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Social Protection

Building social protection floors and comprehensive social security systems

Strengthening national/institutional capacities for implementation

Updated by Xenia Scheil-Adlung on 12.06.2015

It is important to enhance technical capacities of public authorities, social partners and other stakeholders and improve their participation in social and national dialogue.

Creating institutional and administrative efficiency

Leadership, transparency and economic responsibility are good governance and form an integral part of the overall strategy design and implementation. Decision-making should be based on:

  • existing legal frameworks;
  • accountability;
  • transparency;
  • effectiveness and efficiency;
  • equity and inclusiveness;
  • participation and consensus.

Financial management

In order to fulfill the criteria of good governance, the financial and administrative separation of health insurance funds from Ministries of Health and Labour is essential. Generally, revenues earmarked for social health protection should be separated from government budgets. Contributions should only be used for health-care benefits and administration of the scheme, and not in support of Ministry of Health functions; it is particularly important to ensure that health-care contributions are not used for other contingencies.


A recent trend in organizing social health protection with a view to efficiency includes various forms of decentralization of responsibilities from the national to local governments or other sub-national institutions. However, the related shift of financial burden to the local level is often problematic, since fund transfers from the national level may be insufficient and result in increasing inequities in access, for example, of the poor (OECD, 2006a). 

Another form of decentralization of social health protection concerns community-based schemes. They mobilize additional funds at local levels and provide financial protection of out-of-pocket payments, particularly for informal sector workers and their families (ILO, 2006d).


Creating efficiency also relates to purchasing services. Generally, the provision of services can be organized through public or private providers. The most efficient mechanisms to purchase services are:

  • budgeting, such as setting caps on annual expenditure;
  • contracting and accreditation of providers based on performance; and
  • provider payment methods such as salary, capitation, case-based payments and fee-for-service.

Funds – e.g. social health insurance – may also act as purchasers. By so doing, insurance funds shift (financial) power from the supply to the demand side.  This might result in important changes in the availability and affordability of services, particularly for poor segments of the population.

Governance Tools

ILO provides quantitative tools for financial governance that aim at achieving quality assurance and monitoring progress and outcome: They include:

  • social budgeting;
  • Social Protection Expenditure and Performance Reviews (SPERs);
  • Social Security Inquiry;
  • STEP tools on community-based insurances.


It is particularly important to train administrators who are expected to implement related reforms. Strengthening institutional technical and administrative capacity is essential for ensuring that efficient structures and procedures are in place to guarantee the viability of national security schemes and their responsiveness to their members' needs.

The capacities gained will further contribute to the design, implementation and testing of national health protection to ensure its viability.

Currently, however, many developing countries lack sufficiently trained staff to ensure successful extension in social health protection.


Enhancing technical capacities of public authorities, social partners and other stakeholders is crucial for overall governance and supervision. Evidence from many countries proves that successfully extending social health protection to the poor requires the consensus of various levels and entities of government, social partners, civil society and others.

Given the diverse interests of stakeholders, obtaining the necessary support is a highly complex and difficult task. Problems often arise when stakeholders and social partners feel that they have been ignored in the process involved in the design and provision of social health protection; that concerns have been misunderstood; or that the quality and depth of participatory decision-making was limited

This might result in a lack of support in implementation, enforcement, funding, and compliance to new laws and regulations, leading to a complete failure of important reform activities - even when parliamentarian hurdles have been cleared.


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