The COVID-19 pandemic has boosted the role of information and communication technology (ICT) in social security. Despite the human tragedy of the pandemic, handled correctly, this is a golden opportunity for long-lasting improvements to service delivery by social security institutions. This conclusion came out of the ISSA Virtual Symposium on Information and Communication Technology in Social Security, organized on 19 May in cooperation with the Estonian National Social Insurance Board (ENSIB).
The outbreak of COVID-19 led to an urgent and unprecedented need for digital solutions in social security. ICT innovation and upscaling were keys to ensuring business continuity, to maintain customer access to benefits and services, to handle the explosion in demand, and to implement new schemes. The ISSA virtual symposium was therefore dedicated to ICT responses to COVID-19. “Information and communication technology plays a crucial role in the response to COVID-19”, said Marcelo Abi-Ramia Caetano, ISSA Secretary General, in his opening remarks.
With speakers from social security institutions in Africa, the Americas, Asia and the Pacific and Europe, as well as international bodies, the virtual symposium gave a rich panorama of innovations and adoptions of ICT technologies in social security since the start of the pandemic. The virtual symposium was organized in two thematic sessions focussing on Customer services during COVID-19, and Health services during COVID-19, as well as a CEO Roundtable on lessons learnt, improving readiness and preparing for the future.
Maintaining customer services during a pandemic
With the immediate implementation of lockdowns and social distancing measures due to COVID-19, one major challenge for social security institutions was to maintain customer services. This topic has also been covered in a number of webinars organized by the International Social Security Association (ISSA) since early 2020. During the ICT Virtual Symposium, Edmund Cheong Peck Huang, Chief Strategy and Transformation Officer of the Social Security Organisation (Pertubuhan Keselamatan Sosial – PERKESO), Malaysia, outlined how they had to deal with existing programmes, new schemes and a surge in demand, while at the same time handling the pandemic as an organization.
After a short period, PERKESO experienced four times more claims during COVID-19 than before. A new job retention and wage subsicity package resulted in over 20,000 applications per day. The use of ICT was central in its strategy aiming to maintain high quality customer services during the pandemic. PERKESO experienced a massive shift from traditional contact to over 90% use of online services. Building on this experience, PERKESO is investing in new digital platforms. A new App, which includes push-messaging, should make it easier to reach beneficiaries with targeted services and messages. The App will be a catalyst to create a digital ecosystem, including pushing forward on an e-wallet system. A new service during the pandemic was the chatbot Hanna, which relieved pressure on staff and ensured that more customers could be helped. Efforts were made to be more targeted in information and services, and artificial intelligence (read also our analysis of artificial intelligence in social security) and machine learning became gradually more important in this regard.
Still, not all customers have the equipment, knowledge or skills to go digital. This was highlighted by PERKESO as well as Tony Olang, Head of Information and Communication Technology at the Local Authorities Pension Trust (LAPTRUST), Kenya. LAPTRUST has worked on developing a digital work environment, digitalizing files and ensuring online service solutions, which became an important asset when setting up its response to COVID-19. This was echoed by Morten Meyerhoff Nielsen from the Operating Unit on Policy-Driven Electronic Governance (UNU-EGOV), United Nations University, who emphasised that it all depends on the back-office being digitally enabled.
Meyerhoff-Nielsen demonstrated how there has been a vertical and horizontal expansion of social security services during the pandemic, and how this has amplified ongoing trends of ICT transformation. In his view, this gives social security institutions a golden opportunity, because both staff and customers have changed their behaviour drastically in record time. A combination of hi-tech (chatbots, digital payments, artificial intelligence, big data, machine learning) and low-tech (call centres, e-mail, online information) have been important in the response to COVID-19. The digital divide will not go away by itself, and continued focus on digital inclusion is crucial. In terms of innovation, Meyerhoff-Nielsen emphasised that public institutions should always be a second mover, using tried and tested technology, but still accepting some risks in piloting their own solutions.
The role of ICT in health services during COVID-19
The pandemic has been a real stress test for health care and health insurance systems around the world (read our analysis on health systems and COVID-19. Social security institutions had to deal with COVID-19 almost overnight. Fortunately, they could often build on existing strategies and solutions. This session was introduced by Ali Ghufron Mukti, President Director of the Social Security Administering Body for the Health Sector (BPJS Kesehatan), Indonesia, and Chair of the ISSA Technical Commission on Medical Care and Sickness Insurance.
In his presentation Philippe Naty-Daufin, Advisor to the President of the National Sickness Insurance Fund (Caisse nationale de l'assurance maladie – CNAM), outlined how digitalization was already a pillar in the ongoing transformation of the French health system. In terms of responding to the pandemic, ICT solutions are central when it comes to information and communication, treatment and isolation, tracking and understanding the pandemic, and allowing a re-opening of society. An anti-COVID-19 app was developed and launched through a public-private partnership, email interactions went up from 35,000 to 80,000 per day, medical teleconsultations (read also our analysis on telemedicine in Latin America) exploded from 5,000 to 650,000 per week, and a digital health pass is on the way, to mention just some examples. In the view of Naty-Daufin, the pandemic helped break down resistance from patients and medical professions, accelerating the digital transformation.
The Republic of Korea was one of the countries that felt the early impact of COVID-19, and ICT solutions played a key role in its effective handling of the pandemic. Sang-Baek Chris Kang, Director General, Department of Global Cooperation, National Health Insurance Service (NHIS), outlined the importance of already having a fully digitalized health system and a national e-governance system in place. He placed particular emphasis on applying a data-driven approach for social security administration, particularly based on big data comprising civil registries and vital statistics. Such big data, which is developed in collaboration with other agencies, enables the NHIS in implementing eligibility checks, defining contribution and benefit levels, and setting the health-care policies. During the pandemic, big data resources were instrumental in effectively implementing contact tracing and directing patients in most critical conditions to central hospitals and others to regional centres. Furthermore, the application of artificial intelligence, deep learning and linear projection on the big data are seen as central elements in the Korean response to COVID-19. While Mr Kang sees this as the future, he stressed the crucial role of quality data governance structures, including rules on which data is accessible for whom and how.
For Tom Verdonck, President of the European Healthcare Fraud and Corruption Network (EHFCN), the digitalization of social security and health services are a welcomed development, but it requires increased attention on the prevention and detection of fraud. He stressed that solutions that are created with the best intentions can still be used for fraudulent purposes. He mentioned the surge in the use of online consultations, digital payments, e-certificates and new reimbursement codes, as something for which control structures were often not in place or sufficiently developed. By way of example, some doctors falsely registered most of their e-consultations as having taken place in the evening in order to claim higher reimbursement. With more interactions moving online there are also serious cybersecurity and data protection issues that need to be tackled, and there is a need for more aggregated data on the use of digital solutions. Mr Verdonk would like to see more attention on such issues in the future.
CEO perspectives: Lessons learnt and the way forward
The final session of the Virtual Symposium on ICT in Social Security was a discussion among high-level executives from three continents. The aim of this session was to take stock of lessons learnt, and how this can help improve readiness and prepare for future crises. Raúl Ruggia-Frick, Director of Social Security Development at the ISSA, moderated the discussion.
For T.B.J. Memela, Chief Executive Officer of the South African Social Security Agency (SASSA), we should not lose sight of care for the vulnerable when discussing the transformation of social security to a digital environment. ICT has played an important role in the response to the pandemic, in South Africa as elsewhere. However, Ms Memela emphasised the importance of a reality check. Not all beneficiaries have access to the internet, to digital solutions, to mobile payments, or even to bank accounts. A broader approach focussing on digital inclusion, but also providing more traditional solutions, is therefore still needed. In addition, she emphasised the need for an all-of-government approach to ensure interoperability between government agencies and institutions, ensuring effective data sharing in the interest of beneficiaries.
Héctor Jaramillo Gutiérrez of the Chilean Mutual for Safety CChC (Mutual de Seguridad CChC) focussed on occupational safety and health during the pandemic (read our analysis on prevention work in Latin America). For him, flexibility is the keyword that has defined the response to the pandemic. Everyone was suddenly faced with a new reality, and agility, flexibility and cooperation were key an effective response. In terms of the workplace, in particular the switch from meeting face to face to meeting digitally was instant and widespread. Through a solution oriented approach, protocols and ways of working were changed and updated. Mr Gutiérrez was positively surprised by the ability to be flexible and adapt, and this also points to a new worklife reality. New monitoring and use of data is also important in ensuring occupational safety and health, for example data on the roll-out of vaccinations, which can inform decisions on the possibility of returning to the office.
In Europe, Spain had to handle a very rapid spread of COVID-19 during a period in 2020 (read our analysis on social security responses in Spain). Francisco De Argila Lefler, from the National Social Security Institute (Instituto Nacional de la Seguridad Social – INSS) outlined the continuous reinforcement and introduction of new schemes, and how ICT played an enormous role in getting to grips with the pandemic. On this note, he flipped the image and asked what would happen if the next crisis was a cyber-attack? With social security moving faster and faster towards a digital reality, how would we cope if our digital solutions were put out of service? Could we go back-to traditional non-digital solutions? Probably not, which emphasises the importance of back-up plans and solutions, and of preparing for the unexpected crisis.
On this note, Indrek Holst, Director General of ENSIB, Estonia, stressed that even the most digitalized countries, institutions and systems, have their challenges when responding to a pandemic or other crises. His country markets itself as e-estonia, and prides itself with 99% of governmental services being online. Naturally, the Estonian response to COVID-19 has been managed highly digitally, for example with an efficient digital register for vaccination, which is linked to the amount and distribution of vaccines. At the same time, like others, he also stressed the threat of a cyber-attack, and the importance of dealing very carefully with data. In the area of efficiency gains still to be realized, he stressed the importance of breaking down silos within the public sector and in particular the great potential of closer cooperation between the social and health areas.
Raúl Ruggia-Frick highlighted the relevance of these lessons learnt to improve institutions’ capacity and readiness to deploy quick responses and to ensure the continuity of services in a crisis context. The experiences shared by the institutions show the importance of inter-institutional collaboration to maintain quality information about beneficiaries and contributors, of flexibility and agility to quickly adapt to new contexts, and of a robust protection of key systems and data. These elements will be taken into account in upcoming ISSA Guidelines on the continuity of social security services and institutional resilience.
See you in Tallinn in 2022
The ICT Virtual Symposium was organized in anticipation of the 16th ISSA International Conference on Information and Communication Technology in Social Security. Meant to take place in May 2021, COVID-19 made it necessary to move this to May 2022. Like the virtual symposium, next year’s event will be organized in cooperation with ENSIB. Its CEO, Indrek Holst, rounded off the virtual symposium by welcoming all ISSA members to Tallinn next year, and by presenting a short promotional video for the event.