Promoting Global Health and Social Protection for a Life in Dignity
This research and policy advisory project provides strategic evidence and analysis to inform and strengthen German development cooperation in the areas of global health and social protection. It identifies concrete policy options for BMZ and its partners to enhance the effectiveness, coherence, and impact of interventions in global health and social protection. By combining empirical research, policy dialogue, and targeted advisory outputs, the project generates actionable insights on how financing, governance, and service delivery can jointly strengthen health, reduce poverty, and mitigate migration pressures.
Project Lead:
Francesco Burchi
Christoph Strupat
Project Team:
Stefanie Roost
Tekalign Gutu Sakketa
Srinivasa Srigiri
Paula von Haaren
Financing:
Federal Ministry for Economic Cooperation and Development
Time frame:
2026 - 2028
/
ongoing
Co-operation Partner:
Project description
Low- and middle-income countries face a new era of overlapping pressures: intensifying climate risks, social conflicts, growing antimicrobial resistance (AMR), tightening fiscal space, and increasingly fragmented multilateral cooperation. These dynamics strain health and social protection systems precisely when households most need reliable financial protection and access to quality services. Large population shares, especially informal workers, women, and children, remain under-covered. Climate-related shocks such as heatwaves, floods, and droughts escalate morbidity, mortality, and costs; AMR erodes the effectiveness of health care services; and budget volatility heightens the risk of poverty reversals, instability, and migration pressures.
In this context, strong health and social protection systems constitute the foundation for promoting well-being, eliminating poverty, and addressing other forms of deprivation. Inclusive health systems protect households from catastrophic expenditures, keep people healthy and productive, and contribute to stability and economic development. Social protection tackles poverty, enables people to manage risks, strengthens social cohesion and trust in institutions, and helps prevent displacement and conflict. To exploit the individual and synergistic effects of policies in these two areas, it is necessary to move beyond short-term crisis response, exclusively financed by international donors, with none or little country ownership. Building resilient health and social protection systems implies securing domestic financing and risk-pooling mechanisms, strengthening governance across sectors and levels, and implementing practical, scalable interventions that effectively reach those most at risk.
This research and policy advisory project provides strategic evidence and analysis to inform and strengthen German development cooperation in these areas. It identifies concrete policy options for BMZ and its partners to enhance the effectiveness, coherence, and impact of interventions in health and social protection. By combining empirical research, policy dialogue, and targeted advisory outputs, the project generates actionable insights on how financing, governance, and service delivery can jointly strengthen resilience, reduce poverty, and mitigate migration pressures. The respective research team members contribute to their specific scientific communities within two work packages (WPs).
Work Package 1 (Global Health) focuses on the levers that make health systems resilient. First, it examines domestic revenue mobilization and risk-pooling options—such as health taxes, insurance contributions, and strategic purchasing—to reduce aid dependence and expand effective coverage. Second, it investigates the governance and institutional dimensions of climate change and health, analyzing how cross-sectoral coordination and policy coherence can strengthen national and subnational responses to climate-related health risks. Building on this, it also quantifies how access to and quality of care can serve as climate adaptation, assessing to what extent improved availability, affordability (including health insurance or free health care policies), and service quality mitigate climate-related health impacts, particularly for women and children. Third, it addresses AMR through governance and provider behavior: identifying One Health coordination mechanisms that work at national and subnational levels and generating rigorous evidence on antimicrobial stewardship in pharmacies, including the know–do gap and scalable training and incentive designs.
Work Package 2 (Social Protection) focuses on how to increase the effectiveness of social protection systems in order to address the current multiple challenges. First, it investigates the little-explored question of how access to (and the quality of) social protection systems or specific schemes – such as cash transfers, public works programs or health insurance – influences people’s willingness to migrate abroad. The plan is to focus on countries that are characterized by intensive international migration. Second, it examines the role that social protection plays in climate change adaptation and how the specific design of these instruments can address climate resilience. Third, it concentrates on a fundamental social protection scheme, public works programs with the aim of generating empirical evidence of their multiple benefits for their direct beneficiaries as well as the overall communities in which they are implemented.
Publications
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A change in thinking: new pathways for citywide inclusive sanitation in Nakuru County, Kenya
Saravanan V. Subramanian, Pireh Hezekiah, Moses Onyango, Simon Okoth (2026)
in: Water International, first published 16.01.2026 -
Social acceptance of social transfer policies: the role of climate vulnerabilities and policy design
Roost, Stefanie (2025)
Discussion Paper 36/2025 -
Securing Germany’s Leadership in Global Health
Strupat, Christoph / Srinivasa Srigiri (2025)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 7 April 2025 -
Sanitation governance and its implications on environmental health in Nakuru City, Kenya
Bug, Marius / Maria Gerlspeck / Aline-Victoria Grassl / Saskia Metz / Johannes S. Vogel / Carolin Wicke / Saravanan Subramanian (2025)
Studies 108 -
Who remains uncovered? Assessing inequalities and determinants of national health insurance enrolment among informal sector workers in Kenya
Wamalwa, Phidelis / Christoph Strupat / Kavita Singh / Jacob Kazungu / Manuela De Allegri (2025)
in: Global Health Research and Policy 10, article 62 -
Mitigating anti-microbial resistance in the environment: a One Health governance analysis in Kenya
Srigiri, Srinivasa / Morris Buliva (2025)
Discussion Paper 34/2025 -
Gender differences in multidimensional poverty in low- and middle-income countries
Burchi, Francesco / Daniele Malerba (2025)
in: Journal of International Development, first published 28.11.2025 -
Trends in social protection spending and its effects: evidence from the Harmonized Social Protection Expenditure Database (HASPED)
Burchi, Francesco / Sophia Schubert / Daniele Malerba (2025)
published on ssrn.org, 17.11.2025 -
Do free healthcare policies play a role in expanding national health insurance enrollment among informal sector workers? The case of the Afya Care pilot program in Kenya
Wamalwa, Phidelis / Christoph Strupat / Edmund Yeboah / MaryBennah N. Kuloba / Boniface Mbuthia / Manuela De Allegri (2025)
in: BMC Public Health 25, article 3610 -
Do public works programmes foster climate resilience? Conceptual framework and review of empirical evidence
Burchi, Francesco / Anastasia Terskaya / Tekalign Gutu Sakketa / Elisabetta Aurino (2025)
in: International Social Security Review 78 (2/3), 145-171 -
Establishing the effect of COVID-19 lockdown policy on the resilience of facility-based delivery in Kenya: a multi-method study
Kuloba, MaryBennah N. / Christoph Strupat / Thit Thit Aye / Phidelis N. Wamalwa / Judy Gichuki / Benjamin Tsofa / Manuela De Allegri (2025)
in: BMC Health Services Research 25, article 1014 -
Responses to the Third Lancet Commission on Investing in Health from Denmark, Germany, and Norway
Alfvén, Tobias / Angela Y. Chang / Hanna Ohm Cleaver / Anna-Katharina Hornidge / Steven L. B. Jensen / Eirik Mofoss / Fride Nordstrand Nilsen / Ole F. Norheim / Marco Schäferhoff / Martin Siegel / Christoph Strupat (2025)
in: The Lancet Regional Health – Europe 56, article 101377 -
The impact of shock-responsive social cash transfers: evidence from an aggregate shock in Kenya
Strupat, Christoph / Emmanuel Nshakira-Rukundo / Arndt Reichert (2025)
in: Journal of Development Studies, first published 28.05.2025 -
Overcoming silos for One Health: key determinants of One Health governance platforms in low- and lower middle-income countries
Strupat, Christoph / Sandul Yasobant / Srinivasa Srigiri / Saravanan Subramanian (2025)
Discussion Paper 13/2025 -
Global health at a crossroads: policy recommendations in light of the Lancet Global Health 2050 Report
Strupat, Christoph / Marco Schäferhoff / Martin Siegel / Anna-Katharina Hornidge (2025)
Policy Brief 5/2025 -
The protective role of index insurance in the experience of violent conflict: evidence from Ethiopia
Sakketa, Tekalign Gutu / Dan Maggio / John McPeak (2025)
in: Journal of Development Economics 174, article 103445 -
Enhancing public works programmes: sustainable impact through participatory asset creation and digitalisation
Burchi, Francesco / Tekalign Gutu Sakketa (2025)
Policy Brief 4/2025 -
Power up One Health to effectively combat antimicrobial resistance!
Srigiri, Srinivasa / Angela R. Schug (2024)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 9 September 2024 -
Do public works programs foster climate resilience? Conceptual framework and review of empirical evidence
Aurino, Elisabetta / Francesco Burchi / Tekalign Sakketa / Anastasia Terskaya (2024)
IEB Working Paper (2014/12), Barcelona: Institut d’Economia de Barcelona/Universitat de Barcelona -
The impact of shock-responsive social cash transfers: evidence from an aggregate shock in Kenya
Strupat, Christoph / Emmanuel Nshakira-Rukundo / Arndt Reichert (2024)
Ruhr Economic Papers 1073, Essen: RWI Leibniz-Institut für Wirtschaftsforschung -
International rules on health data sharing for a new pandemic agreement
Holzscheiter, Anna / Maria Weickardt Soares (2024)
Policy Brief 23/2024 -
The Road to an Equitable Pandemic Agreement
Strupat, Christoph / Remco van de Pas (2024)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 7 May 2024 -
Why transportation should work for women in Africa
Asimeng, Theodore / Pooja Balasubramanian (2024)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 6 March 2024 -
The gendered nature of poverty: data, evidence and policy recommendations
Burchi, Francesco / Daniele Malerba (2023)
Policy Brief 24/2023 -
Global trends in multidimensional poverty and horizontal inequalities in poverty
Burchi, Francesco / Daniele Malerba (2023)
in: UNDESA - Expert Group Meeting on the Implementation of the third United Nations Decade for the Eradication of Poverty (2018-2027), Draft paper (May 2023) -
How can climate-resilient health systems be successfully established?
Strupat, Christoph (2023)
Bonn: German Institute of Development and Sustainability (IDOS), The Current Column of 27 November 2023 -
Gesundheitsfinanzierung in Zeiten von Mehrfachkrisen: Analyse und Empfehlungen
Strupat, Christoph / Pooja Balasubramanian / Srinivasa Srigiri / Anna-Katharina Hornidge (2023)
Policy Brief 13/2023 -
Health financing in times of multiple crises: analysis and recommendation
Strupat, Christoph / Pooja Balasubramanian / Srinivasa Srigiri / Anna-Katharina Hornidge (2023)
Policy Brief 11/2023 -
Effects of the Indian National Health Insurance Scheme (PM-JAY) on hospitalizations, out- of-pocket expenditures and catastrophic expenditures
Strupat, Christoph / Divya Parmar / Swati Srivastava / Stephan Brenner / Diletta Parisi / Susanne Ziegler / Rupak Neogi / Caitlin Walsh / Manuela De Allegri (2023)
in: Health Systems & Reforms 9 (1), article 2227430
Events
From Climate Negotiations to Resilient Health Systems
Advancing Climate and Health Resilience
(How) does social protection promote climate change mitigation and adaptation?
Innovating One Health Governance for Global and Local Action
Health Economics, Development and Climate Change
Pandemic prevention: a planetary health perspective
Re-considering international health data sharing rules for a new Pandemic Treaty.