Adequacy of Benefits
From a rights-based perspective, the level of benefits provided must be adequate. According to the CESCR’s General Comment 19 (para 22), “Benefits, whether in cash or in kind, must be adequate in amount and duration in order that everyone may realize his or her rights to family protection and assistance, an adequate standard of living and adequate access to health care, as contained in articles 10, 11 and 12 of the Covenant”.
ILO Conventions and Recommendations also set out the principles of adequacy and predictability for the design and implementation of social protection benefits (see for example Recommendation No. 202, para 3c). States parties must pay full respect to the principle of human dignity, which is also stated in the preamble of the Covenant, and the principle of non-discrimination, so as to avoid any adverse effect on the levels of benefits and the form in which they are provided. Methods applied should ensure the adequacy of benefits. The adequacy criteria should be monitored regularly to ensure that beneficiaries are able to afford the goods and services they require to realize their Covenant rights. When a person makes contributions to a social security scheme that provides benefits to cover lack of income, there should be a reasonable relationship between earnings, paid contributions, and the amount of relevant benefit.”
Nature and level of benefits
ILO social security instruments state that social protection benefits should, at a minimum, guarantee effective access to at least essential health care and basic income security as defined at the national level (Recommendation No. 202, para 4). In addition, international standards recognize that, while the definition of the level of the benefit is the prerogative of the State, it should take into account the needs of the population, as well as the capacity to finance and deliver the benefits and services. This implies that, at a minimum, benefit levels should ensure effective access to essential goods and services, defined as necessary at the national level. Taken together, cash and in kind benefits should at a minimum secure protection against poverty, vulnerability and social exclusion and enable a life in health and dignity (Recommendation No. 202, paras 2 and 8b).
Regarding the right to health care specifically, adequacy is measured in terms of affordability, availability, accessibility, and quality. Affordability means that those in need of health care should not face hardship or an increased risk of poverty due to seeking and accessing health care. Availability and quality of services are refer to the State’s institutional capacity to respond to people’s needs in a manner that is adequate (for example, in terms of the range and quality of services provided). (See standards of accessibility, adaptability, and acceptability and Recommendation No. 202, para 5a)
In terms of cash benefits, the minimum benefit levels in Recommendation No. 202 can be considered adequate if and when they provide beneficiaries with the means to a life in dignity. Depending on the national context, this may mean that levels correspond to the monetary value of a set of necessary goods and services, national poverty lines or income thresholds for social assistance. Social protection for children can be considered adequate when benefits are fixed at a level that is sufficient to ensure access to nutrition, education, care and other necessary goods and services (Recommendation No. 202, para 5b).
Long-term benefits can be considered adequate when they are provided in a manner that also protects against the erosion of their purchasing power (Convention No. 102, Articles 65 and 66). This means including provisions in law and in practice which secure the periodic adjustment of benefits with changes in living costs.
The impact of social protection initiatives on beneficiaries’ standard of living depends on quality social services. Service delivery relies, to a large extent, on the efficient functioning of other public services such as electricity, education, emergency services, environmental protection, fire service, gas, health care, law enforcement, military, postal service, public broadcasting, public security, public transportation, public housing, social services, telecommunications, town planning, waste management, and the water supply network. For example, the benefit from a non-contributory pension can be cancelled out by the burden posed by healthcare-related costs. As highlighted by Recommendation No. 202, high quality public services are essential to the delivery of social protection systems (para 3n), in particular with regard to ensuring access to health, education and care services.
The UN Guide Good Governance Practices for the Protection of Human Rights states that governments are “responsible for delivering a variety of services to their populations, including education, health and social welfare services. The provision of these services is essential to the protection of human rights such as the right to housing, health, education and food.” From a rights-based perspective, there is no doubt that service provision by public or private actors is critical for the realization of all human rights, particularly social and economic rights. According to the High Commissioner for Human Rights, “certain services, such as policing or administering justice, focus directly on the protection of individual freedoms and others, such as education, health and food, have a markedly social character which is essential for building the human capital necessary for sustainable development and the realization of economic and social rights” (Report on the 25th regular session of the Human Rights Council).