inclusion and strengthening of social services: the case of jamaica presentation by faith innerarity

Third Regional Intergovernmental Conference on Ageing in Latin

America and the CaribbeanSan José, Costa Rica, May 8-11 2012

Inclusion and Strengthening of Social Services: The Case of Jamaica

Presentation byFaith Innerarity

Introduction and Background◦ Jamaica at a Glance◦ Historical context◦ Demographic profile◦ Socio-economic situation

Advances in implementation of Brasilia Declaration◦ Social policy framework◦ Coverage of older persons in the social protection system◦ Promoting participation

Gaps and Challenges Conclusion and Recommendations

Outline of Presentation

Jamaica at a Glance Jamaica is a mountainous island, which is comprised of 14

parishes and spans 11,242 sq. miles of land in the Caribbean Sea.

It is the largest English-speaking Island in the Caribbean. The country is classified as Upper Middle Income in the

World Bank’s World Development Indicators (GNI per capita of US$ 4,990 in 2009)

The level of human development has been ranked as medium range (100 out of 182 countries in 2009) by the UNDP in the Human Development Index (HDI).

The population has been growing at about 0.5 per cent per annum and was estimated at about 2.7 million in 2009.

While the country’s population is ageing 28 per cent is still under the age of 14.

This year (August 6th) Jamaica celebrates 50 years as an independent nation.

Range of cultural and other events planned to mark this milestone.

Recent seminar (April 26, 2012) hosted by the Sir Arthur Lewis Institute (SALISES) of the University of the West Indies provided critical analysis of achievements in the area of social policy since independence.

Historical Context

Presentation by Faith Innerarity

HAS SOCIAL POLICY ACHIEVED ANYTHING SINCE INDEPENDENCE?

7

As a post-colonial society, Jamaica’s social protection system had its genesis in British social policy and has evolved over time influenced by the political economy and international norms and trends.

Overall movement from residualism in social protection policy to the rights-based approach.

Paradigm shift from welfare to developmental model in the provision of social services.

Historical Evolution of the Social Protection System in Jamaica

8

Residual Model (Titmuss) - Proceeds from the premise that the market

and the family are the two ‘natural’ or ‘socially given’ means of properly meeting the needs of the individual and that only when these fail should welfare institutions come into play and only on a temporary basis. - Seen as having its roots in the English Poor Laws dating back to the 14th Century

Residualism

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The first attempt at providing formal social protection in the island was represented by the Poor Law introduced in 1682 that was similar in nature to that which existed in England at the time.

The law recognized three categories of poor persons, the ‘able-bodied poor’, ‘vagrants’ and the ‘aged sick’.

The ‘able-bodied’ persons were to be ‘rehabilitated’ so that they could work, the ‘vagrants’ were to be sent to houses of correction, while the ‘aged sick’ were to be cared for in their homes.

Slavery, Colonialism and Influence of British Social Policy: Poor Law 1682

Period of SlaveryPoor Laws 1682

Reflected Elizabethan Poor Laws 1597

&160119th Century British Political Economy

centered on Laissez-faire

Belief that poverty stemmed from

idleness

Emancipation 1838

Extreme Social hardships

Morant Bay Rebellion 1865 Passage of Poor Relief Law 1886 replacing Poor

Laws

Labour Revolts 1930’s

Increased expenditure on social services and greater state involvement

such provisions Social policy became more integral part of public policy making Movement away from

residual approach

Moyne Commission Report

Passage of the Colonial

Development and Welfare Act in 1940

revised in 1945 Establishment of

the Colonial Development and

Welfare Fund

Slavery, Colonialism and Influence of British Social

Post World War II and rise of Welfare State in

developed world Far reaching changes in the system of welfare

provisioning in the United Kingdom

Changes in policy direction in colonies

Old Age Pension and Superannuation Scheme Law passed in Jamaica in 1958 reflecting elements

of Britain’s National Insurance Act (1946)

based on the Beveridge Scheme for Social Security

which ushered in the British Welfare State.

Developmental and Rights-Based Approach

Ratification of International Human Rights instrumentsNational Insurance Scheme Act 1965 Conditional Cash

Transfer Programme 2002

Impact of Post-War International Developments

Social Protection: Conceptual Framework

Jamaica’s population is ageing rapidly. In 2010, the estimated number of persons

sixty years and over constituted 11.1 per cent of the total population (299,500 persons).

Between 2010 and 2050, the elderly is expected to double both in absolute numbers and as a percentage of the population.

Demographic Profile

Year No of elderly 60+ years % of total population

2010299,500 11.1

2020348,392 12.4

2030453,177 15.8

2040528,688 18.4

2050614,902 21.8

Demographic Profile

Source: Statistical Institute of Jamaica (Demographic Statistics 2010, Projections 2010)

Indicator 2010 2030 2050

Median age 27 33.6 41.7

% Over 80

years

1.8 2.5 6.8

Indicators of Ageing 2010, 2030 and 2050

Source: Kristin Fox, Report to ECLAC 2012

There is a predominance of females among older persons: In 2010 the ratio was 55 per cent females (163,900) to 45 per cent males (135, 600) or 100 females to 82.7 males.

Demographic Profile

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Expectation of Life** At Specific Ages: Jamaica 1999-2001Age Male Female Both Sexes 0 70.94 75.58 73.25 1 71.38 76.04 73.7 5 67.86 72.47 70.15 10 62.96 67.55 65.24 15 58.06 62.62 60.33 20 53.33 57.74 55.33 25 48.88 52.95 50.91 30 44.53 48.3 46.41 35 40.17 43.69 41.92 40 35.77 39.15 37.45 45 31.43 34.65 33.04 50 27.24 30.32 28.78 55 23.23 26.16 24.71 60 19.51 22.28 20.92 65 16.24 18.77 17.53 70 13.25 15.42 14.39

Source: Demographic Statistics STATIN 2002. **Additional years

Life expectancy at birth for the period 2010-2015, is estimated at 76.0 for females and 69.7 years males.

Life Expectancy 2010 -2015

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2006 2007 2008 2009 Jamaica (% of individuals) 14.3 9.9 12.3 16.5 By Region KMA 9.4 6.2 7.0 12.8 Other Towns 9.2 4.0 10.7 10.2 Rural Areas 19.8 15.3 17.0 22.5 By Gender (%)

Male 14.6 11.2 13.3 17.7 Female 13.9 8.8 11.3 15.4 By Household Head (%)

Male 9.9 7.2 7.9 11.4 Female 10.8 8.0 9.1 12.8 All Households 10.3 7.6 8.5 12.0

By Age Group (%)

0-5 18.6 11.2 15.7 19.3 6-18 17.0 12.2 15.2 20.8 19-24 14.0 10.2 13.9 16.7 25-59 11.9 7.9 9.7 12.7 60+ 12.1 10.8 10.3 17.2 Memoranda items:

Number of poor 380,824 264,907 330,531 444,771 Poverty Line (All JA) J$/annual 74,349 80,090 104,737 110,100

Food Poverty Line (JA) J$/annual 59,908 52,712 68,933 72,463

Mean Per capita Consumption J$/annual 139,597 165,761 214,015 205,693

Mean Per capita Consumption (1990 prices)

9,531 10,508 10,377 9,578

Prevalence of Poverty: Jamaica 2006-2009 (%)

Source: Social Protection Diagnostic Study May 2011

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Regional Distribution of Poverty: Jamaica 2006-2009 (%)

2006 2007 2008 20090.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

KMA Other Towns Rural Areas

Male%

Female%

Total%

KMA 10.8 13.3 11.7

Other Towns 11.3 12.7 11.8

Rural 12.6 12.5 12.6

Total 11.8 12.3 12.2

Percentage of population who are elderly by sex and area of residence: Jamaica 2009

Source: STATIN. JSLC 2009

Year Percentage of the elderly

below the Poverty Line

Percentage population

below the PovertyLine

2007 11.1 9.9

2008 12.8 12.3

2009 17.7 16.5

Percentage of elderly and total population below the Poverty Line

Jamaica 2007 – 2009

STATIN. JSLC, 2007, 2008, 2009

Social Policy Framework: Pre Brasilia Declaration National Policy for Senior Citizens adopted by

Parliament in 1997:

◦ Reflects Vienna Plan of Action on Ageing 1982◦ Incorporates developmental and rights-based approach

National Policy for Persons with Disabilities adopted in 2000:◦ Based on UN Standard Rules for Equalization of

Opportunities for Persons with Disabilities

Vision 2030 National Development Plan (2009-2030):

◦ Crafted using participatory and consultative approach involving over 30 technical working groups from all spheres of society representatives of retired persons associations.

◦ Stated goals include provisions to create secure future for vulnerable segments of the population, ensuring in particular, that older persons and persons with disabilities are fully integrated within society, have access to appropriate care and support services and are treated as valuable human resources.

◦ Explicitly recognizes the importance of planning for the changing demographic landscape and that older persons are within the “most vulnerable” category of social groupings.

◦ Clearly aligned with MIPAA and Brasilia Declaration

Social Policy Framework: Post Brasilia Declaration

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Factors central to the social protection reform process and the decision to adopt the conditional cash transfer (CCT) model:◦ Recognition of the need for a more systematic

and equitable mechanism for the targeting of beneficiaries for non-contributory social assistance programmes.

◦ Policy shift from a welfare to developmental mode for greater effectiveness.

◦ Achieving greater administrative efficiencies.

Social Safety Reform and Adoption of CCT: 2002

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CCT Programme Of Advancement Through Health and Education (PATH) Target 2002:

236,000

71%

5%

14%

8% 2%

Children 0-17

Pregnant & lactating

Elderly (> 60yrs)

Persons with Disabilities

Adult poor (18-59 yrs.)

PATH Registered Beneficiaries February 2012

Benefit Category Number

Children (0-18 years) 302,623 (76.8%)

Adult Poor/Poor Relief 18,577 (4.7%)

Disabled 10,243 (2.6%)

Elderly 60,616 (15.4%)

Pregnant/Lactating 1,955 (0.5%)

Total 394,014

Constant lobbying by social workers and advocacy groups on behalf of older persons.

Dialogue on universalism versus means testing in social policy.

Global economic and financial crisis resulted in multilateral and bilateral assistance to broaden scope of social assistance to include older persons and persons with disabilities (additional 10,000).

Broadening of scope of CCT to include more older persons: 2008

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From the standpoint of redistributive justice PATH has been fairly successful in redistributing benefits from higher consumption groups to the poor based on its targeting mechanism.

Confirmed by Targeting Assessment (Mathematica Policy Incorporated 2003)

Diagnostic Study Social Protection System 2011.

Redistributive Justice and Targeting Efficiency

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Distribution of PATH Beneficiaries by Quintile

KMA Other Towns Rural Areas Q1 Q2 Q3 Q4 Q50

10

20

30

40

50

60

70

80

90

2006 2007 2008 2009

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Concentration Curve for PATH and Poor Relief

0 0.2 0.4 0.6 0.8 10

0.2

0.4

0.6

0.8

1

PATH Poor Relief Consumption

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Govern Health Insurance and Drug subsidy Programmes – Elderly Population: 2010

Age Cohort

No. in Cohort a/

Government Health Insurance Programmes JADEP b/ NHF/Card b/ NI GOLD d/

No. % No. % No. %

60-64 68,463 59, 716 87.2 25,896 37.82 7,662 11.19

65-69 65,255 40,836 62.58 25,835 39.59 17,019 26.08

70-74 59,674 41,572 69.66 24,713 41.41 18,876 31.63

75+ 104,668 71, 024 67.86 56,373 53.86 41,260 13.84

Total 298,060 213, 148 71.51 132,817 c/ 44.56 84,817 28.46

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Distribution of NHF Beneficiaries

Sex JADEP NHFCard (all age groups)

No. % No. % Female 130,865 61.40 152,671 63.45 Male 82,283 38.60 87,927 36.55 Total 213,148 100.00 240,598 100.00

Gender and Access to Health Benefits

Distribution of NHF Beneficiaries by Sex (March 31, 2010) Sex JADEP NHFCard (all age groups)

No. % No. %

Female 130,865 61.40 152,671 63.45 Male 82,283 38.60 87,927 36.55 Total 213,148 100.00 240,598 100.00

Source: Based on data from the National Health Fund

General applicability but of particular value to the elderly.

Progress in realization of right to health care for older persons.

Increased access accompanied by range of resource constraints because of underfunding of the health services (shortage of drugs longer waiting time).

Strategy for financing of public health sector required to ensure accessible and quality health care for elderly.

Abolition of User Fees in Public Health Facilities: 2008

37

Persons that could not Afford Seeking Health Care: 2006-2009 (%)

Jamaica KMA Other Towns Rural Areas Q1 Q2 Q3 Q4 Q50

5

10

15

20

25

30

35

40

2006 2008 2009

No user fee policy for public hospitals has intensified debate on the merits of universalism versus the targeted approach in the delivery of social services.

Abolition of User Fees in Public Health Facilities: Universalism versus Targeting Debate

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Contending views have been particularly strong in terms of the Abolition of the User Fees in public health facilities;

Supporters of the policy point to the increased access for the poor and the inefficiency of the former system of fee collection;

Critics have highlighted the increased strain on the human and other resources in the public health system and the drain on the national budget.

Abolition of User Fees in Public Health Facilities: Universalism versus Targeting Debate

40

Concentration Indices of Selected Programmes

Programmes Concentration Indices 2008

Concentration Indices 2009

PATH -0.38 -0.34 Poor Relief -0.31 -0.31 Health Fee Waiver -0.15 -0.15 JADEP 0.14 0.09 NHF 0.11 0.11

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Contributory Social Security: National Insurance Scheme (NIS) Annual Summary of Contributors 2006-2008Category Year

2006 2007 2008

Male Female Total Male Female Total Male Female Total

Employed 191,559 208,592 400,151 203,880 215,697 419,557 197,759 210,658 408,417

Self-Employed

8,609 15,195 23,804 9,536 17,096 26,632 10,042 18,540 28,582

Total 200,168 223,787 423,955 213,416 232,793 426,189 207,801 229,198 436,999

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Contributory Social Security: Distribution of NIS Pensioners by Age Cohort

Population Cohort Size of Cohort a/ No. NIS Pensioners b/ % NIS Pensioners 60-64 68,463 7,662 11.19 65-69 65,255 17,019 26.08 70-74 59,674 18,876 31.63 75 and over 104,668 41,260 13.84 Total 298,060 84,817 28.46

a/ Statistical Institute of Jamaica (STATIN), End of Year population 2009 b/Ministry of Labour and Social Security (MLSS) – No. NIS Pensioners as at March 2010

Population Cohort

Size of Cohort a/ No. NIS Pensioners b/

% NIS Pensioners

Male Female Male Female Male Female

60-64 33,400 35,000 917 6,745 2.75 19.27

65-69 31,300 33,700 6,633 10,386 21.19 30.82

70-74 28,000 31,100 8,884 9,992 31.73 32.13

75 and over 41,400 61,700 16,918 24,342 40.86 39.45

Total 134,000 161,500 33,352 51,465 24.89 31.87

Distribution of NIS Pensioners by Age Group and Sex (2010)

Source: a/ STATIN End of Year Population; b/ National Insurance Scheme, MLSS

Calendar Year

Retirement Age

Females Males

2010 60 65

2011 61 65

2012 62 65

2013 63 65

2014 64 65

2015 65 65

NIS Retirement Ages 2010-2015

Source: Ministry Paper 41/2010 Reform t the National Insurance Scheme

Age group

(years)Currently employed

Nos. a %

60-69 74007 52.40

70-79 28113 28.00

80+ 7716 13.40

Number and percentage of elderly employed by age group: Jamaica 2009

aSurvey data raised to provide national estimatesSource: STATIN, 2009, unpublished data reported by Kristin Fox 2012

Number/

PercentagePopulation 60 years and older

299,500No. NIS Pensioners 60 years and older

84,817No. PATH Beneficiaries 60 years and older

58,133

Number persons 60 years and older covered by NIS and PATH 142,950Number persons 60 years and older not covered by NIS or PATH

155,110

Percentage population 60 years and older covered by NIS and PATH 47.73

Percentage population 60 years and older not covered by NIS or PATH 52.27

Social Protection Coverage Gap in Income Support for Elderly (2010)

Age Group SpendingJ$000

% Total GOJ Spending

% GDP % SpendingOn Social

Protection

%Poverty

Spending Excl. Pubic Pensions

J$000

% Spending

On Social Assistance

0-18 8,837 1.5 0.8 22.8 46.6 8,837 54.0

(0-5) 931 0.2 0.1 2.4 12.1 931 5.7

(6-18) 7,906 1.3 0.7 20.4 34.5 7,906 48.3

19-24 1,024 0.2 0.1 2.6 9.8 1,024 6.3

25-59 5,046 0.9 0.5 13.0 30.8 5,046 30.8

60+ 23,894 4.0 2.2 61.6 12.8 1,468 9.0

Sub-Total 38,800 6.5 3.5 100.0 100.0 16,374 100.0

Households 9,166 1.5 0.8

Social Assistance 19,772 3.3 1.8

Social Insurance 28,194 4.8 2.6

Public Pension Plan 14,689 2.5 1.3

Total 47,966 8.1 4.4 Memo:

Total GOJ Expenditure 593,064 100.0 53.9

GDP 1,100,223 100.0

Distribution of Social Protection Spending by Age Group:Jamaica (2010-2011)

Country Social Insurance

Social Assistance

Social Protection

Education Health Social Sectors

Year

Jamaica 2.6 1.8 4.4 6.3 2.5 13.2 2009/10Average 2.4 1.8 4.0 6.3 4.1 14.5 Antigua &Barbuda 3.6 1.6 5.2 3.9 3.2 12.3 2009Dominica 3.4 2.2 5.6 5 4.6 15.2 2000Grenada 1.8 1.6 3.4 5.2 5.9 14.5 2001St. Kitts & Nevis 2.7 1 3.7 6.4 3.6 13.7 2000St. Lucia 1.3 1.6 2.6 7.5 3.3 13.4 2000/01

St. Vincent & the Grenadines 1.4 2.5 3.6 9.9 4.1 17.6 2002

Sub-Regional Comparison of Social ProtectionPublic Spending (% of GDP)

Source: World Bank ; Jamaica Social Protection Assessment Study 2011

HelpAge International (HAI), global network that advocates for the rights of older persons. HelpAge has been very active in Jamaica monitoring and supporting the government’s commitment to the Madrid International Plan of Action on Ageing.

Between 2007 and 2012, HelpAge has implemented several projects in communities across Jamaica, including, Disaster Risk Management, HIV Surveys, Poverty Alleviation and the Older Citizens Monitoring Project.

Enabling Environment: Promoting Participation and Advocacy

Older Citizens Monitoring is essentially a process which promotes dialogue and interaction between older people, civil society organizations and governments in order to develop policies and practices that benefit disadvantaged older people.

Concept was developed by HelpAge International to ensure that signatories to the Madrid Plan of Action on Ageing institute policies and programmes to ensure implementation.

HAI Older Citizens Monitoring Project: Best Practice

Older Citizens Monitoring approach was first piloted by HelpAge in five developing countries in Asia (Bangladesh), Africa (Kenya and Tanzania), and Latin America and the Caribbean (Bolivia and Jamaica).


The model focuses on: ◦ inclusion; ◦ providing information about services and how to

access those services; ◦ monitoring access to and delivery of services;

and◦ promoting dialogue between people at the

grassroots level (the poor in particular) and public officials responsible for policy formulation and programme implementation


OCM model in essence seeks to empower poor older people and their communities to identify problems with access and delivery of services to which they have an entitlement and to dialogue with key decision-makers to bring about improvement in their situation.

Underlying principles are participation, efficiency, self-reliance and sustainability


The main objective of the Older Citizens Monitoring Project in Jamaica (2007-2010) was to monitor effectiveness of JADEP, NHF, and PATH in providing access to social protection benefits by older persons.


In relation to the HAI/OCM’s core objective of improving the access of older persons to available social assistance benefits, participants were of the view that this was achieved in terms of the number of persons for whom registration to NHF and JADEP was facilitated through the project.

However, the consensus was that no appreciable increase in access to PATH was recorded largely because of the rigours of means-testing for entry into the programme.


Objective to develop advocacy skills among older persons to empower them to dialogue with government officials and representatives of other public institutions and the media, in respect of their rights and interests, was considered to have been realized by stakeholders.

There were very outstanding Older Citizens Monitors who rose to prominence in their communities as a result of their involvement in the project.


Many project participants felt greatly empowered as a result of the Information Fairs which provided contact with a range of institution such as the Ministry of Labour and Social Security (NIS and PATH representatives), the Registrar General’s Department (Birth certificates and other documents) and the Tax Registration and Administration Division of the Inland Revenue Department (Tax Registration Number application).


Capacity building in partner agencies was a major outcome of the project especially in relation to the networks developed with state institutions, foremost among these being the National Council for Senior Citizens (NCSC) with its considerable knowledge and experience in dealing with issues related to older persons.


Use of existing community-based organizations at the operational level for implementation was a distinct advantage in the project design because of the tremendous social capital which these agencies brought in terms of engagement with the communities and the trust which existed.


The intergenerational nature of the activities of the partner organizations was also a very positive factor for the project and a very important strategy for longer term impact.


Vast majority of older persons who participated expressed the view that one of the areas in which the project had the most significant impact was the social interaction fostered through the strengthening of existing senior citizens clubs or the formation and establishment of new groups.


Allowed seniors to overcome exclusion, isolation and loneliness by participation in a range of recreational and other social activities.

This outcome of the project must be highlighted as studies of older person in Jamaica have identified loneliness as one of their main problems. See for example, Denise Eldemire Shearer (1997), The Jamaican Elderly: A socio-economic Perspective and Policy Implication.


Stakeholders at the community level pointed to the assistance to some of the most marginalized and vulnerable older persons through the senior citizens clubs as a major achievement under the HAI/OCM project.

Project demonstrated importance of social capital – social networks - in access to social protection


Women were the main participants in the HAI/OCM Project, accounting for 67% of the overall number of beneficiaries.

In terms of registration on the social assistance programmes and all the other support services provided under the project, they also constituted the largest percentage of beneficiaries.

HAI Older Citizens Monitoring Project: Gender Dimensions

Male Male as % of Total

Female Female as % of Total

Total Service as % of Total

Ranking of Beneficiary Access in the Project

Overall Total Beneficiaries

558 32 1166 67 1724 100 n/a

JADEP 131 29 311 74 442 25 2nd

PATH 14 36 24 63 38 2 7th

NHF 65 27 172 72 237 13 3rd

Bus Pass 48 34 91 65 139 8 6th

TRN 68 43 90 56 158 9 5th

RGD 134 26 375 73 509 29 1st

NIS 4 33 8 66 12 0.70 8th

Other support services/ Innovations by Partners

65 34 124 65 189 11 4th

Distribution of HAI/OCM Programme Beneficiaries by Gender

Source: HAI Caribbean Office, IFKO End of Project Final Report

Limited male participation in senior citizens clubs and its wide range of social, health, educational, welfare, and other activities to promote active ageing and the well being of seniors, has long been observed by the National Council for Senior Citizens.

Membership

Category

Male Female Total

Active Members 6,285 20,464 26,749

Shut-ins2,015 3,542 5,557

Total No. Members 8,300 24,006 32,306

Volunteers1,052 2,845 3,897

Participation in Golden Age Clubs by Sex : Jamaica March 2010

Low male participation rates in senior citizens clubs partially reflect the demographic structure of the population in which women outnumber men in the older age groups;

More importantly, however, men appear to have other interests and preferred modes of social interaction.

Launch of the Caribbean Community of Retired Persons (CCRP) in Jamaica in 2010

Highly influential membership The CCRP recently recognised several older

persons who have influenced national and regional development in various spheres.

Promoting a positive image of old age

70

Economic Security – Some progress has been made in the strengthening of the social protection system for older persons but a significant coverage gap remains in the contributory social insurance scheme and means-testing limits access to non-contributory social assistance benefits.

Conclusion

Health – Equitable access to quality health care remains a challenge for significant numbers of older persons in spite of range of state provisions including abolition of user fees in public hospitals and health centres.

Conclusion

Enabling Environment - Important advances have been made in respect of greater public participation of older persons and in the promotion of positive images of ageing but the legislative and regulatory framework to protect the rights of older persons needs to be strengthened.

Conclusion

Assessment and review of National Policy for Senior Citizens in keeping with key international commitments.

Strengthening of the legal and socio-economic framework to safeguard rights and improve the quality of life of older persons.

Further strengthening of the social protection system to close the coverage gap.

Improvement in health financing. Application of a truly gendered approach which takes

into account the vulnerabilities of not only older women but also older as a guiding principle.

Build on best practices.

Way Forward: Key Actions

Thank you!

inclusion and strengthening of social services: the case of jamaica presentation by faith innerarity

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