Support to social protection for economic development
Title: Support to Social Protection including Social Health Protection (SP-SHP)
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Lead executing agencies: Economic Affairs Division (EAD), Ministry of Finance, Revenue and Economic Affairs, Government of Pakistan
Overall term: 2016 to 2020
The majority of people in Pakistan still must make a living without protection against life-cycle risks such as illness, inability to work, poverty in old age and property loss. Seventy per cent of economic shocks experienced by poor households relate to expenses for health services. These place a dual burden on many households, reducing employability and productivity on the one hand, and disposable income on the other. Out-of-pocket expenses, which represent 56.3 per cent of total health expenditures in Pakistan, are among the highest in the region. Without coverage through a social protection system, workers in the informal sector in particular face a higher risk of falling into poverty if they incur unforeseen expenses or suffer a sudden loss of income. Most wage earners work under precarious conditions with little or no employment security, low wages and a lack of employee participation and social protection. Thirty per cent of the working population are classified as ‘working poor’. The Government of Pakistan is introducing social protection systems based on state transfer payments with the aim of preserving the livelihood of population groups affected or threatened by poverty. It is also promoting contribution-based payments to facilitate social protection of further life risks and new programmes to create opportunities for productive participation in development.
The Government of Pakistan is improving access to needs-based social protection services, especially for people living in poverty and those at risk of falling into poverty.
The project advises national and provincial partners on strategy development and supports the implementation of government social protection initiatives in the provinces of Punjab and Khyber Pakhtunkhwa. It promotes interprovincial information exchange at national level, supports government-led reforms, facilitates capacity development of implementing organisations and strengthens the structural framework for the effective application of sustainable solutions for social protection.
The project operates in three main fields of work:
- System design to strengthen intersectoral cooperation on social protection initiatives at the provincial level.
- Support to partners’ implementation of social protection programmes, including through capacity development of relevant actors at provincial and district levels. To improve access to social protection schemes, in Khyber Pakhtunkhwa the project supports expansion of existing social health protection programmes and the establishment of Single-Window Service (SWS) Centres, while in Punjab it promotes the integration of social assistance services in existing Citizen Facilitation Centres.
- Interprovincial exchange and learning to encourage actors at the national and provincial levels to engage in dialogue and reciprocal learning in the area of social protection. By introducing interprovincial and multi-level peer learning groups for the SWS centres and social health protection initiatives, the project supports mutual learning based on experience in planning and implementation, and at the same time promotes networking that helps harmonise measures across provincial boundaries.
Access to medical services for vulnerable people and those living in poverty has been improved through the Government’s introduction of a social insurance system. Since their launch in 2016, these reforms have benefitted more than 4.5 million underserved families across Pakistan. The fully subsidised health insurance card under the Sehat Sahulat Program (SSP) facilitates access to health services at over 450 private and public hospitals in 84 districts. The Government will now scale up these initiatives with the aim of reaching 14 million families. SSP has facilitated significant improvement in the domains of health management, design and insurance for over 650 policymakers and managers of district, provincial and federal health departments, hospitals and insurance companies. Data-driven decision-making and awareness of the need for risk management concerning the financial sustainability of initiatives have increased. With support from the project, national training institutes such as the Health Services Academy have developed short courses on health insurance and contract management.
Two distinct SWS centre prototypes have been developed and have been endorsed by both district and provincial governments. A beneficiary registration system provides district authorities with a unified database for all social protection services and benefits. District authorities coordinate efforts to better respond to the needs of their populations for social protection services and avoid discrepancies.
In collaboration with Punjab’s Social Protection Authority, an assessment of the provincial social protection system using internationally developed assessment tools has fostered multisectoral coordination for better harmonisation and reflection on the effectiveness of existing schemes.
The national-level exchange between provinces has led to mutual trust and learning from country-specific implementation experiences, including on translating international and regional lessons into solutions for the country context.