What works? Best practices of social protection for informal workers
Transcription
What works? Best practices of social protection for informal workers
WHAT WORKS? Best practices of social protection for informal workers A cross-country study Kyrgyzstan, Pakistan, Vietnam What Works? Social Protection of Informal Sector Employees EPOS Health Management I Contents Contents .......................................................................................................................................................... II Abbreviations and Acronyms ........................................................................................................................... V Summary ......................................................................................................................................................... 1 1 2 Introduction ........................................................................................................................................... 2 1.1 Aims and Objectives of the Study .............................................................................................. 2 1.2 Methodology ............................................................................................................................... 2 1.3 The Study Team......................................................................................................................... 5 Case Study I: Vietnam .......................................................................................................................... 6 2.1 Country Background .................................................................................................................. 6 2.2 The Current National Policy on Social Protection ...................................................................... 6 2.2.1 Supporting Policies on the Labour Market ...................................................................... 6 2.2.2 Supporting Policies on Insurance .................................................................................... 7 2.2.3 Supporting Policies on Social Assistance ....................................................................... 8 2.3 The Informal Sector and Social Protection................................................................................. 9 2.4 Best Practice on Social Protection for the Informal Sector ...................................................... 10 2.4.1 National Social Protection Scheme ............................................................................... 11 2.4.2 Commercial Insurance .................................................................................................. 13 2.4.3 Non-profit Organisations ............................................................................................... 14 2.5 Conclusion and Recommendations for Improved Social Protection in Vietnam ...................... 16 2.5.1 Focus Energy on Formalising the Informal Sector ........................................................ 17 2.5.2 Develop a Targeted Approach to Integrating the Informal Market ................................ 19 2.5.3 Improve the Social Insurance Product .......................................................................... 20 2.5.4 Assist the VSS in Product Distribution and Data Management ..................................... 21 2.5.5 Improve Risk Management Skills .................................................................................. 23 2.6 3 Final Thoughts ......................................................................................................................... 23 Case Study II: Kyrgyzstan................................................................................................................... 24 3.1 Country Background ................................................................................................................ 24 3.2 The Current National Policy on Social Protection .................................................................... 24 3.2.1 The Social Protection Strategy for 2006-2008 .............................................................. 24 3.2.2 The Country Development Strategy/Poverty Reduction Strategy Paper (CDS/PRSP) 2007-2010 ..................................................................................................................... 25 What Works? Social Protection of Informal Sector Employees EPOS Health Management II 3.2.3 The New Social Policy................................................................................................... 25 3.3 The Informal Sector and Social Protection............................................................................... 25 3.4 Best Practice on Social Protection for the Informal Sector ...................................................... 27 3.4.1 Social Insurance ............................................................................................................ 28 3.4.2 Health Insurance ........................................................................................................... 29 3.4.3 Social Assistance Programmes ..................................................................................... 31 3.4.4 Private Sector ................................................................................................................ 31 3.4.5 Other Social Protection Schemes ................................................................................. 32 3.5 Conclusion and Recommendations for Improved Social Protection in Kyrgyzstan.................. 33 3.5.1 The impact of the informal sector to social protection in Kyrgyzstan ............................ 33 3.5.2 Gaps in Social Protection .............................................................................................. 34 3.5.3 Government response to addressing need of the informal workers for social security . 35 3.6 4 Final Thoughts ......................................................................................................................... 36 Case Study III: Pakistan...................................................................................................................... 38 4.1 Country Background ................................................................................................................ 38 4.2 The Current National Policy on Social Protection .................................................................... 39 4.2.1 Relevant Legislation ...................................................................................................... 39 4.2.2 Poverty Reduction Strategy Paper (PRSP II) ................................................................ 41 4.2.3 Policy Coherence in Social Protection .......................................................................... 41 4.3 The Informal Sector and Social Protection............................................................................... 42 4.4 Best Practice on Social Protection for the Informal Sector ...................................................... 43 4.4.1 Bait-ul -Mal .................................................................................................................... 43 4.4.2 National Rural Support Programme / Adamjee Insurance ............................................ 45 4.4.3 Benazir Income Support Programme ............................................................................ 47 4.4.4 The Bacha Khan Income Support Programme ............................................................. 48 5 4.5 Conclusion ............................................................................................................................... 49 4.6 Final Thoughts ......................................................................................................................... 50 Cross-Country Comparison of Best Practices for the Informal Sector ................................................ 51 5.1 Policy Framework ..................................................................................................................... 51 5.2 Extending Social Protection to the Informal Sector .................................................................. 55 5.3 Comparison of Benefits and Disability Package ...................................................................... 56 What Works? Social Protection of Informal Sector Employees EPOS Health Management III 5.4 Contrasting the configuration of social protection mechanisms available for the informal workers ..................................................................................................................................... 58 6 Recommendations .............................................................................................................................. 61 Annex 1: Methodological Considerations ...................................................................................................... 63 Annex 2: Meeting Schedule for Vietnam ....................................................................................................... 70 Annex 3: List of People Met in Pakistan ........................................................................................................ 72 Annex 4: List of People Met in Kyrgyzstan .................................................................................................... 73 What Works? Social Protection of Informal Sector Employees EPOS Health Management IV Abbreviations and Acronyms ADB Asian Development Bank BISP Benazir Bhutto Income Support Scheme CFRC Community Finance Resource Centre CSR Corporate Social Responsibility DFID Department for International Development GDP Gross Domestic Product GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit GoV Government of Vietnam HDI Human Development Index ILSSA Institute of Labour Science and Social Affairs (Vietnam) IMF International Monetary Fund MFI MicroFinance Institution MHIF Mandatory Health Insurance Fund MOF Ministry of Finance MoLISA Ministry of Labour, Invalids and Social Affairs (Vietnam) MOSP Ministry of Social Protection (Kyrgyzstan) MSB Monthly Social Benefit NGO Non-governmental Organisation NRSP National Rural Support Programme OHS Occupational Health and Safety PBM Pakistan Bait-ul-Mal PRSP Poverty Reduction Strategy Paper PwD Persons with disabilities SGBP State Guaranteed Benefits Package’ SOE State-owned Enterprise UMB Unified Monthly Benefit UN United Nations UNDP United Nations Development Programme UNHCR United Nations High Commissioner for Refugees VHI Voluntary Health Insurance VND Vietnamese currency VSS Vietnam Social Security Services WG Working Group What Works? Social Protection of Informal Sector Employees EPOS Health Management V Summary Background: Informal nformal workers make up the majority of the workforce of many Asian partner countries of German development cooperation. The overwhelming majority of these are not covered by any form of sos cial protection. Hence, in order to achieve universal coverage of social social protection, it is crucial to identify well working schemes and approaches on how to reach and cover this part of the population. However, most of the studies to date that address the issue of informal workers and social protection, aim at describing certain characteristics of these groups including willingness to pay for social protection coverage. Therefore, the study at hand aims at closing this knowledge gap at least in part, by drawing a focus on identification of best practices of social protection on – and especially social health protection – of informal workers in Kyrgyzstan, Pakistan and Vietnam. Method: The study was conducted by teams of Epos Health Management in close cooperation with GTZ/GIZ GIZ projects and programmes in the respective countries. countries The conceptual background for the research questions is the so called universal (health) coverage cube, which basically addresses the three dimensions of social (health) protection: population coverage (who ( is actually covered?), ), service coverage (what ( services are covered by the respective scheme?) scheme? and cost coverage (what what proportion of the costs are covco ered?).1 Three approaches were applied: Desk research,, which aimed to provide an overall picture of the social protection landscape in terms of legal and regulatory frameworks and the different agents involved and to list down a menu of social protection systems that are made available to the informal sector following statutory or legal mandates. Interviews with key informants to substantiate information acquired a from desk research with the intention of deepening appreciation of national policy and the consequent configuration of social protection systems and their mechanisms. Finally, visits to selected sites were conducted to inquire about key operation and nd organisational elements of social protection systems. Results: For Kyrgyzstan and Pakistan, no “best practice” schemes of social protection for informal workers as such could be identified. This is due to the fact that in both countries no explicit laws laws and/or programmes have been established to date that address the specific issue of (extending) social protection for (to) inforinfo mal workers. The national social health insurance scheme of Vietnam, however, in deed proved to be a best practice case for reaching eaching out to informal workers in terms of social health protection coverage. The Vietnamese government provide full subsidies for social health insurance contributions of those informal workers and their families living below the poverty line (BPL), while providing in-part part subsidies of contribucontrib tions of those who are defined to be near poor. Although, the principle of providing tax-financed tax subsidies for social insurance contributions of those, who don’t have a regular or o only a very low income is not new, it could be of interest for those countries in the region that currently strive to achieve universal coverage. Enforcement of compliance with existing laws on social protection, protection however, is a major issue in Vietnam and Kyrgyzstan as well. Especially employers’ reluctance to register their employees in existing social insurance schemes was reported to be a troublesome issue. issue This is not just problematic in terms of coverage and aca cess to social services for those who are not registered. Moreover, Moreover, this deprives national social insurance schemes of contributions,, which would otherwise increase the pooled funds and thereby enhance the finanfina cial viability of the respective schemes. Accordingly, more research is needed on how to effectively enforce companies’ registration to national social protection schemes. 1 Cf. WHO (2010) The World Health Report. Health systems financing. The path to universal coverage. Geneva, p. XV. What Works? Social Protection of Informal Sector Employees EPOS Health Management 1 1 Introduction 1.1 Aims and Objectives of the Study On behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ) the Deutsche Gesellschaft haft für Internationale Zusammenarbeit Zusamme (GIZ) intends to further support partner countries in strengthening their social protection schemes in order to reach more effectively the t excluded and vulnerable segments of the population,, with a particular focus on workers in the informal sector. So far little is known as to “what works” to protect informal sector workers in selected partner countries. To what degree ree do public and private (profit and non-profit) non profit) schemes already exist, that cater for the need of the informal sector and what conclusions conclusions can be drawn from the experience? This study intends to fill a knowledge gap with regard to good practice in the area of social protection in the countries of Vietnam, Pakistan and Kyrgyzstan. For each of the three countries the study aims to provide the following: A brief description of the existing social security systems; A brief description of respective state provisions and legal framework conditions, especially labour and social security law and tax law where relevant, including the political background; background; The identification and description of (good) practice examples for the inclusion of informally eme ployed persons in social protection systems; and the establishment of specific social protection systems tems for this group; the emphasis is on schemes for which target groups are paying contribucontrib tions, i.e. micro-insurance insurance schemes; The description of the potential of cooperation (both in terms of technical exchange and expanding coverage for development aims) with the private sector in the different identified identified mechanisms; The description of potential lessons learnt that may be derived from the comparison of the councou tries; the study will provide recommendations as to which of the good practice found may be replirepl cated elsewhere and under which conditions. 1.2 Methodology This study intends to showcase social protection systems that cater to informal sector groups. To further scope this study, we have subscribed to the International Labour Organisation’s (ILO) definition of the informal sector, which is “broadlyy characterised as comprising production units that operate on a small scale and at a low level of organisation, with little or no division between labour and capital as factors of producprodu tion, and with the primary objective of generating income and employment employment for the persons concerned.” Statistically, they are considered to comprise those household unincorporated enterprises with market producprodu tion that are: Informal own account enterprises (optionally, all, or those that are not registered under specific forms rms of national legislation); What Works? Social Protection of Informal Sector Employees EPOS Health Management 2 Enterprises of informal employers (optionally, all those with less than a specified level of employemplo ment and/or not registered and/or employees not registered). Other than providing an inventory of notable social protection systems, our study took particular interest in the mechanisms employed by these systems that could be categorised as best practice in targeting and covering risks among the informal sector. There are several organisations organi ations that implement social protection mechanisms echanisms for the informal sector and come from the ranks of the private and public sectors, or non-profit non organisations. ations. Best practices cited here come from organisations organi ations given special mention by credible agenage cies in the countries we have visited. Instinctively, Instinc organisations ations that deserved mention are those that have considerable membership bases and/or have gained notice of the government and development partners. We identified best practices as successes in three broad criteria: 1. Coverage Ratio:: number of people participating in the scheme within the target group vis-à-vis vis total target population 2. Coverage Depth:: how much financial mitigation is provided in cases of catastrophic expenditure or when exposed to risks 3. Coverage Breadth:: the range of social protection protection products made available for clients. These criteria mirror the framework adopted by GIZ in supporting countries in achieving universal coverage. These dimensions are shown in the figure 1 below. Fig. 1: Universal (health) coverage cube2 What this means conceptually is that the cases we showcase here are what we perceive as mechanisms that could viably assist towards universal coverage, particularly reaching the informal sector by offering products that address their specific specific risks. The case studies focused on schemes that beneficiaries are rer quired to contribute to. 2 WHO (2010) The World Health Report. Health systems financing. The path to universal coverage. Geneva, p. XV. What Works? Social Protection of Informal Sector Employees EPOS Health Management 3 The study employed three methods to gather information about social protection practices. practices The use of the three methods made possible cross-referencing, cross data verification and cross-validation. validation. 1. Desk research.. The review of available documents provided an overall picture of the social protection landscape in terms of legal and regulatory frameworks and the different agents involved. The objective of this activity was to list down a menu of social protection schemes that are made available to the informal sector following statutory or legal mandates. The documents had been propr vided by governmental units e.g. departments of labour and social welfare, as well as, constituted cons bodies and institutes and civil society organisations. 2. Key informant interviews. interviews Interview of key informants substantiated information acquired from desk research and had the intention of deepening appreciation of national policy and the consecons quent configuration of the social protection system and their mechanisms. The interviews inquired about how access to a social protection system is assured and whether adjustments in the system were made to accommodate the needs of the sector. sector Key informants were ere asked about noteworthy social protection schemes within and outside the government establishment. 3. Site visits. From a list of noteworthy social protection schemes, organisations were visited to inquire about key operation and organisational elements of their respective social protection scheme. s The purpose of the visit is to unpack good practices that could be readily attributed to successes in reaching the scheme’ respective coverage targets and/or providing substantial risk protection. This study consequently equently looked at schemes as run by three agents: state or public sector instituinstit tions, commercial enterprises and cooperatives systems. We have selected key informants for interviews on the basis of referrals from our national experts and nan tional agenciess and later through snowballing. It is assumed that national agencies would have an overview of social protection schemess that are in operation in their respective countries. Key people of these national agencies are themselves respondents in interviews to supplement information gathered from document rer view. Annex I provides an overview of the methodological considerations for this study. In chapter two, three and four of this report, the findings from each of the three countries are described in detail. Chapter five makes a comparison of the findings from the three countries and draws conclusions for the replicability of the results. What Works? Social Protection of Informal Sector Employees EPOS Health Management 4 1.3 The Study Team The study team was deployed in tandems for each country, except for Kyrgyzstan. With the tandem, the short-term term experts were able to cross-validate cross validate their findings in interviews and site visits. The appropriation of expert days are shown in the following table. Table 1: Distribution of Expert Days NAME Laura Donovan Gary Asperas Monica Burns Ashar Malik Bart Smet Patrick Krause Total Working Days ED Total 12 17 12 11 16 6 74 Vietnam Desk 3 3 Kyrgyzstan Field Report Desk 6 6 Pakistan Field Report Desk 2 2 3 3 4 22 6 4 14 What Works? Social Protection of Informal Sector Employees EPOS Health Management Meth./ Quality Check/ Field Report Consolidation 1 6 6 2 1 2 6 2 6 22 16 5 2 Case Study I: Vietnam 2.1 Country Background Since implementing the Doi moi (Renewal Policy) in 1986, Vietnam has succeeded in advancing its sociosocio economic development. With sustained high economic growth over the last 25 years, Vietnam has lifted millions of people out of poverty. The poverty rate of the country was reduced impressively from 58% in 1993 to 9.45% in 2010. Per capita income rose from 220 US$ in 1994 to 1.169 US$ in 2010.3 It is no surprise that living standards ndards have been improved significantly. 2.2 The Current National Policy on Social Protection It is in this backdrop that the social protection system was set up in Vietnam. The social protection system stands on three pillars. The first pillar is composed of policies affecting the labour market, which include job training, job matching, financial assistance for job creation and labour export. The second pillar involves policies on insurance, which includes social insurance, healthcare insurance, unemployment insurance and crop insurance. The third pillar pertains to policies on social assistance, which covers cash transfers, povpo erty reduction and social services. 2.2.1 Supporting Policies on the Labour Market Social protection policies that address the labour market market target the poor, youth, workers in rural areas, workers in informal sector, redundant workers, persons with disabilities (PwD) and other vulnerable labour groups affected by socio-economic economic policies and globalization. Through several policies, the Government Governm of Vietnam (GoV) has been striving to create employment opportunities. The Vietnamese Government has paid increasing attention to training, especially vocational training, for vulnerable groups. As a result, there are over one million people of working age attending technical and professional training annually. Within the period 2006 – 2009, there were on average more than 300.000 300 rural workers participating in short-term short term and elementary vocational training, accounting for 2% of total rural youth.4 The employment mployment service system has been operating since the early 1990s. Employment introduction serse vices are being provided by both state and the private sector. By 2010, 150 employment introduction cence tres were established nationwide. These centres provide employment employment consultancy for about 603.000 jobjob seekers. From among them, about 230.000 employees are sent to work work.5 Furthermore, the GoV has been focusing on supporting migrants, particularly ethnic minorities, as they work and settle in new economic zones. 3 General Statistics Office, Statistical Hand Book of Vietnam 2010. http://www.gso.gov.vn/default.aspx?tabid=512&idmid=5&ItemID=11022 4 The Current Situation of Vietnam’s Social Welfare in 2001-2010 2001 2010 Period, Draft of Vietnam’s Strategy for Social Welfare 20112011 2020, Ministry of Labour – Invalids and Social Soc Affairs. 5 Ibid What Works? Social Protection of Informal Sector Employees EPOS Health Management 6 For PwD,, employment funds have been established to assist employment creation. In the periods of 1999 – 2004 and 2005 – 2008, there were 19.000 and 8.000 disabled people, respectively, participating in vocavoc tional training programmes. s. By 2010, among the 260 vocational training centres nationwide, there are 55 centres especially catering to disabled people. people 6 To sustain employment generation, the GoV has set up preferential credit programme programmes. Some of the credit programmess that were instituted include: those that that were set up in 62 poor districts according to Resolution No. 30a/2008/NQ-CP; CP; credits for traders in difficult settings as per Decision No. 92/2009/Qð-TTg 92/2009/Q from the Prime Minister on 8 July 2009; and, credit programs for housing among low-income low income people. The T National Target Programme on Employment issued in 2007 ties in training and job introduction to set up of preferenprefere tial credit programmess as combined approaches to promoting employment creation. In the period 2006 2009, the National Fund for Employment provided loans to 418.000 participations, annually created 250.000- 300.000 000 labourers (comprising 20% of the total employment created annually) with business genge erated through the employment creation model model.7 A significant number of the beneficiaries of this thi Fund are the poor and vulnerable groups. 2.2.2 Supporting Policies on Insurance The Government made social insurance, healthcare insurance and more recently unemployment insurance as the main cornerstones of this system. It involves participation of three parties: parties: employees, employers and the GoV, with the aim of reducing the burden on State’s budget in conformity with the fundamental principles of market economy. Social Insurance In 2006, the State issued the law on Social Insurance which is a policy milestone milestone with regard to Vietnam’s pursuit of universal social protection. This law covers compulsory social insurance (for formal sector eme ployees),, voluntary social insurance and unemployment insurance, which broadens access for workers, especially those in the informal sector, to participate in social insurance. The implementation of this law has improved the coverage of social insurance. Millions of workers have benefited under the social insurance regime, which covers sickness (time away from work due to illness), illn maternity (time away from work due to a pregnancy), pregnancy), retirement, survivors' benefits and disability. The number of people participating in social insurance has been increasing by about 400.000 people per year, from 4,8 8 million people in 2001 to 9,1 million million people in 2009, accounting for 18% of the total labour force. The revenue from compulsory social insurance has grown dramatically, up to 36,8 36 8 trillion VND (2,041 billion US$) in 2009 from 6,348 billion VND (0,431 million US$) in 2001. Total expenditure re of compulsory social insurance also increased rapidly, from from 1,856 billion VND (0,126 million US$) to about 54.9 54. trillion VND (3,045 billion US$) in 2009, of which the t state budget spending was 26.8 8 trillion VND (1,486 billion US$). Implemented since the beginning of 2008, 200 , the number of people participating into voluntary social insurance 6 “Vocational Training for the Disabled Should be Prioritized”, The Laodong Online, April 15, 2010. 7 418,000 participations loaned from the National Fund for Employment, Hanoi Moi Online, January 21, 2010, http://www.hanoimoi.com.vn/newsdetail/Chinh http://www.hanoimoi.com.vn/newsdetail/Chinh-tri/306208/418000-luot-nguoi-duoc-vay-von-tu-quy quy-quoc-gia-ve-vieclam.htm. What Works? Social Protection of Informal Sector Employees EPOS Health Management 7 is about 50.000 people, and the revenue of voluntary social insurance fund was estimated to be 69,5 billion VND (3,855 million US$) and its spending was 10,9 billion VND (0,605 million US$) in that year.8 Health Insurance The healthcare insurance system went through a series of policy amendments. Started in 1992 by the DeD cree No 299/HDBT dated 15 August 1992, and then further defined by Decree No 58/1998/ND-CP 58/1998/ND dated 13 August gust 1998 and Decree No 63/2005/ND-CP 63/2005/ND CP dated 16 May 2005, the State had set up the healthcare ini surance through community contribution with the aim of achieving social justice and humane healthcare and medical treatment, health protection and the reduction of financial burdens on households. The Law on Health Insurance finally came into effect on 1 July 2009, additionally articulating the objective of attaining universal health insurance by 2014. Participation costs 4,5% of a salary (or of the minimum wage for f nonformal sector workers. Employees pay 1,5% and employers 3%. In the voluntary scheme, participants pay the entire 4,5% unless they are subsidized by the government. The Health Insurance Law demonstrates the Government’s commitment to fund health insurance ins contributions for the poor and near poor, ethnic minority people, households living from agriculture, forestry and salt industries with medium and lower incomes and beneficiaries of social preferential treatment and social asa sistance. The number of participants in compulsory and voluntary health insurance increased sharply to 53,3 3 million people nationwide in 2009, accounting for more than 60% of total population. The compulsory scheme covers formal-sector sector workers. The voluntary scheme is composed of either the poor / near-poor near (subsidized by the GoV) or those from the informal sector who choose to enrol. 30 million of those participated via the compulsory health insurance with 20% in rural areas.9 There were 13,2% 2% of the poor participartic pating in health insurance, 93% of whom were in rural areas. Nearly 9,6% 9 6% of pupils and students are covco ered by health insurance, of which participants from rural areas account for nearly 40%. Around 11 million people participated in voluntary health insurance, of which 66,6% 66 6% are from rural areas10. Unemployment Insurance In terms of supporting workers who have lost their jobs, the unemployment insurance has been providing benefits since 1 January 2010.. According to information gathered during our interview with MOLISA, in June 2010, there were about 6,4 4 million people participating in this insurance regime. By October 2010, there were 128.000 who have received an unemployment allowance. 80% of them also received employemplo ment consultancy services. 2.2.3 Supporting Policies on Social Assistance The social assistance policies include two groups, namely regular assistance and emergency relief. Both programmess have played important roles in providing income income to vulnerable groups such as PwD elderly, children with special needs, etc. allowing allowing them some economic stability and protection from risks. 8 Vietnam Social Insurance Agency,, Report on Social insurance for the development of Socio-economic Socio economic Development Plan in 2011-2015. 9 Vietnam Social Insurance Agency. 10 Vietnam Social Insurance Agency. What Works? Social Protection of Informal Sector Employees EPOS Health Management 8 A major step to expand regular egular social assistance was the issuance of Decree No. 13/2010/ND-CP 13/2010/ND dated 27 February 2010, established with Decree No. 67/2007/ND-CP 67/2007/ND CP issued on 13 April 2007, which expanded exp social assistance to non-poor poor household members with severe disabilities who are unable to work. Later, through, amendments and supplementary articles were added to the 2007 decree, and the number of beneben ficiaries increased rapidly from 416.000 people peopl in 2005 to more than 1,25 25 million people in 2009. The assisassi tance level is adjusted to match economic growth, thereby ensuring that benefits matches rising living stansta dards.11 The number of social protection centres similarly increased.12 By December 2008, there were 571 social protection centres nation-wide wide serving about 14.613 beneficiaries. More than one third of these ese tablishments are non-state-run. Emergency relief is designed to deal with unforeseeable events that cause financial risks. Emergency relief re has been socialized and has been getting financial support from individual benefactors, mass organizations, enterprises, international organizations and Vietnamese oversees workers, which make up for the shortage of resources from the GoV budget. 2.3 The Informal Sector and Social Protection The population of Vietnam was 86.9 6.9 million of which almost 47 million are of working age. Approximately 12,3 3 million people (27% of the labour force) are working in the formal sector (public sector, registered ene terprises, semi-public public institutions, etc.). Those working in the formal sector are supposed to be covered by social insurance,, this, however, is not always the case.. case. The majority of the labour force is working in the informal sector. The informal sector is defined as farmers and workers in the agriculture sector, rural non-farm, non own-account account workers, and household businesses. In Vietnam, the informal sector is regarded as one of the pioneers in the renewal process and it has contribcontri uted significantly in the transformation from a planned economy to a market economy. The flexibility and adaptability played an important role in helping the Vietnamese economy overcome the most difficult periper ods in the early 1990s and the recent world economic recession in 2007-2008. 2007 008. The informal sector has also absorbed the redundant workers and laid-off laid off workers resulting from the economic restructure and SOEs reforms. It has created jobs and generates income for many labourers in Vietnam. It is estimated that about 33,3 million people working in informal sector, sector, and generate annually about 20% of total GDP of Vietnam.13 With this significant number, providing social protection to the informal sector had to be an essential part of the goal to attain universal coverage. Yet, only 3,7% 3 of labour forces working in the informal sector benefit from the voluntary social insurance and about 3,7% of them from the voluntary health insurance. 15,9% 15 of 11 Do Trong Huynh, Some Views on Reforming the Social Protection System in Vietnam, Vietnam, November 3, 2010, http://www.molisa.gov.vn/news/detail2/tabid/371/newsid/51857/seo/BAN-VE-CAI-CACH-HE-THONG http://www.molisa.gov.vn/news/detail2/tabid/371/newsid/51857/seo/BAN THONG-AN-SINH-XA-HOI-OVIET-NAM/language/vi-VN/Default.aspx VN/Default.aspx 12 These are the protection centers for people with severe mental disorders, disabled, elderly, etc. 13 Dong Quoc Dat, Social protection for informal sector in Vietnam: Current Situation and Recommendations. Recommendations. Journal of EcoEc nomics and Forcast, No 15 (431), August 2008. What Works? Social Protection of Informal Sector Employees EPOS Health Management 9 labour forces working in the informal sector benefit from the compulsory health scheme as their th premium is paid by the government (decided by poverty levels)14. The illustration below shows how the informal sector enters into the state social protection systems – mainly tapping into the voluntary schemes that were setup within the national social insurance and national health insurance. Figure 1: Participation of the Informal Sector to the National Programmes Ironically in terms of government policies, there is no mentioning mention of the informal economic sector as a disdi tinct group with specific needs.. Therefore, there is no official policy to support this sector. The protection of labourers in this sector goes through different pathways, and despite its capacity to do much for the informal sector, these policies have not been made specific enough to their their increase enrolment. In the interim, comco mercial insurance and mass organizations have been attempting to offer social protection to this group. The sections below identify and analyse best practices coming out from these institutions in providing social socia protection to the informal sector. 2.4 Best st Practice on Social Protection for the Informal Sector There are presently three actors involved in offering social protection15 to the Vietnamese: the government, commercial insurance and social organizations. In the the case of social protection benefiting the informal secse tor, we have identified examples from each of these three categories which deserve mentioning so that their best practices can serve as lessons. The schemes themselves might not be the answer but there are practices that can be learned from the below examples. 14 Ibid. 15 It should be noted here that – according to BMZ’s sector strategy on social protection – the term social protection includes also approaches like conditional or non-conditional non cash transfers, cash-for-work, food-for-work, work, school feeding schemes as well as social insurances. Hence, the term social protection is a broader concept than social insurance. What Works? Social Protection of Informal Sector Employees EPOS Health Management 10 2.4.1 National Social Protection Scheme Interestingly enough, in our opinion, the best practice in the domain of social protection in Vietnam would have to be the government scheme. For the formal sector, the coverage in terms of population covered is relatively wide. The voluntary scheme for the informal sector has the majority of the poor and near poor population.. To date, enrolment in the health insurance scheme has been high and this high health care outreach can – potentially – be replicated for social insurance. Features of the national programmes are sumsu marised in the following table. Table 2: Main Features of the National Social Protection Schemes Social Insurance No. of Insurees Health Insurance Compulsory Voluntary Compulsory Voluntary 9.05M 50T 30M 23.3M Outreach Urban and rural Urban and rural 20% in rural 66.6% in rural Elgibility Formal workers Informal Formal workers Informal workers, students Monthly Premium 7,84 US$ (22% of min. wage) 6,41 US$ (18% of min. wage) 1,60 US$ (4.5% of min. wage) 1,60 US$ (4.5% of min. wage) Benefit package Sickness; matermate nity; labour acciacc dent/ occupaational disease; retirement; survisurv vorship allowwance Retirement; suvivorship allowance Outpatient: 100% medical cost if under 4,88 US$, 80% if over; Inpatient: 80% but not exceeding 976,80 US$ Outpatient: 100% medical cost if under 4,88 US$, 80% if over; Inpatient: 80% but not exceeding 976,80 US$ The GoV is already making considerable progress in embarking on universal coverage with social protecprote tion. It claims to have reached 60% of the population with its National Health Insurance, although efforts have been much more modest with its social insurance. Dissemination Dissemination of the two programmes program is most effective for the formal sector with the compulsory scheme – essentially obligating employers to register and pay a share of their employees’ insurance premiums. This is enforced following the Labour Code and Social Soci Insurance Law. In the case of the National Health Insurance, the Government is aggressive on subsidising premiums of the poor. Similarly, the poor are targeted under the national targeted program on poverty rer duction. The middle segment, the informal sector, sector, which is a significant part of the population estimated to be between 75% - 80% of the population, population 16 is expected to participate with the voluntary scheme. Both in terms of coverage and potential enforceability, the national programme is best able to provide social protection to the informal sector,, especially if many of the workers become eligible for the compulsory 16 Although there is no official accounting regarding the informal sector, sec the 75-80% 80% figures were repeated by different governgover ment ministries. What Works? Social Protection of Informal Sector Employees EPOS Health Management 11 scheme.. This is primarily for two reasons. First, the national schemes are set-up set up for country-wide country coverage, which means resources and logistics are invested so that the government will not just be able to attain its membership target but also provide the corresponding benefits. Even though the informal sector coverage is today proportionally small compared to other target groups, the number of informal sector members in the national scheme is still considerable when compared to any community insurance schemes (which remain very local).. Second, because of their membership base, the national programmes program s are potentially more fif nancially viable. They have the potential to reach a scale that effectively distribute financial risks as against small risk pools that are prone to adverse selection, epidemiological risks, and the like. The premium sharing that the government is implementing implementing for voluntary membership in the national health insurance scheme (and later potentially in the social insurance scheme17) is particularly notable in removing disincentives for low-income income individuals to participate and in reducing adverse selection. The government pays 100% of the premium for the poor and 50% for the near-poor. near Premiums are determined as a percentpercen age of the national minimum wage. In early 2011, the government strongly raised the ceiling of the income levels of the categories of the poor and near-poor. poor. The number of new beneficiaries of the health insurance scheme (and other social assisassi tance) is not yet known but it is expected that there will be an increase over the 10 million presently benefitbenefi ting from the programme.. The new ceilings underline underline the GoV’s efforts to assist the poor in accessing risk protection. Table 3: Income Levels (monthly) Receiving Government Benefits Urban Rural Earlier System (income ceiling) 260.000 VND (12,64 US$) 200.000 VND (9,72 US$) 2011-15 Poor 500.000 VND (24,30 US$) 400.000 VND (19,44 US$) 501.000 – 650.000 VND (24,35 – 31,59 US$) 401.000 – 520.000 VND (19,49 US$ - 25,27 US$) 2011-15 Near Poor Likewise, in what was perhaps a response to the financial crisis with the realisation reali ation that a significant si number of formal sector workers could be moving to the informal sector, VSS (Vietnam Social Security, the govgo ernment body managing social insurance) instituted a system that allows members to move easily from the compulsory scheme to the voluntary voluntary scheme and vice versa. This allows workers who have lost their insurinsu ance privileges as a consequence of contract termination to hold onto their insurance policies under the voluntary scheme without losing their years of contribution for a pension and survivor’s vivor’s benefits. Voluntary members can move to the compulsory scheme just as easily. The programmes program s have also been adapted for members who have to move residences for economic reasons. The policies have been made portable such 17 We will see below that the existing voluntary social insurance product is not very enticing, which explains low membership. What Works? Social Protection of Informal Sector Employees EPOS Health Management 12 that members can continue with th their payments and file for claims at places other than the one of initial regre istration. Movement across the two schemes has real consequences in terms of benefit entitlements under the social insurance programme.. In the voluntary scheme, members are only only entitled to two out of the five staple benefits under the compulsory scheme, namely, survivorship allowance and retirement pension. However, this did not stop an estimated 30,000 members who continued with their membership under the voluntary scheme. Regardless of present shortfalls, what has to be noted is that the ease of movement offered to members is a system that adapts to the nature of employment in Vietnam. Vietnam The structure serves as a good base not only in evolving targeted insurance packages but also also in developing mechanisms that makes it convenient for all segments of the informal sector to participate. Finally, itt needs to be noted that currently there is intermixing of funds between the social insurance and the health insurance because contributions are kept in one pool. pool The VSS even reported that the social insurance fund cross-finances finances health insurance claims since the latter has been experiencing an increase in utilisation. Although this practice prevents defaults in reimbursements forr the health insurance, insurance it actually exposes the social insurance in the long run when claims pick up in the future. The VSS realises this risk but do not have concrete plan on how to separate the funds. 2.4.2 Commercial Insurance Though the private sector has experimented experimented with microinsurance, we were not able to identify many schemes that offer good examples of social protection. In lieu of government schemes, commercial micromicr insurance can be a successful means of offering risk protection to the poor. Microinsurance Microinsur is “a means of protecting low-income income households against specific risks in exchange for a regular payment of premiums whose amount is proportional to the likelihood and cost of the relevant risk.”18 The Ministry of Finance (MoF) has had the issue of the regulation of microinsurance on the table for at least two years. In 2008, top officials from the Ministry of Finance (MOF) and Bao Viet, Viet one of the country’s larglar est insurers, travelled to India to learn from what has been set up by the IRDA, the Indian regulatory body for insurance. However, there is no recent news of the status of regulating microinsurance. Bao Viet offers a credit life product but the number of persons enrolled is small and according to the Deputy General Manager, Health & Personal Accident Accident Insurance Department, there is little drive within the organiorgan zation to expand the program: top op management has yet to be convinced of the financial interest in developdevelo ing the micro-market. market. Drivers have been non-financial non and related to CSR (Corporate Social Responsibility) work: the importance of image and the desire to be seen involved in a social activity. 18 Micro Insurance Network. (n.d.) Microinsurance in Keywords. Retrieved 26 March 2010 http://www.microinsurancenetwork.org/keywords.php What Works? Social Protection of Informal Sector Employees EPOS Health Management 13 However, we did find two very interesting microinsurance programs being run with the assistance of the ILO. The ILO is supporting two insurers, ManuLife ManuLife and Aviation, which needed assistance in strengthening their products and outreach. ManuLife works with the National Women’s Union to offer a credit life product. They have sought the supsu port of the ILO to improve the product and understand the low renewal rates. In the last nine months, ManuLlife has expanded to nine provinces. They have clarified the workflow between the insurer and the women’s organization via defined roles that use the strengths of each entity; for example, the Women’s UnU ion has good social marketing skills. The result has been 100.000 100 clients. Aviation Insurance Co works with a local MFI (microfinance institution) to offer a health insurance product which is complementary to the government scheme. The premium is very low (7.200 (7 200 VND or 0,35 US$ / month) and the maximum benefit package is 15 million VND (729 US$) per event.. They are trying to imi prove their communication to clients so as to boost sales. The ILO has also devoted many resources to a capacity-building component. There e are 18 resource traintrai ers that can work with other mass organizations to market microinsurance. They are pushing to show micromicr insurance as a means to address risk. The importance of financial education has been demonstrated. As a best practice, the ILO hass shown the benefits of the partner-agent partner agent model with clear roles in the work flow (processes conform to commercial insurance standards) and the use of the social marketing skills of mass organizations to offer viable risk protection to the poor. Capacity building uilding is also a necessary element. Moreover, with private insurance absorbing the risk, the system is more financially viable. Nonetheless,, total outreach remains low, especially outside credit life, a product that is designed to protect a loan more than an individual. As a long-term long term solution to offering social protection, commercial insurance seems less viable than the government schemes. 2.4.3 Non-profit Organisations In addition to non-profit profit organisations working with commercial insurers to offer microinsurance, microinsu there are a few examples in Vietnam of these entities developing their own form of social insurance. These organizaorganiz tions have no third-party party risk transfer and generally contend with the issue of financial viability. We identified different types of schemes from three organizations. Several interesting practices need to be noted. Community Finance Resource Centre The Community Finance Resource Centre (CFRC) provides TA to 15 microfinance institutions (MFIs), with a total membership of 30.000.. The MFIs provide mainly savings and loan products to women (99% of MFI membership), bership), who are mostly middle-aged middle and long-standing standing members (for about 15 years); they are prepr dominantly engaged in agriculture. The TA provided focuses on the design of the operation systems, sys the capacity building of staff and the education of clients. CFRC also supports the transformation into formal micro-finance institutions. What Works? Social Protection of Informal Sector Employees EPOS Health Management 14 More recently, CFRC has begun managing a mutual benefit fund which supports 16.000 16 contributors by providing credit edit life and basic life protection. The life product has a premium of 3.000 3 000 VND (0,15 US$) / month for a pay-out out that varies with time of membership. The product has the following features: Return of payment for less than 6 months VND 300.000 (14,65 US$) $) for 6-12 months VND 1.000.000 (48,84 US$) for more than 12 months The policy covers spouse and two children Hospitalization and Personal Accident benefits for members only We were able to identify several best practices in relation to the microinsurance programme program in the operations of CFRC: Client education includes basic risk management, household budgeting and insurance concepts, ideas that are new to the rural members and essential; Cluster meetings19 are held twice a month; meetings are used to inform clients about claims and fund utilization; Meetings are also venues to gather feedback from members about the benefit package; Recognised ed women village leaders are appointed as cluster leaders; assemblies assembl are held at community learning centres which further reinforces trust in the system; Claims are processed during meetings; MFIs advance benefit payments in case of emergency; The concept of solidarity and mutual benefit is shared among members which discourages adverse selection and abuse (since the members can better identify fraud in the group and since members are less likely to cheat each other); other) There is a strict separation of funds from microfinance and microinsurance (as required by law); Since ce members are in mountain areas and are usually beneficiaries of subsidies from the state, ini surance complements benefits (health) provided by social system. The next step planned by CFRC is to establish a mutual insurance company. They are hoping to offer off retirement insurance and are working on a new business plan with new pricing and benefits. They will need to raise the required capital. TYM Due to the lack of availability of Vietnam Women’s Union management, we were unable to meet with the NGO. However, r, the organization and the TYM Fund are well-known well known examples of successful community-run community microinsurance. oinsurance. TYM (which means ‘I Love L You’ in Vietnamese) strives to provide financial and nonnon financial services to groups of poor women and is one of Vietnam’s largest largest MFI. In August 2010, it received 19 A cluster is a group of self-help help groups (SHGs) What Works? Social Protection of Informal Sector Employees EPOS Health Management 15 its formal MFI operating license from the State Bank of Vietnam. The MFI began a Mutual Assistance Fund in 1996. It should rightly be considered among the best practices in the non-profit non profit as a pioneer in much of sociall insurance, for which reason we cite the name. Social Risk Fund The GIZ Vietnam Poverty Reduction Project supports the piloting of a Social Risk Fund, a community-based community model of risk protection. The fund is managed by local authorities in four communes and an today there are 2.000 members. The households contribute based on the number of members: up to five members costs 30.000 30 VND (1,46 US$) per household per year (or 36.000 36 VND/ 1,75 US$ if paid in two instalments). Households above five members pay 40.000 VND (1,94 US$) per household per year (or 44,000 VND/ 2,14 US$ if paid in two instalments).20 The commune also contributes based on the numbers of households in the commune. Communes with less than 1.000 000 households pay 10 million VND (486,15 US$) and communes nes with less than 1.500 1 households contribute 15 million VND (729.22 US$). US$) Benefits include 1 million VND (48,61 US$) for the death of a family member earning substantial revenue. Other benefits and best practices have been identified: Fund is managed locally cally in line with decentralization; Family shocks which are covered include those most likely to move families into poverty and debt (death of breadwinner, health problems); The scheme is voluntary – families must understand the product (and by extension extensio risk management) in order to be convinced to enrol; The commune also supports the fund financially via the local People’s Committee budget; The health protection is complementary to the government scheme. 2.5 Conclusion and Recommendations for Improved Social Protection in Vietnam Social protection for the informal sector remains very limited in Vietnam. However, the government schemes offer potential to scale up operations and reach a larger percentage of the population. Best PracPra tices from the other providers oviders offer ideas for the national programme: program Focus on capacity building; Use of local networks for efficiency and trust (cf. 2.5.4 below); Use of local governments to support roll-out roll and possibly subsidize (as done with the Social Risk Fund). 20 The prices in Euros are approximately 1.05 / 1.25 and 1.40 / 1.50 Euros. What Works? Social Protection of Informal Sector Employees EPOS Health Management 16 We have chosen to focus our five recommendations on the government social protection schemes. In our opinion, it would be most beneficial to the informal sector to be able to access the national programme program – voluntary or compulsory. The schemes are relatively new but there is real potential for moving toward uniun versal coverage. However, to make the schemes more beneficial to the informal sector, we suggest the folfo lowing five areas of action: Focus energy on formalising the informal sector; Develop a targeted approach ach to integrating the informal market; Improve the social insurance product in the voluntary scheme; Assist the VSS in product distribution and data management; and, Improve risk management skills (and secure financial viability). 2.5.1 Focus Energy on Formalising ising the Informal Sector The most efficient and cost-effective effective social protection scheme is the compulsory version. However, what makes it of interest is that a large proportion of the cost is paid by the employer. In the case of the poor, the health insurance ance is subsidized by the state (100% for the very poor; 50% for the near poor). The informal sector, the majority of the population, falls between the cracks. What in fact the government could start doing is to ‘squeeze’ the informal sector from both sides sid so that those in this category are slowly but surely moved to either the formal sector or to assistance from the govgo ernment.. As illustrated below, it would mean approaching the coverage of the informal sector at two ends: enforced registration of employment, ment, which gives the government leverage to impose provision of insurance benefits under the compulsory scheme, and offering subsidies, which offers incentive for individuals to enrol under the voluntary system. Figure 2: ‘Squeezing’ the Informal Sector with Compulsory and Voluntary Schemes Compulsory System Formalise through registration Voluntary System Small entrepreneurs Contractual workers Uninsured Seasonal workers Street vendors Employees of small businesses Subsidise insurance premiums Small farmers Farmers Informal Sector There are a number of reasons why this approach might be appropriate for Vietnam. First, the formal secse tor: registration has been a common practice from the national down to the level of the communes. AccordAccor ing to a representative of the World Bank, the government is discussing the use of a national ID, perhaps in the form of a tax ID. Thus, there would be an existing platform, which could be optimised and used to idenide tify and classify assify the informal sector and divide them between compulsory and voluntary schemes. What Works? Social Protection of Informal Sector Employees EPOS Health Management 17 Research21 has shown that there is a high number of workers in formal settings who do not benefit from the compulsory scheme as required by law. Workers are reticent to speak speak up for fear of losing their jobs. MoLISA acknowledged that the lack of compliance by companies is a problem for the ministry because there is no clear body to enforce payment to the VSS. To date, the government has failed to impose a strict adherence to to the scheme. According to Oxfam, this could be due to a fear of a return to the financial crisis or the decision of foreign companies to buy products elsewhere. However, according to ILLSA, foreign companies comply at almost 100%. The non-compliance non is among ong Vietnamese companies (who might export and fear the higher costs would lower their competicompet tiveness). out pocket payment is in efe Secondly, subsidizing the poor informal sector is more distributive since full out-of-pocket fect required from the segment of the informal info sector that has a lower ability to pay. The national health ini surance program has already started with this approach and it is proving successful. A targeted approach to subsidizing the poor for the voluntary scheme in social insurance could be set up. up It would be in the govgo ernment’s interest to promote self--financing financing of pensions (even when partially subsidized) rather than be exe pected to pay all pensions 20 years down the road. If targeting of eligible beneficiaries for premium subsidy is done properly, properly, workers in insecure employment contracts and those with seasonal employment would be able to sustain their insurance coverage without the burden of taking on the employer’s counterpart.22 Similarly, premium sharing makes participation in the insurance programs ograms financially accessible to individuals engaged in micro-enterprises micro enterprises such as street venve dors and small retailers. Already, the government is extending partial to full subsidies (for health insurance coverage) to the so-called near-poor, poor, which is presumably presumably the segment of the population vulnerable to falfa ling into poverty when faced with financial strain. Financing options are being looked at to broaden subsisubs dies so that this could be carried over to the social insurance program and also extended to include inclu low income entrepreneurs and irregular wage earners. Finally, not the entire informal sector is poor. In a study by Tran, et al.23 that profiled individuals in the inforinfo mal sector who are uninsured, it was found that 80% of them have an income (at very much varying levels). A targeted approach, developed below, would separate those who are in need of subsidy and those who can be ‘motivated’ to join. Needless to say, incentives will have to be given accordingly to enterprises for registering their employees employe and providing counterpart payments to insurance premiums to motivate compliance. Likewise, financial ini centives will be needed to push the informal workers to enrol. However, the benefits, if not immediate, are tangible. The use of a voluntary scheme is riddled with problems related to adverse selection. Only those who need protection actually choose to join – as a result of which the program is less likely to be viable. 21 “Quality of Private Enterprises in Vietnam”, Vietna Le Duy Binh, UNDP – Government Taskforce for the Implementation of the EnterEnte prise Law, December 2009 22 Since the employer contributes to the compulsory scheme, the formal worker only pays a small percentage. In the voluntary scheme, workers pay the entire ire premium. 23 Tran Mai Oanh, et al. ‘The Case of the Workers of the Informal Sector.’ UNDP Policy Research Study. December 2010. What Works? Social Protection of Informal Sector Employees EPOS Health Management 18 According to VSS, this is already an issue for the health insurance scheme: there are are presently three million people in the voluntary health scheme but they use more than they pay. To balance the adverse selection, the percentage of healthy enrolees must rise. This will also be the case for pensions if the informal sector expects the government to cover er their pension in the future – they must be pushed to fund their own retireretir ment needs. The more successful the government is in attaining these ends, the better able it is to ‘squeeze’ the number of uninsured individuals in the informal sector. sector. Understandably, the limiting factors for these would be the viability of local enterprises, on the one hand, and the government’s fiscal space, on the other. Concerted support from the donor sector could be of real assistance. 2.5.2 Develop a Targeted Approach Approa to Integrating the Informal Market To date, the government has no formal definition of the informal sector. Officially, the informal sector does not actually exist, despite its size, and there are no policies that have been developed to address this population.. As a result, there is no structured approach to integrating the segment. The VSS uses as a reference point “all not covered by formal sector scheme.” Before any successful campaign can be undertaken to promote the government schemes, a segmented approach must be set up. The informal sector covers individuals from both urban and rural setting and ini come-wise, ranges from middle income to poor. Consequently, the means to convince the respective segment to join the voluntary scheme will need to vary. A one-size-fits-all campaign is unlikely to work. Below, we propose a simple breakdown of the informal sector into six different categories. Table 4: Informal Sector Segmentation Informal Sector Segment Small enterprise (with less than 10 employees) Income / Geographical Classification Middle income Urban and Rural Low-income income to near poor Street vendors Urban Potential Approach to Reach Segment Department of Employment can strongly rer quire businesses to register employees and therefore obligates their enrolment; incenince tives will be needed Registration of all vendors (with no restricrestri tions for migrants); subsidized premiums Middle-income to near poor Middle (varies greatly) Rural VSS relies on resident registration at comco munes in reaching out to farmers; targeted subsidies based on income Underemployed (working part-time, redundant workers, etc.) or Unregistered workers Low-income income Aggressive enforcement of enrolment of workers by companies; need for a specific agency to take the lead in monitoring; tarta geted marketing with subsidies Seasonal workers (mainly farmers who take employment occasionally) Low income *New entrants to the labour Varies Farmers Urban workers Rural migrants To be cross-registered registered with farmers so as to assure that there are no double subsidies Government implements complementary What Works? Social Protection of Informal Sector Employees EPOS Health Management 19 Informal Sector Segment Income / Geographical Classification force Urban Potential Approach to Reach Segment programs to provide employment to new graduates (e.g. skills training, job placement, etc.); insurance is not available until the time that new graduates find work The informal sector is too large and too heterogeneous, both geographically and financially to be targeted with a single approach. 2.5.3 Improve the Social Insurance Product The government is set to make the voluntary system the platform for individuals who do not have h legal entitlements for social protection under employment contracts. However, even if the informal market is segse mented, it will still be difficult to promote the existing social insurance product. There are several product characteristics that require a second look: Benefits The voluntary scheme does not offer the same protection as the compulsory scheme as only pension and survivorship are benefits. The compulsory scheme offers work-related work related coverage such as illness, disability and maternity (salary losss is covered). covered) The lack of short-term benefits (e.g. coverage of salary loss during illness and maternity) will make it hard to convince people of the interest of buying into the scheme. Price – Benefits Ratio Under the Labour Code and Social Insurance Law, Law, insurance premiums of individuals who are gainfully employed will be split between employers and employees on a set percentage. None such entitlement exe ists with the voluntary scheme, where membership premiums are, in principle, borne by enrolees. To illusil trate, a registered worker on minimum wage will only need to pay 6% of his salary for social insurance and 1,5% 5% for health insurance. With voluntary enrolment, a minimum wage earner has to shoulder the full amount of 18% for social insurance and 4,5% 4 for health insurance. Pricing Since the premium for the voluntary schemes is computed on the basis of the national minimum wage, the same amount is imposed on voluntary members regardless of income (131.400 VND or 6,41 US$ /month for social insurance and 32,850 ,850 VND or 1,60 US$ /month for health insurance). For those whose income is lower than minimum wage, the price becomes demotivating. Admittedly, VSS believes that the benefit package, particularly for the social insurance, could be made more responsive to the needs of the informal sector. With its current offer, the benefits of the social so insurance package are too far in the future for individuals to see the value. Revision of the insurance package should be attractive enough that members participating in the compulsory scheme view uninterrupted membership even in the voluntary scheme as a sensible financial decision. decision What Works? Social Protection of Informal Sector Employees EPOS Health Management 20 2.5.4 Assist the VSS in Product Distribution and Data Management To tackle the above points, efforts will need to be made at VSS to be able to carry carry out the recommendarecommend tions. We have identified at least four areas that need be addressed: Strengthened administration to improve public image and trust Among the agencies interviewed from both government and development partner agencies, there is a conco sensus that the insurance programmes program s suffer from a lack of public trust. Specifically, they claim that the public is anxious about the government’s capacity to deliver services when it becomes necessary. The VSS therefore has to contend with its public image image of inefficiency, which is an unfortunate legacy of government institutions in Vietnam. Moreover, there are apparently concerns about the government’s credibility in manma aging the programmes’ funds. VSS claims to be undertaking measures to have its processes proces more client-oriented. oriented. One concrete measure is to extend its office time until Saturday to accommodate the programmes’ program s’ claim load. The World Bank is assisting the VSS in digitising its database and computerising computerising business operations with the aim of speedspee ing-up up process times and insulating the system from errors and fraud. Although the results of these measmea ures are still far from influencing a change in public perception, it is a step in the right direction when programmes’ s’ process modifications focus on improving improving client satisfaction. What will be further needed are opo erational targets that have been consensually set and committed to by VSS’ departments. Improved use of grassroots agents VSS reportss to have a staff network of 16.000 16. people, which is dispersed ed to the districts and even some communes. This allows clients to have first-person first person contact with the VSS, which is especially valued in vilvi lage settings. The VSS also reports to using community leaders as its agents (paid on an incentive basis). basis) According to the VSS, tapping apping grassroots social networks has proven prove effective in building public trust ala though this often relies (sometimes precariously) on personal reputation. Membership uptake is usually obo served to be high when endorsement of insurance programmes program s is done by reputable village leaders. It is not known though if VSS capitalizes sufficiently on its network of staff and agents for programme program promotion and marketing. It is one of VSS’ available resources which could be optimised ed to expand programme program coverage, benefitting mainly groups in the informal sector. Involvement of community organizations Community insurance schemes are often associated with local mass organisations, ations, such as women’s unu ions.24 This makes for another reason why community schemes are are successful in drawing in considerable percentage e of the population in an area.25 Approaching mass organizations, like women’s union, cooperacooper tives, farmers’ union, as well as associations of street vendors, taxi drivers and the like has merit because it is an efficient way of marketing with sizeable return and it shields the insurance system from adverse selecsele 24 25 Mass organisations are usually well-organised organised and structured entities that the target a specific membership (women, youth, farmers). Although not formally a government body, they are paid by the government and support government policies. The present disadvantage of how mass organizations are being used is related to the limited use of their capacity: commercial insurers have not expanded operations and the VSS has not exploited all of the potential. A a result, numbers are still small. small What Works? Social Protection of Informal Sector Employees EPOS Health Management 21 tion. It would also be a means of working at the household level to build awareness and stimulate buy-in. It would be of interest for VSS to look at how how community insurance schemes engage with mass organizations, specifically what roles are agreed with them that count as intermediation. Another meaningful way for other community organisations organis (NGOs, MFIs, civil society organisations) to contribute to the e expansion of the social protection schemes is with their knowledge of financial education. Studies on microinsurance point to financial literacy as one of the determinants of membership uptake. This underscores the need for insurance education to encourage encoura participation. Among the organisations organis interviewed that support community schemes, insurance education is said to be an essential activity. In fact, they have dedicated staff equipped with learning modules and materials who are mobilised to train intermeinterm diaries once they decide on expanding their programme program to include insurance products. These schemes have good enrolment rates even when their clients are mostly from the low-income low income bracket; bracket for example, ManuLife has over 100,000 clients. clients The education programme me includes the familiarisation familiarisation of clients with the principles of risk-pooling risk and often builds on the concept of social solidarity. With high value placed on solidarity, communities are more likely to subscribe to a formalised ed form of risk-sharing risk thatt protects them from financial shocks during personal catastrophes. We were told that in educating groups about insurance processes, trainers highlight the imi portance of guarding against breach in mutual trust and responsibility. By and large, these schemes scheme are mutual associations that count heavily on existing societal bonds and controls. Although their operations could be mostly considered parochial,, community schemes offer practical lessons in educating members about insurance and, in a way, improving financial financial literacy using popular media. It is to be expected that instructional materials used by community organizations are in a language that is unu derstood and in the context that resonates with ordinary Vietnamese. Vietnamese. Furthermore, these organisations organis are in a better position to give recommendations about a suitable media that would have substantial reach. Considering that the national programmes program s have to take on social marketing at some point, VSS should start by looking at communication strategies ategies employed by b mass organisations. An improved communications scheme As just seen, the promotion of voluntary enrolment in insurance programmes program s is a considerable marketing exercise. It is important to note that when Vietnam established the voluntary insurance systems, there apa pears to have been no accompanying marketing campaign to encourage participation. This failure might be due to VSS’ limited capacity to launch extensive marketing campaigns. campaign MOLISA recognises the need to increase use of media as a way to communicate the schemes. As seen with the market differentiation proposed above, the campaign should be adapted to key characteristics of the target groups. Any marketing scheme would need to emphasise emphasi both product characteristics and enrolment/claims enrolment procedures. The programme would need a simple deal to sign up without any of the usual bureaucratic strucstru tures. Financial transactions should be made easy and transparent. Enrolment should come to the villages What Works? Social Protection of Informal Sector Employees EPOS Health Management 22 and be clearly understandable able to all. The reason to enrol should focus as much on the individual’s advanadva tages as on the national benefits. 2.5.5 Improve Risk Management Skills The concept of “risk” is new to the discussion in Vietnam where to date the focus has been on building ini frastructure. The National Communist Party’s next 10-year year plan makes no mention of risk and, for example, only slightly addresses climate change. MultiMulti and/or bilateral lateral organizations will need to assist the governgover ment in integrating risk management into its expansion e of social protection. Currently, according ccording to the World Bank interview, interview, there are no basic safety nets in place that can kick in in times of shock (although the Government regularly intervenes with stimulus packages in times of crises). crises) In other words, there are currently no financial instruments available to help poor households respond to cricr ses such as price increases and lay-offs. lay offs. Moreover, the risk management culture remains undeveloped. The voluntary scheme, especially if revamped with more short-term term benefits, would begin to fill this gap for safety nets. But promoting social and health insurance will require an exposure to risk management and its importance in planning for the future (saving for retirement, having protection in case of illness, illn theft, crop failure, etc.). 2.6 Final Thoughts MoLISA LISA spoke of future plans for the voluntary scheme and it foresees a revision of the product in the next five years as well as a revision of its implementation. In the opinion of the Director General of Social So Insurance, an evaluation of the scheme (both policy and implementation) is needed as is the need for conducting market surveys (the last time was 10 years ago). However appropriate these steps are, in our opinion, the work should begin sooner rather than han later. Any campaigns to promote the scheme should be with the best possible products and targeted campaign. VSS is interested in increasing coverage to the informal sector and recognizes the need for a good commucomm nication program. More importantly, the director of VSS acknowledges that as VSS goes forward there is a need to work like a company and not like bureaucrats. This would integrate most of the recommendations from above. Finally, we would need to note that the programmes, as they stand, are gender-blind gende blind and do not segregate women beneficiaries both in terms of target and keeping track of their participation. It is generally accepted that direct interventions that target women do well in contributing to some gains in poverty reduction. AdmitAdmi tedly, the voluntary schemes intend to target small vendors, who are traditionally women. But this initiative is lumped with all the others as the general approach to promote the voluntary programmes. This need to be considered in planning by the MoLISA. What Works? Social Protection of Informal Sector Employees EPOS Health Management 23 3 Case Study II:: Kyrgyzstan 3.1 Country Background Kyrgyzstan, a former Republic public of the Soviet Union, became independent on August 31, 1991. It is a landlan locked country in central Asia and has a continental climate that is characterized by extreme winters and summers. The population is 5.508 508.626 with a density of 28,7 people ple per square kilometre. kilometre Bishkek, being the capital, is the commercial centre and the largest city. It has a population of 837.000. 000. 36,6% 36 of the population lives in urban areas. Kyrgyzstan yzstan is officially officiall bilingual with 64,7% 7% of the population speaking Kyrgyz and 12,5% of them speak Russian. Kyrgyzstan is ranked 120 of 182 in the 2009 UNDP HDI. Poverty is widespread: 51,9% 51 of the population living on less than 2 US$ a day, the per capita income is 872 US$ (IMF estimate for 2009). Life expectancy in Kyrgyzstan is 69,7 years; the infant mortality rate is 30,3 30 per 1.000 live births; and the maternal mortality rate is 150 per 100.000 000 live births. births Kyrgyzstan has a young population with 29,4% 4% under the age of 15 years. The Kyrgyz economy was severely affected by the collapse of the Soviet Union and the resulting loss of o its vast market. Before 1990, a hefty 98% of Kyrgyz exports were going to parts of the Soviet So Union. As factories and state farms collapsed with the disappearance of traditional markets in the former Soviet Union, Union Kyrgyzstan's 's economic performance in the early 1990s was worse than any other former Soviet republic except war-torn torn Armenia, Azerbaijan and Tajikistan. Tajiki Poverty is especially pronounced among rural populations (almost three-quarters three quarters of the poor live in the rural and mountainous regions) and is aggravated by ineffective governance and corruption. Moreover, access to basic public services such as running water, public sewerage, health and education education has deteriorated over ov the past decade (European Training Foundation, 2009). While economic performance has improved conco siderably in the last few years, and particularly since 1998, difficulties remain in securing adequate fiscal revenues and providing iding an adequate adequa social safety net. Following the global economic crisis in 2008, the country ntry received external aid, which is unprecedented in the country’s history in terms of scale. Support came in the form of grants and soft loans from the UN, IMF, WB, B, ADB, the EC and Russia. In 2009, 2009 Kyrgyzstan received more than 100 million US$ from the IMF, 150 million US$ from Russia for budget support, sup and soft loans totalling to 300 million US$ for economic development. The volume of the Kyrgyz external debt has skyrocketed, exceeding 2,5 5 billion billi US$ at the end of 2009. 3.2 The Current National Policy on Social Protection 3.2.1 The Social Protection Strategy for 2006-2008 2006 In 2006, the Kyrgyz government adopted the Social Protection Strategy for 2006-2008 2008. The strategy paper lays out specific short- and medium-term medium term reform objectives that emphasize effectiveness in providing social protection to the vulnerable population. It intends to refine targeting of beneficiaries, put a stop to monetisamonetis What Works? Social Protection of Informal Sector Employees EPOS Health Management 24 tion of utility benefits and handing out of privileges, reinforce labour market policies to promote entrepreentrepr neurship and independent job creation and expand the scope of social services for the elderly, disabled and children and families at risk (WB, 2009). 3.2.2 The Country Development Strategy/Poverty Strategy/Poverty Reduction Strategy Paper (CDS/PRSP) 2007-2010 2007 Meanwhile, the priority within the CDS/PRSP 2007-2010 2007 for the period up to 2010 aimed at providing social protection to people in need, who are identified as the poor, children and families in crisis cri situation, invalids, living alone and elderly people. The CDS was updated in 2009 (CDS Update 2009-2011) 2011) to adjust national policies and outline an ‘action plan’ to improve social protection as well as labour market problems. It aims at increasing the size of state pensions and allowances; improving targeting of the state support; reforming and development of the system of social service; and ensuring financial sustainability of the pension system that assumes improvement of insurance payments collection, collection, optimization of insurance tariffs, improvement of insurance coverage of labour migrants, introduction of funded elements in the pension system. 3.2.3 The New Social Policy A new social policy is being developed. Chaired by the Ministry of Social Protection Protection,26 a working group has been established, consisting of all relevant ministries, development partners partners,27 civil society. It is expected that the draft policy will be ready by October 2011. 3.3 The Informal Sector and Social Protection The informal economy in Kyrgyz Republic in 2004/05 was estimated to be between 40 and 53.6% of GDP. According to ILO sources, 77% of all employment is in the informal sector. Literature provides a diverse array of definitions and categories of the informal economy. In this report, we focus cus on those sectors that were raised during the interviews. In general, informal informal can refer to those not registered or registered but under--reporting reporting profits. The informal sector are said to be engaged in the followfollo ing economic activities. Agriculture Farmers ers make up approximately 55% of the population and one third of the registered contributors (to the Pension Fund). Their contributions, however, make up less than 1% of the beneficiary population and aba sorb close to 60% of the pension expenditures (WB, 2009) 20 Farmers are registered, based on the land they possess (land tax), as they became landholders after indeind pendence. Tax tariff is very low (60 Som S or 1,33 US$/year), /year), yet even this is difficult to collect. The annual Social Insurance fund (SIF) revenue should sh have been 250 million Som om (5,52 million US$), US$) but only half of that amount is collected,, of which only 1% of all social insurance contributions are from farmers (source: SIF). 26 Until ntil 2010, social welfare was under the Ministry of Labour, but then became an independent ministry. Early 2010, in a reshufreshu fle of the government, the Ministry of Social Welfare was ‘degraded’ to ‘State Agency. In January 2011, it was re-instated re as ‘Ministry of Social Protection. 27 GIZ, through its social protection programme headed by Mr. Alfredas Zabieta,, is member of this working group. What Works? Social Protection of Informal Sector Employees EPOS Health Management 25 Most farmers are ‘self-employed’, employed’, but cooperatives exist. For cooperatives the contribution rate is set 27%, of total payroll, but this will be reduced to 15% in the near future. Also more simplified procedures are planned in order to allow farmers to get easier access to loans and technical assistance from the government. Farmerss get lowest pension in the country – the idea behind is that they pay less, thus receive less. Plans exist to increase the social insurance contribution, in order to get them a higher pension. Textile industry The textile sector is important, but very heterogeneous. It ranges from single households to large enterente prises, but overall, most pay no or few taxes or social security contributions, making it one of the ‘biggest’ informal economies in Kyrgyzstan. Until 5 years ago an estimated 100-300.000 100 people were active in the textile sector, but current estimates are lower: about 100.000 people in total, of which 60,000 are female sewers and 40.000 are involved in the supply system (source: tax consultant). The Tax Office recently conducted survey on SMEs, including including street markets, textile entrepreneurs and taxi drivers. It revealed that, in the textile sector, 90% of the enterprises with 15-50 15 50 employees are not registered. Hence, these companies do not pay taxes and social contributions28. Because of the volume, me, the textile industry is one of the economic sectors targeted by the government. A new regulation for the textile sector is being discussed in the Parliament. The new regulation will temporarily decrease the current contribution rate of 27% to 5,25% 5 - to be increased again to 27% % by 2020. Hence, the following nine years are a sort of ‘grace period’ to allow textile workers to be officially registered at lower rates. Essential is to set up a campaign to inform people about the new law. Plans to do so exist, exis in cooperation with the Association of Textile Workers, the Tax State Committee, and the Social Insurance fund (SIF). ( Migrant workers Migration is a very prominent face of Kyrgyzstan’s informal labour economy,, both international and national. International migration: According ccording to the Kyrgyz government, 12% of the population works overseas – often in Russia and Kazakhstan. According to Russia's Uralsib investment bank, around 800.000 800 Kyrgyz migrant workers are in Russia, making up 40% of the Central Asian state's GDP. While other estimates are lower (e.g. SIF: puts the figure at 400.000 people in labour migration, mostly in Russia and Kazakhstan), there is no doubt that the Kyrgyz Republic is among the world’s most remittance-dependent remittance countries (HelpAge International, 2010). 28 According to the SIF, only 2.500 pay SI contribution. What Works? Social Protection of Informal Sector Employees EPOS Health Management 26 According to the survey from HelpAge International, on average, remittances from migrants mi constituted less than 5 % of total household income. This eviev dence supported earlier findings by HelpAge in Moldova and the Kyrgyz Republic on the irregularity and low value of remittances received by the poorest households. Migrants from the poorest households typically have the lowest levels of skills, which makes it hard to earn enough money to send home. In other words, while the national remittance flow is substansubsta tial, benefits from migration are not distributed to the poorest population, even when they have family Extent of labourr immigrants A survey from HelpAge International (2009) on informal sector and vulnerability revealed that each of the 90 households participating in the survey had at least one family member workwor ing in Russia or Kazakhstan. khstan. All of these migrants were working without regre istration, and all the households in question received the remittances in cash, rather than through a recorded system such as a bank. While these remittances have the potential to contribute to wider development, velopment, they can ofo ten add another level of uncertainty to poor people’s lives members in diaspora. (HelpAge, 2009). Labour migration in the Commonwealth of Independent States (CIS) ( is characterised by a very high proportion of irregular migrants. The ILO estimates that 80% of the Kyrgyz migrants in Russia are irregular and therefore without protection or records. In practice, this this means that data on migration refers to the minority of migrants who tend to be more income secure. The data is therefore inadequate in understanding the patpa terns of actual movement. Internal migration: Internal migration is also a reason of the growth of of the informal sector, especially in the capital Bishkek, where the number of migrants makes make more than a quarter of the city population of 1 million. Hardly any of the new comers to enlist in the city register and therefore they cannot be legally employed (HelpAge International, 2010). 3.4 Best Practice on Social Protection for the Informal Sector The Government is well aware of the magnitude of the problem of providing social protection to the informal sector. However, there is an amazing lack of political willingness wil to tackle le this, despite global consensus on its benefits at the political, economic and social level. This is in part because the Government views that the informal sector has negative effects to the economy. To quote the PRSP/CDS (2007-2010): (2007 “specific attention will be paid to legalisation ation of informal sector of economy, which accounts for 45-50% 45 to GDP. Shadow economy negatively affects tax and social basis and leads to vicious circle of mutual increase of the tax burden and shadow sector. Shadow Shadow economy causes unfair competition for registered enterprises and distorts official statistics, which leads to inefficient policy decisions”. decisions In 2007, a government decree was signed introducing the ‘Programme ‘Programme of legalisation of shadow economy in Kyrgyz Republic for 2007-2010.. A special committee was established to oversee the implementation of this programme (HelpAge International, 2010). 2010) 29 29 Six main directions were identified: (1) national information information campaign, (2) simplification of tax procedures and reducing tax burden, (3) improvements in business environments, (4) optimisation of labour contracts, (5) review of the patent taxation system, and (6) reduction of smuggling and fight with corruption What Works? Social Protection of Informal Sector Employees EPOS Health Management 27 Generally, a Kyrgyz citizen would have access to the centrally-administered centrally administered social protection system. The current system of social protection includes both contributory (social insurance) and non-contributory non (social assistance) benefits that are weaved together with a patchwork of ‘old-style’ ‘old style’ categorical benefits30 and subsidies (privileges) and two new targeted benefits (WB, 2009). However, participation in state social protecprote tion system is an entitlement given to either the formal workers, who are provided this privilege when they are registered, or the poor, who are provided social assistance as a form of mitigation. As could be seen in the later discussion, the informal sector workers would often ‘fall in to the crack’ so to say, if they are unable to pay for a private insurance. 3.4.1 Social Insurance Old-age age related risks are addressed by the current pension system which is being shaped as a result of an ongoing reform since 1997, and basically consists of (WB, 2009): a. a basic pension component, component, which combines elements of a contributory and a social pension (the basic pension is not earnings-related earnings meaning that everyone with th the minimum contribution history of 25/20 years is entitled to a flat-rate flat rate of basic pension set at 12% of the average wage.31 On the other hand a shorrter length of service results in proportional reductions to the basic pension. b. a transition component, c. a notionally-defined defined contributions component with individualised accounts which notionally accrue contributions and are credited with a notional interest equal to 75% of wage growth. The scheme is pay-as-you-go go financed and contributions are used to pay concurrent concurrent benefits, therefore the NDC scheme only accrues notional capital to be translated into annuities at retirement. d. a mandatory defined contribution scheme (2% channelled channelled to individual accounts); and, e. a pension contribution,, which is 27% of the payroll payroll of regular workers, of which 17% is provided by the employer (for individual entrepreneurs without registering as legal entity, contribution is 9,25%, of which 8% goes as pension fund). All contributions go to the Social Insurance Fund (SIF or SF). There e has been considerable increase in older people who do not participate in the contributory pension scheme, as more people are employed in the informal economy. This number will further increase in the near future and result in increasing incidence of poverty pove among the elderly. One solution is to include inforinfo mally employed people in a contributory pension scheme. However, there must be discussions on how ini centives and proceduress could be adjusted to do this (GIZ, (GI 2010). Social insurance further consists of o sickness, maternity and work injury benefits. 30 The state provides 37 types of benefits to 30 categories of the population 31 For 2010, average wage was 8.041 Som (177.66 US$) in Bishkek and 6.140 Som (135.66 US$) in the rest of the country. Minimum age for the old-age age pension is 63 for men with at least 25 years of covered employment and 58 for women with at least 20 years of covered employment.(see ISSA).. What Works? Social Protection of Informal Sector Employees EPOS Health Management 28 An interesting development that would have some implications to the informal sector is the initiative of the Tax Committee at the Ministry inistry of Economic Regulation. The Tax Committee had carried out studies that involved main informal sectors (street street markets, textile, taxi drivers). Based on their findings fin they will start a pilot project in one bazaar that would include the installation of cash machines that allow sellers to pay the patent (registration) and at the same time make mak social contributions. This will circumvent the notoriously not corrupt tax collectors. The pilot is at the planning stage and at a this point, is far too early to assess potential benefits. 3.4.2 Health Insurance The health reform programme known as ‘Manas’ and launched in 1996, was a fundamental response to the deteriorating situation in the country, followfollo Quick facts on Health Insurance (January 2011 data) ing independence and an ‘extreme fiscal contraccontra Health insurance coverage as percent of the population tion in the first half of the 1990s’ (Kutzin et al, Total officially insured: 77,7% 2009). The collapse of the economy also had neganeg 1. Paying contributions: Working population: 22,8% Farmers: 6,7% Self insured military: 0.03% (not VHI certificertif cates) Enrolled refugees paid by UNCHR: 0.09% tive consequences for the ability of the government to spend on health, aggravated by the rising costs of the inherited health system that heavily relied on physical infrastructure and specialisation. The government announced a law to introduce the new mandatory health insurance fund (MHIF). Rather than an attempt to fully fund a comprehencomprehe 2. Supported through the State budget Pensioners: 9,8% Children < 16y.o.: 32,6% Children at 16-18y.o.: 18y.o.: 4,4,% Recipients of social benefits: 1,4% sive insurance package for the insured population, it was decided that the MHIF would instead top up the existing budget flows to public hospitals. This means that the MHIF covers the gap between actual expendie tures and government funding of hospitals. Manas also envisaged introduction of a purchaser-provider purchaser split and contracting between the MHIF and health providers under a single-payer single payer system (WB 2005). Since 2009, the MHIF is independent from the MoH. The ‘State State Guaranteed Benefits Package’ Package (SGBP) improved access by making primary care free for the whole population lation while displacing out-of-pocket payments with formal co-payments for secondary care with exemptions for expectant mothers, children under 16, pensioners and other socially vulnerable groups. This was perhaps the most remarkable ble success in financing reform i.e. the formalisation of informal payments and improved foreknowledge of the amount to be paid for care. These measures, combined with the fact f that hospitals were allowed to retain fee revenues and use them to improve service delivery, resulted not only in reduced out-of-pocket pocket spending by patients but also removed other deterrents to improved access, e.g. the fact that patients no longer had to bring food, bedding and other provisions for hospital stays (WB, 2005) Initially the insured population included employees, pensioners and those in receipt of social benefits (ap(a proximately oximately 30% of the population in 1999). In 2000, children aged less than an 16 were added to the insured What Works? Social Protection of Informal Sector Employees EPOS Health Management 29 category, funded by a direct transfer from the central state budget, increasing the insured population to about 70% (Kutzin et al , 2009). This number has not substantially increased over the last 10 years. years 32 Table 5: Main Features Features of the National Health Insurance Schemes Mandatory Health Insurance No. of Insurees 77% of population Voluntary Health Insurance • 14,500 cards have been issued since the start; only valid 1 year; ‘preva‘prev lence’ is much lower • Individual membership Outreach Urban - rural Some efforts to involve informal sector; military; refugees Elgibility Employees (contributions) Open to all Pensioners, ensioners, social benefits recipients and children < 16 yrs (state support) Premium 2% of gross salary (paid by employer) 7 EUR / annum Benefit package State Guaranteed Benefit Package Same benefits as under State GuaranGuara teed Benefit Package (free PHC) + reduced co-payment co for referral care The contribution however remains very restrictive. Only 30% of the population do pay contributions (regular workers and farmers).. The fixed contributions are 2% of the gross salary (paid by the employer), which is very low. The MHIF is now trying to increase this to 3% (to be paid by the employer), which willl will require an amendment to the law (4% would be better, but is politically not acceptable). Contributions from farmers vary. For farmer associations that are registered as legal entity, contribution rate is 2%. ‘Individual’ ‘Individual farmers (not registered as legal entity) pay contributions based on the land tax (7,4%). In addition to the mandatory insurance, insurance a ‘voluntary health insurance’ exist. People who are not regularly contributing can ‘buy’ an insurance certificate/card certificate/ for 400 Som (8,84 US$) per year. year This gives the same benefits as under the SGBP. The card is individual and valid for one year. Special arrangements exist for military (150 Som/ 3,32 US$,, with reduced benefit package) and refugees (400 som/ som 8,84 US$, paid by UNHCR). 32 Currently 76,9% of the Kyrgyz population are covered by the HIF. This includes refuges, employees, farmers, children, penpe sioners and other vulnerable ble groups. The latter are covered under the State Guarantees Programme that pays contributions for those who are uninsured. Other categories, like the unemployed, are still excluded (GIZ, 2009) What Works? Social Protection of Informal Sector Employees EPOS Health Management 30 Since the start of the voluntary insurance, 14.500 14. cards have been issued, including uding 2.600 for the military, 2.000 for refugees and 7.000 000 for the informal sector (the latter, on average, 400 – 500 cards per year). year Last year the MHIF went to the bazaars to promote the card car and as a result more cards were ere issued. Potentially the system of VHI, I, set up by the MHIF, could be used for inclusion of informally employed perpe sons in social security systems or the establishment of specific social security systems for this group. However, the system of VHI, as it is currently organised, is not viable and the MHIF is is very reluctant to expand the system. stem. For example, for military personnel, figures from 2010 showed that contributions/co-payments contributions/co covered only 11% of all medical expenses. More promotion for the VHI card (to the informal sector) would mean more cost for MHIF which they cannot afford. On the other hand, a more expensive card would deter many potential candidates in the informal sector. In order to qualify as ‘good practice’ a number of conditions need to be fulfilled. The system must be financially viable and to do so, coverage must be expanded, risk pooling and cross-subsidisation subsidisation guaranteed, contribution rates increased, etc. Possibly, with the review of the VHI system laterr this year, an inclusive approach, similar to other countries like Vietnam, can be conco sidered. An important technical achievement is the establishment of a good information system. A single hospital information system has been developed (Kutzin et al, 2009). 20 Recently the three main databases (MHI – 900.000 entries, VHI – 14.500; 500; and drugs management) database have been linked. 3.4.3 Social Assistance Programmes While social insurance benefits account for just below 6% of GDP (figures 2008),, the country spends annua ally between 1 and 1,5% 5% of GDP on social assistance benefits and services in the 2000s. After 2005, spending on social assistance benefits and services has been declining in relative terms, and in 2009 fell below 1% of GDP (WB, 2009). In 2007, the total number of recipients of welfare payments exceeded 10% of the total population of the country. In addition, the state provides various types of benefits to about a quarter of the population (CDS, 2009-2011). Two targeted cash transfer programmes were introduced introduced after independence in 1991. These include the Unified Monthly Benefit (UMB – introduced via Presidential Decree in 1995 and regulated in the law on State Benefits in 1998) and the Monthly Social Benefit (MSB - also established by the Law on State BeneBen fits), which together account for 0,,74% of GDP in 2007 and 0,64% 64% of GDP in 2008. Spending on UMB and MSB has also going down to less than 0,5% 0 of GDP in 2009.33 3.4.4 Private Sector A small market exists for the private sector. They target the better-off better and/or bigger companies/international organisations. An example is ‘Zdorovie Zdorovie’, ’, a Kyrgyz private insurance company, founded in 1993. Zdorovie offers two types of voluntary medical insurance programmes: (i) the ‘Special,’ which offers reimbursement 33 For more details see the World Bank report “Social Safety Net in the Kyrgyz Republic: capitalising on achievements and ada dressing new challenges”, 2009 What Works? Social Protection of Informal Sector Employees EPOS Health Management 31 of medical expenses ses against an insurance fee and (ii) the Fund in which the insuree deposits a sum that later is used for medical expenses. When the sum of the insured is exhausted, the insured can replenish it. The cost of the insurance policy is rather high and will deter deter the poor and other vulnerable groups. The ‘Fund’ can be used for family members,but the ‘Special’ is individual. Also international insurance companies are establishing branches in Kyrgyzstan. Reportedly a private pension fund exist, but different sources sources estimate the number of contributors at less than 1.500. 3.4.5 Other Social Protection Schemes For sake of completeness, two other initiatives are mentioned. There re are decided on a case-by-case basis and have no potential for rolling out. Coverage is limited to a small circle and scope of benefits is at the disdi cretion of the community/employer employer – hence it is more about charity than a systematic safety net. Parts of the information that we cite here were from the focus group discussion done with ‘Prima ‘Pri Vera,’ a private company which employs sewers. Discussions were done separately with the employees and management. Informal community-level level initiatives34 (e.g. duck/black cash), pooling of funds, to be distributed to those in need. According to MoSP, this thi can include micro-credits. In the focus group discussion, the employees mentioned a ‘black budget,’ which they contribute in to on a schedule and take turns getting. The ‘black budget’ is often used to buy merchandise (refrigerator, television, etc.). Membership in the scheme is selective and done very prudently because the scheme works on trust and is rarely backed by anything written or recorded. This makes it not stable and a very dangerous ini vestment, in the words of our informants. Some employers do take care of their employees and provide additional benefits such as medical care, mortuary benefits and extended sick or maternity leave. With Prima Vera, additional maternity compensation is given on top of the maternity benefit provided by the government govern for adequate augmentation. The company even takes hold of a portion of the salaries of some employees as savings by request. These initiatives are, however, purely on a voluntary basis and solely at the discretion of the employer. Anecdotal evidence exists of initiatives within the informal sector. One example is the case of taxi drivers organising themselves in a district outside of Bishkek. Reportedly they pool contributions, which can then be used in case of catastrophic costs for one of the members. members. It was also reported, however, that one of the main drivers behind this organisation is ‘economic protection’ and monopmono oly of the sector. 34 Jamoats in Tajikistan and Aiyl Okmets in Kyrgyzstan, are the lowest level of local government and form distinct administrative, legal and political entities. Each of these sub district units contain between 2-6 2 6 settlements which while forming separate communities will usually have some common social ties based based on ethnicity, geographic location and ecosystem resource use. Confusingly the term Jamoat is used in Kyrgyzstan to refer to a common interest group of households with potentially one or more Jamoats within an individual settlement (http://www.ehs.unu.edu/palm/file/get/3478) (http://www.ehs.unu.e What Works? Social Protection of Informal Sector Employees EPOS Health Management 32 3.5 3.5.1 Conclusion and Recommendations for Improved Social Protection in Kyrgyzstan The impact of the informal sector s to social protection in Kyrgyzstan When we asked the Ministry of Social Protection how the government addresses the informal sector, the question was taken as an inquiry why the informal sector was not a direct beneficiary of social assistance. The reply was that current priorities are the other categories such as children, dren, orphans, disabled and elderly. The government seems to regard that the informal workers abuse the system (“they (“they don’t pay contributions, so they can’t expect benefits”). ”). Nevertheless, it is acknowledged that informal sector and poverty often go hand-in-hand.35 Quoting the PRSP: “Legalisation ation of shadow economy will allow reducing poverty and can effectively generate new jobs, innovations, income and growth”. growth Therefore a special commission has been established under the Ministry of Finance with involvement of government and public organizations to ded velop and enforce reforms aimed at legalisation legali of shadow economy” (PRSP 2007-2010). 2010). Equally important is that the informal sector doesn’t contribute contribute to taxes and social insurance, making the revenue basis for social insurance and social assistance extremely small. As was explained by the MoSP, the few who pay taxes/contributions have to finance all other categories (poor, pensioners, unemployed). The SIF pointed out that, at this moment, moment an equivalent of 1 ½ months of pension cannot be paid. This will ill constitute a significant problem in the future, notable for social security for the elderly. The situation Migration vis-à-vis vis Social Protection of migrants – an estimated quarter of the working popupop As most migrants work in the informal secse tor, they do not contribute to any social ses curity system. lation – is an important factor in this. According to HelpAge (2010): “Hundreds Hundreds of thousands thousand of people will return to the Kyrgyz Republic with no access to social s security in old age; the he lack of bilateral agreements prepr vents the portability of social insurance such as the oldold age pension, but also of health insurance, even if the individual has been a regular migrant and has contribcontri uted to the system in Russia or Kazakhstan. Kazakhstan 36” Furthermore,, HelpAge International revealed that with regard to accessing social assistance, the participating The current lack of any non-contributory non oldage pension, coupled with an official unemune ployment rate of 11%, means that the numnu ber of vulnerable people reaching retirement age with no access to social security in the Kyrgyz Republic is increasing rapidly. On the bases of these se official statistics for unemployment, informal labour and migramigr tion figures, in the next 10-15 10 years up to 1 million Kyrgyz citizens will be without a complete official labour record, and will therefore be without any pension or health insurance. households reported that having a migrant in the family often en resulted in external assumptions of wealth. In some cases, families were refused the UMB because they had a member working abroad. 35 Empirical evidence has shown that the informal sector as a whole is not synonymous with poverty. It is found to be a heteroheter geneous group: while some are engaged in subsistence economic activities, others run very profitable enterprises. enterpr In many cases those in the latter accrue incomes well above the minimum wage in the formal sector of the economy (ILO, 2002). 36 According to the SIF, the government ment is currently cur ently negotiating regularisation of the international migrant workers and portability port of their contributions for social security. What Works? Social Protection of Informal Sector Employees EPOS Health Management 33 3.5.2 Gaps in Social Protection Other than the barrier for informal workers to access mainstream programmes of the government, as a explained above, these mainstream programmes themselves have some design flaws. While economic performance has improved considerably in the last few years, difficulties remain in Kyrgyzstan in securing adequate fiscal revenues and consequently providing an adequate e social protection system. We summarise the following gaps below. Limited risk mitigation The main issue is the insufficient level of social benefits and pensions and their inadequate impact on imi provement of living standards of recipients (CDS, 2009-2011). In n view of many recipients of social paypa ments and limited resources in sustaining the state budget, the size of these payments is small and its imi pact on improving the standard of living is insignificant. Average size of UMB and social allowance allow in 2005 made up only 19% and 76% respectively of the extreme poverty line (PRSP, p. 65)37. This had even gone down in 2007 when the average amount of UMB and social benefits made only 14,1% and 58,6% of the poverty line (CDS. p. 110). A study from HelpAge International (2009) demonstrated the minimal impact of the current social assistance programme on older people’s lives, particularly for multigenerational households consisting of older people and young children. Pension benefits are particularly low for farmers who make up approximately appr 55% of the population and one third of the registered contributors (WB, 2009). Inaccurate targeting of beneficiaries According to a WB study, the social safety net (UMB) strategies are fairly effective. In terms of targeting accuracy, the WB report claims that the poorest 40% of the population receives 81% of total benefits paid out. Still, leakages to the non-poor poor are notable.. 19% of benefits go to those in the top three quintiles. Other sources, ces, however, are less convincing and depend on how figures are interpreted. Less than 1/3 of the poorest 20% of the population have access to the UMB. UMB One of the scheme’s major challenges is to assess the family’s income, especially ‘invisible’ income from agricultural activity activit (since farmers pay taxes and social contributions based on land tax and not on real income), income), remittances and wages from migrant family members that are difficult to trace (GTZ, 2010). 2010). This is explained in the next section. Communities perceive that the targeting of social assistance programmes had been inadequate as was revealed by the study of HelpAge International. Inadequate targeting of the social assistance is particularly true for the system of privileges (CDS, 2009-2011). 2009 During the interviews, the e Ministry of Social Protection likewise admitted to the unfairness in the system. They argue that some benefit users get more than those 37 The value of extreme poverty is defined as the costs needed to cover a minimum of 2.100 kcal per individual per day. The absolute poverty line includes an allowance for non-food non goods and services deemed d necessary to cover basic needs. Both poverty lines were calculated in 2003 by the National Statistics Committee and have since been updated annualy using the consumer price index (WB, 2009). What Works? Social Protection of Informal Sector Employees EPOS Health Management 34 who have contributed.. To some extent, this explains why the government is reluctant to focus on the inforinfo mal sector, who they perceive as profiteers. The introduction of the ‘Social Social Passport’ may be a powerful instrument to improve targeting and monitoring processes. The social passport not only reaches out to the extreme poor who receive ‘passive’ assistance in the form of social transfers but also to those who are physically unable to engage in productive activities (GIZ, 2009). Low contribution rate Perhaps the most acute challenge for the low level of pensions and benefits is the great number of their recipients that does not match limited resources of the state budget and Social Fund (PRSP, 2007-2010). 2007 Only about 15% of the working age population is accruing any pension rights, due to low labour force parpa ticipation rate (44 - 45%) and low compliance. complianc Out of 2,4 million n people in the labour force in 2008, 2008 only an estimated 800.000 (WB) to 1 million are registered as contributors to the social fund. fund Some categories in the labour force, who are not necessarily poor, poor are exempted or pay very little contributions, like military, etc.. Farmers make up approximately 55% of the population but only comprise one third of the registered conco tributors. Their contributions make up less than 1% of total contribution revenues. revenues At the same time, retired farmers represent approximately 65% of the beneficiary population and absorb close to 60% of the pension expenditures (WB, 2009). Others A number of other problems related to social protection are mentioned in the updated CDS, CDS which are listed below. Poor oor quality and high cost of social services in boarding houses and other specialized institutions for children – orphans, elderly persons, people with limited physical ability; Insufficient nsufficient development of the social services system for for vulnerable categories of the population delivered at the community-based community based level, therefore, many needy people, and particularly children from groups at risk, who need social benefits, remain without due support; There here is an acute shortage of experts capable cap to render these services; There here is lack of interest in their development by local authorities and nd local self-government self bodies. 3.5.3 Government response to addressing need of the informal workers for social security In the section 3.4, we refer to several schemes schemes as best practices, although categorically they fall short of what would be considered effective approaches in reaching and providing social protection to the informal workers. The seeming lack of best practice in this aspect is more a matter of economic economic principle for KyrKy gyzstan than the lack of ingenuity in designing schemes. None of the persons interviewed could point at a single policy/strategy that targets the informal sector (in relation to social protection). protection After almost 20 years of independence, ce, the attempts were insignificant and unfruitful (HelpAge International, 2010). A discrepancy exists between policy papers and implementation. What Works? Social Protection of Informal Sector Employees EPOS Health Management 35 Most significant is the fact that no ministry assumes responsibility for the cross-links cross links between informal work and social protection. According to the MoSP it is responsibility of the Ministry of Labour. The latter, howho ever, states that their responsibility ponsibility is (un)employment. All seem to agree though that better coordination among different ministries is needed. Perhaps Perhaps there is an opportunity to do so when developing the new social policy. Labour legislation is not the main issue, however, enforcement of compliance As reported by the Ministry of Labour, is. An important role is attributed to the State Labour Inspection Inspection,38. which looks, inter alia, at occupational health and safety (OHS) issues. However, their impact is very limited: they need to announce their visit in advance and can conduct control visits only once a year. According to ILO, the current government is even considering abolishing this inspectorate. Tax collectors play a major role in forcing the economy underground as they often insist on using traditional taxation system based on accounting (ignoring governmental decrees on the patent system), which de facto fact means giving bribes to them (HelpAge International, 2010). Most important perhaps is that the government loses trust of its citizens (and as a result threatens the politipolit cal stability of the country because it involves both corrupt government and criminal criminal structures at all levels). Lack of trust was mentioned by several interviewees (both private sector and government officials) as a mam jor concern. rn. It leads to a vicious cycle where people are reluctant to pay contributions because ‘they don’t see any benefit from it’, whilst services remain poor (amongst others) because of the limited resources. Solving this dilemma requires indeed awareness raising, public campaigns, but also a ‘clean government and improved services. For the international migrant workers, however, negotiations negotiations with Russia and Kazakhstan have been initiinit ated to discuss payment and portability of social security contributions. According to the SIF, a special webwe site has been set up so that labourers can pay contributions contributio online. Reportedly, tedly, about 16.000 16. people have made use of this since its initiation in 2008. 3.6 Final Thoughts In the debate on ‘improving social safety net’, the focus is on the poor, or for that matter, on better targeting (e.g. systems of means-testing) testing) and less on specific specific categorisation of groups (e.g. informal sector). The informal sector can be approached from different angles (economic, political, social), but it requires a multi-sectoral sectoral approach, strong coordination and leadership, which is currently lacking. In the t whole discussion on social protection, the informal sector is not mentioned specifically (see for example the Bishkek conco ference on social protection). Surprisingly, none of the government stakeholders interviewed mention that the informal sector was a priority.39 38 According to the PRSP “The bodies of the State labor inspection inspection conduct supervisory and control functions on protection of labor rights, lives and health of working people. Some 1 800 inspections of enterprises and organizations are carried out ana nually, during which some 8 000 violations are disclosed” 39 Ministry of Finance and Ministry of Economic Regulation were not interviewed. What Works? Social Protection of Informal Sector Employees EPOS Health Management 36 Lack of trust in government (and social services) is prominent. A commonly heard complaint is ‘why ‘ to pay more contribution if we don’t’ get anything in return’. return’. This is particularly true for the informal sector. It should be mentioned that because of their design, the social protection schemes of the national governgover ment, and potentially commercial providers as well, might actually be deterring women from participating. The national social insurance and the MHIP are meant for individual enrolment enrolment of registered workers, who are traditionally men. The children and elderly meanwhile participate in the schemes through subsidised contributions or through social assistance. Women, or for that matter, those who are left to care for the household, are left without social protection coverage if the schemes do not allow enrolment as family units. Moreover, in Kyrgyzstan, we do not see any targeted programmes for women, unlike in other countries. Thus, it could well be that a good portion of those without protection are women. There is no solid evidence to back this, to date, since data available are not segregated by category. This therefore deserves further investigation. The new ‘Social Policy’ that is currently being prepared provides a good opportunity opportunity for all stakeholders to focus more explicitly on the informal sector. Since all relevant ministries are part of the working group (WG), cross-cutting cutting issues can be easily addressed. Moreover, GIZ is member of the WG and as such is in an ideal position to put its mark on the policy. What Works? Social Protection of Informal Sector Employees EPOS Health Management 37 4 Case Study III:: Pakistan 4.1 Country Background Pakistan is a country of approximately 173 million people. Estimates of those who are poor range between 30 - 35% of the population living below the poverty line,40 with general acceptance eptance that the numbers are rising. Various measures have been used to determine poverty levels in Pakistan but all of them have limilim tations, tions, not least because they do not take account of the very diverse terrain, terrain which makes up Pakistan, the ethnic and political olitical instabilities and tensions in the country, the acknowledged corruption, and the diffidiff culties relating to the physical mapping of the country41. The recent devolution of responsibilities to provpro inces for most social protection issues does not help in in making an educated assessment of the total numnu bers of those who face social protection risks. Given that all of the poor are in the informal sector (but not all in the informal sector are poor) the governgover ment has categorised the poor into a range of levels, leve as follows Table 6: Categories of poverty vis-à-vis vis income levels42 Poverty category Extremely poor Income level 50% of poverty line or less Ultra poor 50 – 75% Poor 75 – 100% Vulnerable 100 – 125% Quasi non-poor 125 – 200% Difficulties with some of the poverty measurements used are in their relevance to the different circumcircu stances – rural/urban, mountain/desert, agricultural/production etc. et Due to the relative inaccessibility of much of the country for systematic surveying, all of the surveys undertaken und thus far – and indeed including the current huge survey - use yes/no answers to questions. This makes objective assessment of social propr tection risk difficult and highlights the issue of having to assess social protection risk on a regional basis rather than a national basis. The World Bank estimates that about 56% of households could be classified as vulnerable in Pakistan. In a study commissioned in 2007, an astonishing two thirds of the households surveyed reported to have sufsu fered from one or more major shocks in the past three years. More than half of all shocks (about 60%) 40 Official poverty line in 2005/06 was set at 944.47 PKR (11 US$) for a household per day (cf. http://siteresources.worldbank.org/PAKISTANEXTN/Resources/Poverty http://siteresources.worldbank.org/PAKISTANEXTN/Resources/Poverty-Assessment/3613611216396471531/PAK_OPL.pdf) 41 During the data collection phase in the current survey, whole villages are being excluded from assessment because they don’t appear on the maps being used, which date from the early 1990s and do not take account of the many settlements which have been established since then. 42 Source: Brief overview on social protection in Pakistan, Markus Ruck, ILO, 2010 What Works? Social Protection of Informal Sector Employees EPOS Health Management 38 were brought about by individual specific factors i.e. health, sickness and disability. The remaining ones are external, including droughts, economic shocks, etc. It was established that the non-poor non households deal with shocks by using asset-based based strategies (e.g. sale of physical assets, cutting down on savings). Among the poor, meanwhile, their coping strategies are mainly behavioural, for example, reduction of conco sumption ption or longer labour hours. The effects of these shocks are known to be catastrophic for the poor. But considering that private health expenditure is 70% of total health expenditure and 81,5% of this is out-ofout pocket, even the lower segments of the non-poor non oor could be vulnerable to financial ruin if there are no safety nets in place for services such as health care. 4.2 The Current National Policy on Social Protection There is no single national social protection policy and, according to a number of key figures in the field ‘there is no appetite’ to develop one. There is a real disconnect in Pakistan at national level about who is responsible for social protection (and the organisations and groups, therefore, which may benefit from ini coming financial and technical al assistance on the subject). The recently appointed government originally intended to assign responsibility for it to the Ministry of Social Welfare, but those opposed to this argued that it was unconstitutional to do so (the term ‘social protection’ does does not feature in the constitution), so there is no Ministry with specific responsibility for social protection. This means there is no specific coherent policy for social protection which leaves the field wide open for fragmentation and duplication of effort. effo Possibly more worrying is the recent change to the constitution which resulted in all ‘service’ Ministries beb ing disbanded at national level and responsibilities devolved to provincial levels. These include health, lal bour, social welfare and education, education, the Ministries which would normally address directly issues of social protection and with whom the international development partners would engage. All of these Ministries have now been devolved to provincial responsibility. In terms of social protection provision, each of the provincial ministries has some responsibilities but these are not prioritised in any way. Central legislation, of which a number are discussed below, does not necessarily translate to specific ministries. Inevitably, the demarcademarc tion lines between ministries get drawn at provincial level and there is little co-operation co operation between them or consolidated activity. There are a number of key policy documents and a number of key legislations, which address social protecprote tion issues. It is important ortant to remember that most of these documents specifically address poverty reducredu tion rather than social protection issues per se but their relevance to social protection is clear. 4.2.1 Relevant Legislation The oldest Act which relates to social protection is the Societies Registration Act of 1860 which provides provi for the establishment of non-profit profit organisations in the country. Various philanthropic organisations (mostly NGOs) including national, regional, rural support programmes are established under this Act, most of which are working for social protection or social risk interventions. The West Pakistan Employees Social Security Ordinance, 1965 (and its different versions in four other provinces) inces) provides legal cover for the establishment of social protection institutions for formal sector eme ployees. What Works? Social Protection of Informal Sector Employees EPOS Health Management 39 The Employees Old Age Benefits enefits (EOB) Act, 1976 (amended in September September 2002) provides for a benefit package for insured employees over age 55 (for men) and 50 (for women). Under EOB scheme, insured perpe sons are entitled to an old-age age pension (on the event of retirement), invalidity pension (in case of permanent disdi ability), old-age age grant (for an insured person who reached retirement age, but did not reach the15-year the15 payment requirement) and survivor's pension (in case an insured person has expired). Contributions are shared between the employer and employee with 5% of the minimum wage provided by the former and 1% from the latter. This is only available for those formally employed. The Zakat and Usher Ordinance of 1980 0 provides the legal basis to establish a Zakat fund. Zakat is an IsI lamic tax of 2.5% of the income during an Islamic calendar year, which is deducted at source from deposits in commercial banks from all eligible people (according to Islamic Law) and it is disbursed to different parts of the country to provide assistance to needy Muslims, based on the assessment of local Zakat CommitCommi tees. In addition it also supports institutions such as hospitals and universities to meet the cost incurred by poor and needy Muslims. There is no restriction on applicants: they could be from the formal or informal sectors. The Ordinance was previously used as the legal basis for the Zakat and Usher Directorate in the Federal Ministry of Zakat, Usher and Religious Affairs, which which no longer exists, with all functions now ded volved to provincial areas. Pakistan Bait-ul-Mal Mal Act of 1992 has a very broad spectrum target population, providing assistance to oro phans and widows, stipends for educational activities, medical care, rehabilitation rehabilitation from job related accidents and injuries, and disbursements to disabled people. Any Pakistani citizen is eligible to apply for assistance. The system still operates and, after a number of recent scandals about misuse and misappropriation of funds, has now been put under new management and is focusing attention primarily on orphanages. The Home Based Workers Social Protection Act of 2008 is based on a social protection strategy of 2007 and a labour policy of 2006, which are no longer in play. The Act however, however, is still in force. It aims to estabesta lish a Social Protection Commission Fund for home based workers to provide basic benefits to the workers and their families, specifically those working in industrial, commercial and agricultural areas: eligibility exe cludes ‘government servants and those earning more than rs.7000 per month. Though much of the work carried out under this legislation relates to documenting the numbers of people involved in home based working, and advocacy of rights and networking, but provision provision of financial benefits to mitigate economic risks is not provided. With funding and better organisation the potential for creating a social protection risk pool of home workers could be achieved. It, It however, hasn’t yet been developed. The most recent cent piece of legislation affecting social protection was introduced by the current government. government The pre-election election intention was to have one group, outside of the ministries, responsible to provide assisassi tance to the poor and needy. The legal cover required to to operate was created through the enactment of the Benazir Income Support Act of 2010. The Act assigns powers similar to other social welfare organisations such as Bait-ul-Mal Mal and Zakat. Benazir Income Support has now been established as a social safety net ne organisation, with poverty alleviation as its primary goal. The Board of Directors (of which an MP is Chair) determines eligibility criteria and disbursement methods using direct grant funds from government. govern We identified this scheme as one of the best practices, practices, which we discussed at length in the later section of this rer port. What Works? Social Protection of Informal Sector Employees EPOS Health Management 40 4.2.2 Poverty Reduction Strategy Paper (PRSP II) The Poverty Reduction Strategy Paper (PRSP II) draws on the acknowledgement of the growing gap beb tween the rich and the poor by addressing addressing potential projects to alleviate and reduce poverty. A wide variety of public sector investments are considered as measures to reduce poverty such as health, education, sos cial security, irrigation, rural development, water and sanitation and others. PRSP PRSP II is a continuation of the first PRSP which was developed in early 2000. All public sector expenditure is seen as an effort to reduce poverty and the paper calls for better targeting, based on an assessment of the potential for sustainable development. PRSP focuses on macro-economic macro economic stability while protecting the poor and vulnerable from major economic and social protection risks.43 4.2.3 Policy Coherence in Social Protection Pakistan’s Social Policy and Development Centre produced an appraisal of literature on social protection in May 2010, A Profile of Social Protection in Pakistan: an appraisal of empirical literature. literature This provides a useful analysis of policies and documents which have been produced by, mostly, international development partners and highlights the difficulties encountered through not having a cohesive social protection strategy and adopting ad hoc and political responses to problems. The report relates that most of the schemes have weak institutional structures, their funding is limited limited and uncertain, their targeting inefficient and their covercove age small. The combined coverage of all of the schemes is low. The report argues for the need for a policy and research capacity for social protection, protection which could be located in one or two existing existi academic institutions.. It argues for the development of social protection schemes, schemes which people themselves want and perpe ceive as necessary, to which they can contribute, which will protect against interruptions to earnings and income. The study undertaken en by the Social Policy and Research Centre in 2010 itemised the flaws in current polipol cies and programmes thus: 43 • Lack of coordination among executing authorities • Design fault in various schemes • Corruption and embezzlement • Inadequate cash or in-kind kind assistance • Low coverage • High administrative costs • Programme overlap and duplication • Poor or no targeting mechanism • Political interference and bureaucratic malfeasance http://finance.gov.prsp_report.html What Works? Social Protection of Informal Sector Employees EPOS Health Management 41 • Lack of monitoring and supervision An unpublished ILO Brief Overview of Social Protection in 2010 reiterates the views of the Social Policy and Development Centre, while also commenting on the failure to act on a number of social protection internaintern tional agreements despite being signed and ratified by Pakistan. Two brief GTZ/GIZ Pakistan papers papers also support the positions of the Social Policy and Development CenCe tre. The Social Assistance Mapping of 2010 argues that the lack of a holistic strategy means that individual programmes remain ad hoc, reactive and fragmented. fragmented The paper Support to the development of a social health protection strategy argues that while other low and middle income countries have now managed to put in place policies, which at least aim to provide complete coverage for health care, Pakistan has not. The argument is made forr sensitisation and design of a national social health insurance scheme, based on rer ports that out of pocket payments for health care are the key tipping point of a family into poverty and are also key to keeping families in poverty over prolonged periods. There is a real disconnect in Pakistan at national level about who is responsible for social protection. The government originally intended to assign responsibility for it to the Ministry of Social Welfare. But since there was no mention of social protection protection in the constitution, it failed to have legal basis. Instead, the government devolved all responsibilities for ‘service’ ministries, such as education, health, labour and social welfare. There is reportedly very limited capacity at provincial level for undertaking these responsibilities. The government established a de facto ministry in the form of the Benazir Income Support Programme (BISP), which has a national mandate and has become the focus of all international development partners as it addresses issues ssues of the poorest in society. Funding for BISP comes directly from government and from loans and grants from development partners. 4.3 The Informal Sector and Social Protection Despite there being no cohesive national social protection policy all activities in relation to those in the ini formal sector and to the poor seem to be labelled under the ‘social protection’ banner in most literature reviewed.. It is difficult to assess the relevance to national policy and many of the programmes do not have clear targets ts but are reactive, ad hoc, responding to those who come to look for help and responding to the not infrequent natural disasters which beset Pakistan. None of the schemes in operation which were rer viewed has a target number of beneficiaries or a clear assessment assessment mechanism to determine eligibility, makma ing it impossible to gauge the efficacy of the scheme in reaching those who need the assistance on offer. A huge survey, costing US$ 36 million, is currently being undertaken across the country by Benazir Income Inco Support Programme (BISP). Resources are coming from a World Bank loan. The data will be processed using a ‘proxy means testing’ approach.44 It is intended that the results of the survey will be made available – for a fee – to bilateral organisations and others, once it is completed by the end of 2011. While this is the biggest survey undertaken to date it has many limitations: it is recognised that the methodology will not catch people living in the bottom two rungs of the poverty scale; the survey is a one-off o off survey and there are 44 According the World Bank documents, in an evaluation of the different measures available, proxy means testing has a ‘high margin of error’. What Works? Social Protection of Informal Sector Employees EPOS Health Management 42 no plans (or earmarked resources) for it to be repeated; the physical size of the country and the establishestablis ment of settlements in remote areas makes it extremely difficult to get a clear picture of living conditions and risk; there ere are very different risks associated with living in the mountains than in living in desert – distinctions such as these are not accommodated in the survey. Within the international community (including the Banks) there is also fragmentation (and a good degree of frustration with the difficulties in finding responsible national counterparts). While all activities appear to come under the labels of social protection or poverty alleviation it is difficult to locate individuals with rer sponsibility for social protection in the key international agencies, which all have their own agendas. It is hoped that the establishment of the UN Coalition on the Social Protection Floor, which has explicit support and participation from key bilateral partners and as well as the ADB and World Bank, may help to galvanise the government into assigning responsibility for social protection to a named Ministry at the national level. The National Planning Commission of Pakistan has indicated serious concerns about the current governgover ment approach to social protection and poverty alleviation, saying that it has adopted a purely political mechanism and has excluded involvement of all ministries and national agencies while focusing all attention on the BISP. There are serious concerns about about sustainability of the approach if/when this government loses power. 4.4 Best Practice on Social Protection for the Informal Sector Three schemes are described in detail in this section: they each offer ‘life cycle support’ to the poorest two groups (extremely poor and ultra--poor) poor) though none of them have clearly defined eligibility criteria, target groups or poverty assessment mechanisms in place when providing that support, relying instead on percepperce tions of those who seek the assistance. Each of the schemes schemes has limitations which are described, but they do address social protection risks of some of the poorest in society. While none of them would warrant ‘best practice’ status under normal circumstances they are included here as examples of the best practices practice found in Pakistan. 4.4.1 Bait-ul -Mal Pakistan Bait-ul-Mal (PBM) is a state funded organisation providing a wide range of services including: EsE tablishment and running of ‘Pakistan Sweet Homes’ for orphans, child support, national centres for rehabilirehabil tation of child labour, vocational training centres, provision of wheelchairs, white sticks and hearing aids, institutional rehabilitation for disabled (through NGOs) and relief assistance to those affected by floods. The organisation was established to mitigate a wider range of risks than it currently covers. Those covered curcu rently include age, disability, permanent incapacity to work, economic shocks, major health costs, and natunat ral disasters. Each of the services provided is described in more detail below. Funds for Bait-ul-Mal Mal come directly from government and from private contributions, though have been rer duced under the current government (re-directed (re directed to BISP) and have also been reduced due to financial difdi ficulties in the organisation (lack of transparency) under previous management as well as due to the financial resource challenges of the previous government. Funds are not invested but are disbursed and aca counted for each year. Assistance is provided mostly in kind; where it is provided as a cash transfer an a as- What Works? Social Protection of Informal Sector Employees EPOS Health Management 43 sessment is made for individuals who are seeking assistance, to ascertain if they establish whether or not they can afford to make a contribution towards the item or service they are requesting. The programme aims to cover all of those living below the poverty line. But because funds are very restricted and have been previously committed to other budget items, the programme’s outreach out has become limited. The Pakistan Sweet Home programme has established 13 orphanages in 13 districts distric for 900 children. A total of 48.001.467 PKR (560.045 US$) has been spent on this up to June 2010. The Child support propr gramme offers food subsidies in 11 of 144 districts nationwide. The National Centre for Rehabilitation of Child Labour focuses on education to completion of primary level. It is currently operational ational in 158 centres, with 19.372 372 students. Most of the students are former child soldiers. The vocational training programme provides free training to widows, orphans and the poor at 157 centres, with a total total of 6.453 6. people currently availing of the training programmes. Individual financial assistance is the only cash transfer available through Bait-ul-Mal. Bait Mal. It is provided to pay for tuition fees,, catastrophic health expenditure and rehabilitation in case of accident accide orr injury. The programme works through direct cash handouts and not through an insurance scheme for beneficiaries. It was previously the core activity of the Pakistan Bait-ul-Mal Bait and offices around the country to act as agents for the programme. Funding for the individual ndividual financial assistance is currently cur 2 billion PKR/ 23,362 million US$ (down from 8 billion PKR/ 93,447 US$ in 2008-2009). To date fewer than 100.000 000 people have benefited from financial disbursements under the scheme. Eligibility for a cash transfer is determined by officers in the Bait-ul-Mal Bait Mal offices around the country on the basis of findings at interview, when an assessment is made if the applicant could make some contribution themselves to the amount requested. The programme guidelines require that assistance be provided to “needy individuals’ having no support or source of income in following order of priority: a. Individual with major ailments/ disability b. Widow with dependent children c. Invalid with dependent children d. Infirm (senior citizenss above 65) e. Poorest of the poor to be reviewed f. periodically for rehabilitation g. Orphans h. Destitute i. Victims of unpredictable circumstances” A ceiling of 300.000 PKR (3.054 US$) is available to disburse to any single individual or family. With limited funds, the he demands for services from Bait-ul-Mal Bait Mal significantly outweigh capacity to provide support. What Works? Social Protection of Informal Sector Employees EPOS Health Management 44 The Bait-ul-Mal Mal programme provides a last-resort last safety net for the ultra-poor poor and extremely poor but in a very limited way. Their institutional services have a broader broader scope. There is no critical assessment of the target population, in terms of numbers of location. 4.4.2 National Rural Support Programme / Adamjee Insurance The National Rural Support Programme (NRSP) was established nearly 50 years ago with a policy of rural ru development through social mobilisation, specifically at village level. Products available include micromicro finance loans and rehabilitation services for people disabled through work accidents. Direct investments is also made in infrastructure nfrastructure development, development, specifically link roads from villages to main roads to facilitate bringing ing produce and goods to market. mar The National Rural Support Programme is funded by government and considers itself the state’s principal agent in providing mitigation against social risks. isks. It does so through 300.000 000 local organisations which liaise with the central office in Islamabad. Grants are provided to those in the 0-9 0 level of the poverty scale, with micro-finance finance products45 available to anyone who is assessed as ‘rural poor’. r’. The programme uses its network of offices to provide information on voters’ rights, civil rights and responsibilities and health education. On the basis of evidence from their clients who fell into extreme poverty through the costs of ill health, NRSP initiated a secondary scheme with Adamjee Insurance ComCo pany to develop a health insurance scheme targeted only for the poor. NRSP initially offered the health insurance on a voluntary basis to all those applying for loans, but realrea ised very quickly that it was easier and a lot more effective to make the health insurance component compulsory, which they did by adding 100 PKR (1,17 US$) to the loan NRSP’s Poverty Scorecard NRSP uses its own ‘Poverty Scorecard’ developed by Mark Shreiner. The scorescor card is a simplified eligibility tool which uses 10 indicators, which are translated to 10 questions. The one-page one tool asks the household respondents about their province of residence, number of children under 13 years old, school attendance of the children, type of employment, highest educational attainment of the female spouse, source of drinking water, type of toilet and possession of refrigerator, teletel vision and vehicles. Answers to quesque tions have equivalent scores, which add up to a value from 0 to 100. Households fall in to 6 levels depending dependi on their scores: (i) 0 to 9, (ii) 10 to 24, (iii) 25 to 34, (iv) 35 to 49,(v) 50 to 69 and (vi) 70 to 100. processing fee. Now everyone who takes out a micromicro finance loan pays the additional premium which provides on-going on ing health cover through a private insurer, for the duration of the loan. With an average of 700.000 7 000 clients per annum the health insurance was a way of mitigating NRSP’s losses due to defaulting on loan repayments (which made the family or individual ini eligible igible for any further loans) and also provided social protection for their clients in in the face of a major risk. Adamjee Insurance Company is a private commercial insurer. As an organisation they offer a range of products including life assurance, health insurance, insurance, accident and disability insurance, old age pension plans, and marriage and child education savings plans. Under their in-house in house insurance product plans all premiums are paid by the insured person. person The compulsory health insurance for borrowers that Adamjee offers in joint venture with the National Rural Support Programme has a flat rate payment for everyone, irreirr 45 NRSP's micro-finance productss consist of micro-credit, micro credit, savings, and hospitalization and accidental death insurance. Credit is disbursed through the Micro-finance finance and Enterprise Development Programme and through the Urban Poverty Alleviation Programme (UPAP). What Works? Social Protection of Informal Sector Employees EPOS Health Management 45 spective of pre-existing existing conditions, or the amount of the loan. Insurance benefits cover hospitalisation up to 15.000 PKR (175,19 US$) each for the loanee and spouse and accidental death/ disability benefit up to 15.000 PKR (175,19 US$) for the loanee only. In addition to this, another 15.000 PKR (175,19 US$) is given in case of natural death to pay up for loan balance and funeral charges. Since Since July 2008, child birth is also covered with a ceiling of 7.500 PKR (87,60 US$). Following the relative success of the compulsory insurance for the NRSP clients, Adamjee now offers simisim lar insurance in three districts of Sindh province: the insurance is provided through the Government of Sindh. Currently the additional schemes sche provide health cover for 75.000 000 households in these three districts. Similar arrangements have also recently been established with Thardeep and Sarhad Rural Support propr grammes in Khyber hyber Pukhtoonjwawa Province. The scheme provides cover to population groups with a poverty score of 20 or lower. The cover provided includes selected health services such as inpatient care, pregnancy and delivery, accident and disability. More recently, transportation transportation costs to health facilities can also be claimed under the scheme. The maximum ceiling of reimbursement is 25.000 000 PKR (292 US$), although the premium is a lot more higher than the compulsory (250 PKR/ 2,92 US$) The contribution rate for each of the schemes is determined in tandem with whichever organisation AdamAda jee is working (BISP, Sindh government etc). Because the contributions are taken out from loans issued by the NGO or the government organisation, the contribution contribution payments are guaranteed. The products are only offered to rural populations, with service providers in locations close to the insured population groups. While the health services available are very limited, Adamjee, in conjunction with their partners, partn have set standards of care based ased on Agha Khan health services in Pakistan. The micro-health insurance package for NRSP is based on a card system which is presented at the point of service delivery for pre-designated designated service providers. The cards provide de details of the members’ benefit entitlements. NRSP’s report for March 2011 placed claims from the insurance to be less than the ceiling of 15.000 PKR (175,19 US$), which gives the scheme a very good support ratio. This fact though loses its spark when put p alongside the figure that only 0,3% of private health spending are from private health insurance. This means that although the micro-health health insurance of NRSP provides considerable shield against catastrophic health shocks for its members, its outreach is is still small to have an effect on a national scale. In should be considconsi ered, however, that the programme is for the rural poor, which is just a segment of the population and that health costs are much higher among urban residents. One of the reasons for Adamjee’s damjee’s continued involvement in the programme is the low claims ratio which is currently lower than 50% (less than one percent for March 2011). 2011) The reason for this is not explained in any of NRSP’s reports and deserves further investigation. Nevertheless, Nevertheless the he low claims ratio would indicate that there is limited understanding about entitlements. Because the micro-finance finance scheme is offered to people living below a certain income threshold, it is safe to assume that the clients are either illiterate or have very low levels of education. One should also not discount that, since the micro-health micro health insurance is compulsory, it is getting a good client mix and keeping adverse selection at bay. This is in contrast with voluntary health insurance, which naturally attracts racts potential users of the programme. What Works? Social Protection of Informal Sector Employees EPOS Health Management 46 Adamjee got involved in the programme at the request of government but accepts that it continues only beb cause they still see a marginal profit from the various schemes. As long as that remains the case, the comco pany can an continue with the scheme and use it as a public relations exercise to reflect the organisation’s ethos of social responsibility.. This does not guarantee that they would continue with their involvement once financial returns go unfavourable. 4.4.3 Benazir Income me Support Programme This programme is currently the keynote social protection programme in the country for the poorest populapopul tion groups. Initiated by the current government, it has become the focus of almost all government attention and much of the attention tion of donors and development partners. BISP was formed by law (Benazir Income Support Act of 2010) after the election of the government to power.46 It reports to the Board of BISP, the Office of the President and the Central Office for Management and Governance rnance and Policy. It has a central office in Islamabad and has provincial offices in all provinces. Beneficiaries could get hold of applications from the local offices of their MPs, with every MP being given multiple application forms for collection and distribution distribution in their constituencies. The applications are asa sessed by BISP centrally. The BISP uses its own poverty scorecard, this time with 13 indicators. The syssy tem of establishing eligibility is the same, with each household having an aggregate score as a sum of their scores per indicator. Given the attention it has been receiving, it was able to launch a survey of households in almost every country with the intention of going nationwide. With this database, BISP is able to crosscross check applications with ith their own record of the applicants’ poverty scores. Aside from their poverty score, applicants have to pass the following pre-qualifications: pre qualifications: (i) possession of a national identification card, and (ii) monthly family income of 6.000 PKR (70 US$). They also have to be in at least one of the following circi cumstances: (i) widowed/ idowed/ divorced women, without adult male members members in the family, (ii) having physically or mentally retarded tarded person(s) in the family, and (v) any any family member suffering from a chronic disease. The target beneficiaries are primarily women, in the lowest categories of poverty and are almost universally illiterate. This latter fact calls into question que the efficacy of providing the loan money direct to bank accounts, which BISP indicates is an key feature of their scheme and demonstrates transparency. BISP opens aca counts on behalf of the clients and are also moving towards ‘smart card’ disbursements to clients. Services provided under the scheme include long term (15 years) of micro-finance micro loans, technical training for one family member and life assurance of 100.000 100 PKR (1.166 US$) for the family breadwinner. Loans are provided only after a family member has undergone employment related training. The available prodpro ucts were determined by the government and the BISP Board of Directors. The mechanisms are known as the ‘graduation path’ to get people out of poverty. The target population is ‘the poorest of the poor’, with a focus on women. 46 General elections were held on February 2008, the current government was formed in March 2008 with the appointment of the Prime Minister. The President was installed in September 2008. What Works? Social Protection of Informal Sector Employees EPOS Health Management 47 In addition to these mechanisms BISP is currently planning planning the introduction of ‘social health insurance’ for the poorest of the poor, with ith a BISP contribution of 1.000 1. PKR (11.66 US$) per family per annum and a pop tential benefit of up to 25.000 PKR (291,51 US$) per annum worth of health care in--kind. It seems though that the insurance fund would not be from clients and would be from subsidies as no contributions are planned. Neither is there any link planned to other health insurance schemes. BISP plans to implement the scheme through a state insurance company with private partners. Delivery of services would also be through private providers. BISP plans to pay the providers direct, rather than having an entitlement card or a reimbursement system. No risk assessment has been undertaken by BISP (or development partners pa supporting the plans). There were also no discussions yet about the benefit package and the claims process. There appears to be some confusion in understanding the basic concepts of social health insurance but BISP is confident of their approach, having having got a full time World Bank consultant helping them to prepare the detailed plans for implementation. The organisation has ‘a government mandate to support 5-7 5 7 million families’, but do not have specific tarta gets yet. Due to the limitations of targeting, targeting, the numbers of those supported are currently being measured on the basis of numbers of families reached for the various products (though BISP was unable to provide total numbers of clients or families supported thus far). A major baseline poverty survey is currently conducted across the country to determine poor population groups and levels of poverty. BISP has a budget in this financial year (2010 – 2011) of 1 billion PKR (11.66 million US$),, with funds coming from government subsidy, part grant, part loan oan from World Bank, ADB, DFID and USAID. Reserves are not invested and no premiums are paid by beneficiaries. The risks covered include life (including health) and economic risks, with an emphasis on assisting people to learn useful skills to encourage uptake of employment. BISP was conceived during the time of Benazir Bhutto as a way of targeting the ultraultra-poor or extreme poor, to try to improve their lives. After the death of Benazir Bhutto and the election success of her party, the non tion was adopted and d implemented as a key government action. Having dismantled the central ‘service’ Ministries, which would normally be the focus of social protection initiatives (education, health, labour and social welfare), the government established BISP almost as a quasi-Ministry, qua Ministry, with authority to negotiate and deal directly with external and internal donors and development partners. The organisational vision is clearly personified through the Chairperson, who acts as de facto CEO of BISP. BISP is in receipt of 1 bilbi lion on rupees in this financial year of government funds, some of which come through WB and ADB grants and loans (some of which are earmarked by WB and ADB specifically for BISP). Technical assistance has also been provided to BISP for the ‘health insurance’ programme programme planned to come into effect this year. BISP has cross party support, with the new law being passed unanimously in Parliament. Nevertheless, there were initial concerns about ethnic/ provincial bias in the selection of beneficiaries but this might have been addressed by a more objective poverty score card system. Still, this deserves investigation. 4.4.4 The Bacha Khan Income Support Programme The Bacha Khan Income Support Programme Program is being planned in Khyber Pukhtoonkhawa province. The name is taken from om the late Bach Khan who was a freedom fighter and headed the political party that is curcu rently part of the coalition government in the province. The programme program is in the planning stages and will What Works? Social Protection of Informal Sector Employees EPOS Health Management 48 follow a similar approach to previous relief programmes of being b province-specific specific and without clear-cut clear guidelines for disbursement of funds. 4.5 Conclusion In Pakistan many social protection schemes have been started, both formally and informally and this has resulted in a high degree of fragmentation and duplication. duplication. While the number of schemes increases, no rar tionalisation of existing schemes has been done, to improve coverage or efficiency or to consolidate the resources or the risk pool. The four major schemes discussed above, namely PBM, BISP, Zakat and NRSP health lth insurance model cannot be simply advocated as models for extension and funding. The political viv ability and organisational limitations of each of these are diverse. Against the backdrop of the Pakistan socio-economic economic and political culture and the inevitable inevi changes in policies and government structures, the schemes that are mentioned above seem to continue, with different names and different mandates in the provinces. BISP has been provided legislative cover by an act of Parliament. Its major flaw is that that financial relief is not adjusted according to family size. Pakistan Bait-ul Mal has a well-defined defined corporate governance structure and is covered by legislation. It has had continuous state funding since its inception. It is based on the concept of the Islamic Islamic Welfare State and traditional values of society. It has been maintained for two decades during various political upheavals. However its mandate is broadening and its ability to address the risks it purports to address is limited: the most obvious flaw aw in the functioning of PBM is the discretionary nature of identifying those who are entitled to relief and, possibly more importantly, the process of prioritization of the applicants. Zakat has an eligibility issue (since it targets Muslims only) for donors’ donors’ technical and financial support. It has an administrative structure up to union council (the smallest administrative unit of the Government of PakiPak stan). After decentralisation of Ministries it is likely that provincial governments will increase funding fund due to large share they are now receiving from the federal government through the 7th National Finance commiscommi sion award 2010. The NRSP health insurance model is relying on the organizational structure of the micro-finance micro network. It is contracting with h a private insurance company to provide services. Thus the future extension of the scheme will depend on the commitment of the private sector to its corporate social responsibility rather than to profit making, which makes it unlikely to be tenable long-term. long What is gleaming in the Pakistan case is the sophistication of the above schemes’ targeting methodologies. The schemes target beneficiaries are clearly defined to benefit the poor. For this reason, they have come up with very precise eligibility criteria and developed innovative yet practical practical instruments to accurately idenide tify them. Although this does not directly benefit the informal sector per se, the resulting database, if this would be expanded nationwide, could be used to identify the informal workers and profile them. Should the national tional government choose to service this sector, then this information would be useful in planning and formulating policies, a luxury that not all countries have. What Works? Social Protection of Informal Sector Employees EPOS Health Management 49 While all the above schemes provide some lessons for the international audience they are disparate, dis overlapping in nature, and highly selective in coverage. The future of alleviating social protection risks is more likely to lie in exploring the possibility of integrating these schemes to create mutual benefit and to signifisignif cantly increase the risk-pool pool and consolidate funding streams, while consolidating benefit packages. In ada dition, tion, the government should acknowledge the function and effectiveness of cross subsidisation and sense of ownership by the participants rather that approaching social protection protection from a ‘charity’ perspective. 4.6 Final Thoughts The social safety nets that Pakistan has put in place significantly focus on women. This reverse gender-bias gender seems to be deliberate for all the schemes that were investigated. It resonates the internationally internati recognised fact that most of poor are women and capacitating women is one of the most effective approaches to achieving the MDGs. What Works? Social Protection of Informal Sector Employees EPOS Health Management 50 5 Cross-Country Country Comparison of Best Practices for the Informal Sector There is a lot that set Kyrgyzstan, Pakistan and Vietnam Vietnam apart that finding the common ground for which to base cross-country country comparison of best practices poses difficulty. The three countries have such divergent historical trajectories that they have little in common in their current socio-political socio political systems. syste The countries though have been responsive to the international call for social protection being advocated within the United Nations and championed particularly by the ILO. Although poles apart, the three countries could be said to find common ground with ith the issue on social protection. The translation of that value i.e. provision universal protection especially to disadvantaged groups, is expressed in different ways that one is presented with various configurations of social protection systems as could could be seen in the cases above. As a starting point of comparison, we subscribe to the definition of the BMZ of social protection: “Systems of social protection support individuals or households in risk prevention, mitigation or in coping with the following aims: (i) to secure a certain absolute minimum level of socioeconomic livelihood for all individuals and households, especially for people who are physically unable to work due to age, disability, or rer duced potential to help themselves caused by poverty or other ot factors; (ii) to ensure that individuals or households not suffering from poverty do not experience a strong relarel tive deterioration in their socio-economic socio situation or a decline into poverty; (iii) to encourage poor and non--poor individuals and households to invest est in education, health and propr ductive real capital, to secure their own capability for employment and thereby improve their sociosoci economic situation through their own efforts. To us, the BMZ definition gives a useful basis in reviewing government policies policies with regard to social protecprote tion. Using this definition, we could determine how adequate a government’s response is to risk prevention and mitigation by assessing whether its socioeconomic programmes benefit the disenfranchised, the assisassi tance it provides es during economic shocks and the mechanisms it institutes to enable households to improve their lives. We have used this definition therefore to evaluate the policy frameworks of the three countries. Furthermore, we tried to assess how the three countries countries perform in terms of actualising their policies on sos cial protection in relation to the informal sector. In doing this we find useful GIZ’s three dimensions of uniun versal coverage, which was shown in Figure 1. Coverage of the informal sector depends on how h well the system identifies and responds to needs of the informal sector. We noted that a country’s regard of its ini formal sector’s role in economic development explains the attention given to providing targeted services. It deserves to mention the approach ach employed to reach the informal sector and the depth and breadth of serse vices that are made available for them. 5.1 Policy Framework A coherent policy framework for a social protection system implies guaranteeing a set of services that insulates the household from economic blows that would cause it to spiral down poverty. These services are broad-range range from vocational training and job placement to provision of insurance coverage and basic health What Works? Social Protection of Informal Sector Employees EPOS Health Management 51 care among others.. The initial step for a country country is to identify crucial protection gaps and determine a suitsui able configuration of services that would facilitate closing these gaps. It means therefore that every country would have its own set of social protection services and products according to what what it sees as priority risks of its vulnerable population. This said, said the countries of Kyrgyzstan, Pakistan and Vietnam have their unique policy framework in supplementing a rationale for the services it chose to implement. We show below the different legall instruments used by these countries that make up their social protection system. Table 7:: Configuration of social protection system in three countries: Vietnam, Pakistan, Kyrgyzstan Social protection services Vietnam Pakistan Kyrgyzstan State pension, 1992 Unified Monthly Benefit (Presidential Decree 1995) Law on State Benefits, 1998 Insurance of formal workers Labor code, 1998 Law on social insurinsu ance, 2006 Law on social health insurance, 2009 West Pakistan employees social security ordinance of 1965 Employees old age benefits act of 1976 Insurance of informal workers Provision on voluntary participation in Law on social insurance, 2006 Voluntary contribution provision in Law on social health insurance, 2009 Home-based workers social protection act, 2008 Social assistance for specific target beneficiaries Decrees directing propr vision of social assisassi tance to poor and households with severe disabilities Program No. 134 which supports house buildbuil ing and land production for ethnic minority groups Zakat and Usher ordinance (1980) provides financial assistance to needy Muslims Bait-ul-Mal Act (1992) provides assistance to orphans and widows, stipends for educational activities, medical care, rehabilitation from job-related accidents and injuries and disbursements to disabled people Benazir Income Support Act (2010) which provides life assurance package for eligible poor Support entry to labor market Master Plan on VocaVoc tional Training and Employment Creation for youth in 2008 – 2015 Master Plan on VocaVo tional Training for Rural Labour by 2020 Several decrees crecr Benazir Income Support Act (2010) which provides micro-finance after employment related traiing What Works? Social Protection of Informal Sector Employees EPOS Health Management 52 Social protection services Vietnam Pakistan Kyrgyzstan ated the labour ded mand-suppy suppy matching service and the eme ployment introduction centers Decision No. 33/2007/Q 33/2007/Qð-TTg creates support structures for migration and setse tlement of ethnic minormino ity people peopl Ordinance on Disabled People issued, 1998 created employment funds for disabled peope ple It is evident in the table above that Vietnam is far advanced out of the three countries in laying the legal bab sis for its social protection system. The three countries have national policies that set out targets and interinte ventions to institutionalize social protection mechanisms. A step more progressive progressive than the rest, Vietnam places importance not just on provision of social security through insurance and social transfers but also economic security through employment opportunities. Needless to say, the three countries have their rer spective Poverty Reduction uction Strategy that ensures ensure provision of essential services to the poor. In terms of institution structures, both Vietnam and Kyrgyzstan have clear lines of authority from oversight to administration in actualizing their respective social protection policies. policies. For both countries, national Ministries take the lead in steering social protection structures. Pakistan has devolved much of the functions to the provincial offices, which confuses overall supervision. The table below shows the different administrative administrati organizations that take on functions for the social protection system. Table 8:: Oversight and administration of the social protection schemes Administrative Organisation Vietnam Pakistan Kyrgyzstan Old Age, Disability and Survivors National oversight and supervision Ministry of Labor, InvaInv lids and Social Affairs Ministry of Labor, Manpower and Oversees Pakistanis Ministry of Labor and Social Protection Administration Vietnam Social Security Employee’s Old-Age Benefits Institution Provincial and county Prov offices of the Ministry of Labor and Social Protection administer the program, Social fund administers beneben fits Sickness and Maternity What Works? Social Protection of Informal Sector Employees EPOS Health Management 53 Administrative Organisation Vietnam Pakistan Kyrgyzstan National oversight and supervision Ministry of Labor, InvaInv lids and Social Affairs Devolved to the Provincial Labour Departments Cash benefits: benefits Social Fund Medical benefits: benefits Ministry of health and health departments of local governments Administration Vietnam Social Security Provincial Employees’ Social Security Institutions administer the program in each province. The Institutions are managed by a tripartite governing body and a commissioner Cash benefits: benefits Social Fund administers, eme ployers pay cash beneben fits Medical benefits: benefits Ministry of Health and local health departments administer medical medica services, Mandatory Health Insurance Fund provides health care benefits National oversight and supervision Ministry of Labor, InvaInv lids and Social Affairs Social security: Provincial Labor Department Workmen’s compensation: Workmen’s compensation commissioners in each province Temporary disability benefits Social Fund benefits: Permanent disability and survivor pensions: pensions Ministry of Labor and Social Protection Medical benefits: benefits Ministry of Health and health departments of local governments Administration Vietnam Social Security Provincial Employees’ Social Security Institutions in each province Temporary disability benefits enterprises benefits: and employers pay cash benefits Permanent disability and survivor pensions: pensions Provincial county ofo fices of the Ministry of Labor and Social ProPr tetion Medical benefits: benefits Ministry of Health and health departments of local governments National oversight and supervision Ministry of Labor, InvaInv lids and Social Affairs No statutory unemployment benefits Employment service Administration Vietnam Social Security Work Injury Unemployment Local employment cence ters Family Allowances What Works? Social Protection of Informal Sector Employees EPOS Health Management 54 Administrative Organisation National oversight and supervision Vietnam None Pakistan None Administration Kyrgyzstan Ministry of Labor and Social Protection Local offices of the Ministry istry of Labor and Social Protection Although much is to be desired in optimising agency performance, the state structures that Vietnam has set up reflect the coherence of its social protection policy - concentrating key functions to two agencies. InciInc dentally, Vietnam has also set up the Institute of Labor Science and Social Affairs, which aims to support the national agencies through research. search. Kyrgyzstan maintains two separate funds for its social insurance and mandatory health insurance, with two independent agencies administering their respective programs and benefits. In terms of supervision, the funds are overseen by two separate Ministries. Ministries. Its reason to separate the funds maybe is in recognition of the difference in the nature of risks being covered and how benefits are dispensed. Separation also insuins lates the funds from each other in the event of insolvency, which makes the system more stable. However in addition to the insurance, Kyrgyzstan has overlapping cash benefits that are awarded for the same condicond tions, which has made the system be perceived as fragmented. 5.2 Extending ding Social Protection to the Informal Sector S Among the three countries, ountries, Kyrgyzstan leads the way in specifically addressing the informal sector. ReR ferred to as the shadow economy, the informal sector is defined mainly as unregistered enterprises and rer garded as causing unfair competition, distortion of statistics and tax deficit. Despite having negative connoconn tation ascribed to the so-called called shadow economy, Kyrgyzstan is the only country that has a particular policy that is directed at and seeks out the informal sector.47 To no surprise, it keeps a profile of the types of economic activities the informal sector are engaged in and is interested in knowing the proportion in the statisstati tics these sub-groups groups comprise. Kyrgyzstan’s main approach to the informal economy is legalisation, which is expected to help balance out the country’s fiscal position following improved tax collection. An improved cash flow will help relieve the burden of providing social services. Estimated between 40 to 53% of the country’s GDP, the informal economy is a big resource for the Government to tap tap and a significant strain to the country’s social infrastructure. Kyrgyzstan sees legalisation as a way to cut the vicious cycle of deficits in social services as a result of badly performing tax revenue. Although it should be said that deficiency in tax collection as well as corrupt practices could as well affect tax revenue performance. Although the move to legalise the informal sector is primarily economic, doing so would provide the informal workers access to mainstream programs of the government. It could be said then that part of Kyrgyzstan’s 47 Athough Vietnam purportedly instituted the voluntary schemes for the informal sector, which they consider vital to their econeco omy, there is no mention of the sector as a group and as a priority of the government for its social protection programmes in the policy documents reviewed. This is in contrast with Kyrgyzstan that has a clear polity standpoint on the matter. What Works? Social Protection of Informal Sector Employees EPOS Health Management 55 intention to register the informal sector is to integrate them to government systems that include social secusec rity. Mainstreaming of the informal sector could also be considered an approach being pursued by Vietnam. Vietn Like Kyrgyzstan, Vietnam has registered its farmers and is enforcing registration of casual employees and informal enterprises. Registration allows Vietnam to insist on compulsory insurance of labourers under the social security system of the government. government. However, in contrast to Kyrgyzstan, Vietnam has a voluntary ini surance scheme catered specifically for people who fall through the compulsory program. This scheme has not been as intently campaigned as it should and is slow on membership uptake. Nevertheless, Neverthe the government is planning to invest in subsiding premiums of eligible beneficiaries to increase membership. Both Vietnam and Pakistan are silent about the informal sector and have no clear policy in addressing their needs. To match Vietnam’s voluntary volunta scheme, Pakistan has the Home-based based Workers Social Protection Act of 2008. Enforcement of the act had only been documentation of workers in the informal economy and fell short of setting up an actual fund for their protection. The act had now been repealed repealed and was replaced with the Benazir Income Support Program, which targets the poor and near poor. In Pakistan, the resort for ini formal workers is to be categorised as poor to access BISP. Although, this in a way is true for Vietnam and Kyrgyzstan as well,, both countries either offer an alternative avenue or aggressive campaign in integrating the informal sector into the mainstream social protection system. 5.3 Comparison of Benefits and Disability Package Vietnam has the most generous coverage among the three in terms of cash benefit (which for the informal sector includes survivorship and pension). However, Kyrgyzstan provides a better range in terms of number of risks covered. Pakistan’s package is meager in both breadth and depth. Kyrgyzstan uses notional defined contribution to determine eventual pension obligations. This means that the payouts are not tied to the workers’ last salary but to how much the individual contributions earn (as explained in the previous chapter). This makes the system financiallyy sustainable in contrast to Vietnam and Pakistan where pension payouts are taken from current tax revenue, which makes disposable funds for payouts vulnerable to deficit. The table below also shows pension regulations in the three countries and additional additional assistance afforded to the disabled. All three extend disability benefits in case of work-related work related injuries and permanent disability, with additional financial support as in the case of Pakistan. In Vietnam, disabled people are enrolled in vocavoc tional trainings inings and could access employment funds so that they are integrated into the labor force. Table 9: Benefits and disability package in the three countries Vietnam Pakistan Kyrgyzstan Type of program (National) Social Insurance including voluntary scheme, social assistance program Social insurance program, voluntary pension system and social assistance programs (operations devolved provincially) Social insurance, notional defined contribution (NDC), mandatory individual aca count and social assistance program m Benefits for the insured Old age pension: 45% of the insured’s average earnear ings for the first 15 years of Old age pension: 2% of the average monthly earnings in the last 12 months multi- Old age pension: the monthly benefit is the sum of several components: a What Works? Social Protection of Informal Sector Employees EPOS Health Management 56 Permanent disability benefits for insured workers Vietnam Pakistan Kyrgyzstan contributions plus 2% (men) or 3% (women) of the insured’s covered ava erage monthly earnings for each year of contributions exceeding 15 years is paid. Average earnings are based on 5 to 10 years of contributions or the whole contribution period, ded pending on length of conco tribution and wage. The maximum pension is 75% of the insured’s averave age earnings. Insured persons with more than 30 years of contribucont tions also receive a lump sum of 50% of their averave age monthly earnings in the last 5 years before the pension is first paid for each year of contributions exceeding 30 years. Early pension: The pension is reduced by 1% of the insured’s average earnings for each year the pension is taken before the ini sured’s normal pensionable age. The minimum benefit is the monthly minimum wage. The monthly minimum wage is 730.000 VND. Benefit adjustment: BeneBen fits are adjusted according to changes in the cost-ofcost living and economic growth. Old-age age grant: A lump sum based on the number of years of covered employemplo ment and average monthly earnings is paid. plied by the number of years of covered employment is paid. The minimum old-age pension is 3.000 rupees a month. Early pension: The pension is reduced by 0,5% for each month that the pension is taken before the retirement age. Benefit adjustment: Benefits are adjusted on an adhoc basis. Old age grant: A lump sum of 1 months of earnings for each year of covered employment is paid. basic flat-rate flat benefit (800 soms or 12% of the averave age wage in the last year, whichever is higher), hi a transition component, an NDC component and a benefit based on the value of the individual account from 2010 onward. The transition component is calculated as average earnings for 60 consecutive working months multiplied by 1% for every complete year of insured employemplo ment before 1996. The NDC component is calcucalc lated as accumulated conco tributions (of at least 1 year) from 1996 onward divided by 12 months and multiplied by a coefficient. There is no maximum penpe sion. The maximum average earnings used to calculate benefits are 23 times the basic rate. The basic rate is 100 soms. Partial pension: A percentpercen age of the full pension s paid according to the numnu ber of years of covered employment. Pension supplement: 20% to 475% of the basic rate is paid. Benefit fit adjustment: BeneBen fits are adjusted periodiperiod cally according to changes in the cost of living. Disability grant: A lump sum is paid (not yet defined by legislation). The old-age old pension is paid to certain groups of insured persons with an assessed disability of at least 61%. Disability pension: 2% of the average monthly earnings in the last 12 months multiplied by the number of years of covered employment is paid. The minimum pension is 3.000 rupees ($35.12) a month. Disability pension: If asa sessed with a Group I or Group II disability, the monthly benefit is calcucalc lated as the sum of several components: a basic flat rate benefit (800 soms or 12% off the average wage in the last year, whichever What Works? Social Protection of Informal Sector Employees EPOS Health Management 57 Vietnam Pakistan Benefit adjustment: Benefits are adjusted on an adhoc basis. Additional social assistance to disabled people 5.4 Employment funds for the disabled; vocational traintrai ings Kyrgyzstan is higher), a transition component, and an NDC component. The transition component is calculated as average earning for consecutive working months multiplied by 1% for every complete year of insured employemplo ment before 1996. The NDC component is calcucalc lated as accumulated conco tributions (of at least 1 year) from 1996 onward divided by 12 months and multiplied by a coefficient. Constant Constant-attendance supplement: 150% of the basic rate is paid for blind perpe sons and 50% of the basic rate for other categories of disabilities. The basic rate is 100 soms (January 2010). Partial pension: A percentpercen age of the full pension is paid according to the numnu ber of years of covered employment. Pension supplement: 50% to 475% of the basic bas rate is paid. Benefit adjustment: BeneBen fits are adjusted periodiperiod cally according to changes in the cost of living. Bait-ul-Mal provides assistance, medical care, rehabilitation for job-related accidents and injuries and also disbursement to disabled people Contrasting the configuration of social protection mechanisms available for the ini formal workers Finally, we summarize below the various social protection schemes that were available for the informal secse tor. We list down, aside from the national programmes, products offered by commmercial sector and the non-profit profit organizations. The discussions above have centered on Governments, which have always been the dominant player and biggest provider of social security services. We show the table below to illustrate What Works? Social Protection of Informal Sector Employees EPOS Health Management 58 how the other agents respond to fill in the gap left open by Governments as they trod contrasting developdevelo ment ideals. Table 10: Social protection protection of the informal workers in the three countries Vietnam Pakistan Kyrgyzstan National programme Informal workers are able to participate through the voluntary scheme for both health insurance and social insurance. Social ini surance uptake rer mains low since workers have to pay for the premiums full without counterpart. Seasonal workers, migrant workwor ers and street vendors lack access to the nan tional programmes. program The voluntary health insurance has considconsi erable uptake although adverse selection apa pears to be the reason. Poor Informal workers could access livelihood support and social assistance provided by BISP, Zakat fund and Bait-ul-Mal. There are no government social security programs available for people without formal employment. Informal workers would woul only be able to access national social security programs if they are registered; voluntary health insurance are meant for informal workers Commercial insurance Mainly breaking into the micro-insurance micro market. MicroMicro insurance is tied to mim cro-credit credit programs of community organizaorganiz tions. Although they service the informal sector, they are most often confined to a geographical area. Micro-insurance products are attached to loans which are awarded to qualified poor individuals. Commercial insurance is the only option to an informal worker not eligible to participate in pro-poor programs Small and target the high high-end market Non-profit tions Started as micromicro finance that now offer insurance products. These schemes are local and often have small risk sk pools with limited service packpac age. NGOs are the primary insurance providers and they operate in a defined locality organiza- We see above that in terms of providing insurance to the informal sector, the Governments of Vietnam and Kyrgyzstan have been the main players. Particular to Kyrgyzstan, benefits offered by the national propr gramme are comprehensive that the only demand commercial insurances could fill is to top-up top the existing package, which is what is seen in European countries. Since the commercial insurances insur providers are unlikely to offer packages for the informal sector, technical support would potentially be of value in assisting What Works? Social Protection of Informal Sector Employees EPOS Health Management 59 the government legalise and integrate the informal workers to mainstream programs. This is likewise true for Vietnam. The government overnment of Vietnam would benefit from developing systems to register informal workwor ers so that they join the compulsory program or effectively target deserving individuals for subsidies under the voluntary scheme. Assistance is also needed in marketing the the voluntary insurance to the informal secse tor. Since they work with community organisations, both the commercial and the non-profit non profit sectors in Vietnam could be used to reach informal workers in geographically-isolated geographically isolated areas, which are usually remote to the national programs. Mechanisms adopted by community organisations are briefly explained in the chapter on Vietnam. The Government of Pakistan mostly target the poor and near-poor near poor and generally leave out the informal secse tor. It would not be to anyone’s surprise surprise if the commercial providers are found to be very active in filling this gap. Intervention would be necessary to commit commercial insurance into providing more responsive packages for informal workers at a reasonable premium. Public-private Public partnership p could yield innovative arrangements such as government premium co-payment, co payment, tax incentive and intermediation. What Works? Social Protection of Informal Sector Employees EPOS Health Management 60 6 Recommendations We have outlined our recommendations using the dimensions of universal coverage. We put forward these recommendations with the caveat that they could not be expected to be entirely relevant to a particular setse ting. Moreover, given that we conducted the study in a limited period, our findings are naturally not exhausexhau tive. mproving coverage of the informal sector On improving Governments have ve to first clarify their respective policy standpoint with regard to the informal economy. We are presented with three scenarios in the study. Workers in this sector could be seen as detrimental to development (Kyrgyzstan), capable of providing for their thei own needs (Pakistan) and instrumental to economic growth (Vietnam). Since all three countries commit to universal social protection, then they would have different frameworks on providing social protection to their informal workers, none better than the others. GIZ could facilitate this process by creating the fof rum to discuss this. As we have noted, not every country would see as essential having a common understanding of the sector and its needs in terms of services. As we have seen in the three cases, governments have the main task of identifying and classifying the informal sector. This is necessary because the informal sector itself could be segmented in difdi ferent categories based on the nature of risks that they are particularly exposed to. We point to the government as having this responsibility because it is the only institution that has stake in universal coverage, while other institutions (say commercial insurance or even non-profit non organisations) would tend to focus on a particular segment. GIZ could could provide the necessary technical support to do the informal sector (market) segmentation. In Vietnam and Kyrgyzstan, voluntary schemes were set-up set up to draw participation of the informal sector. Much is to be desired though in terms of marketing the product. product. In any case, creating these platforms whereby an informal worker has ease in enrolment is a good first step to reaching this group. GIZ could bring its own experience in assisting countries to set up voluntary insurance schemes. or the informal worker especially if the premiums for the voluntary insurance are Price is an issue for pegged at the minimum wage. Particularly for the near-poor, near poor, who has intermittent income, mainmai taining premium payments would prove to be a challenge. None of the cases showed an alternative formula to make premiums more equitable and distributive. There is definitely need for technical assistance in this area. On expanding depth and breadth of coverage In all three cases, it is not demonstrated that insurance products were developed developed on the basis of the informal workers’ risks and demand for social protection. Doing a thorough market study would have established what should be the appropriate coverage for this group to protect them against economic shocks or secure their livelihoods. livelihoods. In the voluntary insurance of Kyrgyzstan and Vietnam, the benefits are made universal, i.e. there is a single benefit package across the board. Although What Works? Social Protection of Informal Sector Employees EPOS Health Management 61 the bases of which could be the computation of the minimum essential services, an insurance product oduct could not be expected to appeal to all segments of the informal sector. As seen in VietVie nam, informal workers are hesitant to commit their money and wait for 20 years for their old age benefit, the reason why enrolment in the voluntary social insurance insuran is low. Portability seems to be an important feature that attracts the informal sector given their mobility. Proximity of the programme to the beneficiaries and the fact that they could bring it with them when they need to move are factors in maintaining g participation in the scheme. A centrally administered programme makes it feasible for this system to operate. Vietnam could offer its experience in making its benefits portable. What Works? Social Protection of Informal Sector Employees EPOS Health Management 62 Annex 1: Methodological Considerations Definition of Social Security According to the “Sector Strategy on Social Protection” by BMZ, social protection is defined in the following way: “Systems Systems of social protection support individuals or households in risk prevention, mitigation or in coping with the following aims: (iv) to secure a certain absolute minimum level of socioeconomic livelihood for all individuals and households, especially for people who are physically unable to work due to age, disability, or rer duced potential to help themselves caused by poverty or other factors; facto (v) to ensure that individuals or households not suffering from poverty do not experience a strong relarel tive deterioration in their socio-economic socio situation or a decline into poverty; (vi) to encourage poor and non-poor non individuals and households to invest in education, ucation, health and propr ductive real capital, to secure their own capability for employment and thereby improve their sociosoci economic situation through their own efforts. A variety of agents can be the sponsors of such social protection systems: • • • • informal communities of mutual solidarity based on family ties, neighbourhood or friendship whose members support each other in case of emergency; cooperative systems based on membership which are founded upon the goal of self-help self (cooperatives, mutual self-help help associations), a commercial enterprises (insurance companies, companies offering employer-sponsored employer insurance schemes); and the state or public sector institutions (like social insurance and social assistance). In this, the state determines the framework for the interaction of all stakeholders and is responsible for ene suring that all systems are inclusive for the poor.” poor. (BMZ, p. 7) For the purpose of the best practice study we are assuming that we are focusing on the cooperative syssy tems and state or public ic institutions in the three countries. Target Group This study intends to showcase social protection systems that cater to informal sector groups. To further scope this study, we shall subscribe to the International Labour Organisation’s (ILO) definition defini of informal sector, which is “broadly characterised as comprising production units that operate on a small scale and at a low level of organisation, with little or no division between labour and capital as factors of production, and with the primary objective bjective of generating income and employment for the persons concerned.” Statistically, they are thought to comprise those household unincorporated enterprises with market production that are: informal own account enterprises (optionally, all, or those that that are not registered under specific forms of national legislation); enterprises of informal employers (optionally, all those with less than a specified level of employment and/or not registered and/or employees not registered). registered Of particular interest of this study are mechanisms employed by these social protection systems that could be categorised as best practice in targeting and covering risks among the informal sector. Since best pracpra tice mechanisms inherently imply some form of organisation, the study study shall examine cooperative systems and state or public institutions. This is not to exclude other systems especially if these systems could showcase remarkable features. In identifying best practices therefore, the study shall look at successes in two broad criteria: 1. Coverage ratio: number of people participating in the scheme within the target group vis-à-vis vis total target population What Works? Social Protection of Informal Sector Employees EPOS Health Management 63 2. 3. Coverage Depth: how much financial mitigation is provided in cases of catastrophic expenditure or when exposed to risks Coverage Breadth:: the range of social protection products made available for clients. Approach The study shall employ three approaches in identifying and examining social protection best practices. Other than to gather information, these approaches make possible cross-referencing, referencing, data verification and cross-validation. • Desk research. The review of available documents shall endeavour to provide an overall picture of the social protection landscape in terms of legal and regulatory frameworks and the different di agents involved. The main objective is to list down a menu of social protection systems that are made available to the informal sector following statutory or legal mandates. Data sources would include governmental units e.g. departments of labour and social welfare, as well as, constituted bodies and institutes and civil society organisations. • Key informant interviews. Interview of key informants shall substantiate information acquired from desk research with the intention of deepening appreciation appreciation of national policy and the consequent configuration of social protection systems and their mechanisms. Interviews will also be done to further inquire about best practices among noteworthy social protection systems. • Site visits. Multiple respondents respondents will be sought for interviews during visits of selected sites to ini quire about key operation and organisational elements of social protection systems. It is expected that investigation of these key elements would reveal best practices that could be readily read attributed to successes in reaching the systems’ respective coverage targets and/or providing substantial risk protection. Guideline Conduct of Desk Review. Documents review shall list down available social protection systems available for the informal mal sector and identify defining features of these systems for comparison. Following the BMZ, social protection systems have the following defining classification: 1. In terms of employed protection rotection mechanism: a. Risk prevention b. Risk mitigation c. Coping 2. In terms of the principal agent: gent: a. Informal communities of mutual solidarity b. Cooperative systems c. Commercial enterprises d. State or public sector institutions 3. In terms of type ype of risk averted a. Life cycle risks (age, disability, permanent incapacity for work) b. Health th risks (illness, accidents, epidemics) c. Economic risks (unemployment, price shocks) d. Natural and ecological risks Itt could further be classified in terms of its financing/financial management: 4. Whether financing is: a. Tax-based b. Contributions c. Others (donors, etc.) 5. Whether reserves are invested What Works? Social Protection of Informal Sector Employees EPOS Health Management 64 6. Whether there is cross-subsidy subsidy To situate social protection schemes under investigation, the study will provide background information about each of the country, which will pertain particularly to policy frameworks that govern social protection mechanisms and coverage of the informal sector. Document review will thus further entail research on exe ecutive orders and decrees, legislations, policy papers and strategic promulgations and directives that were articulated att the national level on how to approach social protection of informal sector. Regulations for mim croinsurance, mutual benefit schemes and other forms of risk mitigation for those outside employment conco tracts would also be investigated. The intention is to illustrate the political context that provides the setting for how these schemes should operate. Document review should answer the following research questions: 1. 2. 3. 4. 5. 6. How is the informal sector group regarded in relation to the ILO definition? How are they identified i (in terms of employment arrangement, income, economic activity, etc.)? Is ensuring social protection a national agenda? How is social protection defined and what are the defining features of social protection schemes? What is the approach to social social protection of the populace? Who are the principal agents? Is coverage of the informal sector an articulated target? Are non-state non state providers of social security products incentivised for reaching traditionally-considered traditionally non-commercial commercial markets? What legislations, gislations, executive decrees and regulations impose themselves on social protection schemes? What do published literatures say about the status of social protection in the country, particularly on how well is able to cover for risks affecting the informal sector? Specific to the last question, relevant articles from reputable sources would also be reviewed. Conduct of Key Informant Interviews. Interviews will be open-ended and face-to-face face and shall encourage respondents to expound on particular themes. The following are suggested themes during interviews of key informants. 1. 2. 3. 4. 5. 6. 7. 8. 9. The mandate/organisational vision of the social protection system, who who formulated it and how strongly this was communicated How accomplishment of the vision is being measured How intended beneficiaries/targets are being reached, eligibility drawn, and communication stratstra egy is being implemented How contributions are determined determined and how to ensure take up and retention in the light of irregular incomes How products/packages are developed and the basis for providing them Portability of the products offered How claims are processed The client/participants’ level of satisfaction General impression of clients’ financial literacy Selection of the key informants will be on the basis of referral from national agencies and then later through snowballing. It is assumed here that national agencies would have knowledge of social protection protect mechanisms that are in operation. Key people of these national agencies would be respondents as well in interinte views to supplement information gathered from document review. These offices include, but not limited to: 1. 2. 3. 4. 5. National office for social welfare National office for health services State-run run social security systems and health insurance Insurance regulatory bodies Research institutes for social security Conduct of Site Visit.. From the above inventory of social protection schemes, sites to be visited visit will be selected on the basis of coverage ratio and coverage depth (defined in the previous section). It is assumed that schemes that do well on these criteria would have good practices that merit elaboration as case studstu ies. What Works? Social Protection of Informal Sector Employees EPOS Health Management 65 Appendix I: Document review view checklist 1. Documents relating to the identification of the informal sector and definition of services that provide social protection Title of the policy paper 1. Description (Note here in verbatim the operational definitions used) 2. 3. 2. National agenda on social protection of the informal sector Title of the legislation/decree Description (Identify here promulgations in relation to social protection of the informal sector with reference to the research questions for document review) 1. 2. 3. 4. 5. 6. 3. Regulations governing social protection schemes Title of the legislation/decree Description (Identify here regulatory bodies created for oversight and their mandate in terms of monitoring social protection schemes) 1. 2. 3. What Works? Social Protection of Informal Sector Employees EPOS Health Management 66 Appendix 2: Topical Outline for Interviews of Key Informants in National Agencies (Note: Representative of regulatory bodies should be part of key informants if particular items in the policy paper need elaboration) Key Informant: Office and position: 1. Elaboration on the policy instrument being used by the government to provide social protection and how it ties es to overall national agenda e.g. poverty reduction 2. The state’s principal agent in providing social protection 3. The mechanism used to reach the informal sector 4. Performance targets in terms of reaching the informal sector and the degree by which they are achieved 5. Support given to non-state state social protection schemes that target the informal sector 6. Involvement of the private sector 7. Other topic arising (Specify): What Works? Social Protection of Informal Sector Employees EPOS Health Management 67 Appendix 3a: Social Protection Schemes Inventory (Note: Source of data would be respondents from national agencies or research institutes; this tool shall be used to identify schemes to be interviewed for case study) Name of the organisation: Address: 1. Nature of association (please tick appropriate box) Informal communities of mutual solidarity Cooperative system Commercial State or public 2. Products offered 3. Types of risks covered Life cycle risks (age, disability, permanent incapacity for work caused by pregnancy or death in the family) Health risks (illness, accidents, epidemics) Economic risks (unemployment, price shocks) Natural and ecological risks 4. Source of financing premium Contributions (out-of-pocket) pocket) Tax (government subsidy) Donor Others (specify): 5. Reserves are invested? Yes (specify): 6. No Premiums adjusted according to capacity to pay? Yes 7. 8. No Coverage ratio (proportion of people participating in the scheme within the target group vis-à-vis vis total target population) Coverage Depth: (comment on degree of financial mitigation provided in cases of catastrophic expenexpe diture or exposure to risks) What Works? Social Protection of Informal Sector Employees EPOS Health Management 68 Appendix 4: Topical Outline for Interview of Key Informants in Selected Social Protection Scheme for Case Study Key Informant: Organisation: Office and Position: 1. The mandate/organisational vision of the social protection system, who formulated it and how strongly this was communicated 2. How accomplishment of the vision is being measured 3. How intended beneficiaries/targets are being reached, eligibility drawn, and communication stratstra egy is being implemented 4. How contributions are determined and how to ensure take up and retention in the light of irregular incomes 5. How products/packages are developed and the basis for providing them 6. Portability of the products offered 7. How claims are processed 8. The client/participants’ level of satisfaction 9. General impression of clients’ financial literacy What Works? Social Protection of Informal Sector Employees EPOS Health Management 69 Annex 2: Meeting Schedule for Vietnam DATE INSTITUTIONS/ PERSONS PERSON TO BE MET CONTACTS/ VENUE Friday, 18 February Meeting with Ms. Brigitte Koller, CTA, GIZ Poverty Reduction Project 2, Dinh Le Hanoi Meeting with ILLSA (MOLISA) • Dr. Ngoc, Vice Director of ILSSA • Mr. Bui Xuan Du, Manager of the Social Security Division, ILSSA 2, Dinh Le Hanoi 9h00 Ms. Kim Dung Interim Country Director Oxfam Great Britain Le Kim Dung 22 Le Dai Hanh Ha Noi, Viet Nam Tel: +844-3945 3945 4362; ext. 141 Fax: +844-3945 4365 Email: [email protected] Web: www.oxfam.org.uk 11h00 World Bank Christian Bodewig Senior Economist, Human DevelopDevelo ment Sector Unit World Bank Office in Vietnam 63 Ly Thai To, Hanoi Tel: +84-4-3934 3934 6600 Ext. 264 Fax: +84-4-3935 0752 [email protected] 10h30 Community financial resource centre Ms. Le Lan Director of CFRC Căn hộ số 4 dãy ãy A14 khu ñầm trấu, liền kề khách sạn ðặng ặng Anh (ñối diện bến xe Lương Yên). 14h00 ILO Hanoi Meeting with Ms. Loan, Micro-insurance/ insurance/ microfinance [email protected] 50, Nguyen Thai Hoc, Hanoi Meeting with Social insurance departdepar ment, Ministry of labor and Social AfA fairs 2 Dinh Le street, Hanoi 14h00-15h00 Monday, 21 February 14h00 – 15h30 Tuesday, 22 February Wednesday, 23 February Thursday, 24 February 8h30 Topic of discussions: Formulation of policy on voluntary social and health What Works? Social Protection of Informal Sector Employees EPOS Health Management 70 DATE INSTITUTIONS/ PERSONS PERSON TO BE MET CONTACTS/ VENUE insurance policies 10h30 Meeting with Institute for insurance studies, Vietnam Social Security Area of discussion: Implementation of voluntary social and health insurance policy 61 E, De La Thanh street, Hanoi 8h30 ðỗ Hoàng àng Phương Ph (Mr.) D. General Manager of Health insurinsu ance and Personal Accident Dept. BaoViet Insurance Corporation 35- Hai Ba Trung Hanoi 14h00-15h15 Oxfam Belgium Thibaut Hanquet 22 Le Dai Hanh, Hanoi 15h30-16h30 Debriefing session with the Poverty Project Friday, 25 February What Works? Social Protection of Informal Sector Employees EPOS Health Management 71 Annex 3: List of People Met in Pakistan Organisation People met ILO Islamabad ILO Building, Sector G-5/2, 5/2, IslamaIslam bad Manzoor Khaliq Senior Programme Officer Benazir Income Support ProPr gramme, Islamabad BISP Secretariat, Ataturk Avenue GG 5/2, Islamabad +92 51 9215331 [email protected] Dr. Muhammad Tahir Noor, Director, Donor CoordiCoord nation Gul Najam Jamy, Project Manager, Social Safety Nets Syed Javed Abbass, Director, Health Product Farazana Raja, Chairperson National Rural Support Programme, Islamabad 46, Aga Khan Road, Sector F-6/4, F Islamabad Agha Ali Javaid, General Manager Jawad Rehmani, Senior Programme Officer Pakistan Bait-ul-Mal Head Office, Street No 9, Sector HH 8/4, Khayaban-e-Johar, Johar, Islamabad +92 51 9250461-4 [email protected], [email protected] Zamurrad Khan, Managing Director Khalid Raza, Director, IT Planning Commission P Block, Pak Secretariat, Islamabad Saba Gul Khattak, Member Social Sector GIZ Imran Masson Durrani, Senior Advisor and Head of Social Protection st Adamjee Insurance, 1 Floor BusiBus ness Center, I I Chudrigar Road, Karachi Captain Mehmood Sultan, Senior Program Office, Corporate Division What Works? Social Protection of Informal Sector Employees EPOS Health Management 72 Annex 4: List of People Met in Kyrgyzstan Name Joe Kutzin Mr. Bolotbek Orokov Position Contact WHO Tel.:+34 93 241 8270 [email protected] ILO Kyrgyzstan 215 Tynystanov Street, Room 418 Bishkek 720040 Kyrgyzstan Tel./Fax: +996 312 624 539 +996 312 624 539 E-mail: [email protected] ocus group discussion List of participants of the focus 1. Madina Kasmankulova 2. Ayzada Kadikulova 3. Gulmira Kalikova 4. Davleta Sakieva 5. Olga Kim – separate meeting 6. Aleksandr KimKim separate meeting 7. Farrukh Tyuryaev 8. Aziz Tyuryaev What Works? Social Protection of Informal Sector Employees EPOS Health Management 73