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In low-income countries, vaccination campaigns are lagging, and evidence on vaccine acceptance, a crucial public health planning input, remains scant. This is the first study that reports willingness to take COVID-19 vaccines and its socio-demographic correlates in Ethiopia, Africa's second most populous country. The analysis is based on a nationally representative survey data of 2,317 households conducted in the informal economy in November 2020. It employs two logistic regression models where the two outcome variables are (i) a household head's willingness to take a COVID-19 vaccine or not, and (ii) if yes if they would also hypothetically pay (an unspecified amount) for it or not. Predictors include age, gender, education, marital status, income category, health insurance coverage, sickness due to COVID-19, chronic illness, trust in government, prior participation in voluntary activities, urban residence. Willingness to take the vaccine was high (88%) and significantly associated with COVID-19 cases in the family, trust in government and pro-social behavior. All other predictors such as gender, education, income, health insurance, chronic illness, urban residence did not significantly predict vaccine willingness at the 5% level. Among those willing to take the vaccine, 33% also answered that they would hypothetically pay (an unspecified amount) for it, an answer that is significantly associated with trust in government, health insurance coverage and income. The results highlight both opportunities and challenges. There is little evidence of vaccine hesitancy in Ethiopia among household heads operating in the informal economy. The role played by trust in government and pro-social behavior in motivating this outcome suggests that policy makers need to consider these factors in the planning of COVID-19 vaccine campaigns in order to foster vaccine uptake. At the same time, as the willingness to hypothetically pay for a COVID-19 vaccine seems to be small, fairly-priced vaccines along with financial support are also needed to ensure further uptake of COVID-19 vaccines.

The “traditional view” on the historical decline of child labour has emphasised the role of the approval of effective child labour (minimum working age) laws. Since then, the importance of alternative key driving factors such as schooling, demography, household income or technology has been highlighted. While historically leading countries such as England and industrial labour have been studied, peripheral Europe and a full participation rate also including agriculture and services have received limited research attention. The contribution of this paper is to provide a first empirical explanation for the child labour decline observed in a European peripheral country like Portugal using long historical yearly data. For doing so, we use long series of Portugal’s child labour participation rate and several candidate explanatory factors. We implement cointegration techniques to relate child labour with its main drivers. We find that not only factors related to the “traditional view” were important for the Portuguese case. In fact, a mixture of legislation, schooling, demography, income, and technological factors seem to have contributed to the sustainable fall of Portugal’s child labour. Hence, explanations for observed child labour decline seem to differ by country and context, introducing a more nuanced view of the existing literature.

ObjectivesIn recent years, Ethiopia has made enormous strides in enhancing access to healthcare, especially, maternal and child healthcare. With the onset and spread of COVID-19, the attention of the healthcare system has pivoted to handling the disease, potentially at the cost of other healthcare needs. This paper explores whether this shift has come at the cost of non-Covid related healthcare, especially the use of maternal and child health (MCH) services.SettingData covering a 24-month period are drawn from 59 health centres and 29 public hospitals located in urban Ethiopia.Primary and secondary outcomes measuresThe primary outcome measures are the use of MCH services including family planning, antenatal and postnatal care, abortion care, delivery and immunisation. The secondary outcome measures are the use of health services by adults including antiretroviral therapy (ART), tuberculosis (TB) and leprosy and dental servicesResultsThere is a sharp reduction in the use of both inpatient (20%–27%, p<0.001) and outpatient (27%–34%, p<0.001) care, particularly in Addis Ababa, which has been most acutely affected by the virus. This decline does not come at the cost of MCH services. The use of several MCH components (skilled birth attendant deliveries, immunisation, postnatal care) remains unaffected throughout the period while others (family planning services, antenatal care) experience a decline (8%–17%) in the immediate aftermath but recover soon after.ConclusionConcerns about the crowding out of MCH services due to the focus on COVID-19 are unfounded. Proactive measures taken by the government and healthcare facilities to ring-fence the use of essential healthcare services have mitigated service disruptions. The results underline the resilience and agility displayed by one of the world’s most resource-constrained healthcare systems. Further research on the approaches used to mitigate disruptions is needed.

Low contract renewal rates have been identified as one of the challenges facing the development of community-based health insurance (CBHI) schemes. This article uses longitudinal household survey data gathered in 2012 and 2013 to examine dropout in the case of Ethiopia’s pilot CBHI scheme. We treat dropout as a function of scheme affordability, health status, scheme understanding and quality of care. The scheme saw enrolment increase from 41 % 1 year after inception to 48 % a year later. An impressive 82 % of those who enrolled in the first year renewed their subscriptions, while 25 % who had not enrolled joined the scheme. The analysis shows that socioeconomic status, a greater understanding of health insurance and experience with and knowledge of the CBHI scheme are associated with lower dropout rates. While there are concerns about the quality of care and the treatment meted out to the insured by providers, the overall picture is that returns from the scheme are overwhelmingly positive. For the bulk of households, premiums do not seem to be onerous, basic understanding of health insurance is high and almost all those who are currently enrolled signalled their desire to renew contracts. 以社区为基础的医疗保险 （CBHI） 计划面临的一大挑战就是 低合同续签率。本文采用 2012 年和 2013 年收集的家庭跟踪 数据来检查埃塞俄比亚以社区为基础的医疗保险试点计划的 退出情况。我们将退出视为经济承受力、健康状况、对计划 的理解程度和服务质量的一个函数。计划实施后参与人数从 第一年的 41% 增加到一年后的 48%。引人注目的是，在第一 年订购的人中 82% 选择了续订，没有订购的人中有 25% 选 择了加入到计划中。分析显示，社会经济状况、对医疗保险 的更深入理解和对 CBHI 的了解与体验都与低退出率相关。 尽管对于服务的质量和给被保险人提供的治疗有质疑的声 音，总的来说这项计划的结果还是非常乐观的。对于大多数 家庭来说，保险费并不繁重，人们对医疗保险有很高的基本 理解，并且参与的人中几乎全部都表达了想要续订的意愿。 Las bajas tasas de renovación de los contratos se han identificado como uno de los desafíos que enfrenta el desarrollo de los planes de seguros de salud basados en la comunidad (SSBC). Este artículo utiliza datos longitudinales de encuestas de hogares recogidos en 2012 y 2013 para examinar la deserción en el caso del esquema piloto del SSBC de Etiopía. Tratamos la deserción como una función de la asequibilidad del esquema, el estado de salud, la comprensión del esquema y la calidad de la atención. El esquema vio el aumento de la inscripción desde el 41% 1 año después de su inicio hasta el 48% un año después. Un impresionante 82% de las personas que se inscribieron en el primer año renovaron sus suscripciones, mientras que 25% de aquellos que no se había inscrito se unió al esquema. El análisis muestra que el estado socioeconómico, una mayor comprensión de los seguros de salud y la experiencia y el conocimiento del esquema de SSBC se asocian con tasas de deserción inferiores. Si bien existen dudas acerca de la calidad de la atención y el trato dado a los asegurados por los proveedores, el panorama general es que los rendimientos del esquema son abrumadoramente positivos. Para la mayor parte de los hogares, las primas no parecen ser onerosas, la comprensión básica del seguro de salud es alta y casi todos aquellos que están inscritos actualmente señalaron su deseo de renovar los contratos.

Ethiopia’s Community-Based Health Insurance (CBHI) scheme was established with the objectives of enhancing access to health care, reducing out-of-pocket expenditure (OOP), mobilizing financial resources and enhancing the quality of health care. Previous analyses have shown that the scheme has enhanced health care access and led to reductions in OOP. This paper examines the impact of the scheme on health facility revenues and quality of care. This paper relies on a difference-in-differences approach applied to both panel and cross-section data. We find that CBHI-affiliated facilities experience a 111% increase in annual outpatient visits and annual revenues increase by 47%. Increased revenues are used to ameliorate drug shortages. These increases have translated into enhanced patient satisfaction. Patient satisfaction increased by 11 percentage points. Despite the increase in patient volume, there is no discernible increase in waiting time to see medical professionals. These results and the relatively high levels of CBHI enrollment suggest that the Ethiopian CBHI has been able to successfully negotiate the main stumbling block—that is, the poor quality of care—which has plagued similar CBHI schemes in Sub-Saharan Africa.

There is substantial evidence that due to perceived childcare obligations, mothers are disadvantaged in labor markets. To what extent can childcare support ameliorate such a disadvantage? To answer this question, we ran a CV experiment in a large Indian city and examined whether indicating access to childcare support in a CV may offset the motherhood penalty associated with labor market entry. We randomly varied motherhood, as well as access to childcare in CVs sent to online applications for service sector jobs in Delhi. Indicating motherhood on a CV led to a 57% or 20 percentage point reduction in callback rates for interviews as compared to non-mothers. A simple indication of access to childcare support offsets the motherhood penalty by 20% or 4 percentage points. We interpret the findings in the Indian context and with respect to potential sources of discrimination.

International travel – isolation of passengers arriving from international destinations and suspension of flights, Quarantine – more than 16 000 people have been placed in quarantine for 14 days with 27 universities serving as quarantine center, Spread of World Health Organization recommended practices – such as frequent hand washing, avoiding handshakes, elbow sneezing and coughing through mass media, Free provisions – toll free telephone lines for information and free provision of sanitary items such as soap and hand-washing gels to targeted groups in Addis Ababa, Closures – of schools, universities, bars and nightclubs; suspending public gatherings and meetings and issuing stay-at-home orders for all but necessary staff, Subsidized – internet and voice package offered by Ethio telecom, Mass disinfection – of critical urban locations, Avoiding overcrowding – by reducing the maximum number of passengers in trains, taxis and buses to half their capacity, Complete transport lockdown – in some regions of the country except for carriage of essential supplies, Release of prisoners – release of around 4,000 pr,isoners who committed minor offences and/or were to be soon released Postponed – perhaps most notably, national elections scheduled for August 2020 have been postponed. The social distancing measures in rural areas relate to agricultural marketing, avoidance of social gatherings while at the same time continuing daily agricultural tasks such as belg (autumn) crop season plantation. The government’s health care team has been working with Chinese health care experts to enhance the capacity and expertise of its health care system. While access to health care has sharply increased in the last ten years and a substantial number of households are covered by a community-based health insurance scheme introduced in 2011, resources are limited.

The Ethiopian health system is largely financed through household out-of-pocket payments and external donor support, increasing the risk of catastrophic health expenditures. To address these challenges, the government introduced two health insurance schemes: Community-Based Health Insurance (CBHI) targeting the informal sector and a still to be implemented Social Health Insurance (SHI) scheme for the formal sector. Although designed to operate separately, the long-term goal is to integrate them into a unified national risk pool. Achieving this integration requires cross-group solidarity, especially as formal sector employees may subsidize CBHI. This study investigates the willingness of formal sector workers to support CBHI, which is critical for long-term financial sustainability in the Ethiopian health insurance landscape. The paper is based on a survey of 1,919 formal sector workers and pensioners in major administrative regions of Ethiopia. A survey-based experiment was used to elicit support for CBHI. Respondents were randomly assigned to one of five cases that varied by the information provided on CBHI subsidies and benefits. Descriptive statistics and logit models were used to analyze willingness to support CBHI. There is strong support from urban formal sector employees for the CBHI. Regardless of the scenario presented, after adjusting for non-response, at least 66% of participants supported the scheme. Regional variations were observed, and knowledge of health insurance was positively associated with support. Existing access to formal insurance was linked with lower support. Strong evidence of solidarity among formal sector workers bodes well for further expansion of the CBHI. Despite supporting CBHI, formal sector employees are resisting SHI due to cost concerns and skepticism about its benefits, unlike CBHI's known outcomes. SHI resistance signals the need for targeted communication and trust-building as the country moves toward achieving universal health coverage.

This article assesses insurance uptake in three community-based health insurance (CBHI) schemes located in rural parts of two of India's poorest states and offered through women's self-help groups (SHGs). We examine what drives uptake, the degree of inclusive practices of the schemes and the influence of health status on enrolment. The most important finding is that a household's socio-economic status does not appear to substantially inhibit uptake. In some cases scheduled caste/scheduled tribe households are more likely to enrol. Second, households with greater financial liabilities find insurance more attractive. Third, access to the national hospital insurance scheme Rashtriya Swasthya Bima Yojana does not dampen CBHI uptake, suggesting that the potential for greater development of insurance markets and products beyond existing ones would respond to a need. Fourth, recent episodes of illness and self-assessed health status do not influence uptake. Fifth, insurance coverage is prioritized within households, with the household head, the spouse of the household head and both male and female children of the household head, more likely to be insured as compared with other relatives. Sixth, offering insurance through women's SHGs appears to mitigate concerns about the inclusiveness and sustainability of CBHI schemes. Given the pan-Indian spread of SHGs, offering insurance through such groups offers the potential to scale-up CBHI.

Background: After years of planning, in 2024 the government of Ethiopia proposes to introduce a compulsory Social Health Insurance (SHI) program for formal sector employees. The proposed scheme will provide access to contracted healthcare facilities at a premium of 3% of the gross monthly income of employees with another 3% coming from the employer. Objectives: Several studies have examined the willingness to pay (WTP) this premium, however, little is known about the healthcare seeking behavior (HSB) of formal sector employees. This paper investigates both – the determinants of healthcare seeking behavior and among other aspects, WTP the premium. Through these explorations, the paper sheds light on the potential challenges for implementation of SHI. Methods: Descriptive statistics, logit, and multinomial logit (MNL) models are used to analyze retrospective survey data (2,749 formal sector employees) which covers the major regions of the country. Findings: Regarding outpatient care, a majority of the visits (55.9%) were to private healthcare providers. In the case of inpatient care, it was the opposite with a majority of healthcare seekers visiting public sector hospitals (62.5%). A majority of the sample (67%) supported the introduction of SHI but only 24% were willing to pay the proposed SHI premium. The average WTP was 1.6% of gross monthly income. Respondents in the two richest income quintiles were more likely to oppose SHI and consider it unfair. Conclusion: The prominent role of the private sector and the resistance to SHI amongst the two richest income quintiles, suggests that the SHI program needs to actively include private healthcare facilities within its ambit. Additionally, concerted efforts at enhancing the quality of care available at public health facilities, both, in terms of perception and patient-centered care and addressing drug and equipment availability bottlenecks, are needed, if SHI is to garner wider support.