While coordination in social security is often necessary, it is not sufficient on its own. Sound policies and strong institutions are also needed to guarantee social security rights. As coordination is costly, global studies have cautioned against pursuing it for its own sake or designing highly complex policies that require extensive coordination in low-capacity contexts.

When coordination is required however, policies and institutional structures vary widely, and there is no single recipe for how to achieve it. Mechanisms that work in one country or institution may not work in another. In addition, the degree or complexity of coordination required for successful implementation may vary according to different strategic or policy aims, as well as the capacities of the actors and institutions involved. Coordination solutions must therefore be adapted to the local context and respond to specific and well-defined strategic objectives.

In the Americas, coordination is not a new practice for social security organizations; on the contrary, there are many examples of coordination at the policy level (high-level coordination), at the level of operations and procedures (mid-level coordination) and at the level of service delivery (street-level coordination). This simplified typology, described in Table 1, forms the basis for the discussion of the following cases, bearing in mind that in practice, the boundaries between levels are not always strict.  

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Implementation of multi-level coordination initiatives in social security in the Americas

This article explores examples of good practices in the Americas that involve at least two of the three defined levels of coordination. Although some type of coordination may exist at all three levels across all cases, the focus in the descriptions is on the levels where coordination was most salient. The article draws heavily on the framework developed for the United Nations Department of Economic and Social Affairs (UNDESA) and the International Labour Organization (UNDESA and ILO 2021; ILO et al., 2021).

Both Brazil's experience in the Campaign for the Prevention of Workplace Accidents, and Argentina's experience in the Inter-harvest Programme, have clear coordination at all three levels. In Argentina and Mexico, the cases of co-responsibility agreements (Argentina) and specialized care for high-risk pregnant women (Mexico) highlight situations in which coordination was required at the level of operations and service delivery. Finally, examples in which both policy and operational level coordination efforts stand out can be found in Uruguay (Public Software), Argentina (digital labour and social security documents), and in an international context with the Southern Common Market (MERCOSUR) and its International Agreement System in Social Security (Sistema de Acuerdos Internacionales de Seguridad Social – SIACI).

These examples and the levels where coordination was required are summarized in Table 2.

Multilevel coordination (policy, operational, service delivery)

Argentina’s Inter-Harvest Programme

In Argentina, the Ministry of Labour, Employment and Social Security (Ministerio de Trabajo, Empleo y Seguridad Social – MTEySS) implemented the Inter-harvest Programme. This programme aims to compensate the income of temporary agricultural workers who are inactive during the period between harvests.

Agriculture is an activity characterized by conditions of vulnerability, labour precariousness, seasonality, geographic mobility, high turnover and lack of registration with social security. In addition, climatic contingencies threaten harvests and affect workers' incomes.

The programme consists of a monthly financial transfer during the seasonal break (up to four months), access to courses and/or training opportunities, employment agencies and ease of mobility between regions.

The programme aims to cover the entire country. Given the wide geographical dispersion of the rural population, implementation is carried out through specific agreements between the MTEySS and provincial governments, with the support of trade unions in the sector and the National Registry of Rural Workers and Employers (Registro Nacional de Trabajadores Rurales y Empleadores – RENATRE).

The provincial and municipal governments, together with the producers’ associations and trade unions of each activity, survey the workers in their territory, generate the lists of possible beneficiaries and request their registration with the department dedicated to employment and training (Secretariat for Social Security, 2015).

Brazil’s Campaign for the Prevention of Accidents at Work

The Under-Secretariat of Labour Inspection within the Social Security Secretariat of the Brazilian Ministry of Finance has implemented the National Campaign for the Prevention of Accidents at Work (CANPAT). This initiative consists of a series of actions aimed at promoting a culture of safety and health at work. It is a purely preventive initiative aimed at raising society's awareness of the harm caused by accidents and illnesses.

CANPAT has two axes. The first one is aimed at workers and employers through specific actions in the workplace, and the second one aims to create a culture of prevention among young people and adolescents through activities in public and private schools.

The campaign involves the central labour inspection agency as well as the regional labour inspectorates, which are established in the 27 federal units of the country. Several public and private partner institutions, federations and confederations of employers and workers are also involved.

Internal coordination between the central agency and the regional labour inspection units, as well as between the labour inspectorate, institutional partners and other authorities, is essential for the smooth running of the campaign (Ministry of Social Security, 2017).

Coordination at two levels (policy level and service delivery)

Argentina’s joint responsibility union agreements

The Social Security Secretariat (Secretaría de Seguridad Social – SSS) within the MTEySS in Argentina implemented a tool to contribute to decent work in rural areas. This initiative involves the signing of agreements of joint responsibility between the trade unions and employers. This facilitates access to social security for workers and their families (including old age and invalidity pensions, insurance against work-related accidents or occupational diseases, unemployment insurance, family allowances and health coverage) and to ensure the payment of social security contributions.

The agreements are signed between the associations of rural workers and the business entities for the sector. Once signed, they are submitted to the Federal Administration of Public Resources (Administración Federal de Ingresos Públicos – AFIP) and the National Administration of Social Security (Administración Nacional de la Seguridad Social – ANSES), which proceed to send them to SSS. The SSS approves the agreements, verifies their compliance, and resolves disputes or questions related to the application or interpretation of the agreements (Secretariat for Social Security, 2012).

Mexico’s specialized care for high-risk pregnant women

One of the most important determining factors for maternal death is the lack of specialized medical care. Such care enables the timely and effective resolution of health problems and complications that arise during, or after, pregnancy. However, many rural hospitals in Mexico are unable to provide this complex care and management because they lack the necessary infrastructure and personnel.

As part of the strategy to reduce maternal mortality in rural areas, the Mexican Social Security Institute (Instituto de Seguridad Social de México – IMSS) implemented a model for coordinating specialist care between the national public health system IMSS Bienestar and second- and third-level hospitals of the IMSS compulsory regime. Specifically, the Expert Council of the IMSS, through Resolution 126, authorized compulsory regime hospitals to grant free specialized care to beneficiaries of the IMSS Bienestar system for prenatal care, childbirth and new-born care in high-risk cases.

To implement the resolution, an intervention model was designed that focuses on modifying the main factors that contribute to the occurrence of deaths; reinforcing their prevention from before pregnancy; as well as effective and timely management of the main obstetric emergencies and those arising from complicated births. The latter was carried out through a systematic, sequential, and coordinated referral and counter-referral model for specialized and multidisciplinary medical care, at no cost, when the needed care exceeds the level of care provided by the programme's rural hospitals (Mexican Social Security Institute, 2020).

Coordination at two levels (policy and operational)

Argentina’s digital labour and social security documents

In Argentina, AFIP implemented a digital payroll system that enables employers to utilize a one-stop shop and single data source for digital labour and social security documents.

The initiative is a joint project between AFIP and the MTEySS that simplifies the employer's obligations and ensures the quality and consistency of the information submitted. It avoids duplication of data entry for different government agencies and simplifies the process through a single (through which the information is collected) respects the requirements of the different actors or bodies involved, both in labour and social security matters. The application is a web tool that allows employers to systematize their labour records by logging into the system with their tax code and importing a file containing their salary statements. They are then able to confirm this information through the summary statement returned by the AFIP.

The whole service required coordination not only at the policy level, but also at the operational level, since it requires each agency to define its needs, as well as the data needed for each agency. In addition, it replaced existing forms (Federal Administration of Public Resources, 2016).

Uruguay’s Public Software and collaborative work

The Social Insurance Bank (Banco de Previsión Social de Uruguay – BPS) has promoted the adoption of Public Software (software that was developed with state resources and can therefore be shared among the different bodies within the state) before launching a new system or entering a bidding process to acquire it.

By encouraging BPS to seek existing software solutions being used in other state agencies and determine their degree of applicability to its needs, the Public Software initiative promoted inter-organizational coordination and strengthened collaborative networks. In addition, it achieved real results in terms of costs and resources by taking advantage of economies of scale, enabling the use of proven software solutions with a significantly shorter implementation time than if they were to be developed or acquired from scratch.

In the case of the Electronic Agenda System (EAS), the original development took about ten months. The implementation in BPS, including the necessary adaptations that were made to the BPS environment, took four months – that is, 40 per cent of the time.

The success of this experience has led other bodies to want to implement the solution. It was taken up by the e-Government Agency (AGESIC) to continue improving the system and subsequently offer it to the entire Central Administration (Social Insurance Bank, 2017).

MERCOSUR’s (Argentina, Brazil, Paraguay, Uruguay) SIACI

The MERCOSUR countries – Argentina, Brazil, Paraguay, and Uruguay – implemented an ICT‑based data exchange system to operationalize the regional multilateral social security agreement. The system, named SIACI, improved the efficiency and reliability of the information exchanges, which until 2008 were sent in paper form by mail. SIACI uses securitized communication channels and digital certificates to authenticate the information exchanged. The system also keeps a log of the information requested and sent by each country, which enables auditing of the multilateral agreement operations.

In this way, the information exchange between countries has become more agile, allowing benefits to be granted more quickly, and facilitating the recognition of the right of insured persons. The use of the system facilitated the work of the benefits administration units in the countries’ social security institutions, increasing the trust in the information exchanged through the agreement.

The project involved operational coordination between the MERCOSUR countries for the system design and implementation, notably concerning the architecture and selected technologies. It also involved operational coordination for the system follow-up. Policy coordination was established with the Ibero-American Social Security Organization (OISS), as a trusted third organization, to host the operations audit log and sensitive data (National Social Security Institute. 2009).

Conclusions

As presented in this article, the good practices drawn from the Americas illustrate how different types of coordination have been successfully implemented at different levels, with potential lessons for other countries considering similar coordination initiatives. These cases, together with the analytical framework and references to cases from other regions found in ILO et al (2021), provide a basis for understanding and developing coordination initiatives within the region and beyond.

Well-managed coordination plays a decisive role in social security governance and enables the extension of coverage and the implementation of beneficiaries' rights. The need for coordination goes beyond social security and requires a whole-of-government approach that involves all relevant actors and institutions, both public and private.

Good policies designed on paper often fail because of a lack of coordination, or failures of implementation. Coordination however, is not a silver bullet. While some degree of coordination is generally necessary to effectively implement complex social security policies and programmes, it is not sufficient on its own. Good coordination systems must be backed by strong policies.  

Finally, governments and institutions must be mindful that coordination is costly. Because of this, the cost-benefit ratio must always be assessed before embarking on complex coordination initiatives, as not all policies require coordination.

According to Sir Michael Jacobs "Everybody believes in coordination, but nobody wants to be coordinated".