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The Evolution of African Social Welfare Systems

This post is part of our special coverage Global Development.

Considering the debate generated by healthcare reform in the United States and the gradual withdrawal of the French state from public-funded social action, one might think that social protection is an endangered idea. On the contrary, the right to security is an integral component of the Universal Declaration of Human Rights (Article 22) and an important part of the Millenium Development Goals (MDG), as conceived by the United Nations.

For the majority of African countries, social welfare systems are still evolving. Each African government has chosen a system specific to its culture, with varying degrees of success, but all recognize the necessity of protecting at a minimum the most vulnerable populations.

An insufficient social protection system 

Assane Fall-Diop summarizes the struggles that are still needed to achieve a real social welfare system in Africa [fr]:

La protection sociale est devenue un thème obligé des débats électoraux en Afrique. En Côte d’Ivoire et en République démocratique du Congo, la Constitution ou la loi font même de l’assurance-maladie un objectif prioritaire. Cependant, l’essor de l’économie informelle et la faiblesse politique et financière des Etats handicapent les réalisations concrètes [..] En Afrique, « seulement 5 % à 10 % de la population active bénéficie d’une couverture sociale », selon l’Organisation internationale du travail (OIT), qui note une dégradation de la situation au cours des vingt dernières années. L’organisation souligne que « près de 80 % de la population n’a pas accès aux soins de santé de base ».

Social protection became a necessary theme of the electoral debates in Africa. In Cote d’Ivoire and the Democratic Republic of Congo, either the Constitution or the law make health insurance a priority goal. However, the booming informal economy and the financial and political weaknesses of African states make it difficult to achieve real progress. In Africa, “only 5-10% of the workforce receives social security coverage,” according to the International Labour Organization (ILO), which notes that the situation has deteriorated over the last 20 years. The organization emphasizes that “close to 80% of the population does not have access to basic healthcare.”

 

End of the month pension queues. Clermont Township, Kwazulu-Natal, South Africa by HelpAge on Flickr (CC-license-BY).

End of the month pension queues. Clermont Township, Kwazulu-Natal, South Africa by HelpAge on Flickr (CC-license-BY).

Lambert Gbossa, deputy director of the International Labour Organization's Regional Office for Africa, explains why he thinks that social welfare is in decline all over the continent. The force of informal economy is, in his opinion, one of the principal causes [fr]:

d’abord, une poussée démographique galopante qui produisit chaque année des cohortes de primo-demandeurs d’emplois; ensuite, une crise économique grave proche de la récession qui a réduit à néant les capacités d’absorption du secteur moderne; enfin, la poussée de l’exode rural obligeant bon nombre d’individus à venir «bricoler» dans les villes. Ainsi, la population active atteint plus de 40 pour cent dans l’ensemble des pays, avec un taux d’accroissement de plus de 4,5 pour cent, légèrement supérieur à celui de la croissance démographique. Au rythme actuel d’évolution des données sur la population active et sur la population salariée, le taux d’occupation des travailleurs salariés pourrait n’être plus que 2 à 3 pour cent au maximum dans les 25 prochaines années. Comme cette population est la seule à bénéficier d’un système organisé de sécurité sociale, il y a ainsi une dégradation prévisible de la rentabilité sociale du système de couverture.

First, a runaway population boom that produces each year a cohort of first-time jobseekers; next, a severe economic crisis, verging on recession, that wiped out the modern sector’s absorptive capacity; finally, a mass rural exodus forcing many to come “mess about” in the cities. In this way, the workforce rose to over 40 percent in all countries, with a growth rate above 4.5 percent, which is slightly higher than the growth rate of the general population. At the current rate, the occupancy rate of employed workers could be more than 2 to 3 percent in the next 25 years. Since this population would be the one to benefit from an organized social security system, there is a predictable drop-off in the social benefits of such a system.

Unequal progress across the continent

Steps have been taken to mitigate this lag in the development of a social welfare system for Africa. The Africa Platform for Social Protection (APSP) wants to see concrete measures to elevate and reinforce the social contract between states and their citizens. The APSP recommends [fr]:

tout programme doit être conçu à partir des structures existantes, y compris les systèmes classiques de protection sociale. En parallèle, la Plateforme insiste sur le fait que les défis de l’intégration régionale et notamment ceux liés à la portabilité des droits sociaux ne pourront être surmontés qu’à la condition que l’évaluation des réalités et opinions locales et nationales s’accompagne d’approches régionales et continentales

For the APSP, programme design must build on existing structures, including traditional social protection systems. At the same time, the Platform highlights that this attention to national and local situations and perceptions has to go hand in hand with the development of regional and continental approaches.

However, Lambert Gbossa is concerned about the danger represented by the willingness to provide a standard welfare system without considering the specificities of each region and without a participatory dialogue [fr]:

..la question de la réforme de la protection sociale dans les pays d'Afrique se pose avec acuité, elle s’est cantonnée à l'intérieur du système actuel et a rarement essayé de s'intégrer dans une politique globale. Le résultat de ce cantonnement est non seulement une marginalisation de l'immense majorité de la population mais surtout, la perpétuation d’un modèle extraverti et parfois incompris qui a fait de la protection sociale au profit du secteur formel l’essentiel et non le complément d’une problématique plus conforme aux identités. Les schémas très techniques et parfois très formels sont conçus en dehors des populations et n’ont pas été conformes au plan national de développement intégré..

…the question of reforming the social welfare system in the African countries is a good one. This question is confined within the current system and has rarely tried to insert itself into a comprehensive policy. The result of this confinement is not only the marginalization of a great majority of the population, but more importantly the perpetuation of an often misunderstood model that prioritized social protection for the formal sector over the problems in line with identities. The very technical and often extremely formal systems were conceived outside of these populations and were not part of a national plan for integrated development…

Some successful implementations   

Before Mali was shaken by the current political crisis, the country had made considerable progress with regard to social protection and healthcare coverage. This video of a project to improve the treatment of diabetes in Mali by the NGO Santé Diabète Mali, shows an example of social action with a strong impact on healthcare coverage:


Mandatory health insurance was established in Mali in 2010. This program enabled better protection for poor and marginalized populations, but did not reinforce the two other pillars of social welfare in Mali: the development of production infrastructure and the consolidation of structural adjustments. Funding remains one of the major obstacles affecting the sustainability of these social programs.

The foundation for social welfare in Burkina Faso meanwhile is currently being built. The basic principle of a social protection system rests on two essential tools: services and transfers. Olivier Louis dit Guérin defines these tools [fr]:

- Accès géographique et financier aux services essentiels : eau, assainissement, santé, alimentation, éducation, logement, épargne, assurance
- Transfert sociaux versés aux enfants, personnes âgées et personnes actives disposant d'un revenu insuffisant pour les services essentiels mentionnés précédemment.

- Services: Geographic and financial access to essential services, such as water, decontamination, health, diet, education, housing, savings, insurance
- Transfers: Welfare payments to children, seniors and working individuals who earn less than what is needed to have the essential services identified above.

In a study comparing the social welfare systems of Rwanda and Burundi, Solidarité Mondiale offers the following conclusions on social welfare in these two neighboring countries [fr]:

L’étude comparative des systèmes de protection sociale du Rwanda et du Burundi a clairement montré que le Rwanda a déjà réalisé des pas importants dans ce secteur clé qui sont aujourd’hui portés par une forte volonté politique et bénéficient d’un encadrement soutenu de la Cellule Technique d’Appui aux Mutuelles de santé au sein du Ministère de la Santé. La complémentarité fortement encouragée par les pouvoirs publics entre le système étatique de protection sociale, actuellement en pleines réformes, et les systèmes communautaires des mutuelles de santé extrêmement avancés au Rwanda, constituent un atout très important du processus de renforcement et d’extension des systèmes de protection sociale [..] Le Burundi, à la suite d’une guerre prolongée, n’a pas pu renforcer les systèmes existants de protection sociale en vue de leur extension au secteur informel et rural. Néanmoins, à certains égards, certaines initiatives privées ont fait des avancées remarquables dans ce domaine. le Burundi devraient l’inciter à privilégier des systèmes de protection sociale à forte participation populaire, s’il veut en garantir l’appropriation et la durabilité. En effet, la tentation peut être très grande de mettre rapidement en place un système de couverture universelle largement soutenue par les bailleurs de fonds externes.Le retrait de tels bailleurs peut rapidement conduire à la catastrophe comme cela a déjà été le cas pour certaines provinces du pays.

The study comparing the social protection systems of Rwanda and Burundi clearly shows that Rwanda has already made significant strides in this key sector that are today bolstered by a strong political will and that benefit from the support of the staff of the technical support unit (CTAMS—la Cellule Technique d’Appui aux Mutuelles de Santé) within the Ministry of Health. The government strongly encourages extremely sophisticated collaboration among the state system of social protection, current reforms, and the system of community-based health insurance. This collaboration is a very important trump card in the process of strengthening and extending the social protection systems […] Burundi, following a lengthy war, could not support the existing systems in order to extend them to the informal and rural sectors. Nevertheless, certain private initiatives have made remarkable advances in this field. If it wants to ensure ownership and sustainability, Burundi should encourage the prioritization of social protection systems through strong popular participation. It may be tempting to put in place a system of universal coverage, largely supported by external donors. The withdrawal of funds by such donors could quickly lead to a disaster, as has already been the case for some provinces in the country.

This post is part of our special coverage Global Development.

Featured and thumbnail image shows examination close-up in a hospital for women and children, Cote d'Ivoire, by Flickr user World Bank Photo Collection (CC BY-NC-ND 2.0).

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