Complementarities between social protection and health sector policies

ESSP Working Paper 112, by Kalle Hirvonen, Anne Bossuyt, and Remy Pigois.

Abstract: Social protection policies typically involve multiple sectors, ranging from food security to health care. Despite this, limited research is directed toward understanding how different social protection programs complement each other. In this study, we explore complementarities between three major national social protection programs in rural Ethiopia: the Productive Safety Net Programme (PSNP), the Health Fee Waiver (HFW) system, and the Community Based Health Insurance (CBHI) in the Ethiopian highlands (Amhara, Oromia, SNNP, and Tigray regions). Using PSNP-4 baseline data collected by the Central Statistical Agency (CSA) of Ethiopia in 2016, we find that in woredas (districts) where CBHI does not operate, only 3.5 percent of PSNP households report having benefited from the HFW. CBHI operates in about one third of PSNP woredas in the Ethiopian highlands. In these woredas, nearly 22 percent of all PSNP beneficiary households are enrolled into CBHI. We find no evidence that PSNP households are either more or less likely to enroll into CBHI than are other poor households. For only 10 percent of all PSNP beneficiary households, the CBHI insurance premium was waived due to their low welfare level. Considering that PSNP consists of the poorest and most food insecure households who would potentially greatly benefit from health insurance, this relatively low proportion of CBHI clients who receive premium waivers is of concern. In addition, 10 percent of PSNP households have experienced a serious income shock because of an illness, resulting in loss of consumption or loss of assets. Finally, many households, even those enrolled in CBHI or benefitting from HFW, incur out-of-pocket health expenditures. We take this to suggest that CBHI and HFW do not fully cover all health care costs relevant to rural households. Overall, these findings suggest that more work remains to be done to better link these three major social protection programs in Ethiopia in order to protect the poorest and most vulnerable households.. Download the PDF.