Social protection in Africa

Africa is the continent where the greatest proportion of the population does not have access to adequate health care and where the incidence of infant mortality is highest. These are only some of the social risks and adversities being faced in day to day life, but Africa is also the continent where the coverage of social security is at its lowest. Why is this? There is a clear deficit between social security needs and the capacity to meet those needs.
 
Access to health care is one of the most pressing challenges for social protection in Africa. Many people face major difficulties in accessing health services due to financial constraints. In Kenya and Senegal, 45 per cent of total health expenditure is paid as out-of-pocket payments. Catastrophic health expenditure is one of the major poverty risks for individuals and their families. Paying for medicine and health care may force families into poverty for years.

The proportion and number of older persons in the population will increase rapidly over the coming years. Although deplorably low life expectancy at birth seems to suggest otherwise, an increase in the ageing population is a reality for much of Africa. On reaching the age of 40, Africans can expect to live another 30 years on average.

Only in the heavily HIV-affected countries of Botswana, Lesotho and Swaziland is the remaining life expectancy at age 40 less than 20 years. In the rest of Africa, 40-year olds can expect to reach at least the age of 60, if not well beyond. Older persons constitute a particularly vulnerable population group. 26 Only a small proportion of older persons have access to an old age pension: some 3 per cent of those aged 65 and older in Burkina Faso, 9 per cent in Ghana and 10 per cent in Senegal.

In sub-Saharan Africa, coverage by statutory social security schemes is very limited and largely confined to workers in the formal economy and their families. Preliminary data shows that for old age, disability and survivor pensions, slightly more than 10 per cent of the economically active population contributes to a pension scheme in Ghana and Zambia, and just over 5 per cent in Senegal. 28 These figures reflect the fact that only a small minority of workers are in the formal economy, while most workers in the informal economy are not covered.

Challenges

Although there is a great need for social security in Africa, factors such as limited formal economy employment, high rates of inflation and the impact of HIV/AIDS, make meeting this need, even partially, particularly difficult. Low productivity limits the necessary fiscal space, and weak governance mechanisms pose serious challenges to efficient delivery and administration. At the same time, governance and administrative problems in some existing social security schemes undermine trust and public support for social security. The coverage of targeted populations tends to be narrow, leaving the most vulnerable, in particular those in rural areas, without any form of social protection. There is therefore a very limited capacity to provide adequate social protection. High levels of unemployment and underemployment, as well as the inadequacy of current labour and social protection standards, hamper the delivery of social protection in many countries.

ILO’s response to social protection in Africa

It is estimated that in sub-Saharan Africa only about 10 per cent of the economically active population is covered by statutory social security schemes, most of these being old-age pension schemes, while in some cases also providing access to health-care. However, with increasing informalization, coverage is declining. Public health services in some countries reach a higher percentage of the population but only with a very limited range of public health programmes and medical care benefits. In North Africa, coverage tends to be substantially higher, although levels of exclusion are still very high.

There are essentially three options for extending the coverage of social security in Africa that can be combined to form pluralistic national social security systems: Extending existing social insurance schemes, building community based or occupation based insurance schemes on a voluntary or collective bargaining basis and introducing basic tax-financed benefit systems. A promising way to extend coverage in this area is through non-contributory, tax-financed cash transfers delivered in various forms: as universal social pensions paid to all the elderly, as cash benefits paid to families with children conditional on school attendance or participation in public health programmes, as categorical benefits aimed at persons with disabilities, orphans and other vulnerable groups, and as targeted social assistance programmes.

National experience from Botswana, Namibia and South Africa, as well as ILO research, has demonstrated that it would in principle be possible and affordable to provide all of the poor in Africa with a minimum package of social benefits and services including access to basic health care, basic income transfers in case of need, and basic education. In some cases these benefit systems would have to be introduced gradually, in step with the growth of the economy and the expanded fiscal space. This type of basic social protection package would have a major impact on the reduction of poverty and the improvement of living standards. Evidence from countries such as Botswana, Lesotho, Mauritius, Namibia and South Africa shows that social pensions have a remarkable impact on the living standards of elderly persons and their families, and particularly on children.

The ILO is assisting all African countries adopt coherent national social security strategies, including for the introduction or extension of a basic social security package that includes essential health care, child support for school age children and a minimum pension.
The ILO and the African Union Commission play a leading role to provide a strategic plan of action for the Yaoundé Tripartite Declaration on the Implementation of the Social Protection Floor  in active cooperation with national, regional and international employers’ and workers’ organizations, other UN agencies including the World Bank and the IMF, the ISSA, as well as all other active members of the coalition of donors and international NGOs representing national and global civil society movements.