1. Social Protection “Trade union training on OSHE and HIV/AIDS” Social Protection “Trade union training on OSHE and HIV/AIDS” Course A102570 Ginette Forgues September 28, 2010

2. What is social protection? “Protection offered by society for its members through a set of public measures…….”* ____________________ *World Labour Report 2000, “Income security and social protection in a changing world”

3. Social Protection in ILO One of the four strategic objectives of the Decent Work Agenda What is the Decent Work Agenda?

4. The Strategic Objective on Social Protection Enhance the coverage and effectiveness of social protection for all

5. Thematic components of social protection in the ILO 1.Social Security 2.Safety and Health at Work 3.Working Conditions 4.International Labour Migration 5.HIV/AIDS

6. Why is social protection important? 1)A human right - UN Declaration on Human Rights, Declaration of Philadelphia, ILO standards, national constitutions, international frameworks 2)Poverty alleviation & prevention (MDGs) – i.e social transfers

7. Why is social protection important? 3. Essential part of economic growth & performance – Declaration on Social Justice for a Fair Globalisation – 2008, response to the financial crisis 4. Income security - G8 statement 5. Solidarity, social justice, social consensus

8. What is the global situation with regard to social protection?

9. The global situation  20% of world population = adequate coverage  50% + of world population = no coverage  Less than 10% covered in least developed countries  20 to 60% covered in middle-income countries  Close to 100% covered in most industrialised countries

10. Options to extend coverage?

11. Options to extend coverage 1) Extending formal statutory schemes 2) Introducing community based social protection schemes 3) Extending tax financed schemes (conditional & unconditional social transfers, universal) 4) Basic social services for all

12. Option 1: Enlarging coverage by extending formal schemes

13. The formal social security component 1) Convention 102 is key instrument, though there are other instruments also 2) Nine contingencies 3) Social partners play a strong role in the management of social security funds

14. Nine contingencies in C102 Health care/insurance Sickness Old age Invalidity Unemployment Employment injury Maternity Family responsibilities Death/survivors

15. Survivors Family allowances Employment injury benefits Maternity Sickness Pensions Invalidity Unemploymentbenefits Benefits Medical care

16. Formal schemes -No cross subsidisation for the non covered part of population (i.e informal) -Primarily designed for formal economy - reaches that part of the population (employer-employee contributions) -Could be extended to informal economy via voluntary contributions and also premium subsidization, i.e. Ghana for its health coverage -Some new components relating to HIV/AIDS

17. Who is excluded? Self-employed & informal economy Workers in micro and small enterprises Temporary workers Domestic and home workers Migrant workers Agriculture, services, transport, construction, etc Indigents

18. Option 2: Enlarging coverage by creating schemes for the informal economy

19. The community social protection schemes Examples for access to health acre Pre-payments Cooperative social programmes Welfare Funds Traditional solidarity Community social protection

20. Who runs these schemes? Associations, CBOs, NGOs, cooperatives, health care providers, villages, trade unions West Africa – “mutuelles” managed by members, moving towards universal coverage Asia – NGOs, health providers, etc Note: organised by private organisations, with many variations in size, benefits & approaches

21. What kind of schemes? Mainly access to health care Also, life (i.e with micro-finance) Assets Combined schemes (i.e VimoSEWA) +/- 90 million people access some social protection via community schemes

22. Example SKY-GRET in Cambodia Cambodia – GDP 409 USD per capita, population of 14 million, 85% in rural areas, 80%+ informal economy, 35% of population at poverty level, growth rate improving Health situation poor, user fees high, no social health insurance Health expenditure per capita = 28 USD 25% from Govt, 11% from NGOs, 64% out-of-pocket spending – mistrust in public system Health costs- second largest cause of indebtedness, 60% of loss of land because of healthcare costs (Oxfam and GTZ study) – higher than household financial capability Increase of health risk – wait for treatment, impoverishment Even if ART is accessible, ODs impact on health and socio- economic status of families

23. Example SKY-GRET in Cambodia 1998- SKY “Insurance for our families” in khmer Micro-finance institution AMRET (1991), 150,000 clients + – high number of default due to health costs Contracts with public health care providers, voluntary membership, primary & secondary health care, CBOs Family based coverage – no consideration of pre-existing conditions, HIV+ included Impact on families with HIV+ - no cash upfront, immediate access to health care, fixed cost for health care (premium) ILO/Rockefeller Foundation study shows most health care use by HIV+ people is at primary care level- not large impact on costs Worked with Khemara in a few districts around the capital to increase the no of households affected or vulnerable to HIV/AIDS to join the scheme

24. Option 3: Enlarging coverage by extending tax financed schemes

25. Tax financed schemes Can reach out to entire population sub-groups Allows for some level of social protection to all Probably the biggest potential at the moment in terms of larger coverage

26. Cash/social transfers – some key programmes

27. Why is social protection important with regard to HIV/AIDS?

28. ILO Recommendation on HIV & AIDS and the world of work (2010) The Recommendation no 200 includes social protection as an essential element in addressing HIV/AIDS i)article 3 – General principles, ii)article 20 –Treatment & care iii)article 37 - Implementation

29. UNAIDS priority 2009- 2010 One of the ten priorities of UNAIDS in the Joint Action for Results We can enhance social protection for people affected by HIV:We can enhance social protection for people affected by HIV By promoting the provision of a range of social services to protect vulnerable populations, including populations of humanitarian concern, refugees, internally displaced persons and migrants, informal-economy workers, people experiencing hunger, poor nutrition and food insecurity and orphaned and vulnerable children.

30. Which social protection components are important for HIV/AIDS? Health care & insurance Child benefits Pensions Cash transfers Survivor benefits Etc

31. Social Protection Floor - A new approach providing a minimum set of guaranteed universal benefits based on access to social services: health, education, food security, sanitation, social security, income security, etc and social transfers - A UN initiative adopted in 2009

32. Mainly four key universal benefits 1)Universal basic essential health care for all, through a set of sub-systems linked together: basically a public health service funded by taxes, social and private insurance and micro-insurance systems 2)Basic child benefits – family/child benefits aimed at facilitating access to basic social services – food security, nutrition, education, housing

33. Social Protection Floor 3) Income support – access to social assistance for the poor and the unemployed in active age groups 4) Income security- for people in old age, invalidity and survivors through basic pensions

34. Objective of Social Protection Floor Enhance the coverage and effectiveness of social protection for all Does NOT replace C102 package but creates a minimum floor on which a country can build comprehensive social protection

35. What is the role of HIV/AIDS actors in the social protection floor? 1.Political will 2.Include HIV/AIDS in national social protection policies and strategies, integrating Social Protection in broader economic development frameworks & comprising sequential and step by step approach with immediate, medium term and long term benefits 3.Active role of social partners 4.Capacity building of main actors

36. The vision in Year 2010 1.Basic coverage for all, universal but not necessarily uniform coverage (accepting pluralism) 2.Overall responsibility rests with the state but delivery can be shared w/ private sector and communities in states

37. The Vision Year in 2010 3. Rights based – “Everyone has the right to social security”, Article 22 of the Universal Declaration of Human Rights 4. Social outcomes in terms of adequate benefit levels have to be reached, independent of the type of organisation. ILO conventions are important as global safeguards and benefit benchmarks.

38. The vision in Year 2010 5. Good tripartite and financial governance is essential – capacity building increased with that objective in mind 6. Preparation of ILC discussion on social protection for 2011 in view of a new instrument

39. The social security staircase Voluntary Insurance Contributory Social Security Semi-Contributory Social Security Income and Food Security Children Benefit Assistance Unemployed & Poor Income Security Elderly & Disabled The Social Protection Floor Access to Social Services Health, Sanitation, Education

40. Capacity building in social protection 1)ITC-Turin OPEN courses on pensions, social health insurance, employment injury, good governance, financing social security, extension of social protection to excluded populations. Summer School next September 2011. 2)Courses specifically designed for projects, organisations and institutions

41. Thank you!