ILO promotes the extension of Universal Health Coverage to rural households in cocoa-producing areas

In Côte d'Ivoire, the project focuses on the "cocoa supply chain" in the sub-prefecture of Soubré and M'batto and includes a social protection component. This component aims to find ways to strengthen the social protection of families on cocoa farms and thus improve decent working conditions for the adult workforce, which would have a direct impact on reducing child labour.

Article | 22 September 2021
The extension of Universal Health Coverage (UHC) to cocoa farming communities in Côte d'Ivoire is one of the expected results of the project
Faced with shocks such as sudden job loss, illness or injury to breadwinners or other family members, in the absence of other coping mechanisms, households may be forced to resort to child labour as a fallback mechanism.

This is why social protection systems are essential in policy responses to reduce and prevent poverty and eradicate child labour.

An analysis by the International Labour Office argues that health insurance is potentially important in combating child labour, so extending health protection to alleviate the social distress and economic losses associated with illness appears to be directly linked to efforts to combat child labour.

Côte d'Ivoire had adopted a National Social Protection Strategy (NSPS) in 2014 which aims to facilitate access to basic social services and extend social security to all in line with ILO Recommendation No. 202 on social protection floors.

However, to date, only 6% of households are covered by social insurance institutions against various social risks, including retirement, death, occupational accidents and diseases, family benefits and maternity benefits.

The current crisis linked to the COVID- 19 pandemic which the world is going through, and from which Cote d'Ivoire is not spared, is a further reminder of the importance of effective, universal and sustainable social protection systems, and in particular of health protection.

Accelerating Action for the Elimination of Child Labour in Africa (ACCEL Africa) is a regional project, which aims to "accelerate" the elimination of child labour in the specific supply chains of cocoa, coffee, cotton, gold and tea. It is scheduled to run for four years (from 15 November 2018 to 15 November 2022) and is funded by the Dutch Ministry of Foreign Affairs.

In Côte d'Ivoire, the project focuses on the "cocoa supply chain" in the sub-prefecture of Soubré and M'batto and includes a social protection component. This component aims to find ways to strengthen the social protection of families on cocoa farms and thus improve decent working conditions for the adult workforce, which would have a direct impact on reducing child labour.

The extension of Universal Health Coverage (UHC) to cocoa farming communities in Côte d'Ivoire is one of the expected results of the project.

The ACCEL Africa project collaborates with the Institution de Prévoyance Sociale, known as the Caisse Nationale d'Assurance Maladie (IPS-CNAM), which is responsible for managing the UHC schemes. The IPS-CNAM was created by decree n° 2014-395 of 25 June 2014. It is under the supervision of the Ministry of Employment and Social Protection.

The objective of the collaboration with CNAM is to improve the implementation of the Universal Health Coverage (UHC) in the target areas (SOUBRE AND M'BATTO), with a view to using it as a tool to reduce social vulnerability to child labour.

Already in 2019, a study to understand the demand and supply of labour in cocoa producing areas was conducted by the ILO. It revealed that families affected by health problems see their labour force decline and their financial capacity weakened. These families end up using child labour as a response strategy.
In 2020, a fifth of African children (92 million) were in child labour, nearly half of them were in hazardous work.

These families also face financial difficulties in coping with unplanned expenses such as those related to illness.

A study was carried out to identify the obstacles to accessing UHC for rural cocoa-producing households in the Soubré (Grand-Zattry) and M'batto areas. The study generated proposals to improve access to UHC for the targets. The ILO and the CNAM will validate these proposals with a view to building a pilot for their implementation, in which the cooperative movement plays a very important role.

The outcome of this process will encourage the consideration of cocoa communities in the implementation of the UHC, particularly in rural areas, by raising awareness of the benefits of the UHC, deploying innovative solutions to facilitate affiliation and the collection of contributions, and improving the quality of the services offered.

The interventions will also help to envisage with the government the modalities of replication of this pilot experience in other rural areas and the informal economy, or even throughout the Ivorian territory.

Universal Health Coverage in Côte d'Ivoire is an opportunity to advance the agenda of the fight against child labour in cocoa-producing areas of Côte d'Ivoire, particularly as a means of reducing social vulnerability which is a cause of child labour.
Most children who work do so because their families depend on their wages, production or domestic work (including unpaid, often by girls) to make ends meet.

Inspired by the SDG 17 call for partnerships for the achievement of the SDGs, actors advocating for sustainable cocoa farming need to dialogue and engage in strong partnerships and cooperation at all levels in order to facilitate access to UHC for producers and workers in cocoa producing areas.

Private sector companies could play a particularly important role in exploring the possibility of facilitating access to UHC for farmers in their supply chains.