Stifled in development and scared of getting old

Maggie Schmeitz
Stichting Ultimate Purpose

The Social Safety Net intended to provide the population with the social protection measures guaranteed by the Constitution is currently riddled with holes. The benefits paid out are so minimal as to be ineffectual, while services such as free health care are used by many individuals who do not need them, but are unavailable to some who do. Meanwhile, low employment rates lead to concern about the sustainability of social security programmes in the future.

The Constitutionof the Republic of Suriname mentions a just distribution of national income as ameans of extending well-being and prosperity over all segments of the populationas one of the social goals of the state (Article 6). It instructs the state tocreate the necessary conditions to meet such basic needs as work, food, health,education, energy, clothing and communication (Article 24). The state is alsoobliged to protect workers, with special attention for women during and afterpregnancy, minors, the less able, and people working in straining, unhealthy ordangerous circumstances (Article 29). It recognizes work as the most importantmeans for human development (Article 25), while instructing the state to definesocial security policies for widows, orphans, the elderly, people living with ahandicap and people who cannot work anymore (Article 50).

Holes in the ‘Social Safety Net’

The principles set out in the Constitution are translated primarily through thepolicies of the Ministry for Social Affairs and Housing (MSAH). This ministry isresponsible for the Social Safety Net (SSN), targeted at groups consideredunable to work for a living, such as the elderly, children (aged 0 to 18), andpeople living with a handicap, as well as (poor) female-headed households andother households living in poverty (MSAH, 2007, p. 1).

The material assistance offered through the SSN includes general servicesprovided to any household meeting the obvious criteria (households with minorchildren, persons aged 60 and over or living with a handicap),
regardless of income, such as childsupport, old age pension, and financial assistance for the disabled. There arealso services specifically aimed at households living in poverty, such asfinancial assistance, free medical aid, the child food programme and the schoolnecessities programme (MSAH, 2007, p. 2).

The first thing to be observed about the different forms of materialassistance to households and people living in institutions is that the actualamount of money distributed is so low that it renders the service almostobsolete. For example, in the event of unemployment, a household composed of twoadults and two children would receive as financial assistance USD 3.27 per month(MSAH, 2007, p. 4).[1]In comparison, the poverty line for such a household varied between USD 365 andUSD 429 over the years 2005 to 2006 (GBS, 2006).[2]It is sad to see that people actually do still apply for this kind ofassistance, because the bus fare to get there in most cases will be 50% of thebenefit received.

Other things to be observed in the functioning of the SSN in recent decades area lack of adequate cooperation and coordination between different services, alack of standard criteria and a central data bank, and high administration costs(MSAH, 2007, p. 3).

Free Medical Aid for whom?

The provision of Free Medical Aid (FMA) cards helps to illustrate some ofthe social security system’s current shortcomings. Persons who are eligiblefor FMA are divided into households with a monthly income up to USD 14.55(so-called indigents) and the slightly better off with a monthly income betweenUSD 14.55 and USD 29.09 (insolvents). These criteria have not been linked toinflation over the last five years, despite significant rates of inflation.

In his report on health sector reform, Hindori (2003, p. 10) maintains that FMAcards should only be available to 5% of the population, but they have in factbeen issued to 30%. It was calculated that 36% of households receiving this cardcould not be considered poor, while 23% of the households that wereconsidered poor, did not receive it, nor any other form of health insurance.

The number of FMA cardusers rose from 111,814 in 2002 to 165,510 in 2006, which demonstrates that anincreasing number of households continue to be issued this card, while in factno one in Suriname could be expected to still be breathing on an income belowUSD 30 a month. When compared to the total population – 492,829 according tothe 2005 Census Report – we find that one third of all Surinamese people areusing a Free Medical Aid card meant for the poorest of the poor! The figuresseem to prove what everybody already knew from experience: people who are notcovered by the state health insurance fund and are not willing or able to payfor private insurance opt instead to buy or ‘lie’ themselves an FMA card.

TABLE 1. Coverage of health care costs

Payment of health care

Absolute figures

As % of population

SZF (civil servants)



SZF (self-employed)



MM (covering interior)*



Free Medical Aid






Private insurance



No insurance (self-paying)



Other/don’t know/no answer






Source: General Bureau of Statistics(2004). SeventhGeneral Population and Housing Census of Suriname. Edited version of Table 13, p. 54, in Census Report 2005.
TheMedical Mission (MM) is an NGO delegated by the government to provide primaryhealth care services to people in the interior of Suriname.

According to the resultsof the last census (shown in Table 1), the National Health Insurance Fund (SZF)covers only 21.3% of the population, and the overwhelming majority of this groupconsists of civil servants. Being insured is the reason for many people to staywith the civil service, even if they are engaged in much more profitableentrepreneurial activities outside (GCAP Action Group, 2005). The tradition ofpolitical parties ‘rewarding’ supporters after elections with a civilservice job puts extra strain on the already small financial base of the SZF. Asa result, poor availability of drugs, poor service, forced extra charges, longwaiting times and inconvenient clinic operating hours are frequent complaints ofSZF clients (Hindori, 2003, p. 7-8). Such complaints are even more common amongFMA card holders.

It is interesting to note that in self-reporting, the percentage of FMAcard-holding households (23.3%) is much lower than in accordance with MSAHregistration records (32%). This could be due to a relatively high mobilitybetween the group without insurance and the FMA-covered group (Hindori, 2003, p.22). That being said, the percentage of people with no insurance (18.9%) andpeople who do not know whether they are insured (16.8%) is alarmingly high. Bothgroups combined add up to a total of 35.7% of the population. These people withno access to insurance are typically informal sector workers, people who are(temporarily) unemployed, people working for businesses without health insuranceas part of their labour agreement, or undocumented immigrants.

A blessed old age?

Suriname has had a General Old Age Pension scheme (AOV) since 1973.[3]To qualify for this pension, one must live in Suriname, have reached the ageof60, and have Surinamese nationality. Statistics show a steady rise in thenumber of pensioners from 30,000 in 1990 to over 40,000 in 2005 (Jubithana,2007a). In 2004, the number of pensioners was equivalent to 25% of the activeworking-age population. Assuming that all working people pay their AOV premiums,this would mean that there are four active working people to cover the costs ofone pensioner. In fact, however, people working in the informal sector do notcontribute to the scheme (Jubithana, 2007a).

AOV was originally intended to complement pensions received from formeremployment, but in fact, many senior citizens depend on it for survival. Thiscan be explained, first of all, by the large segment of senior citizens who werenot formally employed and so did not build a pension, and also by the fact thatpensions are neither index linked (with inflation) nor welfare linked (withactual salaries). Employment-based pensions therefore do not guarantee socialsecurity for the majority of senior citizens. Jubithana (2007c) suggests thatsocial justice should be served better by creating a ceiling for senior citizenswith a good pension. It is indeed ironic that the beneficiaries of AOV in thecurrent system include former government directors, parliamentarians andministers.[4]A small proportion of senior citizens (7.39%) do not receive any AOV benefits.This group most likely includes immigrants who never obtained Surinamesenationality.

As of January 2006, the AOV monthly benefit payment was raised to USD 81 (GBS,2006). The raises implemented over a period of 15 years (1990 to 2005) have notkept track with inflation, which means senior citizens nowadays often face asignificantly lower living standard than before (Jubithana, 2007c). This is evenmore striking in light of the fact that 59% of senior citizens aged 60 to 64 and47% of senior citizens aged 65 and older are still the heads of householdscontaining three or more persons. Jubithana (2007a) cautiously suggests that inthese cases, AOV benefits probably need to sustain more people than theindividual beneficiary. This is not at all unlikely: welfare organizations oftenreport on grandparents being left with grandchildren when a daughter or sonmigrates (usually to the Netherlands, but also from rural areas to the capitalor to French Guiana) to make a better life for themselves. Unfortunately, thepromises of “coming to get the children after they have settled in” arefrequently not fulfilled. Contact becomes increasingly sporadic and after awhile simply stops. This phenomenon has also been reported upon by regionalwomen’s organizations such as the Caribbean Association for Feminist Research and Action (CAFRA).More research is needed to determine to what extent this plays a multiplyingrole in the problem of senior citizens living in poverty and extreme poverty.

Steps towards greater social justice and security

The government, acknowledging the non-impact of the social protectionsystem, declared the strengthening and modernizing of the SSN as a priority inits Multi-Annual Development Plan 2006-2010. With support from theInter-American Development Bank (IDB) a technical cooperation programme wasstarted up, resulting in an Institutional Strengthening Assessment and a SocialSafety Net Reform Strategy. The main elements in the strategy are improvementsin efficiency (improvement ofcoordination, selection procedures, monitoring and evaluation), capacitybuilding (within both the MSAH and civil society) and stimulationof human development (education and access to the labour market) (Blank andTerborg, 2007). One important improvement so far is the computerizing of clientfiles by the MSAH. However, it is the stimulation of human development that isespecially crucial in attaining sustainable social security and positiveprospects for the future.

Half of working age population unemployed

Statistics show that only 50.7% of the total working age population isemployed, with an unemployment rate of 14.7% (GBS, 2005c, p. 36). The fact thatonly 17.7% of women report being employed is a particular source for concern. Inthe non-economically active group (a total of 36.5%), women account for themajority with 25.2%. People reporting to be non-economically active homemakers(37,247 women versus 605 men) are dependent on someone else’s salary andpension (if any) and are therefore extremely vulnerable. Without being aclairvoyant, it is possible to foresee that those in this category who are notmarried (17,209) are likely to be in a client file of the MSAH their entirelives.

Civil service employment makes up approximately 44% of total employment today,with women holding the majority of lower echelon civil service jobs. When thesalaries of civil servants are compared to the poverty line for the years 2005to 2006 for a household with two adults and two children (USD 365 to USD 429)(GBS, 2006), we find that 65% of them (24,292 out of a total of 37,303) earn anincome that places them below that poverty line. The massive hiring of lowerlevel civil servants, especially after elections, is the way in which successivegovernments hide the real unemployment and the fact that little to nothing isdone to boost production and entrepreneurship (Schmeitz, 2006).

The Constitution of Suriname recognizes work as the most important means forhuman development (Article 25). The state has ratified all the maininternational conventions regarding equal opportunities and access toemployment. We need all the skill, talent and labour that we have to create asocially just society for all of us. If the trend of rising numbers of clientsof social services continues, beneficiaries might very well outnumber workingpeople in less than 50 years. Then we will all be stifled in development, andscared of getting old.


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Perèz-Calle, F. and Saveedra, J. (January 2005). Suriname Poverty and Social Safety Net Assessment. Paramaribo:MSAH/IDB.

Schmeitz, Maggie (2006). PoliticalPatronage and Bondage. Wanica: Stichting Ultimate Purpose.


*One of the BCI componentswas imputed based on data from countries of a similar level.
[1]Amounts in Surinamese Dollars have been transformed in US dollars using theexchange rate of SRD 2.75 = USD 1.
[2]The poverty line used is based on a food basket with 28 items (GBS, 2001).
[3]The system was set up by the Dutch before Independence in 1975.
[4]In the current system, a person who has served as a government minister for atleast one year is eligible for a pension equalling 40% of the highest salaryof a permanent secretary (Jubithana, 2007b).