Efficient service delivery in the implementation of the National Health Insurance Scheme (NHIS) in Zambia calls for the speedy processing of claims from health care providers (HCPs) that have provided services to NHIS members and beneficiaries.

As part of the National Health Insurance Management Authority’s (NHIMA) service level agreements with HCPs, all approved claims for services rendered must be paid within 45 days. To enhance efficiency and reduce fraud in claims, NHIMA introduced the biometric claims management system called APACE.

The Santa Fe Municipal Fund (Caja Municipal de la ciudad de Santa Fe) of Argentina’s Federal Social Insurance Council (Consejo Federal de Previsión Social – COFEPRES) is a social security body created in 1904 by Ordinance 554. It was the first of its kind in the country and is an autarchic entity staffed by civil servants and employees of the Municipality of Santa Fe.

In 2022, Morocco’s CDG Prévoyance signed an agreement with the State to manage the Tayssir Programme, one of the country’s most important welfare programmes, dedicated to reducing the rate of school drop-outs among the most vulnerable segments of the population.

The project is called Compilation of suggestions. It brings together all of the opinions, suggestions and comments given by users of the products and services of the National Social Security Fund of Public State Employees (Caisse nationale de sécurité sociale des agents publics de l’État − CNSSAP) of the Democratic Republic of the Congo (DRC) in a given period, as well as the improvements that have been made on the basis of this user feedback. It is shared with staff, members and other interested parties.

Mexico’s Retirement Savings System (Sistema de Ahorro para el Retiro – SAR) is an efficient way of financing pensions that ensure people can live a dignified life once they stop working. Social and economic protection in old age is a constitutional responsibility of the State, and this right must be supported by individualized, reliable, transparent and securely safeguarded records and information. In this way, it is possible to guarantee the person is able to fully exercise their social right.

The law passed in February 2022 defined how to proceed in the event of a major mutual fund closing for reasons of non-viability, establishing incorporation criteria for members and employees within a new structure. In accordance with the legislative criteria, the Catholic Workers’ Circle of the Uruguay Mutual Fund (Círculo Católico de Obreros del Uruguay Mutualista) was one of the institutions included in this process.

Insurable earnings ceilings are automatically adjusted in line with total consumption poverty line (TCPL). This is one of the effective ways to ensure sustainability of the schemes in a hyper-inflationary environment. Statutory reviews of the ceilings would take a considerable time to the time of gazetting the statutory instrument, and the value of those earnings would be eroded by inflation.

The Health Care Administration and Management Platform (Ambiente para la Administración y Manejo de Atenciones en Salud – AAMATES) of Mexico’s State Employees’ Social Security and Social Services Institute (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado – ISSSTE) is a sectoral initiative run jointly by the National Digital Strategy Committee (Coordinación de Estrategia Digital Nacional) and the Ministry of Health that is aimed at standardizing clinical processes in medical units at the primary care level at the national level, which mak

The Brazilian social security works as a system that guarantees income for workers and their families in case of illness, accident, imprisonment, pregnancy, death, or advanced age. In turn, it is composed by three programmes: the General Programme (RGPS)[1], the Specific Programme (RPPS)[2], and the Complementary Pension Programme (RPC)[3]. The latter is individual while the first two are public.

Crises and extreme events may strain the capacity to communicate records of medical leave to subsidiary cash benefit units. The pandemic has demonstrated the need to systematize procedures that have traditionally been carried out manually, which would provide significant benefits by making processes faster and more efficient, avoid the need for users to visit administrative offices, thereby avoiding expenditure, risks and outbreaks, and reduce spending on institutional resources.