Social protection to support vulnerable children and families: the potential of cash transfers to protect education, health and nutrition

Abstract

Investing in social protection in sub-Saharan Africa has taken on a new urgency as HIV and AIDS interact with other drivers of poverty to simultaneously destabilise livelihoods systems and family and community safety nets. Cash transfer programmes already reach millions of people in South Africa, and in other countries in southern and East Africa plans are underway to reach tens and eventually hundreds of thousands more. Cash transfers worldwide have demonstrated large impacts on the education, health and nutrition of children. While the strongest evidence is from conditional cash transfer evaluations in Latin America and Asia, important results are emerging in the newer African programmes. Cash transfers can be implemented in conjunction with other services involving education, health, nutrition, social welfare and others, including those related to HIV and AIDS. HIV/AIDS-affected families are diverse with respect to household structure, ability to work and access to assets, arguing for a mix of approaches, including food assistance and income-generation programmes. However, cash transfers appear to offer the best strategy for scaling up to a national system of social protection, by reaching families who are the most capacity constrained, in large numbers, relatively quickly. These are important considerations for communities hard-hit by HIV and AIDS, given the extent and nature of deprivation, the long-term risk to human capital and the current political willingness to act.

Keywords:

• social protection
• cash transfers
• HIV
• AIDS
• Africa
• Latin America
• maternal and child health and nutrition
• education
• gender

Acknowledgements

Support for this research was provided by the Joint Learning Initiative on Children and AIDS (JLICA) and the Regional Network on AIDS, Livelihoods and Food Security (RENEWAL) of the International Food Policy Research Institute. We would like to thank JLICA and RENEWAL colleagues and donors, and the many programme implementers and researchers who assisted us in accessing documents.

Notes

1. Whether they achieve these goals depends on a number of political, economic and technical factors.

2. Several lines of argument and a vast amount of evidence point to the wisdom of targeting on poverty and vulnerability criteria, rather than on AIDS and orphans (see Adato & Bassett 2008).

3. See Tables 4 through 7 later in this article for descriptions of the cash transfer programmes and evaluations reviewed.

4. The categories of “protective,” “preventative” and “promotional” social protection come from Guhan (1994). The category of ‘‘transformational’’ comes from Devereux and Sabates-Wheeler (2004).

5. HIV and AIDS can lead to increased food insecurity and malnutrition via undermining livelihoods, decreasing food intake and absorption and increasing energy requirements. In turn, food insecurity and malnutrition can heighten susceptibility to HIV exposure and infection via increasing transactional sex, migration, susceptibility to TB and mother-to-child transmission (For reviews of studies of these relationships see Gillespie & Kadiyala, 2005; Gillespie, Kadiyala, & Greener, 2007).

6. § = Signifies that information on statistical significance is not available for the reported figure.

7. Survey data from Van and Diyarbakir provinces showed secondary school enrolment among beneficiaries at 11 and 65%, respectively, though this national dataset is not considered statistically representative at the provincial level (Adato et al., 2007).