michael samson economic policy research institute, south africa
DESCRIPTION
Operationalizing HIV-sensitive social protection: opportunities and challenges. Michael Samson Economic Policy Research Institute, South Africa [email protected] www.epri.org.za. AIDS 2012 Symposium Social protection: Promoting a more effective response 23 July 2012. - PowerPoint PPT PresentationTRANSCRIPT
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Michael SamsonEconomic Policy Research Institute, South Africa
[email protected] www.epri.org.za
Operationalizing HIV-sensitive social protection: opportunities and challenges
AIDS 2012 Symposium Social protection: Promoting a more effective response
23 July 2012
EconomicPolicyResearchInstitute
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Social protection for equitable HIV responses
Global Commitments to Universal Access to HIV prevention, treatment care and support
HIV epidemic has put equity issues in the spot light (gender, income, social exclusion)
Importance of addressing economic deprivations and social exclusion
Emerging priority area for UN cosponsors and development partners
Washington D.C., USA, 22-27 July 2012www.aids2012.org
2000 9 countries, 25 programs
2010 35 countries, 120 programs
2012 41 countries,
245 programs
2000 2012
SOURCE: Garcia and Moore (2012)
Social cash transfer programmes have emerged in countries all across sub-Saharan Africa over the past 12 years
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Govern
ment
Other
DFID
Worl
d Ban
k
UNICEF
Oxfam
Save t
he Chil
dren
EU/ECHOCARE
UNHCR
USAID0%
10%
20%
30%
40%
50%
60%50%
40%
20%
12% 12% 10% 8% 7% 7% 6% 4%
SOURCE: Marito Garcia and Charity Moore. 2012. Cash Dividend: The Rise of Cash Transfer Programs in Sub-Saharan Africa. Washington, D.C.: The World Bank.
Government is the main funder of cash transfers in Africa, followed by DFID, the World Bank, and UNICEF
Washington D.C., USA, 22-27 July 2012www.aids2012.org
A framework for HIV-sensitive social protection evidence
Reaching people with HIV-sensitive social protection: ● Exclusive versus inclusive approaches ● Targeting versus more universalism
Achieving core impacts: ● Prevention ● Treatment ● Social and economic care and support
Enhancing impacts: building complementary linkages and moving to more comprehensive approaches ● Synergies with development sectors ● Critical enablers
Expanding and sustaining HIV-sensitive social protection ● Resources required ● Financing ● Investment returns
Design and Implementation
1
4
3
2
Washington D.C., USA, 22-27 July 2012www.aids2012.org
HIV-sensitive social protection’s transmission mechanisms to impact follow complex pathways
Broad-based HIV-sensitive social protection policies and programmes
Income protection and livelihoods support Direct access to
vital goods and services
Better treatment and improved health outcomes
reduced poverty, better nutrition, increased educational access
Reduced mortality and morbidity
Reduced new infections (particularly for girls and young women)
Reduced susceptibility to HIV infection
Greater economic power for vulnerable groups
Washington D.C., USA, 22-27 July 2012www.aids2012.org
National scale programmes are yielding positive impacts on HIV-related outcomes
• South Africa’s Child Support Grant…– targets with inclusive approaches that effectively
reach HIV-affected households – generates behavioural impacts that strengthen
prevention efforts• Kenya’s scaling up of its OVC programme may
be yielding similar results• Research in ongoing in Ghana, Lesotho and
Malawi—and with other projects around the world
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Important opportunities exist to ensure greater coverage of HIV-affected populations and
strengthen HIV-related impacts
• Inclusive versus HIV-specific targeting– Reaching excluded groups– Addressing stigma
• Maximising the empowerment effect of social protection– Addressing economic vulnerability
• The role of the Investment Framework in maximising impact• An appropriate and efficient mix of instruments• The virtuous circle of effective impact as well as
developmental multipliers strengthening political will and leading to increased resources, improving coverage and propelling the virtuous circle
Washington D.C., USA, 22-27 July 2012www.aids2012.org
HIV-affected households in South Africa are twice as likely to receive the Child Support Grant than are non-affected households
0%
10%
20%
30%
40%
50%
60%
70%
No Social Grants Child Support Grantonly
Other Grants
prob
abili
typrobability of grant receipt by HIV-affected household status
likely HIV-affected not likely HIV-affected
SOURCE: EPRI micro-simulation model calibrated with National Income Dynamics Survey 2010
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Adolescents in South Africa receiving the Child Support Grant are less likely to engage in a range of risky behaviours
SOURCE: EPRI/Government of South Africa/UNICEF CSG impact assessment (2012)
• EPRI’s impact assessment of South Africa’s Child Support Grant (CSG) demonstrates reductions in risky behavior resulting from both early (within 2 years from birth) and current receipt:– Early CSG receipt reduces the likelihood adolescents
engage in sexual intercourse, use alcohol or drugs, become pregnant and work outside the home.
– Household receipt of the CSG in adolescents’ teenage years is important in reducing absences from school as well as engagement in the above risky behaviours.
Washington D.C., USA, 22-27 July 2012www.aids2012.org
‘Sensitive periods’ in early brain development
Binocular vision
0 1 2 3 7654
High
Low
Years
Habitual ways of respondingLanguage
Emotional controlSymbol
Peer social skillsRelative quantity
Central auditory system
Early childhood intervention is a key driver of impact
SOURCE: Handa (2007) citing and adapting Heckman & Carneiro (2003)
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Systemic challenges limit opportunities to scale up HIV-sensitive social protection
• Weak systems for cross-sectoral linkages
• Resource constraints limiting adequate financing
• The interaction of these two challenges is particularly constraining: when resources are limited, support for inter-sectoral linkages erodes
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Reduce RiskReduce the
likelihood of transmission
Reduce mortality and
morbidity
Critical Enablers
Basic Programme
Activities
• PMTCT• Condom promotion and distribution• Key populations • Treatment care and support to PLWH • Male Circumcision• Behavior Change Programmes
Synergies With Development Sectors including social protection
Investment Framework (Schwartlander et al., 2011)
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
pro
gram
mes
Pre
venti
on se
rvic
es
Prim
ary
heal
th c
are
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health outcomes Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
pro
gram
mes
Pre
venti
on se
rvic
es
Prim
ary
heal
th c
are
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health outcomes Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
Nut
rition
pro
gram
mes
Pre
venti
on se
rvic
es
Prim
ary
heal
th c
are
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health outcomes Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Identified knowledge gaps limit opportunities for scale-up
• Do existing programmes reach and effectively cover households affected by HIV and AIDS?
• How can social protection programmes promote behavioural change that strengthens prevention initiatives?
• How do social protection programmes reinforce capabilities for treatment adherence?
• How can integrated social protection systems better achieve these impacts?
• What are the benefits (investment returns) to more integrated and comprehensive approaches to HIV-sensitive social protection?
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
pro
gram
mes
Pre
venti
on se
rvic
es
Prim
ary
heal
th c
are
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health outcomes Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
+1
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
+1 +1
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
+1 +1
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
+2+1 +1+2
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
+1 +1 +1 +1 +1 +1 +1 +1 +1
Cas
h tr
ansf
ers
Hea
lth In
sura
nce
Anti
-stig
ma
mea
sure
s
Nut
rition
Pre
venti
on se
rvic
es
Prim
ary
heal
th ca
re
Edu
catio
n
Soc
ial c
are
serv
ices
Liv
elih
oods
supp
ort
Poverty reduction Social risk management Equal rights Improved nutrition Reduced infection rates Improved health Human capital development Improved well-being Economic growth
Policy instruments (INPUTS)
Social protection
HealthO
ther
Policy objectives (OU
TPUTS)
Social Protection
Health sector Other sectors
calculatormode
+6+5
+4
+2+4+2
+3+2
+1 +1 +1 +1 +1 +1 +1 +1 +1+4
Washington D.C., USA, 22-27 July 2012www.aids2012.org
Conclusions• A rich evidence base on HIV-sensitive social protection is
emerging• In many countries key policy-makers are open to using this
evidence to design and implement better policies and programmes
• Identified gaps exist across the spectrum of areas of policy interest
• In particular, policy-makers see robust and credible evidence on cross-sectoral investment returns as essential for scaling up successful programmes
• Research partnerships with development partners and key stakeholders can help build the required evidence