[et_pb_section fb_built=”1″ admin_label=”!! PLEASE DO NOT EDIT !!!” _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_row use_custom_gutter=”on” gutter_width=”1″ admin_label=”!!! PLEASE DO NOT EDIT !!!” _builder_version=”4.20.4″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.19.5″ _module_preset=”default” global_colors_info=”{}”][et_pb_text admin_label=”SUMMARY ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”10px||20px||false|false” global_colors_info=”{}”]<\/p>\n
Universal health coverage (UHC) and universal social protection (USP) are complementary objectives embedded in the 2030 Agenda for Sustainable Development. With only few years left to meet the SDG targets, it is urgent to strengthen those synergies.\u00a0Health and wellbeing should not be the privilege of a few.\u00a0Equitable and solidarity-based social protection is central to facilitate financial access to health care services and address the socio-economic inequalities that impact on health outcomes.<\/strong><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 1 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Key messages:<\/em><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 2 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n The United Nations General Assembly recalled in September 2023 the fundamental importance of social protection mechanisms to meet the objective of Universal Health Coverage (UN, 2023). Social protection systems, including floors, support health and wellbeing by providing:<\/p>\n [\/et_pb_text][et_pb_image src=”https:\/\/p4h.world\/app\/uploads\/2024\/05\/p4h_social-protection-floors_2024.png” title_text=”p4h_social-protection-floors_2024″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][ba_gradient_heading title=”Social health protection to protect people against healthcare costs” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 3″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Social health protection refers to government-led measures to secure affordable healthcare services and adequate cash benefits for all in case of sickness (ILO, 2020b). Countries such as Rwanda or Lao PDR have shown that extending social health protection is achievable even in low-income settings (ILO, 2021c). Their experience demonstrates that a sustained political and financial commitment embedded in a rights-based approach is indispensable to leave no one behind.<\/p>\n [\/et_pb_text][et_pb_text quote_border_color=”#EA3A32″ admin_label=” BLOCK QUOTE (250-300 ch.)” _builder_version=”4.21.0″ _module_preset=”default” quote_font=”Oswald|||on|||||” quote_text_color=”#5EAABC” quote_font_size=”26px” quote_line_height=”1.3em” global_colors_info=”{}”]<\/p>\n While social health protection has expanded over the last decades, important inequalities persist across and within countries.<\/p><\/blockquote>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 4 ” _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n The data we are currently compiling for the forthcoming World Social Protection Report, which will be released in September 2024, puts it in sharp focus. A review of legal frameworks shows that globally eight in ten people have a right to access healthcare services for free or with limited co-payments (ILO forthcoming). However, in low-income countries, only six in ten people have this right according to their national legislation. There is a further gap between those legal entitlements and their implementation in practice, resulting in a situation where less than a fifth of the population is effectively protected by a social health protection scheme in low-income countries.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 5″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Figure 1: Percentage of the population covered by a social health protection scheme (protected persons), by region, subregion and income level, 2020 or latest available year.<\/strong><\/p>\n [\/et_pb_text][et_pb_image src=”https:\/\/p4h.world\/app\/uploads\/2024\/05\/p4h_protected-persons_2024-1024×810.png” title_text=”p4h_protected-persons_2024″ _builder_version=”4.21.0″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][et_pb_text admin_label=”TEXT – caption” _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”10px||||false|false” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Source: ILO (2021) and OECD Health Statistics (2020); national administrative data published in official reports; information from regular national surveys of target populations on awareness on rights.<\/span><\/em><\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 5″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n In this context, it is no surprise that out-of-pocket spending\u00a0on healthcare is increasing<\/strong>, with 1 billion people facing catastrophic spending and almost 1.3 million pushed into poverty in 2019 (WHO and World Bank, 2023). Without social health protection, the most vulnerable may not even seek medical care. Financial barriers remain a lead reason for forgoing care (WHO and World Bank, 2023). Effective access is further constrained by shortages of healthcare services and their inequitable distribution. The majority of the world\u2019s population is not able to access the minimum package of healthcare services guaranteed by international social security standards, with the biggest deficits in Africa and Asia (ILO, 2021c).<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 6″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Those figures hide important inequalities within countries<\/strong>.\u00a0For instance, the lack of resources to pay for health services is identified as a main reason for forgoing care among women in reproductive age in 58 low- and middle-income countries, following a clear social gradient: two thirds of women in the lowest income quintile forego care for this reason, while this is the case for less than a third in the richest quintile (WHO and World Bank, 2023).<\/p>\n [\/et_pb_text][et_pb_text quote_border_color=”#EA3A32″ admin_label=” BLOCK QUOTE (250-300 ch.)” _builder_version=”4.21.0″ _module_preset=”default” quote_font=”Oswald|||on|||||” quote_text_color=”#5EAABC” quote_font_size=”26px” quote_line_height=”1.3em” global_colors_info=”{}”]<\/p>\n Urgent action is needed along four priority areas towards 2030:<\/p>\n<\/blockquote>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 7″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 8″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Health and wellbeing should not be the privilege of a few. Collective financing, broad risk pooling and rights-based entitlements are key elements of strong social health protection systems geared towards social justice.\u00a0Practical tools<\/a>\u00a0exist to extend coverage. More broadly, overcoming inequalities requires addressing comprehensively financial protection against the costs of illness, covering not only the costs of services but also non-medical costs such as transportation and lost income during recovery, that are key determinants of health equity (ILO 2021b; 2020a).<\/p>\n [\/et_pb_text][ba_gradient_heading title=”Universal social protection to support health equity throughout the life course” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 9″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Health and wellbeing are strongly determined by the conditions in which people live, work, grow and age<\/strong>\u00a0(Marmot, 2001). Income insecurity, poverty, vulnerability, and social exclusion have significant negative impacts on health, affecting and food security, education, housing, healthcare seeking behaviours, and other social determinants of health. Health outcomes, such as infant mortality rates, lifetime risks of maternal death during pregnancy and post-partum, as well as lifetime risk of long-term disabilities are higher in LMICs than in HICs, but also tend to be higher for social groups with low education levels and at the lower end of the income distribution within countries (Commission on Social Determinants of Health, 2008). Evidence suggests that social determinants of health may account for as much as 50 percent of health outcomes, with significant inequities (WHO, 2024). Global mega-trends such as climate change and health security threats are reinforcing existing social and economic inequalities that are responsible for health and wellbeing inequity globally and locally (Jay and Marmot 2009).<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 10″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Social protection contributes to address the social determinants of health equity<\/strong>, with an important role for adaptive social protection in the current climate crisis context. Impact assessments have shown the positive impact of social protection on both healthcare seeking behaviour and health outcomes, for example for family benefits such as Bolsa Familia in Brazil (de Andrade et al., 2015). Moreover, unemployment insurance has positive impacts on health, including mental health (Kuka, 2020). Income support has demonstrated impact on prevention, detection and adherence to treatment in the context of HIV and tuberculosis (WHO and ILO, 2024; ILO, 2021b). More broadly, in the WHO EURO region 35% of the inequity in self-reported health between those who are most and least affluent is due to \u201csystematic differences in risk and exposure to income insecurity and the lack or inadequacy of social protection\u201d (WHO, 2019).<\/p>\n [\/et_pb_text][et_pb_image src=”https:\/\/p4h.world\/app\/uploads\/2024\/05\/p4h_life-cycle-risks_2024-1024×687.png” title_text=”p4h_life-cycle-risks_2024″ _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”||1em||false|false” global_colors_info=”{}”][\/et_pb_image][et_pb_text quote_border_color=”#EA3A32″ admin_label=” BLOCK QUOTE (250-300 ch.)” _builder_version=”4.21.0″ _module_preset=”default” quote_font=”Oswald|||on|||||” quote_text_color=”#5EAABC” quote_font_size=”26px” quote_line_height=”1.3em” global_colors_info=”{}”]<\/p>\n To maximise the impact of social protection on health and wellbeing, we put forth two actionable priorities:<\/p><\/blockquote>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 11″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n [\/et_pb_text][ba_gradient_heading title=”No UHC without USP and vice-versa” html_tag=”h3″ primary_color=”#455A64″ secondary_color=”#455A64″ admin_label=”HEADING (50-60 characters)” _builder_version=”4.21.0″ _module_preset=”default” title_font=”||||||||” title_font_size=”24px” title_line_height=”1em” custom_padding=”15px||10px||false|false” global_colors_info=”{}”][\/ba_gradient_heading][et_pb_text admin_label=”TEXT – BLOCK 12″ _builder_version=”4.21.0″ _module_preset=”default” custom_padding=”||1em||false|false” global_colors_info=”{}”]<\/p>\n Achieving universal social protection that fosters individual and societal resilience requires a rights-based approach. Such approaches support the predictability, transparency, and accountability in delivery of entitlements for right-holders, promoting sustainable entitlements over time that are resilient to short-termism. Social protection systems are crucially important to address the social determinants of health whilst preventing people from facing financial hardship when accessing healthcare services, or foregoing care altogether.\u00a0 As a redistributive mechanism geared towards protecting people against social and economic risks, social protection policies can make an important contribution to a broader shift towards an economy that promotes human well-being and remains within planetary boundaries.<\/p>\n [\/et_pb_text][et_pb_text admin_label=”TEXT – disclaimer” _builder_version=”4.21.0″ _module_preset=”default” custom_margin=”10px||||false|false” custom_padding=”||1em||false|false” global_colors_info=”{}”]The opinions expressed in this blog are those of the authors and may not necessarily represent the views of their respective institutions.<\/span><\/em>[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 9 – references” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”13px” custom_margin=”20px||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]References<\/strong><\/p>\n [1]<\/span> Including the Medical Care Recommendation No. 69 of 1944, the Nursing Personnel Convention No. 149 of 1977 and its Recommendation No. 157, and the Domestic Workers Convention No. 189 of 2011.<\/span>\u00a0[\/et_pb_text][et_pb_text admin_label=”TEXT – BLOCK 9 – references” _builder_version=”4.21.0″ _module_preset=”default” text_font_size=”13px” custom_margin=”20px||||false|false” custom_padding=”||||false|false” global_colors_info=”{}”]<\/p>\n Andrade, Luiz Odorico Monteiro de, Alberto Pellegrini Filho, Orielle Solar, F\u00e9lix R\u00edgoli, L\u00edgia Malagon de Salazar, Pastor Castell-Florit Serrate, Kelen Gomes Ribeiro, Theadora Swift Koller, Fernanda Natasha Bravo Cruz, and Rifat Atun. 2015. \u2018Social Determinants of Health, Universal Health Coverage, and Sustainable Development: Case Studies from Latin American Countries\u2019. The Lancet 385 (9975): 1343\u201351.<\/span><\/p>\n Commission on Social Determinants of Health, WHO. 2008. \u2018Closing the Gap in a Generation<\/a> – Health Equity through Action on the Social Determinants of Health – Commission on Social Determinants of Health Final Report\u2019. WHO.<\/p>\n Dur\u00e1n Valverde, Fabio, Jos\u00e9 Pacheco-Jimenez, Taneem Muzaffar, and Hazel Elizondo-Barboza. 2019. \u2018Measuring Financing Gaps in Social Protection for Achieving SDG Target 1.3: Global Estimates and Strategies for Developing Countries\u2019. ESS Working Paper No. 73.<\/p>\n High-Level Commission on Health Employment and Economic Growth<\/a>. 2017. \u2018High-Level Commission on Health Employment and Economic Growth\u2019. WHO.<\/p>\n ILO. 2020a. \u2018Sickness Benefits: An Introduction\u2019. Geneva: International Labour Organization.<\/p>\n ILO. 2020b. \u2018Towards Universal Health Coverage: Social Health Protection Principles<\/a>\u2019. Social Protection Spotlight. Geneva: ILO.<\/p>\n ILO. 2021a. \u2018Extending Social Health Protection: Accelerating Progress towards Universal Health Coverage in Asia and the Pacific<\/a>\u2019. Regional Report. Bangkok and Geneva: ILO.<\/p>\n ILO. 2021b. \u2018Making Universal Social Protection a Reality for People Living with, at the Risk of, and Affected by HIV or Tuberculosis<\/a>\u2019.<\/p>\n ILO. 2021c. World Social Protection Report 2020\u201322<\/a>: Social Protection at the Crossroads \u2013 in Pursuit of a Better Future. Geneva.<\/p>\n ILO. Forthcoming. World Social Protection Report 2024\u201326.<\/p>\n ILO and UNHCR. 2020a. \u2018Handbook on Social Health Protection for Refugees: Approaches, Lessons Learned and Practical Tools to Assess Coverage Options<\/a>\u2019. Geneva: International Labour Organization and UN High Commissioner for Refugees.<\/p>\n ILO and UNHCR. 2020b. \u2018Social Protection in Action: Exploring Public Options of Social Health Protection for Refugees in West and Central Africa\u2019.\u00a0<\/p>\n Jay, M, and MG Marmot. 2009. \u2018Health and Climate Change<\/a>\u2019. The Lancet 374 (9694): 961\u201362.\u00a0<\/p>\n Kuka, Elira. 2020. \u2018Quantifying the Benefits of Social Insurance: Unemployment Insurance and Health\u2019. Review of Economics and Statistics 102 (3): 490\u2013505.<\/p>\n Marmot, Michael. 2001. \u2018Economic and Social Determinants of Disease\u2019. Bulletin of the World Health Organization 79: 988\u201389.<\/p>\n UN. 2023. \u2018Political Declaration of the High-Level Meeting on Universal Health Coverage \u201cUniversal Health Coverage: Expanding Our Ambition for Health and Well-Being in a Post-COVID World\u201d\u2019.<\/p>\n\n
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\n(High-Level Commission on Health Employment and Economic Growth, 2017).\u00a0 From an operational standpoint, it is crucial that funding commensurate to service demand flows in healthcare facilities. Robust management information systems that are both affordable and provide a good interface at the healthcare facility level are needed.<\/li>\n\n