Economic Role of Solidarity and Social Capital in Accessing Modern Health Care Services in Nigeria
CHAPTER ONE
Objective of the study
In this study, we argue that social capital is a facilitating factor, in the same manner as economic capital, in terms of health care access. To elucidate this argument, we will first provide a brief description of the context of the study, followed by a more detailed discussion of the research itself. Finally, we offer a discussion on the factors that determine financial solidarity and, more specifically, social capital and its association with other forms of social interaction.
CHAPTER TWO
Conceptual framework
The desire to giveFamong humansFis felt as strongly as the desire to receive (Godbout, 1992). Based upon this assumption, it thus becomes essential to elucidate the factors that underpin giving, or donations and solidarity as well as to understand the laws of the market or bureaucracy that have been more thoroughly studied to date. Theoretical analysis conducted by Polanyi (1975), Bourdieu (1980, 1986, 1989, 1994, 2000), Bourdieu & Wacquant (1992) and Granovetter (2000) provide a point of reference in the current conceptualisation of the determinants of solidarity that allow an ill, poor person to have access to paid health care.
In this study, our principal objective is to understand and explain the factors upon which giving and solidarity are based. Our study is all the more pertinent as previous social science research has been principally concerned with the two systems of social regulation that are represented by the public sphere (or the State) and the market. Yet as Polanyi (1975) posits, a third system of social regulation exists that is referred to as solidarity. This system becomes important when the market and state bureaucracy no longer function as they should in a given society. African countries in the southern Sahara, where market logic is weak and the state is often incapable of assuming its responsibilities, rely on the third system of solidarity, donations and mutual aid in order to survive. Polanyi (1975) finds that there are three theoretical models of regulation in human societies: (i) the system of public regulation, or the state; (ii) the system of market regulation, and (iii) the system of regulation through solidarity, or reciprocity. These three models of regulation, Weberian ideal types, propose different approaches to regulate organisational pro- blems and those of social cohesion. All three are comprised of norms, rules and processes of individual socialization that promote the internalisation of the beliefs and values that each model proposes.
CHAPTER THREE
RESEARCH METHODOLOGY
Introduction
In this chapter, we would describe how the study was carried out.
Research design
Research design is a detailed outline of how an investigation took place. It entails how data is collected, the data collection tools used and the mode of analyzing data collected (Cooper & Schindler (2006). This study used a descriptive research design. Gill and Johnson (2002) state that a descriptive design looks at particular characteristics of a specific population of subjects, at a particular point in time or at different times for comparative purposes. The choice of a survey design for this study was deemed appropriate as Mugenda and Mugenda (2003) attest that it enables the researcher to determine the nature of prevailing conditions without manipulating the subjects.
Further, the survey method was useful in describing the characteristics of a large population and no other method of observation can provide this general capability. On the other hand, since the time duration to complete the research project was limited, the survey method was a cost effective way to gather information from a large group of people within a short time. The survey design made feasible very large samples and thus making the results statistically significant even when analyzing multiple variables. It allowed for many questions to be asked about a given topic giving considerable flexibility to the analysis. Usually, high reliability is easy to obtain by presenting all subjects with a standardized stimulus; observer subjectivity is greatly eliminated. Cooper and Schindler (2006) assert that the results of a survey can be easily generalized to the entire population.
CHAPTER FOUR
RESULTS
As illustrated by Fig. 2, three types of factors were identified as determinants of financial solidarity for access to health care services. These are: factors of predisposition, activating factors, and factors of capacity. Within the factors of predisposition, we find those factors that refer to the household and those that refer to the ill person. Many factors of predisposition concerning the household and the ill person have a significant association with financial solidarity (Tables 1 and 2).
Factors of capacity, in which is found each measure of the level of social capital attributed to the ill person or their family, only the variable ‘‘existence of a social support network’’ was found to have a significant association (po0:05) with social support for access to general health care services (Table 3). The variable ‘‘existence of a social support network’’ indicated the potential existence or complete lack, of financial solidarity from the household of the ill person. As for access to formal modern health care services, no variables were found to indicate that the social capital had a significant link (Table 3).
Activating factors are those events or situations, which allow financial solidarity to manifest itself. In the context of our study, the activating factor is illness, or more precisely, the perceived severity of illness or the attributed diagnosis. The results indicate that the more severe the illness is perceived to be, the more the ill person benefits from financial solidarity.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATIONS
Conclusion
With the inability of the State to cover illness-related costs inflicted upon its citizens and the affordability of insurance premiums due to a weak stock market, African populations has drawn upon other strategies to install equitable access to modern medical services. These strategies rest upon networks of solidarity and mutual support. The solidarity networks and mutual support occur as a consequence of social capital which prevails at a micro-social level between individuals, groups of individuals, and communities as opposed to being at the macro-social level between State and citizen (Collier & Gunning, 1999).
In this study, we have shown the role of social capital in the processes of financial solidarity for the access to modern health care services that now require payment. Due to its exploratory nature and methodological limitations, this study did not permit the formation of formal conclusions regarding the role of social capital in the acquisition of financial solidarity for access to medical care. Still, our investigation has provided valuable insights on the role of social capital with respect to social strategies and community financing mechanisms for the acquisition of modern health care in Africa.
Until there is general agreement that the economic development of all poor countries should be built upon local values and realities, it will be critical for us to understand the links between solidarity and the logic of economic exchange in Africa. This understanding can, on the one hand, teach us the limits of economic rationality in a context such as Africa where there is neither the market nor a public system of resource redistribution. On the other hand, it can also lead to new analytic pathways such as inter-individual exchanges of capital where ‘‘homo capitalus’’ emerges as more predominant than ‘‘homo economicus’’.
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