GTZ-ILO-WHO-Consortium on Social Health Protection in Developing Countries


Stakeholders in extending social protection in health
The extension of social protection in health and the quest for universal coverage requires the involvement and commitment of a variety of actors:


State legislative and executive bodies have a priority role in facilitation, promotion, and extension of health protection, including legislative decisions on its form. Overall government stewardship and a strong political will to engage in health financing reform are essential for steering the implementation of sustainable systems of social protection.

Workers and Trade Unions

Trade unions are vital in advancing the principles of solidarity and social justice among their members and in society at large. Workers and trade unions should be included in participatory forms of decision-making. Trade unions could also support governments in establishing measures to extend coverage to people not covered so far (e.g. workers in the informal economy, rural population) and in taking account of gender-related aspects.

Employers and Employers’ Organizations

Employers should be included in social dialogue and, where social health insurance schemes are present, should be included in decisions about the boards of such schemes. Further, employers should respect national and international labor standards. Supporting the establishment of social protection systems is also an element of corporate social responsibility.

Voluntary Health Insurance

Voluntary health insurance (e.g. private for profit or community-based) can offer supplementary insurance packages or complement a basic benefits package to that funded from compulsory sources. In some countries, privately owned health insurers are critical agents in the implementation of public compulsory health insurance. Community-based health insurances might be important organizational devices in extending coverage to the excluded in particular in the informal economy.

Social Security Institutions

Due to their institutional interest, social security institutions are a cornerstone in any coverage extension strategy. They need to be at the center of capacity-building and training strategies. Civil Society Groups Civil society groups (e.g. religious bodies, non-governmental organizations, cooperatives) play a key role in promoting the principles of equity and solidarity in society. They should participate in national dialogues to further the extension of coverage to excluded groups.

Health Care Providers

Private and public health care providers should be adequately equipped to provide quality health care services, including the treatment of specific diseases (e.g. HIV/AIDS). Health care providers also need to be acquainted with the principles of modern health care purchasing arrangements, including the procedures of accreditation, contracting and payment mechanisms’ advantages and limits within a third party payment agreement.

Development Partners

Development partners need to strengthen their efforts and commitments to enable countries to develop fair financing health systems. This includes offering technical cooperation as well as further knowledge and capacity development to partner countries. External funds should be made available to partner countries on a predictable and longer term basis. In line with the Paris Declaration on aid harmonization, development partners should work together more closely and harmonize their agendas. National and international organizations and agencies sharing the values of equity, universality, and solidarity in health are invited to join the global partnership and cooperate at the international, regional and country level.

Technical Cooperation Agencies

A central problem in organizing health financing is that governments and other decision-making authorities often face limited capacities and experience to develop socially balanced and pro-poor health care systems. Technical cooperation and collaboration at regional, country and community level should be demand driven and originate from country level as a result of broad consultation between partners and donors. It includes the following activities:

Providing comprehensive policy advice to interested partners

Collaborating in analyzing the benefits and costs of different methodologies in health financing
Intensifying efforts for financing health promotion and disease prevention including environmental issues
Jointly applying tools to support the planning, implementation, evaluation and monitoring of social health protection systems
Carrying out feasibility studies to analyze systematically the political and socio-economic conditions, needs and expected costs related to the introduction or expansion of a social protection mechanism


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