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Actors and Social Reforms in Five Dual Welfare
Regimes in Latin America: Brazil, Mexico,
Colombia, Panama and Venezuela
Carlos Barba Solano and Enrique Valencia Lomelí
During the last three decades, the social security and health systems of the
dual welfare regimes of Latin America (LA) have undergone thorough
reforms, and these countries have also developed numerous conditional
cash transfer (CCT) programmes and social pension schemes. This has
occurred in the context of a tension between two welfare paradigms:
Professors and researchers at the University of Guadalajara members of the
National Research System of Mexico level III.
C. B. Solano (B)
Departamento de Estudios Socio Urbanos, Universidad de Guadalajara,
Guadalajara, Jalisco, México
E. V. Lomelí
Centro Universitario de Ciencias Sociales Y Humanidades, Universidad de
Guadalajara, Guadalajara, México
© The Author(s), under exclusive license to Springer
Nature Switzerland AG 2021
N. Sátyro et al. (eds.), Latin American Social Policy
Developments in the Twenty-First Century,
62 C. B. SOLANO AND E. V. LOMELÍ
one of a liberal type and the other closer to universalism. We argue
that the paradigms that orientated the reforms depended on the polit-
ical ideology of the governments that carried them out, but the political
alliances and supporting networks built by each government to support
them determine their success and continuity.
The purpose of the work presented here is to classify the reforms,
showing which paradigms were behind them, determining to what extent
the reforms have had an effect on social well-being, and whether they
have promoted or restricted the building up of rights and social citizen-
ship, and also to analyze the impact of these reforms on ﬁve Dual Welfare
Regimes (DWR): Brazil, Colombia, Mexico, Panama and Venezuela. Our
analysis is focused on the actors who promoted the reforms, the social
agenda that they proposed and the progress made in carrying out the
The work is divided into four parts; the ﬁrst classiﬁes the welfare
regimes of the ﬁve cases studied during the period of import substituting
industrialization (ISI). The second shows the welfare gaps between them
as they were in the years 1970–1980, just before the reforms came in.
The third part addresses the reforms to social security and health systems
and the creation of Conditional Cash Transfer (CCT) programmes. To
conclude, the fourth part assesses the impact of the reforms on indicators
for social expenditure, poverty and income inequality, up until 2015.
3.2 Characteristic of the DWR
of LA During the Period of ISI
Various studies have established similarities and differences in the
processes of consolidation of the welfare regimes in Brazil, Mexico,
Colombia, Panama and Venezuela during the period of ISI. In all ﬁve
cases democracy was slow to get established, after 1980, and the forms of
political inclusion tended to be corporative and vertical.1There was less
“social mobilization” in those countries where “ethnic/racial diversity”
was greater2(Pribble 2011).
The ﬁve countries adopted a variety of economic models: Brazil and
Mexico proceeded with their industrialization, Panama established itself
1Particularly in the cases of Brazil, Mexico and Panama (Pribble 2011).
2Mexico, Brazil and Colombia (Pribble 2011).
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 63
as an economy based on logistical, ﬁnancial and tourist services, Colombia
as an economy exporting primary goods and Venezuela as an extractive
rentier economy (Barba and Valencia in press). In spite of their differ-
ences, in four of the cases presented here, as pointed out by Mesa-Lago
(1986,2007), their social security systems had all been set up between
1940 and 1950, with Brazil, where this took place in the 1920s, the only
In general terms these systems were not inclusive and equitable and
were built on stratiﬁed forms of labor inclusion, co-existing with social
assistance programmes and informal mechanisms concerned with the well-
being of those without formal employment, that were associated with
clientelist and patrimonial practices (Filgueira 2005;Barba2003,2007;
Wood and Gough 2006; Martínez-Franzoni 2008). This created a great
segmentation of institutions, stratiﬁed cover in social security and health,
and a strong dualism between the rights of those participating in the
formal economy and those of people who were not. This was an impor-
tant factor that stood in the way of reducing poverty in those countries
(Barba 2003 and 2007).3
In all ﬁve cases, the provision of care was considered a task for the
family because it had come to be seen as being naturally a female respon-
sibility, and in countries with a larger indigenous or Afro-descendant
population, the tendency was to reproduce the social inequalities inher-
ited from the colonial period all the more, along with gender inequalities
3As opposed to what happened in others, such as Argentina, Chile, Uruguay and Costa
Rica, where there was more social homogeneity.
64 C. B. SOLANO AND E. V. LOMELÍ
3.3 Welfare Gaps Among
DWR in the 1970s and 1980s
Although there was a greater ethnic and racial heterogeneity in Brazil,
Mexico and Venezuela, the rates of economic growth4and social expen-
diture5were similar in all of them, while the cover provided by social
security was grater in Brazil and Mexico than in the rest of the countries
of this cluster.6The ﬁve countries had similar ﬁgures for formal EAP,7
educational cover8and the standard of living9, as well as similar rates for
poverty10, inequality11 and labour precariousness12.Table3.1 provides a
4Between 1960 and 1970 the average GDP per capita for Brazil and Mexico (the most
industrialized countries in this cluster) was 3.4; in the same stage, the average GDP per
capita for Colombia, Venezuela, and Panama (the least industrialized countries in this
cluster) was 3.1 (Urrutia 1993:Table2.1).
5In 1980–1981 average social expenditure as a percentage of GDP for Brazil and
Mexico was 11.8%, in the same stage such average for Colombia, Venezuela and Panama
was 11.6% (Cominetti and Ruiz 1998:Table2).
6In 1980 the average EAP insured as a percentage of the EAP was for Brazil and
Mexico 41.5%, while such average for Colombia, Venezuela and Panama was only 33.0%
7In 1970 the average formal EAP for Brazil and Mexico was 54.5%, while such
average for Colombia, Venezuela, and Panama was a little bit greater: 57% (Thorp 1998:
8In 1970 the average coverage of primary education for Brazil and Mexico was 72.3%,
while such average for Colombia, Venezuela and Panama was 69.9%, the same year the
average coverage of secondary education for Brazil and Mexico was 46.9%, while such
average was greater in the rest of the countries of this cluster: 53.5% (Urrutia 1993:
Tables 2.6 and 2.7).
9The relative standard of living index uses three variables: GDP per capita, life
expectancy at birth, and the literacy rate in the adult population. It allows comparing
the level of well-being of each Latin American country with the well-being of the United
States in the same year, so always the attributed value is 100 for the USA. In 1970 such
an average index was 64 for Mexico and Brazil, and 68 for the rest of the countries of
this cluster (FitzGerald 1998: Table 9.5).
10In 1970 the average rate of total poverty (as a percentage of households) for Mexico
and Brazil was 41.5%, a although it was smaller for Colombia, Venezuela and Panama:
35.3% (Altimir 1995:Table2.1).
11In 1970 the average Gini coefﬁcient for Mexico and Brazil was 0.590, and it was
smaller for Colombia, Venezuela, and Panama: 0.530 (Altimir 1995: Table 2.1).
12In 1970 the average percentage of precarious employment (employment in the
informal sector, domestic services, and employment in traditional agriculture) for Mexico
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 65
Table 3.1 Dual Welfare Regimes in the period of ISI (1940–1980). Typology developed by Carlos Barbaa
Historical contexts Characteristics compared
Industrialized Brazil, MexicoaRapid industrialization.
degrees of ethnic and
inherited from the
Similar to universalist regimes in the expansion of social rights,
concentrated on formal urban sectors. Social policy favored middle
income groups (industrial workers, public employees and members of
the middle class). But the rural population, informal urban workers
and indigenous peoples or Afro-descendants remained outside the
main welfare institutions. An important institutional deployment of
the sectorial systems of education and health. Less development, and
slower, of their social security systems, segmented by social and
labour status and regressive in terms of gender
Intermediate indicators in the context of LA for inequality, poverty,
employment, social expenditure, coverage of social security and
education and health
Strong familialism in the care ﬁeld
primary goods Vene z uela,
High rate of labour
informality. Less ethnic
and racial heterogeneity
Sources Barba (2003,2007,2009); Barba and Valencia (2013). aIn the work by Barba and Valencia (2013) we have reviewed some of the reforms
introduced to these two welfare regimes during the ﬁrst decade of the new millennium. Barba has also reviewed these reforms in a number of more
recent publications (Barba 2016,2018 and In Press)
66 C. B. SOLANO AND E. V. LOMELÍ
summary of the characteristics of this type of WR during the ISI period
according to the typology developed by Carlos Barba.
3.4 Reforms of Pensions and Health Systems,
and the Creation of Conditional Cash Transfers
In LA from the 1990s there have been two crisscrossing waves of social
reforms, based on two opposing welfare paradigms. The ﬁrst derives from
a neoliberal perspective, backed by a global technocratic coalition, and has
had a signiﬁcant inﬂuence on reforms of pension and health systems and
on poverty reduction programmes (Barba 2007). The second, which is
closer to universalism in that it aims to build up rights and social citizen-
ship, has been adopted by progressive governments and social coalitions
with an important national component.13 Following this paradigm, a new
social agenda seeks to broaden the cover of social security through norma-
tive and institutional reforms, instead of strengthening the role of the
market in the provision of social services and targeting State action on
the poorest as proposed by the neoliberal paradigm (Barba 2018).
In this section we shall look at two major categories of reform: those
of pensions and health systems, and then at a number of conditional cash
transfers (CCT) programmes developed in the DWR. In the reforms and
programmes considered, it is possible to see the imprint of actors pursuing
opposing interests and objectives (Cecchini et al. 2014;Barba2018).
3.4.1 Reforms of the Pension Systems
Two kinds of reform have been made of pensions system in DWR: para-
metric reforms and structural reforms. The second type of reforms was
realized with the aim to replace the old pay-as-you-go systems with others
based on individual savings and the private administration of pensions.
Structural reforms were carried out by Colombia in 1994 and Mexico in
and Brazil was 47.5%, while such average for Colombia, Venezuela and Panama was 43.1%
13Support for these coalitions has come from a number of social movements whose
demands express dissatisfaction with particular processes: the weakening of the social func-
tion of the State, the great tensions felt in the social security systems, the great instability
of the family, atypical types of employment and an increasing absence of social security.
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 67
1997. While parametric reforms were carried out by Brazil in 1998 and
2003, as well as by Panama in 2000 (GES 2007:2).
220.127.116.11 Parametric Reforms with Complementary Private
In Brazil and Panama these reforms did not aim to impose a new model,
but to strengthen the workings of the systems already in play, through
adjustments to three variables: the rate of the contributions to be paid in,
the age of retirement and the size of the pensions to be paid out; and to
complement these systems with private systems.
In Panama contribution pensions, called social security funds (Cajas
del Seguro Social,CSS ), were introduced in 1941, and during the
period between 1998 and 2004, a technical team from the International
Labor Organization (ILO) with methodological support from the United
Nations Development Program (UNDP) carried out an actuarial study to
facilitate the reform. After a stage of political negotiation and a ﬁnancial
crisis in the CSS, the reform was carried out in 2005. Two subsystems
were set up: one paying out ﬁxed beneﬁts, which underwent a para-
metric reform14 and a mixed subsystem that contemplates the possibility
of private savings, but it is not very important. The coverage of this three-
part system is very high: 81.7% of the population in 2010 (Rodríguez
In Brazil with the adoption of the Federal Constitution of 1988, social
security was recognized as a social right15 and the separation between
private-sector workers and those employed by the State,16 that had been
established in 1966 with the creation of the Social Security Institute
(Instituto Nacional de Previdência Social,INPS)andtheSocialSecu-
rity Institute for Public Servants (Instituto de Pensão e Aposentadoria
dos Servidores Estaduais ,IPASE),wasconﬁrmed.The1988Constitution
allowed complementary and voluntary private funds to be established, and
14Retirement ages were raised and so were the quotas needed to obtain the beneﬁt.
15Even though the ﬁrst social security systems (Cajas) were started in the early years
of the 20th century.
16There was also a semi-contribution plan that was set up for rural workers and another
of beneﬁts without contributions (Beneﬁcios de PrestacionesContinuas), called continual
68 C. B. SOLANO AND E. V. LOMELÍ
these were also conceived of under a pay-as-you-go system17. However,
in Brazil, the emphasis has always been on regarding social security as a
public matter (Robles and Mirosevic 2013:29–30).
In 1991 the National Social Security Institute was founded, but the
logic of the system did not change: it still had greater beneﬁts and rights
for State employees. Two compulsory regimes were started: the ﬁrst was
for private-sector workers, and the second for people who were working
for the government,18 with much better conditions and beneﬁts in the
latter (Robles and Mirosevic 2013:30–32).
18.104.22.168 Structural Reforms: The Creation of Private Pension
Reforms of this type, which were made in Mexico and Colombia are
emblematic products of a social policy agenda on a global scale, in which
the main actors are advocacy coalitions (coalitions promoting social poli-
cies) whose members share the same belief system, and usually develop a
strong consensus over the central idea of a policy but are ﬂexible about
secondary aspects (Gómez Lee 2012:11–30).
In these reforms the most important external actors have been inter-
national ﬁnancial institutions (IFI), especially the World Bank (WB) and
the Inter-American Development Bank (IDB), while the principal actors
domestically have been organized private interests and ministries of the
economy and ﬁnances (MEF) who appoint specialized technical reform
teams to design and apply the reforms, that are advised by international
experts and are ﬁnanced by the IFI (De León 1994: 176; Orenstein 2005:
177–178; Gómez Lee 2012:11–30;Valencia2018).
The reforms came in response to a big ﬁnancial crisis in the pay-as-you-
go systems, in the context of a low rate of economic growth.19 A number
of studies show that the reforms were the product of pressures from the
17Complementary social security is voluntary and is administered by the private sector
through proﬁt making and non-proﬁt making bodies and they run collective social security
plans for employees in speciﬁc companies, co-operatives or unions (Robles and Mirosevic
18And would have mixed ﬁnancing: with contributions from employees and the State.
19The pensions systems were in a parlous state, with 40% of pensions expenditure
going to the pensions of state employees, at a time of high rates of unemployment, high
inﬂation and an ageing population (Grindle 2002: 87–90).
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 69
IFI, but they were also supported by domestic actors such as the MEF
and coalitions of private interests.
The aim of these reforms has been to give up the old pension
systems,20 with deﬁned beneﬁts, set up at various times in the twentieth
century, and replace them with private pensions, in which the contribu-
tions are ﬁxed, on the basis of individual savings accounts, and the beneﬁts
are pre-ﬁnanced through individual savings and investment in private
accounts, but their amounts are not deﬁned in advanced because they
depend on the individual’s savings and income from the invested funds:
so processes or mechanisms of redistribution are not allowed. To sum
up, in this model the risk and the reward are assumed by the individual
The process of reform closely follows the logic of deploying policies
promoted by the advocacy coalitions, with their strong consensus on the
central ideas of policy and considerable ﬂexibility in secondary aspects, as
happened with the WB proposal of 1994, which did not seek to replace
the model of saving for retirement with a radically different one21,justto
follow a model with three pillars (Gómez Lee 2012:11–30).
The WB sought to facilitate the application of the reform, while recog-
nizing the existence of powerful local actors opposed to any radical
reform. Their ﬂexible approach is evident in the cases of Mexico and
Colombia, where the reforms did imply a change of paradigm in both
cases, though their scope varied.
The most radical reform was that of Mexico, which followed the
Chilean model of closing down the public systems and replacing them
with the new systems of capitalization through individual accounts. The
20In which the State and employers are responsible for managing the systems, and
income taxes are used to pay for those who have retired, with beneﬁts deﬁned in advance
which may be redistributed between generations and are linked to the beneﬁciary’s whole
employment trajectory in order to maintain the standards of living of recipients prior to
retirement. In this scheme the risk is shared by all the workers in order to provide social
security against a lack of income, old age, disability, and emergencies (Orenstein 2005:
21As in the case of Chile.
22The social reforms applied in the 1990s had the signiﬁcant participation of technical
teams directed to making structural changes supported by a discourse of modernizing
institutions, criteria such as the free market, freedom of choice, ﬁnancial rationalization,
and re-structuring the systems of providing services (Uribe 2007:446).
70 C. B. SOLANO AND E. V. LOMELÍ
Table 3.2 A global social policy applied to the reform of pension systems in Latin America
Earliest reforms Model of reform The promoting
Application of the
The opponents A ﬂexible reform
In Chile in the 1980s The Chilean reform
started to be
promoted as a model
of reform by the
World Bank in 1994a
Coordinated by the
World Bank (WB)
• Through the
creation of technical
teams for the
with three pillars:
• The United States
support of agencies
belonging to the
The ILO • Minimum
pensions for the
poor paid for by
Creation of a private
sector system of
that replaced the
employee unions • Compulsory
pension based on
ministries in Latin
political partie •Voluntarysavings
Sources Original elaboration based on: Orenstein (2005: 189–194) and Banco Mundial (1994). aWith publication of the report titled Adverting the
Old Age Crisis
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 71
Colombian reform was closest to the WB model: a public system of distri-
bution, complemented by a private system and a solidarity insurance fund
to subsidize the contributions of those who did not have access to the
social security system, and give ﬁnancial support to those in extreme
poverty (GES 2007:4).
The long road taken by reforms to Mexico’s pension systems23 clearly
illustrates the orthodox process of reform promoted by powerful techno-
cratic coalitions (techno network) of a transnational type in Latin America
and in particular in the Dual WR (Table 3.3).
Table 3.4 shows the path followed by the reforms in Colombia and
illustrates a heterodox process, adjusted to the model proposed by the
WB in 1994, in which the relative veto power of certain national actors
at the stage of implementing the reform is also noticeable.
22.214.171.124 Results of the Pensions Reforms in the Welfare DR of LA
The results of these reforms have been a greater segmentation due to the
multiplication of schemes, with different rules applying to those afﬁliated
to the regimes before they were reformed and those who joined later, a
growing polarization (due to the veto power of the unions opposed to
the reforms) and a continuation of the old patterns of exclusion (Valencia
CEPAL (2006: 36–37) considers that the capitalization reforms have
not translated as had been expected into an increase in the participa-
tion of the productive sector, due to the limited or non-existent capacity
to save of important segments of the population, as a result of the
tendency towards informal and precarious employment during the last few
decades. This has meant that the reforms have turned out to be ineffec-
tive in extending insurance cover to sectors traditionally excluded, in the
informal economy, which has led to labour inequalities being transformed
into insurance inequalities.
The ﬁgures also show that in every case where pension systems based
on individual accounts were introduced, coverage rates and beneﬁts levels
either stagnated or went down, while administrative costs increased signif-
icantly, and the risks stemming from ﬂuctuations in ﬁnancial markets now
fell directly on pensioners and could translate into the loss of all their
23Carefully analyzed in Valencia (2018).
72 C. B. SOLANO AND E. V. LOMELÍ
Table 3.3 The process and the actors in the reform of pensions systems in Mexico, 1992–2016
Antecedents Objectives Agenda of reforms Promoting coalition Design of the
Actors with veto
in Mexico in the
context of a low
rate of economic
economic: Process played out in
various spaces and
A “techno network”g
integrated by: Centro de
and approval of
private pillar in
1. National and
with interests in
the ﬁnancial and
systems, with a
to reform pensions
the capacity to
and ofﬁcials of
created by the
reform of the
Law of 1995
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 73
Antecedents Objectives Agenda of reforms Promoting coalition Design of the
Actors with veto
• A succession of
reforms of pension
regimes of the
employees of the
in IMSS, PEMEX,
f(2007) Team to
reform of the
and 2007) and
Reform of the
statute of IMSS
• Make the
and able to
of Pemex workers
Reform of the
The armed forces
74 C. B. SOLANO AND E. V. LOMELÍ
Sources Valencia et al. (2012); Valencia (2016: 315–320); Valencia (2018:175–191).aBetween 1985 and 2014 per capita GDP grew by 0.9% on
average. bApart from the systems mentioned here (which are the most important) other pensions schemes were also reformed such as those of
the workers of the national electric company la Comisión Federal de Electricidadand the public universities. In 2016 there were 42 public schemes.
cRetirementSavingsSystem, Sistema de Ahorro para el Retiro. dCentre forthe Strategic Development of Social Security, Centro de Desarrollo Estratégico
para la Seguridad Social. eMexican Social Security Institute, Instituto Mexicano del Seguro Social. fInstitute of Social Security and Services of State
Employees,Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado. gWhich, to quote (2018): “… joins… technical knowledge to
beliefs held in common, a political fabric and private interests”. hWho work for the central bank, el Banco de México, the Department of Tax and
Public Credit, Secretaría de Hacienda y CréditoPúblico, the Ministry of Foreign Affairs, Secretaría de Relaciones Exteriores, the Energy Department,
Secretaría de Energía, the Department of Social Development, Secretaría de Desarrollo Social, and the National Bank of Foreign Trade, Banco Nacional
de Comercio Exterior. iWho studied or are professors at the ITAM, Autonomous Technological Institute of Mexico (Instituto TecnológicoAutónomo
de México)and have an academic historycovering important universities in the USA, such as: Yale, Stanford, Chicago, MIT-Massachusetts Institute of
Technology, Harvard, and UPenn. jWorld Ba nk (WB), Internat ional Monetar y Fund (IMF ) , Inter-A merican Devel o pment Bank (IA D B), Organisa tion
for Economic Cooperation and Development (OECD). kLa Confederación de Trabajadores Mexicanos (Confederation of Mexican Workers), la Unión
Nacional de Trabajadores (National Workers Union) and el Movimiento Uniﬁcador Nacional de Jubilados y Pensionados (United National Movement
of Pensioners and Retirees). lEl Partido de la Revolución Democrática,PartyoftheDemocraticRevolution
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 75
Table 3.4 The process and the actors in the reforms of the pensions system of Colombia, 1992–2016
Antecedents Objectives Agenda of reforms Promoting
Actors with veto
reform of 1991
the State as a
To deal with
ﬁscal imbalances Creation of the
System in 1993
through the passing
of Law 100
approval of Law
100, by legislators
Creation of two
regimes for salaried
employees and the
could opt for:
76 C. B. SOLANO AND E. V. LOMELÍ
Table 3.4 (continued)
Antecedents Objectives Agenda of reforms Promoting
Actors with veto
Old system of
provided cover for
to private sector
the Institute of
To improve the
Or the Regime of
It did not allow
the Institute of
Social Securities to
disappear and be
replaced by a single
regime of individual
accounts run by
In the case of
was a plethora of
coverage Also, in 2003 the
Fund, el Fondo
passed, with Law
This led to the
formation of a
parallel or dual
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 77
Antecedents Objectives Agenda of reforms Promoting
Actors with veto
Until 2010 there
was also another
savings) for the
armed forces, the
national police, the
legal profession and
With their own
rules of afﬁliationc
However, the Law
of a plethora of
funds and security
their afﬁliates to
choose one of the
two schemes on
But the same law
made it explicit that
the armed forces,
teachers, and the
oil company would
retain their special
Sources Ocampo (1992), Mina (2013: 12–15), GES (2007:3).aRégimen Solidario de Prima Media. bTo subsidise the pensions of those unable to pay
contributions to either of the established schemes. cUp until 2008, 25% of the population making contributions belonged to the distributive system,
66% paid into the regime of private savings and only 6.2% into the exceptional savings regime. dWhich suggested a design that sought to reconcile
opposing points of view
78 C. B. SOLANO AND E. V. LOMELÍ
Table 3.5 Performance of pensions systems in the Dual WR of LA (around
ageing stageaType of system
65 (%) in
Brazil Advanced Public-Mixed High 15.8 667.5
advanced Mixed-Parallel Low 21.3 926.6
Mexico Moderate Private Low 30.6 232.2
advanced Public-Mixed Medium 15.8 532.5
Venezuela Moderate Public Medium 19.8 363.5
Source Original elaboration based on ILO (OIT 2018: Table 2.2) aAccording to the criterion used
by CEPAL. bAccording to the criteria of this work. cTill 2011. dFigures of CEPAL. eIncluding
contributive and non-contributive schemes
life’s savings. Furthermore, this reform failed to produce an improvement
either in ﬁscal or in ﬁnancial terms (OIT 2017:104–107).
According to estimates by the ILO (2018: 70) the coverage of pensions
and the poverty levels of senior citizens in the Dual WR, around 2015,
were better in the one country that did not introduce reforms to its
pension system (Venezuela), and in those countries that brought in
parametric reforms in combination with complementary private schemes
(Brazil and Panama). However, these indicators were lower for the coun-
tries that set up private pension schemes based on individual savings
accounts (Mexico and Colombia) (Table 3.5).
It is not surprising in this context that since the middle of the ﬁrst
decade of the century, a topic central to the agenda of reforming insurance
schemes has been the creation of a non-contributive component, focused
on the population over 65 without access to the contributive pensions25
24The costs of the transition from one distribution system to another were underesti-
25For lack of space we shall not go into this subject in any great depth in this work.
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 79
Table 3.6 Social pensions in Dual WR in Latin America (2018)
Programme Years of start Annual
and ﬁnish (% GDP) (Dollars) (% of over
Dual WR with universalist reforms
Brazil Benefício de
1996– 0.77 261 7.4
1993– 1.14 261 23
Económica a los
(“120 A LOS
2009– 0.28 120 26
VenezuelaaaaGran Misión en
2011– 0.23b477 19.8
Dual WR with liberal reforms
2012– 0.12 25 26.2
Mexico Pensión Para
2007–2018 0.15 30 38
Source CEPAL (2020A). aRefers to 2012. Data for 2013–2018 are not complete in the ECLAC
database. bRefers to the budget. cRefers to 2017. Between 2003 and 2012 there was another
programme, called Programa de Protección Social al Adulto Mayor (Social Protection Program for
theElderly). dOriginally called Programa de Desarrollo Social y Humano 70 y más (Program for
Human and Social Development 70 and over). In 2019 the pension program for the welfare of
senior citizens, Pensión para el Bienestar de las Personas Adultas Mayores (“Elderly Welfare Pension”),
was started, increasing the pension to 65 dollars and coverage to 53.7%
3.4.2 Reforms of the Health Systems
In the dual WR, health reforms were concentrated on the period between
1984 and 2005: in Mexico in 1984 and 2004, in Brazil in 1990, in
Colombia in 1994, in Panama in 1996 and in Venezuela in 1999, 2002
80 C. B. SOLANO AND E. V. LOMELÍ
and 200526 (Mesa Lago 2004,2005,2007). As in the case of the reforms
of pension systems, these reforms were undertaken because the public
health systems were facing a serious deterioration in the early 1990s
Again the reforms followed two opposite paradigms: the residual
paradigm that encourages ﬁscal balance, market mechanisms, decentral-
izing services, the promotion of a private pillar, competition between
service providers, reducing costs, efﬁciency, the division of tasks and
ﬁnancial sustainability. And the sanitarist, aiming for universal coverage,
equality, prevention, guaranteeing rights, services that are free of charge
and comprehensive, with social and community participation (Grindle
The design of the health reforms fell to groups of experts but during
the stages of being approved by Congress the reforms suffered impor-
design was put under a lot of pressure from groups with opposing inter-
ests and the reforms also faced considerable technical difﬁculties because
reforms of this kind implied the provision of different services, and struc-
tural inequalities in accessing them that had been inherited from previous
stages (Grindle 2002:87–109;MesaLago2005:34).
The reforms followed contrasting paradigms, sometimes hybrids, and
aimed for distinct objectives. In Brazil and Venezuela, the reforms
followed a sanitarist paradigm and the objective was to create universal
health systems, capable of guaranteeing the right to health for all citi-
zens. In Colombia and Mexico, the reforms were guided by a paradigm
of structured pluralism,28 where the central idea was that of competi-
tion between public and State regulated private institutions, which did
not however have the same objectives. In Colombia, the reform sought
to reconcile sanitarist, mercantile and corporative visions in the context
of the introduction of a new Constitution in 1991 that consecrated the
26For reasons of space we shall not address these reforms in detail as they are the most
studied of the three types studied here.
27For example, to exclude powerful public employee unions from the reforms.
28Lordoño and Frenk (1996) propose linking functions (regulation, funding, co-
ordination and employment), and the services provided (social security, private insurance
schemes, protection of the poor), where regulation is the responsibility of ministries of
health, funding is public, the different health institutions are combined, and there is
pluralism in the offer of services (public, social security, mercantile and focalised).
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 81
social State in law but in a contradictory situation of economic opening,
liberalization and deregulation of the markets. In Mexico the idea was
to introduce a reform that would incorporate those sectors that did not
have access to private or social security services, through a focused scheme
(Alvarado et al. 2008: 114; Bonniec 2002: 207; Bonvecchio et al. 2011:
279; Capriles et al. 2001:34;Cohn2008:88;GES2007:3;Giovanella
2013: 23, 73; Gómez and Nieto 2014: 734; Mesa-Lago 2007: Table 7.1;
OCDE 1998:96;Pereira2001: 56; Tolentino 2009:252;Uribe2009).
Reforms in DWR were top-down, with the exception of Brazil.
Most were promoted in a context of changes to the Constitution,
with the exception of Mexico. Their design tended to be technocratic
and the ministries of health, work and social security were responsible
for appointing the teams of planners, with Mexico again providing an
exception, as the main role was played by the tax ofﬁce (Secretaría de
Hacienda). Getting the reforms passed meant complicated negotiations
with various political parties, that were settled in the Congress, but the
results were often different to those hoped for. Getting them applied was
even more difﬁcult because it required confronting coalitions of actors
who were intent on reorienting the reforms and succeeded in doing so,
so the negotiations always expressed a ﬁght between market and sani-
tarist conceptions, where the predominating tendency was that of the veto
power of corporations and the market (Dión 2006:44,67and72;Fleury
2007: 149; Hunter and Sugiyama 2009:44;Melo2014:3;Pêgo2010:
53; Uribe 2009:46–7;Vianaetal.2013:218).
To conclude it should be noted two things: the ﬁrst one is that the
orientation of the reforms has been marked by the political ideology of
the governments that promoted them. Left-wing governments promoted
sanitary reforms, centre-right governments liberal reforms. The second
one is that the success and the continuity of reforms have depended
on state resources and the capacity of governments to form alliances
and supporting networks of an international, national and local character
29For a detailed analysis of this subject it is worth consulting: Barba and Valencia
(mimeo.); Mesa Lago (2005,2007); OPS (2018); Bonvecchio, et al. (2011); Alvarado,
et al. (2008); Uribe (2009).
82 C. B. SOLANO AND E. V. LOMELÍ
3.4.3 Conditional Cash Transfer Programmes
The consolidation of the conditional cash transfer (CCT) programmes
in the DWR, started in LA during the second half of the 1990s with
the experience in Brazil of municipal and state programmes, and the ﬁrst
national CCT programme of the region, in 1997 in Mexico, which was
initially called Progresa and then went on to be called Oportunidades in
2002 and ﬁnally Prospera in 201430 (Progresa—Oportunidades—Pros-
pera, PROP). After these seminal experiences, CCT expanded over the
region in the form of various national adaptations (Barba 2019), with
heterogeneous promoters, and was also developed in countries with Dual
It is no surprise that the CCT should have started in these countries
because for a good part of the twentieth century they had made attempts
to include more of the population in social protection mechanisms, but
leaving important segments of the population out; and with the big crisis
of the 1980s, the weaknesses of their social protection systems showed up
with greater clarity.
In this context, a number of coalitions promoted the application of
new actions by the State to deal with poverty: Progresa, in Mexico
in 1997, Bolsa Família in Brazil in 2003,31 Familias en Acción in
Colombia in 2000 and Red de Oportunidades in Panama in 2006. The
development of CCTs in DWRs was signiﬁcant but uneven, with wide
coverage32 and low or very low spending.33 These four programmes
had some central elements in common, in particular the fact that the
CCT aimed to encourage investment in the human capital of families
through education, health and food (CEPAL 2020A; Barba 2019). The
coalitions promoting them were heterogeneous giving the programmes
30Vera (2019) considers that there was a break between Progresa-Oportunidades and
Prospera, with the incorporation of elements of productive and labour inclusion. In this
work we consider Prospera to be a continuation of Progresa-Oportunidades.
31The origin of Bolsa Família can be traced back to a series of actions by municipal
and state governments, undertaken since 1995, and a national programme focused only
on education in 2001, called Bolsa Escola (Valencia 2019).
32In 2018, Brazil, Mexico, and Colombia stand out with a coverage of 26.8, 24.1 and
21.5 of their population, respectively; on the other hand, in Panama the coverage only
reached 7% (CEPAL 2020B).
33In 2008 spending represented iin Brazil 0.44% of GDP; in Mexico, 0.35% (refers to
the budget), in Colombia, 0.21% and in Panama a meager 0.04% (CEPAL 2020B).
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 83
their individual characters. These coalitions succeeded in getting national
programmes consolidated, and inﬂuenced the spread of CCT abroad
(especially Progresa and Bolsa Família,butalsoFamilias en Acción).
The original idea might have formed inside or outside the country. In
the case of PROP a solid national coalition focused on a central belief in
the importance of investment in the human capital of families in order
to break the chain of the transmission of poverty from one generation
to the next, got the programme started in association with a group of
government ofﬁcials working on demographics (who introduced signiﬁ-
cant changes to the original design, especially with regard to the role of
the female in the family) and managed to forge a strong alliance with
an international coalition of academics, and ofﬁcials from international
ﬁnancial institutions (Valencia 2019).34
In the case of Bolsa Família different approaches from within the
nation combined in a coalition of human capital formed by municipal,
state and federal ofﬁcials, from different parties, a coalition advocating
unconditional citizen income formed by militants and legislators from
the Partido del Trabajo,andacoalitionindefenseoffoodsecuritythat
emphasized the right to food and was formed by activists from NGOs,
and municipal, regional and federal ofﬁcials; these approaches continued
with the creation of the federal programme Bolsa Família,following
adecisionbyPresidentLuladaSilvain2003(Valencia2019)35; as a
result of the convergence of these three coalitions, the programme is
“hybrid”: a combination of guaranteed citizen income and the strength-
ening of human capital (Ivo and Torres 2010). Probably its hybrid nature
downplayed the importance of the alliance of this programme with the
international coalition for human capital.
By contrast, in Familias en Acción and in the Red de Oportunidades,
the original idea was foreign and to a large extent, though both these
programmes imported the central ideas of the Progresa-Oportunidades
programme, they also followed Programa Puente from Chile. Familias
34Several analysts point out a small inﬂuence from the experiences of the Bolsa Escola
programme, through school grants, at the stage when Progresa was being designed
(Morais 2017: 141; Valencia 2019).
35Several analysts point out a small inﬂuence from the programme Oportunidades in
2003 in the combination in a national programme of the three elements: education, health
and nutrition (Valencia 2019). Another inﬂuence was from Puente (Chile), with regard
to the strategy of support for families (Morais 2017:139).
84 C. B. SOLANO AND E. V. LOMELÍ
en Acción was designed with knowledge of the programmes Oportu-
nidades (Mexico), Bolsa Escola (Brazil) and Puente (Chile); it is of
special relevance that the “technical and operative guidelines of Opor-
tunidades were adapted to the case of Colombia” (Núñez and Cuesta
2006: 247) so in this way it was “modeled” on the basis of Progresa-
Oportunidades (Attanasio et al. 2010: 183), following contacts between
Colombian government ofﬁcials and academics and ofﬁcials associated
with the Mexican programme (Urrutia and Robles 2018: 2) and under
pressure from the WB (Garzón 2013: 44). Also taking an active part
were ofﬁcials from the Ministry of Education who adopted an approach
“based on efﬁciency” (Morais 2017: 107–108). In addition to receiving
this inﬂuence from the national and international coalition of human
capital, in the history of Familias en Acción there has been a convergence
of other actors: the programme started as part of the Plan Colombia36
(Urrutia and Robles 2018:7–8),inthecontextofaseriouseconomic
crisis and peace negotiations; so there was a complicated convergence of
matters of security (to deal with drug cartels and guerrillas), humanitarian
concerns (peace) and social policies (Balen 2014: 56–57; Vera 2017).
Taking part in the initial creation of information systems were economists
and think-tank members (Balen 2014: 37). Further, the Constitutional
Court included to some extent a human rights approach in 2004, when
it required the government to protect the rights of displaced persons and
the government decided in response to include them as beneﬁciaries of
Familias en Acción (Balen 2014: 53–54); and in 2012, Law 1532 was
passed to ensure the continuity of the programme, establishing that 100%
of families in a situation of poverty and all displaced families should be
beneﬁciaries of the Programme (Vargas 2015), which was re-named Más
Familias en Acción (Castilla 2014:69).
The programme Red de Oportunidades in Panama was also designed
as an adaptation of other programmes in the Latin American region (Him
2017: 115), especially with regard to the experience of the Progresa-
Oportunidades,37 and the Programa Puente in Chile, from which it took
36Plan signed by the president, Andrés Pastrana, with the United States government to
combat drug cartels and guerrillas (Vera 2017:94).AtﬁrsttheWBandtheIADBwere
reluctant to get involved in a programme of CCT linked to this security plan (Garzón
37Personal communication from an ofﬁcial of Oportunidades in Mexico: designers of
the Red de Oportunidades were in the ofﬁces of the Mexican programme.
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 85
the strategy of family support (Arim 2009:52;Rodríguez2010:25).
Those who took part in the design were ofﬁcials from the social cabinet
of the national government and from local governments, and also inter-
national experts (Him 2017: 114), who were explicit in adopting the
approach of accumulating human capital and of applying targeted poli-
cies to deal with poverty (Rodríguez 2010:14).Thestrategyadoptedto
design the programme was top-down, “due to the need to fulﬁl the terms
and conditions of the international ﬁnancial institutions” (Him 2017:
These experiences are all associated with a strong international human
capital coalition, formed of academics and ofﬁcials from international
ﬁnancial institutions, especially the WB and the IADB. This coalition has
made loans to the programmes, put pressure on governments to adapt
the programmes, organized the sharing of experiences, and helped to
spread them in the rest of LA and worldwide. However, this is a heteroge-
neous association. The four experiences have been supported with loans
either to start up the programme (Bolsa Família,Familias en Acción and
Red de Oportunidades ) or to make sure it continued (PROP and the
rest). Bolsa Familia received loans from the WB and the other three
received them from the WB and the IADB (Him 2017: 114; CEPAL
2020A). PROP also received technical and ﬁnancial support from the
IADB to conduct an evaluation.38 The WB and the IADB have been
very important in spreading the programmes of these dual regimes, espe-
cially Progresa-Oportunidades and Bolsa Família;theprogrammethathas
been presented by these institutions as a paradigm is PROP, as it centres
its design on an approach concerned with the accumulation of human
capital and it has promoted evaluations since the beginning, and for other
reasons. For example, on the World Bank web page there were 5,442
entries for Progresa-Oportunidades up until 2010 and 2,040 for Bolsa
Familia; on the IADB web page, there were 432 and 110, respectively,
according to a study by Morais (2017:142–143).AccordingtoaWB
report (Fiszbein et al. 2009: 6) “What really makes Mexico’s program
iconic are the successive waves of data collected to evaluate its impact, the
placement of those data in the public domain, and the resulting hundreds
of papers and thousands of references that such dissemination has gener-
ated”. There is no doubt that PROP, Bolsa Família,Familias en Acción
38Personal observation of one of the authors of the present text.
86 C. B. SOLANO AND E. V. LOMELÍ
and Red de Oportunidades were supported by the international coalition
for human capital, and in turn, the ﬁrst three of these have collaborated
in consolidating the coalition and its dissemination worldwide.
3.5 The Impact of the Reforms
Certainly, some things have changed with three decades of reforms. Since
the 1990s, Brazil and Panama appear to have reduced their welfare gaps
considerably, while Mexico and Colombia have made smaller achieve-
ments, though these are by no means insigniﬁcant. The case of Venezuela
is however uncertain because of its profound economic and political
crisis. Brazil and Panama are closest to the universalist regimes of LA
(with widespread, though not universal, social security, complemented by
important non-contributive initiatives), Colombia and Mexico have kept
their dualism (with important non-contributive initiatives whose approach
is minimalist) and Venezuela is caught up in a process where the central
agreements are breaking up as a result of the ongoing crisis. Behind the
current situation are the different strategies followed by these countries,
which vary between a vision centred on the State (clearly the case of Brazil
and Venezuela), a vision more closely aligned to the market (clearly true
of Mexico and to a lesser extent of Colombia) and a gradualist perspective
as in the case of Panama.
The ﬁve dual regimes showed divergent economic performances
(Table 3.7): initially Brazil, Venezuela and Panama showed a signiﬁcant
dynamic, but only the latter kept it up; Brazil went through important
recessions without recovering growth. Colombia and Mexico had low
rates of growth, that was more constant in the case of Colombia. In this
macro-economic context (from 2000 to 2018), all the countries increased
their social expenditure, most signiﬁcantly in Venezuela and Brazil, and
to a lesser extent in Colombia and Mexico in the framework of a conser-
vative macro-economic policy (Table 3.7). Even with the crisis, Brazil
maintained its tendency to increase social expenditure, which was prob-
ably the result of institutional inertias from previous agreements. Until
just before the crisis in Venezuela, this country and Brazil were close to
the average for OECD countries.
The regimes with universalist reforms reduced poverty very signiﬁ-
cantly, to around half, at least until the economic crisis came back again
after 2014; at which time Brazil slowed the momentum of its poverty
reduction a little, while Venezuela started to show signs of a social crisis
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 87
Table 3.7 DWR in Latin America: growth and social expenditure 2000, 2008, 2015 and 2018
GDP 2000aGDP 2008aGDP 2015aGDP 2018aSocial Social Social Social
budget budget budget budget
2000 2008 2015 2018
(% of GDP)b(% of GDP)b(% of GDP)b(% of GDP)b
3.6 6.8 −1.3 2.5 10.6 11.8 14.5 13.3
Brazil 4.4 5.1 −3.5 1.3 12.5 14 16.3 17.7
Panama 2.7 9.9 5.7 3.7 8.4 8.4 8.5 8.8e
Venezuela 3.7 5.3 −6.2 −19.6 10.8 13.1 18.8fn.d.
3.9 2.2 3.2 2.4 7.4 10 11.8 10.7
Colombia 2.9 3.3 3.0 2.6 8.4 11.3 13 12.6
Mexico 4.9 1.1 3.3 2.1 6.3 8.6 10.5g8.7
3.8 4 −0.2 1.0 8.5 9.5 11.2 11.3
Source CEPAL (2020C). aRate of growth of GDP at constant prices (based on national sources). bSocial budget of the central government(based on
national sources). cNot including Venezuela. dIncluding Venezuela. eFor 2017. Rodríguez (2013:Table9)noteshighersocialexpenditureﬁguresfor
Panama, that are proportionally even higher than in Brazil. fFor 2014. gOrdóñez (2016: 186) notes higher social expenditures ﬁgures for Mexico,
close to the Colombian case. n.d.=no data
88 C. B. SOLANO AND E. V. LOMELÍ
in 2015 with an increase of four points on the poverty index, unlike
Panama which maintained a downward tendency. In the regimes that
undertook liberal reforms there was also a reduction in poverty, espe-
cially in Colombia where it went down by around 40% and Mexico with
inequality (measured by the Gini coefﬁcient), most notably in Brazil (up
until the crisis) and in Panama; in the regimes with liberal reforms the
tendency was the same, but at a slower rate. Venezuela still had one of
the lowest rates of income inequality in Latin America during this period.
However, with the crisis, a good part of what had been achieved in this
area by Brazil was lost. It should be pointed out that in general, reduc-
tions in inequality, when they occurred, were proportionally less than the
reductions achieved in ﬁgures for poverty (Table 3.8).
It is probable that social security coverage increased in countries
that undertook universalist reforms, especially in the cases of Brazil
and Panama and to a lesser extent in Venezuela. Some indicators39 for
Brazilian (in 2017) and Panamanian social security show a coverage
of roughly two-thirds (CEPAL 2020A) and 80%, respectively,40 and
although Venezuela got to above half, it fell several points with the
crisis.41 Mexico and Colombia maintained indicators for social security
coverage of a third, with a slight increase in Colombia.42 If these dynamics
can be conﬁrmed, with other indicators, it will be possible to show, with
greater clarity, the institutionalized dualism of the regimes with liberal
reforms, and the universalist tendency of the others. It is clear that the
regimes with structural pension reforms, Colombia and Mexico, did not
radically change the real participation rate in the social security system of
those in employment, so they had to create social pensions with a wide
coverage but an extraordinarily weak expenditure; whereas the regimes
with universalist reforms only modiﬁed their pensions systems parametri-
cally and created social pensions that were noticeably more generous and
had bigger budgets. In short, the regimes with universalist reforms tried
39In the cases of Brazil, Colombia, México, and Venezuela we used the indicator of
employed people supported by a social security schema in 2017 (CEPAL 2020c).
40Rodríguez (2013: Table 23) shows social security coverage for 2010 of 81.7% in
41It fell from 55.6% in 2011 to 43.4% in 2014 (CEPAL 2020c).
42The ﬁgures are as follows: Mexico with 30.1% in 2016 and Colombia, 37.3% in 2017
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 89
Table 3.8 DWR in Latin America: poverty and income inequality, 2000, 2008, 2015 and 2018
Poverty 2000 Poverty 2008 Poverty 2015 Poverty 2018 Concentration
of income 2000
of income 2008
of income 2015
(% of the
population)a(% of the
population)a(% of the
population)a(% of the
37.5 25.6 21.7 16.7 0.511 0.481 0.468 0.519
Brazil 38.4b25.3 18.8 19.4 0.576b0.536 0.511 0.540
Panama 29.8 26.8 17.9 14.5 0.564 0.528 0.516 0.498
Vene z uela 44.2 2 4 . 7 28.3cn.d 0.392 0.379 0.378cn.d.
51.3 43.9 37.1 35.7 0.548 0.543 0.514 0.498
Colombia 53.8d44.6 30.5 29.9 0.567d0.572 0.524 0.52
Mexico 48.8 43.1 43.7e41.5 0.528 0.513 0.504e0.475
44.0f33.5 29.0 30.0 0.531d0.500 0.467 0.462
Source CEPAL (2020C). aOn the basis of questionnaires applied in households of the nation. bIn 2001. cIn 2014. dIn 2002. eIn 2016. fIn 2001.
n.d. =no data
90 C. B. SOLANO AND E. V. LOMELÍ
to have new forms of social inclusion that were more relevant than those
of Colombia and Mexico.
Some of the regimes considered increasing public commitment to the
health system with greater expenditure, in the framework of the reforms
addressed here. Among the reformers with universalist tendencies, the
case of Brazil is of special interest with its increase in public expenditure
on health, a reduction in out-of-pocket citizen expenses and an increase in
services provided, achieving total coverage of the social protection system,
following the criteria of the ILO (including those covered by social secu-
rity and those covered by the SUS) (ILO 2020). In spite of the limitations
of the Brazilian health system this tendency stands out, although it will
probably suffer reversals with new policies promoted by the right-winger
Jair Bolsonaro, especially those of slowing down expenditure.
In the same segment, Panama practically maintained its expenditure
and reduced out-of-pocket citizen expenses, as well as improving services.
It is paradoxical in this group that Venezuela should report to the ILO
(2020) total coverage by the social protection system, but in the last
few years of crisis, the country’s social expenditure has been drastically
reduced and out-of-pocket citizen expenses have increased so much as to
become the highest of any in the dual regimes. Wide coverage with an
abrupt reduction in services has meant weakness in the services provided
and the need for citizens to spend more.
The liberal reformers have also shown heterogeneous results: the public
commitment of Colombia to health increased and the country’s expendi-
ture on health is the highest among the dualist regimes, with the lowest
(though ﬂuctuating) out-of-pocket citizen expenses of any in the group,
while the commitment by Mexico is the smallest (not counting the critical
case of Venezuela) and with a lowering of out-of-pocket citizen expenses
but with these still the highest of any in the dualist regimes (again, not
counting the critical case of Venezuela); in spite of progress made by the
reforms in these two regimes, according to the ILO (2020), they have
not managed to include the whole population in the social protection
system and there is still a sector of those excluded.43 To sum up, the
health reforms of Brazil and Colombia appear to have obtained the best
43The population covered by health social protection was in 2010 87.2% in Colombia
and 85.6% in Mexico, included social security and the non contributory schemes (ILO
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 91
results, but with the doubt remaining of what will happen in the former
country in the near future (Table 3.9).
The dualist regimes tried to overcome a good part of the limitations of
their social security systems and the signiﬁcant exclusion of large sectors
of the population, with social pensions, conditional cash transfers, new
health packets to help achieve universal coverage, and protection for
labour fortiﬁed with increasing minimum wages.
As explained above, these initiatives have been heterogeneous as rati-
ﬁed by the TMC: Panama promoted a basic pension with a monthly
transfer four or ﬁve times the size of that of Colombia or Mexico
(Table 3.6), though less than half the amount of the Brazilian and hardly
a quarter that of the Venezuelan system, and designed an extremely mini-
malist CCT programme, with the smallest expenditure of any of the
dual regimes and the smallest maximum cash transfer per household,
while promoting an increase of nearly 40% in the minimum wage from
2000 to 2018. Thus, the universalist tendencies in Panama are associated
with a degree of minimalism. Brazil shows more generous pensions and
transfers, with the CCT programme having the widest coverage and the
largest sums per transfer, and the greatest social expenditure44 (including
increases to basic pensions and the TMC), and it has had the largest
increase in the minimum wage of all the dual regimes (doubling between
2000 and 2008) (Table 3.10), although with the general slowdowns we
have mentioned several times.
By contrast, Venezuela, with no important CCT programme in the
last few years, shows signs of a severe crisis in its universalist tenden-
cies, with minimum wages going down (Table 3.10); while the increase
in social expenditure in general (in 2014 the highest in all the regimes
considered) is countered by a serious decline in health expenditure and
an economic depression that will make it difﬁcult to keep up the social
expenditure and generous social pensions. Colombia increased its social
expenditure, and to a lesser extent its minimum wages (by only about
24% between 2000 and 2018) (Table 3.10), but its CCT featured weak
expenditure (half that in Brazil and Mexico), meagre transfers (half the
size of the Brazilian) (CEPAL 2020B) and the lowest social pensions
among the dualist regimes, although social expenditure increased. It is
probable that the associated wage increases, low but constant economic
44According to the ﬁgures of Rodríguez (2013)Panamawouldhavealargersocial
budget than Brazil.
92 C. B. SOLANO AND E. V. LOMELÍ
Table 3.9 DWR in Latin America: health expenditure, 2000, 2008, 2015 and 2018
2000 2008 2015 2017 2000 2008 2014
Dual WR with
reforms 3.9 3.6 3.4 2.9 37.9 36.2 37.4
Brazil 3.5 3.5 3.8 4.0 38.0 31.5 25.5
Panama 4.8 4.7 4.3 4.4 26.0 25.8 22.3
Venezuela 3.4 2.6 2.0 0.2 49.7 51.3 64.3
Dual WR with
liberal reforms 3.1 3.7 4.1 3.9 31.2 36.1 29.7
Colombia 4.2 4.8 5.1 4.9 12.2 21.4 15.4
Mexico 2.0 2.6 3.1 2.8 50.1 50.8 44.0
Source WHO (2020). aDomestic expenditure on health by the government in general. bOut-of-pocket expenses as proportion of total expenditure on
health. cIn 2009
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 93
Table 3.10 DWR in Latin America: real minimum wages 1990–2018
Real minimum wage
1990 1995 2000 2005 2010 2014 2018
Brazil 73.8 87.2 100.0 128.5 182.1 203.6 211
Colombia 98.2 94.2 100.0 107.2 115.2 123.2 123.8
Mexico 143.5 112.9 100.0 101.3 100.5 101.7 116.6
Panama 82.4 88.0 100.0 104.5 113.3 123.9 136.7
Venezuela 103.4 117.2 100.0 103.7 93.8 94.1 n.d.
Source CEPAL (2020C). n.d. =no data
growth, and new minimalist programmes (CCT and social pensions), have
combined to diminish poverty and inequality in this regime. Mexico,
pioneer among the national CCT programmes and with a large coverage,
is the country with the smallest wage increases in the countries studied
(except for Venezuela in recent years), and even a serious decline if we
take the 1990s into consideration (Table 3.10); and one of the lowest
social pensions (similar to that of Panama) although with a large coverage,
like the new health package (large coverage but limited services).
Finally, to sum up, we propose the following classiﬁcation: Panama
has a regime tending towards universalism and Brazil a regime also
tending towards universalism but that has been limited and is now being
held back. The Venezuelan dualist regime with a universalist project is
currently immersed in a political crisis and in danger of breaking up
with the depression of the economy. By contrast, Mexico and Colombia
have institutionalized their dualist features (and minimalist programmes)
but have in recent times shown a different performance, with Colombia
tending to be more progressive.
Altimir, Oscar. “Crecimiento, ajuste, distribución del ingreso y pobreza en
América Latina.” In Políticas de Ajuste y Pobreza. Falsos dilemas, verdaderos
problemas, edited by José Núñez, 31–76. Washington, D.C.: Banco Inter-
americano de Desarrollo, 1995.
Alvarado, Carlos, María E. Martínez, Sarai Vivas-Martínez, Nuramy Gutiérrez
and Wolfram Metzger. “Cambio social y política de salud en Venezuela”.
94 C. B. SOLANO AND E. V. LOMELÍ
Medicina Social 3, no. 2 (2008): 113–129. https://www.medicinasocial.info/
Arim, Rodrigo, Verónica Amarante, Mónica Rubio, and Andrea Vigorito. Pobreza
yprotecciónsocialenPanamá. Washington: BID, 2009.
Attanasio, Orazio, Emla Fitzsimons, Ana Gómez, Martha Isabel Gutiérrez,
Costas Meghir, and Alice Mesnard. “Children’s Schooling and Work in
the Presence of a Conditional Cash Transfer Program in Rural Colombia”.
Economic Development and Cultural Change 58, no. 2 (2010): 181–210.
Balen, María Elisa. Queuing in the Sun, Action at a Distance: The social poli-
tics of a conditional cash transfer programme in Colombia. PhD diss., Bristol
Banco, Mundial. Adverting the Old Age Crisis. Policies to Protect the Old and
Promote Growth. New York: Oxford University Press, 1994. http://docume
Barba, Carlos. “Una mirada no convencional a las transferencias monetarias
condicionadas (TMC) en América Latina: Tres oleadas y una tipología”. In
Estados de bienestar, derechos e ingresos básicos en América Latina, edited by
Alberto Cimadamore, Anete Ivo, Carmen Midaglia, and Alejandra Barrantes,
48–84. Mexico: Comparative Research Programme on Poverty. México:
CROP and Siglo XXI Editores, 2019.
Barba, Carlos. “Liberalismo y universalismo en tensión: 25 años de reformas
sociales en los regímenes de bienestar latinoamericanos”. In Políticas Sociales
en América Latina en los Inicios del Siglo XXI, edited by Carmen Midaglia,
Gerardo Ordoñez y Enrique Valencia, 75–108. Tijuana, México: El Colegio
de la Frontera Norte y CLACSO, 2018.
Barba, Carlos. El Nuevo Paradigma de Bienestar Social Residual y Deslocalizado.
Reformas de los regímenes de bienestar en la OCDE, América Latina y México.
3. PhD diss., University of Guadalajara and CIESAS, 2003.
Barba, Carlos. ¿Reducir la Pobreza o Construir Ciudadanía Social? América
Latina: Regímenes de bienestar en transición al iniciar el siglo XXI. Guadala-
jara: Universidad de Guadalajara, 2007.
Barba, Carlos. “Reforma social y ciudadanía social en América Latina durante los
años noventa: Una perspectiva comparada”. In Retos para la superación de
la pobreza y la integración económica y social en América Latina, edited by
Carlos Barba, 51–84. Buenos Aires: CLACSO, 2009.
Barba, Carlos. “Las propuestas de reforma y las nuevas estrategias sociales del
gobierno de Peña Nieto ¿Cambio de rumbo en la política social mexicana?”
En Enrique Valencia y Gerardo Ordoñez (Coord.) Nueva Ronda de Reformas
Estructurales en México ¿Nuevas Políticas Sociales?, 85–122. Tijuana: El
Colegio de la Frontera Norte, 2016.
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 95
Barba, Carlos and Valencia, Enrique. “Brazil, Mexico, Colombia, Panama and
Venezuela: Inertias and Transformations in Five Dual Welfare Regimes”, (in
Barba, Carlos and Enrique Valencia. “Diversos universalismos en las trayectorias
de las políticas de salud en México y Brasil”, (mimeo).
Barba, Carlos, and Enrique Valencia. “La transición del régimen de bien-
estar mexicano: entre el dualismo y las reformas liberales.” Revista
Uruguaya de Ciencia Política 22, no. 2, (July–December 2013): 47–
Bonniec Le, Yves. “Sistemas de protección social comparados: Colombia, Brasil
yMéxico”.Revista Salud Pública 4, no. 3 (2002): 203–239.
Bonvecchio, Anabelle, Víctor Becerril, Ángela Carriedo and Maritza Landaeta.
“Sistema de salud de Venezuela”. Salud Pública de México 53, no. 2 (2011):
Capriles, Edgar, Díaz Polanco, Jorge, Fernández, Yajaira, and Pereira, Zegri.
“La reforma del sistema de salud de Venezuela: opciones y perspectivas”.
In La reforma de salud de Venezuela: Aspectos políticos e institucionales de
la descentralización de la salud en Venezuela, edited by Jorge Díaz Polanco,
15–53. Caracas: Cendes, IESA, CIID, MSDS, Corposalud, Ediciones de la
Fundación Polar, 2001. http://bibliofep.fundacionempresaspolar.org/public
Castilla, Myriam Mercedes. “Breaking Poverty Traps with Band-Aid Solu-
tions: The Impacts of Conditional Cash Transfers in Colombia”, MSc. diss.,
University of York, 2014.
Cecchini, Simone, Fernando Filgueira and Claudia Robles. Sistemas de Protección
Social en América Latina y el Caribe. Una perspectiva comparada. Santiago
de Chile: CEPAL and Ministerio de Asuntos Exteriores de Noruega, 2014.
CEPAL (Comisión Económica para América Latina y el Caribe). La Protec-
ción Social de Cara al Futuro: Acceso, ﬁnanciamiento y solidaridad. Santiago
de Chile: CEPAL, 2006. https://repositorio.cepal.org/bitstream/handle/
CEPAL. “Base de datos de programas de protección social no contributiva en
América Latina y el Caribe. Pensiones sociales”. Accessed 10 April 2020A.
CEPAL. Base de datos de programas de protección social no contributiva en
América Latina y el Caribe. Programas de transferencias condicionadas.
Accessed 5 April 2020B. https://dds.cepal.org/bpsnc/ptc.
CEPAL. CEPALSTAT. Bases de Datos y Publicaciones Estadísticas.Accessed
15 February 2020C. https://estadisticas.cepal.org/cepalstat/WEB_CEPALS
96 C. B. SOLANO AND E. V. LOMELÍ
Cohn, Amelia. “La reforma sanitaria brasileña: la victoria sobre el modelo
neoliberal”. Medicina Social 3, no. 2 (2008): 87–99.
Cominetti, Rossella and Gonzalo Ruiz. Evaluación del Gasto Público Social en
América Latina: 1980–1995. Santiago de Chile: CEPAL, 1998. https://rep
De León, Peter. (1994). “Policy Change and Learning: An Advocacy Coalition
Framework.” Policy Studies Journal 22, no. 1 (1994): 176–185.
Dion, Michelle. “Globalización, democratización y reforma del sistema de
seguridad social en México, 1988–2005”. Foro Internacional 46, no. 1
Filgueira, Fernando. Welfare and Democracy in Latin America: The Develop-
ment, Crises and Aftermath of Universal, Dual and Exclusionary Social States.
Genova: UNRISD, 2005. http://www.unrisd.org/80256B3C005BCCF9/
Fiszbein, Ariel, Norbert Schady, Francisco Ferreira, Margaret Grosh, Niall
Keleher, Pedro Olinto, and Emmanuel Skouﬁas. Conditional cash transfers:
reducing present and future poverty. World Bank policy research report
47603. Washington, DC: World Bank, 2009. http://documents.worldb
Fleury, Sonia. “Salud y democracia en Brasil. Valor público y capital institucional
en el Sistema Único de Salud”. Salud Colectiva 3, no. 2 (2007): 147–157.
Garzón Moreno, Natalia. Concepciones de pobreza y de ﬂorecimiento humano en
funcionarios y hogares beneﬁciarios y no beneﬁciarios de los programas Opor-
tunidades y Familias en Acción en el 2012. Masters diss., Universidad de
GES (Grupo de Economía de la Salud). “Reforma a la seguridad social
en Colombia, 1993–2007”. Observatorio de la Seguridad Social,no.15
(2007): 1–13. http://bibliotecadigital.udea.edu.co/bitstream/10495/3429/
Giovanella, Ligia. Los sistemas de salud de Argentina, Brasil y Uruguay en
Perspectiva Comparada. Río de Janeiro, Brazil: Observatorio MERCOSUR
de Sistemas de Salud, 2013.
Gómez Lee, Martha. “El marco de las coaliciones de causa-Advocacy Coali-
tion Framework”. Revista Opera, no. 12 (2012): 11–30. https://www.red
Gómez, Rubén Darío and Emmanuel Nieto. (2014). “Colombia: ¿Qué ha pasado
con su reforma de salud?” Revista Peruana de Medicina Experimental y Salud
Pública, 31, no. 4 (2014): 733–739. http://www.scielo.org.pe/scielo.php?scr
Grindle, Merilee. “Despite the Odds: The Political Economy of Social Sector in
Latina America”. In Exclusion and Engagement: social policy in Latin America,
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 97
edited by Christopher Abel and Colin Lewis, 83–110. London: Institute of
Latin American Studies-University of London, 2002.
Him Camaño, Martina Isabel. Las transferencias monetarias condicionadas como
instrumento de reducción de la pobreza: incidencia sobre la formación de capital
humano del Programa Red de Oportunidades (2010–2014) en Panamá.PhD
diss., Universidad de Valladolid, 2017.
Hunter, Wendy and Natasha Borges Sugiyama. “Democracy and Social Policy
in Brazil: Advancing Basic Needs, Preserved Privileged Interest.” Latin
American Politics and Society 51, no. 2 (2009): 29–58.
ILO. Panorama Temático Laboral 4. Presente y Futuro de la Protección Social
en América Latina y el Caribe. Lima, Peru: ILO/Regional Ofﬁce for Latin
America and the Caribbean, 2018.
ILO (International Labour Organization) ILOSTAT. Accessed 20 April 2020.
Isuani, Ernesto. “Seguridad social y asistencia pública”. In Crisis de la Seguridad
Social y la Atención a la Salud, edited by Carmelo Mesa-Lago, 113–128.
Mexico: Fondo de Cultura Económica, 1986.
Ivo, Anete and José Carlos Exaltação Torres. “O Programa Bolsa Família -
PBF- na arena política”. In Programas de transferências condicionadas de
renda (TCR) no Brasil: O Programa Bolsa Família e o Benefício de Prestações
Continuada, BPC.Relatório ﬁnal edited by Anete Ivo, 77–120. Mimeo,
Lordoño, Juan Luis and Julio Frenk. Pluralismo estructurado: Hacia un modelo
innovador para la reforma de los sistemas de salud en América Latina. Banco
Interamericano de Desarrollo. Documento de trabajo 353, 1996. https://
Martínez-Franzoni, Juliana. ¿Arañando bienestar? Trabajo remunerado, protección
social y familias en América Central. Buenos Aires: CLACSO, 2008.
Melo, Marcus André. Political and Institutional Drivers of Social Security
Universalization in Brazil. UNRISD Working Paper 2014–20, 2014.
Mesa-Lago, Carmelo. La Crisis de la Seguridad Social y la Atención a la
Salud. Experiencias y lecciones latinoamericanas. Mexico: Fondo de Cultura
Mesa-Lago, Carmelo. Las reformas de pensiones en América Latina y su impacto
en los principios de la seguridad social. Serie Financiamiento al Desarrollo, no.
144. Santiago de Chile: CEPAL, 2004. https://repositorio.cepal.org/bitstr
Mesa-Lago, Carmelo. Las reformas de salud en América Latina y su impacto
en los principios de la seguridad social. Serie Documentos de Proyectos.
Santiago de Chile: CEPAL, 2005. https://repositorio.cepal.org/bitstream/
98 C. B. SOLANO AND E. V. LOMELÍ
Mesa-Lago, Carmelo. Reassembling Social Security. A Survey on Pensions and
Healthcare Reforms in Latin America. Oxford, New York: Oxford University
Mina Rosero, Lucía. Sistemas de Protección Social en América Latina y el Caribe:
Colombia. Santiago de Chile: CEPAL, 2013. https://repositorio.cepal.org/
Morais de Sá e Silva, Michelle. Poverty Reduction, Education, and the Global
Diffusion of Conditional Cash Transfers.Cham:PalgraveMacmillan,2017.
Núñez, Jairo and Laura Cuesta. “Colombia: Programa Familias en Acción.” In
Transferencias con corresponsabilidad, edited by Ernesto Cohen and Rolando
Franco, 227–278. México: FLACSO México, 2006.
Ocampo, José Antonio. “Reforma del Estado y desarrollo económico y social en
Colombia.” In Análisis Político, no. 17 (1992): 3–37. https://revistas.unal.
OCDE (Organización para la Cooperación y el Desarrollo Económicos). Estudios
Económicos de la OCDE. México 1997–1998. Capítulo especial: Reforma del
sistema de Salud. Paris: OCDE, 1998.
OIT (Organización Internacional del Trabajo). Informe Mundial de Protección
Social. La protección social universal para alcanzar los Objetivos del Desarrollo
Sostenible 2017–2019. Geneva: OIT, 2017.
OIT. Panorama Temático Laboral 4. Presente y Futuro de la Protección Social
en América Latina y el Caribe. Lima: OIT/ Oﬁcina Regional para América
Latina y el Caribe, 2018.
OPS. “Respuesta de la OPS para mantener una agenda eﬁcaz de cooperación
técnica con Venezuela y en los Estados miembro vecinos”. 162ª Sesión
del Comité Ejecutivo. CE162/INF/22, Rev.1., 2018. http://iris.paho.
Ordóñez, Gerardo. “Las ﬁnanzas públicas y el gasto social en las últimas tres
décadas en México, 1982–2014.” In Nueva ronda de reformas estructurales
en México. ¿Nuevas políticas sociales?, edited by Enrique Valencia and Gerardo
Ordóñez, 177–200. Tijuana: El colegio de la Frontera Norte, 2016.
Orenstein, Mitchell. “The Pension Reform as Global Policy”. In Global Social
Policy 5, no. 2 (2005): 175–202. https://www.academia.edu/2673390/
Pêgo, Raquel. Salubristas y neosalubristas en la reforma del Estado. Grupos de
interés e instituciones públicas de salud, 1982–2000. Zamora: El Colegio de
Pereira, Zegri. “Descentralización y desempeño insitucional: una aproximación
inicial”. In La reforma de salud de Venezuela: aspectos políticos e institucionales
de la descentralización de la salud en Venezuela, edited by Jorge Díaz Polanco,
54–69. Caracas: Cendes, IESA, CIID, MSDS, Corposalud, Ediciones de la
3 ACTORS AND SOCIAL REFORMS IN FIVE DUAL WELFARE REGIMES … 99
Fundación Polar, 2001. http://bibliofep.fundacionempresaspolar.org/public
Pribble, Jennifer. “Worlds Apart: Social Policy Regimes in Latin America.” In
Studies in Comparative International Development, no. 46 (2011): 191–216.
Robles, Claudia and Vlado Mirosevic. Sistemas de Protección Social en América
Latina y el Caribe: Brasil. Santiago de Chile: CEPAL, 2013. https://reposi
Rodríguez, Alexis. Programas de transferencias condicionadas, políticas sociales y
combate a la pobreza en Panamá. Serie Políticas Sociales, no. 162. Santiago
de Chile: CEPAL, 2010. https://repositorio.cepal.org/handle/11362/6167.
Rodríguez, Alexis. Sistemas de Protección Social en América Latina y el Caribe:
Panamá. Santiago de Chile: CEPAL, 2013. https://repositorio.cepal.org/
Tolentino, Marcus. “Sistema Único de Salud: La experiencia brasileña en la
universalización del acceso a la salud”. In Revista Peruana de Medicina
Experimental y Salud Pública 26, no. 2 (2009): 251–257.
Tamburi, Giovanni. “La seguridad social en América Latina: Tendencias y
perspectivas”. La Crisis de la Seguridad Social y la Atención a la Salud. Expe-
riencias y lecciones latinoamericanas, edited by Carmelo Mesa-Lago, 76–107.
Mexico: Fondo de Cultura Económica, 1986.
Thorp, Rosmary. Progreso, Pobreza y Exclusión. Una historia económica de
América Latina en el Siglo XX. Washington D.C.: BID, European Union,
Uribe, Mónica. “Reformas sociales en América Latina: las perspectivas analíticas
y los actores del cambio.” In Estudios Sociológicos 25, no. 2 (2007): 427–461.
Uribe, Mónica. “La dinámica de los actores en la implementación de la reforma
del sistema de salud en Colombia: exclusiones y resistencias (1995–2003).”
In Revista Gerencia y Políticas de Salud 8, no. 17 (2009): 44–68.
Urrutia, Miguel. Tendencias a Largo Plazo en el Desarrollo Económico de América
Latina. Washington D.C.: Banco Interamericano de Desarrollo, 1993.
Urrutia, Miguel and Christian Robles Baez. Las transferencias condicionadas en
Colombia: Una historia del programa Familias en Acción (2001–2018). Serie
Documentos CEDE no. 016964. Bogotá: Centro de Estudios sobre Desar-
rollo Económico (CEDE), Universidad de los Andes, 2018. https://ideas.
Valencia, Enrique. “Heterogeneidad de las coaliciones de soporte de los
programas de transferencias monetarias condicionadas (TMC).” In Estados
de bienestar, derechos e ingresos básicos en América Latina, edited by Alberto
Cimadamore, Anete Ivo, Carmen Midaglia y Alexandra Barrantes, 85–109.
Mexico: Comparative Research Programme on Poverty (CROP), Siglo XXI
100 C. B. SOLANO AND E. V. LOMELÍ
Valencia, Enrique. “Coalición reformista de mercado y transformaciones de las
políticas económicas y sociales en México (1985–2017)”. In Políticas Sociales
en América Latina en los Inicios del Siglo XXI. Innovaciones, inercias y retro-
169–199. Tijuana: El Colegio de la Frontera Norte and CLACSO, 2018.
Vargas, Jakeline P. “Observancia del principio de igualdad y no discriminación en
el programa Más Familias en Acción en Colombia”. In Reﬂexión Política 17,
no. 33 (2015): 94–107.
Viana, Ana Luiza, Hudson da, Silva, Luciana Dias de Lima and Cristiani Vieira
Machado. “O sistema de saúde brasileiro: dilemas atuais”. In Políticas Sociais,
Desenvolvimento e Cidadania,editedbyFonseca,AnaandEduardoFagnani,
179–224. Sao Paulo: Fundación Perseo Abramu. Partido de los Trabajadores,
Vera, Juan Pablo. The humanitarian state: social policy and bureaucracy in
Colombia, PhD thesis in Anthropology, University of the State of New Jersey
Vera, Juan Pablo. “Los programas de transferencias monetarias condicionadas y
los retos de la inclusión productiva y laboral: aprendizajes relevantes para el
programa POP a partir de la experiencia latinoamericana”. In El Progresa-
Oportunidades-Prospera, a 20 años de su creación, edited by G. Hernández L.,
Th. De la Garza, J. Zamudio and I. Yaschine, 598–624. Ciudad de México:
WHO (World Health Organization). World Health Statistics.Geneva:WHO,
Wood, Geof and Ian Gough. “Welfare regimes: Linking social policy to social
development”. World Development 34, no.10 (2006): 1–14.
Latin American Social
in the Twenty-First
Natália Sátyro · Eloísa del Pino ·