Social Protection and HIV AIDS: an introduction Luisa Guimares - - PowerPoint PPT Presentation

Luisa Guimarães Manager, S

• cial Protection Programme, International

Training Centre of the ILO Turin, 21 November 2013

Social Protection and HIV AIDS: an introduction

Structure of the presentation

What is Social Protection?

Social Protection and HIV AIDS?

What is the global situation? Part I: Part III : Part II:

Structure of the presentation – Part I

What is Social Protection Part I: Part III : Part II: What is the global situation Social Protection and HIV AIDS

Birth first child Birth last child Death first parent Death second parent RETIREMENT

Death Birth

Marriage EDUCATION, TRAINING, WORK

Life events and contingencies

CONTINGENCIES/RISKS VULNERABILITIES SOCIAL PROTECTION

What is S

• cial Protection?

“ S

• cial protection” is used to mean protection

provided by social security systems in the case of social risks and needs (World S

• cial S

ecurity Report, 2010- 2011)

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What is social protection? Contingencies - Classification

ILO European Commission OECD United Nations

(1) Medical care (1) S ickness/ health care; (1) Old age (1) S ickness and disability (2) Cash sickness benefits (2) Disability (2) S urvivors (2) Old age (3) Disability (3) Old age (3) Incapacity related (3) S urvivors (4) Old age (4) S urvivors (4) Health (4) Family and children (5) S urvivors (5) Family/ children (5) Family (5) Unemployment (6) Maternity (6) Unemployment (6) Active labour market programmes (6) Housing (7) Family/ children (7) Housing (7) Unemployment (7) S

• cial exclusion not

elsewhere classified (8) Unemployment (8) S

• cial exclusion not

elsewhere classified (8) Housing (8) Research and development in social protection (9) Employment inj ury (9) Other social policy areas. (9) S

• cial protection not

elsewhere classified. (10) Protection against poverty and social exclusion through social assistance (10) Health

S

• cial protection measures

Those providing benefits, whether in cash or in kind, to secure protection, inter alia, from:

• 1. lack of work-related income (or insufficient income)

caused by sickness, disability, maternity, employment inj ury, unemployment, old age, or death of a family member;

• 2. lack of access or unaffordable access to health care;
• 3. insufficient family support, particularly for children

and adult dependants;

• 4. general poverty and social exclusion.

S

• cial protection schemes can be of a contributory (social

insurance) or non-contributory nature.

Social Protection: types of schemes

• 1. S
• cial security

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Contributory schemes Non contributory schemes

Social Protection Systems

• Social Insurance
• National

Provident Funds

• Universal
• Categorial
• Means-tested

Social assistance schemes

Social Protection: principal obj ectives

9 Ensuring (1) absence of discrimination and (2) fiscal affordability, efficiency and sustainability

Reducing income insecurity and poverty Improving access to health services for all people Reducing inequality and inequity Providing adequate benefits as a legal entitlement

Decent work and living conditions

The right and the need for social protection

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Social security as a HUMAN RIGHT

Universal Declaration of Human rights (Art. 22 and 25) International Covenant on Economic, Social and Cultural Rights (Art. 9)

Economic, social and cultural rights indispensable for dignity and free development of personality

1948 1966

Why do we need social protection?

• S
• cial protection is a social necessity

(a) S

• cial security transfers are a powerful tool to reduce poverty and inequality. It

reduced poverty by at least 50% in almost all OECD countries (b) All socially and economically stable societies have extensive social security systems

• S
• cial protection is an economic necessity

(a) Economic growth does not automatically reduce poverty (b) Access to social health protection and education improves productivity levels an has a positive impact on growth (c) The famous trade-off between efficiency and equity is a myth. Cash transfers in developing countries have multiplier effects on local markets

Structure of the presentation – Part II

What is social protection? Social Protection and HIV? What is the global situation? Part I: Part III : Part II:

The need for social security

13 ...%

• f the

world population do not have access to comprehensive coverage ...%

• f the

population do not have access to essential health care … %

• f the

elderly do not receive a pension ...%

• f children

are living in poverty, many lack access to health and education Child and family benefits S trengthening social health protection S

• cial pension programmes

National social security strategies, based on social dialogue

S

• cial

security coverage gap

Social protection coverage: Statutory and effective coverage

Branches of social security: Number covered by a statutory social security programme, 2008–09

Health protection: Proportion of the population covered by law

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S

• cial security expenditure

16

18.0 14.1 9.0 11.0 9.9 7.1 7.6 3.6 2.8 5.7 7.1 4.8 7.0 2.5 3.6 3.1 2.2 1.7 2.5 2.7 5 10 15 20 25 30 Western Europe Central and Eastern Europe North America North Africa CIS Latin America and the … Middle East Asia and the Pacific Sub-Saharan Africa Total Percentage of GDP

Total public social protection in percentage of GDP - regional estimates Weighted by population

Public social security expenditure (excluding health) Public health expenditure 8.4 13.6 13.5 10.2 9.8 5.3 5.3 25.1 18.9 16.0

Options to extend coverage to vulnerable groups

• 1. Extending formal statutory schemes
• 2. Introducing community based social

protection schemes

• 3. Extending tax financed social

protection schemes (conditional & unconditional social transfers, universal)

Structure of the presentation – Part III

What is social protection Social Protection and HIV What is the global situation Part I: Part III : Part II:

• It affec

ects t the he mo most e econ

• nomically a

active age ge gr group (15-49) who who are i e in n emp mploym

• ymen

ent an and d pot

• tent

ntially c contributors

• It therefore may

may r red educe t the he nu numb mber of

• f cont

ntributors t to SS scheme mes

• It affec

ects t the he po poor

• r disproportionat

ately an and d exac acerbates inc ncome ineq equal ality a and nd ab absolute po poverty

• Already f

fragi gile h hea ealth s systems a are b being r g robbe bed o

• f skilled s

d staff

• HIV/Aids

ids o

• ver

ertax axes es t the s socia ial p l protec ectio ion s n system ems

Nu Numb mber er o

• f ol
• ld

d age ge pe pens nsions Amo moun unt of Hea Health Car Care c e costs Sickness b ben enef efits Inv nval alidi dity c claims ms/pension

• ns

Sur urvivors c claims ms/pen ensions Fu Fune neral gr grant nts

HIV/ V/Ai Aids I ds Impact act o

• n So

Social Pr l Protect ection ion syst ystems

Whe When a n a breadwi dwinn nner falls i ill: – Los

• ss o
• f lab

abou

• ur a

and nd con

• nsequ

quen ently i income

• me

– Ri Rising g me medi dical c costs – Ul Ultima mately f fune neral ex expenses

Nex ext gen generation’s c cap apacity to c

• climb out
• ut of
• f pov

poverty i is signif gnific icant ntly ly r reduc duced ed Poo

• orest hou

households are are mos most l likely t to

• resor
• rt t

to coping s ping strat ategi egies es : : sale o le of land nd

• r lives

estoc

• ck o
• r withd

hdrawa awal o l of child ildren f en from school hool Chro ronic p c pove vert rty

HI HIV/ V/Ai Aids ds Impact mpact on

• n Soci

Social al Pr Prot

• tec

ection

• n sys

systems

Why is social protection relevant to HIV?

S

• cial Protection can significantly reduce HIV-

related vulnerability and is a critical enabler for successful HIV prevention and treatment

• utcomes
• Reduces disavantadges and inequalities
• Helps overcome barriers to access to

treatment

• Mitigates the impact of HIV on household

poverty and social exclusion

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• The ILO Code of Practice on HIV/AIDS and the World of Work -

2001

• Calls on governments to ensure that social security programmes take into

account the progressive and intermittent nature of the disease and tailor schemes accordingly, for example by making benefits available as and when needed and by the expeditious treatment of claims.

• The Recommendation no 200 includes social protection as an

essential element in addressing HIV/AIDS (article 3, 20, 30 and 37)

• Draft WHO HIV strategy 2011–

2015

• Under the strategic direction 3: Build strong and sustainable systems:
• “ ...Mobilize f inancing f or healt h and st rengt hen social prot ect ion syst ems.”
• UNAIDS Outcome Framework 2009–

2011

One of the nine priority areas: HIV and S

• cial Protection Guidance Note

Recognition by the international community of the importance

• f social protection measures in the fight against HIV

/ Aids

Signif gnific icant nt i impac pact on p pover erty r reduc ductio ion n in h hous useh ehold

• lds a

affec ected ed b by HIV IV a and AID IDS

Soc

• cial

al t transfers ( (cash or

• r in

n kind) 2 roles:

• Prevent Households affected by AIDS from adopting non-

reversible coping strategies to pay for medical or funeral expenses – diversion of savings and capital (e.g., livestock) – removing children from school to care for sick adults or to engage in income earning activities

• Productive investment, e.g. purchase education, health care,

fertiliser

Condi nditiona ional socia ial l transf sfers rs: : by linking the income support to prevention and education, increase the impact of the measure

Examples of social protection mechanisms to address needs related to HIV/AIDS

CBHI scheme mes

• De

Despi pite i e increased a access t to pr prev evention, t trea eatme ment an and care services, a significant pr prop

• portion
• n of
• f AIDS

DS-affected c comm

• mmuni

nities rema main ex excluded ed f from

• m t

these s e services du due e to : – Inf nfrastructure b e bar arriers t to

• del

eliver ery – Prohi hibi bitive ve t trans nsport c costs – Virology t testing ng, t trea eatment nt an and other er costs – Lac ack o

• f inf

nformation a and nd educ ucation

• CB

CBHI HI schemes ma may pl play ay a an n active e rol

• le i

in redu ducing g the hese b barriers

3 3 rol roles

– Preven ention – Link nking ng wi with publ blic he health h care p program ammes – Provision o

• f a comp

mplem ementary h heal alth i insur urance e coverage

Examples of social protection mechanisms to address needs related to HIV/AIDS

Examples of social protection mechanisms to address needs related to HIV/AIDS

Non-contributory pension programmes

• Among the countries most affected by HIV/ AIDS

, only a few have comprehensive social protection measures for older people, in the form of a basic non-contributory pension. For example: Namibia, Botswana, Lesotho and S

• uth Africa
• According to ILO estimates, financing a social pension would

require less than 1 percent of GDP in low income countries. If well designed, social pensions can reduce poverty and vulnerability among older persons an their households, especially those affected by HIV/ Aids and migration, and contribute to production, trade, and growth in poor communities.

Question

S hould we go for social protection programmes exclusively targetting people affected by HIV - HIV-exclusive approach?

• r

S hould we go for HIV-sensitive social protection programmes? HIV-sensitive approach Why?

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Thank you

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