+This article is an edited summary of a paper entitled "Social Safety Nets in Lebanon" and prepared for the Sustainable Human Development Profile in Lebanon prepared by United Nations Development Program, Beirut. It is printed by kind permission of the UNDP. The report reflects the views of Adin Na`meh, not the UNDP.
*Adib Ne`meh is lawyer and a consultant at the United Nations Development Program.
Safety nets and social funds are among the instruments proposed by the World Bank to alleviate poverty. The reasoning is that structural adjustment programs which are implemented in developing countries only begin having a positive impact on the social and economic situation in the medium and long term, while in the short term they impose a burden on the poor and on vulnerable groups. As a result, during this period the poor must be assisted by social safety nets and social funds.
The way social safety nets are envisaged by the Bank, they must not modify the basic assumptions underlying the structural policies judged adequate for a given country. Instead, they are seen as additional measures designed to curb the short-term negative effects of a chosen economic strategy.
Usually, safety nets and social funds involve two general types of measures:
* Programs which aim to increase opportunities for employment through training and consultancy programs for the unemployed; and,
* Income support programs, both in cash and in kind. These include social insurance programs or other forms of social assistance, as well as money transfers to the poor such as loans or grants.
The above approach to safety nets is controversial, with critics questioning both its conceptual and practical aspects. This criticism has centered around a series of observations:
* The notion of poverty alleviation itself is unsatisfactory. This has been evident in the literature on development, and was highlighted at the International Summit for Social Development held in Copenhagen in March 1995. Discussion of poverty often reveals a disagreement between those who advocate palliative measures which address only the results of poverty, and those who support more radical approaches to face the structural causes of poverty and impoverishment.
* The temporary negative social effects of structural adjustment have proven to be far less temporary than was thought. This has led to the suggestion that structural adjustment programs themselves, which are acknowledged to be generators of poverty, be modified.
* Safety nets and social funds are selective. As concepts, they emerged in the wake of efforts to dismantle the "Welfare State" and the universal social service system. However, experience has shown that the results of these efforts were largely negative, and that safety nets could not, and should not, replace the universal provision of social services.
* Evaluation has shown that provision of safety nets and social funds has had a very limited impact on the poor. Resources have often been too limited to alleviate poverty, and have been wasted because of corruption and red tape.
Safety nets and social funds are necessary in Lebanon. The question, however, is whether they should be considered as the only measures to alleviate poverty, or whether they should be seen as short-term steps in an integrated medium- and long-term strategy to reduce and then eradicate poverty. Such an integrated strategy would target the government's macro-economic policies and development programs, while also allowing room for programs which alleviate the effects of poverty.
The deteriorating economic and social situation in Lebanon has placed a serious burden on the middle and lower classes. The reconstruction process and the social and economic policies pursued by the government have lowered the living conditions of many Lebanese. This has only underlined the need to implement adequate and effective safety net programs in Lebanon, specially designed to confront the negative impact of the post-war economic revival.
Social safety nets are designed to cover special groups, or needs, not covered by the public or private social services system. In Lebanon, public sector social services system contains two types of services:
* Permanent institutions providing social services, including:
- The National Fund for Social Security;
- The Cooperative of Public-Sector Employees;
- The social services system of the army and the Internal Security Forces.
* Special services offered by the ministries of Health, Social Affairs, and the Displaced, as well as by the High Relief Committee and the Council of the South. These services, through their activities, approximate the definition, and function, of social safety nets, as we defined them earlier.
We can summarize the situation of permanent institutions providing social services in the following tables. Two variables will be examined, namely the kinds of services provided and the beneficiary groups. And then the percentage of the population covered by these services.
The previous table creates the impression that a very large proportion of the population is covered by some form of social security, especially the National Fund for Social Security (NFSS). This impression should be qualified by the fact that private sector enterprises do not necessarily register their workers in the NFSS. According to statistics provided by the NFSS, in 1974 the NFSS covered around 38% of the work force; in 1995, it covered only 29%.
In the table below one can see the breakdown, in percentage terms, of coverage as declared by the Ministry of Health and as shown in World Bank studies.
However, a more precise breakdown of the figures, based on different sources, allows us to prepare an additional table showing both the lower estimates of beneficiaries, and the higher estimates.
As the table shows, the public-sector social system covers between 42% and 48.8% of the Lebanese population. We should add that the maximum coverage for the public-sector (and private-sector) social system goes to hospitalization, and is much lower for other kinds of services.
The distribution of these services can also be seen to be very centralized. The geographical distribution of coverage by the NFSS and the Cooperative of Public-Sector Employees (CPSE) is as follows:
The main kind of services provided by the NFSS and CPSE are hospitalization, health care, and scholarships. For the NFSS, health care and hospitalization represented 53.5% of services provided in May 1995. For the CPSE, health care represented about 48% of services provided and scholarships around 50% in 1994. Even among private-sector insurance companies, the share of health services as a percentage of total services grew from 7% in 1987 to 51% in 1994.
One can conclude several things about the permanent institutions providing social services:
* Around 50% of the Lebanese population is not covered by the permanent social system. This makes them potential target groups for social safety nets;
* Some kinds of services are not provided at all to the population, or are provided in a very limited way. This includes unemployment payments, retirement systems, compensation for work accidents, and scholarships for the children of private-sector employees;
* In geographical terms, most major social services are provided in the Beirut and Mount Lebanon area. This reflects a similar pattern of geographical centralization evident in the distribution of economic activities.
* There is a growing need for public-sector social intervention in health and education.
In this section, we will examine social services provided by the ministries of Health, Social Affairs, and the Displaced, as well as the Council of the South and the High Relief Committee.
* The Ministry of Health: The ministry estimates that it covers around 44% of the population. This figure is theoretical, however, since it represents the percentage of the population not covered by other health systems. The health ministry provides hospitalization and health insurance safety nets for individuals who are not otherwise insured. Among the most important of the ministry's activities is paying for particularly expensive medical services such as open-heart surgery, kidney treatment, cancer treatment, and the provision of medication for chronic diseases. In 1993, The health ministry spent more than 50% of its budget on these kinds of services.
The only criteria for the health ministry's paying for services is that a patient not be covered by other insurance systems. No other criteria, whether social class or income, are requested. Most often, the ministry intervenes by covering treatment expenses in private hospitals; this takes up more than 80% of the ministry's budget. The ministry finances some 20% of private hospital beds, which serve, according to a report prepared for the World Health Organization, an estimated average of 36% of those entering hospitals per year.
* The Ministry of Social Affairs: The social affairs ministry is the provider of the main public safety net in Lebanon. It offers several kinds of services, including primary health care, rural development programs, training, as well as special programs for different social groups, including children, senior citizens, juvenile delinquents, widows and the disabled. For example, the ministry has provided special care to an estimated 3,011 disabled, which represents approximately 3% of the disabled population in Lebanon.
These services are offered through social centers belonging to the ministry, or through contracts with Non-Governmental Organizations (NGOs) or private institutions. The geographic distribution of the services provided is more decentralized than those provided by the NFSS and CPSE, although it does not uniformly cover all areas of the country. As the table below shows, contracts with social care institutions in Beirut and Mount Lebanon represent about 50% of all contracts.
The social centers network is more decentralized in favor of rural regions. Of 85 social centers, only two are located in Beirut and 14 in Mount Lebanon. Twenty centers are located in North Lebanon, nine in the Biqa`, and 35 in South Lebanon. This variation indicates the absence of a national social plan, at least as regards providing balanced services to the poor in both urban and rural areas.
In 1993, the services provided by these social centers were distributed as follows: health care accounted for 91.6% of services; social activities for 4.8%; and educational activities for 3.6%. This suggested that the centers acted more or less as local dispensaries.
A similar imbalance in activities may be seen in the distribution of activities provided by NGOs having contracts with the social affairs ministry: health care activities accounted for 80.2% of services provided; social activities for 1.4%; educational activities for 16 %; and other activities for 2.4%.
The relatively large number of those benefiting from services provided by the social affairs ministry was estimated at 269,000 in 1993. This figure, however, must be qualified by the limited kinds of services offered, with the focus primarily on health care. The main problems faced by the ministry are a duplication of functions, outdated training programs, and the lack of an adequate national social plan.
* The Ministry of the Displaced: The problem of the displaced is subject of a separate study. However, we can comment on some aspects of the problem related to social safety nets and social funds. The ministry and the Fund for the Displaced generally operate through cash transfers to displaced families. The bases on which transfers are made often are determined by a combination of political and social factors.
The main forms of transfers are compensation offered to squatters, at times themselves displaced, so that they evacuate occupied properties and return them to their previous owners who left because of the war; and subsidies provided to formerly displaced persons to rebuild or restore their homes damaged in fighting. Until October 1995, according to the Ministry of the Displaced, the number of people benefiting from evacuation compensation was 88,612. The number of those receiving subsidies to rebuild homes was only 17,182. The discrepancy between the two figures is remarkably high, and shows that there is no strong correlation between the money paid out by the ministry and the return of the displaced.
Many critics underline that the decisions of the ministry and the Fund for the Displaced are guided mainly by political interests, rather than by an adequate plan for the return of the displaced. This can lead us to say that the two institutions are, in fact, working far more as political safety nets through their cash transfer programs, than as social safety nets.
* The Council of the South: The council was established the early 1970s to pay compensation to the victims of Israeli attacks against southern Lebanon. Today, the council is acting as a sort of super-ministry of southern affairs and carries out a wide range of activities. A breakdown of the council's spending for the years 1994 and 1995 (until September) is found in the following two tables. It shows that compensation, which accounted for 30% of spending, has become a secondary concern of the council, while infrastructure and social projects totaled 70% of spending.
Politics largely govern the way the council distributes aid. It is particularly difficult to control the council's distribution of aid to individuals and households, and the same holds true for the way its selects which development projects will be funded and where. Again, for political reasons, the council duplicates the work of many ministries, for example that of Public Works, Electricity and Water Resources, Social Affairs, Public Health, and Municipal and Rural Affairs.
* The High Relief Committee: The committee was established to coordinate the action of public agencies and NGOs involved in social affairs. During the period 1993-1995, the committee intervened 33 times in all Lebanese regions in a wide range of activities. The committee implemented programs on 14 of these occasions, while the remainder were implemented by ministries or public organizations.
The nature of donations from the High Relief Committee varies from financial aid to implementation of public works. The wide range of activities carried out by the committee has limited both the efficiency of the safety net it has established and the committee's coordinating role.
The committee has also faced problems due to the politicization of social assistance programs. For example, it tried to collaborate with the World Bank to design a social fund under the name of the Community Development Fund. The fund was to cover development in rural areas and human settlements of less than 10,000 people, representing some 30% of the population. Preliminary studies had shown that these communities did not benefit from the government's reconstruction program. This effort to establish a modern and rational social fund was blocked both for political reasons and because of conflicts between the different institutions which would have implemented it.
A number of conclusions can be drawn about social safety nets and social funds in Lebanon:
* The many public organizations dealing with social issues operate in a vacuum as regards a national action plan for social policy. Moreover, there is no real coordination between them, which leads to duplication of efforts and inter-institutional conflicts.
* Almost 50% of the Lebanese population is not covered by the permanent institutions providing social services such as the National Fund for Social Security or the Cooperative of Private-Sector Employees. Furthermore, the kinds of services which these institutions offer are mostly limited to health care and hospitalization and scholarships.
* There is an absence of effective safety nets for the poor or vulnerable social groups. This includes unemployment payments, retirement systems, and programs for the disabled and the urban poor.
* The existing, and limited, social service system is essentially manipulated for political and electoral purposes. This has led to waste, duplication of functions, and the diverting of aid away from those to whom it is destined.
Conditions are deteriorating in the civil service and in the social infrastructure. The economic policies adopted by the government for the reconstruction period are placing greater burdens on most social groups. This is leading to an ever greater demand for adequate social safety nets and social funds within an integrated national program for poverty reduction, and, eventually, eradication.