quantitative studies and 15 qualitative studies, evaluating 26 unique interventions. A majority of studies reviewed were conducted in Eastern and Southern Africa. Interventions reviewed showed a greater number of significant results in improving economic outcomes; mental health and psychosocial outcomes; sexual and reproductive health knowledge and services utilization; and HIV prevention knowledge and testing. They showed fewer significant results in improving outcomes related to HIV incidence/prevalence; sexual risk behaviours; gender-based violence; gender attitudes; education; STI incidence, prevalence and testing; and sexual debut. CONCLUSIONS: Our review demonstrated the potential for bundled, multisectoral interventions for preventing HIV and facilitating safe transitions to adulthood. Findings have implications for designing HIV sensitive programmes on a larger scale, including how interventions may need to address multiple strata of the social ecological model to achieve success in the prevention of HIV and related pathways.

Social protection as a strategy for HIV prevention, education promotion and child marriage reduction among adolescents: a cross-sectional population-based study in Lesotho.

BACKGROUND: Lesotho's government has shown consistent efforts to implement social protection programmes. However, while recent evidence established a positive causal relationship between some of these programmes and food security there is little evidence on the extent to which these initiatives are associated with better educational and sexual and reproductive health outcomes among vulnerable adolescents in Lesotho. METHODS AND FINDINGS: The study uses cross-sectional, nationally representative data from the 2018 Lesotho Violence Against Children and Youth Survey. Our research examined the association between social protection receipt and educational and sexual and reproductive health outcomes among adolescents and young people (13-24 years) living in poverty. We employed multivariate logistic regression controlling for age, orphanhood, HIV status and sex. Social protection receipt was defined as household receipt of financial support from a governmental, non-governmental, or community-based program that provides income. Additionally, we fitted a marginal effects model by sex. Among the 3,506 adolescent females and males living in the two lowest poverty quintiles, receipt of social protection was associated with improvements in multiple adolescent outcomes: higher odds of consistent condom use (aOR 1.64, 95% CI 1.17-2.29), educational attainment (aOR 1.79, 95% CI 1.36-2.36), and school enrolment (aOR 2.19, 95% CI 1.44-3.34). Stratified analyses by sex showed that social protection receipt was also associated with reduced likelihood of child marriage among females (aOR 0.59, 95% CI 0.42-0.83) and higher odds of educational attainment and school enrolment among males (aOR 2.53, 95% CI 1.59-4.03 and aOR 3.11, 95% CI 1.56-6.19, respectively). CONCLUSIONS: Our study provides evidence that social protection programs are associated with improved educational, sexual and reproductive health and child marriage prevention outcomes among adolescents living in poverty. Implementing and expanding such social protection initiatives could prove instrumental in improving the well-being of vulnerable adolescents. CONTRIBUTIONS: Social protection programs have been increasing in sub-Saharan African countries, playing a pivotal role in poverty reduction, with Lesotho being no exception. Despite the optimistic outlook brought about by the implementation of the National Social Protection Strategy Lesotho I (2014-19) and II (2021-2031), the impact of these programs on some specific outcomes that concern the lives of the most vulnerable adolescents in Lesotho remains to some extent unexplored. Additionally, Lesotho grapples with high rates of HIV, adolescent pregnancy, child marriage and early school dropout, which can further contribute to poor long-term health and social outcomes among adolescents. In this study, we used data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS) to examine the association between receiving social protection and multiple adolescent outcomes: educational, sexual and reproductive. The findings revealed that social protection programs, particularly the existing government-provided cash transfers, are significantly associated with multiple better outcomes among adolescents living in the poorest households in Lesotho. Such cash transfer schemes in Lesotho are associated with improved sexual and reproductive health outcomes for adolescent females, including reduced child marriage rates, and improved educational outcomes for males. These findings indicate that government-led social protection programmes are positively associated with favourable outcomes that can improve the quality of life for adolescents in resource-limited settings.

Gender and non-communicable diseases in Mexico: a political mapping and stakeholder analysis.

BACKGROUND: Mexico and other low- and middle-income countries (LMICs) present a growing burden of non-communicable diseases (NCDs), with gender-differentiated risk factors and access to prevention, diagnosis and care. However, the political agenda in LMICs as it relates to health and gender is primarily focused on sexual and reproductive health rights and preventing violence against women. This research article analyses public policies related to gender and NCDs, identifying political challenges in the current response to women's health needs, and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care in Mexico. METHODS: We carried out a political mapping and stakeholder analysis during July-October of 2022, based on structured desk research and interviews with eighteen key stakeholders related to healthcare, gender and NCDs in Mexico. We used the PolicyMaker V5 software to identify obstacles and opportunities to promote interventions that recognize the role of gender in NCDs and NCD care, from the perspective of the political stakeholders interviewed. RESULTS: We found as a political obstacle that policies and stakeholders addressing NCDs do not take a gender perspective, while policies and stakeholders addressing gender equality do not adequately consider NCDs. The gendered social and economic aspects of the NCD burden are not widely understood, and the multi-sectoral approach needed to address these aspects is lacking. Economic obstacles show that budget cuts exacerbated by the pandemic are a significant obstacle to social protection mechanisms to support those caring for people living with NCDs. CONCLUSIONS: Moving towards an effective, equity-promoting health and social protection system requires the government to adopt an intersectoral, gender-based approach to the prevention and control of NCDs and the burden of NCD care. Despite significant resource constraints, policy innovation may be possible given the willingness among some stakeholders to collaborate, particularly in the labour and legal sectors. However, care will be needed to ensure the implementation of new policies has a positive impact on both gender equity and health outcomes. Research on successful approaches in other contexts can help to identify relevant learnings for Mexico.

Financial literacy, social security, and healthcare cost anxiety in China.

This study examines the impact of financial literacy and social security on healthcare cost anxiety in China using data from the 2021 Global Financial Inclusion database. Employing an ordered logit model and its marginal effects, we analyse how these factors influence varying levels of healthcare cost anxiety (worried, somewhat worried, and not worried at all) across total, female-headed and male-headed households. Financial literacy and social security both demonstrate significant negative effects on healthcare cost anxiety across all household types. It implied that individuals who save for old age and those with social security coverage are less likely to experience high levels of healthcare cost anxiety. The ordered logit results show consistent negative coefficients for financial literacy and social security across all household categories. Marginal effects analysis further illustrates how these factors affect the probability of falling into each category of healthcare cost anxiety. These findings underscore the importance of promoting financial literacy and expanding social security coverage as potential strategies to alleviate healthcare cost anxiety in China.

Cette étude examine l'impact de la littératie financière et de la sécurité sociale sur l'anxiété liée aux coûts des soins de santé en Chine à l'aide des données de la base de données mondiale sur l'inclusion financière 2021. En utilisant un modèle logit ordonné et ses effets marginaux, nous analysons comment ces facteurs influencent différents niveaux d'anxiété liée aux coûts de santé (inquiet, quelque peu inquiet et pas du tout inquiet) dans l'ensemble des ménages dirigés par une femme ou un homme. La littératie financière et la sécurité sociale démontrent toutes deux des effets négatifs significatifs sur l'anxiété liée aux coûts des soins de santé dans tous les types de ménages. Cela implique que les personnes qui épargnent pour leur vieillesse et celles qui bénéficient d'une couverture de sécurité sociale sont moins susceptibles de ressentir des niveaux élevés d'anxiété liée aux coûts des soins de santé. Les résultats du logit ordonné montrent des coefficients négatifs cohérents pour la culture financière et la sécurité sociale dans toutes les catégories de ménages. L'analyse des effets marginaux illustre en outre comment ces facteurs affectent la probabilité d'appartenir à chaque catégorie d'anxiété liée aux coûts des soins de santé. Ces résultats soulignent l'importance de promouvoir la culture financière et d'élargir la couverture de sécurité sociale en tant que stratégies potentielles pour atténuer l'anxiété liée aux coûts des soins de santé en Chine.

An unlevel playing field: Immigrant assimilation and welfare utilization.

This paper investigates the existence and mechanisms of segmentation in the welfare assimilation process of first-generation immigrants in the Netherlands. Using longitudinal administrative data (2007-2015) from Statistics Netherlands (CBS), we estimate the welfare utilization trajectories of migrants over the working-age life course vis-à-vis two reference groups representing different economic segments from the population, namely: average Dutch natives and Dutch natives with low education level. Empirical evidence shows a predominant trend of mainstream assimilation; however, two findings with more concerning implications should be highlighted. Welfare assimilation into the economically disadvantaged segment is found to concentrate among first-generation immigrants characterized by structural and human capital disadvantages, despite the notable extent of upward intragenerational mobility observed. In the worst-case scenario, there seems to be a lack of welfare assimilation to the comparison segments, raising concerns over the prospective emergence of marginalized ethnic groups at the bottom of the economic ladder. The implications of this finding are twofold. Firstly, automatic closing of the migrant-native gap over time should not be presumed in the absence of a level playing field for all regardless of their migration backgrounds. Secondly, systematic discrepancies observed between refugees and other types of migrants in terms of welfare assimilation patterns and determinants point to the need to have a clear distinction between immigration policy and refugee policy, which explicitly avoids bundling all migrants as one homogenous group.

Identifying measures for coverage of nutrition-sensitive social protection programs: Learnings from India.

Optimal child growth requires a combination of nutrition-specific and sensitive interventions in the first 1,000 days. There is limited guidance on how to measure the population-level coverage of nutrition-sensitive social protection (NSSP), which is designed with explicit nutrition goals and often provides food or cash transfers and co-coverage with nutrition and health intervention. In this study in India, we designed a questionnaire that captures seven core NSSP program elements (transfer type, size, modality, population, timing, provider, conditionalities), then used cognitive testing to refine the questionnaire, and then implemented the questions as part of a telephone survey. Cognitive testing indicated variability in understanding the terms used to specify NSSP programs, including the need to use regional program names. Respondents also had difficulty recalling the timing of the benefit receipt. We included the refined NSSP coverage questions in a phone-based survey with 6,627 mothers with children <2 years across six states. Coverage of subsidized food was 73% across all households. Women were more likely to report receiving food than cash transfers during pregnancy (89% vs. 60%) and during lactation (75% vs. 13%). Co-coverage of NSSP with nutrition and health interventions during pregnancy (16%) and early childhood (3%) was low. It was feasible to measure coverage of NSSP investments in these populations; however, further research is needed to comprehensively assess all the dimensions of the NSSP benefits, including benefit adequacy and the validity of these questions when administered in person and by phone.

State Regulation of Ensuring the Quality Medical Care During Martial Law in Ukraine: Lessons for the International Community.

Background: Nowadays, the quality of medical care and health care measures is considered the main target function of the health care system and at the same time the determining criterion for its activities. Objective: The article examines state regulation of medical care quality post- COVID and during martial law, identifying improvement areas. It emphasizes state roles in healthcare standardization, continuous feedback monitoring, and studying patient satisfaction. Interrelationships among Ukraine's state regulation mechanisms are determined, highlighting the need to enhance tools such as criteria and quality indicators for medical care assurance. Methods: The authors of this article utilize various scientific methods, including analysis, synthesis, induction, and deduction, as well as historical and legal, formal legal, and comparative legal methods to examine the state regulation of ensuring the quality of medical care during martial law in Ukraine. Results: The article considered the interrelationships of mechanisms and instruments of state regulation of quality assurance of medical care in Ukraine. Conclusions: The state should enhance medical care quality regulation, drawing on international experiences from the EU and the USA and adapting best practices to national circumstances. The resilience of the healthcare system depends on effective quality assurance, ensuring preparedness, stability, and ongoing improvement prospects.

Planning for retirement during active service in Ghana: Insights from pensioners in the Greater Accra Region.

Workers often participate in pre-retirement planning activities to gain awareness of the likely changes they may experience when they retire to enable them to prepare accordingly. Although pre-retirement planning is essential for successful retirement and healthy aging, studies on pre-retirement planning activities among older adults in Ghana are limited. This study explored pre-retirement planning actions that were taken by Social Security and National Insurance Trust (SSNIT) pensioners in the Greater Accra Region of Ghana. A sequential explanatory mixed-methods approach was adopted to gather data from 437 pensioners aged 60 years and above through surveys, interviews, and focus group discussions. The results indicate that while in active service, many (309) pensioners were not motivated to plan for retirement due to issues, such as low income, and distrust of financial institutions. When planning did take place, the pensioners favored financial planning over social, mental, and physical planning. The respondents also revealed that they did not prepare adequately for retirement due to low salaries, as well as low knowledge on pre-retirement planning. Policies are needed to encourage pre-retirement planning among workers in Ghana to enable them to have an appreciable quality of life in old age.

Work-retirement transitions and mental health: A longitudinal analysis of the role of social protection generosity in 11 countries.

AIMS: This study aimed to analyse the effect of work-retirement transitions on post-retirement mental health in individuals with different working conditions in late working life. The focus was on transitions that involve the use of social protection schemes to bridge the gap between the exit from work and retirement, and the extent to which the generosity of such schemes is related to mental health after retirement. METHODS: Individual-level panel data from the Survey of Health, Ageing and Retirement in Europe for 11 European countries were analysed using structural equation models. A total of 1642 individuals who worked in 2004 or 2007 and who retired in 2013 or 2015 were included in the analyses. The outcome measure was mental health as measured by the EURO-D scale. RESULTS: Respondents with a 'high strain' and 'passive' work situation have a significantly higher likelihood of using social protection schemes, such as early retirement, sickness, disability and invalidity schemes before retirement. The generosity of such schemes has a significant positive relation to post-retirement mental health. CONCLUSIONS: This study shows that the generosity of early exit pathways is important for post-retirement mental health, especially for individuals with adverse working conditions at the end of their working lives.

The socioeconomic burden of pediatric tuberculosis and role of child-sensitive social protection.

BACKGROUND: Households of children with tuberculosis (TB) experience financial and social hardships, but TB-specific social protection initiatives primarily focus on adults. METHODS: We conducted a single-arm, pilot study of multi-component supportive benefits for children with pulmonary TB in Kampala, Uganda. At diagnosis, participants received in-kind coverage of direct medical costs, a cash transfer, and patient navigation. Caregivers were surveyed before diagnosis and 2 months into TB treatment on social and financial challenges related to their child's illness, including estimated costs, loss of income and dissaving practices. RESULTS: We included 368 children from 321 households. Pre-diagnosis, 80.1% of caregivers reported that their child's illness negatively impacted household finances, 44.1% of caregivers missed work, and 24% engaged in dissaving practices. Catastrophic costs (> 20% annual income) were experienced by 18.4% (95% CI 13.7-24.0) of households. School disruption was common (25.6%), and 28% of caregivers were concerned their child was falling behind in development. Two months post-diagnosis, 12 households (4.8%) reported being negatively affected by their child's TB disease (difference -75.2%, 95% CI -81.2 to -69.2, p < 0.001), with limited ongoing loss of income (1.6%) or dissavings practices (0.8%). Catastrophic costs occurred in one household (0.4%) at 2 months post-diagnosis. CONCLUSIONS: Households face financial and social challenges prior to a child's TB diagnosis, and child-sensitive social protection support may mitigate ongoing burden.

The impact of income-support interventions on life course risk factors and health outcomes during childhood: a systematic review in high income countries.

BACKGROUND: In high income countries one in five children still lives in poverty, which is known to adversely shape the life course health trajectory of these children. However, much less is understood on whether social and fiscal policies have the capacity to reverse this damage, which intervention is likely to be most effective and when these interventions should be delivered to maximise their impact. This systematic review attempts to address these questions by looking at the impact of income-support interventions, delivered during the first 1,000 days of life, on cardiovascular, metabolic, respiratory and mental health outcomes. METHODS: The review was restricted to experimental or quasi experimental studies conducted in high income countries. Studies were retrieved from multidisciplinary databases as well as health, economic, social sciences-specific literature browsers. All papers retrieved through the search strategy were double screened at title, abstract and full text stage. Relevant data of the selected studies were extracted and collected in tables, then summarised via narrative synthesis approach. Robustness of findings was assessed by tabulating impact by health outcome, type of intervention and study design. RESULTS: Overall, 16 relevant papers were identified, including 15 quasi-experimental studies and one randomized control trial (RCT). Income-support interventions included were unconditional/conditional cash transfers, income tax credit and minimum wage salary policies. Most studies were conducted in United States and Canada. Overall, the evidence suggested limited effect on mental health indicators but a positive, albeit small, effect of most policies on birth weight outcomes. Despite this, according to few studies that tried to extrapolate the results into public health terms, the potential number of negative outcomes averted might be consistent. CONCLUSIONS: Income-support interventions can positively affect some of the health outcomes of interest in this review, including birth weight and mental health. Given the large number of people targeted by these programs, one could infer that - despite small - the observed effect may be still relevant at population level. Nonetheless, the limited generalisability of the evidence gathered hampers firm conclusions. For the future, the breadth and scope of this literature need to be broadened to fully exploit the potential of these interventions and understand how their public health impact can be maximised.

The social and health protection of migrants in Chile: qualitative analysis of civil society proposals for constitutional change.

BACKGROUND: A sustained period of social, economic, and political unrest took place during October of 2019 in Chile. As an institutional solution, the "Agreement for Social Peace and the New Constitution" was signed. In this document, most political parties committed to reestablishing peace and public order in Chile, agreeing on the initiation of a constitutional process. To promote participation of civil society actors, the "Popular Initiative for Norms" was enabled. This was a platform where civilians could submit proposals for constitutional norms to be discussed by the Constitutional Convention. We aimed to analyze proposals related to migrants and migrant health. METHODS: We conducted a qualitative thematic analysis of the proposals. Sixteen of them were related to migrants, and we analyzed their association to health. We also evaluated their link to the Health Goals 2030 set out by the Chilean Ministry of Health and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. RESULTS: Four main thematic categories were identified: 1) Humans rights of migrants, refugees, and asylum seekers; 2) Nationality and regularization of migrants and refugees; 3) Political participation and cultural integration of migrants and refugees; and 4) Specific regulations on slavery and human trafficking. These resonated with broader frameworks established in the Health Goals 2030 (Chile) and the Global Action Plan 2019-2023 for Promoting the Health of Refugees and Migrants by the World Health Organization. CONCLUSIONS: The 'Popular Initiative for Norms' was a non-binding participatory mechanism. Although the proposals sent through were not guaranteed to be included in the constitutional draft-and despite the final draft being rejected last September 2022-the platform allowed to gain insights into civilian opinions. Our findings showed that there is an incipient yet weak recognition of the rights and situation of migrants in Chile. There was no direct mention of health nor an explicit contemplation of social determinants of health. Despite there being an urgent need to define strategies for migrants' health in Chile, this study demonstrated that civil awareness and interest are still insufficient.

Determinants of catastrophic costs among households affected by multi-drug resistant tuberculosis in Ho Chi Minh City, Viet Nam: a prospective cohort study.

BACKGROUND: Globally, most people with multidrug-resistant tuberculosis (MDR-TB) and their households experience catastrophic costs of illness, diagnosis, and care. However, the factors associated with experiencing catastrophic costs are poorly understood. This study aimed to identify risk factors associated with catastrophic costs incurrence among MDR-TB-affected households in Ho Chi Minh City (HCMC), Viet Nam. METHODS: Between October 2020 and April 2022, data were collected using a locally-adapted, longitudinal WHO TB Patient Cost Survey in ten districts of HCMC. Ninety-four people with MDR-TB being treated with a nine-month TB regimen were surveyed at three time points: after two weeks of treatment initiation, completion of the intensive phase and the end of the treatment (approximately five and 10 months post-treatment initiation respectively). The catastrophic costs threshold was defined as total TB-related costs exceeding 20% of annual pre-TB household income. Logistic regression was used to identify variables associated with experiencing catastrophic costs. A sensitivity analysis examined the prevalence of catastrophic costs using alternative thresholds and cost estimation approaches. RESULTS: Most participants (81/93 [87%]) experienced catastrophic costs despite the majority 86/93 (93%) receiving economic support through existing social protection schemes. Among participant households experiencing and not experiencing catastrophic costs, median household income was similar before MDR-TB treatment. However, by the end of MDR-TB treatment, median household income was lower (258 [IQR: 0-516] USD vs. 656 [IQR: 462-989] USD; p = 0.003), and median income loss was higher (2838 [IQR: 1548-5418] USD vs. 301 [IQR: 0-824] USD; p < 0.001) amongst the participant households who experienced catastrophic costs. Being the household's primary income earner before MDR-TB treatment (aOR = 11.2 [95% CI: 1.6-80.5]), having a lower educational level (aOR = 22.3 [95% CI: 1.5-344.1]) and becoming unemployed at the beginning of MDR-TB treatment (aOR = 35.6 [95% CI: 2.7-470.3]) were associated with experiencing catastrophic costs. CONCLUSION: Despite good social protection coverage, most people with MDR-TB in HCMC experienced catastrophic costs. Incurrence of catastrophic costs was independently associated with being the household's primary income earner or being unemployed. Revision and expansion of strategies to mitigate TB-related catastrophic costs, in particular avoiding unemployment and income loss, are urgently required.

Self-employment, illness, and the social security system: a qualitative study of the experiences of solo self-employed workers in Ontario, Canada.

BACKGROUND: Today's labor market has changed over time, shifting from mostly full-time, secured, and standard employment relationships to mostly entrepreneurial and precarious working arrangements. Thus, self-employment (SE) has been growing rapidly in recent decades due to globalization, automation, technological advances, and the recent rise of the 'gig' economy, among other factors. Accordingly, more than 60% of workers worldwide are non-standard and precarious. This precarity profoundly impacts workers' health and well-being, undermining the comprehensiveness of social security systems. This study aims to examine the experiences of self-employed (SE'd) workers on how they are protected with available social security systems following illness, injury, and income reduction or loss. METHODS: Drawing on in-depth interviews with 24 solo SE'd people in Ontario (January - July 2021), thematic analysis was conducted based on participants' narratives of experiences with available security systems following illness or injury. The dataset was analyzed using NVIVO qualitative software to elicit narratives and themes. FINDINGS: Three major themes emerged through the narrative analysis: (i) policy-practice (mis)matching, (ii) compromise for a decent life, and (iii) equity in work and benefits. CONCLUSIONS: Meagre government-provided formal supports may adversely impact the health and wellbeing of self-employed workers. This study points to ways that statutory social protection programs should be decoupled from benefits provided by employers. Instead, government can introduce a comprehensive program that may compensate or protect low-income individuals irrespective of employment status.

Enhancing the resilience and well-being of rural poor to climate risks: are the economic functions of social protection enough?

As climate change accelerates, adaptive social protection programmes are becoming increasingly more popular than conventional social assistance programmes, since they are seen to enhance people's resilience and well-being outcomes. Despite this upsurge, little is known about the impacts of adaptive programmes on resilience and well-being outcomes as compared to conventional programmes. This paper examines the economic functions that both types of social protection programmes offer through empirical studies in two climate-vulnerable zones in Bangladesh. By operationalising a simplified analytical framework to comprehend subjective resilience, the qualitative data reveal that the adaptive programme is more effective in enhancing beneficiaries' perceived resilience to climate risks. Regrettably, neither programme is found to contribute much significantly in terms of enabling beneficiaries to achieve the desired well-being outcomes that one might expect to see. The paper offers rich insights into the design components of the programmes, affording an on-the-ground understanding of their implications for resilience and well-being.

Green Environment-Social Protection Interaction and Food Security in Africa.

Expanding food production to commensurate with population growth has often come at a cost resulting from environmental problems. Industries generate pollutants that destroy the environment and negatively affect the level of food security. These trends threaten the sustainability of food systems and undermine the capacity to meet food security needs. Against this backdrop, this study examines how the green environment influences food security in Africa. To further articulate the novelty and contributions of the research to the extant literature, the study also examines the interaction effect of the green environment and social protection on food security. The study engaged panel data consisting of 37 African countries listed in the International Development Association (IDA) of the World Bank. The data was sourced from Food and Agricultural Organisation (FAO), Country Policy and Institutional Assessment (CPIA) and the World Development Indicators (WDI) for the period 2005 to 2019 and applied the system Generalised Method of Moments (SGMM). The result shows that a green environment and social protection are statistically significant and positively determine the level of food security in Africa. In addition, the result shows that a green environment and social protection interaction positively and significantly influence food security. The implication is that a 1% increase in the drive for a green environment may improve the level of food security by 0.8%. Also, increases in the level of social protection intervention may increase food security by 1.2%. The interaction between social protection and food security can increase food security by 0.96%. In summary, it is found that African countries under study have moderate social protection coverage and policy for environmental management and sustainability required to drive food security. The discussions of the findings and policy implications of the study are underscored in the paper.

Trust, social protection, and compliance: Moral hazard in Latin America during the COVID-19 pandemic.

Political trust is an important predictor of compliance with government policies, especially in the face of natural disasters or public health emergencies. During the COVID-19 pandemic, for example, multiple studies related political trust to increased compliance with mobility restrictions. Yet these findings come mostly from high-income countries where political trust and wealth correlate positively. In Latin America, both variables correlate negatively, allowing for better testing of competing explanations. Using a difference-in-differences design, we find that in Latin America wealth and, counterintuitively, low political trust predict increased compliance. To understand mechanisms, we decompose political trust and wealth into underlying predictors (social protection, corruption, and education) and reinsert them into the model. While education, as a wealth proxy, predicts decreased mobility across all periods, social protection, which was the strongest predictor of political trust, relates significantly to increased mobility, but only at the beginning of the lockdown prior to distribution of emergency support. This suggests the existence of a public health moral hazard early in the pandemic, whereby citizens who benefited previously from government benefits may have been more risk tolerant in the face of the COVID-19 threat. We interpret these findings within the context of the region's recent "inclusionary turn." Future studies should explore the distinct relationships between political trust, risk perception, and compliance, especially in low- and middle-income countries, and their implications for policy responses to national emergencies.

Gimme shelter. Social distancing and income support in times of pandemic.

Stay-at-home orders feature high in the set of policies used to curb the spread of epidemics such as COVID-19, but are potentially less efficient among poor people who must continue to work during pandemics. We examine how income support programs help poor people comply with stay-at-home order and thereby generate positive health externalities. We use data on work-related mobility in 2020 and on poverty rates for 729 subnational regions of Africa, Latin America and Asia. We focus on within-country differential mobility changes between higher- and lower-poverty regions. Accounting for all time-variant country-level factors, we show that lockdowns have decreased mobility significantly less in poorer regions. In turn, emergency income support programs have helped reduce this difference, mitigating the regional poverty gap in virus exposure through work mobility.