A comparative analysis of public social assistance systems in Belgium and Health Equity Funds in Cambodia: an overview of lessons learned

Belgium has a solidly implemented multi-purposed public social assistance system that is the result of a long social and political history characterised by an evolution from charitable privately funded systems in the 19th century to a publicly funded and operated social assistance system in the last quarter of the 20th century. In a first part of this paper we describe the decision-making structures and processes concerning the delivery of social assistance benefits in Belgium. The main strengths and weaknesses of the Belgian social assistance system are analysed. In a second part, the paper discusses this specific experience of social assistance in relation with the emerging movement in low- and middle-income countries of single-purposed social assistance systems put in place for the payment of health care for the poorest in society. The Cambodian experience with health equity funds is central in this description. Finally, in a third part of the paper, a number of possible lessons from the specific Belgian experience are presented for the design and operation of social assistance systems in low- and middle-income countries. They pertain to the use of social assistants as front-line staff in the delivery of social assistance; to the need for health equity funds to extend their services beyond destitute households; to the importance of stigma as a barrier in the utilisation of social assistance services; to the stewardship role of public administrations of social assistance; and last but not least, it cautions policymakers for reducing social assistance to a technical issue; they should instead also address its political dimensions.