1. Valérie Schmitt Diabaté SEC SOC / STEP Geneva, 07 October 2009
Social security extension: The ILO/STEP programme of the social security department
Valérie Schmitt Diabaté
SEC SOC / STEP
Geneva, 07 October 2009

2. Structure of the presentation
I- Definitions
II- Coverage gaps
III- Strategies to extend coverage and examples
IV- The contribution of the STEP programme

3. I- Definitions: social security and social protection
Social security is the protection which society provides for its members through a series of public measures:
to compensate for the absence or substantial reduction of income from work resulting from
sickness, maternity, employment injury, unemployment, invalidity, old age and death of the breadwinner
to provide people with healthcare
to provide benefits for families with children.
Social protection includes not only public social security schemes but also private or non-statutory schemes with similar objectives
provided that the contributions to these schemes are not wholly determined by market forces (i.e., redistribution)

4. I- Definitions: social security is a human right
Every human being is equally entitled to social security -Univ. decl. of HR, article 22
Consequences:
States and international community have the obligation to take appropriate measures to guarantee this right (legal, administrative, budgetary …)
Each individual is entitled to a minimum level of social protection, without exception or discrimination
Social security has been part of the ILO mandate since its creation (1919) … The Declaration of Philadelphia (1944) on the goals and objectives of the ILO recognizes the Organization’s solemn obligation to further programmes among the nations of the world which will achieve “the extension of social security measures to provide a basic income to all in need of such protection and comprehensive medical care”

5. I- Definitions: social security branches
Old age
Employment injury
Family benefit
Unemployment
Maternity benefit
Invalidity benefit
Sickness
Medical care
Survivor’s benefit
Social Security (Minimum Standards) Convention, 1952 (No. 102)
Other up-to-date conventions
Equality of Treatment (Social Security) Convention, 1962 (No. 118)
Employment Injury Benefits Convention, 1964 (No. 121)
Invalidity, Old-Age and Survivors' Benefits Convention, 1967 (No. 128)
Medical Care and Sickness Benefits Convention, 1969 (No. 130)
Maintenance of Social Security Rights Convention, 1982 (No. 157)
Employment Promotion and Protection against Unemployment Convention, 1988 (No. 168)
Maternity Protection Convention, 2000 (No. 183)
ILO Convention 102 (1952) concerning social security (minimum standards) defines nine areas (branches) of social security

6. Structure of the presentation
I- Definitions
II- Coverage gaps
III- Strategies to extend coverage and examples
IV- The contribution of the STEP programme

7. Low level of coverage in developing countries
II- Coverage gaps: access to social protection is far from being a reality
Low level of coverage in developing countries
Horizontal (limited portion of the population reached) and vertical (limited range of contingencies/risks covered)
Sub-Saharan Africa and South Asia
Only 5 to 10% of population covered by statutory social security (namely old age and health)
Decrease in % of population covered:
Structural adjustment policies, privatisation and development of the informal economy
With the increasing informalization of work (90% of new jobs created in Africa), exclusion is on the rise in most countries
Yet in many developing countries, social protection coverage is dramatically low: it reaches only a small proportion of the population and provides protection against only a limited range of risks. In sub-Saharan Africa and South Asia, only 5 to 10 per cent of the population is covered by a statutory social security scheme, primarily old-age pension schemes and access to healthcare (ILO, 2001). In some countries, the percentage of the population covered is even shrinking due to structural adjustment policies, privatization and the development of the informal economy. Although some excluded people work in the formal sector, the vast majority are active in the informal economy.
Until the last decade, social protection strategies were based on the assumption that the formal economy would progressively gain ground on the traditional economy, and therefore social security would progressively cover a larger proportion of the workforce. However, this has not happened.
Majority of the excluded: the informal economy

8. II- Coverage gaps: old age pensions
(contributory and non-contributory)
Old age coverage < 20%

9. II- Coverage gaps: health care coverage
Each year 100 million people fall into poverty due to sickness-related costs (WHO)

10. II- Coverage gaps: unemployment benefits
No unemployment benefits

11. Structure of the presentation
I- Definitions
II- Coverage gaps
III- Strategies to extend coverage and examples
IV- The contribution of the STEP programme

12. III- Strategies to extend coverage
Social insurance
Universal schemes (free access to health care structures, universal old age pensions)
Social assistance, cash transfers, CCTs
Private insurance
Micro-insurance, community-based schemes
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations
Pluralistic approach with partial subsidized schemes, cross subsidizations, administration mergers, synergies between CCTs and health insurance, etc. … the concept of linkages

13. III- Strategies to extend coverage
Civil servants
Public / private employees
Self employed
Informal economy
BPL
Social health insurance (+ private insurance)
Unemployment insurance
PAYG / funded schemes
Colombia
Linked schemes
EXTENSION
EXTENSION
EXTENSION
Micro-insurance, CBHI
NREGA (India)
Bolsa Famila
Equity funds
Universal access
Subsidized health insurance
Employment Guarantee schemes
Minimum old age pensions
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations
CCTs
South Africa
RSBY (India), Rwanda
Access to health care
Unemployed
Elderly
Families with children

14. III- Strategies to extend coverage
Bolsa Famila
Conditional cash transfer program (created in 2003)
11,6 million poor families covered in 2008 (total population 190 million inhabitants)
Amount of transfer: US$ per family paid through banking network and agencies, using a magnetic card
2009 Budget: US$ 5 billion % GDP
Conditionalities
On health and nutrition, school attendance, socio-educational activities for children in risk of child labour
Aim at expanding the skills of future generations and at breaking the intergenerational cycle of poverty
Non-fulfilment is an indicator of vulnerability (no punition)
Main results
Reduction of poverty and inequality 14

15. III- Strategies to extend coverage
Bolsa Famila 15

16. III- Strategies to extend coverage
NREGA (India)
The National Rural Employment Guarantee Act or NREGA (created in 2005), India
The scheme provides a legal guarantee for 100 days of employment per year to adult members of any rural household willing to do public work related unskilled manual work at the minimum wage of Rs. 100 per day (3 US $)
Annual budget is US$ 8 billion
Objective: improving the purchasing power of the rural people
Around one-third of the work force is women
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations

17. III- Strategies to extend coverage
Rwanda
In Rwanda, Mandatory National HI Scheme
Based on a network of mutual health organizations (30 mutual funds and 403 mutual units)
2 packages:
Basic health care package: access to health centers
Complementary health package: hospital care
Cost of coverage: FRW / pers / year
1000 FRW paid by insured 1000 FRW paid by district + national pooling mechanism (including Global fund)
Full subsidy for the “indigents”, PLWA, orphans (the global fund paying premium for person, i.e. 8% of total population)
Yet in many developing countries, social protection coverage is dramatically low: it reaches only a small proportion of the population and provides protection against only a limited range of risks. In sub-Saharan Africa and South Asia, only 5 to 10 per cent of the population is covered by a statutory social security scheme, primarily old-age pension schemes and access to healthcare (ILO, 2001). In some countries, the percentage of the population covered is even shrinking due to structural adjustment policies, privatization and the development of the informal economy. Although some excluded people work in the formal sector, the vast majority are active in the informal economy.
Until the last decade, social protection strategies were based on the assumption that the formal economy would progressively gain ground on the traditional economy, and therefore social security would progressively cover a larger proportion of the workforce. However, this has not happened.
Population covered: 7% in 2003  85% in 2008!!!
Development of Health care supply (accessibility)
88 health centres in 2003  403 in 2007

18. National Guarantee Fund (pooling)
III- Strategies to extend coverage
Rwanda
National HI Scheme in Rwanda
403 health centers
32 district hospitals
4 referal hospitals
Government
MMI, RAMA
GLOBAL FUND,
donors
800 FRW
National Guarantee Fund (pooling)
Yet in many developing countries, social protection coverage is dramatically low: it reaches only a small proportion of the population and provides protection against only a limited range of risks. In sub-Saharan Africa and South Asia, only 5 to 10 per cent of the population is covered by a statutory social security scheme, primarily old-age pension schemes and access to healthcare (ILO, 2001). In some countries, the percentage of the population covered is even shrinking due to structural adjustment policies, privatization and the development of the informal economy. Although some excluded people work in the formal sector, the vast majority are active in the informal economy.
Until the last decade, social protection strategies were based on the assumption that the formal economy would progressively gain ground on the traditional economy, and therefore social security would progressively cover a larger proportion of the workforce. However, this has not happened.
Health mutual fund
403 Mutual units
30 districts MU
200 FRW …
Districts
1000 FRW
Cash less (only 200 FRW copayment)

19. III- Strategies to extend coverage
Colombia
In Colombia : 1 contributive, 1 subsidized health insurance schemes
Established by Law 100 in 1993
The subsidized health insurance scheme
Various operators of the scheme (ARS) including mutuals, cooperatives, cajas de compensacion and insurance companies
Subsidized package POS = 120 US $ / capita (<< contributive package 240 US $ / capita)
Contracting arrangements to avoid leakages
Several sources of funding
Eligibility to the subsidized scheme : vulnerability level (SISBEN inquiries)
ARS
Hôpitaux
Municipalités
Contrat
Yet in many developing countries, social protection coverage is dramatically low: it reaches only a small proportion of the population and provides protection against only a limited range of risks. In sub-Saharan Africa and South Asia, only 5 to 10 per cent of the population is covered by a statutory social security scheme, primarily old-age pension schemes and access to healthcare (ILO, 2001). In some countries, the percentage of the population covered is even shrinking due to structural adjustment policies, privatization and the development of the informal economy. Although some excluded people work in the formal sector, the vast majority are active in the informal economy.
Until the last decade, social protection strategies were based on the assumption that the formal economy would progressively gain ground on the traditional economy, and therefore social security would progressively cover a larger proportion of the workforce. However, this has not happened.
Population covered by these 2 schemes : 87% in 2008!!!
Towards a merger of the 2 packages (PLUS)

20. Contributory Scheme HPEs
III- Strategies to extend coverage
Colombia
Taxes (alcohol, tobacco, games of chance)
Health Lottery
Coffee Corporations
Local Taxes
The Municipalities’ and Departments’ Own Resources
11%
General Participation System (GPS)
48%
FOSYGA
41%
Contributory Scheme HPEs
1.5 per cent of CS Dues
Equalization Funds
7% of Dues paid to the Funds
Municipality
Special “cuenta maestra” Account
Contract for a Number N of Affiliates 1.
Transfer of List of Cardholders n<N 2.
Subsidy = n * UPC * Duration of Affiliation 3.
Contracts Between SSAs and Municipalities Are Defined For A 3-Year Period; N>n in order to allow for inclusion of new affiliates during the 3 years (e.g., in case of changes in family situation)
ARS

21. Structure of the presentation
I- Definitions
II- Coverage gaps
III- Strategies to extend coverage and examples
IV- The contribution of the STEP programme

22. IV- The contribution of the STEP programme
Created in 1998, with an aim to support the development of mutual health organizations in order to facilitate access to health care for IE workers and their families
In 2003 STEP became a key tool of the Global campaign on social security for all
Today it highly supports the development of the 1 UN Social protection floor initiative at global and country levels
1. ESSENTIAL SERVICES
Water
Sanitation
Health
Education
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations
2. SOCIAL TRANSFERS
Food security & nutrition to Poor and Vulnerable
Income security and access to essential services
Unemployment
Elderly
Disabled
Access to Health
Access to Education

23. IV- The contribution of the STEP programme
STEP supports the extension at country level
Supporting national strategies for the extension of SS
Promoting an enabling environment for the development of health Micro Insurance
Developing new approaches to the extension of SP
Strengthening health micro-insurance capacities and skills
Promoting knowledge management and sharing
STEP supports the development of regional networks of mutual health org. and community based schemes
La Concertation in Africa
AMIN in Asia
ACYM in Latin America
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations
STEP develops knowledge management Internet platforms at global level

24. IV- The contribution of the STEP programme
It is therefore necessary to find other ways to translate the right to social protection into reality. At the International Labour Conference in 2001, governments and employers’ and workers’ organizations representing 160 countries agreed upon a new consensus on social security; they agreed notably that highest priority should be given to policies and initiatives to extend social security to those who have none. At the suggestion of the Conference, in 2003 the ILO launched the “Global Campaign on Social Security and Coverage for All”.
A range of mechanisms can be used to implement these strategies:
– Social insurance schemes can extend existing or modified benefits to previously excluded groups, on either a compulsory or a voluntary basis.
– Special social insurance schemes can be set up for excluded groups.
– Universal benefits covering the whole target population without any condition or income test (for instance, those over a certain age) can be implemented.
– Social assistance programmes targeting specific vulnerable groups can also be implemented: waivers, social pensions/cash benefits, conditional cash transfers (for instance on school attendance).
– A complementary option is to encourage and support the development of microinsurance and innovative decentralized social security schemes to provide social protection through communities, social partners or other civil society organizations