WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB

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WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
WorldRiskReport 2021
Focus: Social Protection
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
WorldRiskReport 2021
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Imprint
Publisher WorldRiskReport 2021

Bündnis Entwicklung Hilft
Ruhr University Bochum – Institute for International Law of
Peace and Armed Conflict (IFHV)

Concept and implementation

Peter Mucke, Bündnis Entwicklung Hilft, Project lead
Dr. Katrin Radtke, IFHV, Scientific lead
Lotte Kirch and Ruben Prütz, Bündnis Entwicklung Hilft, Editors in chief

Julia Walter, MediaCompany, Editing
Naldo Gruden and Karolina Musial, MediaCompany, Graphic design and
information graphics

Authors

Dr. Mariya Aleksandrova, German Development Institute
Impressum
Sascha Balasko, Plan International
Prof. Dr. Markus Kaltenborn, Ruhr University Bochum
Dr. Daniele Malerba, German Development Institute
Peter Mucke, Bündnis Entwicklung Hilft
Oliver Neuschäfer, Christoffel-Blindenmission
Dr. Katrin Radtke, IFHV
Ruben Prütz, Bündnis Entwicklung Hilft
Dr. Christoph Strupat, German Development Institute
Daniel Weller, IFHV
Nicola Wiebe, Brot für die Welt

In collaboration with

Lennart Bade, Bündnis Entwicklung Hilft
Jenifer Gabel, DAHW
Sr. Dr. Elizabeth Nalloor, RAHA, Misereor
Anja Oßwald, Kindernothilfe
Silke Wörmann, Kindernothilfe

Translation

Lisa Cohen, IFHV

ISBN 978-3-946785-12-5

The WorldRiskReport has been published annually
since 2011 by Bündnis Entwicklung Hilft
Responsible: Peter Mucke

 2 WorldRiskReport 2021
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Foreword
                            The year 2021 has again been strongly marked                  of different protection mechanisms and their
                            by the Covid-19 pandemic. In addition, cli-                   relevance for disaster risk reduction. Social
                            mate-related extreme weather events, includ-                  protection systems respond to the basic needs
                            ing heat waves, forest fires, and floods, have                of people in the event of disaster, strengthen
                            preoccupied us in many parts of the world. This               their resilience, and prevent them from auto-
                            year, also Germany was severely hit by floods in              matically slipping into poverty. The necessity of
                            the West and South. This disaster has shaken                  a further expansion of social protection and its
                            many people and made us painfully aware that                  stronger integration into disaster risk reduction
                            climate change – which makes such floods more                 and measures against climate change becomes
                            likely in many places – affects us all and can                also evident. From the perspective of science
                            have devastating effects even on our immediate                and practice, the report identifies approaches
                            surroundings. A reappraisal of the causes, also               and points out possible solutions. These anal-
                            with respect to disaster management, is inevi-                yses, in combination with the WorldRiskIndex
                            table and must lead to a significantly enhanced               2021, once again make the WorldRiskReport an
                            coordination of responsibilities and to a – long              important tool for decision-makers in society
                            overdue – ambitious climate protection.                       and politics.

                            At the same time, and despite all the criticism,
                            the floods have shown very clearly that Germa-
                            ny has the capacities to respond to such extreme
                            events. Many buildings and infrastructures
                            withstood the water masses, emergency forces                  Wolf-Christian Ramm
                            were on the spot, and the majority of those af-               Chairman Bündnis Entwicklung Hilft
                            fected has swiftly received support. In most cas-
                            es, they have access to social protection and will
                            receive governmental financial support where
                            insurance coverage is not available.

                            The importance of social protection takes cen-
                            ter stage in this year’s WorldRiskReport. The                 Prof. Dr. Pierre Thielbörger
                            articles by our authors highlight the importance              Executive Director IFHV

Bündnis Entwicklung Hilft is formed by the aid organizations Brot für die   The Institute for International Law of Peace and Armed Conflict
Welt, Christoffel-Blindenmission, DAHW, Kindernothilfe, medico interna-     (IFHV) of Ruhr University Bochum is one of the leading institutions in
tional, Misereor, Plan International, terre des hommes, Welthungerhilfe     Europe for research and teaching on humanitarian crises. Coming from a
and the associated members German Doctors and Oxfam. In contexts of         long tradition in scientific analysis of international humanitarian law and
crises and disasters the member organizations provide short-term relief     human rights, the Institute today combines interdisciplinary research in
as well as long-term support in order to overcome poverty and prevent       the fields of law, social science, geoscience, and public health.
new crises.

                                                                                                                      WorldRiskReport 2021 3
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Further information

In-depth information, methodologies, and tables are
available at www.WorldRiskReport.org.

The reports from 2011 – 2020 can be downloaded
there as well.

 4 WorldRiskReport 2021
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Contents

Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  6

1. Social Protection in Crises and Disasters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9
     Peter Mucke, Ruben Prütz

2. Focus: Social Protection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17

      2.1 C risis and Disaster Preparedness
          through a Global Fund for Social Protection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  17
          Markus Kaltenborn, Nicola Wiebe

      2.2 Access to Social Protection Systems
           through Participation and Inclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
           Sascha Balasko, Oliver Neuschäfer

      2.3 “Building Back Better” through Social Protection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
          Mariya Aleksandrova, Daniele Malerba, Christoph Strupat

3. The WorldRiskIndex 2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  41
    Katrin Radtke, Daniel Weller

4. Requirements and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  51
   Bündnis Entwicklung Hilft, IFHV

Appendix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

                                                                                                                                                                         WorldRiskReport 2021 5
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Figure 1: WorldRiskIndex 2021

                                Key Findings
                                WorldRiskIndex 2021                                      the principle that low or very low vulnerability
                                                                                         can drastically reduce disaster risk.
                                + The WorldRiskIndex 2021 assesses the disaster
                                  risk for 181 countries. This covers almost 99 per-   + In a comparison of continents, Oceania has the
                                  cent of the world’s population.                        highest disaster risk, mainly due to its high
                                                                                         exposure to extreme natural events. Africa, the
                                + A total of ten island states are among the 15          Americas, Asia, and Europe follow in descend-
                                  countries with the highest disaster risk. Their        ing order of disaster risk.
                                  risk profile is increasingly also determined by
                                  sea-level rise.                                      + Africa is the continent with the highest over-
                                                                                         all societal vulnerability. Twelve of the 15 most
                                + The countries with the highest disaster risk           vulnerable countries in the world are located
                                  worldwide are Vanuatu (WRI 47.73), the Solo-           there.
                                  mon Islands (WRI 31.16), and Tonga (WRI 30.51).
                                                                                       + Europe has by far the lowest disaster risk of all
                                + Vanuatu is the most exposed, followed by Anti-         continents, with a median of 3.27 comprising
                                  gua and Barbuda, and Tonga. The most vulner-           40 countries. It is also in the most favorable
                                  able country in the world is the Central African       position in all other components of the risk
                                  Republic, followed by Chad, and the Democratic         analysis.
                                  Republic of the Congo.
                                                                                       + Countries with low economic capacity and
                                + Germany has a very low disaster risk. With             income tend to have higher vulnerability or
                                  a value of 2.66, Germany ranks 161st in the            lower capabilities in averting disasters. In these
                                  WorldRiskIndex.                                        countries, extreme natural events often lead to
                                                                                         further reductions in existing capacities.
                                + The examples of the Netherlands, Japan,
                                  Mauritius, and Trinidad and Tobago illustrate
                                  ­

 6 WorldRiskReport 2021
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
Focus: Social Protection                                 Rank    Country                          Risk
                                                            1.   Vanuatu                          47.73        Figure 2:
                                                                                                               Extract from the
+ Social protection contributes to reducing                 2.   Solomon Islands                  31.16        WorldRiskIndex 2021
  a ­society’s vulnerability to extreme natu-               3.   Tonga                            30.51
  ral events. In the event of a disaster, social            4.   Dominica                         27.42
  protection must often be expanded at short
  ­                                                         5.   Antigua and Barbuda              27.28
  notice to meet increased protection needs.                6.   Brunei Darussalam                22.77
  Adaptive protection systems are particularly              7.   Guyana                           21.83
  suitable for this purpose, as they can respond            8.   Philippines                      21.39
  promptly to new protection needs and effec-
                                                            9.   Papua New Guinea                 20.90
  tively cope with shocks such as the Covid-19
                                                           10.   Guatemala                        20.23
  pandemic.
                                                           11.   Cape Verde                       17.72

+ Informal social protection systems, which                12.   Costa Rica                       17.06
  include community-based institutions such as             13.   Bangladesh                       16.23
  savings groups or grain banks, exist in parallel         14.   Fiji                             16.06
  to formal, often state-run, protection systems.          15.   Cambodia                         15.80
                                                           ...                              ...     ...
+ Access to rights-based social protection systems        161.   Germany                           2.66
  has so far only been a reality for a minority of         ...                              ...     ...
  the world’s population. In many parts of the            167.   Singapore                         2.50
  world, the Covid-19 pandemic has highlight-             168.   Sweden                            2.25
  ed how unequally access to social protec-               169.   Lithuania                         2.18
  tion is distributed. Without social protection,         170.   Switzerland                       2.04
  disasters ­exacerbate poverty, deepen exist-
                                                          171.   Finland                           2.00
  ing ­in­­
         equalities, weaken resilience to future
                                                          172.   Estonia                           1.99
  crises, and increase the need for humanitarian
                                                          173.   Egypt                             1.82
  assistance.
                                                          174.   Iceland                           1.71

+ In reality, social protection systems do not            175.   Maldives                          1.69
  always reach the people who depend on                   176.   Barbados                          1.37
  them. The causes for this may be institutional,         177.   Grenada                           1.06
  communicative, social, or physical barriers –           178.   Saudi Arabia                      0.94
  they often result from a combination of several         179.   St. Vincent and the Grenadines    0.70
  factors.                                                180.   Malta                             0.69
                                                          181.   Qatar                             0.30
+ A Global Fund for Social Protection can help to
  ensure a protection floor is provided even in
  countries that do not have the financial means      + While social protection has gained impor-
  themselves. Beyond that, in crisis situations         tance in reducing disaster risk and addressing
  the fund could also help those countries that         the consequences of climate change in recent
  are dependent on international support due to         years, a more systematic linkage that creates
  short-term financial bottlenecks.                     synergies between the fields of action is still
                                                        needed. For the purpose of Building Back
+ Social protection is a task that must be financed     Better, it is also important to integrate effective
  from national resources. In this respect, inter-      social protection measures for the mitigation
  national co-financing of the systems can only         of and adaptation to climate change into the
  be a temporary solution.                              recovery of the effects of the pandemic.

                                                                                                              WorldRiskReport 2021 7
WORLDRISKREPORT 2021 FOCUS: SOCIAL PROTECTION - RELIEFWEB
1         S ocial Protection in Crises
                                        and Disasters
                              Protecting people against risks such as illness, loss of possessions, unem-
Peter Mucke                   ployment, or old-age poverty significantly contributes to reducing their
Managing Director,
Bündnis Entwicklung Hilft
                              vulnerability, including vulnerability to extreme natural events. The state
Ruben Prütz,                  is usually seen as having the primary responsibility for protecting people
Program Officer Content and   against social risks and in crisis situations, but also non-governmental,
Information,                  often informal structures of various kinds, contribute to this. For effec-
Bündnis Entwicklung Hilft
                              tive disaster management, the short-term expansion of social protection
                              systems is a decisive factor. International frameworks and strategies such
                              as the Sendai Framework for Disaster Risk Reduction already take the
                              importance of social protection into account to some extent. However, even
                              greater consideration of social protection systems in the field of disaster
                              management and climate change adaptation is possible and necessary.

                              During the devastating floods in West and South      risks such as illness, unemployment, and care
                              Germany in July 2021 that claimed more than          dependency, the family, the neighborhood, and
                              180 lives and caused damages in the billions,        the church have historically played a central
                              mutual aid in times of need was manifold: in         role in individual protection (Kannan 2007).
                              Hagen in North Rhine-Westphalia, for example,        In the course of industrialization and urban-
                              residents from higher-lying city districts helped    ization, as well as the profound social changes
                              those affected by the flood in the valley with the   that accompanied them, the state increasingly
                              clean-up work. One man gave away food from           took over social protection. In consequence,
                              his window to those in need, and a Facebook          the Western welfare state has gradually devel-
                              group was set up to coordinate neighborly help       oped since the 19th century, initially in Europe-
                              (Rinaldi 2021). During extreme natural events,       an countries (Kannan 2007). Today, states are
                              it is often neighbors or relatives who make a        generally seen as having the primary responsi-
                              decisive contribution to emergency relief.           bility for protecting people against social risks.
                                                                                   Nonetheless, non-governmental social protec-
                              Not only in the case of extreme natural events,      tion structures have remained of great impor-
                              but also in the case of more commonplace social      tance worldwide to this day.

                              Types and significance of social protection systems
                              Following the definition of the International        unemployment provision and survivors’ bene-
                              Labour Organization (ILO), for the purpose of        fit. In this context, access to essential goods
                              this report social protection is understood as the   and services, prevention and protection against
                              entirety of measures that a society provides for     risks, and promotion of chances and opportu-
                              its population to protect them from economic         nities are the three central goals (see Figure 3).
                              and social hardship. Social protection is based
                              on the pillars of reserve building and solidarity.   In terms of formal benefit structures – often
                              The spectrum of social protection ranges from        provided or supported by the state – a dis-
                              employment injury insurance to retirement            tinction can be made between four types of
                              provision, from medical care to family provision,    social protection (Bowen et al. 2020; Carter et
                              from benefits in case of illness or disability to    al. 2019):

                                                                                                          WorldRiskReport 2021 9
of social prote
                                                                  bjectives                         ction
                                                                 O     sk pre
                                                                             vention and protectio
                                                                                                  n
                                                                            Ri

                                                                                                                  €
                                                                                                                                                Pr
                                                                          Employment injury benefit                                               o
                                             es

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                                         ic

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                                                     €                                                                                    €

                                                                                                                                                      io
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                                sa

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                                                                            benefit                        Family benefit
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                                                                                                                                                  €
                           sen

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                      to es

                                                               benefit                                             benefit

                                                                                                                                                                        ortun
               Access

                                                                                                                                                                             ities
                                                               Sickness                                               Survivors’
                                                                benefit                                               benefit                             €
                                                                                                                                                          €
                                                                Medical                                               Invalidity
                                                                  care                                                benefit

                                                                               Social protection according to ILO:
                                            “The set of public measures that a society provides for its members to protect them against economic and
                                            social distress caused by the absence or a substantial reduction of income from work as a result of various
                                            contingencies (sickness, maternity, employment injury, unemployment, invalidity, old age or death of the
                                                breadwinner), the provision of health care and the provision of benefits for families with children.”

           Figure 3: Objectives and sub-sectors of formal social protection according to ILO (compiled based on ILO 2004)

                                        +     Social assistance: This includes non-con-                                      In addition to formal state services, social
                                              tributory benefits for particularly vulnerable                                 protection can also be provided through
                                              groups such as unconditional or condition-                                     privately chosen or informal means, including:
                                              al cash transfers, transfers of goods, social
                                              housing, or school meals.                                                      +     Social protection through the family, the
                                                                                                                                   neighborhood, and communities
                                        +     Social insurances: This includes contributo-
                                              ry benefits such as health care or retirement                                  +     Privately funded, self-selected insurances
                                              provision.
                                                                                                                             +     Help and support from religious com-
                                        +     Labor market interventions: This includes                                            munities.
                                              both non-contributory and contributory
                                              labor market programs. Active programs                                         In most cases, social protection involves costs
                                              include, for example, training opportunities                                   that many low-income countries, particularly in
                                              or job placement services. Passive programs                                    the Global South, are often unable to finance, as
                                              include unemployment insurance or early                                        well as regular contributions that not all people
                                              retirement options.                                                            can afford. Globally, the degree of coverage of
                                                                                                                             protection measures in the sub-sectors of social
                                        +     Social care services: This includes special                                    protection is therefore highly unequal (see
                                              pre- and aftercare services such as trau-                                      Figure 7). In addition, there sometimes exist
                                              ma care in the context of social risks like                                    considerable qualitative differences between
                                              discrimination or violence.                                                    the benefits offered. Particularly vulnerable

10 WorldRiskReport 2021
groups are often the ones with insufficient          International requirements and approaches to
access to existing protection structures (see        implementing social protection
Chapter 2.2).
                                                     As early as 1948, Article 22 of the Univer-
The role of informal protection structures           sal Declaration of Human Rights established
                                                     social protection as a human right: “Every-
Irrespective of the formal protection systems        one, as a member of society, has the right to
provided by the state and private insurance          social ­security” (UNGA 1948). The core aspects
companies, informal social protection struc-         of the right to social protection consist of
tures continue to exist. They include, for exam-     (OHCHR 2021):
ple, community-based measures to improve
individual and collective protection within a        +   “Availability: A social security system needs
municipality or community. Especially – but              to be in place under domestic law to ensure
not exclusively – in countries where formal              that benefits are effectively administered
social protection systems function poorly or             and supervised.
are met with little acceptance, informal struc-
tures continue to be of great importance (von        +   Adequacy: Benefits, whether in cash or
Benda-Beckmann 2015). They primarily include             in kind, must be sufficient in quantity and
(Carter et al. 2019; UNDP 2016):                         duration so that everyone may realize his
                                                         or her rights to family protection and assis-
+   Community grain banks for food security              tance, a reasonable standard of living and
    (for example in the case of crop failures due        access to health care.
    to extreme natural events)
                                                     +   Affordability: Costs and charges associated
+   Unpaid, sometimes rotating obligations               with contributions to social security must
    and tasks within communities such as                 be economical for all, and must not compro-
    municipalities                                       mise the realization of other Covenant
                                                         rights.
+   Roles and responsibilities within families
                                                     +   Accessibility: A social security system should
+   Practiced norms, culture of reciprocity and          cover all persons, especially those belonging
    solidarity within communities, such as               to the most disadvantaged and marginalized
    neighborhood assistance                              groups, without discrimination. Benefits
                                                         should also be physically accessible.”
+   Remittances from emigrated family or
    community members                                Within the framework of international agree-
                                                     ments, this right was substantiated in central
+   Lending transactions                             conventions, starting with the 1952 ILO
                                                     convention on minimum standards for various
+   Credits and savings groups.                      sub-sectors of social protection. Several inter-
                                                     national conventions followed, for example
Such informal protection systems can provide         on equal treatment, the protection of children
effective protection at the community level, but     and mothers, and the protection of the rights of
are usually regionally limited and do not always     migrant workers.
provide access for all members of a community.
In some cases, such evolved informal structures      Over the course of the last two decades, differ-
can also be supported, expanded, and connect-        ent approaches to the design of formal social
ed to formal structures through public funding       protection have replaced each other. In the
(Carter et al. 2019). The advantage of informal      early 2000s, the dominant approach was the
protection structures is that they are oftentimes    so-called “Social Risk Management” approach,
more flexible, especially in the case of neighbor-   which focuses on the primary management of
hood and family protection.                          acute risks. This approach was criticized for not

                                                                            WorldRiskReport 2021 11
sufficiently considering the structural causes     formulated in 2012 (The ILO Social Protec-
                          and risk drivers such as inequality, discrimi-     tion Floors Recommendation 202) (Carter et
                          nation, and poverty (HLPE 2012). In contrast,      al. 2019).
                          so-called “Transformative Social Protection”
                          aims to address the structural causes of social    In 2016, the Universal Social Protection
                          insecurity. However, this approach sometimes       Initiative – initiated by the World Bank
                          blurs the objectives and boundaries between        and ILO – which promotes universal social
                          social protection and development policy,          protection by 2030, followed. This includes
                          which has negative effects on the achieve-         the targeted basic social protection of the
                          ment of the core goals of social protection        Social Protection Floor Initiative, but the
                          (HLPE 2012).                                       measures and programs to achieve universal
                                                                             social protection are defined individually and
                          In 2009, the United Nations launched the           country-specifically at the national level. The
                          Social Protection Floor Initiative. This rights-   model is thus considered less rigid than its
                          based approach generally considers states as       predecessors. Despite broad international
                          duty bearers and citizens as rights holders.       support, the initiative is considered difficult
                          On this basis, comprehensive recommenda-           to implement given the often-limited financial
                          tions on what rights-based basic protection        resources in many countries (Carter et al.
                          should look like at the national level were        2019; see also Chapter 2.1).

                          Social protection and disaster management
                          After extreme natural events, which also           The importance of adaptive social protection
                          include pandemics such as the current Covid-       in the event of a disaster
                          19 pandemic or the Spanish flu of 1918  / 19,
                          functioning social protection structures –         In the event of crisis or disaster, social protec-
                          both formal and informal – are of enormous         tion often has to be expanded at short notice
                          importance, because in these situations a large    in order to meet increased protection needs.
                          number of people face existential crises (Bünd-    In this context, it is often referred to adaptive
                          nis Entwicklung Hilft  / IFHV 2020). During        social protection. The adaptive social protec-
                          the Spanish flu in Sweden, for example, the        tion approach aims to expand existing social
                          proportion of the population living in poor-       protection systems in a short period of time
                          houses increased significantly: on average,        (World Bank  / GFDRR 2020). The fastest
                          there were four people who had to go to a          way to expand existing systems is by adding
                          poorhouse for every flu death (Karlsson et         more beneficiaries (horizontal expansion) or
                          al. 2014).                                         by increasing benefits or extending them for
                                                                             those covered within the existing system (verti-
                          However, crises and disasters in particular        cal expansion). In addition, there is the short-
                          also show the limits of the capacities of social   term development of protection systems that
                          protection systems. What is then required is       are conceptually based on existing systems or
                          an increase in state funding for formal and        single elements (see Chapter 2.3). In compari-
                          informal social protection systems and, if         son, the establishment of new types of protec-
                          necessary, international support for individual    tion programs is often time-consuming and
                          states, for example through a Global Fund          cost-intensive and is thus usually not a prior-
                          (see Chapter 2.1). The Covid-19 p    ­andemic      ity as a response to acute crises and disasters
                          clearly demonstrated the immense costs that        (Bowen et al. 2020).
                          can be associated with the expansion of social
                          ­protection: In Germany alone, several billion     In addition to the four core aspects of the
                           euros were made available to cushion the          right to social protection already mentioned,
                           economic and social consequences of the           the quality of adaptive social protection in
                           Covid-19 pandemic (BMAS 2021).                    the event of acute crises depends on whether

12 WorldRiskReport 2021
Social Protection in Disaster Management

                          + Use of existing information from                                + Adaptability strengthening of
                            social protection systems on                                      social protection systems for
                            particularly vulnerable groups                                    disaster situations

                                                                                                                          + Early expansion of social protection
                                                                                  red
+ Early and continuous analysis of                                           Prepa ness                                     benefits in the event of impending
  adaptive capacities and gaps in                                                             Ea                            disasters
                                                             is                                 rl
  the provision of existing social

                                                                                                 yw
                                                           lys
  protection systems                                                                                                      + Early warning and information

                                                        ana

                                                                                                   arn
                                                                             Disaster                                       dissemination by means of formal and

                                                                                                      ing
                                                                                                                            informal protection networks
                                                   Risk
                                                                             preparedness

                                                                                                                 Extreme natural event /
                                                                             Coping with
                                                                             disaster                            acute crisis
                                                    Re c

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                                                       on

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                                                         st

                                                                 c ti
                                                                        on               rg   en
+ Covering increased protection                                                      Eme
  needs and mitigating individual
  and societal consequential
  damage and long-term
  consequences of disasters by                                           + Utilization of existing knowledge             + Stabilization of social protection systems
  means of social protection                                               about local conditions and needs by             against possible crisis-related
  benefits                                                                 involving social protection workers             impairments and capacity overloads

 Figure 4: Social protection in disaster management phases (compiled based on World Bank  / GFDRR 2020)

                       cost-effective, responsive, needs-oriented, and                                      Adaptive social protection provides a means
                       sustainable adaptations of existing protection                                       to promote synergies between the three fields
                       benefits can be implemented despite great time                                       of action and to efficiently use capacities and
                       pressure (World Bank  / GFDRR 2020; O’Brien                                          resources to achieve shared goals.
                       et al. 2018).
                                                                                                            Social protection as a part of the
                       Besides the acute adaptation and expansion                                           WorldRiskIndex
                       of existing social protection systems to cope
                       with disasters, adaptive social protection is                                        In order to assess disaster risk, the World-
                       often also seen as a relevant instrument in the                                      RiskIndex analyzes exposure as well as vul-
                       context of long-term adaptation – for exam-                                          nerability based on the three components
                       ple to climate change. Through preventive                                            susceptibility, coping capacities, and adaptive
                       protection measures and adaptations of exist-                                        capacities (see also the textbox “The Concept
                       ing protection systems, precautions can be                                           of the WorldRiskReport”). To this end, social
                       taken for long-term developments and newly                                           protection plays an important role: Five of the
                       emerging risks (see Figure 4). Adaptive social                                       22 indicators used to calculate vulnerability are
                       protection thus represents an interface between                                      directly related to it (see Chapter 3):
                       the three fields of action of social protection,
                       disaster risk management, and climate change                                         +   Public health expenditures
                       adaptation: All three aim to reduce individu-                                        +   Private health expenditures
                       al and societal vulnerability or promote resil-                                      +   Insurance coverage
                       ience through targeted measures, thereby                                             +   Number of physicians per 1,000 persons
                       managing and mitigating acute and future risks                                       +   Number of hospital beds per 1,000 persons.
                       (Carter et al. 2019; FAO  / Climate Centre 2019).

                                                                                                                                         WorldRiskReport 2021 13
Four additional indicators are indirectly related     nets and insurance systems to promote resil-
                          to cross-cutting issues of social protection:         ience in households and communities (UNISDR
                                                                                2015). Despite the indirect links between the
                          +   Literacy rate                                     Sendai Framework and social protection, the
                          +   Participation in education                        explicit linkage of social protection with disas-
                          +   Share of the population living on less than       ter management in UNDRR’s work seems to
                              1.90 US dollars per day                           remain limited: Neither in the expressed strate-
                          +   Share of undernourished population.               gic objectives and focus activities for the coming
                                                                                years, nor in the UNDRR’s 2019 flagship report
                          Social protection is thus linked to all three         “Global Assessment Report on Disaster Risk
                          areas of vulnerability according to the World-        Reduction” (GAR) is social protection named
                          RiskIndex. Reducing vulnerability through             as an essential building block for disaster risk
                          the expansion of social protection leads to the       reduction (UNDRR 2021; UNDRR 2019).
                          realization of central goals of social protection:
                          prevention and protection against risks as well       In contrast, in the context of the 2030 Agenda,
                          as promotion of chances and opportunities.            the importance of social protection is taken into
                                                                                account explicitly, as several of the Sustainable
                          Institutional embedment of social protection          Development Goals (SDGs) have a direct link to
                          as disaster preparedness                              social protection. Among other things, the 2030
                                                                                Agenda calls for universal health coverage,
                          Social protection contributes to the reduction        greater consideration and support for unpaid
                          of societal vulnerability to extreme natural          care services, and improved coverage of nation-
                          events. In the Sendai Framework for Disaster          al protection systems across societies.
                          Risk Reduction, initiated by the United Nations
                          Office for Disaster Risk Reduction UNDRR              The ongoing global crisis situation caused by the
                          (formerly UNISDR) and adopted in 2015, there          Covid-19 pandemic and the progressive nega-
                          are already indirect links to social protection:      tive impacts of climate change emphasize that
                          prevention and protection against risks form          social protection and especially its enhanced
                          the core objectives of the framework – objec-         flexibility must be taken into account even more
                          tives that, according to the ILO, social protec-      strongly in national and international political
                          tion should also fulfil. As one of four priorities,   processes in the future, especially with regard
                          extensive investments in social, economic,            to disaster management and climate change
                          and health resilience building are suggested to       adaptation (see Chapter 4). In this respect, the
                          prevent damage to individuals and societies. It       potential of social protection systems is far from
                          also highlights the need to promote social safety     being fully realized.

14 WorldRiskReport 2021
The Concept of the WorldRiskReport

Concept of “risk” and approach                            the WorldRiskReport always contains a                     The WorldRiskIndex can only consider in­di-
                                                          focus chapter examining background and                    cators for which comprehensible, quan-
The risk assessment in the WorldRiskReport                context from a qualitative perspective –                  tifiable data is available. For example,
is based on the general notion that the                   this year’s topic is “social protection”.                 while immediate neighborhood assistance
intensity of the extreme natural event                                                                              cannot be measured in the event of a
is not the only factor of relevance to the                The calculation of the disaster risk has                  disaster, it is nonetheless very important.
disaster risk, but that the overall situation             been performed for 181 states worldwide                   Furthermore, variances in data quality
of society is equally important. A society                and is based on four components:                          among different countries may occur if
that is insufficiently prepared will be more                                                                        data is only gathered by national author-
vulnerable to natural events than one that                + Exposure to earthquakes, cyclones,                      ities and not by an independent interna-
is better prepared in regard to susceptibili-                 floods, drought, and sea-level rise                   tional institution.
ty, coping capacities, and adaptive capaci-
ties. (Bündnis Entwicklung Hilft 2011).                   + Susceptibility depending on infrastruc-                 The aim of the report
                                                              ture, food supply, and economic frame-
Risk assessment                                               work conditions                                       The exposition of the disaster risk using the
                                                                                                                    index and its four components shows the
The WorldRiskReport contains the World­                   + Coping capacities depending on gover­                   disaster risk hotspots across the world and
RiskIndex. Since 2018, it has been calcu-                     nance, health care, social and material               the fields of action to achieve the neces-
lated by the Institute for International Law                  security                                              sary reduction of risks. Complemented by
of Peace and Armed Conflict (IFHV) at Ruhr                                                                          qualitative analyses within the report, it is
University Bochum. The index was devel-                   + Adaptive capacities related to upcom-                   possible to formulate recommendations
oped by Bündnis Entwicklung Hilft in coop-                    ing natural events, climate change,                   for action for national and international,
eration with the United Nations University                    and other challenges.                                 state and civil society actors.
in Bonn. In addition to the data section,

                                Natural hazard sphere                                                     Societal sphere

                                                                                                               Vulnerability
                                       Exposure
                                                                                                               Mean of the three
                                   Exposure to natural                                                           components
                                        hazards

                      Sea-level rise                       Floods                   Susceptibility                                                 Coping
                                                                                    Likelihood of suffering                                        Capacities to reduce
                                                                                    harm                                                           negative consequences

                        Cyclones                         Earthquakes

                                        Droughts                                                                                   Adaptation
                                                                                                                                   Capacities for long-
                                                                    WorldRiskIndex                                                 term strategies for
                                                            Product of Exposure and Vulnerability                                  societal change

Figure 5: The WorldRiskIndex and its components

                                                                                                                                           WorldRiskReport 2021 15
2          Social Protection
                                    2.1 Crisis and Disaster Preparedness
                                    through a Global Fund for Social Protection

                                    Pandemics, extreme natural events, violent conflicts, and economic upheavals
Markus Kaltenborn                   lead to disasters wherever they encounter high vulnerability. Both in normal
Professor at the Faculty of Law,
Ruhr University Bochum
                                    times as well as in crisis situations, social protection systems make it possi-
Nicola Wiebe                        ble to guarantee basic human rights and to cope with the negative effects of
Policy Advisor Social Protection,   crises. However, access to rights-based social protection systems has so far
Brot für die Welt                   only been a reality for a minority of the world’s population. This is partic-
                                    ularly due to the considerable funding gaps in some countries of the Global
                                    South. A Global Fund for Social Protection can help to ensure basic protection
                                    in countries that are not yet able to provide this level of protection financially.
                                    Moreover, in crisis situations the fund could help countries that are depen-
                                    dent on international support due to short-term financial constraints. Social
                                    protection is a reasonable investment in many respects, not least with regard
                                    to global disaster prevention.

                                    Social protection systems enable states to            responsive social protection systems are needed
                                    respond quickly to various forms of crises and        in the long-term. Depending on the context-spe-
                                    alleviate their impact on individuals and the         cific risks, coordination with other sectors plays
                                    whole of society. In this manner, disasters can       a central role, for example with climate change
                                    be mitigated and the permanent fall into pover-       adaptation policies (see also Chapter 2.3).
                                    ty can be prevented, for example by including
                                    additional beneficiaries in already established       The precautionary gap
                                    social programs or by a crisis-related expan-
                                    sion and adaptation of benefits (O’Brien et           Around 53 percent of the world’s popula-
                                    al. 2018). The mechanisms of action through           tion has no sufficient access to social protec-
                                    which social protection programs can support          tion benefits (ILO 2021). Notably, despite an
                                    disaster risk reduction instruments range from        impressive number of additional social protec-
                                    safeguarding livelihoods in the event of a crisis     tion measures taken in the context of the Covid-
                                    (protective function), contributing to preven-        19 pandemic (ILO 2020), these have been far
                                    tion and promoting crisis resilience, to support-     from providing protection to all people. While
                                    ing longer-term transformation processes              high-income countries invested an additional
                                    (­Devereux  / Sabates-Wheeler 2004). In addi-         average of 695 US dollars per person in social
                                    tion to the immediate reduction of vulnera-           protection between March and October 2020,
                                    bility, the interplay of different social policy      the average in low-income countries was 4 US
                                    instruments can, at best, trigger broader social,     dollars (Almenfi et al. 2020). In some countries,
                                    economic, and political changes.                      it was particularly difficult to reach individuals
                                                                                          who were not yet integrated in the social protec-
                                    To realize these contributions to disaster risk       tion system, such as workers in the informal
                                    reduction, established, rights-based, and             sector and people in extreme poverty.

                                                                                                                 WorldRiskReport 2021 17
Impact

      Function                           Individual                                        Societal                            Instruments (examples)

                        +   Ensuring livelihood security               +     Maintaining demand, reducing the            +   Social insurances
      Protection        +   Access to health services                        depth and duration of the economic          +   Guaranteed minimum protection
                        +   Protection against negative coping               recession                                       (social assistance)
                            strategies                                 +     Protection of productive capacities         +   Basic income

                        +   Reduction of individual susceptibility     +     Reducing susceptibility to losses through   +   Regular and reliable social
                            through access to nutrition, health care         risk reduction or risk hedging measures         transfers
                            and education                                                                                +   Public employment with a
     Prevention
                                                                                                                             focus on prevention (such
                                                                                                                             as construction of dams or
                                                                                                                             irrigation)

                        +   Increasing skills and revenue,             +     Improvement of coping mechanisms            +   Regular and reliable social
                            diversification of sources of revenue      +     Reduction of poverty                            transfers
     Promotion
                        +   Accumulation of reserve funds                                                                +   Cash-programs
                        +   Enabling of risk-taking for change

                        +   Inclusion und empowerment                  +     Reduction of the inequality of              +   Access to education, health care,
                        +   Promotion of investments in sustainable          opportunities (ex ante)                         and child benefit
   Transformation
                            agricultural strategies                    +     Redistribution (ex post)                    +   Progressive design of the
                                                                                                                             tax-transfer system

 Figure 6: Mechanisms of action of social protection in a crisis context (adapted from Devereux  / Sabates-Wheeler 2004 and FAO 2019)

                                 In addition, low-income countries are exposed                     In disaster situations, poverty is exacerbated,
                                 to a disproportionately high risk of disasters                    existing inequality is deepened, and resilience
                                 (see Chapter 3). Within these countries, low-in-                  to future crises is further weakened. Conse-
                                 come population groups are again dispropor-                       quently, the question arises as to how this nega-
                                 tionately at risk, partly because they are more                   tive spiral can be counteracted. National solu-
                                 exposed to the influence of extreme natural                       tions alone will not suffice. The international
                                 events due to the geographic location of their                    community must consider how it can accelerate
                                 settlements, the precariousness of their living                   progress in building social protection systems
                                 and working conditions, or due to their employ-                   in low-income countries and thus improve
                                 ment sector (for example agriculture or fish-                     global crisis and disaster prevention.
                                 eries). They also have fewer resources to cope
                                 with crises or proactively adapt to crisis-related                Role and mandate of a Global Fund for Social
                                 changes (FAO 2019).                                               Protection

                                 Gaps in social protection make individuals, as                    When the global financial and economic crisis
                                 well as entire societies, susceptible to crises.                  of 2007  / 2008 demonstrated the importance

18 WorldRiskReport 2021
of countries having sufficiently stable protec-     of non-governmental organizations and trade
tion systems, the ILO, together with the World      unions, called on the international community
Health Organization (WHO), launched the             to establish such a fund (GCSPF 2020).
Social Protection Floor Initiative, which result-
ed in a corresponding recommendation in 2012        Despite deviating ideas with respect to details,
(The ILO Social Protection Floors Recommen-         the existing concepts offer a general under-
dation 202). Since then, this document has          standing of a prospective fund’s mandate: First
significantly impacted the international debate     and foremost, it would be involved in the estab-
on global social protection (for further legal      lishment and temporary co-financing of social
bases, see Kaltenborn 2020).                        protection floors where low-income countries
                                                    do not have sufficient financial resources of
The voluntary commitment to which states have       their own (especially tax revenues) for such
subscribed consists of two components: the          systems. In extraordinary crisis situations (for
social protection floor, which guarantees access    example extreme natural events, pandemics, or
to basic health care and a minimum level of         economic crises), the fund would also support
income security for all residents, and the more     countries that are forced to reduce the range
comprehensive protection programs, which            and level of benefits provided by their social
require continuous development. The recom-          protection floors due to short-term financial
mendation grants the states a wide margin of        constraints.
appreciation in the design of both levels. It is
up to their social policy priorities whether they   Social protection is a task that must, in princi-
prefer contribution-financed security systems       ple, be financed from a state’s own resources.
(for example health or pension insurance) or        To this extent, international co-financing of
tax-financed basic social protection programs.      the systems should only serve as a temporary
                                                    solution. The fund’s mandate should there-
In fall 2012, with reference to ILO’s Social        fore also include advising partner countries in
Protection Floor Recommendation, then-UN            how to mobilize additional domestic resourc-
Special Rapporteurs Olivier de Schutter and         es to finance their social protection systems.
Magdalena Sepúlveda proposed the establish-         Another important task of this new institution
ment of a Global Fund for Social Protection to      could be to promote coordination and coher-
implement the first component – the floor-con-      ence among existing international programs to
cept (de Schutter  / Sepúlveda 2012). Such a        support social protection systems in the Glob-
fund, which could be established for example        al South. This way, the fund could help reduce
within the framework of the Global Partnership      the problem of fragmented development
for Universal Social Protection (USP2030),          cooperation (Klingebiel et al. 2016), which is
should help to ensure that basic protection         particularly damaging to the development of
could also be provided in countries financially     coherent social protection systems. The vari-
not yet able to provide it themselves. Though       ous financial and technical resources available
similar proposals were developed before and         for this global task could be used much more
increasingly after de Schutter and ­Sepúlveda’s     efficiently if they were pooled by an interna-
proposal (ILO 2002; Cichon 2015; GCSPF              tional institution.
2015; Greenhill et al. 2015), it was only in the
wake of the Covid-19 crisis that the discussion     Organizational principles
gained momentum. The French government
introduced a proposal to create a new inter-        The establishment of new international insti-
national financing mechanism into the G20           tutions must take place within the frame-
deliberations. De Schutter submitted a report       work of applicable international law. From
on this to the UN Human Rights Council in           the perspective of international development
April 2021 (UN Doc. A/HRC/47/36). Civil soci-       law, the guidelines of the Global Partner-
ety stakeholders also support the cause. In fall    ship for Effective Development Cooperation
2020, the Global Coalition for Social Protec-       contain important principles. The details are
tion Floors (GCSPF), an international alliance      derived from the Nairobi Outcome Document

                                                                          WorldRiskReport 2021 19
(2016) and the predecessor documents, the              to monitor the compliance of all fund decisions
                          Paris Declaration on Aid Effectiveness (2005)          with agreed guidelines and principles. It is
                          and the Busan Partnership Agreement (2011).            equally important that the governments of the
                          For the operation of a Global Fund for Social          countries receiving support from the fund are
                          Protection, the principle of country owner-            accountable for the correct use of the financial
                          ship would be of particular importance: Coun-          means – not only to the fund, but also to their
                          tries should be enabled to develop their social        respective populations. These requirements can
                          protection systems based on their own social           be implemented through reporting obligations,
                          policy ideas and priorities. The key underlying        monitoring and evaluation procedures, nation-
                          assumption for the new institutional approach          al social dialogue with civil society, and the
                          is the idea of a global risk community and the         establishment of complaints mechanisms.
                          sociopolitical principle of solidarity, in clear
                          distinction from neocolonial patterns of heter-        Financing
                          onomy in a donor  / recipient relationship. This
                          must be anchored in the organizational struc-          Given the ambitious mandate of a Global Fund
                          ture of the fund.                                      for Social Protection, the question of financing
                                                                                 arises: To enable the financing of a social protec-
                          Other principles of the Aid Effectiveness-Agen-        tion floor in low-income countries with high
                          da relevant for the design of fund structures are      vulnerability, considerable sums are required.
                          the principles of inclusion and accountabili-          Following the calculations made as part of the
                          ty. For the concretization of these principles,        Social Protection Floor Index, ten countries had
                          the relevant ILO standards (including the ILO          financing gaps larger than ten percent of their
                          Social Protection Floors Recommendation 202)           gross domestic product in 2018 (FES 2020).
                          and the principles of the human rights-based           If one were to focus on this selection and the
                          approach to development cooperation (UNDG              fund were to cover half of the social protection
                          2003) should also be taken into account. Inclu-        costs in these countries, a total of 10 - 15 billion
                          sivity requires parties to be willing to adequately    US dollars annually would be required. In the
                          involve all stakeholders in the steering process-      event of a crisis, the international community
                          es of the fund. This means that in addition to         would presumably have to shoulder a larger
                          the governments of partner countries involved          share of the costs. However, investments in
                          in the fund and the international organizations        social protection can be economically reward-
                          active in the field of social protection (in partic-   ing and should thus by no means be regarded as
                          ular ILO, WHO, World Bank), social partners            a “lost subsidy”: Especially in low-income coun-
                          (international trade unions and employers’             tries, they contribute to a significant increase in
                          organizations), and civil society representatives      the gross domestic product in the long-term
                          of the affected groups in partner countries in         (ITUC 2021).
                          the Global South must also have the opportu-
                          nity to contribute their views to the fund’s deci-     The funds needed for international co-fi-
                          sion-making and monitoring processes.                  nancing could come from a combination of
                                                                                 different sources. The obvious solution is to
                          The principle of accountability urges that a           provide additional funds from official devel-
                          high degree of transparency is necessary in all        opment assistance (ODA) for this purpose. At
                          decision-making processes in the fund’s bodies         only 0.4 percent of the total ODA volume, the
                          and that institutional arrangements are put            share of expenditures on social protection is
                          in place to ensure mutual accountability of all        still dramatically low, even though numerous
                          stakeholders. In part, this is already achieved        research studies have demonstrated the posi-
                          through the participation mechanisms in the            tive effects of social protection instruments
                          fund’s organizational structure, which ensure          in reducing (extreme) poverty. Taking into
                          that all stakeholders are represented in its           consideration that social protection programs
                          bodies. However, the decisions of the fund’s           should also be seen as an important compo-
                          bodies must also be open for review. State             nent of preparedness for climate-related
                          representatives should be given the opportunity        disasters, it would also be conceivable to make

20 WorldRiskReport 2021
greater use of international climate funds for        Conclusion
the development of social protection systems.
                                                      International support for the development of
New earmarked sources for the financing of            social protection systems in low-income coun-
global priority tasks such as education, health,      tries is already available, albeit to a far too
and poverty reduction have already been               limited extent. The establishment of a multi-
proposed several times. They include national,        lateral fund would offer several advantages for
regional, or global financial transaction taxes,      further expansion: In addition to the increased
carbon taxes, solidarity levies on airline tickets,   attention to a globally pressing issue and the
and an international levy on corporate prof-          above-mentioned gains in coherence and effec-
its or assets. Such financing methods should          tiveness, a multilateral solution would be linked
also be considered for a Global Fund for Social       to longer-term financing commitments by the
Protection (GCSPF 2020). Particularly in crisis       international community. This aspect is of
situations, an additional issuance of special         utmost importance if the aim is not only to set
drawing rights (SDRs) by the International            up short-term protection programs but – in the
Monetary Fund – and the subsequent redirec-           sense of effective crisis prevention – to estab-
tion of wealthier countries’ SDRs to low-income       lish permanent protection systems in low-in-
countries – could also be an option for global        come countries with high vulnerability.
solidarity-based financing (Plant 2021).

                                                                            WorldRiskReport 2021 21
India

                                  Community Health Care
                                  Country profile                               population are unemployed. According to
                                                                                the Global Hunger Index the nutritional
Rank 90 in WorldRiskIndex 2021    India is faced with unpredicted rains         situation in India is serious.
                                  and heavy floods which often result in
WorldRiskIndex             6.65   large scale destruction and humanitarian      The state of Chhattisgarh has around
                                  emergencies. In addition, climate change      30 million inhabitants and is home to
Exposure                  12.52   is expected to have profound effects on       large tribal groups. Most of its popula-
                                  the country. In recent years, the Indian      tion primarily depends on a subsistence
Vulnerability             53.09   Government has undertaken measures            agricultural economy. Many farmers grow
                                  to establish a national database on           paddy rice as the only crop, which is
                                  disaster risk. However, the initiatives for   dependent on regular monsoons, making
                                  disaster risk management remain scat-         these agricultural livelihoods vulnerable
                                  tered across regions and agencies and         to extreme weather events, also induced
                                  investments in climate change adapta-         by climate change.
                                  tion are lacking.
                                                                                Project context and activities
                                  India has a population of 1.3 billion –
                                  roughly 66 percent live in rural regions      Raigarh Ambikapur Health Associa-
                                  where critical infrastructure and social      tion (RAHA) is a non-profit organization
                                  services are often scarcely available.        established in 1969 to improve rural
                                  More than 23 percent of the Indian youth      health care in Chhattisgarh. The region

22 WorldRiskReport 2021
State of                                            monetary contribution to the health care      health care through publicly owned struc-
Social Protection                                   fund. It also aims to reduce exploitation     tures remains scarce. The CHPS manages
(see also supplement “Social Protection: Needs      of people in need through money lend-         to reduce the financial burden of health
for Action in High Risk Countries”)                 ers. It is similar to an insurer model,       care treatment for individuals in case
                                                    where RAHA collects the premium from          of illness. In addition, the availability of
1,380,004,385                                       the community and purchases health care       RHCs improves the coverage and avail-
Inhabitants (2020)                                  on their behalf from the RHCs and three       ability of health care facilities, providing
                                                    associated hospitals. Associated hospitals    the rural population with quality health
               Social protection plans for
                                                    provide additional treatment capacity if      care at their doorsteps.
               certain age groups                   required.
               , High need for action                                                             However, RAHA is also faced with chal-
                                                    Participants in the CHPS pay a small annu-    lenges: Frequent fluctuation and rota-
                                                    al premium of 30 Rupees (~ 34 euro cents      tion of nurses in the RHCs hampers the
               Social protection plans for people
               with disabilities and / or special   as of June 2021). Seventy-five percent of     relation between health workers and
               protection needs
                                                    this fee go to the RHCs and are pooled        patients. Another issue is the partly prev-
               , High need for action               for minor treatments, 25 percent go to        alent misperception of the health care
                                                    a RAHA central fund. The membership           necessity: With preventive and promotive
                                                    in the CHPS includes a balance of up to       health care many potential health prob-
               Social protection plans for the
               work context
                                                    100 Rupees over the year for treatments       lems can be avoided, thus some people
                                                    taken at the RHC level. Once the balance      feel that there is no benefit in remaining
               , Very high need for action
                                                    of 100 Rupees is depleted, patients have      in the CHPS as they face no health issues.
                                                    to pay for treatments. In the event of        RAHA is aware of these challenges and is
                                                    hospitalization, members are eligible         actively engaged in further improving the
                                                    for a subsidy up to 2,500 Rupees on the       value of the CHPS and the RHCs for the
                                                    hospital bill, this amount is provided out    participating communities.
                                                    of Misereor grants. The RAHA central fund
                                                                                                  Sr. Dr. Elizabeth Nalloor
                                                    is used to pay hospital bills of very poor
                                                                                                  Executive Director, Raigarh Ambikapur Health
is mostly inhabited by people with a                people above subsidy. While the premi-        Association, partner of Misereor
very low income. Since its foundation,              ums are deliberately kept low to facilitate
RAHA has implemented a comprehensive                access for community members with low
health and development program through              incomes, some people still struggle to
several Rural Health Centers (RHCs) situ-           afford it.
ated in different villages. These RHCs are
the basic local infrastructure to treat and         A membership also includes programs
cure minor ailments. Every RHC covers               on preventive and promotive health,
between five to ten villages with a total           as well as training in organic farming,
of 10,000 to 15,000 people. RAHA runs 93            water conservation, herbal medicines,
RHCs, built and equipped by RAHA’s part-            and a school health program, all for free.
ner Misereor.                                       Through the health education program,
                                                    vital information is also disseminated
Beyond the RHCs, RAHA started a health              on community-based disaster prepared-
care scheme called Community Health                 ness towards hazards such as floods and
Protection Scheme (CHPS) to facilitate              droughts and threats posed by climate
peoples’ access to and the affordabili-             change.
ty of quality health care. The CHPS is a
movement of solidarity which transfers              Results and impacts
the costs of health care between people
to lower the costs for individuals: healthy         More than 92,500 members were enrolled
people subsidize the cost of health and             in the CHPS in 2020. Through the RHCs
medical care for the sick. The CHPS aims            and the CHPS, RAHA succeeds in offering
to foster “caring communities” through              social protection in terms of preventive
people’s active participation in health             and curative health care to a large group
services and their willingness to make a            of vulnerable people in districts where

                                                                                                                   WorldRiskReport 2021 23
Pakistan

                                  Empowerment of Women through
                                  Self-Help Groups
Rank 85 in WorldRiskIndex 2021    Country profile                              high levels of poverty and socio-eco-
                                                                               nomic inequality, especially between
WorldRiskIndex             6.80   The Islamic Republic of Pakistan is locat-   urban and rural areas. Many families
                                  ed in South Asia and is bordered by the      are dependent on economically active
Exposure                  11.95   Himalayas to the northeast and the Indi-     male household members who can bare-
                                  an Ocean to the south. The country faces     ly meet their daily needs. Opportunities
Vulnerability             56.88   major geological and climatic challenges,    for women to generate income are very
                                  with earthquakes, floods, and droughts       limited. Deeply rooted cultural norms and
                                  posing significant threats. The National     values contribute to women’s discrimina-
                                  Disaster Management Authority NDMA           tion and make it difficult for women to
                                  is responsible for implementing all areas    access the labor market. This discrimina-
                                  of disaster management at the federal        tion already begins in childhood. Despite
                                  level. This includes the development of      compulsory schooling, only 56 percent of
                                  guidelines for the protection of vulnera-    children between the ages of five and 16
                                  ble groups and standardized procedures       attend school. Particularly, girls attend
                                  in the event of a disaster.                  school less frequently and for shorter
                                                                               periods. The national literacy rate is 59
                                  Despite some progress in the last two        percent, among women only 46 percent.
                                  decades, the country is characterized by     The prerequisites for a socially and

24 WorldRiskReport 2021
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