Risk management is the process of identifying, analysing, accepting, mitigating or transferring uncertainty in investment decisions. Fund managers apply risk management by analysing and attempting to quantify the potential loss of an investment and then acting accordingly.

Institutions are being transformed thanks to the integration of new technologies. This vision represents a corporate change with a social impact, reducing costs, simplifying processes and procedures, and raising awareness of the importance and benefits of this transformation.

In June 2022, the Salvadoran Social Security Institute (Instituto Salvadoreño del Seguro Social – ISSS) in El Salvador put new technological solutions in place to improve its health-care services. Three electronic kiosks for confirming medical appointments were installed in the Consultorio de Especialidades (Specialist Clinic), the first working prototypes of a device that aims to support health centres’ processes.

Article 12 of Law No. 5508 on the Promotion, Protection of Maternity and Support for Breastfeeding establishes that maternity allowance should be paid to employed women by the social security scheme of Paraguay’s Social Insurance Institute (Instituto de Previsión Social – IPS). This amount is equivalent to 100 per cent of her salary at the time of delivery, and is paid for the prescribed months of rest. This used to be given to women in a single payment.

The issue of population growth and social security planning is one of the biggest challenges facing governments today, and is a key part of a good social security system that instils confidence in its members.

The Retirement and Pension Fund for Employees of Banks and Related Institutions (Caja de Jubilaciones y Pensiones de Empleados de Bancos y Afines) (Bank Fund, hereinafter) is in constant communication with its members. It therefore continuously updates its databases, in order to have a better understanding of members’ current realities, experiences and needs.

Digital transformation is happening in institutions through the integration of new technologies. This vision represents an institutional and social change, optimizing available resources, reducing costs, shortening processes and procedures, and raising awareness of the importance and benefits of this transformation.

Good practice in health – service quality.

As health-care systems have evolved to become more complex and due to the resultant increase in patients coming to harm in health care settings, patient safety has emerged as a health-care discipline.

The Actuarial Advisory Office (Asesoría Actuarial) of the Social Insurance Institute (Instituto de Previsión Social – IPS) carried out an actuarial valuation of the Common Retirement and Pension Fund (Fondo Común de Jubilaciones y Pensiones). The valuation looks to comply with international best practices and observe the guidelines and standards of the International Standards of Actuarial Practice 2 (ISAP 2), and the ISSA-ILO Guidelines on Actuarial Work for Social Security, with technical support from the International Labour Organization (ILO).

Like most of the world’s countries, Paraguay has adopted lockdown measures to prevent the spread of COVID-19. These steps taken by the government have impacted the productive sector, leading to mass suspensions of employment contracts for persons insured with the Social Insurance Institute (Instituto de Previsión Social – IPS) of Paraguay.

When the COVID-19 pandemic was declared by the World Health Organization (WHO), in El Salvador the Directorate General of the Salvadoran Social Security Institute (Instituto Salvadoreño del Seguro Social – ISSS) put forward a new form of care. This was authorized by the ISSS board in agreement No. 2020-0651 ABR. This made it possible to implement virtual care through telemedicine, known as Dr. ISSS en línea (Dr. ISSS online).

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.

As of 2022, the Salvadoran Social Security Institute (Instituto Salvadoreño del Seguro Social – ISSS) in El Salvador has 12 palliative care home support teams nationwide, four of which deal with the most complex cases. The teams are distributed across a variety of care networks.

Paraguay’s Social Insurance Institute (Instituto de Previsión de Social – IPS) used to make sick leave payments at its administrative offices, which had associated administrative costs and meant beneficiaries had to visit the IPS service counter in person.

Late payment of claims to certified health care was a daunting challenge experienced by the National Health Insurance Fund (NHIF, hereafter the Fund) of the United Republic of Tanzania. Delays on payments to health care providers was also source of complaints to certified health facilities, as well as registered beneficiaries. Amongst the key causes of late payments to health care providers were the use of an offline claims submission system or sometime manual process.

Workers Compensation Fund (WCF) of the United Republic of Tanzania was established in July 2015 to provide reliable and efficient workers compensation services that mitigate
socio-economic impact of occupational injuries. As a new social security institution, it operated under manual systems, which triggered delays in employers’ registration, contribution receipting, file retrieval, claims notification and claims payment.

WCF began to automate its processes to:

For years, the Salvadoran Social Security Institute (Instituto Salvadoreño del Seguro Social – ISSS) has had a reputation in El Salvador for not providing personalized care to beneficiaries, both in terms of health services and economic support. For this reason, people often think the employees who provide the services dehumanize and are indifferent to the needs of patients and their families. It is therefore urgent to transform this institutional culture, using a humanized approach to health as the transversal and fundamental axis.

The Public Service Social Security Fund (PSSSF) United Republic of Tanzania, hereafter also referred to as the Fund, is a scheme that was established on 1 August 2018 by the Public Service Social Security Fund Act, No. 2 of 2018.

Before July 2019, the National Health Insurance Fund (NHIF, hereafter the Fund) of the United Republic of Tanzania deployed various contribution collection systems, which caused a number of challenges on contribution management. Main challenges were experienced on contribution remittance, including accumulation of contribution arrears and suspense or direct credits contribution.

The Public Service Social Security Fund (PSSSF) of the United Republic of Tanzania, hereafter also referred to as the Fund, was established in August 2018 as a social security scheme for public Sector. In its mandate it had to serve employers, members, and pensioners of the Fund. PSSSF has the role of registering members, collect contributions, invest and pay benefits.

Before July 2019, the National Health Insurance Fund (NHIF, hereafter the Fund) of the United Republic of Tanzania had a service portal; a verification system that required internet connectivity to verify members prior access to medical services. Requirement of internet connectivity was a challenge to most of the health facilities located in remote areas. As such, some health facilities in remote rural areas used to provide medical services even to ineligible beneficiaries.

The main objective of investing social security funds is to generate returns that help to finance payment of benefits and services to members. Apart from maximizing returns, investment by social security schemes aim to create positive social-economic impact to the Community. The Public Service Social Security Fund (PSSSF), hereafter also referred to as the Fund, being the leading social security scheme in United Republic of Tanzania, has made investments in four industrial projects apart from the traditional investments.

Previously, the United Republic of Tanzania had five social security schemes namely National Social Security Fund (NSSF), PPF Pensions Fund, LAPF Pensions Fund, GEPF Retirement Benefits Fund, and Public Service Pension Fund (PSPF), offering pension and allied benefits.

The Social Security Regulatory Authority (SSRA) in Tanzania was established under section 5 of the Social Security (Regulatory Authority) Act No.5 of 2008. Among other things, the Authority has powers to regulate and supervise the Tanzania Social Security Sector. The Authority regulates five DB schemes namely; NSSF, PSPF, LAPF, GEPF and PPF. It also regulates one Workers Compensation Fund, WCF and one health Fund, NHIF.

The National Health Insurance Fund (NHIF) has been experiencing a number of operational challenges including some attempts by non-contributing members to access health care services by using invalid membership cards.

According to the rules and procedures, members who are not contributing to the Fund for past three consecutive months, are not eligible to access medical services provided by the Fund. However, since around 95 per cent of contributing members of the NHIF are drawn out of the public sector, enforcement of this requirement has been a big challenge.

The Social Security Regulatory Authority (SSRA) in Tanzania, was established under section 5 of the Social Security (Regulatory Authority) Act No.5 of 2008. Among other things, the Authority has powers to regulate and supervise the Tanzania Social Security Sector. The Authority regulates Five DB Schemes namely; NSSF, PSPF, LAPF, GEPF and PPF, it also regulate one Workers Compensation Fund (WCF) and one health Fund (NHIF). The Social Security Schemes have Regional and Zonal Offices across the Country.

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 National Health Insurance Fund (NHIF) (T), the major health insurance organization in the country took the initiative to accredit pharmacies and drug dispensing outlets so as to enable the Fund's members to get medicines once a health facility does not have such medicines in its stock. This practice created loop-holes for fraudulent practices whereby some people benefited from the Fund by creating ghost patients in pharmacies and from patients visiting more than one facility, hence getting multiple prescriptions as a result costing the Fund millions.

The Public Service Pensions Fund (PSPF) was established in 1999 to serve public servants employed in the central government and executive agencies. The PSPF operates two schemes, the mandatory scheme and the supplementary scheme. To date the Fund serves 340,098 contributing members in the mandatory scheme, 91,137 members in the supplementary scheme and has 77,508 pensioners.

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

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 main objective of establishing the Medical Equipment Loans was to alleviate service providers' shortage of basic equipment while that of Facility Improvement Loans was to assist accredited health facilities to undertake needed modernization projects to update, remodel, partition or replace dilapidated hospital facilities. Following the provision of these loans, accredited health facilities have been enhanced, members' complaints reduced as well as NHIF's income increased due to the interest obtained from the loans.

Preliminary actuarial studies recommended the NHIF's operations be centralized in Dar es Salaam. However, in view of the fact that the majority of the NHIF's members live in rural areas, particularly primary school teachers, the NHIF took initiatives to decentralize its services.

The main objective of decentralization was to improve services with the expectation of accentuating a spirit of ownership in members, reducing operational costs and bringing stakeholders closer to the scheme.

At the time of its inception, the scheme had accredited all government facilities. Later on, in 2004, the NHIF started to accredit faith based, NGO and private health facilities to bridge the gap on the supply side at the public health facilities that were initially accredited. Due to members' complaints about the inadequacy of medical services obtained from accredited medical facilities, the NHIF considered what improvements could be made to its medical services package.

Thus, the Fund being a public institution, it was seen just as other public institutions that could as well not deliver.

Management is vested in the Board that draws representation from employers, private-for-profit service providers, trade unionists, government and experts in social health insurances.

The conference normally attracts around 500 participants per year from the following categories; members, employers, trade union representatives, government officials and foreign participants from other social security institutions and social security experts from the International Social Security Association (ISSA), the International Labour Organization (ILO), etc.

PPF TAARIFA was therefore developed in-house to cater for the current operational environment. PPF TAARIFA is an SMS and online information system used to provide services to members without the need for them to physically attend any PPF offices for services that can be provided online. The application provides easy access of information to the Fund's members, enables timely responses and handles a massive number of members' queries simultaneously.