HelpAge International

This Forum brings together a set of papers examining how social protection systems are adapting to transformations in labour markets driven by technological innovation and the expansion of non-standard forms of work. Despite progress, major coverage gaps persist, particularly among informal and self-employed workers. The contributions in this Forum explore emerging policy responses to these challenges, with a particular focus on financing. McClanahan analyses comparative international experience in extending social security to self-employed workers, identifying affordability as a critical determinant of success. Cetrángolo and Sirisena draw on a global survey of social security contribution subsidies to show that such mechanisms are widely used policy tools to improve access. Castel‑Branco, Cook, Ewinyu and Madonko examine how globalisation, neoliberalism and digitalisation have constrained domestic revenue mobilisation, while assessing the potential of innovative tax instruments to finance social protection. Pellerano and Juergens-Grant analyse how automation, financialization and declining labour shares are eroding the contributory foundations of social insurance and explore for financing models that extend social security obligations beyond employment and towards to capital. Together, these contributions demonstrate that there is significant awareness among policy makers of the need to adapt social security systems to evolving labour markets, and that social security systems already show a remarkable degree of adaptation.

Ukraine is undergoing accelerated population ageing under conditions of full-scale war, displacement, and systemic pressure on public institutions.These dynamics have exposed structural limitations of fragmented health and social care systems and intensified the need for integrated, person-centred approaches to supporting older people.This article analyses Ukraine's systemic readiness to implement the World Health Organization's Integrated Care for Older People (ICOPE) framework, with a particular focus on governance, financing, workforce policy, and administrative coordination.The study is based on a national mixed-methods readiness assessment conducted in 2025-2026 across two regions of Ukraine.Using the WHO ICOPE Implementation Scorecard as an analytical framework, the research evaluates macro-level (system) and meso-level (service delivery) capacities for integrated care implementation.Findings indicate that Ukraine demonstrates partial and uneven readiness, corresponding to an early implementation stage.While important enabling factors exist -including primary health care reform, decentralised social service networks, and high professional motivation -critical systemic enablers remain underdeveloped.These include interministerial governance mechanisms, integrated financing models, workforce coordination structures, and interoperable information systems.A structured SWOT analysis suggests that Ukraine's challenge lies not only in limited system capacity but in the misalignment of institutional, financial, and governance arrangements.Workforce shortages and resource constraints remain significant, yet existing elements of integrated care operate largely in parallel rather than as a coordinated system, reducing their effectiveness and sustainability.At the same time, post-war recovery, digitalisation, and ongoing public administration reforms create a window of opportunity to align these capacities and institutionalise integrated care as a core component of national ageing policy.

BackgroundThe Cambodian government aims to boost healthcare utilisation in public facilities and reduce the spending burden for disadvantaged households. This study aims to describe patterns of public and private outpatient and inpatient healthcare use and investigate the factors associated with public healthcare usage in Cambodia.MethodA cross-sectional study was conducted in all provinces in Cambodia, including the capital, Phnom Penh. The analysis included 4603 individuals aged ≥18 who had received care within the last 12 months.ResultsAround 9% of outpatient and 50% of inpatient visits were made to public healthcare facilities. The number of outpatient visits made to public healthcare compared with private healthcare facilities was significantly higher in women (aOR 1.4, 95% CI 1.1, 1.8), living in rural settings (aOR 1.4, 95% CI 1.1, 1.7), those in the poorest (aOR 1.7, 95% CI 1.2, 2.3) and poor (aOR 1.5, 95% CI 1.1, 2.1) compared with the richest wealth quintiles, and respondents with insurance coverage (aOR 2.0, 95% CI 1.6, 2.5). The number of inpatient visits made to public healthcare compared with private healthcare facilities was significantly higher in the poorest (aOR 2.4, 95% CI 1.4, 3.9), poor (aOR 2.4, 95% CI 1.5, 4.0) and middle (aOR 2.5, 95% CI 1.5, 4.1) compared with those in the richest wealth quintiles and respondents with insurance coverage (aOR 2.1, 95% CI 1.5, 3.2).ConclusionOur study shows that private healthcare dominates outpatient services in Cambodia, while public healthcare is more significant for inpatient care. Individuals with low socioeconomic status and those with insurance showed higher public healthcare utilisation for outpatient and inpatient services, with women more likely to use public outpatient care. To progress towards universal health coverage, it is essential to improve public healthcare quality, especially in rural areas, expand service coverage and social health protection and develop strategies to engage the private sector.

Esta Nota de Reflexão explora as necessidades de WASH das pessoas idosas, tanto em contextos de desenvolvimento como de emergência, bem como o papel fundamental que as pessoas idosas desempenham na facilitação do acesso a WASH, saúde e bem-estar de outras pessoas. O artigo baseia-se nos dados que os actores de WASH recolhem sobre as pessoas idosas, a fim de compreender as suas diferentes necessidades de WASH, os obstáculos ao acesso a WASH e a necessidade de assegurar a participação das pessoas idosas, nomeadamente o seu papel activo para ajudar a encontrar as soluções.

Older women are coming to the fore in Latin America in challenging the ‘macho’ culture and setting up their own support structures

Dear Editor, I very much enjoyed reading Jane Fleming’s article on the work of HelpAge Kenya, ‘Growing old in Kenya’ ( Nursing the Elderly November/ December 1990). HelpAge Kenya is one of the founder members of HelpAge International, along with Help the Aged (UK). HelpAge India and Pro Vida Colombia.