Health care is a vital component of any comprehensive social security system and an important priority for members of the International Social Security Association (ISSA). The experience of the COVID-19 pandemic has underscored this fact, highlighting the need for sustainable, adaptable and resilient health care systems capable of ensuring universal access to affordable and effective care. Achieving this is not simple. Health is a complex and challenging branch of social security, requiring an array of coordinated inputs and structures to meet health care needs.

Institutional resilience and the need to maintain operational continuity are concepts widely recognised in social security as the main indispensable characteristics for providing services to the population in the event of natural disasters or unforeseen catastrophic events. This has manifested itself over the years in efforts to strengthen processes, infrastructure and the resources that institutions have available to cope with different crises.

Extending social security coverage is a key challenge for the quasi-totality of members of the International Social Security Association (ISSA) in Africa. Social security coverage for a diverse workforce is therefore one of four topical priorities for ISSA in the 2023–2025 triennium. This follows from extensive work on extending social security coverage in the previous triennium culminating with new guidelines on extending health-care coverage launched in October 2022.

Fraud has become a major threat for health care systems globally. While social security institutions constantly aim for the optimization of processes with the help of advanced analytics and artificial intelligence (AI) to detect and monitor fraud more effectively and efficiently, adopting such emerging technologies poses important challenges.

Sickness benefits are an essential component of social health protection, promoting the human right to health and social security, by preventing impoverishment due to the loss of income during sickness. The COVID-19 crisis has brought sickness benefits into the spotlight as a major measure to mitigate the spread of the disease and ensure income protection for those who fall sick. At the same time, the pandemic has emphasized coverage gaps and key concerns that need to be addressed for sickness benefits to attain their purpose.

Effective access to adequate social protection plays a crucial role in promoting sustainable development, social cohesion and socioeconomic resilience. In recognition of this, African governments have expressed a renewed commitment to expand the scope and extend social security coverage to the vast majority of the population on the continent during the last decades. However, effective coverage rates remain generally low and vary within countries and across branches of social security due to low labour participation in the formal economy (ILO, 2017).

Universal health coverage (UHC) is a global health priority and access to health care services is one of the most important components of social security. The COVID-19 pandemic has once again highlighted the need for universal access to affordable care. Health care service delivery systems and financing methods have important repercussions for people in accessing and benefitting from health coverage. While national health insurance systems enable comprehensive and equitable access to health-care services in many countries, implementing them involves several challenges.

Rehabilitation is a core issue for individuals and social security. Having already been brought to the forefront in the context of ageing societies, the COVID-19 pandemic has further accentuated the important role of rehabilitation, as many coronavirus patients require help to get back to a normal life and work. Rehabilitation programmes that are based on a holistic approach combining care, return-to-work and social benefits, whilst improving cooperation between different actors, have emerged as most promising to effectively meet increasing rehabilitation needs.

Telemedicine is a discipline that involves the use of information and communication technology (ICT) to provide remote medical services. Health-care professionals can use it to carry out prevention activities and those related to the diagnosis, treatment and monitoring of health-care system users, in particular those who are unable to seek care in person.

After over a year since the outbreak of the COVID-19 pandemic, efforts to address existing and new social security coverage gaps due to extensive labour market disruptions continue to be at the forefront of governments’ agendas to minimize the negative impact of the crisis and protect people’s livelihoods.