20 CHAPTER 2
development (see more on these in Chapter 9).7 These are also potentially important interventions that should be piloted and scaled up at the pace pos- sible. However, public works, especially those involving more ambitious plans for skills certification in service provision, are not necessarily the best way to provide income support to the very poorest and most severely affected by AIDS (although they will benefit from the services). The remaining intervention that needs to be considered seriously is that of food transfers and nutrition interventions.8 These approaches have the same strengths as cash with respect to where they fall on the household capacity continuum. They do better on the scalability and inputs continuum in comparison with livelihood approaches but involve complexities in these dimensions. Food and cash have relative advantages and disadvantages in different contexts related to factors such as infrastructure, food markets, seasonality, logistical and administrative capacities, politics, gender relations, and the target group and the nature and urgency of their needs (Gentilini 2007).9 These are factors that apply to food and cash comparisons in all con- texts, not specifically that of HIV and AIDS. How these factors look through an “HIV/AIDS lens” is an important area for research.10 Food-based interven- tions may be better than cash for specific groups of AIDS-affected adults and children under specific conditions, and these conditions need to be better understood. However, there are issues of logistics, economics, and political economy at the international and national levels that make it unlikely that food transfers would be scaled up as a national strategy of social protection. Cash has been gaining momentum in recent years in countries looking at national social protection systems for children affected by AIDS. Furthermore, many food transfer programs operate in conjunction with other livelihoods, health, nutrition, and education programs. Although some, like school feed-
7Although these provide services rather than income for AIDS-affected families, they can strengthen their human capital through ECD services and through HBC that frees up older chil-
dren to go to school. 8Nutrition interventions are often food-based transfers or supplements that have the specific objective of improving nutritional status. These may include transfers of different types of
nutritional supplements or fortified food. 9Interviews carried out on beneficiary preferences for cash versus food in four African coun- tries found that beneficiaries preferred cash, mainly because of the choice it offered them in meeting a wider range of needs (Devereux et al. 2005). Interviews in Malawi revealed similar preferences, although the results were mixed, and the market had food shortages (Savage and Umar 2006). A comparison of cash versus food from a survey in Bangladesh also found that bene- ficiaries preferred cash and that cash and food transfers performed similarly with respect to tar- geting and school enrollment; however, food consumption was increased only by the food trans-
fers (Ahmed 2005). 10The “HIV/AIDS” lens is a conceptual tool for reviewing situations and actions in the light of HIV/AIDS and how they may increase or reduce risks (Loevinsohn and Gillespie 2003).
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