First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
With the enactment of Statutory Instrument No. 72 (2019), Zambia is extending pension coverage to workers in the informal economy. We present evidence on the experiences and perspectives of domestic workers and bus and taxi drivers regarding pension scheme coverage in Zambia. We use data generated through interviews and focus group discussions. The analysis shows that pension schemes, as conventionally designed for formal economy employees, are not compatible with the values, beliefs and needs of informal economy workers, and pension coverage was not a priority for them. As a form of social innovation, extending access to pension coverage had a lower relative advantage and lacked incentives to attract informal economy workers. We propose a member-centred framework for initiating the extension of social security coverage to informal economy workers.
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.