Gaps and efforts in social protection

Sawsan El Masri
Arab NGO Network for Development (ANND)

Lebanon lacks a coherent and comprehensive system for social protection. Over half the population is not covered by any form of health insurance, and retirement schemes exclude the most vulnerable and poor. NGOs play a major role in providing social assistance to those cut off from formal protection systems. Meanwhile, Palestine refugees, who comprise 10% of the population, face severe discrimination in the right to social security, to work, and to own property, resulting in high rates of abject poverty.

Social protectionis defined as the set of policies and mechanisms in a given country to protectits citizens (or residents) from any risks they might face. In a country likeLebanon, faced with continuing political instability and its adverse impact onthe country’s economic performance and the people’s living conditions,social protection becomes even more essential. However, is social protectiongiven the priority it deserves? Are vulnerable groups and the poor adequatelycovered against the high possibility of shocks? What shape do the socialprotection mechanisms take? And what actions is the government planning toundertake to ensure proper protection for its citizens?

No health insurance for over half the population

Although Lebanon is considered a middle-income country, poverty rates arestill relatively high. Around one quarter of its population is considered poor(deprived of basic needs), with 5% living in extreme poverty.

A major characteristic of social security mechanisms isthat those most in need are the least covered. This is the case, for example,with regard to health insurance. More than half of the population (53.3%) is notcovered by any form of health insurance. In terms of the type of healthinsurance, 23.4% of all residents are covered by the National Social SecurityFund, 9% by health services provided by the Army and the Internal SecurityForces, and 4.3% by the Public Servants’ Cooperative. An additional 2.6% ofresidents are insured at their own expense, 2.2% receive private insurancethrough an institution or a syndicate, 1.7% are enrolled in a private insurancescheme at the expense of their employer, and 1.7% are covered by some other typeof health insurance.

While there is no significant gender disparity in coverage – 43.6% of malesand 46.3% of females are beneficiaries of some form of health insurance –coverage varies significantly based on age. The population aged 65 and aboveaccounts for only 8.2% of the total number of beneficiaries (MoSA, 2006).

Regional disparity is a characteristic of poverty and inequality in the country,and disparity in health insurance follows the same pattern as disparity in othersocioeconomic indicators. The peripheral regions like the Beka’a, SouthLebanon, North Lebanon and Nabatieh have lower numbers of beneficiaries ofinsurance schemes – accounting for 10.9%, 8%, 15.4% and 4.1% of totalbeneficiaries, respectively – compared to central regions like the capitalcity Beirut (13.7%) and Mount Lebanon (home to 47.9% of all health insurancebeneficiaries) (MoSA, 2006).

The absence of health insurance is highly correlated with unemployment. Theunemployed and those who are unable to work represent 1.6% and 2.3% of the totalbeneficiaries of at least one type of health insurance, respectively. Thecorrelation between poverty and the absence of health insurance is illustratedby the fact that the percentage of deprived households is 14% where the head ofthe household is covered by health insurance, while it increases to 34% wherethe head of the household is not covered by health insurance (MoSA, 2006).

Employment is the entry point for receiving health and social insurance. Onceunemployed, beneficiaries and their families (as indirect beneficiaries) losesocial insurance coverage. The current system, especially the public insurers,excludes the unemployed, agriculture workers, the self-employed, and thoseworking in the informal sector (unskilled labourers, seasonal workers), who earnlower incomes and are more vulnerable to shocks and risks. Moreover, health andsocial insurance coverage of the elderly and the retired is largely limited tostate employees and the staff of big corporations.

Poorest and most vulnerable cut off from retirement schemes

Retirement schemes are not much different from health insurance; similarly,they are largely linked to the labour market and generally non-universal. Onlystate employees (civil servants and military personnel), who account for around10% of the labour force, have the opportunity to choose between receiving amonthly retirement income or a lump sum amount as end-of-service compensationafter retirement. Those employed in the private sector, public utilities andmunicipalities – representing 25% of the labour force – do not enjoy theoption of a continued
retirement income. When they retire, they are entitled to anend-of-service lump sum payment only.

The better-off groupincludes those who are employers, self-employed or members of a liberalprofession (lawyers, engineers, doctors) and therefore enjoy a middle to highincome. Although they do not benefit from formal social insurance schemes, theirincome level makes it possible for them to invest in private pension schemesand/or accumulate substantial savings for the future. Much lower down on theladder of protection are the wage earners employed in agriculture, construction,small business and domestic services. Workers in this group do not benefit froma retirement scheme unless they enter into one on their own initiative. Theunemployed are definitely the most vulnerable, as they are theoretically andpractically outside any protection mechanism. Lebanon does not have anunemployment compensation system to protect them while they are out of work, andwhen they reach retirement age, if they have not been employed, they will not beprovided with the benefits of any retirement scheme.

Clearly the retirement system does not provide adequate coverage and excludesthe most vulnerable and poor. Despite this poor performance, the retirementscheme covering civil servants, military personnel and private sector employeesconsumes 3.5% of GDP (2004), one of the highest levels of spending in theregion.

TABLE 1. Vulnerability at retirement in relation to employment status




Very low




Liberal professions



Self employed (higher level jobs)






State employees






Formal Private Sector Employees



Self employed (lower income jobs)






Informal workers





Very high



NGOs play a major role in providing social services

Social protectionmechanisms take two major forms. The firstis that of institutional and formal mechanisms funded by contributions from thebeneficiaries or their employers. Coverage by these institutions and mechanismsis based on the fulfilment of certain criteria, usually employment, as mentionedabove. The second form isbasically comprised by ad hoc interventions and programmes such as socialassistance, relief efforts and credits that are financed by external or localfunds and are usually managed by the government, civil society institutions,international organizations or the private sector.

Different government players are involved in mitigating the adverse effects ofpoverty, political instability and economic fluctuations. The Ministry of SocialAffairs (MoSA) and the Ministry of Public Health (MoPH) act as a safety net to asubstantive share of the population.

MoSA provides a wide number of social services (primarily health care andeducation) through a network of social development centres scattered all overLebanon. In addition to social services, it provides in-house care to around30,000 beneficiaries including children (especially orphans), the elderly andthe disabled; this accounts for 60% to 70% of its budget.

MoPH, for its part, acts as a health safety net for those who are not covered byany health insurance scheme, by covering the costs of hospitalization in publicor private hospitals. It should be noted that MoPH beneficiaries are treated ona case-by-case basis and have to negotiate before receiving service. Thecoverage does not include primary care, medical exams or consultations.

The role of NGOs in Lebanon is substantial. NGOs have played a major role inproviding social assistance to the poor and vulnerable population in the pastdecades, especially during the years of civil war and the Israeli attacks. Theyhave greatly contributed to the relief work and acted as a true safety net to asignificant share of the population. Around 53% of the NGOs active in thecountry are primarily devoted to assisting the poor and the needy. The socialassistance and support provided by NGOs gives priority to two major areas, theprovision of health care and educational services, including literacyprogrammes.

In general, Lebanon lacks a coherent and comprehensive system for socialprotection. Spending on social protection is not proportionate with the outcomesreflected in the performance of the education and health sectors, where the vastmajority of expenditure is allocated. The biggest share of the budget of theMoSA, public insurers and the civil sector is spent on education and healthservices, while the National Social Security Fund spends 32% of its budget onhealth, the Army spends 53% of its social budget on education and 40% on health,and the Public Servants’ Cooperative disburses 55% on health and 40% onscholarships. The end result is that the provision of these services is mostlyduplicated, largely improvised, and not always of sufficiently high quality.

Palestinian refugees: a neglected population

The official number of Palestinian refugees is currently about 409,000,which is roughly 10% of the population. Most of them live in 12 camps scatteredthroughout the country and are registered with the United Nations Relief andWork Agency for Palestine Refugees in the Near East (UNRWA),[1]which provides them with social assistance, particularly in relation to healthcare and education.

According to the UNRWA,
all 12 of the refugeecamps “suffer from serious problems – no proper infrastructure,overcrowding, poverty and unemployment.” Lebanon is also home to “thehighest percentage of Palestinian refugees who are living in abject poverty.”

The deplorable living conditions are the cause and effect of the inadequacy ortotal absence of social services and protection mechanisms and deprivation ofthe right to work. The refugees are not allowed to practice a number ofprofessions, including pharmacy, law, medicine and journalism, in addition to alist of dozens of other trades and professions, as they do not have Lebanesecitizenship. Palestinians face similar discrimination with respect to the rightto social security. With the exception of those working at the UNRWA, who enjoythe benefits of a secure job, Palestinians face severe discrimination in theright to work, to social security, and to own property, and this is reflected inincreased poverty and worsening living conditions.

Plans for future action

After the Israeli attacks waged on Lebanon in July 2006, the internationalcommunity gathered in January 2007 at the Paris III Donor’s Conference tosupport Lebanon. The Lebanese government submitted a Social Action Plan to theconference, outlining the basic starting points for enhancing the livingconditions of the poor and vulnerable groups, as well as improving theshortcomings in the social sector. The plan aims at 1) reducing poverty andimproving education and health indicators; 2) improving the efficiency of socialspending; and 3) minimizing regional disparities and achieving betterdissemination of allocations in the national budget for social intervention. Theobjectives of the plan are to be achieved through strengthening social safetynets in the short term and introducing social sector policy reform in the mediumto long term (GoL, 2007a).

In addition to the Social Action Plan, the “Recovery, Reconstruction andReform” paper submitted by the government to the Paris III conference calledfor a reform of the pension system in Lebanon as a top priority (GoL, 2007b).The reform will work on merging the different systems into one modern scheme,reducing administrative costs, and extending coverage to the self-employed andcasual workers with limited savings capacity. Implementation plans for thesereforms are currently in preparation and efforts are underway to secure theneeded funding.

In general, the Lebanese still rely on family and community networks forprotection, especially when they are old or unemployed. More than half of thepopulation, including the very poor and vulnerable, is not protected by anyformal systems. The government appears to be committed to reforming andimproving social protection mechanisms, as reflected in the documents submittedto the Paris III Donors’ Conference, including the Social Action Plan.However, the government needs to translate this commitment to reform andcost-effective protection mechanisms into long-term and sustainable changes thatprioritize the needs of the poorest and most vulnerable segments of thepopulation. Reform plans must be linked to the adoption and implementation ofcomprehensive and integrated social policy. There is also a need to revisit therole of the state in relation to other partners to lead to a systematic andefficient division of labour between the state, NGOs and the private sector onthe basis of a lengthy process of social dialogue involving the differentstakeholders and partners.


Amnesty International (2003). “Economicand Social Rights of Palestinian Refugees”. Lebanon.
GoL (Government of Lebanon) (2007a). “Social Action Plan.
Toward Strengthening Social Safety Nets and Access to Basic SocialServices”. Submitted to the Paris III Donors’Conference, January. Availablefrom: <>.
GoL(2007b). “Recovery,Reconstruction, and Reform”. International Conference for Support to Lebanon. 25 January. Available from: <>.
MoSA and UNDP (Ministry of Social Affairs and United Nations DevelopmentProgramme) (2004). “The Socioeconomic Conditions in Lebanon”. Beirut.
MoSA and UNDP (2006). “Living Conditions of Households. The National Survey ofHousehold Living Conditions 2004”. Beirut. <>.
MoSA and UNDP (2007). “The Evolution of the Mapping of Living Conditions inLebanon between 1995 and 2004”. Beirut.
The World Bank Group (2005). “The Republic of Lebanon Update. First Quarter2005”.
UNDP (2002). National Human DevelopmentReport 2001-2002. Globalization: Towards a Lebanese Agenda. Beirut.


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The author acknowledge the kind support of Zena Ali-Ahmad.