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Inequities in access to health care for vulnerable groups in Europe and Central Asia.docx
•
Making essential benefits affordable and available and of adequate quality
, for example by introducing fair burden sharing based on the capacity to pay, and
ensuring availability of the health workforce in rural areas. Further, adequate benefit packages should be envisaged with the ultimate goal of attaining the requirements
laid out in related ILO Conventions. When defining benefit packages, policies must consider the health-care needs of specific groups such as women, female migrants and
Roma, and ensure close coordination of existing programmes such as in the area of HIVAIDS and TB among migrants and Roma, and crucial links to maternal health as
well as long-term care, especially in rural areas. In some cases this may require expanding the scope of benefits in cash or in kind, such as including transport costs in
rural or underserved areas, or services that are essential for migrant and Roma women, including dental care and long-term care.
•
Strengthening governance
through social dialogue, and raising institutional capacities for effective management, supervision, monitoring and evaluation. This
will allow for efficient and effective use of funds as well as long-term success and sustainability of social and economic developments.
5.2. Addressing wider socioeconomic inequalities through the social protection floor approach
In addition to improving the overall performance of and access to social health protection for the vulnerable population, given the socioeconomic determinants for both health and
access it is important to tackle the underlying issues identified in the broader socioeconomic environment.
By tackling the wider socioeconomic inequalities, the suggested policies that refer to the overall responsibility of the government enable synchronized strategies to address a variety
of
•
policy areas
, including health protection, education, housing, food, water, sanitation, unemployment and ageing; and
•
population groups
, including persons with disabilities, families, women, children, people living with HIVAIDS, as well as migrants and ethnic minorities such as the
Roma. Thus, it is important to coordinate social and health protection policies with a view to
poverty alleviation. Poverty and social exclusion can be minimized through a number of policies that have proven efficiency, including
•
Providing income security and benefits in kind
to mitigate the impacts of poverty, unemployment, and old age for those in need. Income support should include
children, pregnant women, the elderly, and people with disabilities. Improving access to housing and education can also contribute to mitigating inequalities in access to
health care, for example of Roma women, by promoting knowledge about rights and entitlements, but also by enhancing employability in the formal sector through
providing social security or enabling professional development.
•
Increasing labour market participation
of the most vulnerable, including the provision of training and skills advancement matched to the changing needs of the
labour market, job placement services, care services for children and the elderly, and ensuring accessibility to the workplace, i.e. availability of public transport WHO,
2010c.
Inequities in access to health care for vulnerable groups in Europe and Central Asia.docx
37
•
Supporting the transition from the informal to the formal economy
. Social
protection – as outlined in the framework of the Social Protection Floor Initiative SPF
2
– is designed to address the vulnerability of populations through a holistic approach. It consists of a methodology that aims at filling gaps and deficits in the
various areas that result in such vulnerability or that hinder vulnerable groups from progressing, including in income generation and health. It is specifically suited to
ameliorate the deplorable situation of vulnerable and socially excluded women suffering from poverty, low wages and precarious employment whilst receiving little
recognition regarding their specific needs in terms of social health protection and as caregivers.
The SPF builds on the human right to social security and health as enshrined in Articles 22, 25 and 26 of the Universal Declaration of Human Rights, and on the ILO Declaration on
Social Justice for a Fair Glopbalization ILO, 2008b. It gives particular attention to the provision of protection for the most vulnerable, including women, migrants, and ethnic
minorities, by advising on ensuring access to a basic set of guarantees ILO and WHO, 2010, including:
1. essential social rights and transfers, in cash and in kind; and
2. an essential level of goods and social services.
The set of guarantees aims to counteract and soften the economic consequences of financial shocks and crises, including those arising from gaps and deficits in effective
access to health care. More specifically ILO, 2011, the SPF aims at achieving:
• access to a nationally defined set of essential health-care services through national
health services, social or national health insurances or other forms of social health protection;
• a minimum level of income security for children through familychild benefits in cash
and in kind, aimed at facilitating access to nutrition and to basic services such as education, health and housing;
• income security combined with employment guarantees and employability-enhancing
policies for those in active age groups who are unable to earn sufficient income in the labour market, including through social assistance to the poor, unemployment
insurances or public work schemes; and
• income security, e.g. through basic pensions, for all residents in old age and with
disabilities that exclude them from the labour market see figure 33. Given financial constraints, some countries will need to adopt a gradual approach to
implementing elements of the SPF. The SPF framework can serve as a tool to identify priorities and ensure a coherent, well-coordinated implementation of the various SPF
policies. The concept thus serves as a vital and flexible policy tool for a country-specific implementation process; it allows for the definition of priority policy areas or target
groups, and leaves room for sequencing, newly introducing and reforming social protection
2
The Social Protection Floor Initiative was adopted by the United Nations System Chief Executive Board in 2009 in response to the global financial and economic crisis. Promoting access to essential
social services, it aims to mitigate the socioeconomic impacts of financial shocks and crises see ILO and WHO, 2009.
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Inequities in access to health care for vulnerable groups in Europe and Central Asia.docx
policies, and for exploring synergies between different sectors. It thus promotes building on existing social protection measures, schemes or systems and takes national development
strategies into account ILO and WHO, 2009.
5 1
5
This flexibility also applies to the mode of delivery of particular guarantees, which can be adapted according to countries’ capacity and ability to free fiscal space, as well as to the
feasibility of effectively reaching the most vulnerable groups. Guarantees may be granted ILO, 2010b:
• on a universal basis to all inhabitants of a country;
• through compulsory, contributory broad-based social insurance schemes with
provisions made for those without contributory capacity; •
based on needs assessment; or •
tied to conditionalities. When addressing inequities in access to health care, ILO Conventions provide guidance, in
particular the Social Security Minimum Standards Convention, 1952 No. 102. This Convention defines social security as the protection that a society provides to its members
through a series of public measures against loss of work-related income or insufficient income caused by sickness, disability, maternity, employment injury, unemployment, old
age, death of a family breadwinner, lack of access to health care, or insufficient support for childrearing.
Convention No. 102 also includes specific provisions concerning social health protection, such as benefits in cash, medical benefits and medical benefits also in case of maternity.
However, maternity is more specifically dealt with in the Maternity Protection Convention, 2000 No. 183 and its accompanying Recommendation No. 191. ILO Conventions on
social security aim at including all vulnerable people such as women workers engaged in atypical forms of dependent work, and their families ILO, 2003. Further international
labour standards relevant to promoting equal treatment and decent work for all, with particular relevance to women, the poor, Roma or migrants, include:
• Medical Care and Sickness Benefits Convention, 1969 No. 130;
• Invalidity, Old-Age and Survivors’ Benefits Convention, 1967 No. 128;
• Employment Promotion and Protection against Unemployment Convention, 1988
No. 168;
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39
• Equality of Treatment Social Security Convention, 1962 No. 118;
• Equality of Treatment Accident Compensation Convention, 1925 No. 19;
• Maintenance of Social Security Rights Convention, 1982 No. 157.
Generally, ILO Conventions and SPF policies promote protection for all those in need irrespective of nationality e.g. migrants, for the whole population and based on equal
treatment e.g. of Roma women.
3
Achieving universal access to health care can be enhanced through social dialogue and the participation of all stakeholders by establishing
inclusive and participatory policy and implementation processes. Inclusive social protection floor policies can contribute to realizing human rights to both
social security and health for vulnerable groups, while increasing productivity, reducing poverty and simultaneously pushing towards more equality and political stability.
3
See ILOLEX for further information on ILO Conventions and Recommendations.
