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Social Protection

Building social protection floors and comprehensive social security systems

ILO strategy towards universal access to health care

Updated by Sven Nef on 12.06.2015

Core elements of the ILO strategy on rationalizing the use of pluralistic financing mechanisms


  • Assessing the coverage gap and access deficit
  • Developing a national coverage plan
  • Strengthening national/institutional capacities for implementation

There is no single right financial model for providing social health protection or one single pathway towards achieving universal coverage. Countries use various means of resource generation, risk pooling, health care delivery and financing to create dynamic systems that evolve over years, often contingent upon historical and economic developments, social and cultural values, institutional settings, political commitment and leadership.

The most promising approach to attain universal coverage within a realistic time frame is to coordinate and rationalize the use of pluralistic financing mechanisms. Effective social health protection coverage can be achieved through a combination of national health services, social health insurance, community-based insurance and mandated private health insurance that respects existing coverage and financing arrangements, and can be adjusted to the specific social and economic context of each country.

Decisions on key aspects of social health protection should be based on broad social dialogue that includes social partners and representatives of patients, healthcare workers, healthcare providers and the government.

Successful social health protection systems and policies should consider three levels:

  • At the level of the individual, the varying needs and priorities regarding disease burden, poverty/vulnerability, age, gender, ethnic groups, employment status and residence must be considered and adequately addressed.
  • At the system or scheme level, the provision of benefits must be enabled and ensure by adequate, efficient and effective management and financing process as well as the availability of resources such as medical equipment and staff.
  • At the global level, social health protection systems should align with global public health priorities, such as the MDGs and cross-border control of communicable diseases.


Download the strategy

Additional information:  Extending social security to all – A guide through challenges and options (section 3.2)


Main Resources

Social Health Protection. An ILO strategy towards universal access to health care