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THE SOCIAL SECURITY EXTENSION CHALLENGE: INCOME SECURITY AND HEALTH BENEFITS. Dr Diosdado Nsue-Milang Director, Health Promotion Cluster 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Introduction: Poverty, Health and Economic Growth The poverty cycle and it’s drivers: Low Income lead to Low Consumption, which in turn results in Low Capacity and therefore Low Productivity; Disease burden is attributable to three diseases (Malaria, Tuberculosis and HIV/AIDS) annually reduces GDP growth by as much as 1.3% (WHO Commission on Macro-Economics and Health, 2001) 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Social Protection Social protection within the framework of social security is conceived of a series of public or publicly organized and mandated private measures against social distress and economic loss arising from ill health and the cost of the required treatment. The objective of social health protection is therefore to ensure that the financial means to secure health care treatment is available. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. CATASTROPHIC EXPENDITURE WHO defines catastrophic expenditure is defined as out-of-pocket expenditure on health exceeding 40% of household income net of subsistence needs; subsistence needs taken as the median household’s food expenditure. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Current Situation Access to affordable and quality health care is a fundamental human right. However, it is not available for the majority of poor people of Africa because many countries do not have any form of social security protection for their people; The capacity of governments to collect taxes in the informal sector is limited and therefore they are unable to extend social security to the poor; 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Sources of Health Financing social security 4% private prepaid 17% government 40% OOP 32% external 7% 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Sustainable Health Financing The World Health Organization in its efforts to find solutions to the above situation, has identified the Universal Coverage Health Financing Mechanism as the most appropriate, and has passed Resolutions and Declarations at Global and Regional governing body meetings. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Universal Coverage Defined Universal Coverage is defined as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Health financing concepts The principle of financial risk protection ensures that the cost of care does not put people at risk of financial catastrophe; A related objective of health financing is equity in financing: house-holds contribute to health system on the basis of their ability to pay; Universal Coverage is therefore consistent with WHO’s concept of Health for All and Primary Health Care. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Options for Establishing Universal Coverage Rationalization of universal coverage is dependent on: Organizational mechanisms that make it possible to collect financial contributions for the health system efficiently and equitably from different source; Pooling these contributions so that risk of having to pay for health services is shared by all and not borne by each person who is sick; and to use these contributions to provide or purchase effective health interventions. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. General Tax Option The General Tax revenue is the main source of finance for risk pooling. It is also referred to as Tax-funded health financing. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Social Health Insurance Option The social health insurance is the second option. This refers to the situation where specific contributions for health are collected from workers, self-employed people, enterprises, and the government, and are pooled into a single, or multiple “social health insurance funds”. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. What Determinants Success The relative acceptance of the value and concept of solidarity in the society; The effectiveness of government stewardship, and The population’s trust in government and its institutions. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. WHO Resolutions in Support of Sustainable Financing WHA58.33 (2005) - Sustainable health financing, universal coverage and social health insurance: Urged countries to develop health financing systems that ensure Universal coverage. Universal coverage implies that: all people have access to key promotive, preventive, curative and rehabilitative health services at an affordable cost; the cost of care should not drive people into poverty (financial risk protection) 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. WHO RESOLUTION continue WHA58.33 (2005) - Sustainable health financing, universal coverage and social health insurance: Urged countries to develop health financing systems that ensure Universal coverage. Universal coverage implies that: all people have access to key promotive, preventive, curative and rehabilitative health services at an affordable cost; the cost of care should not drive people into poverty (financial risk protection) 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. OUAGADOUGOU DECLARATION ON PHC Framework for the implementation of the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa (2008): recommends that countries develop and implement social protection mechanisms, including social health insurance and tax-funded systems to cushion households from catastrophic (impoverishing) outof-pocket expenditures on health services 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Challenges Insufficient funding of health service delivery by governments. Heavy reliance on Out-Of-Pocket payments, which is inequitable and may lead to impoverishment of house-holds. Almost non existent social security in most countries. 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Perspectives Raising more funds for health by government by reaching the Abuja Target of 15% of total health expenditure; Reduce heavy reliance on Out-Of-Pocket (OOP)expenditure by promoting pre-paid schemes; Improve equity and efficiency in resource allocation and use; Public Private Partnership (PPP) to encourage the design of national social security policies grounded in the concept of a partnership between the different actors concerned (the government, local authorities, social partners, professionals in the sector, civil society organizations, the private commercial sector). 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. Per Capita Total Expenditure on Health Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Cote d'Ivoire DRC Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa Swaziland Togo Uganda United Republic of Tanzania Zambia Zimbabwe 0 50 100 150 200 250 300 350 400 450 Per capita expenditure on health in international dollars, 2004 500 550 Source of data: World Health Statistics 2010 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. 600 Government Expenditure as Percent of Total Government Expenditure, 2007 Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Cote d'Ivoire DRC Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa Swaziland Togo Uganda United Republic of Tanzania Zambia Zimbabwe 0 5 10 15 Source of data: World Health Statistics 2010 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010. 20 Thank you Je vous remercie Muito Obrigado 2nd African Decent Work Symposium: Yaoundé, Cameroon, 6-8 October 2010.