Missing the vulnerable – Inequalities in social protection among the general population, people living with HIV, and adolescent girls and young women in 13 sub-Saharan African countries: Analysis of population-based surveys

David Chipanta, Silas Amo-Agyei, Lucas Hertzog, Ahmad Reza Hosseinpoor, Michael J Smith, Caitlin Mahoney, Juan Gonzalo Jaramillo Meija, Olivia Keiser, Janne Estill
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Abstract

Inequality in access to services is a global problem mainly impacting the poorest populations. The role of social protection in reducing inequalities is recognized, but few studies have investigated whether social protection benefits people facing considerable socioeconomic inequalities. We assessed inequalities in receiving social protection among the public, men and women living with human immunodeficiency virus (PLHIV), and adolescent girls and young women (AGYW), using population-based data from 13 African countries. We constructed concentration curves and computed concentration indices (CIX) for each country and population group. We also conducted a desk review of social protection in the studied countries where information was available on the characteristics of social protection programs and their access by the general population, PLHIV, and AGYW. The sample size ranged from 10,197 in Eswatini to 29,577 in Tanzania. Women comprised 60% or more of PLHIV in the surveyed countries. 50%–70% of the respondents were unemployed, except in Cameroon, Kenya, and Uganda, where less than 50% were unemployed. Generally, the proportion of respondents from wealth quintile one (Q1), the poorest 20% of households, was like that from Q2–Q5. The proportion of the general population receiving social protection varied from 5.2% (95% Confidence Interval 4.5%–6.0%) in Ethiopia to 39.9% (37.0%–42.8%) in Eswatini. Among PLHIV, the proportion receiving social protection varied from 6.9% (5.7%–8.4%) among men living with HIV in Zambia to 45.0% (41.2–49.0) among women living with HIV in Namibia. Among AGYW, the proportion varied from 4.4% (3.6–5.3) in Ethiopia to 44.6% (40.8–48.5) in Eswatini. In general, 15% or less of the respondents from Q1 reported receiving social protection in eight countries (i.e., Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia), with 10% or less in three countries (Cameroon, Côte d'Ivoire, and Ethiopia); 15%–20% in Rwanda, 30% in Zimbabwe, 40% in Lesotho, and more than 50% in Eswatini and Namibia. Among the wealthiest quintiles (Q5), the proportion receiving social protection ranged from 3.6% (2.6%–5.0%) in Ethiopia to 19.7% (16.25–23.8%) in Namibia. Only in countries with higher social protection coverage did the proportion of the poorest wealth quintile households reached also high. Socioeconomic inequalities in receiving social protection favored the poor in 11 out of 13 countries and the rich in Cameroon and were undefined in Côte d'Ivoire. The CIX values for socioeconomic inequalities in receiving social protection in these 11 countries ranged from −0.080 (p=0.002) among the general population in Malawi to −0.372 (p< 0.001) among WLHIV in Zimbabwe. However, in 8 countries (Cameroon, Côte d'Ivoire, Ethiopia, Kenya, Malawi, Tanzania, Uganda, and Zambia) of these 11 countries, 15% or less of the population from the poorest wealth quintile received social protection. In the countries surveyed, access to social protection for the general population, MLHIV and WLHIV, and AGYW was generally low but favored people from poor households. However, pro-poor social protection, although necessary, is not sufficient to ensure that people from the poorest households receive social protection. Further research is required to identify and reach people from the poorest households with social protection in sub-Saharan Africa.
遗漏弱势群体--13 个撒哈拉以南非洲国家的普通人群、艾滋病毒感染者以及少女和年轻妇女在社会保护方面的不平等:基于人口的调查分析
获得服务方面的不平等是一个全球性问题,主要影响到最贫困人口。社会保护在减少不平等方面的作用已得到认可,但很少有研究调查社会保护是否能惠及面临严重社会经济不平等的人群。我们利用 13 个非洲国家的人口数据,评估了公众、感染人类免疫缺陷病毒的男性和女性(PLHIV)以及少女和年轻女性(AGYW)在接受社会保护方面的不平等。我们构建了浓度曲线,并计算了每个国家和人群的浓度指数 (CIX)。我们还对所研究国家的社会保护进行了案头审查,以了解社会保护计划的特点以及普通人群、艾滋病毒携带者和年轻女性获得社会保护的情况。样本规模从埃斯瓦提尼的 10,197 人到坦桑尼亚的 29,577 人不等。在接受调查的国家中,女性占艾滋病毒携带者的 60% 或以上。50%-70%的受访者失业,只有喀麦隆、肯尼亚和乌干达的失业率低于 50%。一般来说,来自第一财富五分位数(Q1),即最贫穷的 20% 家庭的受访者比例与第二至第五财富五分位数相同。接受社会保护的一般人口比例从埃塞俄比亚的 5.2%(95% 置信区间为 4.5%-6.0%)到斯威士兰的 39.9%(37.0%-42.8%)不等。在艾滋病毒感染者中,接受社会保护的比例从赞比亚感染艾滋病毒的男性的 6.9%(5.7%-8.4%)到纳米比亚感染艾滋病毒的女性的 45.0%(41.2%-49.0%)不等。在 AGYW 中,这一比例从埃塞俄比亚的 4.4%(3.6-5.3)到埃斯瓦蒂尼的 44.6%(40.8-48.5)不等。一般来说,在 8 个国家(即喀麦隆、科特迪瓦、埃塞俄比亚、肯尼亚、马拉维、坦桑尼亚、乌干达和赞比亚),15%或更少的第一季度受访者报告说接受了社会保护,其中 3 个国家(喀麦隆、科特迪瓦和埃塞俄比亚)为 10%或更少;卢旺达为 15%-20%,津巴布韦为 30%,莱索托为 40%,而埃斯瓦蒂尼和纳米比亚则超过 50%。在最富有的五分之一人口(Q5)中,接受社会保护的比例从埃塞俄比亚的 3.6%(2.6%-5.0%)到纳米比亚的 19.7%(16.25%-23.8%)不等。只有在社会保护覆盖率较高的国家,最贫穷的五分之一家庭所占比例也很高。在 13 个国家中,有 11 个国家的社会经济不平等现象有利于穷人,喀麦隆则有利于富人,而科特迪瓦的社会经济不平等现象并不明显。在这 11 个国家中,获得社会保护方面的社会经济不平等的 CIX 值从马拉维普通人群的-0.080(p=0.002)到津巴布韦 WLHIV 的-0.372(p< 0.001)不等。然而,在这 11 个国家中的 8 个国家(喀麦隆、科特迪瓦、埃塞俄比亚、肯尼亚、马拉维、坦桑尼亚、乌干达和赞比亚),15% 或更少的最贫穷的五分之一人口获得了社会保护。在接受调查的国家中,普通人群、艾滋病毒携带者、艾滋病病毒携带者和艾滋病青年、妇女和青少年获得社会保护的机会普遍较少,但有利于贫困家庭的人群。然而,有利于穷人的社会保护虽然必要,却不足以确保最贫困家庭的人获得社会保护。需要进一步开展研究,以确定撒哈拉以南非洲最贫困家庭的人,并向他们提供社会保护。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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