12 June 2019
Two recent ESID papers published in African Affairs and Social Science and Medicine (both open access) analyse the political drivers of Ethiopia’s Productive Safety Net Programme (PSNP), one of the largest social assistance programmes in Africa, and Community Based Health Insurance (CBHI), one of the largest health insurance schemes on the continent, covering the rural and informal sector. The papers demonstrate that the adoption of these programmes and the specifics of their design were closely shaped by the developmentalist ideology of the ruling Ethiopian Peoples’ Revolutionary Democratic Front (EPRDF) and the centralisation of power during the 2000s within a small group of political elites. Together these programmes constitute a distinctly ‘productivist’ orientation to social protection that seeks not only to provide basic forms of protection, but also to mobilise all available resources in the pursuit of national development.
Both the PSNP and CBHI have received significant donor support in finance and technical assistance. Nonetheless, careful analysis shows that ruling party ideology and its particular developmental vision have fundamentally shaped each programme. The common ideas underpinning both the PSNP and CBHI are that these programmes seek to mobilise all available resources in the pursuit of development, as part of Ethiopia’s aspirations to create a ‘developmental state’, and that the programmes aim to promote self-reliance and limit dependence on the state. For the PSNP, this entails a requirement that most recipients of support engage in labour-intensive public works as a means of developing community infrastructure and enhancing implementation of other state policies. Programme participants are also expected to strive for ‘graduation’ from government support, through participation in livelihoods programmes and other activities. The CBHI, meanwhile, is based on financial contributions and risk pooling in overt opposition to the principle of free-to-access healthcare.
In certain respects, these social protection programmes are reminiscent of the East Asian ‘developmental states’, which others have also argued pursued distinctly ‘productivist’ forms of social policy. In addition to expansion of education and health as investments in human capital, many East Asian states expanded social insurance, not only as a mechanism of protecting workers, but also as a means of enforcing savings and mobilising resources for state investment. This emphasis on the productive contribution of social policy is clearly evident in Ethiopia, through the specific programmes studied and more broadly in the massive expansion of education and health services in recent decades.
In addition to ideological influences, the policymaking process for each programme closely reflects the changing power relations within and outside the ruling party over the past two decades. CBHI, in particular, is characterised by a long-term vision of creating a sustainable financing system for the health sector, enabled by the lack of serious political opposition and interest groups that might oppose expansion, until relatively recently. The rural and urban PSNP, meanwhile, was established in response to political crises—notably the 2003 food crisis and the 2005 electoral crisis—that forced the government to reconsider its opposition to targeted programmes. In both instances, once key individuals—former Prime Minister Meles Zenawi, in particular—were convinced of the need for change, the centralisation of decision-making power enabled rapid policy change and the mobilisation of the state for large-scale implementation.
Political events over the past few years in Ethiopia inevitably raise questions about the future direction of social protection (as well as a great many other topics). Social unrest and political change under new Prime Minister Abiy Ahmed challenge both the ideological coherence and the centralisation of power that underpinned the PSNP and CBHI. The changes carry risks—such as the weakening of state capacity that underpinned expansion of CBHI in recent years—but also opportunities—the questioning of the ‘developmental state’ agenda could open up space for ideas about different forms of social protection.