First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
The effective implementation of social protection interventions is key for achieving positive change. The existing literature mainly focuses on issues related to programme design and impact, rather than the factors that influence the emergence, expansion and provision of these programmes. This article builds on the recent literature that indicates that the quality of institutions and people’s preferences play an important role in the implementation of social protection. It does so by using Ethiopia and its Productive Safety Net Programme – one of the largest social protection programmes in sub-Saharan Africa – as a case study, thereby contributing to debates on how to implement social protection more effectively, particularly in settings of widespread poverty and relatively low levels of institutional capacity. Based on primary qualitative data, the article finds that greater institutional quality at the local level is associated with the more effective provision of social protection. The ability of community members and social protection clients to voice preferences can lead to adaptations in implementation, although the extent to which this occurs is highly gendered.
This article assesses the effectiveness of pension provision and health insurance in preventing ill health among older people in developing countries. It argues that, until recently, social protection agendas devoted insufficient attention to health risk prevention, instead focusing on the reduction of income poverty through cash transfers. The article shows that there is little reliable evidence to indicate that providing older people with pension benefits enhances their health status and that these effects should not be taken for granted by policy‐makers. The article then focuses on the effect of inclusion in health insurance schemes on health outcomes for older people, with specific reference to outcomes related to hypertension. Drawing on newly‐available data from the World Health Organization for Ghana, Mexico and South Africa, it shows that older people with health insurance are marginally more likely to be aware of health conditions such as hypertension and more likely to have them under control. Nevertheless, the great majority of hypertensive older people, insured or uninsured, are not effectively treated. The chief barriers to treatment are shown to be mainly related to awareness and service provision, rather than financial ones. Consequently, the capacity of pensions or health insurance to enhance health outcomes for older people in such countries, including in rural areas, is heavily contingent upon health education, health screening and adequate health service provision. These interventions should be viewed as an integral element of mainstream social protection strategies, rather than adjuncts to them. Yet, in practice, social protection and health promotion continue to be treated as almost entirely separate spheres, thus presenting substantial institutional barriers to developing combined interventions.