This paper explores the contrasting developments within social security policy and focus its analysis on two case studies with varying policy outcomes: 1) the social cash transfer system, which is well established; and 2) the National Health Insurance (NHI) scheme, a recent policy, which has suffered several delays.
Building on the power resource and historical institutionalism approaches, the paper explores how different actors seek to assert their policy preferences, and how current institutional arrangements shape actors’ interests and their ability to influence policy reforms. The two cases reveal interesting differences that can explain the success of social cash transfer expansion and the sluggish progress (to date) to introduce national health insurance. While the latter has strong vested interests against reform, even though there is consensus on the need for a national health insurance scheme, the former has had no strong opponents and subsequent incremental expansions have benefited from well-established institutional arrangements, positive research evidence and civil society advocacy and litigation. Moreover, the introduction of a health insurance scheme is relatively more complex (politically, institutionally and technically), compared to expanding an already existing social cash transfer programme.
At the time of their collaboration with UNRISD, Sophie Plagerson
and Marianne S. Ulriksen
were senior researchers at the Centre for Social Development in Africa, University of Johannesburg, South Africa.