FRIEDRICH-EBERT-STIFTUNG – A majority working in the shadows Figure 2.7 Demand for better health services and pensions(first priority), by age groups 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Senegal age 15-24 years Benin Côte d'Ivoire age 25-34 years age 35-44 years Ethiopia age 45-54 years Zambia age 55-64 years Kenya age 65 a.m. years household, discussions of state service deficits may balance people’s priorities over time. The findings are shown in Figure 2.7. Here, we compare the priorities of various age groups for improved health services with access to pensions. Our assumption that many older people shift their priorities from health care to pensions is confirmed for Kenya, Zambia and, to a lesser extent, for Côte d’Ivoire. It is not confirmed for Senegal, Benin and Ethiopia. Here, the demand profiles indicate a broad conformity between age groups. The effect of age-biased demand for pensions is particularly strong in Kenya, where elderly people 65 years of age or over shift their priorities towards pensions to an extent that it even outstrips demand for better health services. All other age groups in other countries have a clear leaning towards improved health services and find the introduction of pen­sions less urgent. C. INCOME Income is another factor that makes predictions of how it impacts on demand for better health services difficult. The poor are likely to depend on state provision for access to primary health care, whereas the well-off are more likely to be able to afford private health services. In-between are the »non-poor«, who may be able to tap alternative sources where the state fails to deliver in some service areas(such as primary health care), but may find it difficult to do so in other areas(such as secondary health services). There may also be people who classify some duties as moral duties of the state towards all citizens and designate a particular service a top priority independent of their personal situation. To assess priority voting by income we have grouped re­spondents into four income classes, which differ as a multiple of the statutory minimum wage(MW). The results are shown in Figure 2.8. Voting on health hardly depends on income. Health demand shows some income dependency in Zambia and the»well­off« in Benin are less interested in better health services. Overall, the impact is minor and all income classes express a fairly similar urgency to obtain better health services from the state. D. GENDER Could gender be a factor that affects respondents’ priority setting with regard to health care? Figure 2.9 provides an answer from our survey data. For Kenya, we observe that more male respondents than female respondents favour better health care as first priority. The strength of this effect is small, however. In all other countries, gender is not a variable that explains the demand for improved health services. 2.3.3 Discussion Reasons why»health service« and»school and education« top the list of desired state services easily come into mind. Education is identified as the primary vehicle for social advancement. Obtaining educational qualifications is the easiest way for many to improve their chances on the labour market and climb the social ladder. The strong demand for more educational infrastructure expresses the hope of large segments of the population that they may be able to improve living standards for themselves or for their children. 15 The urgency with which people call for» better health ser­vices« may equally be argued to express a call for improved living conditions. It is important to note that the call for » better health services« far outstrips the demand for» better pensions for the elderly«. On average, eleven times more people identify» better health« as their top need than the number who call for» better pensions«. One explanation may be that the pressure of current social problems exceeds 15 There is indeed a positive relationship between higher levels of educa­tion and access to formal employment. See ILO(2018). 14