Social Protection in Health: The Need for a Transformative Dimension

This paper states that social protection in health (SPH) needs to address structural determinants of health-related social vulnerability. In addition to provision, prevention, and promotion functions, SPH needs to be transformative. The paper advocates the use of a transformative social protection framework and evaluation of SPH. It also provides examples of possible transformative dynamics in different contexts in Africa and Asia.

The current perspective on SPH is largely technical. It focuses on benefits offered and population coverage achieved by specific SPH interventions. The paper emphasizes that the impact of SPH is also related to the extent to which it transforms socio-political and institutional elements that create and sustain people’s vulnerability when falling ill. Conclusions include:

• Taking stock of transformative, a-transformative, and anti-transformative elements of any SPH arrangement is essential to maximize its contribution to health and development;
• More empirical testing of transformative SPH would help to fine-tune it;
• Use of transformative SPH framework could contribute to SPH design orientation, implementation, and evaluation towards sustainable empowerment of the excluded;
• Transformative SPH leads to more effective social protection.