FRIEDRICH-EBERT-STIFTUNG – A majority working in the shadows 35.7 per cent in Ethiopia. This is without including direct health expenditure by the employer, which plays a minor role but provides some kind of protection to four to five per cent of workers in informal employment in Senegal and Côte d’Ivoire, 12 although without any guarantees and of course outside the scope of social health protection. Direct support from employers covers primarily health expenditure related to work injury and more rarely, non-job-related health ex­penditure. 4.2.4 Main features of affiliation Regarding the minority of workers in informal employment who are members of a social health insurance scheme or have private health insurance, their affiliation is more often than not voluntary(Figure 4.2.1). Nearly all affiliated in­formally employed members in Ethiopia(99 per cent) and 65 per cent or more in other countries are affiliated on a vol­untary basis. For most workers in informal employment who report being affiliated on a mandatory basis, the affiliation is actually indirect, benefiting from the affiliation of another member of the household. Irrespective of the voluntary or mandatory nature of the affiliation, indirect affiliation is the most prominent form of affiliation of workers in informal employment to health insurance(considering social health insurance and public health insurance together). Indirect affiliation concerns 40 per cent in Kenya and as much as 93 per cent in Ethiopia(Figure 4.2.2). 12 This type of support could not be assessed in Benin, Kenya and ­Ethiopia owing to the lack of the corresponding question or sufficient answers. The incidence of indirect affiliation highlights the impor­tance of the household dimension. The distinction between informally employed workers living in»fully informal house­holds«(all household members employed being in informal employment) and those living in households with at least one household member who is formally employed(»mixed households«) points to higher affiliation rates among those living in»mixed households«, benefitting from indirect cov­erage(Figure 4.3.1). Considering the same indicator of social health insurance and private health insurance coverage, with the exception of Ethiopia, coverage among workers in infor­mal employment is higher among those living in households some of whose active members hold a formal job. Consid­ering only coverage of workers in informal employment by social health insurance, the proportion is at least two to three times higher for those living in households with at least one member in formal employment. However, the proportion of households concerned and the overall effect of health insur­ance coverage of workers in informal employment remain limited. Including the household dimension as part of the analysis points to characteristics of the households of informal work­ers that may mitigate, or accentuate, the impacts of some of the vulnerabilities associated with informal employment, in­cluding levels of insecurity of income(level, stability, assets), with social protection playing an important role(OECD-ILO 2019). The proportion of informal workers affiliated with social health insurance or private health insurance schemes is positively associated with levels of household income(Figure 4.3.2) or household assets. Figure 4.2 Distribution of workers in informal employment who are members of health insurance schemes according to: 4.2.1 The voluntary or mandatory nature of enrolment 4.2.2. Direct or indirect coverage(through) another household member Eth i op i a(35% coverage) 1% 99% Eth i op i a(35% coverage) 7% 93% Ke n ya(26% coverage) 29% Mandatory Voluntary Côte d’Ivo i re (10% coverage) 32% Se n ega l(8% coverage) 35 71% 68% 65% Ke n ya(26% coverage) Côte d’Ivo i re (10% coverage) 52% 40% Main contributor Another household member Other 30% 68% 8% 3% Se n ega l(8% coverage) 59% 33% 8% Be nin(2% coverage) 48% 52% Be nin(2% coverage) 26% 61% 13% 0 20 40 60 80 100% 0 20 40 60 80 100% . % by type of affiliation% by type of affiliation Note: These results should be considered in light of the proportion of workers who are members of a health insurance scheme as provided in Figure 4.1 and in brackets(close to country names). In Benin, for instance, these results concern only two per cent of all workers in informal employment. 28