Which resources pay for treatment? A model for estimating the informal economy of health

The model proposed is a means for (i) documenting the resources a woman deploys to choose, seek, find, get and pay for treatment; (ii) comparing what she has/does with a neighbour facing similar symptoms and problems, and (iii) understanding which difference between them makes most difference to the way they manage illness. In a narrow economic perspective, only tangible items with easily enumerated values are called resources, and only the formal economy counts. This model allows assessment of the value of both formal and informal resources in the household system. It will not establish the absolute or market worth of households in the sample, but does offer a framework for comparing households which have the same access to a given set of treatment options when faced with the same symptoms. Its application improves the possibility of understanding which resources, or combinations of resources, make most difference to a household's capacity to seek and get the treatment it has decided it needs. The paper is one element of a multi-layered and multi-disciplinary study of 'The Informal Economy of Health in African Cities'. The overall project aims are (i) to map the cultural, infrastructural and clinical factors affecting the treatment-seeking behaviour of women in low-income urban areas; (ii) to compare their effect(s) on the management of symptoms of adult veneral infection (STD) and crisis symptoms in children under five. The project mapped the social context of illness management in a district of Kampala. Important dimensions of that context are: the infrastructure of the area, and the treatment options available in or around it; women's assessments of how good/kind/shameful/private/feasible/appropriate those options are, and the social and physical signs which trigger the conclusion that a symptom is 'serious enough' to need treatment outside the home in the first place. The focus here is the value of resources mobilized after the 'serious enough' assessment has been made. (For a wider picture, see Kampala Women Getting By. James Currey, London, 1996.