Ariel Montesdeoca, Regional Health Care Coordinator & Helene van Acker, Regional Coordinator in Central America What are the major social security systems trends in Central America? In the various Central American countries only a limited group of workers and employees are included in formal social security systems. Incorporating domestic staff and those who work informally is being considered in Nicaragua and El Salvador. El Salvador has already issued a law providing access to social security for domestic staff, but it is not yet widely enforced. In the three countries healthcare reforms are being proposed. Nicaragua and El Salvador base this on a universal human rights perspective and hence a system of integrated health care. The emphasis is on promotion, prevention and free services in public health, although there is not (yet) sufficient budget and staff. Honduras seeks to privatise further.
In countries with a liberal system/privatization, MA should focus on groups with a history of strong internal solidarity, but with a minimal capacity for financial contributions. They should also think through and clarify the consequences of health privatization and establish a clear advocacy role to achieve inclusive public health care systems. They should offer a service that is better than public or private health care provision. They should provide services in geographic areas where the government is unable to do so. They need start-up capital or temporary subsidies to safeguard their operation. They should contribute to a “mutual solidarity” culture through social action. Cohesion among members is an added value, particularly in MA with members from different social strata.
What is the added value of the fos programme?
There is a growing demand from the unions and social movements to bring currently excluded groups and sectors within the social security system. This includes domestic staff, urban and rural workers in informal jobs or working for their own account, and comprises most of the working population in those countries.
In El Salvador, the fos programme supports social auditing and consultations for the reform of the health sector; providing practical answers to immediate needs in the case of drugs and strengthening the MA as instruments of social protection and increasing public awareness at local and municipal levels.
What are the specific challenges for the mutual associations (MA)?
In Honduras, fos works to promote models of mutual solidarity from a management perspective and to strengthen national discussions on proposals of social protection for countries emerging from dictatorship.
Being able to meet several requirements to ensure their survival:
In countries with a national system of social protection, MA need to be able to adapt, to be complementary to universal health care systems and to lobby for the government to play a regulatory role.
In Nicaragua, fos facilitates the review of the entry points of MA and their integration into a new reality of universal health care provided by the government.
Evaluation of fos health programmes