The extension of social protection in health and the quest for universal coverage requires the involvement and commitment of a variety of actors:
Legislative and executive bodies have a priority role in facilitation, promotion and extension of health protection, including legislative decisions on its form. Overall government stewardship and a strong political will to engage in health financing reform are essential for steering the implementation of sustainable systems of social protection.
Further, governments are encouraged to respect national and international labour standards and related Conventions of the ILO. This requires support from all levels of government - federal, state (or provincial) and local.
Workers organizations are vital in advancing the principles of solidarity and social justice among their members and in society at large. Thus, they should be involved in decision-making based on national and social dialogue and be represented at boards of schemes where applicable. Workers organizations can also play an important role in establishing measures to extend coverage to people not covered so far (e.g. workers in the informal economy, rural population) and in taking account of gender-related aspects.
Employers and employers' organizations
Employers play a significant role in ensuring decent work conditions for their workers and should be included in social dialogue and, where social health insurance schemes are present, should actively participate in decisions. Supporting the establishment of social protection systems is also an element of corporate social responsibility.
Voluntary health insurance
Voluntary health insurance (e.g. private for profit or community-based) can play an important role in the informal economy and can offer supplementary insurance packages or complement a basic benefit package. Community-based health insurances might be important organizational devices in extending coverage to the excluded in particular in the informal economy.
Social security institutions
Social security institutions are a cornerstone in national coverage extension strategies. They need to be at the centre of capacity-building and training strategies.
Health care providers
Private and public health care providers should be adequately equipped to provide quality health care services, including the treatment of specific diseases (e.g. HIV/AIDS). Health care providers also need to be acquainted with the principles of modern health care purchasing arrangements, including the procedures of accreditation, contracting and payment mechanisms' advantages and limits within a third party payment agreement.
Development partners need to strengthen their efforts and commitments to enable countries to develop fair financing of health systems. This includes offering technical cooperation as well as further knowledge and capacity development to partner countries. External funds should be made available to partner countries on a predictable and longer term basis. In line with the Paris declaration on aid harmonization, development partners should work together more closely and harmonize their agendas.
National and international organizations and agencies sharing the values of equity, universality and solidarity in health are invited to join the global partnership and cooperate at the international, regional and country level.
Technical cooperation agencies
A central problem in organizing health financing is related to limited capacities and experience to develop socially balanced and pro-poor health care systems. Technical cooperation and collaboration at regional, country and community level should be demand driven and originate from country level as a result of broad consultation between partners and donors.
It includes the following activities:
- providing comprehensive policy advice to interested partners;
- collaborating in analysing the benefits and costs of different methodologies in health financing;
- intensifying efforts for financing health promotion and disease prevention including environmental issues;
- jointly applying tools in order to support the planning, implementation, evaluation and monitoring of social health protection systems; and
- carrying out feasibility studies to analyse systematically the political and socio-economic conditions, needs and expected costs related to the introduction or expansion of a social protection mechanism
Civil society organizations
A broad range of Civil Society Organizations (CSO) is engaged in health and health related fields, representing the interests of various population groups within societies. Civil Society Groups (e.g. religious bodies, non-governmental organizations, cooperatives) play a key role in promoting the principles of equity and solidarity in society.
They should participate in national dialogues to further the extension of coverage to excluded groups. Their efforts to protect, promote and improve overall health of a population can facilitate widening or establishing social protection in health.
CSO’s work can have major effects on the public acceptance of social protection in health and on the acceptance of immanent values and principles which SHP entails.
Community groups (such as self-help groups) represent the demand side and play a significant role in health financing and health care organization/provision. Community involvement is particularly relevant in health promotion, disease prevention, risk pooling, premium setting (in case of insurance), and purchasing/provision of care.
Community support is also crucial in the identification of the poor and other target groups for social health protection.