ILO objective on Social Protection

1. Social Protectionfor Informal EconomyCéline Peyron, ITC- ILO, Trade Union Training on Social Protection, 10/07/03

2. ILO objective on Social Protection Enhance the coverage and effectiveness of the Social Protection for ALL

3. ALL • Workers • Women and children • Disable persons • Old age group • Workers of the informal economy

4. Informal Economy All currently unregistered economic activities which contribute to the officially calculated (or observed) Gross National Product Definition used in “Size and Measurement of the Informal Economy in 110 Countries around the world”, F.Schneider , July 2002.

5. Informal Economy in South Asia and Pacifique “Size and Measurement of the Informal Economy in 110 Countries around the world”, F.Schneider , July 2002.

6. Present Situation • globalization and flexibility of labour markets • 80% of world population insufficient coverage • 50% of world population – no SP • majority of those in developing countries • majority of those in informal economy • particularly women

7. Raisons for low coverage • Conventional social security use the employer/employee relationship as a basis for coverage • Low and irregular income of informal economy workers reduce their capacity to make contribution • Ignorance of social security rights and obligations • Legislative requirements, particularly those concerning employment status, exclude some informal sector workers from participation • Bureaucracy • geographic accessibility of social protection institutions

8. Strategies for Extending SP • Extending social insurance schemes: Universal benefits/services financed by the government • Social Assistance provided by the government for low-incomes • Encouraging health micro-insurance schemes • Emergency Funds of local solidarity in Micro-Finance Institute (savings)

9. Health Micro-Insurance Schemes • Mutual Benefits Association (Trade Union) • Community Based Schemes • Integrated Schemes in an Hospital management • Micro-finance Institutes • Employer’s initiatives

10. Micro-insurance:Characteristics • population excluded from formal social security schemes, often low incomes and vulnerable • solidarity and non-profit organisation • voluntary & contributory schemes • pooling of a group’s resources to share risks (health, pregnancy, death, pension, accidents) & organize protection adapted to their needs • insurance benefit: members covered for a number of risks in line with a defined benefits package and payment of contributions adapted to their contributory capacities

11. Other Characteristics • built on strengths of community / organisation (workers’ organisation) • mechanism promoting participation of beneficiaries in social matters (women) • organizes, influences service providers • increases quality and access to health services • income security and stability • possible mechanisms of re-insurance

12. Different models of HMIS • THE « PARTNERSHIP » MODEL • A DETAILED AGREEMENT IS CONCLUDED WITH A HEALTH PROVIDER (MOST COMMON MODEL) • THE « INTEGRATED » MODEL • THE MHIS SETS UP ITS OWN HEALTH CARE FACILITY ( EXAMPLE : GRAMEEN KALYAN) • THE « INDEPENDENT » MODEL • THE MHIS DETERMINES THE BENEFITS TO BE PAID TO POLICYHOLDERS WITHOUT REFERRING TO A PARTICULAR HEALTH PROVIDER – MEMBERS ARE FREE TO CHOOSE THEIR OWN HEALTH PROVIDER (EXAMPLE : SEWA)

13. THE « PARTNERSHIP » MODEL HMIS Health structure The HMIS is linked with the health provider by means of an agreement

14. THE « PARTNERSHIP » MODEL MicroCare Health Plan,UGANDA • 5000 MEMBERS • Collaboration with 5 hospitals • IT developed management

15. THE « PARTNERSHIP » MODEL MicroCare Health Plan,UGANDA • HEALTH CARE PROVIDED • medical consultations • hospitalisations • specialized tests • surgery • diagnostics and check-up • medicine • delivery services • dental care • ophtalmological consultations • COVERAGE Of HEALTH CARE COST 100% • ANNUAL CONTRIBUTION PER FAMILY : 60 $US (6 members)

16. THE “INDEPENDENT” MODEL HMIS Health provider The HMIS has no contractual links with the health provider

17. THE “INDEPENDENT” MODELTrade Union Experience Solidarity Health Service of the CGTG GUATEMALA • Created in 1996 • Inside the CGT of Guatemala (16.000 members) • members of the SHS: 948 (40% women) • Beneficairies: 5.000 • Sub-urban zone • 70%informal economy 20% private sector 10% public sector • 72,44% low income (average: 2,8$US/day)

18. THE “INDEPENDENT” MODELTrade Union Experience Solidarity Health Service of the CGTG GUATEMALA • CARE SERVICES PACKAGE INCLUDING : • medical visits (in-patient) • drugs and medicine • laboratory analysis • INCOMES • members contributions • special funds from the CGTG • CONTRIBUTION : 4$US / year • Management by the CGTG, no participatory

19. THE « INTEGRATED » MODEL HMIS Health provider The HMIS has developed its own health provision structure

20. THE « INTEGRATED » MODEL Grameen Kalyan BANGALDESH • CREATED IN 1994 • NUMBER OF HEALTH CENTERS : 14 • 40.000 MEMBERS – 100.000 USERS • PREMIUM : 3,20 US PER FAMILY (MAX : 8) – YEARLY • PREMIUM FOR NON-MEMBERS : 4,3 US

21. Limitations of Micro-insurance • a partial and immediate response to an unmet collective responsibility • resource pooling & risks shared in a limited group of people, mostly low income and vulnerable • not necessarily a guarantee of equity for the poor • limited care services provides • capacity of poor to contribute fluctuates with income

22. Linking Micro-insurance to National Policies • Promoting MHIS through recommendations and new legislation • Improving and decentralizing the public provision of health care • Organization and (co-)financing training for the responsible of MHIS • (Co-)financing the access of low-income groups

23. Linking Micro-insurance to National Policies Experience of Las Igualas, DOMINICAN REPUBLIC • first Iguala, in 1968 (now, 150.000 members), created by Medical and health Professionals Association • Now, 2.000 Igualas in the country (autonomy), 8% of the population (7% covered by the National Social Security) • Partnership model, with own medical and health professionals • Better care services quality than public health providers • Affiliation encouraged by the Trade Unions • Negotiation with the Health Ministry to integrate Las Igualas in the Universal Benefits Policy

24. Impact of Micro-insurance on Informal Economy Workers • group organization & solidarity strengthening • linkages with formal systems, governments & employers • empowerment of informal workers organisations (Trade Union) • relevant & affordable services : meets workers needs and contributory capacity

25. Other impacts • impact on poverty alleviation • impact on women empowerment and equity • impact on household incomes security • visibility of informal workers • partnership building • prevention and fight against HIV/AIDS

26. HMIS and HIV/AIDS • Access to health care • Prevention • Voluntary and confidential counselling and testing • Solidarity principle

28. Training ProgrammeEXTENSION OF SOCIAL PROTECTION

29. Curriculum • Extension of Social Security : Global Campaign on Social Security and Coverage for All (ILC 2003) • Cycle of training for trainers and promoters of Health Micro-Insurance schemes + Specialised Training activities • Gender and social protection • Training on Social Inclusion

30. 1.- Setting-up and promotion of HMIS Cycle of training for trainers and promoters of Health Micro-Insurance Schemes

31. 2.- Administrative and financialManagement of HMIS Cycle of training for trainers and promoters of Health Micro-Insurance Schemes

32. 3.- Monitoring and Evaluation of HMIS Cycle of training for trainers and promoters of Health Micro-Insurance Schemes

33. 4.-Impact Evaluation Cycle of training for trainers and promoters of Health Micro-Insurance Schemes

34. Specialized Training Activities • Participatory feasibility Studies • HMIS and Gender • HMIS and HIV/AIDS • HMIS and Micro-finance • HMIS and Reproductive Health

35. Some Figures • Participants from 72 countries • Gender Focal Point for Social Protection Programme of ITC ILO • more than 1100 participants

36. THANK YOU