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Social Security Observer 15
Africa: The essential role of social security in meeting the Millennium Development Goals
The positive social and economic impact of social security is increasingly recognized
Photo: Gates Foundation
An increasing number of success stories in Africa highlight the positive developmental role that social security plays. By increasing coverage and delivering benefits that meet the needs of the population, many countries view social security as an effective instrument to move towards achieving the Millennium Development Goal (MDG) targets of poverty reduction, gender equality and health.

In a recent report (1), the International Labour Office (ILO) stated that “universalizing old-age pensions and child benefits for school children and orphans could reduce poverty by as much as 40 per cent” in Africa. And such cash transfers offer a mechanism to raise disposable income in support of local economic growth.


Millennium Development Goals

All UN Members have signed up to the eight MDGs. The goals cover poverty reduction, gender equality, disease reduction, guarantee of education and environmental sustainability and the initial target date to achieve the objectives is 2015. See <http://www.un.org/millenniumgoals/>.


This confirms the role of social security as not only a reactive instrument that responds to needs but a proactive mechanism for social and economic development.


Coverage has improved dramatically in a number of countries

The challenge in many countries is how to put into place a social security system when resources are limited and infrastructure is under-developed. In Mozambique, where over 50 per cent of the elderly population is considered to be in poverty, improving social security coverage is now a priority as witnessed by the adoption in 2010 of a five-year National Strategy for Basic Social Security. The number of beneficiaries under certain programmes has doubled in less than five years, with two-thirds of all recipients being women. With benefits making a real difference to the lives of beneficiaries, the Mozambique experience shows that with efficient operational and administrative measures in place, an effective social protection system can be built. Other recent examples of effective extension of coverage include:

- In Malawi, a new universal pension system was approved by Parliament in March 2011, which will cover all salaried employees and be financed jointly by employer and employee contributions. The scheme should lead to a reduction in pensioner poverty.

- South Africa extended coverage to an additional 4 million beneficiaries under its Child Grants system between 2000 and 2010. This provides further support to the country’s education system and to meeting child poverty reduction goals.

- In Nigeria, a reformed universal employees’ compensation scheme was signed into law in December 2010. This scheme covers all public- and private-sector employees (and their survivors) for income replacement in the event of injury or disability (or death) and rehabilitation and counselling services after injury.

Where health systems have been formalized and coverage improved, there have been significant reductions in out-of-pocket (OOP) health expenses, which weigh particularly heavily on the poor and vulnerable. Not only do OOP expenses create barriers to access but delayed access to care can exacerbate health problems and increase the eventual cost of treatment. Formalizing coverage through a social security framework has led to a large reduction in OOP expenses, an improvement in health outcomes and a strengthening of the functioning capacity of an economy. For example, Ghana’s National Health Insurance Scheme covers two-thirds of the population and has cut OOP expenses by some 50 per cent.


Extending coverage is cost effective and enhances the productive capacity of the economy

The ILO estimates that extending old-age pensions and child benefits to reach universal coverage would cost just 3.5 per cent of GDP in many African countries.

Indeed the net cost may be much lower; a number of studies have shown how the introduction or extension of coverage has led to positive economic effects. In a survey of the effect of social transfer schemes in 30 countries, the ILO found that 40 studies showed a positive link between the introduction or extension of schemes and subsequent increased entrepreneurial activity.


Namibia old-age pension coverage

The ILO has reported that between 1994 and 2001, Namibia increased old-age pension coverage from 48 per cent to 95 per cent. This has reduced pensioner poverty and led to other positive outcomes, such as reducing gender inequality and improving the status of pensioners. It is estimated that between 25 per cent and 50 per cent of pensioner income is invested in productive enterprises thereby facilitating economic benefits. The benefit has also improved family cohesion and has helped to facilitate school participation and has consequently improved child education levels.


The future

There are a still a number of challenges. In a sample of 25 African countries studied by the ILO, less than 20 per cent of the elderly population receive a pension. However, many countries on the continent are now putting in place innovative measures to extend effective and sustainable coverage and recent history shows that through the coherent use of multiple financing mechanisms, coverage can be extended rapidly. The Yaoundé Declaration (see Box) has also provided a road map for putting in place a Social Protection Floor – i.e. a minimum level of social security – in Africa.


The “Social Protection Floor”

In October 2010, the “Yaoundé Tripartite Declaration on the implementation of the Social Protection Floor” was adopted. This recognized the need and associated benefits for African countries of putting in place a minimum level of social protection for their populations. The declaration had a major influence on the 100th International Labour Conference in June 2011, which concluded that a new instrument, in the form of an ILO Recommendation, to support this objective should be discussed at the 101st ILC in 2012.


The putting in place of an effective administration and operational structure is a common feature of recent positive developments in coverage extension in Africa. The ISSA recognizes this and has selected the extension of coverage, alongside enhancing the adequacy and quality of benefits, furthering operational and administrative efficiency and effectiveness, and supporting proactive and preventive approaches in social security, as one of the four key priorities for the triennium 2011-2013. The ISSA project on coverage extension includes the publication of an extension handbook with good practice examples and an associated training module for its member organizations.


(1) See ILO, 2011: Success Africa III. Realising a New Era of Social Justice through Decent Work: Success Stories from Africa. Geneva, International Labour Office. <http://www.ilo.org/wcmsp5/groups/public/---africa/---ro-addis_ababa/documents/genericdocument/wcms_166733.pdf> (accessed on 14.12.2011).

ISSA Good Practice Award for Africa 2011: Improving health-care benefits in the United Republic of Tanzania
Strategic improvements by the National Health Insurance Fund are extending essential health coverage to more of the population
HIV/AIDS counsellor takes blood from a client. Photo: Geoff Sayer/Oxfam
Health policy and providing access to affordable, sustainable and quality health care are issues that are at the top of social policy agendas in Africa. In the Abuja Declaration of 2001, African Heads of State committed to devoting 15 per cent of government funds to the health sector, a commitment that was reaffirmed at the African Union meeting in Kampala in July 2010.

The need for action is undisputed, urgent and growing: African countries face a greater burden of communicable disease than elsewhere and the WHO predicts that the region will experience a 27 per cent increase in non-communicable diseases in the coming decade.

According to the United Nations Population Division, the world population reached 7 billion this year, of which 1 billion live in Africa – rising to 3.6 billion by 2100. Despite these compelling statistics and the fact that high out-of-pocket expenditures render millions of African households vulnerable, little progress has yet been made towards universal health-care coverage, the aim of the resolution adopted by the World Health Assembly in 2005.

It is against this background that in 2001 the government of the United Republic of Tanzania established the National Health Insurance Fund (NHIF) with the objective of providing health services to employees in the formal sector. Initially, only civil servants (as well as their spouses and up to four legal dependants) were covered, although the intention from the outset was to gradually extend coverage to other employees in the formal sector.

Only government health facilities were accredited at first, but from 2004 the NHIF started to accredit faith-based, NGO and private health-care facilities to introduce greater choice and competition. Starting with a basic medical services package, the Fund has introduced four major strategic improvements over the years, adding specialized surgery, physiotherapy, dental services, medicines, spectacles and prostheses and has also commenced providing services to retirees.


Improvements in health insurance outcomes

Beneficiaries of the health-insurance scheme have acknowledged during stakeholders’ meetings that the benefits package now more closely meets their expectations. Greater satisfaction with the benefits and services provided has helped drive up membership which in turn has increased the funds available to pay service providers.

In five years, the amount of claims reimbursed has grown from 8.2 billion Tanzanian shillings for the year 2006-2007 to 40 billion Tanzanian shillings in 2010-2011 – nearly a five-fold increase. Higher NHIF reimbursements to health-care providers for services delivered to scheme members have contributed to their financial ability to make improvements to the physical infrastructure of medical facilities.

Scheme members now have a wider range of service providers available to them, encompassing dispensaries, health-care centres, pharmacies, accredited drug-dispensing outlets (ADDOs) as well as district and regional hospitals. Not only do scheme members now have a wider choice in the type of medical facilities that they can use, but also easier access in rural areas to selected basic medicines and other medical supplies provided through ADDOs. These factors, together with the improvements undertaken with the help of NHIF reimbursements to the physical infrastructure and equipment in medical facilities, have helped increase satisfaction with the facilities as well as the medical benefits package which in turn has contributed to increased membership, creating a virtuous circle of gradual improvement.

The NHIF scheme now accounts for 20 per cent of the National Health Accounts (NHA) of the United Republic of Tanzania, up from only 5 per cent in 2003. The success of the implementation of the NHIF scheme resulted in the NHIF being entrusted in 2009 with the responsibility for managing the Community Health Funds (CHF), principally through the supervision and control of the CHFs. Based on the National Population Census of 2002, 15.2 per cent of Tanzanians are now covered by the NHIF (7.9 per cent through the CHFs and 7.3 per cent directly by the Fund).


Key factors for success

Introducing improvements in the package of medical benefits on a step-by-step basis and widening the range of accredited health-care facilities have been major factors in the success achieved. Taking a gradual approach has ensured that the improvements have not outstripped the funds available and has kept the scheme sustainable in the long-term. The phased approach also avoided raising unrealistic expectations among scheme members, and has helped maintain the morale of staff in medical facilities as they are not overwhelmed by demand and are better able to manage changes.


The importance of “good practices”

Although major differences in national contexts exist and the driving forces behind choices concerning programme delivery can be varied and complex, the sharing of information on “good practices” presents opportunities for learning about specific solutions to common problems.

The collection and dissemination of good practice examples enables those involved in social security administration to build a culture of exchange about “what works” and understand “why, how and under what conditions”.

By providing ISSA member organizations with greater access to knowledge about the experiences of others, organizations should be better able to reach informed decisions on the choices about the implementation and delivery of programmes appropriate to their own circumstances.


The ISSA Good Practice Award for Africa 2011 was given to the National Health Insurance Fund in December 2011 for its efforts to improve and extend health services in the United Republic of Tanzania.

Brochure: ISSA Good Practice Award – Africa 2011: Competition results >>


ISSA Good Practices in Social Security Database

For the ISSA, a good practice is defined as any type of experience (e.g. an action, a measure, a process, a programme, a project, a technology) implemented within a social security organization that is focused on the improvement of administrative and operational capacities and/or the efficient and effective delivery of programmes.

Good Practices in Social Security Database >>

Social Security Reforms
Reforms from Australia, Chile, the People's Republic of China, Ethiopia, Greece, Italy, Japan, Peru, the Russian Federation, Rwanda and Spain
Reforms
A selection of recent reforms in social security schemes worldwide compiled by the ISSA Social Security Observatory, with links to a full description of the reforms in the ISSA country profiles.

Australia: New Benefits for Age Pensioners and Older Workers

The 2011-12 financial year Australian federal budget saw little substantial changes to superannuation policy, despite impending changes to superannuation set to commence next year, but saw several important changes for pensioners and older workers.

Full article >>

ISSA Country profile: Australia >>


Chile: Measures in favour of low-income and middle-class pensioners

(Source: SSA) A new law enacted on August 28 eliminates the health care contribution for pensioners who receive means-tested benefits and lowers the contribution rate for middle class pensioners.

Full article >>

ISSA Country profile: Chile >>


The People's Republic of China: Toward an integration of the social security system

(Source: SSA) The Social Insurance Law, which became effective on July 1, creates a national unified social security system designed to increase labor mobility within China. The new law contains important provisions that allow workers to transfer accrued rights from one program to another, cover foreign workers, and expand coverage to new segments of the urban and rural populations. However, the new law leaves many details to be resolved eventually through regulations; a timetable for finalizing regulations remains unclear.

Full article >>

ISSA Country profile: The Peopl'es Republic of China >>


Ethiopia: Social insurance programme extended to private-sector workers

(Source: SSA) On July 8, new legislation went into effect that extends coverage to private-sector workers under Ethiopia's pay-as-you-go, earnings-related social insurance programme.

Full article >>

ISSA Country profile: Ethiopia >>


Greece: Austerity measures

(Source: SSA) At the end of June 2011, Greece approved changes to social security as part of a 5-year (2011-2015) austerity plan to secure EUR 12 billion (USD 17 billion) in loans to meet the country's debt obligations through August 2011. Foreign lenders (European Union, European Central Bank, and International Monetary Fund) demanded passage of the austerity measures to enable Greece to avoid default.

Full article >>

ISSA Country profile: Greece >>


Italy: Austerity measures include pension changes

(Source: SSA) On September 14, the Italian parliament approved pension changes as part of a EUR 54 billion (USD 73 billion) austerity plan designed to restore investor confidence in the country's creditworthiness.

Full article >>

ISSA Country profile: Italy >>


Japan: Voluntary defined contribution pension plans overhauled

(Source: SSA) Japan's legislature passed the Pension Security Enhancement Act in August. The new law, which becomes effective January 1, 2012, represents the most significant change to the country's voluntary defined contribution (DC) pension plans since their introduction in 2001.

Full article >>

ISSA Country profile: Japan >>


Peru: New old-age programme to combat poverty

(Source: SSA) On September 13, President Humala's cabinet approved a new means-tested, old-age programme called Pensión 65 to be introduced in stages beginning in late 2011. According to government officials, the programme will start with five of the country's poorest regions and will be extended gradually to the rest of the country by 2013.

Full article >>

ISSA Country profile: Peru >>


Russian Federation: Reform of the public health protection

After wide public discussion with health social security stakeholders, experts, medical professionals, pharmaceutical associations and NGOs the draft law on basic public health protection passed the first reading in the State Duma (Lower Chamber of the Russian Parliament). The law is expected to be finally adopted in autumn and be implemented as from January 2012.

Full article >>

ISSA Country profile: Russian Federation >>


Rwanda: Health insurance coverage for pensioners

As of 1 September 2011, the Rwandan Social Security Board (RSSB) extended health insurance coverage to pensioners through the Rwandaise Health Care Insurance (La Rwandaise d'assurance maladie (RAMA)). The move follows the merger of the former Social Security Fund of Rwanda (Caisse sociale du Rwanda (CSR)) with RAMA to form the RSSB.

Full article >>

ISSA Country profile: Rwanda >>


Spain: New Social Security Law

(Source: SSA) Spain's new social security law, enacted on August 1, increases the retirement age, the number of years of contributions required for a pension, and incentives for workers to remain in the labor force past retirement age. Most of the new rules will be implemented gradually beginning in 2013. The law also introduces an adjustment mechanism to the public pension system in 2027 to help control spending. Pension reform is part of the austerity measures the country is undertaking to reduce the government deficit.

Full article >>

ISSA Country profile: Spain >>


More reforms on www.issa.int/reforms

Regional Social Security Forum for Africa 2011
The Regional Social Security Forum for Africa took place in Arusha, United Republic of Tanzania, from 5 to 7 December 2011
RSSF Africa
Innovation and progress in social security which are enabling the extension of coverage to millions of Africans were the main focus of the Regional Social Security Forum for Africa.

News, photos, videos and documents from the Forum are available the ISSA Website: www.issa.int/rssf-africa11 >>

Africa: A new balance for social security
New ISSA developments and trends report
Cover page
The report analyses important recent developments and trends in social security across the continent. The report points to examples and good practices of social security programmes that have successfully extended coverage, including to previously unprotected workers, older persons and families.

The report also highlights African dimensions of an emerging global trend – a “new balance” – that witnesses social security systems according a greater role to proactive and preventive policy approaches. The aim of these is to support improvements in the quality and adequacy of benefits and services, as well as in governance and administration.

However, with levels of social security coverage on the continent often inadequate, the report recognizes that extending coverage further remains Africa’s major social policy challenge.

In spite of multiple external challenges, including widespread informal employment, inadequate basic social infrastructure, and a high burden of infectious and chronic disease, the report’s conclusions offer ground for optimism for the stronger development of social security in Africa.

Available in English and French


Download

Africa: A new balance for social security

www.issa.int/dt >>

Africa: Rapid coverage extension is possible
New ISSA Publication: Social Policy Highlight 21
Cover page
The assessment of recent developments and trends in social security in Africa is, overall, a positive one, giving ground for optimism. Alongside a growing role for proactive and preventive approaches, significant progress has been achieved in many countries in extending coverage, improving the adequacy and quality of benefits and services, and making social security administrations more efficient and effective.

Available in English, Arabic, Chinese, French, German, Russian, and Spanish


Download

Africa: Rapid coverage extension is possible (Social Policy Highlight 21)

www.issa.int/sph >>

Social Protection Floor for a Fair and Inclusive Globalization
New ILO publication
Publication cover: Social Protection Floor for a Fair and Inclusive Globalization
This report, prepared under the guidance of Ms Michelle Bachelet and members of the Advisory Group on the Social Protection Floor convened by the ILO, shows that the extension of social protection, drawing on social protection floors, can play a pivotal role in relieving people of poverty and deprivation. It can in addition help people adapt their skills to overcome the constraints that block their full participation in a changing economic and social environment, contributing to improved human capital development and stimulating greater productive activity.

The report also shows how social protection has helped to stabilize aggregate demand in times of crisis and to increase resilience against economic shocks, contributing to accelerate recovery towards more inclusive and sustainable development paths.

Publication details and download (external site):

Social Protection Floor for a Fair and Inclusive Globalization

http://www.ilo.org/global/publications/ilo-bookstore/order-online/books/WCMS_165750/lang--en/index.htm

Major ISSA Events 2012
In 2012, the ISSA is organizing the following major events:
ISSA flag
13th International Conference on Information and Communication Technology in Social Security
17.04.2012 - 20.04.2012 | Brasilia, Brazil

17th International Conference of Social Security Actuaries and Statisticians
30.05.2012 - 01.06.2012 | Berlin, Germany

Regional Social Security Forum for Asia and the Pacific 2012
30.10.2012 - 01.11.2012 | Seoul, Republic of Korea



More information on upcoming ISSA events >>

Information on other social security events >>

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