Social protection and cash transfers: To strengthen families affected by HIV and AIDS

SUMMARY xvii

address priority objectives and conditions rather than adopting a blueprint from Latin America. Second, there is a need to determine whether condition- ality adds value. In Latin America, several studies have found significant impacts from conditionality; the one study in Africa did not. The third issue is whether conditional transfers will be more politically popular and thus fis- cally sustainable than unconditional transfers. Fourth is whether a country has the administrative capacity, service availability, and budgets necessary to run a CCT. Given current evidence and the urgency with which cash transfers are needed, UCTs are likely to be more appropriate in severely AIDS-affected communities. However, conditionalities should be tested on a small scale to determine their impact on carefully selected outcomes and where appropri- ate services are available. Services and activities—from productive economic activities and early childhood development to adult education and health awareness—can be linked to cash transfer programs, with participation in these activities encouraged but not required. A final policy debate addressed in this monograph concerns the relative

advantages of cash transfers vis-à-vis alternative social protection interven- tions for families affected by HIV and AIDS. For a government-administered national system of social protection, cash transfers tend to require fewer capacities and inputs, are faster to scale up, and are more likely to achieve wider coverage than are alternative approaches. However, a mix of interven- tions is needed, appropriate to the priority needs and capacities of beneficia- ries. Food and nutrition programs are likely to be particularly useful for sub- groups of AIDS-affected families, for example, people on antiretroviral therapy and children in need of nutrition rehabilitation. Nutrition counseling is also essential to support critical behavioral changes such as appropriate food con- sumption, diarrhea treatment, and prevention of mother-to-child transmission of HIV. Another approach to AIDS-responsive social protection is to use eco- nomic strengthening approaches that include public works, microcredit, and livelihoods activities adapted to the conditions of affected households, such as public works that involve less physically demanding work or family-based work contracts. These will be more effective for families that are “less affected”—less labor constrained, less destitute, and possibly better off in terms of various asset endowments. Given the level of inputs and capacities required, these activities will not reach as many people as cash transfers. “AIDS-affected families” do not comprise a homogenous category; they em- body many variations with respect to wealth or poverty, education, household structure, stage of illness progression, dependency ratios, social status, and access to assets. This argues for a mix of social protection approaches rather than a single approach. However, pursuing a mix does not conflict with a national strategy of scaling up cash transfers for the most vulnerable families.

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