First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
The article sets out key elements of the policy agenda for enhanced integration between health and social care for older people in high-income countries and demonstrates its wider relevance to low- and middle-income countries (LMICs). The article then explores the context for this agenda in Brazil, including growing demand for long-term care (LTC) and current institutional arrangements. It goes on to discuss a case study project of partnering for LTC between local social assistance and health agencies in the Brazilian city of Belo Horizonte. It identifies challenges and potential benefits of this partnership model, offering policy insights for LTC policy in Brazil and other countries.
First published in April 1948 as the Bulletin of the International Social Security Association, this year marks the 75th anniversary of what, since January 1967, we have all come to know as the International Social Security Review. To mark this important anniversary, this special double issue, “The human right to long-term care for the elderly: Extending the role of social security programmes”, talks to current debates on social security coverage extension in a context of population ageing. There is a case to be made for revising the international social security standards to formally recognize long-term care for the elderly, possibly as a distinct branch of social security. At the heart of this discussion, the questions to be addressed by all countries are the roles that social security systems can and should play in helping to meet the long-term medical and social care needs of elders.
With the acceleration of population ageing, healthy ageing is becoming an imperative for all. Social protection systems have an important role to play in this endeavour. Through a life cycle approach, social protection systems can support i) the prevention of disability in old age (i.e. by addressing the social determinants of health and rehabilitation), ii) effective access to long-term care without hardship for those who need it, and iii) decent work in the care economy. To do so will require adopting a gender-transformative approach. Indeed, women are disproportionately represented among both older persons and long-term care providers in their diversity. Further, to adequately contribute to healthy ageing and effective access to long-term care without hardship as a rights-based entitlement, social protection systems will need to build strong coordination between health care, social care and other social policies. This article highlights the key entry points for social protection systems to contribute to the United Nations Decade of Healthy Ageing, building on the rights-based approach of human rights and international social security standards.
The family is the dominant player in India’s current long-term care (LTC) system. Yet informal family-based arrangements will be insufficient to accommodate India’s growing need for LTC due to increasing longevity and geographic mobility, the prevalence of chronic disease and disability among the elderly, and the decline of extended family living arrangements. Addressing the growing need for LTC will require a robust expansion of the current LTC system, especially its non-familial components. This overhaul will require investments in infrastructure, human resources and legal and regulatory environments. The objectives of this study are to i) provide a descriptive summary and analysis of the LTC system in India, with attention to cross-state heterogeneity and to the financial, social and cultural factors that impede the operation of India’s LTC system; ii) estimate and assess the current and future need for LTC and its critical financial and human inputs; and iii) critically analyse and discuss the institutions and policies, technologies and behaviours needed to bring capacity comfortably into conformance with the need for LTC.
In this article, we provide an overview of the current long-term care (LTC) landscape across low- and middle-income countries (LMICs), based on an analysis and synthesis of literature review findings. We begin with a brief assessment of LTC needs on the demand side, followed by a supply side assessment of the available mix of formal LTC services vis-à-vis informal care provision. Next, we describe and discuss the role of government policies in LTC provision and governance. We conclude by discussing and offering practical LTC policy considerations for LMICs, drawing on experiences, best practices and lessons learned from high-income countries.
Care for the elderly is one of the most important socioeconomic issues arising from the ageing of the population. Given the declining workforce in the care and health sectors, difficulties exist already in fully meeting care needs. Moreover, deinstitutionalization, which involves a transition from institutional to community-based care, requires an increase in human resources in the care and health sectors. The article addresses long-term care systems for the elderly and the conditions affecting the possibility for the Visegrád countries (Czechia, Hungary, Poland and Slovakia) to transition from a post-socialist model (familialism by default/unsupported familialization) to a European care model based on deinstitutionalization. A further aim of the article is to show some differences in the provision of long-term care for the elderly that are observed in Central Europe, and to underline that their specific characteristics should be taken into account when planning and designing public policies and guidelines for social policy at the European Union level.
Older people and their care workers have been disproportionately affected by the COVID-19 pandemic. Many OECD Member countries have taken measures to contain the spread of the infection and improve the care workforce. Yet the health crisis is highlighting and exacerbating pre-existing structural problems in the long-term care (LTC) sector. In many OECD Member countries, recruiting enough workers in LTC remains a challenge and care workers experience difficult working conditions. Skills mismatch and poor integration with the rest of health care lie at the root of preventable hospital admissions even in normal times. Such challenges are likely to become ever more acute if no further action is taken given the speed of population ageing. Policies to improve recruitment and which also address retention through training, improvements in coordination and productivity, leveraging the effect of digital technologies, are needed.
This article investigates challenges of ageing for long-term care. The analysis proceeds in three steps. In the first step, we estimate the prospective care demand for 30 developed countries based on projected ageing and disabilities among the elderly. In the second step, we outline challenges for care systems with respect to shortages of care workers, increasing skill requirements for care workers, barriers to universal and equitable access to care, and cost containment subject to adequate care quality. In the third step, we identify solutions for these challenges by comparing the care systems of Germany, Israel, Japan, the Netherlands, and the Republic of Korea.
In Egypt, the Food Subsidy Programme (FSP) contributes greatly to social stability, yet there is academic and political pressure to reform the system to prioritize the effective targeting of the poor. This has been particularly so since the 2011 Egyptian revolution, and in the light of claims by the government and international organizations that the programme is relatively expensive and ineffective in targeting the poor. Accordingly, the ability to measure the programme’s targeting performance is crucial, not least to assess the targeting outcome of this anti-poverty intervention. Most previous studies of the Egyptian FSP address the challenges of exclusion and inclusion errors exclusively from an econometric approach. However, in this study a mixed approach method is developed to better explain the programme and to explore how its governance structure might play an important role in determining its effectiveness. This method generates both a statistically reliable measure of the magnitude of the targeting performance as well as a greater depth of understanding of the programme’s effectiveness in achieving targeting outcomes. Additionally, understanding the actual targeting mechanism should help policy-makers improve its effectiveness, and ultimately support a comprehensive reform to build an effective social protection system.
Processes of public policy formation and implementation in the Middle East and North Africa are underexplored. This article presents a case study in public policy reform, focusing on efforts to expand health insurance coverage in Egypt. The account draws on a thematic analysis of peer and non-peer reviewed literature and print media between 2005 and 2015, with a particular focus on the period to 2011. This analysis shows that reform initiatives failed for much of this period because of fundamental disagreements between key actors over the goals, proposals and the political process for change. The success of planned reforms in Egypt may well depend on the extent to which account is taken of the varied agendas and evolving power relations of these actors, especially given the profound political, social and economic challenges the Egyptian health system now faces.
The current refugee crisis requires new thinking and durable policies which move beyond simply meeting the short-term immediate needs of refugees. In the context of this protracted crisis, humanitarian response has included a focus on cash transfer programming as a way to support Syrian refugees in Jordan to meet their basic needs. While evidence on cash transfers in stable contexts has been well-documented over the last two decades, little is known about the potential effects of cash transfers on populations in protracted displacement. This article examines the economic and social effects of a UNHCR cash transfer programme for Syrian refugees in urban areas in Jordan. We find that almost all beneficiaries used the transfer to pay rent, and that this reduces stress and anxiety among beneficiaries. These effects are important, but depend on the continuation of cash transfer support. For longer-term impacts, assistance for refugees needs to move beyond short-term support and align better with national interventions and a broader enabling policy environment, including refugees’ right to work.
This article compares the effectiveness and efficiency of a food and energy subsidy programme, which is currently implemented by the Tunisian government, and a universal child allowance programme that is discussed as an alternative to these subsidies. The empirical analysis is based on microsimulations on the poverty impact and the costs of both programmes based on Tunisian household survey data. Our results suggest that a universal child allowance is approximately twice as efficient (i.e. the cost of lifting one person out of poverty under a universal child allowance is half of the cost of lifting one person out of poverty using subsidies) in reducing poverty than the current food and energy subsidies. The article concludes that efficiency-enhancing social protection reforms are possible based on a universal approach. Such reforms can be achieved without resorting to narrow poverty-targeting as an alternative to the subsidies whose negative side-effects (e.g. non-negligible exclusion errors, incentives to informality and social tensions) and costs (both public and private costs related to intensive data collection to improve targeting) are usually overlooked or underestimated.
The introductory article of this special issue looks at the genesis, characteristics and challenges of social protection schemes in the Middle East and North Africa (MENA). It argues that social protection policies in the MENA should be seen as a key ingredient of the social contract that governments offered to their citizens after independence. To compensate for the lack of political participation and accountability, free public health and education systems, generous food, energy and water subsidies, social insurance and assistance schemes and mass public-sector employment were established. This was possible because MENA countries benefitted from substantial windfall profits (from the export of oil, gas and minerals; Suez Canal user fees), as well as from income from remittances from migrant workers and income from politically motivated aid. The decline of income from some of these sources and population growth has led MENA governments to focus more closely their social protection spending on strategically important social groups: typically, the urban upper middle class. As a result, social protection systems in MENA countries currently suffer from severe weaknesses in terms of social fairness, efficiency and sustainability. Although MENA countries still spend a very considerable share of gross domestic product on their social protection schemes, these have only very limited effects on the reduction of poverty, vulnerability and inequality – and some even exhibit perverse “bottom-up” redistributive outcomes. The articles that comprise this special issue selectively spotlight a number of opportunities and challenges for the development of sustainable social protection in the MENA countries.
Youth unemployment is a major socio-political issue in the Arab countries of the Middle East and North Africa (MENA). However, active labour market programmes (ALMPs) in support of youth employment remain less prevalent and are generally outside the purview of social policies in the region’s countries. This article addresses this inconsistency. The article provides an overview of such programmes and identifies the challenges to their inclusion as a central part of the region’s social policy mix. Internationally, the article notes that successful models for the integration of ALMPs into social policies have been part of long-term reforms targeting inclusive social security systems. This has not been the case in Arab countries where access to contributory social security systems is limited and where labour markets are characterized by large informal economies and a majority of workers are without social protection. Further contributing factors pertain to limited state budgets and a limited knowledge base about the effectiveness of ALMPs in the region.