xvi SUMMARY


ever, this approach would miss adults and children in households without elderly members, who would be better reached through grants targeting children through their caregivers. An important process of political mobiliza- tion for social protection in the context of HIV and AIDS has convened largely around orphans and vulnerable children, but this has raised questions around how to define a vulnerable child, such as whether orphans are disadvantaged in relation to nonorphans—including children with ill parents as well as those suffering other forms of deprivation and trauma. Some studies find that orphans are disadvantaged with respect to human capital indicators; others find that they are not, with results contingent on variables such as the rela- tionships between children and caregivers, their poverty or wealth status, and household demographics and structure. In light of these equity concerns and those around stigma, there is greater support for targeting cash transfers based on poverty and multiple vulnerability criteria rather than for targeting orphans or families living with AIDS. Given the evidence on the relationship between nutrition and disease progression, there are stronger arguments for targeting food transfers to people living with AIDS. With respect to targeting methods, data-intensive national surveys tend


to have low error rates but are often not practical or cost efficient in the context of low administrative capacity and sparsely populated areas and would also likely be politically problematic if there was no community in- volvement in decisions in which only a small percentage of the population was included. Application-based systems using means tests work reasonably well in South Africa as long as documentation requirements are not too burden- some; otherwise, large exclusion errors are likely. In Kenya, Malawi, and Zam- bia, community-based decision-making processes are reported to have per- formed reasonably well with respect to identifying AIDS-affected and poor households, although they miss some and involve a substantial amount of capacity building to implement. Best methods depend on local conditions and on the prevalence and severity of poverty. Other methods altogether may be needed to reach street children and child-headed households. An interest in the ability of cash transfers to protect children is driven by


the evidence on the interactions among early childhood nutrition, health, and education and the effect of these interactions on the long-term intergenera- tional transmission of poverty or emergence from it. Many children who are not protected from the effects of HIV and AIDS on their families now will never recover. For these reasons, we examine not only UCTs in southern and eastern Africa but also CCTs in Asia and Latin America, which are designed primarily to strengthen nutrition, health, and education. CCTs have shown much promise globally but also raise many concerns in the context of HIV and AIDS. Several issues emerge. First, it is important to design them to carefully


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