Social Protection for agricultural workers in Senegal Aly

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Social Protection for agricultural workers in Senegal Aly CISSE ILO/STEP Sénégal

Social Protection for agricultural workers in Senegal Aly CISSE ILO/STEP Sénégal

Outline l Context of MIS Development l Evolution of the extension of social security

Outline l Context of MIS Development l Evolution of the extension of social security l Positive contribution and limits of micro insurance l National Strategy of Social Protection l Social Protection for agricultural workers

Reminder: Some data GDP / capita: less than 700 US $ Life expectancy: 50

Reminder: Some data GDP / capita: less than 700 US $ Life expectancy: 50 years Child infant mortality: + 150 / 1000 Maternal mortality: + 510 / 100 000 On average, more than 40% of population is poor Poverty in worse in rural areas (57, 5%)

Context Let’s go back in time: In the 60 s (following independance) government was

Context Let’s go back in time: In the 60 s (following independance) government was the only garantee for health care access: free access for all was the principe; Ø Two major events changed the situation: Ø - Structural adjustment policies; - Bamako Initiative.

Structural adjustment policies - Public health expenditures reduction; Bad public health care supply; -

Structural adjustment policies - Public health expenditures reduction; Bad public health care supply; - Difficulties for government to ensure health care access and quality. -

Bamako Initiative Ø Health care services recovery with a tarification policy l End of

Bamako Initiative Ø Health care services recovery with a tarification policy l End of free access to health care: communities should participate to the health cost. l Participation of the population to health care services management

MIS a credible alternative l Democratization process in Africa l Development of a strong

MIS a credible alternative l Democratization process in Africa l Development of a strong civil society l Presence of NGOs and international organizations l Government involvment

Evolution of the extension of social security in Senegal 10 years ago Formal sector

Evolution of the extension of social security in Senegal 10 years ago Formal sector employees (10%) Rural and informal sector (80%) Ex clu de d fro m so cia ls ec ur it y Covered through social security and other mechanisms (private insurance) Isolated beneficiairies from social assistance funds Very Poor (10%)

Evolution of the extension of social security in Senegal Development of micro-insurance (bottom-up) :

Evolution of the extension of social security in Senegal Development of micro-insurance (bottom-up) : 1995 -2003 Complementary mutuals Micro. Insurance developed by a MFI Pamecas in Senegal Health Micro. Insurance Schemes « mutuelles » Werlé Thiès Oyofal Paj in Senegal, Civil servants / corporation / trade unions M M M Formal sector employees (10%) M IMF Insurance managed by Rural and informal sector (80%) a federative structure M ASSURCAD in Senegal M M M Very poor (10%)

Evolution of the extension of social security in Senegal Development of linkages : since

Evolution of the extension of social security in Senegal Development of linkages : since 2000 Linkages formal / informal SP schemes Unions des Mutuelles de Santé de Dakar, UMSD Contracting with HC providers - mutualized agreements in Thiès M M M IMF M M Formal sector employees (10%) M Linkages of MI schemes Cadre local de développement des mutuelles de Kaffrine in Senegal Ind. « Sponsorship » , solidarity and equity funds - Werlé Thies Rural and informal sector (80%) Very poor (10%)

Positive contribution of micro-insurance l Improved comprehension of social protection l Improved conditions of

Positive contribution of micro-insurance l Improved comprehension of social protection l Improved conditions of access to health care and reduced insecurity l Increased transparency in billing / fee setting and management of healthcare thanks to the contracting process with HC providers

Current limits of MIS Weaknesses of the schemes l Size of membership limited reduced

Current limits of MIS Weaknesses of the schemes l Size of membership limited reduced pools – 64% of the schemes have less than 1 000 persons covered in 2003 l Some reasons: – Voluntary membership • When membership is automatic, the size is increased; Ex: Mutuelle des volontaires de l’éducation (Senegal), 135 000 persons covered – Inadequacy of health care the system is less attractive – Limited financial capacity of the members + no subsidies limited benefits packages

Current limits of MIS Weaknesses of the schemes l Poor management skills and information

Current limits of MIS Weaknesses of the schemes l Poor management skills and information systems – Voluntary management staff; little number of schemes with computerized MIS (Progressive installation of MAS gestion in Senegal, Benin and Burkina Faso) l Premium collection mechanisms – Per month & direct payment low collection rates l Weak capacity to negotiate with healthcare providers

Current limits of MIS Limitations at a higher level l Lack of coherence at

Current limits of MIS Limitations at a higher level l Lack of coherence at the national level – Poor redistribution • Between +/ - rich members (flat rate premiums) • With other segments of the population (formal sector) – No functional linkages with statutory SS schemes l Weakness of the environment for the development of these schemes

National Strategy of Social Protection in Senegal

National Strategy of Social Protection in Senegal

Context of NSSP elaboration §Absence of Social Protection in PRSP I §Correlation between absence

Context of NSSP elaboration §Absence of Social Protection in PRSP I §Correlation between absence of social protection and household poverty §Households ( particularly poor households) are vulnerable face to risks such as accident, illness, etc.

Objectives of the SPSN § Increase the social protection coverage level, specially for health

Objectives of the SPSN § Increase the social protection coverage level, specially for health care § Sensitize populations on the importance of social protection as poverty reduction strategy § Train human resources necessary for social protection systems planning and management § More specifically: extend the health insurance level of coverage from less than 20% to 50 % by 2015

Nationwide micro-insurance schemes based on socio-occupational groups Transport operators (400 000 persons to be

Nationwide micro-insurance schemes based on socio-occupational groups Transport operators (400 000 persons to be covered) Agricultural workers (5 million persons to be covered) The groups include cooperatives, GIE, groups of producers, federations of GIEs … Federations Trade unions SCHEME Groups of farmers Groups SCHEME

Social Protection for agricultural workers in Senegal

Social Protection for agricultural workers in Senegal

Context l Level of poverty of agricultural workers l Experiences of social protection in

Context l Level of poverty of agricultural workers l Experiences of social protection in rural areas l Government comittment to support social protection of agricultural workers l Law in 2004 (Loi d’orientation agrosylvo-pastorale)

Principes l Automatic enrollment l Diversity of financing sources (beneficiaries, taxation, budget allocation) l

Principes l Automatic enrollment l Diversity of financing sources (beneficiaries, taxation, budget allocation) l Innovative financing mechanisms (indirect premium collection ) l Outsourcing of technical management and use of computerized MIS l Progressivity in the implementation

Services covered Health insurance first step: a priority for all l Coverage system –

Services covered Health insurance first step: a priority for all l Coverage system – Health care in the public sector • Primary level (health post, health centre) • Secondary and tertiary level (regional and national hospitals) – Quasi-totality of health care covered l Level of coverage – 70% at the primary level – 90% at secondary and tertiary level

Cost of coverage l The cost of coverage is estimated to 13 000 FCFA

Cost of coverage l The cost of coverage is estimated to 13 000 FCFA person and per year (20 USD) l Beneficiaries will pay 23% (7 USD) l Government will pay 67% (21 USD)

Legal framework The implementation of nationwide HMIS such as the agricultural workers social protection

Legal framework The implementation of nationwide HMIS such as the agricultural workers social protection system should help improve access to health care and quality. Ø It goes with the restructuration of the HMIS environment(laws and regulations, relationships with health care providers) Ø

Legal framework The structuration is based on: Ø A legislation on health micro insurance

Legal framework The structuration is based on: Ø A legislation on health micro insurance schemes; Ø A coherent framework for the contracting process with healthcare sector

Social Protection for agricultural workers in Senegal Thank you fo your attention

Social Protection for agricultural workers in Senegal Thank you fo your attention