More Than A Half of Asia-Pacific People Lack SHP

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The people in Asia and Pacific region are literally entitled for health protection but the reality is that an estimated 1.6 billion people in the region still lack access to social health protection (SHP). The International Labour Organization (ILO) in its first ever report Extending social health protection: Accelerating progress towards Universal Health Coverage in Asia and the Pacific said this.

The report pints out pervasive gaps in legal coverage, lack of awareness on rights along with practical difficulties and impediments for accessing health services.

The report that has come out in the backdrop of COVID-19 pandemic highlights progress, challenges and coverage gaps in the region.


The report states that more than three-quarters of the population in the Asia pacific region is legally covered, which means that 950 million people are still excluded from legal entitlements. In the report, the authors mention that effective protection is lower than legal coverage in the region because of lack of awareness of rights and practical difficulties and impediments to access.

Noting that only 63.4 per cent of the population is protected by a health care scheme, the report stated that about 1.6 billion people are wholly unprotected. Less than half of the region’s work force enjoys legal entitlement to income security when sick, the report added.

The Gaps in coverage affect both women and men who have unstable or irregular employment and incomes, under-employed and part-time workers, self-employed and/or in the informal economy and migrant workers and their families. This has a drastic effect on those who depend on agriculture or domestic work. This situation jeopardizes the inclusiveness of SHP systems.

On the report, ILO Director General Guy Ryder stressed that investing in social health protection makes a key contribution to reaching universal health coverage. “The COVID-19 pandemic has reminded us of its critical importance in supporting people’s health, jobs and incomes, and its role as a key element of an inclusive recovery. It is the ethical and rational policy choice, paving the way to sustainable development and social justice,” he said.


The ILO report mentions that several countries have made significant progress in increasing population SHP coverage. However, the adequacy of benefits provided remains a challenge for many countries, it said. The adequacy of benefits implies that they are sufficiently comprehensive, of high quality and provide a sufficient level of financial protection, as defined in international social security standards.

Three main factors determine adequacy.

First, despite recent reforms, many countries remain focused on curative care and do not sufficiently include prevention measures. Second, high levels of out-of-pocket expenditure (OOP) are pervasive, in part  driven by the increased costs of care due to new technologies, population ageing and a growing financial and societal burden of chronic diseases. Third, high population coverage does not necessarily translate into equitable access to services and health outcomes.


In many of the countries, adequate distribution of services and retention of a skilled health workforce remained a concern. This is apart from disruptions in medical supply chains. Moreover, the report mentioned that regulation of private provision of health care is still at a nascent stage in most low and middle-income countries. In addition, this affects the quality of health care services, it added.

ILO Assistant Director General and Regional Director for Asia and the Pacific Chihoko Asada-Miyakawa, said, “far too many people in Asia and the Pacific remain without coverage or effective access to healthcare services, a situation made worse by COVID-19. Extending coverage and enhancing institutional capacities would help societies move towards an inclusive recovery, one which addresses the deep structural inequalities that have obstructed progress for too long.”


The ILO mentions that strong institutions and efficient scheme design and administration can enhance effective coverage and adequacy. In the report, the authors state that the rise of private health sector created new expectations from the population, which only resulted in either higher Out of Pocket Spending or in a greater financial burden on SHP systems. As such, the authors wants the States to enhance purchasing function of SHP institutions and improving the quality of public health facilities, the ILO also demands efficient pooling of risks and financial resources for equity objective pursued by SHP systems requires. It also points out that institutional arrangements need to foster greater coordination with the broader social protection system. The rationale for such coordination is three-fold. First, income insecurity and poverty are both social determinants of health. Second, a person’s health status affects their capacity to fully engage in the labour market. Conversely, poor health can jeopardize income security. Third, where long-term care, child care or social care services are not available, the burden of caring for a sick or dependent relative usually falls on family members, often women, depriving them of the opportunity to fully engage in income-generating activities.


The International Labour Organisation stressed the need for enhanced public resources to make solidarity in financing a reality. Under-funding or
unpredictable funding remained a major barrier to expanding coverage and enhancing adequacy. Embedding entitlements in the legal framework and ensuring meaningful participation and social dialogue are key features of an enabling framework for sustained resource mobilization and allocation, the report stated. The report stressed that public domestic revenues remained the main source of funding for SHP in the region. However, it also takes note that only a few countries rely on external aid to support a large share of their health expenditure.

As part of financing SHP, the ILO report states the countries adopt a mix of taxes and social security contributions. Noting that tax financing was a major means to raise revenues for SHP, the ILO report says that several States resorted to consumption taxes of various types, including  earmarked health taxes on consumer products that are harmful for health and taxes on consumer goods,

  • Political and societal commitments needed. The ILO also calls for the need for the application of guiding principles in line with international social security standards than with specific financing or institutional models.
  • Investing in prevention and primary care is an urgent priority to meet the needs of populations increasingly affected by non-communicable diseases (NCDs) and health security issues.
  • Investing in robust rights-based SHP systems is urgently needed.
  • Prioritizing public investments to guarantee access to health care without hardship, including as part of nationally-defined social protection floors, is central to delivering on the promise of the 2030 Agenda and to leave no one behind.


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