And those African workers lucky enough to be part of a social security plan are not guaranteed comfort. The AIDS epidemic has left many national plans on shaky financial footing because there are more payouts for medical care and death benefits but not as many contributions.

Simply prying the benefits from bureaucrats can be a job in itself.

Charles Owala, 56, a retired Kenyan civil servant, has spent nearly two years trying to get his pension money.

"First when I came here at the beginning of 2004, the officers told me to wait because my membership card number was nowhere to be seen," he said, camped outside the National Social Security Fund offices in Nairobi. "It took a lot of time for it to be traced. Now I'm being told there are some other contributions that my employer has failed to remit. What can I do? Wait again."

Those without an employer to contribute to a formal plan -- those who, to make ends meet, sell food from the curb, iron clothing, dig ditches, harvest crops or perform any number of the other small-scale tasks that keep Africa going -- have long been left out completely.

They are particularly vulnerable to illness because of poverty and exposure, but often put off doctor visits as long as possible. They try traditional medicine because of its lower cost. And they often end up flat on their backs as the price of staying alive soars out of reach.

The fact that many manage to get by is largely because those who have little share with those who have even less.

The community insurance initiatives build on this poor-helping-poor philosophy. They differ from private insurance companies in that they are run by the beneficiaries and not intended to make a single franc. Their target population is people like Ms. Sow, a 40-year-old grandmother who struggles day to day.