The challenge of extending full access to social security coverage to ensure universal access for all citizens, regardless of their living and working situation, and in all circumstances, is an issue across all branches of social security – and to various degrees permeates all institutions, which therefore need to work together.

These Guidelines identify administrative solutions to improve access to social security, with a particular focus on populations that are difficult to cover (the so-called “hard to reach”) under contributory social security programmes. . In line with its strategic vision of dynamic, resilient and shock-resistant social security systems that integrate living environments – the socioeconomic and environmental determinants of health – the International Social Security Association (ISSA) promotes the extension of social security coverage through a number of measures. These include the ISSA Strategy for the Extension of Social Security Coverage, the publication of ISSA handbooks on coverage extension to self-employed and migrant workers, and specific studies on the extension of social security coverage, such as the report on the BRICS countries, the Framework Guidance Document on social security for migrant workers in Eurasia and the corpus published by France’s National School of Social Security (École nationale supérieure de sécurité sociale – EN3S) that addresses aspects of health coverage regulation. Of course, all experiences of extending health coverage that are currently underway around the world can be drawn on to inform both emerging and embedded strategies.

The COVID-19 pandemic has reinforced the need for inclusive social protection. Health coverage is just one aspect of a wider package but, by offering immediate benefits, it attracts people’s attention and makes it more likely that they will sign up to schemes providing longer-term benefits, such as those covering the risks of old age or unemployment.