In West Africa, the right of access to universal social security is far from being respected. International institutions and African governments have been mobilising for several years to fight this phenomenon. In a role that has evolved over the years, the International Labour Organization (ilo) provides technical and financial support to countries in this regard. How and why does the ilo intervene in protecting the health of populations in West Africa? For this institutional study, the methodology is based on a literature review focused on the history of the role of the ilo in the protection of healthcare in West Africa, specifically in Ghana and Senegal. We show the ilo’s involvement since the 1990s for two main reasons: firstly, the lack of access to healthcare in countries with a specific labour form; secondly, the rejection of the idea of social protection by dominant players on the international scene, leading to criticism following the structural adjustment programmes. In the contexts of Ghana and Senegal, both of which have experienced transitions from community-based health mechanisms to universal health coverage, we explain that the ilo has several ways to intervene—technically, institutionally, and financially. An important outcome is the revelation that the vision of the ilo with regard to health protection is systemic, articulating alternative ways to address social protection for the informal economy compared to other international organisations. But this approach is understated considering the dire situation in Africa and the need to improve access to healthcare and progress towards the Sustainable Development Goals.