Health and Old Age in Latin America and Africa

The remarkable dynamism of government welfare provision in Africa and in Latin America and the Caribbean is embedded in a broader context. As a legacy of the colonial past, social protection for old age and health care was generally the privilege of the rather small group of formal sector workers. French colonialism emphasized an active role of the state in social protection and had a quite uniform focus on the nuclear family and especially family allowances. In British colonies, social protection programs were more heterogeneous. Former Spanish colonies used the colonial montepíos as the starting points for their pension systems. In addition to this, there are global influences. For social protection in old age, a growing focus on social pensions replaced recently the two longstanding competing global models of the ILO and the World Bank. In contrast, there is no clear model in the domain of health care. However, in recent years, a certain consensus emerged regarding the question of user fees.