AEGIS ECAS 2007 - View abstract

Panel	39. Livelihood, Vulnerability and Health. Moving beyond existing frameworks
Paper ID	542
Author(s)	Schulze, Alexander
Paper	No paper submitted
Abstract	Livelihood frameworks go beyond the classical poverty concept. While the latter mainly emphasizes socio-economic determinants, the livelihood approach focuses more prominently on household coping strategies that result from an interplay between existing assets of an actor, on the one hand, and institutions, policies as well as the vulnerability context on the other hand. Hence, according to this perspective, poverty and vulnerability are not simply functions of external determinants, but are also influenced by actors as subjects of processes. Despite the stronger emphasis on actors and micro level processes, the livelihood approach tends to highlight the significance of external factors and the scarcity of resources which households have to react upon. Commonly, the perspective is that households need to strengthen their resource basis in order to be able to cope with externally induced risks. This seems to be appropriate when dealing with “poor” households and communities. Yet, it ignores that even people with relatively scarce resources and few opportunities do often have a (limited) choice as well as individual preferences and mind sets. This implies that livelihood strategies may not simply reflect availability of and access to assets and resources, but also (material) preferences, values and attitudes, or even concepts of life which are both determined by external factors and formed by the actors themselves. Consequently, vulnerability with regard to a specific livelihood risk does not necessarily mirror insufficient resources alone, but equally its significance and perception in the view of the actor compared to other risks and priorities. Empirical findings of a recently conducted research in rural Mali are presented. The study compares households enrolled in a voluntary community health insurance with non-enrolled households. Given the low enrolment rates of most community health insurances in Africa - they are considered to be a promising tool for improved access to health services and vulnerability reduction in terms of health costs - the study identifies in particular elements of social differentiation in the communities including household characteristics that determine whether and for whom health is a priority, which health protection strategies people pursue and whether they enrol in a health insurance or not. It is assumed that not only socio-economic characteristics of the households influence enrolment and other health protection strategies, but also values like saving or prevision of potential future risks as well as community factors such as the degree of social cohesion in the villages, the attitude of local leaders towards insurance or trust in the insurance personnel.

Who enrolls in community health insurance? Health protection strategies in the context of social differentiation