Towards universal Social security coverage
30/08/2023 09:35 AM
With incessantly efforts to promote social security coverage over the past decades, 64.3 per cent of the population in the Americas are effectively covered by at least one social protection cash benefit, much higher than the global average of 46.9%.
Illustrative image (internet)
More than two-thirds of children, pregnant women and mothers of newborns, as well as older persons, are covered by social protection cash benefits. Effective coverage for health protection has reached 90 per cent in the region, well above the global figure of 66 per cent. Despite sub-regional differences, a substantial number of countries have successfully achieved universal or near-universal coverage under different schemes.
However, a large coverage gap still exists for persons with disabilities in some countries, and unemployment protection remains the least developed social security branch. In Latin America and the Caribbean (LAC), one out of two people has an informal job often without any social protection. The negative economic effects of the COVID-19 pandemic have been significant, triggering high unemployment rates and a sharp fall in the number of employed and participation rates.
Through strong commitment, innovative measures and proactive approaches, many national governments and social security institutions have in recent years intensified their efforts to close coverage gaps, reinforce social protection floors and enhance the adequacy of benefits. Of importance, the combination of contributory health insurance with publicly funded health care, and the existence of universal schemes in some countries, have dramatically enhanced the coverage rate of health coverage across the region. The expansion of existing programmes as well as the introduction of new programmes in the wake of the pandemic, whether contributory or non-contributory, permanent or temporary, could hold the potential to contribute positively to future coverage extension in the region, but only if lessons are integrated and momentum is sustained.
In the Americas, countries are clearly committed to UHC, implementing various strategies to expand health care coverage, improve access to services and reduce financial barriers. National health systems and social health insurance schemes have been established in countries such as Canada, Costa Rica, Cuba and Uruguay to provide comprehensive coverage to their populations.
Achieving UHC in the Americas has been possible due to an emphasis placed on primary health care and the pursuit of health financing reforms. Examples of strengthening primary health care systems – with a focus on preventive care, early disease detection, health promotion, and managing chronic conditions – can be found in Brazil’s Family Health Strategy and Cuba’s primary health care system. Similarly, increasing public funding for health care, expanding insurance coverage, and improving resource pooling and allocation are vital to coverage expansion, as Chile’s National Health Fund (Fondo Nacional de Salud – FONASA) demonstrates.
Demographic changes lead to a higher demand for long-term care services. Governments in the region are responding by expanding social security coverage, establishing specialized services for older individuals, and strengthening social security systems to address chronic health challenges faced by older adults.
Digital technology, particularly telemedicine, has played a crucial role in improving health care accessibility, especially during the pandemic, as seen in Argentina, Ecuador, Mexico, Peru and Uruguay. However, barriers to accessing health care services still exist, and efforts are ongoing to reduce out-of-pocket payments and improve benefits.
Sustainably financing social protection systems covers the way that governments mobilize, allocate and manage public resources to ensure they are viable in the long run. The programme, on improving synergies between social protection and public finance management (SP&PFM), aims to strengthen the design and financing of national social protection systems and so improve the lives of millions of women, men and children.
The programme - funded by the European Union (EU) and implemented jointly by the International Labour Organization (ILO), UNICEF, and the Global Coalition for Social Protection Floors (GCSPF) - held an international symposium to showcase some of the innovative approaches used to strengthen rights-based social protection systems and prioritize gender responsiveness, disability inclusivity, and resilience to shocks. It is also helping to make social protection systems more resilient so that they can confront future crises; for example through the design and reform of unemployment protection systems in Peru and Ecuador.
Examples of SP&PFM interventions presented at the symposium included supporting countries’ responses to the economic impact of the COVID-19 pandemic. Elsewhere, it has helped to expand social protection for all 200,000 persons with disabilities in Kyrgyzstan, increased family benefits for 316,000 households with children in Senegal, and increased social protection for 230,000 informal economy workers in Nepal.
The programme underscores social protection’s crucial, strategic, role in fostering resilient and inclusive economies, and highlights the need for integrated policies, sustainable public finance management and strong multilateral coordination. One of the keys to its success has been increased coordination between Ministries in charge of finance and social protection. The effective participation of employers and workers organizations, as well as civil society in Africa, Asia, and Latin America, in the design, financing and governance of social protection schemes, has also been crucial.
“This innovative partnership has achieved impressive results in improving synergies between social protection and public finance management, supporting 17 countries in their COVID-19 response, improving the lives of millions, and demonstrating that social protection is not only a human right but also an investment”, said Erica Gerretsen, Director for Human Development, Migration, Governance and Peace at the European Commission department for International Partnerships.
“Austerity often reduces the margin that governments have to expand fiscal space and mobilize domestic resources, threatening budget allocations for social protection and social investments.” said Shahra Razavi, Director of the ILO’s Social Protection Department. “Therefore, working on the specific linkage between social protection and public finance management is literally a matter of life and death.”
“The programme has shown the importance of partnerships in closing financing gaps and increasing access to social protection for all, particularly children,” said UNICEF Director of Social Policy and Social Protection Programme Group, Natalia Winder-Rossi. “UNICEF will continue to build on the momentum created through this collaboration to leverage its country presence, programmatic and public finance expertise and commitment, to move this critical agenda forward.”
“The programme harnessed the power of collective action by strengthening civil society networks to better interact with state institutions.” said Uzziel Twagilimana, representative for the Global Coalition for Social Protection Floors. “We call upon Governments to establish institutional dialogue mechanisms on social protection policies, including its sustainable financing.”
Sickness
Work Injury and Occupational Disease
Survivor’s
Old-age
Maternity
Unemployment
Medical (Health Insurance)
Certificate of coverage
VSS - ISSA Guidelines on Social Security
