Building bridges between social protection and health sectors
Overcoming silos between long-established policy sectors is one of the most arduous challenges when it comes to technical assistance in the fields of social health protection (SHP) and health financing (HF). Yet, SHP provides a rights-based approach to reaching the objective of Universal Health Coverage (UHC) that ensures financial protection and effective access to health care services. Since 2021, the SDC-International Labour Organization (ILO) project “Strengthening social health protection through the Providing for Health (P4H) Network” works at better aligning the support of development partners around national stakeholders, while asserting the role of SHP to reach both UHC and Universal Social Protection (USP).
Encouraging multisectoral policy dialogue at country level
Advancing the UHC and USP agendas at country level requires partners to join forces and to align around national priorities. In Madagascar, the technical dialogue on financial protection towards Universal Health Coverage that took place in November 2022 was co-organised by the Ministry of Public Health, the ILO, the World Bank and the World Health Organization (WHO). It gathered Ministries responsible for social protection, health and finance, which came up with a joint action plan to revitalise policy efforts towards UHC in Madagascar. The workshop echoed results of an ILO publication on extending social health protection for all in Madagascar.
National capacity building is another strong enabler of inter-sectoral policy dialogue. In Burundi, Zambia or Kuwait, joint trainings gathered the health and social protection sectors to raise awareness on standards and best practices of SHP and health financing; build a common understanding of opportunities and challenges; as well as share different perspectives across actors. Similarly, every year, the Social Health Protection course of the ILO-International Training Center “Addressing inequities in access to health care”, organised in collaboration with P4H and CONNECT Networks, has been gathering national practitioners from social protection and health sectors around the world. The training aims at strengthening theoretical and operational skills of participants and highlighting the role of SHP in guaranteeing equitable access to care.
Sharing knowledge among practitioners at global level
Creating opportunities for technical exchanges at global level has been fundamental to share knowledge on SHP and HF across organisations and regions. During the Technical Exchange Group (P4H-TEG) meetings, P4H Focal Points (including ILO Focal Points) and experts from various organisations, ranging from multilateral and bilateral agencies, global health funds, to development banks and even the academia, discussed various aspects of social health protection and its interface with health financing. Discussions encompassed, among others:
- What are the standards and how to advance maternal health and maternity protection?
- How to maximize the health impact of social protection systems in the framework of epidemics and pandemic prevention, preparedness and response? This vast question was also at the heart of the joint ILO-WHO workshop at ILO in 2023.
- What will be the impacts of the climate crisis on social health protection and health financing, and how to address them?
- What is the role of mutuals and community-based health insurance in national social health protection systems?
Similarly, several webinar series, open for public audience, focused on disseminating the latest stage of the art on SHP and HF in India and in the Commonwealth of Independent States region, SHP for migrant workers and their families, as well as SHP for persons with disabilities.
Coming together on concrete financing and implementation tools at country level
While ensuring multisectoral dialogue and creating opportunities for knowledge sharing are of importance, the project noted the need to strengthen implementation tools for joint action as well.
- While people at risk of, or affected by tuberculosis (TB), are often the most vulnerable and in need of protection due to the impoverishing effect of TB, little bridges are established between the health (TB) and social protection actors. The WHO-ILO guidance on social protection for people affected by tuberculosis provides very concrete guidance for TB stakeholders who wish to navigate the social protection landscape to guarantee the inclusion of people affected by TB in national systems.
- Global health partners often act independently at country level, with very different intervention modalities, funding streams and cycles. The Community of Practice on Alignment of the P4H TEG aimed at better sharing information and understanding DPs mandates, approaches and funding cycles, specifically to P4H Focal Persons present in countries. This conversation is also key to properly navigate the health financing and social health protection landscapes and promote alignment at country level.
- When it comes to SHP and HF architectures, technical guidance to Governments can sometimes be provided in an inconsistent fashion, with contradictory messages and reverse policy impacts. The project triggers dialogues and contributes to align messages on the role of mutuals and community-based health insurance in national social health protection systems, through global and regional level technical dialogues with key partners.
- At the operational level, information systems of social health insurance on the one side, and the health sector on the other side, can be disconnected or duplicate efforts. Recently, an OpenIMIS study tour and requirements workshop in Nepal, organised jointly by the GIZ, ILO and Expertise France, raised the issue of inter-operability between social health insurance, social protection and health sectors. This further requires strengthened coordination between national actors.
Building the narrative: There can be no UHC without USP
Establishing bridges between SHP and HF actors requires a deep understanding of the intertwined relationships between social protection and health at large, especially at a time of multidimensional crises (including the climate crisis, conflicts, and pandemics among many others). As highlighted during the joint ILO-WHO workshop on 12 December 2024 in collaboration with the SPARKS Network, social protection and health are mutually reenforcing each other in multiple ways:
- Social protection, including health, provides income protection over the life cycle, and in fine is a determinant of health equity;
- In turn a healthy population contributes to a productive workforce, reducing absenteeism and increasing economic outputs, while reducing the need for income support.
The architecture of, and investment in, social protection systems, including health, can yield dividends for the health sector, while the nature of the health system and the level of health financing ultimately impact social protection. Awareness of this simple fact is a prerequisite to any multisectoral action. It will need to be continuously asserted if we are to move towards USP and UHC by 2030.
