Social Protection

Building social protection floors and comprehensive social security systems

Social health protection and the Social Protection Floor

Updated by Xenia Scheil-Adlung on 11.06.2015

Social health protection is an important tool to reduce poverty and inequality. Healthier workers are more productive; labour supply increases when morbidity and mortality rates are lower. Conversely, the lack of access to medically necessary health care has significant social and economic repercussions, often driving people into poverty and out of the workforce.

An effective Social Health Protection system provides universal access to health care that is affordable, available and offers financial protection in times of illness, injury and maternity.

Learn more about trends in social health protection.

See ILO concepts and definitions.

A country’s social protection floor should guarantee access to essential health care and a minimum level of income protection in the case of illness, unemployment disability and maternity.  These guarantees should be nationally defined and applied consistently to all, regardless of age, gender, ethnicity, income, employment status or geography in order to avoid inequities between formal and informal economy workers, and between the rich and the poor.

Universal access to essential health care and income security for all is the first level of the “social protection floor” – a basic set of guarantees, services and facilities that every person should enjoy. The social protection floor initiative emphasizes the need to implement comprehensive, coherent and coordinated social protection and employment policies to guarantee services and social transfers across the life cycle, paying particular attention to the vulnerable groups. Good governance for universal care requires participatory approaches such as social dialogue to ensure sustainability and compliance

Cost is the primary reason why sick people do not seek care. As out-of-pocket payments approach catastrophic levels, defined as 10% of monthly household income, people must choose between paying for care and paying for other family or business necessities.

The ILO strategy towards universal access to health care therefore addresses the need to overcome financial barriers to access through the development of a social health protection system.

Overall, there is no single best solution, given the different economic, social, political, cultural and legal environments for effectively mobilizing funds and efficiently applying them to a social health protection scheme. Using different financing mechanisms simultaneously, exploiting synergies, and ensuring their complementarity will allow countries to move faster towards the ultimate goal of universal coverage.

Health protection: Proportion of the population covered by law, latest available year (percentages)

Source: ILO (2010), World Social Security Report 2010-2011, p. 41.

Affordability is not the only barrier for access to health services. In addition, geographical, cultural, informational, organizational, and other barriers also come into play. Often, society, economy, institutions or legislation are blind to the needs of certain populations – the poor, migrants or indigenous groups, women, elderly, disabled – who are underrepresented in the formal economy. Consequently, inequalities increase, including access to health services and health-related financial burden.

Gaps in legal coverage: Roma and migrants

Sources: EDIS S.A, 2009 Krumova T. and Ilieva M. 2008 Amalipe, Veliko Turnovo; European Roma Rights Center, 2006.

The ILO approach to social health protection is founded on the human rights to health and social security - and on the significance of such protection with regard to rights at work and employment. It is directly relevant to the Millennium Development Goals, and the Decent Work Agenda, among other international collaborations and interests. Read more about how social health protection relates to these and other international collaborations.


Main Resources




Social Health Protection: addressing inequities in access to health care. Pre-course e-learning: 20 February - 11 March 2012 / Residential phase: 12 - 23 March 2012, Turin, Italy. Download the flyer.