FRIEDRICH-EBERT-STIFTUNG – A majority working in the shadows Figure 2.10 Demand for health as first priority and use of medical care 80% 70% 60% 62.9% 50% 40% 30% 20% 43.6% 34.9% 19.7% 30.2% 17.5% 10% 0% Health 1st. Priority medical care-regular use medical care-low use Senegal Cote d'Ivoire Benin Kenya Zambia Ethiopia the state are strongly connected can easily be observed in Figure 2.10. Health as a priority demand becomes less important if medical care is easily available, and goes up if access to medical care is blocked. While this general trend is confirmed, the three West African countries can also be grouped into a different camp from the three East African countries. For respondents from Benin, Senegal and Côte d’Ivoire, improved health services is their highest priority be­cause access to medical care is difficult. Respondents from Kenya, Zambia and Ethiopia put the urgency with which they demand improved health services in second place because medical care is already more easily available. 2.4 SUMMARY AND CONCLUSIONS The interplay between medical care and income depends largely on the respective national health policies. If people are covered by health insurance or may obtain basic medical treatment at no cost, access to medical care may improve and income might lose its role of deciding whether people are treated or not. Demands for better health cut across social and spatial cleavages and can be called a national priority. The findings of this study confirm that universal health coverage should be prioritised on national agendas. National policy initiatives should embrace universal health coverage as a top priority, in particular with a view to those in the informal economy. The survey looked at the accessibility of health care services for the informally employed, from two sides: it tried to determine the importance of health care within a ranking of essential state services; and it provided an assessment of whether health care is used when needed. The two sides are interlinked: if respondents are confronted by a situation in which health care is not available when health problems arise, they demand improved health services with more urgency; if they find medical care to be always or mostly available, they shift their demand for better state services to other deficit areas. We can conclude with confidence that in identifying»improved health services« as the highest-ranking need, then this is the principal area in which the informally employed want the state or government to intervene and to improve the provision of services. REFERENCES ILO(2018): Women and men in the informal economy: A statistical ­picture. Geneva: International Labour Office. Traub-Merz, Rudolf/ Manfred Öhm(2021): Access to Health Services. A Key Demand of Informal Labour in Africa – Findings from Representa­tive Country Surveys in Sub-Saharan Africa. Berlin: Friedrich-Ebert­Stiftung. WHO(2017): World Health Organisation Zambia, WHO Country Cooperation Strategy 2017–2021; available at: https://apps.who.int/iris/ bitstream/handle/10665/273149/ccs-zmb-eng.pdf?ua=1(accessed on 23.5.2020) Access to health is no doubt an issue of social justice. It is linked to income disparities in two regards: the lower the in­come the less medical care becomes available when needed, and the stronger the likelihood that people will have to incur debt to finance health treatment(for more on this, see Chap­ter 3). People unable to pay tend not to seek treatment when they fall sick. 16