As part of the roll-out of health coverage to the entire Togolese population – an estimated 10 million people – Togo’s National Institute of Health Insurance (Institut nationale d’assurance maladie – INAM) set out to provide rapid access to health care facilities to insured persons across the country.

Achieving universal health coverage (UHC) is a key strategic goal for the government of Zambia. In pursuit of UHC, the National Health Insurance Management Authority (NHIMA) is extending health insurance coverage to the poor and the vulnerable. This extension requires robust estimates of the cost and fiscal implications to the government, and the National Health Insurance Scheme (NHIS).

Gabon’s National Health Insurance and Social Guarantee Fund (Caisse nationale d’assurance maladie et de garantie sociale – CNAMGS) is made up of four funds that cover different categories of members. When the CNAMGS was created, the Gabonese authorities committed to making the system of mandatory health insurance and social guarantee a reality, starting with cover for the most vulnerable population sectors who are not able to directly contribute to funding their own health care.

South Sudan Pensions Fund (SSPF) is in the process of receiving the contributions from Khartoum for all the pensioners who worked in Sudan before South Sudan was given autonomy in 2005, and subsequently, became independent in 2011. This is in line with the Comprehensive Peace Agreement and South Sudan Pensions Fund Act, 2012.

South Sudan, as sovereign nation, has the Constitution and Pension Fund Act, 2012 mandate to follow up and ensure the contributions for the civil servants who worked in Sudan before independence was transferred to South Sudan.

In 2022, the National Social Security Fund (Caisse nationale de prévoyance sociale – CNPS) entered into a three-year partnership with Cameroon’s Ministry of Livestock, Fisheries and Animal Industries (Ministère de l’Élevage, des Pêches et des Industries animales – MINEPIA) to extend social security coverage to workers in the informal economy of the livestock and fish farming, aquaculture, animal and fisheries industries sub-sector.

With a view to increasing social security coverage among non-salaried workers and ensuring contributor loyalty, Algeria’s National Social Security Fund for Non-Salaried Workers (Caisse nationale de la sécurité sociale des non-salariés – CASNOS) launched a portal centred on a workflow of human interaction, digital processes and technology.

Social security is such a fundamental human right that it is absolutely vital for any responsible government to put in place mechanisms to ensure it for all.

The State can proceed by sector of activity. In the Democratic Republic of the Congo, there was one category of public-sector employees – career civil servants – who benefitted from a good social protection system as part of a contributory scheme. Other types of public-sector employees, such as the military, police, teachers and magistrates, were not covered.

The royal project to expand social security coverage in Morocco was launched in accordance with Framework Law No. 09-21 on social protection. The implementation of the royal project to expand social security coverage has been entrusted to the National Social Security Fund (Caisse nationale de sécurité sociale – CNSS), a major player in social protection in Morocco and will take place in line with a staggered implementation schedule.

For the population groups:

Setting up managed entry agreements for innovative medicines is a step forward in Improving access to innovative and costly medicines. They give the Tunisian National Health Insurance Fund (Caisse nationale d’assurance maladie – CNAM) considerable leverage to negotiate with pharmaceutical laboratories to ensure access for the maximum number of people eligible for the treatment, whilst also guaranteeing the budgetary sustainability of the system.

Prior to 2020, less than 10 per cent of the active Ivorian population had suitable social security coverage. This deficiency has prompted the State of Côte d’Ivoire to develop a national social protection strategy aimed at ensuring inclusive social protection and human development.

The COVID-19 pandemic had a severe impact on South Africa’s economy and the livelihood of its citizens. Many South Africans lost their incomes as a result of the pandemic and subsequent lock-down regulations. In an effort to provide relief, South Africa introduced a special COVID-19 Social Relief of Distress grant (cSRD) to address income support gap and food insecurity.

The National Health Insurance Fund (NHIF, hereafter the Fund) of the United Republic of Tanzania has a goal of extending membership coverage to large part of the population. Most of the members covered are those from formal sector of the economy, specifically public servants.

Despite the significant growth of workers in the social security system during the last decade, more than 7 million workers still remain unintegrated.

Investments in operational and technological management to simplify and facilitate declaration and contribution collection, which have contributed to the results achieved, have not been sufficient to change this situation.

The informal sector workers, including youth, are not covered by any regulated savings or social insurance schemes to help cushion the workers from shocks, loss of jobs, etc. In line with the National Social Security Fund (NSSF) of Kenya Act No. 45 of 2013 and Government agenda of providing universal social security coverage, NSSF developed a product “haba haba” which has short term maturity period.

In Côte d’Ivoire, less than 10 per cent of the population is formally covered by the social security system and around 95 per cent of jobs belong to the informal economy. The Social Insurance Institute – National Social Insurance Fund (Institution de prévoyance sociale – Caisse nationale de prévoyance sociale – IPS-CNPS) has therefore begun to extend social security coverage to self-employed workers by creating a specific framework tailored to this group.

In 2019, the Local Authorities Pension Trust (LAPT) carried out a digital marketing campaign dubbed “Eneza Pensheni” which is Swahili for “Spread Pension”. The campaign was premised on the fact that less than 20 per cent of Kenyans were covered by a workplace pension plan. Notably, a survey by Infotrack Research & Consulting, commissioned by the LAPT indicated that the number of Kenyans with a pension plan had declined to 10 per cent as most respondents intended to rely heavily on investments such as property to cater for their financial needs after retirement.

Following instructions from the government, in the last quarter of 2018 the National Sickness Insurance Fund (Caisse nationale d’assurance maladie – CNAM) of Mauritania began preparations for the launch of a voluntary health insurance scheme intended to offer health insurance to individuals in the informal sector and their dependants.

A committee was appointed by the Director General to undertake a study to clarify the circumstances in which the objectives of the project could be achieved and the support measures to be put in place for this purpose.

Twelve years of intensive promotional activities since the launching of the Seychelles Pension Fund (SPF), we now have an appreciation that the importance of pension has well and truly permeated the population; inclusive of the informal sector albeit a slower rate. The key is to maintain member’s interest in their preparation towards retirement – and with a new decade comes a new generation, more IT savvy but with the same need.

With a view to extending social security coverage to rural women working in agriculture, Tunisia’s National Social Security Fund (Caisse nationale de sécurité sociale – CNSS) launched a pilot project in July 2019 entitled “Protège-moi” (Protect Me) in conjunction with the ministries of Social Affairs, Women, Agriculture and Communication Technologies; a telecommunications provider (TT); and a private tech start-up.

It remains a challenge for the Seychelles Pension Fund (SPF) to attract members of the public who are in the informal sector. As a means to get this group to contribute towards SPF and later benefit with a pension, the protecting you campaign was initiated.

Financial sustainability of a social security scheme is heavily reliant on contribution collection and compliance. Inspired by the ISSA Guidelines, the Local Authorities Pension Trust (LAPT) has identified administrative solutions to improve access to contributory social security programmes for populations that are difficult to reach.

“AV+”, a voluntary insurance (assurance volontaire – AV) management project, is the fruit of the shared determination of Mali’s National Social Insurance Institute (Institut national de prévoyance sociale – INPS) and SAER-EMPLOI, which joined forces to increase the number of people registered with a voluntary insurance scheme. This partnership was founded through the signing of a delegation of management agreement on 10 April 2017 and rendered effective through the creation of a company, SAER-EMPLOI-AV+/SASU.

EjoHeza is a voluntary digital pension fund managed as a defined contribution system, officially launched by Government of Rwanda on 14 December 2018, with the objective to increase coverage. All Rwandan residents including foreigners with a national identity number have the right to register, save to the scheme and benefit at the age of 55 years.

As part of its move to extend social security coverage to self-employed workers, the Social Insurance Institute – National Social Insurance Fund (Institution de prévoyance sociale - Caisse nationale de prévoyance sociale – IPS-CNPS) has employed a collaborative tool to aid communication between the teams responsible for the roll-out of the fund’s “New Information System” (Nouveau système d’information – NSI) and to enable the effective monitoring of IT developments and application tests.

The previous marketing campaigns of the Seychelles Pension Fund (SPF) for voluntary contributions have given rise to many instances where participating members in the scheme wanted to open an account for their loved ones. The festive season being a time for giving gift, SPF packaged Voluntary Contribution as a gift that members can add to their list to give to their loved ones. As advocates of the Voluntary Contribution, existing participating members thus add leverage to our mission of cultivating a savings culture in our society.

The issue or challenge addressed by our practice: Proclamation No. 715/2003 excluded a majority of private organization employees (definite period employees and management staff) from pension scheme coverage.

The National Pension Scheme Authority (NAPSA) was created by an Act of Parliament “The NPS Act” No. 40 of 1996 to provide social security cover to all eligible employees in Zambia in case of retirement, invalidity or death. Since commencement of operations in February 2000, NAPSA has largely focused on the formal sector. However, this sector constitutes only 16 percent (950,000 people) of the total employed population of 5.8 million people (Zambia Labour Force Survey Report, 2014). The remaining 84 percent is made up of employees from the informal sector. 

Among several other social security benefits, the National Social Security Authority (NSSA) of Zimbabwe pays a funeral grant of USD 300 under the Pension and Other Benefits Scheme. The benefit is paid to provide assistance towards the burial of a member who would have contributed to the scheme for a minimum period of 12 months. The USD 300 payout is insufficient to cover basic funeral expenses. In an endeavour to accord every retirement pensioner a decent burial, NSSA contracted Econet Life to provide funeral services to NSSA retirement pensioners.

Maintaining financial balance is a major concern for the National Social Insurance Fund for Employees (Caisse nationale des assurances sociales des travailleurs salariés – CNAS) which covers more than 25 million people in Algeria as insured persons and dependants and manages 350,000 contributing employers.

Algeria’s National Fund for Paid Leave and Weather-Related Lay-Offs in the Construction, Public Works and Hydraulics Industries (Caisse nationale des congés payés et du chômage intempéries des secteurs du bâtiment, des travaux publics et de l’hydraulique – CACOBATPH), the only organization of its kind on the African continent and in the Arab world, offers workers in the construction, public works and hydraulics (CPWH) sectors, in addition to paid holidays, coverage for lay-offs owing to bad weather (snow, rain, ice, strong winds and so on) with a view to preserving the health and s

The Community Health Fund (CHF) in Tanzania was established in 2001. Due to the dual role of “Provider” and “Purchaser” of health service played by the Council Health Boards (CHBs) such a design setup has faced challenges of poor management of funds, persistent shortage of services and unreliable membership data. CHF members access services from dispensary level up to district hospital within the Council. As such, unsatisfactory performance of the CHF in most of the councils continue to discourage people to enrol with CHFs subsequently sharply dropout rate of members each year.

The mining sector is naturally hazardous and as such it poses significant danger to the health of workers through mineral dust exposure causing occupational lung conditions in extreme circumstances and excessive noise exposure predisposing workers to irreversible hearing impairment. To address this challenge the National Social Security Authority (NSSA) of Zimbabwe through its Occupational Safety and Health Division procured mobile clinic in September 2016.

By virtue of Law No. 16/009 of 15 July 2016, setting out the rules relating to the general social security scheme, the National Social Security Institute (Institut national de sécurité sociale – INSS) of the Democratic Republic of the Congo (DRC), subsequently the National Social Security Fund (Caisse nationale de sécurité sociale – CNSS) as from 15 July 2018, has undergone its first extensive reform since its creation in 1961.

Prior to 2015, the National Hospital Insurance Fund (NHIF) was only offering Inpatient services to the members on a rebate system. This arrangement was still deficient in breadth for some crucial medical services required by its members, specifically, surgical care and specialized laboratory investigations. This meant that members were still incurring out-of-pocket expenditure to access advanced treatment.

Prior to the introduction of the Collective Scheme for Retirement Allowances (Régime collectif d’allocation de retraite – RCAR) in 1978 and in the absence of a statutory retirement scheme to cover them, several public establishments in Morocco managed their own retirement funds (special schemes, railway workers, mining personnel, water and electricity managers). This however suffered from the following limitations and drawbacks:

Employers are required to register as enterprises and to register their staff, then pay the corresponding social security contributions. When the employer does not do this, the employees may do it themselves. What has been found in practice is that many employers either do not register themselves or their staff, as a result of which the latter cannot access the social security benefits provided by the National Social Insurance Fund (Caisse nationale de prévoyance sociale – CNPS).

A voluntary insurance scheme for independent workers and workers from the informal sector was established in 2014, in line with regulations. In an effort to make this scheme known to all concerned sectors of the population and to facilitate the enrolment of the greatest possible number, the National Social Insurance Fund (Caisse nationale de prévoyance sociale – CNPS) developed a system involving the accreditation of social secretariats.

The National Social Security Fund for Non-Salaried Workers (Caisse nationale de sécurité sociale des non-salariés – CASNOS) oversees the compulsory coverage of social insurance and retirement benefit risks of independent farm and non-farm workers operating in Algeria. It manages the collection of compulsory contributions.

The farming industry experienced difficult times in the 1990s, during which farmers were unable to pay their contributions, resulting in the loss of all benefits for themselves and their dependants. 

As part of the introduction of health insurance for private and parastatal sector employees in June 2014, the National Health Insurance and Social Guarantee Fund (Caisse nationale d'assurance maladie et de garantie sociale – CNAMGS) initially entrusted the task of collecting contributions to the National Social Security Fund (Caisse nationale de sécurité sociale – CNSS).

Financial institutions in Africa have successfully plugged into the mobile ecosystem and deployed services that have revolutionized service delivery, transforming customer engagement touch points and feedback mechanisms as well as enhancing responsiveness of the financial institutions. In addition to this mobile tech has enabled financial penetration. Currently Kenya has 68 per cent financial penetration through mobile tech and is at 80 per cent in use. While many Social Security services providers use mobile technology, they are still to fully leverage on its capabilities.

It has been recognized that a major challenge in developing countries is how to ensure that the poor are included in health financing arrangements and they can access benefit from health insurance coverage as the non-poor.

The National Social Insurance Fund (Caisse nationale de prévoyance sociale – CNaPS) is continuing its efforts to extend social security coverage in Madagascar. An initiative to expand awareness raising activities has become a laudable strategy in terms of its achievements. In 2014 it launched a programme for Catholic school leaders that promotes and raises awareness on the provisions of social security and of their responsibilities regarding such rights.

In Madagascar, a large proportion of the population lacks access to social protection, especially rural producers. For more than a decade, government policy and legislation have foreseen the extension of social security coverage to the entire working population. However, only the scheme for salaried employees is in existence to provide such generalized social security coverage.

As part of its long-term vision, the National Social Security Fund (Caisse nationale de sécurité sociale (CNSS)) adopted a ten-year strategic plan in 2009. One of its operational objectives is to cover 90% of the population under the provisions of Law no. 015-2006/AN of 11 May 2006 relating to the social security scheme applicable to employed and assimilated workers in Burkina Faso by 2020.

As part of the extension of the third-party payment system, a new system was launched in 2012 and is gradually being introduced nationwide to enable a category of insured persons with medical and income-related conditions to benefit from the coverage of the cost of eyeglasses without advance payments. 

The National Hospital Insurance Fund (NHIF) has been focusing its efforts to recruit members from the informal sector in a bid to achieve Universal Health Coverage. Further, NHIF has also engaged strategic partners to cover the indigents. This meant that there was need for innovations to meet the needs of this target group. One area of concern was how NHIF would collect insurance premiums from members in the informal sector.

Due to the transformation of thousands of contributors to beneficiaries who receive cash benefits and pensions, unemployment among recent graduates from universities, and the large geographical area of Libya, it has therefore become essential for the Social Security Fund (SSF, hereafter the Fund) to establish new service facilities in order to provide services, deploy and utilize the youth, reduce the gap between contributors and insured persons, as well as motivate all sectors to produce decent jobs for young people.

The RBA and the National Federation of Jua Kali Associations therefore collaborated to establish a suitable retirement benefits scheme that would cater for people in the informal sector. The "Mbao" Pension Plan was set up and was officially launched on 28 June 2011, for the Medium and Small Micro Enterprises (MSMEs) Sector and to help members of different Jua Kali Associations to save regularly to provide a long-term and reliable income when they retire from their jobs or business.

Pension in figures was first issued by the Seychelles Pension Fund (SPF) in 2011, and has been published every year since then. The aim was to try and attract more members to read and have an idea of the SPF’s annual performance and financial status so that they will be more abreast about the SPF’s current situation.

In 2010, social security policy was reviewed to include the requirement to extend coverage to over 70 per cent of the working population by 2015. The Rwanda Social Security Board (RSSB) reviewed and examined strategies on how to extend coverage to the informal sector. These strategies included establishing joint working partnerships with key institutions dealing with the informal sector, designing benefit packages that are attractive to the informal sector, simplifying administrative procedures to reduce compliance costs and strengthening decentralization of services among others.

Design

The VSRS was initiated on a pilot basis in November 2009 following a series of in-house studies covering different economic players including farmers, small traders and organized groups, with a major focus on self-employed people.

Main features

The Nigeria Social Insurance Trust Fund (NSITF) stands out as Nigeria’s foremost social security institution, with vast experience in the implementation of social security programmes in Nigeria. With a history that dates back to 1961, NSITF is famous for its continuous provision of social security to the Nigerian population. Between 2010 to 2019, i.e. the years covered by this good practice report, the NSITF has experienced tremendous improvement in its operational methods.

Summary

In the context of the introduction of mandatory health insurance in Gabon, the government was concerned about social coverage for its economically disadvantaged citizens. It was not politically or socially acceptable to establish health coverage that would exclude a large segment of the population. This raised the issue of the financing of their benefits. An innovative form of financing was thus found - specifically, an indirect earmarked tax referred to as the "mandatory health insurance fee".

In fulfilling this task, the NHIF used several innovative approaches and strategies, including the preparation of the three year implementation plan, training its employees, and conducting several sensitization and motivation campaigns. Also the NHIF has taken several steps to conduct monitoring and evaluation on matters pertaining to the scheme.

Through the management of the CHF, the NHIF has learnt several practical lessons about the CHF and social insurance schemes in general. The application of these lessons can be extended to similar schemes in the sub-Saharan region.

The number of teachers has increased regularly since that time and, starting in 2000, grew rapidly under the Education for All programme funded by the World Bank. The number of FRAM teachers totalled 8,000 in 2002, 13,000 in 2004 and 35,000 in 2007.

According to the Ministry of National Education, FRAM teachers represent 53 per cent of primary school teachers. The parents' associations pay them as best they can, often compensating instructors with food or by providing plots of land for cultivation.

The benefit accrues from the month in which the worker becomes redundant and is paid for a minimum period of one month and a maximum of twelve months. The scheme is also intended to enhance the employability of laid-off workers as at the time of application, the worker has to choose among three proposed possible options: a job placement, job training and re-skilling or starting a business. The Transition Unemployment Benefit ceases at the end of the month in which the laid-off worker becomes gainfully employed or starts a small business.

Phase 1 covered six Nigerian states (Sokoto, Niger, Gombe, Oyo, Imo and Bayelsa); Phase 2 covered a further six states (Katsina, Jigawa, Yobe, Bauchi, Ondo, and Cross River). So far in Phases 1 and 2 of the project, a total number of 1,545,646 pregnant women and children were covered as at March 2011. Of this figure 1,193,893 are still accessing care while 351,753 have exited the Project i.e. delivered or are above 5 years of age.

The National Social Security and Insurance Trust (NASSIT) was established through an Act of Parliament and is charged with the responsibility of administering the Sierra Leone Pension Scheme. NASSIT started full operations in January 2002 as a partially funded defined benefit pension plan which requires a member to contribute for at least 180 months on/before they retire at age 60 to qualify for full retirement pension.

The progressive establishment of Mutual Benefit Society for Public Employees (Mutuelle de la fonction publique – MFP) agencies in Burundi’s provinces encourages a gradual decentralization of services – notably registration, benefit checks and contribution collection – and also promotes the extension of health-care coverage throughout the country.

These weaknesses included an inefficient computer system, deadwood, general inefficiency in the operational systems of the Fund, high administration costs, poor coverage in terms of benefits etc.

Through the implementation of the said strategy, the Fund undertook a strategic re-engineering process which included the following activities:

In Sub-Saharan Africa, the transport sector is considered an informal sector. As such, the workers in this sector do not generally benefit from social security coverage. This notwithstanding, Niger’s National Social Security Fund (Caisse nationale de sécurité sociale – CNSS) came up with a strategy to provide social security coverage to this sector.

In 1989, Burundi’s Mutual Benefit Society for Public Employees (Mutuelle de la Fonction Publique – MFP), which was founded in 1980, began to establish its own pharmacies near partnering public hospitals as part of its drive to regulate the cost of drugs reimbursed to healthcare partners. Private partner pharmacies were increasing their prices as they saw fit and a financial imbalance between the cost of healthcare services and contributions was imminent.

The progressive opening of Mutual Benefit Society for Public Employees (Mutuelle de la fonction publique – MFP) counters in Burundi’s public and accredited hospitals helps to combat fraud, social security evasion and identification, and prescribing errors while promoting the gradual extension of health-care coverage throughout the country. This results in job creation, as benefit controllers are recruited to work in the hospitals in question. There are also significant advantages for the MFP, as vast amounts of money are returned to the fund and fraud and error are prevented.

We passed through several stages of development, including the measures to expand the coverage, which can be summarized as follows: