Open Access

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.

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.

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.

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.

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.