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I. Einleitung II. Soziale Sicherung als Bestandteil entwicklungspolitischer Agenden – Eine internationale Perspektive III. Internationale Politikdiffusion und nationaler Politikwandel – Konzeptionelle Grundlagen IV. Die Rolle internationaler Politikdiffusion für den Wandel sozialer Sicherungssysteme – Empirische Evidenz V. Schlussfolgerungen
Weltweit verfügen 1,3 Mrd. Menschen in Entwicklungs- und Schwellenländern über keinen ausreichenden und bezahlbaren Zugang zu Gesundheitsleistungen, weder zu präventiver oder primärer Versorgung noch zu lebensnotwendigen Medikamenten oder komplexeren Behandlungen. Nach Schätzungen der WHO treffen zwar 93 % der globalen Krankheitslast die 84 % der Ärmsten der Weltbevölkerung, doch entfallen nur 11 % der weltweiten Gesundheitsausgaben auf diese Gruppe. Problematisch sind nicht allein die in vielen Ländern anzutreffende schlechte Versorgung in ländlichen Gebieten und die unzureichende Qualität des Dienstleistungsangebots, sondern auch die hohen Kosten für die Inanspruchnahme medizinischer Leistungen, da in vielen Entwicklungsländern ein großer Anteil der Gesamtausgaben für Gesundheit durch private Direktzahlungen finanziert wird.
Social protection refers to the entire system of protective measures that assist individuals, households, and communities to better manage risks and economic shocks and that provide support to the critically vulnerable. Among the major risks covered are illness, accident, death, unemployment, or old age. Social protection includes public as well as private approaches.
Over the past two decades many low and middle income countries worldwide have started to extend the coverage and improve the functioning of public social protection systems. The research program on international policy diffusion provides empirical evidence that apart from domestic factors international interdependencies matter as well for national policy change in social protection. However, little is known about the governance structures mediating international policy diffusion in social protection.
Over the past two decades many governments of low and middle income countries have started to introduce social protection measures or to extend the coverage and improve the functioning of public social protection systems. These reforms are a "global phenomenon" and can be observed in many African, Asian and Latin American countries. This paper focuses on international determinants for policy change within social protection by assessing the state of the art of both policy diffusion and policy transfer studies. Empirical studies of policy transfer and diffusion in the field of social protection are furthermore assessed in light of the theoretical background.
The paper examines the effectiveness of transgovernmental policy networks as a governance structure for policy diffusion. The analysis is based on a survey including 50 social protection policy maker and technical practitioner who are country delegates to transgovernmental policy networks within the policy area of social protection. The paper provides anecdotal empirical evidence that policy networks contribute to policy diffusion by inducing mutual learning processes.
The paper contributes to the debate on the political economy of implementation of propoor social policy. It argues for a broadening of the debate, which is dominated by technocratic arguments, emphasizing the lack of financial resources, technology or skills as the major barriers for effective implementation. Describing the dynamic interplay of ‘formal’ operational programme structures and ‘informal’ traditional institutions in delivering the CT-OVC – the largest and oldest cash transfer programme in Kenya – it argues for the need to look more closely into the local political economy as an important mediating arena for implementing social policies. Implementation is heavily contingent upon the local social, political and institutional context that influences and shapes its outcomes. These processes are highly dynamic and ambivalent evolving between ‘formal’ and ‘informal’ structures and institutions. They may change over time and place, challenging the implicit assumption that programmes are evenly implemented across geographic and political entities.
This paper analyzes the complex effects and risks of social protection programmes in Ghana and Kenya on poor people’s human wellbeing, voice and empowerment and interactions with the social protection regulatory framework and policy instruments. For this purpose, it adopts a comprehensive Inclusive Development framework to systematically explore the complex effects of cash transfers and health insurance at the individual, household and community level. The findings highlight the positive provisionary and preventive effects of social protection, but also illustrate that the poorest are still excluded and that promotive effects, in the form of enhanced productivity, manifest themselves mainly for the people who are less resource poor. They can build more effectively upon an existing asset base, capabilities, power and social relations to counter the exclusionary mechanisms of the system, address inequity concerns and offset the transaction costs of accessing and benefitting from social protection. The inclusive development framework enables to lay these complex effects and interactions bear, and points to areas that require more longitudinal and mixed methodology research.
The article contributes to understanding the political economy of implementation of social protection programmes at local level. Current debates are dominated by technocratic arguments, emphasizing the lack of financial resources, technology or skills as major barriers for effective implementation. Describing how chiefs, assistant-chiefs and community elders are routinely at the centre stage of core implementation processes, including targeting, enrolment, delivery, monitoring, awareness and information, data collection or grievance and redress, this study on Kenya argues for the need to look more closely into the local political economy as an important mediating arena for implementing social policies. Implementation is heavily contingent upon the local social, political and institutional context that influences and shapes its outcomes. These processes are ambivalent involving multiple forms of interactions between ‘formal’ and ‘informal’ institutional structures, which may support initial policy objectives or induce policy outcomes substantially diverging from intended policy objectives.
Political economic analyses of recent social protection reforms in Asian, African or Latin American countries have increased throughout the last few years. Yet, most contributions focus on one social protection mechanism only and do not provide a comparative approach across policy areas. In addition, most studies are empirical studies, with no or very limited theoretical linkages. The paper aims to explain multiple trajectories of social protection reform processes looking at cash transfers and social health protection policies in Kenya. It develops a taxonomy and suggest a conceptual framework to assess and explain reform dynamics across different social protection pillars. In order to allow for a more differentiated typology and enable us to understand different reform dynamics, the article uses the approach on gradual institutional change. While existing approaches to institutional change mostly focus on institutional change prompted by exogenous shocks or environmental shifts, this approach takes account of both, exogenous and endogenous sources of change.
Nachhaltigkeit aus institutionenökonomischer Perspektive am Beispiel der Schiefergasförderung
(2014)
Intersectoral collaborations are an integral component of the prevention and control of diseases in a complex health system. On the one hand, One Health (OH) is promoting the establishment of intersectoral collaborations for prevention at the human-animal-environment interface. On the other hand, operationalising OH can only be realized through intersectoral collaborations.
This work contributes to broadening the knowledge of the process for operationalising OH by analysing the governance structures behind different initiatives that tackle health problems at the human-animal-environment interface. The cases taken as examples for the analysis are the control and response to rabies and avian influenza under “classical OH”, and the management of floods and droughts for insights into “extended OH”. Data from Ghana and India were collected and compared to identify the key elements that enable ISC for OH.
Despite the case studies being heterogeneous in terms of their geographic, economic, social, cultural, and historical contexts, strong similarities were identified on how intersectoral collaborations in OH were initiated, managed, and taken to scale.
The actions documented for rabies prevention and control were historically based on one sector being the leader and implementer of activities, while avian influenza management relied more on intersectoral collaborations with clearly defined sectoral responsibilities. The management of the impact of flood and droughts on health provided a good example of intersectoral collaborations achieved by sectoral integration; however, the human health component was only involved in the response stage in the case of Ghana, while for India, there were broader schemes of intersectoral collaborations for prevention, adaptation, and response concerning climate change and disaster.
