First published in 1948, the International Social Security Review is the principal international quarterly publication in the field of social security.
Using the Ghanaian LEAP benefit programme as a case study, we investigate how administrators, service personnel and beneficiaries perceive and respond to implementation dilemmas. The investigation focuses on the LEAP benefit for caregivers of children, which is conditional on children’s school attendance, health check‑ups and vaccinations. An ethical dilemma concerns whether non-compliance should be sanctioned, since this may push caregivers and their children deeper into poverty. Other dilemmas concern how administrative resources should be allocated for the targeting, monitoring, sanctioning and exiting of beneficiaries; how spending should be allocated between providing cash benefits and securing health and education services of sufficient quality; whether available money should be spread widely but thinly to provide incentives for many caregivers to send children to schools and attend health check-ups, or be targeted more narrowly to enhance relief for the very poorest; and whether funding would be less forthcoming if the minimum benefit was not a conditional cash transfer (CCT). We discuss whether similar dilemmas are likely to be present in other low- and middle-income countries operating similar CCTs, and whether some of these also apply to “active” minimum benefits implemented in high-income countries.
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.