Health insurance coverage and non-coverage enhance transparency and accountability, hand in hand with actions on the part of citizens to enhance awareness and the culture of social security, including health and a culture of formality(ILO, 2021d). What is required is a combination of approaches to address the prevalent causes of the gaps identified for different groups. Thus, the assessment and understanding of this diversity of needs calls for different solutions. Figure 4.5 Reasons not to join a health insurance scheme 4.5.1 By sex Senegal Zambia Kenya Ethiopia Total 68% 9% 19% 4% Women 71% % 17% 3% Men 65% 9% 23% 4% Total 55% 24% 14% 7% Women 57% 20% 18% 5% Men 53% 27% 11% 9% Total 69% 15% 14% 2% Women 67% 14% 17% 3% Men 70% 17% 11%2% Total 43% 26% 26% 6% Women 51% 21% 20% 8% Men 37% 29% 30% 4% Total 53% 17% 27% 3% Women 51% 20% 29% 1% Men 56% 14% 26% 5% Total 60% 19% 21% 1% Women 64% 14% 21% 1% Men 54% 25% 21% 1% 0 20 40 60 80 100% % workers in informal employment not willing to join Côte d’Ivoire Benin Insufficient financial resources Don’t trust health insurance schemes Don’t know anything about how they work . Other 4.5.3 By level of education Zambia Secondary+ Primary None 74% 67% 70% 8% 13% 6% 9% 19% 4% 7% 23% Senegal Secondary+ Primary None 29% 52% 64% 41% 18% 12% 27% 12% 8% 15% 16% 4% Kenya Secondary+ Primary None 70% 68% 67% 24% 5%2% 15% 14% 3% 3% 31% Ethiopia Secondary+ Primary None 27% 36% 57% 44% 26% 22% 7% 31% 7% 19% 20% 4% Côte d’Ivoire Secondary+ Primary None 69% 52% 52% 19% 14% 23% 26% 32% 8% 4% 2% Benin Secondary+ Primary None 44% 61% 62% 41% 21% 12% 15% 18% 26% 1% 0 20 40 60 80 100% % workers in informal employment not willing to join Insufficient financial resources Don’t trust health insurance schemes Don’t know anything about how they work . Other 4.5.2 By rural-urban Rural Urban 68% 70% 8% 21% 4% 11% 16% 3% Zambia Senegal Rural Urban 61% 49% 18% 17% 4% 31% 11% 10% Kenya Rural Urban 68% 69% 15% 15% 2% 17% 12%3% Côte d’Ivoire Ethiopia Rural Urban 48% 33% 23% 30% 23% 5% 30% 7% Rural Urban 50% 56% 16% 18% 33% 1% 22% 5% Benin Rural 55% 16% 28% 1% Urban 64% 21% 15% 0% 0 20 40 60 80 100% % workers in informal employment not willing to join Insufficient financial resources Don’t trust health insurance schemes Don’t know anything about how they work . Other 31