The informal labour market in India : transitory or permanent employment for migrants?

The informal economy is a very important sector of the Indian economy. The National Council of Applied Economic Research estimates that the informal sector - "unorganised sector" - generates about 62% of GDP and provides for about 55% of total employment (ILO 2002, p. 14). This paper studies the characteristics of the workers in the informal economy and whether internal migrants treat this sector as a temporary location before moving on to the organised or formal sector to improve their lifetime income and living conditions. We limit our study to the Indian urban (non-agricultural) sector and study the characteristics of the household heads that belong to the informal sector (self-employed and informal wage workers) and the formal sector. We find that household heads that are less educated, come from poorer households, and/or are in lower social groups (castes and religions) are more likely to be in the informal sector. In addition, our results show strong evidence that the longer a rural migrant household head has been working in the urban sector, ceteris paribus, the more likely that individual has moved out of the informal wage sector. These results support the hypothesis that, for internal migrants, the informal wage labour market is a stepping stone to a better and more certain life in the formal sector.

Setor informal: um estudo sobre os camelôs do Shopping Popular em Cuiabá - MT/2003

The phenomenon of the informality has been common in the quarrels that involve Sciences Social and Human. First for not corresponding to a temporary and isolated phenomenon, and on the other hand for dealing with a presente situation in the majority of the Brazilian urban centers. In Cuiabá municipality, the alternative commerce appears as a social answer to the problems caused for the economic crisis of the country and seems to be deep-rooted to the urban landscape. This assignment angles was the street peddlers, in special that ones who develop their in a specific location on lowered of Cuiabá. Researches pretending to fill a blank of information about this subject involve theoritical and empirical levels. The theory searched to raise in a generalized manner given pertinent the informality and the pratical level through field research searched to analyze excellent aspects on the economic and occupational situation of a composed sample for two hundred and theree workers who develope the pratical one of the informal commerce in Shopping Popular in Cuiaba/MT. The analysis of gotten data alllowed to appreciate some excellent aspects with regard to the activity os the peddler, as: origni, formation, income, perspectives with regard to activity among others. In las analysis it still alllowed to verify the factors that condition the permanence these workers in this type of informal activity

Setor informal: um estudo sobre os camelôs do Shopping Popular em Cuiabá - MT/2003

The phenomenon of the informality has been common in the quarrels that involve Sciences Social and Human. First for not corresponding to a temporary and isolated phenomenon, and on the other hand for dealing with a presente situation in the majority of the Brazilian urban centers. In Cuiabá municipality, the alternative commerce appears as a social answer to the problems caused for the economic crisis of the country and seems to be deep-rooted to the urban landscape. This assignment angles was the street peddlers, in special that ones who develop their in a specific location on lowered of Cuiabá. Researches pretending to fill a blank of information about this subject involve theoritical and empirical levels. The theory searched to raise in a generalized manner given pertinent the informality and the pratical level through field research searched to analyze excellent aspects on the economic and occupational situation of a composed sample for two hundred and theree workers who develope the pratical one of the informal commerce in Shopping Popular in Cuiaba/MT. The analysis of gotten data alllowed to appreciate some excellent aspects with regard to the activity os the peddler, as: origni, formation, income, perspectives with regard to activity among others. In las analysis it still alllowed to verify the factors that condition the permanence these workers in this type of informal activity

Caracterización del mercado informal de juegos con máquinas de azar en el barrio Samaria de la ciudad de Pereira

Con el presente trabajo de investigación se determinaron las principales características que presenta el mercado informal de juegos de azar, localizados con Máquinas Electrónicas Tragamonedas (METs) en un barrio de la ciudad de Pereira (Samaria) -- Mercado que funciona en locales de tipología tradicional, la cual está constituida por los negocios como tiendas, misceláneas, cafeterías, graneros, licoreras, heladerías y otros, es decir, locales cuya actividad comercial principal no son los juegos de azar ni el entretenimiento, que optan por incluir en sus portafolios una o dos máquinas electrónicas de juego -- Dichos instrumentos de juego se instalan dentro del espacio de su local y no están inscritas ni cuentan con el permiso de operación de la entidad reguladora de esta actividad en Colombia, que es Coljuegos -- Por tal razón no hay un registro de su magnitud ni mucho menos de los recursos financieros que genera, así como tampoco de las condiciones contractuales en las que opera -- Al ser los juegos de azar localizados una actividad estrictamente regulada por el Estado, el caracterizar la operación informal adquiere relevancia tanto para el Estado como para las compañías formalmente constituidas en la actividad, los cuales ven en ello un competidor informal que captura una participación de mercado de juegos de azar localizados con máquinas de juego

La economía informal: difícil búsqueda en los hogares ante la necesidad tangible de servicios eventuales

Según la Organización Mundial del Trabajo (OIT, 2013), en la informalidad laboral abundan el emprendimiento, la iniciativa, el ingenio, el sacrificio y el esfuerzo -- No obstante, al mismo tiempo es sinónimo de empleos con bajos ingresos, sin protección social ni derechos, sin estabilidad y con escasas perspectivas de futuro -- Al tener en cuenta lo anterior se evidencian tanto la oportunidad como la necesidad de generar nuevas ideas que aprovechen la vinculación en el entorno digital de todo lo referente a la búsqueda y la oferta de servicios no convencionales de manera escalable en el tiempo, dado el crecimiento exponencial del uso de internet en los últimos años, lo que se traduce en ofrecer una forma de mezclar el talento que cada persona desarrolla en labores informales con un medio en el que las puede difundir y promocionar -- Al tomar lo anterior en consideración se plantea un modelo de plataforma digital que busca conectar oferta y demanda para generar soluciones a necesidades eventuales que surgen para el mantenimiento del hogar, como reparación de tuberías, daños eléctricos, carpintería o mejoras locativas en muros, pisos o techos o la consecución de una empleada del servicio con buena calificación, etc -- En este estudio se buscó información mediante entrevistas con las que se pueden generar mecanismos digitales orientados a conectar los oferentes con los demandantes de servicios no convencionales por medio de un canal de contacto directo

Micro-family-owned business : transitory survival mechanism or long term wealth creator?

Principal Topic: Entrepreneurship is key to employment, innovation and growth (Acs & Mueller, 2008), and as such, has been the subject of tremendous research in both the economic and management literatures since Solow (1957), Schumpeter (1934, 1943), and Penrose (1959). The presence of entrepreneurs in the economy is a key factor in the success or failure of countries to grow (Audretsch and Thurik, 2001; Dejardin, 2001). Further studies focus on the conditions of existence of entrepreneurship, influential factors invoked are historical, cultural, social, institutional, or purely economic (North, 1997; Thurik 1996 & 1999). Of particular interest, beyond the reasons behind the existence of entrepreneurship, are entrepreneurial survival and good ''performance'' factors. Using cross-country firm data analysis, La Porta & Schleifer (2008) confirm that informal micro-businesses provide on average half of all economic activity in developing countries. They find that these are utterly unproductive compared to formal firms, and conclude that the informal sector serves as a social security net ''keep[ing] millions of people alive, but disappearing over time'' (abstract). Robison (1986), Hill (1996, 1997) posit that the Indonesian government under Suharto always pointed to the lack of indigenous entrepreneurship , thereby motivating the nationalisation of all industries. Furthermore, the same literature also points to the fact that small businesses were mostly left out of development programmes because they were supposed less productive and having less productivity potential than larger ones. Vial (2008) challenges this view and shows that small firms represent about 70% of firms, 12% of total output, but contribute to 25% of total factor productivity growth on average over the period 1975-94 in the industrial sector (Table 10, p.316). ---------- Methodology/Key Propositions: A review of the empirical literature points at several under-researched questions. Firstly, we assess whether there is, evidence of small family-business entrepreneurship in Indonesia. Secondly, we examine and present the characteristics of these enterprises, along with the size of the sector, and its dynamics. Thirdly, we study whether these enterprises underperform compared to the larger scale industrial sector, as it is suggested in the literature. We reconsider performance measurements for micro-family owned businesses. We suggest that, beside productivity measures, performance could be appraised by both the survival probability of the firm, and by the amount of household assets formation. We compare micro-family-owned and larger industrial firms' survival probabilities after the 1997 crisis, their capital productivity, then compare household assets of families involved in business with those who do not. Finally, we examine human and social capital as moderators of enterprises' performance. In particular, we assess whether a higher level of education and community participation have an effect on the likelihood of running a family business, and whether it has an impact on households' assets level. We use the IFLS database compiled and published by RAND Corporation. The data is a rich community, households, and individuals panel dataset in four waves: 1993, 1997, 2000, 2007. We now focus on the waves 1997 and 2000 in order to investigate entrepreneurship behaviours in turbulent times, i.e. the 1997 Asian crisis. We use aggregate individual data, and focus on households data in order to study micro-family-owned businesses. IFLS data covers roughly 7,600 households in 1997 and over 10,000 households in 2000, with about 95% of 1997 households re-interviewed in 2000. Households were interviewed in 13 of the 27 provinces as defined before 2001. Those 13 provinces were targeted because accounting for 83% of the population. A full description of the data is provided in Frankenberg and Thomas (2000), and Strauss et alii (2004). We deflate all monetary values in Rupiah with the World Development Indicators Consumer Price Index base 100 in 2000. ---------- Results and Implications: We find that in Indonesia, entrepreneurship is widespread and two thirds of households hold one or several family businesses. In rural areas, in 2000, 75% of households run one or several businesses. The proportion of households holding both a farm and a non farm business is higher in rural areas, underlining the reliance of rural households on self-employment, especially after the crisis. Those businesses come in various sizes from very small to larger ones. The median business production value represents less than the annual national minimum wage. Figures show that at least 75% of farm businesses produce less than the annual minimum wage, with non farm businesses being more numerous to produce the minimum wage. However, this is only one part of the story, as production is not the only ''output'' or effect of the business. We show that the survival rate of those businesses ranks between 70 and 82% after the 1997 crisis, which contrasts with the 67% survival rate for the formal industrial sector (Ter Wengel & Rodriguez, 2006). Micro Family Owned Businesses might be relatively small in terms of production, they also provide stability in times of crisis. For those businesses that provide business assets figures, we show that capital productivity is fairly high, with rates that are ten times higher for non farm businesses. Results show that households running a business have larger family assets, and households are better off in urban areas. We run a panel logit model in order to test the effect of human and social capital on the existence of businesses among households. We find that non farm businesses are more likely to appear in households with higher human and social capital situated in urban areas. Farm businesses are more likely to appear in lower human capital and rural contexts, while still being supported by community participation. The estimation of our panel data model confirm that households are more likely to have higher family assets if situated in urban area, the higher the education level, the larger the assets, and running a business increase the likelihood of having larger assets. This is especially true for non farm businesses that have a clearly larger and more significant effect on assets than farm businesses. Finally, social capital in the form of community participation also has a positive effect on assets. Those results confirm the existence of a strong entrepreneurship culture among Indonesian households. Investigating survival rates also shows that those businesses are quite stable, even in the face of a violent crisis such as the 1997 one, and as a result, can provide a safety net. Finally, considering household assets - the returns of business to the household, rather than profit or productivity - the returns of business to itself, shows that households running a business are better off. While we demonstrate that uman and social capital are key to business existence, survival and performance, those results open avenues for further research regarding the factors that could hamper growth of those businesses in terms of output and employment.

On the effectiveness of a license scheme for E-waste recycling : the challenge of China and India

It is well known that China and India have been recycling centers of WEEE, especially printed circuit boards, and that serious environmental pollution in these countries has been generated by improper recycling methods. After the governments of China and India banned improper recycling by the informal sector, improper recycling activities spread to other places. Then, these governments changed their policies to one of promoting proper recycling by introducing a scheme, under which E-waste recycling requires a license issued by the government. In this paper, the effectiveness of that license scheme is examined by means of an economic model. It can be shown that the license scheme can work effectively only if disposers of E-waste have a responsibility to sell E-waste to license holders. Our results run counter to the idea that international E-waste trade should be banned and provide an alternative solution to the problem.

Informalidade na região metropolitana do Rio de Janeiro a partir de 1980

Este estudo busca contribuir à discussão teórica sobre o comportamento do mercado de trabalho e da informalidade na Região Metropolitana do Rio de Janeiro - RMRJ, sobretudo a partir dos anos 1990. As informações utilizadas na análise são provenientes principalmente da Relação Anual de Informações Sociais (RAIS) e do Cadastro Geral do Emprego e Desemprego (CAGED) - Ministério do Trabalho e Emprego (MTE) - da Pesquisa de Amostragem a Domicílio (PNAD), da Pesquisa Mensal de Emprego (PME) e da Economia Informal Urbana (ECINF) - do Instituto de Brasileiro de Geografia e Estatística (IBGE) - com um recorte nos setores tradicionais da economia. Umas das hipóteses centrais é a da existência de uma relação de causalidade entre as políticas econômicas implementadas a partir de 1990, tais como privatizações de empresas públicas, abertura comercial e financeira para o capital estrangeiro com a informalidade. Estas foram determinantes para oscilações nos níveis de emprego formal das indústrias, com o avanço substancial do setor informal, sobretudo na região metropolitana do Rio de Janeiro (RMRJ).A análise, feita por setores de atividade, permite comprovar que a informalidade apresenta-se cada vez mais claramente como uma característica da estrutura da economia da metrópole do Rio de Janeiro e não simplesmente como um fenômeno transitório relacionado à redução das atividades industriais.

Negociar direitos? : legislação trabalhista e reforma neoliberal no governo FHC (1995-2002)

Ao longo do século XX, o Direito do Trabalho esteve associado a um arranjo político e social cujos sentidos estavam vinculados, entre outros aspectos, à civilização das relações de classe e à reprodução do capitalismo com democracia, no âmbito dos Estados nacionais. O propósito desta pesquisa é investigar como ocorreu o processo de deslocamento e reinterpretação desses sentidos (equivalente à codificação da razão do mais forte), no contexto da forte hegemonia política da coalizão de centro-direita que governou o país entre 1995 e 2002. Nesse período, o Poder Executivo Federal, as principais organizações patronais, setores importantes da mídia impressa e a Força Sindical estiveram empenhados na promoção de profunda alteração dos traços centrais do modelo brasileiro de relações de trabalho, no qual a lei é mais importante na definição dos direitos substantivos do trabalho do que os contratos coletivos. Para justificar politicamente essas alterações, o Poder Executivo e seus apoiadores apontaram a responsabilidade do modelo legislado pelos elevados custos do emprego formal, a perda de competitividade da indústria, o aumento da informalidade e do desemprego durante o governo FHC. Por meio da leitura das justificativas dos projetos encaminhados ao Congresso Nacional pelo Poder Executivo, das manifestações de suas principais lideranças e dos apoiadores na mídia e no meio sindical, a pesquisa busca interpretar o sentido político dessa leitura, apresentada como se fosse solução técnica e modernizante para uma legislação que estaria ultrapassada. Consideramos que a reforma trabalhista tinha claros propósitos políticos pois, além de repassar aos trabalhadores os custos do ajuste econômico nos anos 90, permitiu justificar na cena pública a retração do papel do Estado, bem como fortalecer o apoio de setores importantes do patronato a esse projeto político.

Cuidados informais : os idosos em situação de dependência em Portugal

RESUMO - Enquadramento: As mudanças demográficas e na estrutura social das famílias precipitaram reformas das políticas dos cuidados de longa duração da população idosa no continente Europeu. Após um período em que as mulheres assumiam o papel de principais cuidadoras dos membros mais idosos, o aumento da sua inclusão no mercado de trabalho, assim como o envelhecimento geral da população introduziu mudanças no enquadramento dos cuidados a idosos. Estas mudanças têm particular impacte nos países da Europa do Sul, visto que tradicionalmente o cuidado a idosos é prestado maioritariamente pelo sector informal. Finalidade/objectivos: O presente estudo tem como finalidade conhecer as características dos cuidadores informais e dos idosos dependentes em Portugal. Definiram-se três objectivos principais. O primeiro é compreender a realidade demográfica, de saúde e dependência funcional dos idosos alvo de cuidados informais em Portugal. Em segundo pretende-se conhecer a situação actual dos prestadores informais de cuidados de longa duração em Portugal. Em terceiro, discutem-se os aspectos que mais influenciam a acessibilidade a cuidados informais entre os idosos dependentes em Portugal. Metodologia: Para concretizar estes objectivos, para além de se proceder a uma sistematização bibliográfica da literatura mais relevante nesta área, recorre-se à análise descritiva e regressão logística binária. Utilizando os dados do inquérito Survey of Health, Ageing and Retirement in Europe descreve-se a realidade nacional dos idosos dependentes e seus cuidadores informais e estimam-se modelos de acessibilidade aos cuidados informais em Portugal. Resultados/conclusões: Este estudo contribui para o conhecimento de três aspectos fundamentais sobre os cuidados informais em Portugal: o primeiro prende-se com a quantificação da realidade nacional dos idosos dependentes em Portugal; o segundo relaciona-se com a quantificação da situação portuguesa dos cuidadores informais; e, por último, estima-se modelos explicativos sobre a acessibilidade a cuidados informais. Para além da quantificação da realidade nacional, o principal contributo deste trabalho reside na demonstração de que o actual modelo de prestação de cuidados (baseado nos cuidados informais prestados por membros da família) deixa de fora uma parte significativa dos idosos dependentes. Na verdade, este estudo demonstra que uma parte significativa dos idosos não tem acesso a cuidados e que, embora sejam os elementos da família que maioritariamente prestam os cuidados informais, esse facto, por si só, não explica o acesso aos cuidados.

Understanding space, place and leisure of women over 85 living in the community

There is an increase in the number of older adults 85 and over, who are choosing to live alone within the community. Moreover, older adults who live alone are reportedly spending an extensive amount of time alone within the home environment. In an effort to provide additional support and resources to older adults living in the community, a compliment of services are being offered through public and private organizations. These in-home supports focus on the instrumental or functional tasks of daily living, such as personal and rehabilitative care, nourishment, maintenance and upkeep of the home, as well as volunteer social visitation. However leisure resources and programs are not included among these services. Consequently, this creates a gap in leisure provision among this segment of the population. Throughout the life course, an individual's identity, role and purpose are developed and sustained through instrumental work roles in the formal and informal sector, as well as through personally meaningful leisure pastimes and experiences. Although roles shift post retirement, participation in instrumental and expressive activities can provide opportunities through which older adults are able to fulfill their need for agency (individuality and autonomy) and affiliation (social relatedness). Therefore barriers that inhibit instrumental or leisure experiences can negatively impact older adults' quality of life. This study explored the leisure lifestyles of four older adults, all of whom were over 85, lived alone within the community and were oriented to person, time and place. It became apparent that participants ordered their lives around a routine that consisted of instrumental, expressive and socially integrated tasks and activities. Moreover participants purposely chose to remain at home because their home environment facilitated freedom, choice and independence. As a result all four participants viewed their independence within the home as a critical determinant to their overall quality of life. Challenges associated with the home environment, participants' personal capacities and relationships were negotiated on a daily basis. Failure to positively adapt to these challenges inhibited meaningful engagement and personal fulfillment. Traditionally, leisure service delivery has been offered within institutions and through various community based venues. As a result leisure provision has been focused on the needs of the frail elderly who reside in institutions or the well elderly who are able to access leisure amenities within the community. However the growing number of older adults electing to live alone is on the rise. As individuals age the home becomes the preferred context for leisure experiences. If older adults are choosing to live alone, then both their instrumental and leisure needs must be addressed. As a result, it is imperative that leisure professionals extend the scope of service delivery to include home centered older adults.

Le changement social et l'État moderne en Mongolie

Ce mémoire propose une analyse socio-historique d'un cas extrême de changement social par son ampleur et sa rapidité: l'apparition ex-nihilo, à partir des années 1990, d'une population de plus de 100 000 mineurs artisanaux en Mongolie. Pour ce faire, il offre, premièrement, des outils théoriques au lecteur pour comprendre la tension entre permanence et mouvement qui anime les sociétés humaines. Deuxièmement, il identifie les tendances récurrentes de l'histoire mongole pour rendre le présent plus intelligible. Troisièmement, il détaille les principales caractéristiques contemporaines de ce nouveau phénomène, ainsi que ses potentialités pour le proche avenir. Mais surtout, à chaque étape, il construit une théorie locale et partielle du changement social, qui montre l'impact croissant de l'État moderne et de son idéologie du progrès et de la rationalité dans la vie de tous les individus, qui laisse les plus marginaux d'entre eux de plus en plus dépourvus d'influence sur leur environnement.

Méthode pour l’établissement d’une liste de médicaments remboursables dans le cadre du nouveau programme d’assurance-médicaments en Côte d’Ivoire

Contexte général La Côte d'Ivoire est un pays de l’Afrique de l’Ouest qui a décidé, depuis 2001, d'étendre la couverture des prestations de santé à toute sa population. En effet, cette réforme du système de santé avait pour but de fournir, à chaque ivoirien, une couverture médicale et pharmaceutique. Toutefois, la mise en œuvre de cette réforme était difficile car, contrairement aux pays développés, les pays en développement ont un secteur « informel » échappant à la législation du travail et occupant une place importante. En conséquence, il a été recommandé qu’il y ait deux caisses d'assurance santé, une pour le secteur formel (fonctionnaires) et l'autre pour le secteur informel. Ces caisses auraient légitimité en ce qui a trait aux décisions de remboursement de médicaments. D’ores-et-déjà, il existe une mutuelle de santé appelée la Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI), chargée de couvrir les frais médicaux et pharmaceutiques des fonctionnaires et agents de l’Etat. Celle-ci connaît, depuis quelques années, des contraintes budgétaires. De plus, le processus actuel de remboursement des médicaments, dans cette organisation, ne prend pas en considération les valeurs implicites liées aux critères d'inscription au formulaire. Pour toutes ces raisons, la MUGEFCI souhaite se doter d’une nouvelle liste de médicaments remboursables, qui comprendrait des médicaments sécuritaires avec un impact majeur sur la santé (service médical rendu), à un coût raisonnable. Dans le cadre de cette recherche, nous avons développé une méthode de sélection des médicaments pour des fins de remboursement, dans un contexte de pays à faibles revenus. Cette approche a ensuite été appliquée dans le cadre de l’élaboration d’une nouvelle liste de médicaments remboursables pour la MUGEFCI. Méthode La méthode de sélection des médicaments remboursables, développée dans le cadre de cette recherche, est basée sur l'Analyse de Décision Multicritère (ADM). Elle s’articule autour de quatre étapes: (1) l'identification et la pondération des critères pertinents d'inscription des médicaments au formulaire (combinant revue de la littérature et recherche qualitative, suivies par la réalisation d’une expérience de choix discrets); (2) la détermination d'un ensemble de traitements qui sont éligibles à un remboursement prioritaire; (3) l’attribution de scores aux traitements selon leurs performances sur les niveaux de variation de chaque critère, et (4) le classement des traitements par ordre de priorité de remboursement (classement des traitements selon un score global, obtenu après avoir additionné les scores pondérés des traitements). Après avoir défini la liste des médicaments remboursables en priorité, une analyse d’impact budgétaire a été réalisée. Celle-ci a été effectuée afin de déterminer le coût par patient lié à l'utilisation des médicaments figurant sur la liste, selon la perspective de la MUGEFCI. L’horizon temporel était de 1 an et l'analyse portait sur tous les traitements admissibles à un remboursement prioritaire par la MUGEFCI. En ce qui concerne la population cible, elle était composée de personnes assurées par la MUGEFCI et ayant un diagnostic positif de maladie prioritaire en 2008. Les coûts considérés incluaient ceux des consultations médicales, des tests de laboratoire et des médicaments. Le coût par patient, résultant de l'utilisation des médicaments figurant sur la liste, a ensuite été comparé à la part des dépenses par habitant (per capita) allouée à la santé en Côte d’Ivoire. Cette comparaison a été effectuée pour déterminer un seuil en deçà duquel la nouvelle liste des médicaments remboursables en priorité était abordable pour la MUGEFCI. Résultats Selon les résultats de l’expérience de choix discrets, réalisée auprès de professionnels de la santé en Côte d'Ivoire, le rapport coût-efficacité et la sévérité de la maladie sont les critères les plus importants pour le remboursement prioritaire des médicaments. Cela se traduit par une préférence générale pour les antipaludiques, les traitements pour l'asthme et les antibiotiques indiqués pour les infections urinaires. En outre, les résultats de l’analyse d’impact budgétaire suggèrent que le coût par patient lié à l'utilisation des médicaments figurant sur la liste varierait entre 40 et 160 dollars américains. Etant donné que la part des dépenses par habitant allouées à la santé en Côte d’Ivoire est de 66 dollars américains, l’on pourrait conclure que la nouvelle liste de médicaments remboursables serait abordable lorsque l'impact économique réel de l’utilisation des médicaments par patient est en deçà de ces 66 dollars américains. Au delà de ce seuil, la MUGEFCI devra sélectionner les médicaments remboursables en fonction de leur rang ainsi que le coût par patient associé à l’utilisation des médicaments. Plus précisément, cette sélection commencera à partir des traitements dans le haut de la liste de médicaments prioritaires et prendra fin lorsque les 66 dollars américains seront épuisés. Conclusion Cette étude fait la démonstration de ce qu’il est possible d'utiliser l’analyse de décision multicritère pour développer un formulaire pour les pays à faibles revenus, la Côte d’Ivoire en l’occurrence. L'application de cette méthode est un pas en avant vers la transparence dans l'élaboration des politiques de santé dans les pays en développement.

Des principes de responsabilité et de solidarité pour un accès équitable aux soins de santé : le cas des travailleurs de l'informel urbain du Cameroun en situation de vulnérabilité

La question de l’accès financier des personnes socialement défavorisées aux soins de santé est aujourd’hui un enjeu éthique de grande importance dans de nombreux pays à faible revenu ou en voie d’émergence. On peut se demander comment l’équité dans l’accès aux soins peut être rendue effective puisque l’égalité des chances pour tous et la santé sont des pré-requis aux choix de vie et à la réalisation de soi. Les soins de santé sont donc d’une importance éthique particulière du fait qu’ils contribuent à préserver notre statut comme citoyens pleinement fonctionnels. Au Cameroun, bien que des efforts considérables soient consentis par les pouvoirs publics et leurs partenaires extérieurs pour favoriser l’accès aux soins des personnes défavorisées, le secteur de la santé reste encore très marqué par l’inégalité dans l’accès financier aux prestations sanitaires. Les médicaments les plus essentiels ne sont pas financièrement à la portée de tous et les coûts d’accès aux soins ambulatoires et hospitaliers dans les formations sanitaires sont manifestement prohibitifs pour une large frange de la population. Lors des épisodes de maladie, l’accès aux soins se fait par le paiement direct au point d’accès, et la pratique de l’automédication s’est répandue du fait de l’incapacité des personnes socialement défavorisées à payer leurs soins sans courir le risque de perdre l’essentiel de leur revenu. Les mesures de prise en charge sociale ou des systèmes de financement qui garantissent la réduction des inégalités entre les classes sociales sont fortement limitées par les faibles capacités d’une économie qui repose essentiellement sur l’informel. Sur la base de cette réalité, cette thèse analyse à partir du cas des travailleurs vulnérables du secteur informel urbain, la pertinence du choix politique de la couverture universelle santé au Cameroun à travers les principes de responsabilité et de solidarité. La population d’étude choisie est celle des travailleurs vulnérables du secteur informel en considération des problématiques liées à leur accès aux soins de santé, de l’importance de leur apport dans l’économie du pays ( 90 % des travailleurs) et du rôle qu’elle pourrait jouer dans l’atteinte de l’objectif de la couverture universelle santé. La thèse analyse donc, d’une part, les conditions et les modalités de répartition des biens sociaux qui répondent à la nécessaire redistribution équitable des ressources, en l’occurrence l’accès aux soins de qualité. Après avoir montré les préoccupations d’ordre politique, social, économique et éthique liées au problème d’accès universel aux soins, la thèse propose des stratégies opérationnelles susceptibles de conduire à l’amélioration de la qualité des soins et à un assainissement de la gestion du secteur des services de soins (éthique du care et éthique de bonne gouvernance). Aussi, dans la perspective de la recherche d’un financement local soutenable et durable de l’accès de tous aux soins, la thèse propose une approche participative. L’exploration de cette perspective aboutit au résultat qu’une approche inclusive et intégrée de promotion de l’économie informelle (dynamisation de ses activités et potentialisation de ses acteurs) pourrait faire de ce secteur un véritable levier de développement économique et social. Un développement social et solidaire durable et susceptible, sur le long terme, de réaliser l’objectif de la couverture universelle santé. En d’autres termes, elle propose des stratégies de capabilisation et de responsabilisation des travailleurs du secteur informel, en vue d’une société plus impliquée, plus responsable et plus solidaire. Une approche susceptible de matérialiser le droit à la santé, de construire l’autonomie des travailleurs en situation de vulnérabilité et de renforcer leurs capacités contributives à travers une opérationnalisation adaptée au contexte des principes de responsabilité et de solidarité.

Muertes por sustancias químicas en el ámbito laboral municipio de Soacha 1993 - 2008

Este trabajo permite tener un acercamiento a la magnitud del problema que generan las sustancias químicas en los trabajadores de un municipio de Cundinamarca entre los años 1993-2008 basándose en los informes obtenidos de la unidad básica de la Dirección seccional Cundinamarca Regional Oriente del Instituto Nacional de Medicina Legal y Ciencias Forenses; hallando como principal causa de muerte la intoxicación por monóxido de carbono, en los trabajadores del sector informal. Genera además la inquietud de crear, un instrumento que permita un adecuado registro de estos eventos y a través de este, programas dirigidos a empleadores y trabajadores, que pueda concientizarlos de la exposición a la que se someten, ante un enemigo invisible como lo son las sustancias químicas y cuya consecuencia se observa claramente en la mortalidad de menores de edad que se encontraron durante la revisión de los informes