Article Text
Abstract
The COVID-19 pandemic is a reminder that insufficient income security in periods of ill health leads to economic hardship for individuals and hampers disease control efforts as people struggle to stay home when sick or advised to observe quarantine. Evidence on income security during periods of ill health is growing but has not previously been reviewed as a full body of work concerning low-income and middle-income countries (LMICs). We performed a scoping review to map the range, features, coverage, protective effects and equity of policies that aim to provide income security for adults whose ill health prevents them from participating in gainful work. A total of 134 studies were included, providing data from 95% of LMICs. However, data across the majority of these countries were severely limited. Collectively the included studies demonstrate that coverage of contributory income-security schemes is low, especially for informal and low-income workers. Meanwhile, non-contributory schemes targeting low-income groups are often not explicitly designed to provide income support in periods of ill health, they can be difficult to access and rarely provide sufficient income support to cover the needs of eligible recipients. While identifying an urgent need for more research on illness-related income security in LMICs, this review concludes that scaling up and diversifying the range of income security interventions is crucial for improving coverage and equity. To achieve these outcomes, illness-related income protection must receive greater recognition in health policy and health financing circles, expanding our understanding of financial hardship beyond direct medical costs.
- health policy
- public health
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Footnotes
Handling editor Soumitra S Bhuyan
Contributors All authors conceptualised the paper. JT performed the search and data extraction and analysed the data with assistance from KV, GH and KL. JT wrote the first draft. All authors contributed the finalisation of the manuscript and approved the final version. All authors are members of the Health and Social Protection Action Research & Knowledge Sharing network (SPARKS), an international interdisciplinary research network. SPARKS’ multisectoral team characterises and evaluates the direct and indirect effects of social protection strategies on health, economic and wider outcomes.
Funding Funding for this research was received from the Swedish Research Council (2018–05174).
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.