Assessment Based National Dialogue Exercise Policy gaps and

Assessment Based National Dialogue Exercise Policy gaps and implementation issues ILO April 2015

Key questions • What are policy gaps and implementation issues? • How to qualify and quantify policy gaps and implementation issues?

Steps of ABND Step 1 – Building the assessment matrix including the identification of priority recommendations Step 2 – Rapid Assessment Protocol to estimate the cost of implementing the social protection provisions Step 3 – Finalisation of the assessment report for endorsement and further action by the higher levels of government ABND FACTSHEET

Structure of assessment matrix Objectives Existing provisions Planed provisions Policy gaps Implementation issues Recommendations Health Children What is the objective? Working age Four SPF guarantees Elderly What is the existing situation in the country? Who is currently covered / not covered? Why? What can be the priority policy options to fill in the gaps?

Benchmarks to assess situation Four basic guarantees: Do all residents have access to essential health care, including maternity care? Do all children enjoy basic income security, providing access to nutrition, education, care, and any other necessary goods and services? Do all persons in active age who cannot earn sufficient income, enjoy basic income security, particularly in cases of sickness, unemployment, maternity, disability? Do all older persons have basic income security?

Policy gaps: Missing legislation or policy leading to a part of the population being excluded from social protection For example in Thailand: Only formal sector workers are entitled to a child allowance for pre-school children There is no unemployment protection scheme for workers in case of loss of employment

Policy gaps People not covered • Vulnerable groups, informal workers Lack of responsiveness of the benefit packages • No portability of benefits Insufficient protection • No provisions for unforeseen • Levels of benefits insufficient to circumstances like recessions, guarantee income security natural disasters • Benefit package not adapted to existing needs or changing needs Legal framework (e. g. long-term care) • Conflict or overlap between laws or roles • Fragmented schemes Lack of clarity • Implementing decrees not in • Benefit package not clearly place defined • Ad-hoc policies (no laws)

Implementation issues: Despite existing policies or legislation, people do not have effective access to entitlements For example, in Thailand: Despite universal access to social health protection, people from rural areas have limited protection due to poor health care infrastructure Enforcement of the Social Security Act is low, due to employers not registering their staff and a lack of resources to reach out to informal sector workers

Implementation issues Low enforcement • Non-registration or non- Fragmentation leading contribution by formal to inefficiencies and administrative burdens sector employers • Social evasion through outsourcing Inadequate resources or capacities to reach out to Supply-side shortage • Unequal distribution of beneficiaries facilities and skilled personnel by geography Ineffective monitoring and evaluation system to Lack of keep track of effective communication implementation of policy • Low awareness

What is coverage? 3 dimensions – Scope: who is covered for what contingency? – mostly legislative information – Extent: how many persons are covered and how many persons are receiving benefits? – Level: what is the amount of the benefit / package of services ? (Is it adequate to respond to the need? Is it of good quality? )

What is coverage? 1 key distinction – Legal coverage: population entitled to given social protection benefits in the law. Example: in the law all employees from formal sector companies are required to be members of social security and receive pensions. – Effective coverage: population effectively covered by social protection scheme. Example: only roughly 60, 000 private sector workers are part of the social security and are eligible for pensions.

Measuring policy gaps • What is the scope of existing social security provisions and what contingencies are covered in laws? • How many persons are legally covered (in absolute terms and as a percentage of the reference group)? • Is the legal level of benefits adequate compared to poverty line, minimum wage, or other references?

Measuring implementation issues • How many persons are effectively covered? • Is the actual level of benefits adequate compared with benchmarks like average earnings, minimum wage, or poverty line? • Is the actual quality of service enjoyed by beneficiaries good (i. e. availability of health care / education / social services, reliability of benefits, etc. )? • What are the main barriers of access?

Example: Myanmar – Social Security Medical Care Scheme Overview: – Contributory health insurance – Target population: Formal private sector workers – Coverage: 710, 000 workers – Contributions: 2% employer, 2% workers – Covered treatments: In-patient, out-patient, medication, at hospitals and clinics run by Social Security Office

Example: Myanmar – Social Security Medical Care Scheme Policy gaps - Coverage: Only formal sector workers in companies with at least 5 workers. - Coverage: Families of workers are not covered. - Covered treatments: The package of covered healthcare services is not defined in detail yet, as well as whether any fees have to be paid for treatments. - Coordination framework: Coordination between the involved Ministries (Social Security Office, Ministry of Health, Ministry of Finance) is not formalized yet. Implementation issues - Enforcement: Not all companies register their workers, or only register some of their workers. - Access to healthcare: Unequal geographical access to hospitals and clinics, lack of skilled staff and medical supplies in some clinics. - Effectiveness of financial protection: In case where treatments have to be paid in advance, reimbursement can take too long for expensive treatments.