Background and purpose of the handbookThe purpose of this handbook is to guide UNHCR public health and programme staff and ILO staff working on social protection at country level on the considerations and practical steps required to assess options for the inclusion of refugees in national social health protection schemes.
This handbook is based on a growing body of evidence that highlights the importance of social health protection and universal health coverage (UHC) in improving health status and in contributing to Sustainable Development Goals (SDGs), in particular targets under SDGs 1, 3 and 8 when it comes to reducing mortality and morbidity at all ages, reducing poverty, hunger and malnutrition and improving livelihoods. Social health protection is one tool that can be used as part of a wider health and social protection platform aimed at improving the health and socio-economic situation of refugees.
UNHCR has been using social health protection schemes as one of the options of improving access to health services and has pursued this in several countries with varying degrees of success. Since 2014, the ILO and UNHCR have been collaborating on the extension of social health protection to refugees.
On 1 July 2016, the ILO and UNHCR signed a new Memorandum of Understanding (MoU) to engender a new and deeper phase of collaboration between the two organizations in eight common priority areas, including the extension of social protection. The agreement focuses on long-term solutions for refugees and others displaced by conflict and persecution.
Many of the examples laid out in the present handbook are taken from joint assessments and technical support interventions carried out by the ILO and UNHCR since 2014. Those interventions were concentrated in West and Central African countries.
The situation of refugees’ access to health varies from one country to another but overall, UNHCR and humanitarian partners face challenges to cover the health care needs of refugees, which include the challenge of sustaining significant levels of humanitarian funding in protracted situations and avoiding the creation or continuous operation of unsustainable parallel health systems for refugees.
UNHCR advocates that refugees access health services in similar ways to nationals, and that they experience equality of treatment, in line with international human rights instruments and equally embedded in ILO standards on social protection. Hence, where the provision of health protection for nationals is limited, options for refugees may also be limited.
It is, therefore, important to seek sustainable approaches to ensure refugees’ access to health care, in line with the Global Compact on Refugees and national efforts to extend social protection. The inclusion of refugees in social health protection schemes feeds into the broader question of extension of social protection to the informal economy, which requires strategies aiming at gradual integration and closely aligning with programmes focused on economic integration.
If social health protection options are available in a country (i.e. national medical care service or social health insurance, see definitions in the following section), the inclusion of refugees in the national health systems may improve access for refugees, reduce costs and avoid duplication of services. However, the health financing options in each country have to be understood to determine whether the use of an existing social health protection scheme will result in better health access for refugees.