Loveleen De and Thorsten Behrendt (ILO) Cairo, 9 December 2015 Assessment-based National Dialogue (ABND) in Egypt

Agenda Social Protection Floors ABND Objectives Stakeholders Steps and outcomes ABND in other countries ABND in Egypt Joint team Work plan

Four Social Protection Floor (SPF) guarantees Essential health care for all residents Nutrition, care education for all children Basic income security for working age people, in sickness, unemployment, maternity, disability, etc. Pensions and other services for elderly and disabled persons

Social Protection Floor SPFs are defined nationally There is no ‘one size fits all’ approach in designing and implementing SPFs Through multipartite dialogue, countries decide on the type, extent and scope of schemes, such as targeted or universal, contributory or non-contributory

Poor Informal sectorFormal sector Level of protection Population Higher levels of social security to more people Comprehensive national social protection systems Nationally defined SPF

How do we establish an SPF in a country? The first step can be Assessment-based National Dialogue (ABND)

Objectives of ABND To initiate national dialogue with all stakeholders on social protection, SPF and challenges To provide an overview of the social protection system in a country To identify priority recommendations To provide evidence on the affordability and financial sustainability of the SPF recommendations To monitor the progressive establishment of the SPF every few years

Stakeholders Multipartite national dialogue involving Government: MOSS, MOF, MOMM, MOH, MOE, MOP, MOA, HIO, PSIF, GSIF, others Trade unions Employer organizations Civil society groups Academia International organizations

Steps of ABND STEP 1 – ASSESSMENT MATRIX What are the existing schemes and challenges? Recommendations to establish an SPF STEP 2 – COST ESTIMATION How much will the SPF cost? Is it affordable? STEP 3 – ENDORSEMENT Finalizing the ABND report Endorsement and launch

SPF guarantees Existing schemes Design gaps Implementa- tion issues Recommen -dations Health Children Working age Elderly and disabled STEP 1 – Assessment Matrix

Concept of health coverage based on ILO’s Recommendation No. 202, 2012 CoverageLegal coverage Effective access to health care AvailabilityAffordability Financial protection Quality

Gaps in coverage and effective access to needed care Affordability of health care and financial protection Out-of-pocket payments (OOP) as percentage of total health expenditure Legal Health Coverage Percentage of the population that is not affiliated to a health scheme or system Availability of care Percentage of the population excluded from adequate health care due to insufficient numbers of health workers Quality Percentage of the population excluded due to insufficient financial resources Health Outcomes Maternal mortality ratio per 10,000 live births Related ILO indicators to measure gaps and progress when moving towards UHC

ABND matrix for health protection Social Health Protection in Egypt Identified design and implementation gaps Recommendations Health Insurance Organization (HIO) Government employees (1975) Government, public and private employees (1975) Pensioners (1975) Widows entitled to a pension (1981) Students (1992) New-borns prior to school age (2012) Female households (2012) Farmers (2014) Other schemes provided by syndicates (e.g. judges, doctors, lawyers, engineers) Government-funded schemes Patient Treatment at Expense of State (PTES) for tertiary care ‘Coverage for the poor’ programme of the Ministry of Health Conditional cash transfer programmes ‘Takaful and Karama’ Different ministries and public organizations Donor- and government-funded scheme Family Health Funds: Primary (and some secondary) health care delivery at community and district level Legal health coverage deficit: Informal workers largely excluded Unavailability of services: lack of skilled health workers, particularly in remote rural areas (low retention rates) Unaffordability of health care: High OOP constituting 60 % of total health expenditure Low quality of services Inclusive national legislation to ensure everyone is covered incl. informal economy Reducing fragmentation through integration of schemes Provision of sufficient numbers of skilled health workers equally distributed across the country and with decent working conditions Minimization of OOP through sufficiently broad benefit packages and reduction of co- payments Ensuring sustainable and equitable financing based on sufficiently large risk pools through contributions, taxes and other general government revenues Allocating funding more equally Reducing inefficiencies e.g. by introducing separation of functions & strategic purchasing

Example – the SPF as % of GDP in Thailand STEP 2 – Cost Estimation 0.5% 1.2%

Mongolia Myanmar Thailand Vietnam Cambodia Indonesia Fiji Laos Philippines Kyrgyzstan Egypt Zambia Niger Malawi Mozambique Tanzania Timor Leste Uzbekistan India Malaysia Pakistan Tajikistan Moldova ABND in other countries Completed Ongoing Planned

Stakeholders In Philippines, a Core Working Group was created to conduct the ABND process ABND in other countries  Chairs: National Economic Development Authority, Labour Ministry  Reported to ‘Human Development and Poverty Reduction’ Cabinet cluster and national coordination bodies  Administrative Order to institutionalize the process

Results and endorsement In Thailand, the report was launched by 3 Ministers and follow-up actions took place:  Implementation of child support grant and long-term care benefits In Myanmar, recommendations influenced the national social protection strategy ABND in other countries

Proposal Set up a multi-stakeholder team to conduct the ABND Coordination: Social Justice Committee under the Prime Minister Chairs: MOSS, MOF ABND in Egypt

Work plan in Egypt January 2016 – ABND kick-off workshop to be called by MOSS February 2016 – presentation and validation of the consolidated matrix including research and comments from the kick-off workshop March 2016 – workshop to discuss and finalize the joint recommendations April 2016 – additional consultations as needed April-May 2016 onwards – Costing of the SPF recommendations

Thank you!