COVID-19 | How exclusionary social protection systems in the MENA are making the COVID-19 pandemic’s effects worse

The COVID-19 pandemic has made the majority of people living in the MENA region even more vulnerable, adding to existing structural problems that include under-resourced public health services, a high degree of labour informality, and high poverty and unemployment rates. Temporary social and economic support measures to mitigate the pandemic’s effects are not sufficient, however – the region has to go beyond piecemeal policies. Countries need to expand the scope and scale of social provisioning and social protection as well as the quality of and access to public health services by moving towards a universalist approach to social policy, writes Mahmoud Messkoub.

In the Middle East and North Africa (MENA), the COVID-19 pandemic has thrown into sharp relief the importance of state-centred approaches in managing pandemics and mitigating their socio-economic impacts on the population. But public health services in most MENA countries are underfunded and inadequately designed to cope with the pandemic. The MENA population has suffered, especially those people living in low-income and non-oil-exporting countries.

Here, as elsewhere in the world, to mitigate the impacts of the pandemic, states have taken a number of measures ranging from temporary cash payments to the poor and vulnerable, furlough schemes, and financial support to employers and industries to the relaxation of regulations governing financial market support to companies and individuals through lower interest loans. Most MENA countries adopted a combination of these measures (OECD, 2020).

However, these short-term measures cannot deal with the long-term structural insecurity and vulnerability facing the majority of people in the MENA who live precarious lives in highly unequal societies, where the top 10% of the population takes 64% of the total income (Alvaredo et al., 2017). Their vulnerability to a large extent can be ascribed to the concentration of economic activity and employment in the informal sector, which is usually overlooked in social security and regulatory measures that tend to focus more on formal employment sectors (ILO, 2019; O’Sullivan et al., 2012). The exclusionary character of the countries’ social protection programmes is a great cause for concern, as even in ordinary circumstances vulnerable populations working informally do not have adequate social protection against health problems, a loss of income, and other contingencies.

Informality and unemployment rates are high in the MENA

According to OECD (2020), in the MENA the informal sector employs some 68% of the workforce, while in individual countries such as Yemen and Lebanon the portion rises to 74% and 71%, respectively. Another structural problem is persistently high unemployment rates that have particularly hit the youth as well as educated women across the MENA  (O’Sullivan et al., 2012). In 2018, the youth unemployment rate was around 30% in the MENA – the highest in the world (Kabbani, 2019). And large-scale poverty and vulnerability are also high in the MENA despite its riches. MENA countries are heterogeneous in terms of their resource base. The headcount poverty rates of a-dollar-a-day (or more) are high in the labour-abundant and resource-poor countries like Egypt. But poverty is also present in the populous, resource-rich and industrializing countries of Iran and Algeria. The other aspect of poverty is its regional spread: rural headcount poverty rates are higher in rural areas than in urban areas (Messkoub, 2008).

The most vulnerable are being overlooked, also during the pandemic

It is against this backdrop of poverty and vulnerability that the pandemic emerged, plunging the weakest countries in the region into a deeper crisis, with very limited social protection measures to help protect vulnerable populations. Whilst all countries in the region had some kind of social protection programmes before the pandemic, and in some cases extensive ones, coverage in most middle- and low-income MENA countries is limited to members of the civil service, police, and military, as well as those in the modern, regulated private sectors of manufacturing and services. The majority of the population working in agriculture, the informal sector, and other unregulated activities have very limited access, if any, to state social protection programmes. To start with, entitlement to most of these programmes requires a formal labour contract. But entitlement and access vary depending on the area of social protection: health, old age, unemployment, work injury, or family allowance.

Regarding health services, there is an urban-rural divide in favour of the former, in addition to high out-of-pocket expenditure and a general neglect of primary and preventive healthcare. High spending on expensive diagnostic and curative health care can be observed, and low-income/low-status migrants, displaced people, refugees, and ethnic minorities have limited access to public health services (WHO, 2010; Loewe, 2019).

The fragmentation of health insurance and service provision also limits the coverage and adequacy of social policies. In most MENA countries, there are different public and private health insurance programmes and health service providers. If these were integrated into a common national health insurance programme, the result could be increased coverage and an improvement of the services provided by reducing administrative costs and rationalising overlapping services (Loewe, 2019). Other complementary public health measures should also be placed on the agenda: the provision of clean water, improved sanitation, and a greater emphasis of preventative health care (Karshenas et al., 2014).

Why universal social protection is needed now more than ever

Thus, countries in the region are in urgent need of increasing expenditure on public health to manage the current pandemic as well as strengthening the health system to improve entitlement and access to health services. Reform and re-organisation of the health system beyond the public sector is part of this agenda. The region needs to return to the ideals of universal entitlement and access to health and other social services that are essential to the social policy agenda of developmental states. Selectivity and exclusion in terms of who qualifies for social protection benefits will only harm these countries, as responses to the pandemic have shown.

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References and further readings

Alvaredo, R., Assouad, L. and Piketty, T. (2017) Measuring lnequality in the Middle East 1990 2016: The World’s Most Unequal Region? Reprinted  2020. [https://halshs.archives-ouvertes.fr/halshs-02796992/file/2017-15_.pdf] [Accessed: 10 September 2020.]

ILO, 2019. Working Poor or how a job is no guarantee of decent living conditions. April.

Kabbani, N. , 2019. Youth Employment in the Middle East and North Africa: Revisiting and Reframing the Challenge. Brookings Institution. [https://www.brookings.edu/wp-content/uploads/2019/02/Youth_Unemployment_MENA_English_Web.pdf ][Accessed: September 2020]

Karshenas, M., Moghadam, V. and R. Alami (2014), ‘Social Policy after the Arab Spring: States and Social Rights in the MENA Region,’ World Development, Vol. 64, issue C, pp.726-739.

Loewe, M. (2019), ‘Social Protection Schemes in the Middle East and North Africa: Not Fair, Not Efficient, Not Effective,’ in Jawad, R., Jones, N. and M. Messkoub (eds., 2019), pp.35 60.

Messkoub, M. (2008), Economic Growth, Employment and Poverty in the Middle East and  North Africa, Geneva: ILO Working Paper Series, No. 19.

Messkoub, M. (2021, Forthcoming), ‘Social Policy in the MENA Region,’ in H. Hakimian, ed.(2020) Routledge Handbook on Middle Eastern Economy. London: Routledge.

OECD, 2020. COVID-19 crisis response in MENA countries. Updated 9 June [https://read.oecd-ilibrary.org/view/?ref=129_129919-4li7bq8asv&title=COVID-19-Crisis-Response-in-MENA-Countries] [Accessed: 10 September 2020.]

O’Sullivan, A., Rey, M-E and Galvez Mendez, J. (2012) Opportunities and Challenges in the MENA Region. OECD.

An earlier version of this blog titled ‘COVID-19, Public Health and Social Policy in MENA’ was first published by the Alternative Policy Solutions, a public policy research project at the American University of Cairo.