Like many who work in West Africa's fishing industry, Jadim, a porter at the fish market in Hann, Senegal, knows the risks of carrying the heavy load of his daily catch from ship to shore. "The baskets are too heavy and my back hurts," he says. "But I can't carry any less because I get paid per basket."
For Jadim, however, the risks are far greater than aching muscles. What would happen, for example, if Jadim's back gave out and he was unable to work for days or weeks? And with no income at all, how would he afford medical treatment which would enable him to work again, and support himself and his family? And what if he was permanently incapacitated?
These issues are confronted daily by workers in Africa, where in many countries less than 10 per cent of the working population has any form of social security coverage, including health insurance.
Social security – broadly defined as a system of contribution-based health, pension and unemployment protection along with tax-financed social benefits – has long been considered by the United Nations as a basic human right – one relatively few people enjoy. The International Labour Organization (ILO) estimates that only about 20 per cent of the world's population has adequate social security coverage, while more than half the world has no coverage at all.
The expansion of informal employment has become a major obstacle to extending coverage of social security systems across the African continent. What's more, the financial viability of systems which do exist is threatened by such phenomena as weakness of governance and the impact of HIV/AIDS. As a result, workers like Jadim often have few options when it comes to ensuring that illness, injury or unemployment doesn't plunge them deeper into poverty and despair.
Yet, despite the lack of formal systems, experience has shown that even the poorest are willing to contribute some of their income to social security schemes which can meet their needs. Jadim and his co-workers in the fishing industry are living proof of that.
With help from the ILO, they have formed their own community-based health insurance plan enabling them to make small, regular contributions which can ensure ongoing access to basic medical care. Despite its relative simplicity, local doctors say the plan makes a world of difference in raising the level of health care in the community.
"We're living in a developing country and people don't have much money, so when sick people come in, at least their prescriptions are paid for automatically," says Dr. Madou Kane of the Hann Health Center. "We're sure they will follow their treatment.It's guaranteed."
These so-called "microinsurance" schemes 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, non-profit organizations which seek to improve access, mainly through member contributions, to quality health care for members and their families.
Community financing schemes like the fishermans' in Hann, can provide vital health care and protection against the cost of illness. Still, there is a need for more technical support to ensure sustainability, as well as broader awareness and understanding of the schemes' potential for helping countries expand social security coverage.
The ILO STEP programme – Strategies and Tools against Social Exclusion and Poverty – seeks to fill this void by promoting greater coordination between development agencies and the various microinsurance organizations which have emerged throughout the region. The resulting network, known as "La Concertation", makes it possible for these organizations to exchange practical knowledge, and to deal more effectively with health providers, support organizations, public services and donors. It also creates synergies between the various mutual health insurance plans, various partner organizations and their communities through concrete activities, such as training programmes and information exchange meetings, as well as communications tools such as newsletters and a Web site.
This effort is one of many being undertaken by the ILO as part of its Global Campaign on Social Security and Coverage for All, which seeks to broaden social security coverage, particularly in the informal economy, and raise awareness worldwide about the role of social security in economic and social development. The campaign, launched in June of this year and scheduled for rollout in Africa in December, reflects a global consensus on the part of governments and employers' and workers' organizations.
"Social security is an essential element of the safety net that prevents working people and their families from falling into poverty.In some cases, extending social security coverage to the unprotected can actually lift families out of poverty," says ILO Director-General Juan Somavia."Social security systems contribute not only to human security, dignity, equity and social justice, but also provide a foundation for political inclusion, empowerment and the development of democracy. Well-designed social security systems improve economic performance, and thus contribute to the comparative advantage of countries on global markets."
Experience in Africa demonstrates that the situation can be improved through different measures.Tunisia increased health and pension coverage from 60 per cent in 1989, to 84 per cent in 1999. South Africa's tax-financed State Old-Age Pension (SOAP) reaches 1.9 million beneficiaries, about 85 per cent of the eligible population – thereby reducing the poverty gap for pensioners by 94 per cent.
Under the auspices of the campaign, the ILO will seek to work with governments and the social partners to define national action plans, support local efforts to extend coverage, share good practices, and raise the priority of social security extension on the development and poverty reduction agenda for Africa. The ILO is now testing new approaches to open up access, and monitoring initiatives by its member States to extend coverage. Moreover, it is seeking to 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 weak and participation in the informal economy is high.