DAKAR, Senegal (ILO On-line) - Illness brings worrying times for the agricultural workers here, as it does for many agricultural workers in West Africa. They live in small villages, often many kilometres from the nearest health clinic, and where taxis rarely venture. Farmers on an irregular income often find healthcare prohibitively expensive. Paying for doctor's fees and medicines means selling family livestock that otherwise would have been used for children's school fees. But their health must come first - a serious illness would leave them unable to work and support the family.

Workers in Africa - where only 5-10 per cent of the working population has any form of social security coverage, including health insurance - confront these issues daily. The sheer size of the region's large informal economy has been a major obstacle to extending coverage of social security systems across the continent. What's more, the financial viability of systems that do exist is threatened by weak governance and the immense impact of HIV/AIDS, which is devastating the African workforce.

Despite the lack of formal insurance systems, however, even the poorest are willing to contribute some of their income to social security schemes that can meet their needs. With help from the ILO STEP programme (Strategies and Tools against Social Exclusion and Poverty), the National Union of Agricultural Cooperatives of Senegal (UNCAS) is developing a community-based health insurance scheme for the 800,000 members of its 4,500 village organisations. In June 2003, their pilot project in Mboro enabled 4,000 members to make small, regular contributions ensuring free access to basic medical care.

To share the lessons from such experiences and to put social security at the top of policy makers' agendas, the ILO launched the " Global Campaign on Social Security and Coverage for All" at the International Labour Conference in June 2003. In December of that year, the campaign was presented to more than 300 government, trade union and employer representatives on the occasion of the 10th ILO African Regional Meeting in Addis Ababa. Continuing the "road show" around Africa, the Global Campaign went to Maputo, Mozambique in March and arrives in Senegal on 14 April 2004.

Micro insurance schemes such as the UNCAS example are a growing trend in areas where working people and their families try to cope without properly functioning health care systems. Typically, they are promoted by independent, community-based organizations that seek to improve access, mainly through member contributions, to quality health care for members and their families.

Still, there is a need for more technical support and coordination to ensure sustainability, as well as broader awareness and understanding of the schemes' potential for helping countries expand social security coverage. Under the auspices of the Coverage for All Campaign, the ILO works with governments and the social partners to define national action plans, support local efforts to extend coverage, share experiences, and raise the priority of social security extension on the development and poverty reduction agenda for Africa.

The ILO can also apply its long experience in promoting social dialogue and tripartite involvement to address the special challenges of expanding social security in countries where coverage is scant and most of the labour force is in the informal economy. In Mali, the ILO supported dialogue between the government and the social partners that led to a national plan of action for the progressive extension of social coverage in 2003.

Networking increases the spread of knowledge and benefits. The micro health insurance network in West Africa, known as "La Concertation", makes it possible for organizations concerned with social security to exchange practical knowledge, and to deal more effectively with health providers, support organizations, public services and donors. The network has provided training programmes and information exchange meetings, as well as communications tools such as newsletters and a Web site.

As the farmers can testify, the survival of the family is predicated on their health. Millions of families perch precariously on the edge of absolute poverty. Social security coverage is essential in helping them move away from that dangerous edge. "When the structure of social security is improved, the cost of healthcare is lowered," says Assane Diop, Executive Director for Social Protection at the ILO. "At the same time productivity is improved, poverty is lowered and the well being of the family is increased."