Study on Social Protection and Children In

Study on social protection and children in West and Central Africa (RFP-IVCA-2007-003P)

A Study Commissioned by UNICEF WCARO

Inception Report by ODI team

February 2008

Team members William Ahadzie Armando Barrientos Tim Braunholz-Speight, Emma Broadbent, Catherine Toure Cormont Abdou Salam Fall Geoff Handley Caroline Harper, Rebecca Holmes, Nicola Jones, Bethuel Makosso Paola Pereznieto, Eliana Villar, Cora Walsh

Please contact Nicola Jones with comments: [email protected] 2 Contents

1. Introduction and overview……………………………………………..p2 2. Proposed report outlines………………………………………………..4 3. Project timetable…………………………………………………………6 4. Proposed analysis plan per block a. Block 1: …………………………………………………………..8 Review of the poverty situation and types of vulnerability and risk affecting children in WCAR. b. Block 2:……………………………………………………………… 18 Assessment of existing social protection systems and their impact on children. c. Block 3: ………………………………………………………… 29 Assessment of the potential role of cash transfers in reducing poverty and vulnerability among children in the region. d. Block 4:……………………………………………………………… 33 Assessment of the potential role of strengthened health insurance in reducing poverty and vulnerability among children in the region. e. Block 5: ……………………………………………………... 39 Strengthening child protection services within broader social protection systems f. Block 6: …………………………………………………………… 45. Fiscal space for strengthened social protection g. Block 7: ………………………………………………………… 58 UNICEF engagement on social protection

5. Annexes  1. References……………………………………………………….. 63  2. Health Financing Definitions…………………………………. 80

6. List of tables, figures and boxes  Table 1.1 Risk and Vulnerabilities across WCA……………… 10  Table 1.2 WCA countries with poverty, deprivation and vulnerability indicators………………………………………………………… 16  Table 2.1: Social protection package for children…………… 20  Figure 2.1: The Scope of Social Protection…………………… 21.  Figure 4.1 Global distribution of cause-specific mortality among children under five………………………………………………………… 35  Figure 4.2: Malnutrition as a crosscutting co-factor in under-five mortality…………………………………………………………… 35  Table 5.1: Child Protection Priority Areas for Country Case Studies  …………………………………………………………………………...43  Table 6.1:Research Framework for Case Studies……………… 51  Table 6.2 Budget Allocations and Actual Outturns for Country Case Studies – Aggregate Level………………………………………… 55  Table 6.3:Budget Allocations and Actual Outturns for Country Case Studies – Programme Level………………………………………… 55  Table 6.4: Medium Term Budget Framework Allocations for Country Case Studies……………………………………………………… 56  Table 6.5: Composition of allocations and spending within social protection programmes………………………………………… 57

3 Introduction and Overview of Research Plan

The objective of this study is to provide UNICEF with an in-depth understanding of the actual and potential role of social protection systems in reducing poverty, vulnerability and risk among children in West and Central Africa. This will enable UNICEF to apply an evidence-based “systems approach” to social protection that benefits children in place of piecemeal type programmes and interventions which currently exist. Given that this knowledge is at present limited and often scattered, the scope of this study is substantial, and therefore includes:

 A situation analysis of: i) the existing poverty situation and types of vulnerability and risk affecting children in the region; ii) current social protection systems and programmes in West and Central Africa and their impact on children

 An informed assessment of the potential role of social protection in reducing poverty and vulnerability among children in the region, focusing particularly on: i) cash transfers, ii) health insurance and iii) mechanisms to strengthen child protection services.

 An assessment of the priority needs for strengthening social protection systems in the region through i) an analysis of the political context, key institutional and policy actors as well as ways in which social protection debates could be effectively framed; and ii) a child-sensitive budget analysis to identify financing arrangements for strengthened social protection

 Programming and policy recommendations to inform the development of a strategy to promote social protection systems that benefit children by UNICEF in the five country case studies and the WCA region at large.

These four components will be informed by a multi-disciplinary perspective, and by drawing on quantitative, qualitative and participatory data draw attention to the complex interplay of macro-, meso- and micro-level factors that underpin social protection systems.

The final goal of the study is to provide UNICEF with the essential knowledge base needed to begin to develop a strategy for effective engagement by UNICEF country offices (in West and Central Africa) in the strengthening of social protection systems that benefit children, their caregivers and families. The study is timely as, given the increasing investment in social protection by both governments and donors for low income countries, it is important to develop and deepen UNICEF’s understanding, position and strength in supporting social protection systems that address not only the household, but also child-specific manifestations of poverty and vulnerability in the region.

Definitions Definitions of social protection are highly contested and thus it is important to be clear about our conceptualisation from the outset. We concur with Marcus (2007) that “social protection policies and programmes are best understood as those which aim to help poor and vulnerable people manage risk and counter deprivation, through direct cash or in-kind transfers. However, to be effective social protection measures need to be complemented by wider policy reforms and actions that help reduce risks and promote social equity and inclusion” (1). In other words, our definition incorporates protective, preventative and promotional measures, which are in turn

4 embedded within a strategy for broader economic and social transformation. By extension, child-focused social protection is a set of public institutions, norms and programmes concerned with tackling the causes and consequences of childhood poverty and vulnerability, as well as stemming potential intergenerational poverty cycles. Because of the multi-dimensional nature of childhood poverty and vulnerability, it is particularly important to pay attention to complementary actions that could address non-economic/ non-material dimensions, especially exploitation and abuse, and voicelessness.

We concur with UNICEF that addressing childhood poverty also necessitates a concern with gender equality and that there are many potential synergies between enhancing women’s rights and children’s rights (UNICEF, 2007). Where appropriate we therefore also consider the extent to which social protection instruments are likely to empower women in their role as caregivers. There is, however, inadequate time and resources in the project to address the ways in which social protection may empower women more broadly – for example, with regard to the productive and political spheres.

In this research plan, for the sake of clarity and consistency across the team as well as for comparative purposes we adopt a definition of household poverty that is in line with international poverty line conceptualisations, i.e. the 1 or 2USD per day poverty line which is considered minimal to ensure basis survival.1 In the individual country case studies, we will also give due consideration to national poverty line constructs – typically the monetary value of a basket of goods and services that are deemed necessary for an adequate standard of living in a particular country and cultural context. Our conceptualisation of household-level vulnerability follows Dercon (2005) who defines vulnerability as the state of being in which people are not able to cope with threats to their well-being or access to resources without incurring a damaging loss. In other words, we are concerned with vulnerability to poverty (the probability that people will be poor in the future) (Barrientos and Shepherd, 2003).

However, given that the focus of this research is on social protection designed to improve child well-being and that of their carers, we also pay particular attention to the distinctive features of childhood poverty and vulnerability. We argue that there are at least four key dimensions: a) childhood is a dynamic life stage in which children’s capacities are evolving. Windows of opportunity thus tend to be more finite – missed opportunities as a child may be difficult to overcome and have lifelong and irreversible effects; b) children require more care and protection than adults as they are not only undergoing complex biological, neurological, social and moral development, but they are also more vulnerable to disease, abuse and exploitation; c) children are often voiceless with little opportunity to participate in decisions about their life; and d) because of higher levels of vulnerability and reliance on adults, childhood poverty has a strong relational nature meaning that intra-household dynamics and distribution of power and resources may have a profound effect on their experience of poverty.

Research Plan This research plan has been developed as a discussion document for the regional workshop in the Ivory Coast in February. It will be revised and refined following the group discussions in February. The resulting inception phase report will provide a clear roadmap for the research and analysis to be carried out between March to May, and for the report revisions and final synthesis report to be carried out in July to

1 This measure was introduced in the 2000 WDR on Attacking Poverty and was designed to provide a basic internationally comparative income proxy for basic survival.

5 August. In addition, in order to ensure smooth team communication, a group email has already been established, and the international team members undertaking the country case studies have been tasked with liaising directly with the country experts of the country they will visit. A number of key articles have already been sent to the full team in order to establish a common basis of understanding about social protection and challenges and opportunities for addressing childhood poverty through social protection policies and programmes.

In this report, we begin by presenting a draft outline of the structure for the desktop review and country case study reports, and a timetable for each phase, indicating lead responsibility for each component and peer reviewers where appropriate.

The research framework, research questions, methods and sources for each of seven analytical blocks as outlined in the Study’s TOR are then presented in Section 4. For each block we provide: a) a brief overview of key debates in the literature, b) a list of the research questions that will be examined, c) a description of the methodology we plan to use to answer these questions, d) a list of key sources and data.

How these research tasks will be divided among the team and according to what timetable is presented in Appendices 1 and 2.

2. Proposed report outlines a) Desktop review report structure The scope of the desktop review will be all 24 WCA countries, except where otherwise specified. The review will follow the methodology and table templates from the seven blocks outlined in this research plan as well as in Appendices 1 and 2. The lead author is identified in brackets.

Executive summary (CW)

1) Introduction (NJ) Introductory discussion about the significance of social protection and the relevance of this study in WCA

2) Theoretical background and analytical framework (CH/ RH) Review of different theoretical approaches to social protection; key issues relating to social protection as a mechanism to tackle childhood poverty; and presentation of analytical framework to be used in our report.

3) Overview of WCA political and socio- economic context (TB) Discussion of political and economic development models that characterise WCA

4) Analysis of nature of poverty and vulnerability in WCA (TB) Overview of key data on poverty and vulnerability in WCA at the household level, as well as gender and age-specific manifestations of poverty and vulnerability

5) Overview of social protection programmes in WCA (RH) Overview of range of social protection programmes and their characteristics in WCA

6) Analysis of fiscal space for strengthened social protection programmes in WCA (GH/ PP)

6 Overview of governmental and donor budgetary commitments to social protection programmes in the region, existing financing mechanisms, future opportunities and challenges in WCA region.

7) Analysis of cash transfers as mechanism to tackle childhood poverty (RH) Overview of strengths and weaknesses of cash transfer programmes and impacts on child poverty outcomes, drawing on analyses from other parts of SSA, Asia and Latin America. Discussion of known cash transfer programmes in WCA (esp. Ghana and Senegal) as well as likely challenges and opportunities

8) Analysis of health insurance programmes as mechanism to tackle childhood poverty (CW) Overview of strengths and weaknesses of health insurance programmes and impacts on child poverty (esp health and nutrition) outcomes, drawing on analyses from other parts of SSA, Asia and Latin America. Discussion of known health insurance programmes in WCA, as well as likely challenges and opportunities.

9) Analysis of potential linkages between social protection programmes and child protection services (NJ/EB) Overview of strengths and weaknesses of linking social protection programmes and child protection services, drawing on international good practice (Latin America and Europe). Discussion of likely challenges and opportunities in WCA context.

10) Analysis of opportunities for policy engagement on social protection (NJ) Analysis of opportunities and challenges for policy engagement in WCA on social protection, including identification of credible and compelling evidence, framing of policy debates in a context appropriate manner, and forging alliances with influential policy and civil society actors.

11) Conclusions (NJ/ CH) Summary of findings on social protection and its potential as a mechanism to tackle childhood poverty in WCA, including identification of data and analytical gaps, and directions for future research as well as tentative policy recommendations. b) Country case study report structure The international consultant will be responsible for the final report, while the local consultant will be responsible for initial data collection, in-country arrangements, interview transcripts/notes, detailed notes on research process, as well as peer review of the report. The first case study will be on Equatorial Guinea and we will strive to finish the draft write up of this case as early as possible so as to refine the format and use it as a model for the other cases. Each country case will follow the methodology and table templates from the seven blocks outlined in this research plan as well as in Appendix 2.

Executive summary 1. Introduction and analytical framework 2. Methodological approach Combining desktop review prior to country fieldwork, key informant interviews and focus group discussions in the capital city, and short field visit to gain more in-depth understanding of issues at the community level, including views from adults and children. .

7 3. Overview of political and socio-economic development context 4. Analysis of poverty and vulnerability (both general and child-specific) 5. Analysis of national social protection programmes, including cash transfers (both existing and potential) 6. Analysis of fiscal space for social protection programmes (existing and potential) 7. Analysis of potential contribution and feasibility of health insurance (as compared to other health financing mechanisms) as a means to ensure better health care service provision for impoverished children and their carers

8. Analysis of child protection services and potential to link up with social protection programmes

9. Analysis of opportunities for political engagement 10. Conclusions 11. Appendices: interview transcripts

3. Timetable and responsible team members

Key dates Responsible person Peer review PHASE 1 INCEPTION REPORT Jan 21st draft finished and NJ CH circulated for comments AB among team Jan 28th draft research NJ UNICEF plan submitted to UNICEF WCA Feb 11-14th meeting in NJ, RH, EV, PP, WA, CC, Ivory Coast BM, AF

General presentation Nicola Blocks 1, 2, 3 – led by Rebecca Blocks 4, 5, 7 led by Nicola Block 6 led by Paola Feb 28th inception report NJ due Feb 28th finalisation of NJ country fieldwork research plan, including preparation guidelines sent to country teams PHASE 2 DESKTOP REVIEW AND COUNTRY CASE STUDIES March – May 6th TB, EB, CW, PP, GH, CH, NJ desktop review blocks March – May Country teams – preparatory literature

8 review, stakeholder mapping and organising interviews for fieldwork visits March 10th TB, EB and RH block drafts due to then guide other desktop components March – fieldwork in EG RH, EV, BM (3-15 March) and Congo (16-29 March) April – fieldwork in Ghana NJ, WA, PP, CC (April 22-May 6), Mali (13- 26 April) May – fieldwork in PP, AF Senegal (27 April to 13 May) May 6th– desktop review TB, EB, CW, GH, PP, NJ, CH draft sections due so can CH AB be finalised and circulated Country teams for comments May 15th – case study RH, EV, BM, NJ, WA, PP, reports due except for CC Senegal May 28th – country case NJ, PP, AF CH study reports finalised and AB circulated for comments Country teams May 31st – draft reports NJ submitted to UNICEF PHASE 3 FINALISATION OF REPORTS AND SYNTHESIS PAPER June UNICEF comments UNICEF July-August revisions NJ to coordinate CH AB GH August – synthesis report NJ + CH AB August 31st finalised report NJ submitted to UNICEF September workshop NJ/ RH presentation

Team members responsible for desktop review block analysis (with lead writer underlined) Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Tim Caroline Rebecca Cora Nicola Geoff Nicola Emma Rebecca Emma Nicola Emma Paola Caroline Emma

9 Block 1: West and Central Africa Poverty and Vulnerability Analysis

Introduction This block will provide an overview of children and poverty, deprivation and vulnerability in the countries of the region, to be used to inform the analysis in later blocks of the potential for various forms of social protection to improve child well-being as well as that of their carers. It consists of: . Discussion of household poverty and vulnerability in the region in general; . Typology of different countries by income, deprivation and political context; . Discussion of frameworks for analysing childhood poverty and vulnerability, and key analytical and empirical differences between adult and childhood poverty; . A discussion of the methodological approach to be applied, which is then described in more detail in the appendices.

General household poverty and vulnerability in West and Central Africa As mentioned in the introduction, childhood poverty has a strong relational nature as children, especially very young children, are typically reliant on adults (and/or older children) for care, nurture and protection. We therefore begin this section with a discussion of general household poverty and deprivation in the WCA.

Household poverty and deprivation The West and Central Africa (WCA) region contains several of the poorest countries, and populations with the lowest levels of human development, in the world. While there may be particular categories of people or children who have special needs (e.g. street children, migrants); but every country has a significant proportion of its population living in poverty. As Table 2 indicates, in several countries, the majority of the population lives in extreme poverty. Child deprivation is likewise widespread. Although children in the poorest households also seem to suffer the most chronic and severe deprivations, there is often only slight variation between households in the bottom 40-60% of the income distribution. Particularly in the poorest countries, it may be only a very small elite who experience significantly better standards of living and security from risk. For example, in Sierra Leone, the under-5 mortality rate varies from 27% among the poorest households to 18% in the top income quintile. Clearly rates of survival are significantly better among richer households, but they are still shockingly low, worse than the mean for Sub-Saharan Africa as a whole.

However, the scale and pattern of poverty and deprivation, and processes producing poverty and vulnerability, do vary between countries, and within them. Rural areas tend to have higher poverty rates than urban ones – in some countries dramatically so – and the highest levels of poverty appear to be found in the overwhelmingly rural landlocked Sahelian areas, and in those countries that have suffered major conflict over the last 10-15 years.

Measures of income/consumption Data availability is patchy, particularly in countries that have recently suffered protracted conflicts (e.g. Liberia), and may be based on estimates from small samples. However, where we have data, it indicates that the percentage of the population living under the international extreme poverty line ($1/day) varies from 15% in Cote d’Ivoire,2 or 17% in Senegal and Cameroon, to 61% in Niger, 68% in Central African Republic or 71% in Nigeria – and possibly as high as 82% in Chad or 90% in the DR Congo in the late 1990s.3 In most countries, the proportion living under $2/day is at least half the population, and sometimes almost the entire population. Within countries, the general pattern is for a pronounced rural-urban divide, with rural populations almost always suffering a higher rate of poverty than urban ones. This may partly be because many of the countries in the region are still overwhelmingly rural, and so the urban population is disproportionately middle class. Among the more urbanised countries, the rural-urban poverty

2 Although this figure is from 2002, and may well have increased in the years of civil war. 3 WDR 2008; UNCTAD 2002 10 disparity is less stark: e.g. for Nigeria rates are almost the same, and urban poverty rates are reported as higher than rural ones in Cameroon.4

Access to public services: education, health, water and sanitation With a small number of exceptions for populations of some of the middle income countries, large numbers of people in the region have inadequate access to social sector services such as education, health, water, housing and sanitation. Combined with multiple poverty impacts (see below), poor services result in populations with high levels of illiteracy, low levels of formal skills, widespread and severe ill-health and low life expectancies. As revealed in Table 2, most governments of the region spend a low percentage of GDP on social sector services; and given the low GDP of most countries, this translates as very low levels of social expenditure. Where accurate data are available, it seems that some countries in the region spend about 20% of their budget on social sector; but the proportion that is spent on social protection appears to be very low, often less than 5% of total budget.5

The coverage of public social sector services varies between countries, but in general it varies most sharply between rural and urban areas. Significant proportions of the rural population face problems in accessing public services – often simply the need to travel considerable distances to them. Thus for more than a quarter of women living in rural Mali, the nearest primary school is more than an hour’s travel away; for the majority, the nearest post office is a similar distance; and for two thirds, the nearest health centre is 30km or more away. 6 In contrast, in urban areas, 88% of women lived within 15 mins of a primary school, 64% within 30 mins of a post office and two-thirds within 4km of a health centre, with almost the entire population of the capital within quick reach of a health centre. Problems of distance are compounded by income poverty. In Nigeria, distance or transport to health centre was reported as a major problem in accessing healthcare by almost half of the poorest quintile of women (c48%, reducing to 33% for the next quintile and only 8% for the richest).7

To some extent, variation in service coverage between countries appears to be the product of varying levels of urbanisation. Thus, in Niger (in 2005), 20% of the population had access to sanitation facilities, and 50% to an improved water source; the corresponding figures were 60%and 61% for Nigeria. But in both countries, similar proportions of rural people (44% in Niger, 42% in Nigeria) and urban people (84% in Niger, 82% in Nigeria) had access to such water sources. However, Niger is the least urbanised of all countries in the region, with just 17% of the population living in urban areas, while Nigeria’s urbanisation rate is 47%.8

The potential for conflict to devastate social infrastructure provision is illustrated by the 2002/3 household survey in Sierra Leone, which found that just 4% of the population had access to sanitation facilities, and 37% had any access to an improved water source. While we do not have the figures from before the start of the conflict, it is hard to imagine that they were worse, or that the conflict hasn’t severely held back provision of water and sanitation facilities.

Risks and Vulnerabilities Households are vulnerable to impoverishment from a range of risks, varying according to household location, occupation, income and social group.

Table 1.19: risks and vulnerabilities across WCA

4 IFAD 2001: 76 5 IMF 2005 6 DHS 2001: 289-290 7 DHS 2003: 140 8 African Development Indicators 2007: 108-116. However, national variation in methodologies for classifying locations as ‘urban’ or ‘rural’ mean that international comparisons of urbanisation rates are only approximate. 9 Adapted from Ould el Hadj, S. and Diakhate, M. (2005). 11 Category of risk Likely effects Vulnerable groups Economic crises . Unemployment . Wage labourers, casual . Increased cost of basic commodities labourers . Lower incomes . Farmers involved in commercial . Increased levels of poverty and export agriculture (Gulf of . Increased levels of child labour Guinea countries, cotton areas of . Increased cost of access to social Mali and Burkina Faso) services . Children . Decreased children’s participation in . Population in general education . Low expenditures on social sectors . Deterioration of economic and social infrastructures

Environmental shocks . Loss of agricultural production . Subsistence farmers and stresses . Death of cattle . Pastoralists and agro-pastoralists (low rainfall, droughts, . Increased malnutrition . Residents of Sahel zone floods, locust invasion, . Decreased income especially in plant and animal . rural areas diseases) . Rural migration . Increased levels of poverty Conflicts and insecurity . Increased mortality, disablement and . Majority of population of states psychological trauma with recent history of conflict or . Destruction of economic and social political instability (see Table 2) infrastructures . Women (esp to rape) . Increased refugees (internal and . Children (rape, orphanhood, use external) as combatants; poverty and . Increased criminal activities destruction of health and (assassinations, thefts, rapes etc.) education services) . Increased levels of poverty . Increased levels of disease and ill- health Health . Increased mortality and morbidity . Children – esp under-nourished (epidemics -HIV/AIDS . Increased poverty and poor and others, illness, . Increased cost of health services . Children in poor households or injury, disability, etc.) . Increased deaths households with high . Increased number of orphans dependency ratios and few . Economic stagnation income-earners . Loss of human capital

Socially-enforced . Discrimination (age, sex, social . Women and girls inequality status, etc.) . Migrants . Reduced or inferior access to social . Certain ethnic minorities (e.g. services (esp education) pygmies in central Africa, ‘non- . Reduced access to income earning indigenes’ in Nigerian provinces, opportunities etc.) . Denial of ownership of assets . People suffering stigmatised . Denial of participation in life of illness – HIV/AIDS, leprosy, community and informal social mental illness protection

12 Differentiation across the countries of WCA

An analysis of Table 2 suggests the following regional groupings:

1. Low income, very high poverty, major conflict/post-conflict countries with stagnant/deteriorating and very poor child development indicators (CAR, Chad, DR Congo, Cote d’Ivoire, Liberia, Sierra Leone, Togo) 2. Middle income conflict/weak governance countries with stagnant child development indicators (Cameroon, Congo Rep) 3. Low income, high or very high poverty and minor conflict/post-conflict countries, with weak governance, but improving yet still very poor child development indicators (Guinea, Guinea- Bissau, Niger, Nigeria) 4. Low income, medium to high poverty and minor conflict/post-conflict countries with weak governance, but improving yet still poor child development indicators (Benin, Burkina Faso, Gambia, Ghana, Mali, Mauritania, Sao Tome e Principe Senegal) 5. Middle income and medium poverty countries with improving child development indicators (Cape Verde, Gabon) 6. High income, weak governance country with deteriorating and very poor child development indicators (Equatorial Guinea).10

In addition to the rural-urban and education level disparities already commented on, the Club du Sahel categorisation of economic zones in West Africa,11 which has been adapted for Table 2, reveals differing patterns of economic vulnerability and risk. The landlocked Sahel has lower GDP, higher poverty rates, higher proportion of children and higher hhld dependency ratios; this tends to hold for the Sahelian regions within multi-zone countries also (e.g. Nigeria, Burkina Faso). Macro- economic shocks in the sahel zone are linked to agriculture and pastoralism, notably drought and locusts, but with an element of recurring ‘shocks’ such that ‘hungry seasons’ are an annual phenomenon. These zones are also providers of child migrant labour to the more prosperous and less seasonally-cyclical economies of the West African coast and cities, generally found within the “Gulf of Guinea” countries. The forested economies tend to be more dominated by subsistence livelihoods, with accompanying high levels of poverty and rural population, with a few natural resource sectors dominating exports and political competition (and widely believed to be a significant factor in the devastating conflicts that have occurred with much greater frequency in these countries than elsewhere in the region).

Childhood poverty and vulnerability – key frameworks While it is important to understand broader national, community and household poverty and vulnerabilities, there is a growing body of literature that emphasises the specific nature and manifestations of childhood poverty (see e.g. Marshall, 2004). This section begins by outlining some key frameworks and the extent to which they contribute to an analysis of childhood poverty and vulnerability. It concludes with a summary of the distinctive features of childhood poverty and vulnerability.

10 Recent poverty rate figures not available 11 includes Cameroon and Chad. Available at http://www.oecd.org/document/60/0,3343,fr_38233741_38246666_38266492_1_1_1_1,00.html#landlocked 13 Money-metric poverty measures Measures of household income or consumption can be used, together with demographic data, to calculate the numbers of children growing up in poverty. Thus, for example, Kakwani, Soares and Son (2006) have combined household poverty measures with data on household composition to produce estimates of the numbers of children living in poor households for 15 African countries, 7 of which are in the WCA region.

This type of information is important, as household income or consumption figures can reveal (to some extent) the distribution of wealth, income and levels of consumption across populations. .It can be used to complement measures of human development outcomes and qualitative enquiries into socio-economic processes. However, there are limitations to it for our purposes. Household, poverty is obviously likely to strongly affect children’s poverty; but it is not the same phenomenon. Such traditional monetary measures of poverty and sources of data are problematic for the following reasons:

. data is not collected from children themselves but carers; . children have different needs to adults; . children’s employment may be in the informal economy; . non-market channels may be more important in shaping childhood poverty; . children’s access to and control of income is extremely marginal, and . resources and power are distributed unequally within the household.12

Moreover, in the WCA region, recent and comprehensive poverty data of this sort is not always available in any case.

Townsend centre: deprivations in relation to children’s needs The Townsend Centre for International Poverty Research used the UN Convention on the Rights of the Child (CRC) as the basis for constructing a core set of measures of child deprivation for its study of child poverty for UNICEF. The key dimensions of this are access to water and sanitation, shelter, information, health, food and education There are clearly significant similarities with other exercises in constructing multi-dimensional poverty and development indicator sets, such as the MDGs. This framework has the advantage of combining measures of outcomes with those of access to services which are known to impact on outcomes (e.g. formal education, healthcare). However, missing is any direct attempt to gather data on “child protection” issues – such as domestic violence, exposure to conflict, female genital cutting, child labour and status in household (e.g. whether fostered children are especially vulnerable to deprivation). Income/consumption measures are also not included in this analysis.

UNICEF child rights approach to poverty UNICEF, following the UNCRC, has employed a rights base approach to poverty. This framework is based on four core inalienable and linked rights: the right to survival (especially adequate nutrition, health, shelter, water), the right to development (especially access to education and adequate care), the right to protection (from violence, exploitation and abuse) and the right to participation. The focus on child protection is particularly relevant for this project, given that this is one of the 7 core questions mapped out in the project’s TOR, but few social protection initiatives have made this explicit link. UNICEF maps out a number of priority categories of abuses against which children need to be protected:

. Violence against Children . Child combatants . Children Affected by HIV/AID S . Birth Registration (absence of) . Child Labour . Child Marriage . Children and the Justice System . Children without Parental Care . Commercial Sexual Exploitation . Female Genital Mutilation/Cutting . Trafficking

12 Jones and Sumner, 2007. 14 All of these issues are relevant to children in WCA, although some are more prevalent in some areas than others. Thus the Sahelian and rural subsistence farming areas tend to be sources of child migrant labour, with coastal cities and commercial farming areas the destinations; children affected by conflict are obviously found more in countries that have experienced major armed conflict, but also in refugee populations; female genital cutting rates and practices vary across the region and within countries (e.g. in Mali, over 90% of girls in rural and urban areas have experienced FGC, with the exception of the Saharan areas where rates are 33%).13

Within these general patterns, a more detailed examination of these phenomena is necessary to uncover the precise situation of children and inform social protection strategies and priorities. This will not be possible to do for the region as a whole within the time permitted, but might be useful for the case studies. For example, fostering appears very prevalent across the region, with typically around 20% of households in each country containing at least one fostered child; but this covers children in a wide range of circumstances, from those who have migrated for education, to those who have done so for work, or who are orphaned or otherwise excluded from their parental home.14 It will also be important to unpick debates about what forms or quantities of child labour are harmful, and what forms of protection do children who migrate for work need – while not all such practices are ‘traficking’, ‘traditional’ patterns of seasonal migration may raise child protection issues also.

Lifecycle vulnerabilities15 A useful framework for assessing age-specific vulnerabilities and their relational and dynamic nature is the lifecycle vulnerabilities approach. It focuses on the ways in which different vulnerabilities may arise at different ages, how they affect future life stages, and how they may be ‘triggered’ by other actors in the household, or wider society. The table below illustrates this by using the example of high risk child labour.

Vulnerability ‘Trigger’ events double burden of occupation and schooling Care-giving responsibilities to other siblings lack of access to education child labour outside the home Pressure from family due to low household entry into high-risk employment categories, income, which may lead to school drop-outs prostitution low productivity and few opportunities Meso/macro-economic stagnation (isolation) early withdrawal from school – esp. girls Societal norms

The framework developed by the Childhood Poverty Research Centre (CHIP)16 takes a similar approach but focuses on the deprivations that, when experienced in childhood, are the most important drivers of the inter-generational perpetuation of poverty.

Deprivation Explanation Indicator/data required Under nutrition Micronutrient deficiencies can irreversibly Child stunting is the key indicator (child and damage children’s mental and physical of long-term malnutrition (and mother) development, leaving them more vulnerable thus also chronic childhood to poverty in later life; maternal nutrition is poverty.) also key to healthy development of the foetus. Health shocks Acute diseases kill or impair the . Infant and under-five mortality development of millions of children. rates . Prevalence of acute diseases Missed schooling Missed schooling (or low educational . Primary school attendance achievement) can undermine all other . Primary school achievement

13 DHS 2001 14 DHS database 15 Adapted from Sabates-Wheeler and Kabeer (2003) 16 Harper 2004 15 efforts. It not only leads to lost employment . Secondary school attendance opportunities in adulthood, but also makes . Secondary school it harder to make use of health and other achievement public facilities (thus helping perpetuate an . Reasons for non-attendance intergenerational poverty cycle). or non-achievement To be disaggregated by gender Nurture, care, Key for long-term psychological wellbeing . Qualitative data on household family and and positive aspirations. It requires hhlds use of time, division of labour societal with time (not working all hours to make and social norms protection ends meet) and positive social norms, . Quantitative data on income rather than ones which discriminate or or wealth and occupation, teach low aspirations (e.g. gender disaggregated by gender and discrimination or rigid caste or ethnic ethnic group (or other relevant hierarchies). social category) . Data on child protection issues such as FGC, intrahousehold violence, school violence, trafficking, child labour etc.

In sum, an understanding of the characteristics and dynamics of childhood poverty and vulnerability are critical for designing an effective social protection system for children. Childhood poverty and vulnerability, although significantly shaped by household-level poverty, is both analytically and empirically distinct.17 There are at least four distinctive features of childhood poverty which will underpin our analysis in subsequent blocks: i) Dynamic life stage: Although universal Piaget type models of child development have been rightfully criticized for under-estimating the important interplay of environmental, social and cultural factors in shaping children’s experiences of childhood, most (able-bodied) children do undergo certain physical and neurological transformations over the course of the first decades of life. Proponents of a rights- based approach to child well-being similarly point to children’s evolving capacities over time (e.g. Lansdown, 2005). Better understanding such dynamics and processes that might reinforce or reverse ‘patterns of disadvantage or benefit’ (WeD, 2003) is a matter of urgency in light of a growing body of scholarship on life-course and intergenerational impacts of childhood poverty. This literature emphasizes the importance of tackling childhood poverty not only in its own right but also due to possible life-course and intergenerational transmissions of poverty. There is a need to unpack “the linked set of processes that may result in, or entrench, childhood, adulthood or chronic poverty, rather than outcomes or experiences during a specific period of time” (Harper et al, 2003:3). As Sen (1999:4) argues, “…capabilities that adults enjoy are deeply conditional on their experiences as children”. ii) Multi-dimensional and heterogeneous Childhood poverty is also multi-dimensional and needs to take account of the complexities of childhood biological, neurological, social and moral development (e.g. Yaqub, 2002, Ridge 2002). Children are not only more vulnerable (for physiological and psychological reasons) but also have less autonomy/power than adults in domains and decisions that affect their lives (economically, environmental health risks etc). These universal characteristics of child development are however experienced in diverse ways as children are a heterogeneous group living in divergent socio-economic conditions and cultural contexts18 with distinct needs and concerns. Although such

17 Note that this discussion draws heavily on Jones and Sumner, 2007. 18 The diversity of childhoods is not well recognized in development discourse and practice. As Wood (1985 quoted in White 2002:2) argues, “Children become 'cases' which are 'disorganised' from their own context and 're-organised' into the categories given by development intervention”. Whereas there is much broader acceptance of ‘gender’ and ‘sexuality’ as social divisions that are not natural or ‘god-given’ but culturally constructed, recognition of childhood as a culturally constructed phenomenon, whereby children in different 16 diversity (e.g. based on gender, ethnicity, disability and sexuality) is also true of adults, the heterogeneous impacts of age and parental status arguably heighten the variation in childhoods. iii) Voicelessness While it is true that all socially excluded groups may lack opportunities for voice and participation, the conventional voicelessness of children has a particular quality and intensity. Children are not only legal minors, with no right to vote or to make decisions without the approval of their legal guardian, but efforts to promote child participation notwithstanding, their denial of voice in family, school and community decisions is still viewed as ‘normal’ and culturally acceptable in many parts of the developing (and developed) world. iv) Relational nature Finally, in recent years scholars have paid increasing attention to the relational nature of well-being (e.g. White, 2002) and the importance of care (especially for young children and the elderly) (e.g. Folbre and Bittman, 2004, Lewis, 2002). In order to understand child well-being, exploring intra- household dynamics and arrangements of care are critical given children’s greater vulnerability and reliance on (usually) adult care (Marshall, 2003). However, as research on child headed households and the gendered dimensions of child work has underscored, intra-household dynamics especially in large impoverished households often entail children, especially girls’, shouldering of part of the care management burden (e.g. Kabeer, 2003).

A considerable body of research evidence has emphasised the ways in which children are situated and influenced not only by their household environment, but also by their neighborhood, school and society (e.g. Becker et al., 1998; Ruel et al, 1999). Although the current emphasis in the literature on children as ‘participant agents’ in social relations (Mayall, 2002) who shape their circumstances and social structure is a necessary correction to conceptualisations of children as passive and targets of social intervention, it is nevertheless the case that due to unequal power and decision-making relations child well-being is more dependent on community and social influences than that of adults. As White (2002:2) argues, “'Child-centred' development practice must not be 'child-only': social and economic justice for poor children must be tackled in the context of their families and communities”.

cultural contexts have divergent sets of rights and responsibilities, is more recent and poorly understood outside childhood studies circles (e.g. Platt, 2003). The general tendency is for children to be studied for what they will become rather than as social actors in their own right (Corsaro, 1997). Moreover, it is a politically charged issue.

17 Table 1.2: WCA countries with poverty, deprivation and vulnerability indicators Poverty and economy Child development and deprivation indicators Political context Poverty Govt Extreme rate net Townsend social poverty (PPP child birth primary secondary index T. index % T. index % spend income group rate (PPP $2/day) economic zone Trend in child development stunting regist’n completion enrolment % in absolute health info. (% GDP/ country (WDR2008) $1/day) or pattern indicators U5MR (%) % % % Poverty deprived deprived budget) Benin low 31 74 Gulf of Guinea improving but poor 150 30 70 65 - 64 19 27 Burkina Faso low Landlocked improving but poor 191 39 - 31 11 81 18 22 27 72 Sahel Cameroon lower middle Gulf of stagnant/deteriorating 149 32 63 62 40 51 19 22 4/16 17 51 Guinea/oil Cape Verde lower middle 12 56 Island improving, medium 35 - - 81 58 - - - Central low landlocked very poor, stagnant/deteriorating 193 - 73 23 - 61 24 17 African Republic 68 84 Chad low Landlocked very poor, stagnant/deteriorating 208 41 9 32 - 86 50 43 82 94 Sahel Congo, DR low mining/agric/ very poor, stagnant/deteriorating 205 - 34 - - 76 31 52 91 96 forest Congo lower middle stagnant/deteriorating 108 25 - 58 - - - - 3/16 Republic - - Cote d'Ivoire low 15 49 Gulf of Guinea very poor, stagnant/deteriorating 195 25 72 40 - 41 26 17 Equatorial upper middle Gulf of very poor, stagnant/deteriorating 205 - 32 54 - 35 33 - Guinea - - Guinea/oil Gabon upper middle Gulf of improving, medium 91 21 89 ------Guinea/oil Gambia low 36 78 Atlantic sahel improving but poor 137 - 32 - - 28 8 20 Ghana low 45 79 Gulf of Guinea improving but poor 112 29 67 72 37 39 10 18 8/20 Guinea low 65 89 Atlantic forested improving but poor 150 35 67 54 24 66 25 23 Guinea- low Atlantic forested improving but very poor 200 - 42 27 - 54 22 - Bissau 79 93 Liberia low - - Atlantic forested very poor, stagnant/deteriorating 235 ------Mali low Landlocked improving but very poor 218 38 47 38 - 58 32 14 36 72 Sahel Mauritania low 26 63 Atlantic sahel/oil improving but very poor 125 35 55 45 15 66 21 24 Niger low Landlocked improving but very poor 256 50 46 28 8 84 45 23 61 86 Sahel Nigeria low Gulf of improving but very poor 194 39 30 82 27 46 39 17 71 92 Guinea/oil Sao Tome e low Island improving but poor 118 - 70 77 32 - - - 10* Principe - - Senegal low 17 56 Atlantic sahel improving but poor 136 16 62 52 21 35 - 8 7/17 Sierra Leone low 57 75 Atlantic forested very poor, stagnant/deteriorating 282 - 46 - 19 51 17 3 Togo low 66 90 Gulf of Guinea improving but poor 139 82 65 - 53 19 22

18 Notes on data sources:

Income category World Development Report 2008 Poverty rates World Development Report 2008; Chad, Congo DR, Gambia, Guinea, Guinea-Bissau, Togo – UNCTAD Least Developed Countries Report 2002 Economic zone OECD 2006 (adapted) Child development Classification by author; data from State of the World’s Children 2007 trends U5MR State of the World’s Children 2007 Child stunting DHS statcompiler Primary completion, African Development Indicators 2007 secondary enrolment; Townsend indices Gordon et al (2003) Centre for International Poverty Research report to UNICEF Government social As a percentage of: GDP/budget. Sources: GDP - ; budget – IMF (2005) spending Government Finance Statistics Yearbook Armed conflict Classification by author; data sourced from International Crisis Group

19 Block 2: Assessment of existing social protection systems and their impact on children

The aim of Block 2 is to provide an overview of the existing social protection systems and programmes in the region and to analyse their impact on children.

As discussed in our proposal, it is first important to present a working definition of social protection which will be used to define the scope of research in line with the ToRs. Currently there are a range of definitions of and frameworks for social protection which are often very broad in scope. Often, social protection is defined as encompassing a sub-set of public actions, carried out by the state or privately, that address risk, vulnerability and chronic poverty. Operationally, social protection can be defined by sub-dividing it into three key components (DFID 2005):

 Social insurance – which involves individuals pooling resources by paying contributions to the state or a private provider so that, if they suffer a shock or a permanent change in their circumstances, they are able to receive financial support. Social insurance is, in general, more appropriate for better-off individuals although it can have an important role in preventing people from dropping into poverty. Examples of social insurance include unemployment insurance, contributory pensions, health insurance.  Social assistance involves non-contributory transfers to those deemed eligible by society on the basis of their vulnerability or poverty. Examples include social transfers (non-contributory pensions, child welfare grants) and other initiatives such as public works and school or health fee waivers.  Standards refer to the setting and enforcing of minimum standards e.g. to protect citizens within the workplace, minimum standards for protective services for children. This sub-set is often seen as providing an enabling environment in which social protection programmes can operate effectively.

We discuss five key frameworks below which have been influential in framing the debates around social protection to arrive at an appropriate conceptual framework for this study.

From the outset it is important to note that for this study we concur with Marcus (2007) that “social protection policies and programmes are best understood as those which aim to help poor and vulnerable people manage risk and counter deprivation, through direct cash or in-kind transfers. However, to be effective social protection measures need to be complemented by wider policy reforms and actions that help reduce risks and promote social equity and inclusion” (1).

Marcus’ definition is particularly useful here because it recognises core social protection activities and the necessary linkages with other services and programmes in other sectors to address the multi-dimensional nature of childhood poverty and vulnerability. Defining these parameters enables the scope of the research study to be kept manageable, both conceptually and practically, whilst also paying attention to complementary actions that could address non-economic/ non-material dimensions of childhood poverty and vulnerability, especially exploitation and abuse, and voicelessness.

Indeed, for this study, we conceptualise vulnerability at the household level, and also pay particular attention to the distinctive features of childhood poverty and vulnerability. We use Dercon’s (2005) definition of household-level vulnerability as the state of being in which people are not able to cope with threats to their well-being

20 or access to resources without incurring a damaging loss (Dercon 2005). In other words, we are concerned with vulnerability to poverty (the probability that people will be poor in the future) (Barrientos and Shepherd, 2003).

We also argue that there are at least four key dimensions to childhood poverty and vulnerability: a) childhood is a dynamic life stage in which children’s capacities are evolving. Windows of opportunity thus tend to be more finite – missed opportunities as a child may be difficult to overcome and have lifelong and irreversible effects; b) children require more care and protection than adults as they are not only undergoing complex biological, neurological, social and moral development, but they are also more vulnerable to disease, abuse and exploitation; c) children are often voiceless with little opportunity to participate in decisions about their life; and d) because of higher levels of vulnerability and reliance on adults, childhood poverty has a strong relational nature meaning that intra-household dynamics and distribution of power and resources may have a profound effect on their experience of poverty. Table 2.1 presents the types of social protection programmes and institutional actors responsible for delivering a social protection package for children. Importantly it shows the distinctions between core social protection activities and necessary complementary programmes to address childhood poverty and vulnerability which help to guide the scope of this study.

In addition, Figure 2.1 demonstrates where the conceptual and programmatic linkages of formally delivered social protection can occur with other public sector interventions and policies. It also emphasises that across the range of social protection interventions in both social and economic sector spheres, social protection needs to be delivered by a variety of institutions. We have highlighted the social protection interventions in cross-cutting areas and the linkages which are most appropriate for the scope of this study. This is particularly important when we distinguish core social protection activities from necessary linkages to enable social protection programmes to function effectively.

21 Table 2.1: Social protection package for children Core social Specific elements Actors responsible protection actions Social assistance Cash transfers (either child benefit, pension or social assistance to poorest); cash for Governments, typically Ministries of work; in-kind transfers Finance/Economics, Social and Labour Affairs, Rural Development (supported by Provision of direct nutritional assistance (e.g. school feeding, food transfers) where donors, including UNICEF); necessary (i.e. where cash-based social protection does not guarantee essential nutrition to esp. vulnerable groups). Social insurance Social health insurance Ministry of Health (supported by donors, including UNICEF); NGO involvement in pilot/demonstration projects Targeted social Measures to reduce/ eliminate cost barriers facing poorest/ vulnerable groups (e.g. Ministries of Planning, Education, Health, services fee waiver/ exemptions for education and health services) Women and Children (supported by donors, including UNICEF); NGO involvement in pilot/demonstration projects Complementary actions Basic services for Actions to improve the supply and quality of basic services (education, health, child Ministries of Education, Health, Women and children and their protection), and to strengthen systems (particularly health and child protection); Children, Justice, Finance and Economy. carers including adequacy of social sector budgets and predictability of aid. Social equity Legal and regulatory frameworks to promote anti-discrimination and citizenship rights Ministries of Women and Children, Justice provisions for women and children. Communication and awareness raising about these issues, esp. sensitisation of law enforcers Source: Adapted from Marcus, 2006.

22 Figure 2.1: The scope of social protection

Implementing Agencies of formal SP activities

Ministries of Health, Ministries of Labour, Education, Children and Community Ministries of Youth; NGOs Development, Social Agriculture, Trade; Affairs, Gender; NGOs NGOs

Social Protection e.g. direct welfare transfers and productivity enhancing activities

Social sector Market based instruments instruments e.g. school e.g. inputs feeding subsidies programmes, targeted nutrition Economic Sector E.g. agricultural Social Sector extension programmes, E.g. health and education market linkages services, child protection programmes, trade interventions policies

Justice e.g. anti- discrimin. legislation

Source: Adapted from Slater and Tsoka (2006)

23 Social protection frameworks Of particular importance to this study is to use an approach/framework which conceptualises both economic and social risk and vulnerability. Childhood poverty and vulnerability is multi-dimensional, and includes not only economic poverty and deprivation, but also social inequality and exclusion. Minujin et al. (2007) argue that the “orthodox ‘economic’ or ‘market’ bias in most analyses and policy recommendations disregards specific but relevant needs of children that are not addressed by the market” (p. 42).

In order for social protection to address childhood poverty and vulnerability, social protection policies will need to provide a holistic approach which considers programmes and policies which prevent families entering into life-long income poverty, and programmes and policies which promote social inclusion and protection, such as gender equality, or the Convention on the Rights of the Child (Minujin et al. 2007).

Understanding the political and institutional contexts in which social protection operates is also vital to this study. The decision and implementation of social protection policy and programmes is inherently political, for instance, where the policy originates (e.g. a rights based approach as in the case of the National Rural Employment Guarantee Act in India), whether social protection should be targeted or universal, or the processes of intra-household decision making. These political and institutional aspects have both direct and indirect impacts on ways to address childhood poverty and vulnerability through social protection.

We present a number of social protection frameworks which we will briefly discuss here.

Holzmann and Jørgensen (2000) at the World Bank developed the Social Risk Management (SRM) framework. This framework defines social protection as “public interventions to (i) assist individuals, households, and communities better manage risk, and (ii) provide support to the critically poor.”

The framework presents social protection as a safety net and spring board. Through various mechanisms it reduces risk which, it argues, aims to enhance individual and social welfare; contribute to economic growth and development; and contribute to sustainable poverty reduction. The main elements of the social risk management framework consist of:  Risk management strategies (risk reduction, mitigation and coping);  Risk management arrangements by level of formality (informal, market-based, and publicly provided or mandated), and  Actors in risk management (from individuals, households, communities, NGOs, market institutions, government, to international organizations and the world community at large)

The framework has been instrumental in thinking about social protection in development contexts, but has been criticised for having a narrow understanding of risk which focuses on income shocks, a limited understanding of vulnerability and the socio-political structures which contribute to chronic poverty, and a peripheral integration of a rights-based approach to social protection (Guenther et al. 2007; Devereux and Sabates-Wheeler 2004).

Indeed, the approach to social protection promoted by many international institutions (IFIs and donors) which has focused on responding to specific market (economic) shocks for specific groups affected has largely dismissed the human rights principle that all members should benefit from social protection (Minujin et al. 2007). Minujin et al. (2007) argue, in a recent paper written for UNICEF’s conference on social protection, that the social protection debate should move beyond economic risk and stress the role of “solidarity through the life cycle” (p. 33). In this way, a broader conception of linking the different origins of social insurance (related to labour rights) and social protection (focused policies to reduce extreme destitution), would entail redistribution of income and a minimum standard of living for all the population, including children (Minujin et al. 2007 p.33).

24 Sabates-Wheeler and Kabeer (2003) move some way towards addressing this “social” and “economic” approach to understanding risk and vulnerability by taking a gendered and life-cycle framework approach to understanding vulnerability, and examine how social protection interventions can be made more gender-sensitive.

The authors take their starting point from the disadvantaged position of women in relation to work opportunities in comparison to men from equivalent social groups, and argue that women are more likely to be excluded from social protection strategies. A framework is presented to understand gender segmentation of the work force more fully. They present three categories:  Gender specific constraints to the participation of women in the labour market and household livelihood activities. These apply to either men or women because of their gender. For women, this reflects their biological role in reproduction as well as social role of caring, which largely takes up women’s time away from being in paid employment  Gender intensified constraints come from gender-specific beliefs and customs reflecting gender inequalities in opportunities and resources. For women these constraints are found especially in intra-household inequalities, which are sometimes reflected by community/society norms, e.g. customary law (lack of inheritance rights etc.)  Imposed gender constraints are forms of disadvantage which reflect external biases and preconceptions. E.g. employers who refuse to recruit women, or only employ them in stereo- typical female jobs; trade unions who do not encourage women members.

The framework makes an important contribution to placing social and structural inequalities at the centre of a social protection framework. Its narrow focus on the labour force and extending social protection to informal workers however, limits the applicability of the framework for this study.

Hickey (2005) presents a framework which attempts to understand the inter-relationships between social protection and politics. The framework focuses on three forms of politics that are: systemic (e.g. political institutions); societal (e.g. public attitudes); and institutional (e.g. historically embedded ‘rules of the game’). He also suggests that there is a global politics to social protection that cuts across these inter-related dimensions, within which donors and related international policy discourses are particularly relevant.

Hickey argues that conceptualising these inter-relationships as a “political contract” offers an explanation of the ways in which political factors from these dimensions combine in ways that shape the extent to which the poorest groups benefit from social protection. The political contract framework is based on the understanding that contractualism is a “political relationship that places a premium on the political capacity of the individual to bargain within an adequate range of available choices and options". In framing the recipient as an actor rather than a passive recipient, the empowering potential of social protection remains in tact and transcends the 'hand-out' culture with which it is currently associated in many countries in Africa.

Hickey’s framework provides an important conceptual understanding about the political context which influences both provision and access to social protection. Elements of this framework will be useful in informing parts of the study on institutional analysis and engagement in political processes around social protection.

Guhan (2004), provides the foundation for the ILO framework, and suggests that social protection is differentiated between:

 Protective measures – which have the specific objective of guaranteeing relief from deprivation  Preventive measures – which directly seek to avert deprivation in various ways; and  Promotional measures – which aim to enhance real incomes and capabilities

25 The categories usefully suggest a gradation of interventions, proceeding from a narrow domain (protection measures in the form of safety nets) to increasingly broader domains (preventive and even promotional measures).

This framework however, also lends itself to same criticisms as the World Bank framework above, by overlooking the importance of social risk and vulnerability. Devereux and Sabates-Wheeler (2004) therefore build on the above ILO framework to develop a conceptual definition of social protection which includes addressing concerns of social equity and exclusion – the transformative element. The transformative element seeks to: “Address concerns of social equity and exclusion, such as collective action for workers’ rights, or upholding human rights for minority ethnic groups.”

Importantly this “political” or “transformative” view extends social protection to arenas such as equity, empowerment and economic, social and cultural rights, rather than confining the scope of social protection to targeted income and consumption transfers (Devereux and Sabates-Wheeler 2004). This is particularly important in the context of this study, where we are interested not only in children’s rights to survival and development, but also to protection from abuse and violence.

The framework offers a conceptual understanding of economic risk and vulnerability which relates to long-term poverty and chronic poverty as well as the impacts of external shocks to the household. Most importantly it also includes a conceptual understanding of social risk and vulnerability in terms of social inequality and social exclusion. Transformative interventions recognise the socio-political environment and include changes to the regulatory framework to protect “socially vulnerable groups” (e.g. people with disabilities, or victims of domestic violence) against discrimination and abuse to transform public attitudes and behaviour and enhance social equity.

Of particular importance to this study, it seeks to understand and use linkages to social protection policies to address the intra-household division of resource ownership, access and use. Social protection instruments must include a substantial “transformative” element, in the sense that power relations between men and women, adults and children, become more balanced. Appropriate legislation is necessary, but this goes only a small way to changing socio-cultural values (Devereux and Sabates-Wheeler 2004 p.8/9). The importance of women’s empowerment for children’s wellbeing is well known (UNICEF, 2007). However, a recent study by Jones et al. (2007) shows that in Andhra Pradesh, India, although improvements in women’s intra-household decision-making power led to greater investment in children’s nutrition, health and education and increased access to information about child caring practices and services, increased school enrolment and a reduction in child labour was brought about largely due to complementary child-focused policy interventions. Understanding these complexities and especially the extent to which improvements in child well-being stem from reductions in household and gender poverty versus targeted child-focused interventions will be a key challenge in this study.

Social Protection framework for this study Given the importance of both economic and social risk and vulnerability for households, and in particular the types of risk, exploitation and poverty which children in the West and Central African region face, we propose to adapt Devereux and Sabates-Wheeler’s (2004) transformative social protection framework for this study which encompasses protection, prevention, promotion and transformative social protection measures. Operationally, it refers to social protection as the set of all initiatives, both formal and informal, that provide: social assistance to extremely poor individuals and households; social services to marginalized groups who need special care or would otherwise be denied access to basic services; social insurance to protect people against the risks and consequences of livelihood and other shocks; and social equity measures to protect people against social risks such as discrimination or abuse. As mentioned above, in reference to Table 2.1, we see social assistance and social insurance as core social protection activities, and envision essential linkages to social services and social equity instruments to reduce childhood poverty and vulnerability.

26 The conceptual definition states:

Social protection describes all public and private initiatives that provide income or consumption transfers to the poor, protect the vulnerable against livelihood risks, and enhance the social status and rights of the marginalised; with the overall objective of reducing the economic and social vulnerability of poor, vulnerable and marginalised groups.

We also propose to include various elements of Hickey’s political framework in order to understand the political and institutional context of social protection in the region. This will aim to help find appropriate policy entry points for UNICEF’s engagement with social protection in the region, as well as identify the processes and opportunities in which social protection can be politically sustainable and develop (and operationalise) a state-citizen contract which has citizenship rights at its centre.

2.1. Description/mapping of the existing social protection systems Mapping existing social protection systems in the five country case studies will provide an overview of the current social protection programmes and policies in those countries. As the ToRs state, the mapping should be broad in scope, covering “social assistance, social insurance and protection services”. However, it must also be kept within manageable parameters and be in keeping with our definition of social protection. The matrix below lists the potential types of social protection programmes and key information needed about the programmes in each country. The list of programmes which are included in the matrix is informed by our conceptual framework and also guided by the types of interventions discussed in Table 2.1 above (adapted from Marcus 2006).

Given the importance of child protection to this study, it is also included in the matrix below. Whilst we see child protection services as a complementary service to core social protection activities, inclusion of child protection services within the matrix will provide a useful link to block 5. We hypothesise that it may also be the case that government agencies responsible for delivering social protection may also be involved in providing social protection services, and thus unpacking these linkages will be of value.

Additionally, to place social protection in a contextual historical context, we will briefly look at traditional, non-formal, kinship-based solidarity systems that exist in the country case study societies. We will aim to gain an understanding of their existing importance in societies as an informal social protection mechanism, and also their limitations (for example, limited coverage), and whether they are declining (due to, for example, modernisation, urbanisation and changes in family/kinship relations).

In order to make this mapping useful, we will aim to gather as much information as possible on existing schemes which cover a significant number of the population19, or, in the case of small pilot schemes, which have evaluation reports from which to gather sufficient information so as to fill in the majority of fields in the matrix. We will draw on key informant interviews to understand the political economy context of the evolution of such schemes.

19 Definition to be determined at Abidjan workshop.

27 Mapping Social Protection Interventions in the Five Country Case Studies Type of SP Programme Time frame Admin Funders Programme Amount Targeting / Coverage Cost Method of Results / title Arrangement objectives of transfer eligibility USD evaluation outcomes

Social assistance In-kind Unconditional cash transfer Child grants Social Pensions Disability allowance Conditional cash transfer for human development Fee waivers Food transfers School feeding Targeted nutrition Public works Micro-credit Informal - - - transfers Child protection services Services to tackle harmful forms of child labour Services to tackle sexual violence and trafficking of children Services to tackle physical or psychologic al violence against 28 children, including harmful traditional practices Social insurance Health insurance Social equity (transformat ion) Regulatory frameworks to protect vulnerable groups

29 Methodology Secondary data will be collected on the five case study countries in the region through a brief literature review of relevant social protection studies, policy documents and programme documents from key Government and non-government organisations which are currently implementing social protection programmes.

This will be supported by key informant interviews with key stakeholders in the five country case studies to obtain detailed information in those countries where we have identified gaps in knowledge. Interviews will be held with Ministries, UN and NGOs implementing social protection programmes.

2.2. Analysis of the impact of existing programmes on the reduction of poverty, vulnerability and risk among children Using the poverty and vulnerability data collected in Block 1, and information on the existing social protection programmes above, we will review the extent to which the existing social protection programmes address the sources of poverty, vulnerability and risk in the region. This will be done by using existing evaluation reports, and/or key informant interviews in the case study countries, to assess programme objectives, length, type and amount of transfer, target group and coverage against the key poverty and vulnerability issues identified in Block 1. This analysis will be mainly limited to the information gathered on social protection interventions in the five country case studies. Where social protection programme evaluations are available for other countries in the region, they will also be used.

In particular, we will aim to find out i) if the objectives of the programme address the causes of vulnerability, poverty and risk for households in the region; ii) if the length of the programme is sufficient to address needs and achieve programme objectives; iii) the extent to which the type and amount of resource transferred addresses inter- and intra- household poverty and vulnerability iv) the level of inclusion and exclusion errors from targeting (programme data permitting).

Through this analysis we will identify the key gaps where existing social protection is not adequately addressing the dimensions of poverty and vulnerability for households in the region, and childhood poverty and vulnerability in particular.

Methodology The analysis will be based on the literature on existing levels of poverty and vulnerability in the region from the data collected in Block 1 and the Social Protection Mapping – in particular, from evaluation reports. This will be supported by key informant interviews in the case study countries.

2.3 Analysis of political, institutional and implementation constraints

The aim of this final section in Block 2 is to identify the potential political, institutional and implementation constraints which social protection programmes face, and what measures have been put in place to overcome them.

In order to make this relevant for countries given their different political and institutional contexts, we will categorise countries according to the following typologies identified in Block 1:

7. Low income, very high poverty, major conflict/post-conflict countries with stagnant/deteriorating and very poor child development indicators (CAR, Chad, DR Congo, Cote d’Ivoire, Liberia, Sierra Leone, Togo)

30 8. Middle income conflict/weak governance countries with stagnant child development indicators (Cameroon, Congo Rep) 9. Low income, high or very high poverty and minor conflict/post-conflict countries, with weak governance, but improving yet still very poor child development indicators (Guinea, Guinea-Bissau, Niger, Nigeria) 10. Low income, medium to high poverty and minor conflict/post-conflict countries with weak governance, but improving yet still poor child development indicators (Benin, Burkina Faso, Gambia, Ghana, Mali, Mauritania, Sao Tome e Principe Senegal) 11. Middle income and medium poverty countries with improving child development indicators (Cape Verde, Gabon) 12. High income, weak governance country with deteriorating and very poor child development indicators (Equatorial Guinea).20

We will look at the following areas of constraints: institutional arrangements for coordinating and delivering social protection programmes; political support; linking women’s empowerment and reduction in childhood poverty; resource constraints and sustainability; service supply; and socio-cultural attitudes and norms.

Methodology Given the extensive number of countries in the region, we will aim to give a general overview of the issues under the above heading obtained from available evaluations and discussion of existing social protection programmes, supported by key informant interviews from the country five country case studies.

20 Recent poverty rate figures not available

31 Block 3: Assessment of the potential role of social transfers in reducing poverty and vulnerability among children in the region

Social transfers are a sub-set of social protection activities, falling under the “social assistance” component. Social assistance involves non-contributory transfers to those deemed eligible by society on the basis of their vulnerability or poverty. Examples include social transfers (non-contributory pensions, children welfare grants) and other initiatives such as public works and school or health fee waivers (DFID 2005).

The UNICEF ToRs suggest that this Block should limit its focus of social transfers to that of cash transfers in particular (rather than including in-kind and other transfers). Our research agenda for this Block will therefore evaluate the extent to which cash transfers to households with children, based on international evidence, could be a practical, effective and efficient means to reducing poverty and vulnerability among children in the prevailing conditions in West and Central Africa.

In the last few years cash transfers have risen rapidly up the policy agenda as a feasible and appropriate response to chronic poverty, even in countries with low administrative capacities. Emerging evidence on cash transfers from low and middle income countries suggests that they can be relatively easy and cost efficient to deliver, that they can smooth household consumption and income, improve health and education outcomes, empower recipients and in some cases promote asset building.

Evidence also indicates that cash transfers can have positive impacts on reducing child poverty. Devereux et al. (2005) reviewed a number of cash transfer programmes in southern Africa (cash-for-work, direct cash transfer and pension scheme) and found that vulnerable children are able to benefit from cash transfers even if they are not targeted directly. Cash transfers to households were found to be mostly spent on food, clothes and seeds, and meeting the costs of services like education and health. Furthermore, Barrientos and DeJong (2006) find evidence from the child grant programme in South Africa and targeted conditional cash transfers in Latin America that cash transfers are an effective tool in reducing child poverty. In these case studies the strong correlation existing between childhood poverty and the strong correlation of the number of children in a household and the depth of poverty, ensure that cash transfers targeted towards children have strong poverty effects. Additional investments in the provision of basic services are essential to ensure that the demand created by cash transfers is matched by supply.

However, there is a need to carry out careful situational and contextual analyses on the pre-conditions necessary for the success of cash transfers as part of a wider social protection strategy. West and Central African countries include a vast range of different institutional capacities, political regimes and priorities, levels of corruption, depth and spread of poverty and vulnerability etc. which will all need to be seriously considered when discussing the applicability of cash transfers in the region.

32 3.1 Assessment of whether social transfers are a practical, effective and efficient mechanism to reduce childhood poverty and vulnerability and promote well being

Given that cash transfers are increasingly being considered as part of a social protection strategy in many low income countries, there are significant questions being debated in the WCA region around the suitability of cash transfers in WCA. This Block will aim to address three of these questions which have been identified as priority areas of discussion by UNICEF in the region: targeting vs. universal benefits; supply and quality of supply side services; and institutional/administrative capacity to deliver cash transfers.

1. Does targeting make sense in the WCA context?

There are two dimensions to a discussion on targeting. One is the policy decision of who to target; and the second is the practical issue of how to target (e.g. means testing, community based targeting).

There are three key issues which are important in the WCA context to be discussed here: i) the politics of targeting: given the extremely high levels of poverty in the majority of countries in WCA, what are the political influences of targeting specific groups of people, e.g. through categorical targeting? The objectives of a social protection programme will have significant implications as to who is targeted (e.g. does it aim to reduce the poverty gap? To reduce the poverty headcount?). ii) the administrative capacity and resources required to target: what types of targeting could be administratively feasible given the limited institutional capacity and limited resources most ministries who implement social protection have – especially given the proportion of the population living under the poverty line. What options are there for different targeting mechanisms given these institutional and resource constraints and what are the implications for rates of exclusion and inclusion errors? iii) The social implications of targeting: what are the implications of different forms of targeting on community and intra- household relations? Would community based targeting work, or are there risks of ethnic/communal biases and subjectivity problems? Do programmes achieve better welfare results if transfers are targeted to primary caregivers – e.g. mothers?

A recent World Bank study (Coady et al. 2004) of targeting transfers in 122 developing countries showed that targeting can work - the median programme from those observed provides approximately 25 percent more resources to the poor than would random allocations. The best programmes were able to concentrate a high level of resources on poor individuals and households. However, these positive effects are not always realised: in approximately 25 percent of cases targeting was regressive, implying that a random allocation of resources would have provided a greater share of benefits to the poor (Farrington et al. 2007). It also found that implementation strongly influences outcomes. Some of the variability in outcomes is explained by country context: improved

33 performance in targeting may be linked to increased country income levels (the proxy for implementation capacity), the extent to which governments are held accountable for their actions, and the degree of inequality (Farrington et al. 2007).

There is also growing evidence from developing countries that the identity of the recipient of a cash transfer matters in terms of outcomes. Transfers directed at women tend to have a stronger impact on the living standards of children due to gendered social norms and women’s typically greater care work responsibilities (Barrientos and DeJong 2006).

2. Are demand side approaches appropriate in WCA? Both conditional and non-conditional cash transfers are implemented with the objective (either directly or indirectly) to assist households to overcome the financial burdens of accessing basic social services such as health centres and schools - as such, to increase demand for public services by transferring money to the household (and often the mother). This, however, assumes that basic services are actually supplied – both in terms of quality, and quantity.

There are obvious challenges for cash transfers in WCA given the fact that the region has extremely low primary school enrolment/attendance rates and the worst health indicators in the world (including compared to East and Southern Africa) – much of which has to do with limited supply and quality of schools and health centres in these countries.

The implications for this study are two-fold: 1. Does the type of cash transfer influence the appropriateness of cash-based transfers for improving childhood poverty and vulnerability in the region? One could hypothesise that conditional cash transfers based on children’s attendance at school and regular visits to the health care centres would be inappropriate in the short- to medium term for a variety of reasons: limited impacts for children given limited quality of public services, capacity constraints of most governments to implement an effective targeting system, potential distances that families would have to travel, as well as care-givers’ (typically women’s) opportunity cost of time spent adhering to the conditions. However, other forms of unconditional cash transfers in other low and middle income countries, such as pensions or direct cash transfers to households, have shown positive results for childhood poverty and vulnerability indicators. 2. What are the budgetary implications of the trade-offs between investment in supply or demand of basic services? Would it be better for (some) governments to focus mainly (or more) on addressing the supply side problems? This is not only a question of programme efficacy but also a political and financial decision. The budgetary implications will be discussed further in Block 6.

3. Do countries in WCA have the administrative/governance conditions for effective delivery of cash transfers?

Many of the countries in WCA are characterised by low governance indicators and/or conflict or recovering from conflict. Many would be categorised as “fragile” states (DFID 2005). This has significant implications for delivering a cash transfer programme. What are the implications for delivering cash transfers e.g. through the state, or with support

34 from international actors; what are the risks of corruption; and what are the implications of low administrative capacity for different targeting mechanisms?

This section will draw on international experience to identify some of the key institutional and infrastructural pre-conditions necessary to implement a cash transfer. In particular we will look at existing capacities of the public sector internationally and how this effects how and which type of cash transfers can be implemented. We will then draw on evidence which evaluates the institutional strength of the public sector in countries in the region, and examine where the responsibility for cash transfers should be located. It will also look at the extent to which birth registration systems exist in order for children to be eligible to access publicly provided social services.

Unconditional direct cash transfers are perhaps the simplest type of cash transfers to implement in terms of administrative capacity and financial resources, although it does mean that countries are likely to forgo the development of an integrated database system that would facilitate a more integrated approach to addressing childhood poverty. In comparison, the very nature of conditional cash transfers for work as well as cash for human development means that capacity building among the staff in charge of the programme and also in those government agencies covered by the conditions is necessary. For health and education conditional cash transfers to work effectively, inter- agency cooperation across several ministries at the central, federal, and municipal levels is often required, and developing capacity among teachers and health professionals is often needed alongside the coordination of their contribution to the programme.

Importantly, and linked with Section 7, is the extent to which cash transfers are politically acceptable in the region. Is there evidence from national governments and donors that they are interested and willing to invest in a cash transfer scheme? There are a number of initiatives already underway, at both a national and regional level. For example, Ghana’s pilot cash transfer scheme, LEAP, and the African Union’s interest in “Livingstone 2”.

Indeed, some types of cash transfers are more politically acceptable than others. The concerns about cash transfers are partly practical (security, corruption, targeting feasibility) but they are also about attitudes to poor people and the very concept of welfare (Devereux and Sabates-Wheeler 2007). Concern over “dependency” is also a highly political debate in many countries implementing a cash transfer, and has implications for who is targeted, programme design (including the need for exit strategies and “graduation”) and resource sustainability – both the commitment to the level and length of resources needed by government and international institutions. In post-conflict Sierra Leone, discussions with donors indicate that cash transfers must be part of a wider strategy of growth, to be politically acceptable (Holmes and Jackson 2007).

Methodology and sources of information Evidence from other low/middle-income countries’ experiences of cash transfers will be gathered, specifically to demonstrate the necessary political (e.g. who to target, commitment to child poverty reduction) and economic (e.g. institutional capacity, infrastructure, types of targeting mechanisms etc.) pre-conditions for implementing a cash transfer scheme, and to draw lessons on the social effects of cash transfers on children (for example, of targeting the mother of the household). Lessons from different types of cash transfers will be obtained, and their appropriateness and feasibility will be

35 assessed in the region. This will draw on information obtained in Block 1 and 2 (for example, supply of health and education services) and gaps in knowledge will be supported by key informant interviews in the case study countries.

Questions around the affordability of cash transfers, and the potential trade-offs in resource use between cash transfers and supply of health, education and other basic services will be analysed in Block 6.

36 Block 4: Potential role of social insurance (health) in reducing poverty and vulnerability among children in WCA

Block 4 is concerned with the extent to which social insurance can play a role in reducing poverty and vulnerability among children in the region. Social insurance refers to a system whereby people earn benefits in recognition of contributions they make from their pay as workers. Arguments in favour of social insurance include fostering collective responsibility for individual welfare (by the state, employers and individuals); ensuring a basic social minimum for the ‘deserving poor’; fostering a sense that people feel entitled to benefits because they have paid into a system; and promoting greater programme sustainability politically due to this sense of entitlement and strong political pressure against abolition (Classen, 1998). Conversely, however, mechanisms of contribution tend to favour the formal labour market, thereby potentially excluding large numbers of marginalised populations (e.g. women, chronically poor, unemployed, informal sector workers etc.); and in order to make contributions affordable, revenue gained may be too limited to provide quality benefits.

As per the project TOR, we will focus on only one aspect of social insurance, health social insurance, and assess to what extent it could contribute to improved health service access for children and their care-givers, as well as protecting families and children from the risk and poverty-inducing of health shocks and high out-of-pocket medical experiences. We follow Carrin et al. (2001)’s definition of social health insurance (SHI) as “a mechanism for financing and managing health care through pooling of health risks of its members on the one hand, and the financial contributions of enterprises, households, and the government, on the other. It is generally perceived as a financial protection mechanism for health care, through health risk-sharing and fund pooling for a larger section of the population” (12). It is important to be clear from the outset however that we view social insurance as just one possible financing and social protection mechanism for healthcare for children and their caregivers, and will thus approach our analysis from this comparative perspective.

Framework for social protection to improve health service access Health forms a critical component of social protection, underpinned by principles of solidarity and equity: that all individuals are guaranteed access to an adequate package of healthcare for which the financial contributions are based on the ability to pay rather than the degree of illness and health care needed. Drawing on the definition of social protection for children that we presented in the introduction and block 2, social protection in health offers the opportunity to:

. prevent the poverty inducing effects of ill-health and catastrophic health costs, . protect vulnerable populations through relief from ill-health and disease, . promote real incomes and capabilities through smoothing the spending patterns on health and increasing productivity through improved health, and should be embedded within a broader framework of complementary policy and programming action aimed to enhance social equity, especially through facilitating the healthy development of children.

Given that we are expanding our analysis to consider SHI as one among multiple approaches to providing necessary health interventions for children, this block will focus on:

37 1) Identifying as a baseline (drawing from existing literature) the key health vulnerabilities faced by children in West and Central Africa (e.g. malnutrition, infant mortality) 2) Identifying the existing gaps in current health interventions addressing these vulnerabilities amid vulnerable children (e.g. immunisation services, nutrition interventions, primary care) 3) Identifying the most equitable and effective means of providing access to services regarding the gaps identified in 1) and 2) for vulnerable children through health financing schemes. We will focus specifically on the current equity effects of user fees, and the potential expanded role for SHI schemes. We will pay particular attention to the feasibility of making such health financing schemes accessible to vulnerable populations (e.g. largely rural, informal sector populations) and compare the suitability of SHI schemes to other health financing schemes.

Social health protection from debilitating and poverty-inducing effects of disease and malnutrition Health has been recognized as a universal human right for over 60 years since the formation of the World Health Organisation. The signing of Alma Ata promised the realisation of this right through ‘health for all’ by 2000. Children specifically are recognised as having the right ‘to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health’ according to The Convention on the Rights of the Child. This year, for the first time, the number of deaths amongst children under five fell below 10 million (to 9.7 million) (UNICEF 2007). However, significant progress remains to be made, and West and Central Africa continues to have the highest under-five mortality rate (U5MR) in the world, and was evaluated as having made no progress towards the MDG4 target of reducing the U5MR by two-thirds (UNICEF 2007). As can be seen in Figure 1 below, respiratory and diarrhoeal diseases, both of which are highly preventable and low-cost to treat, represent the leading causes of child mortality (UNICEF 2007a). Maternal and child under-nutrition in turn is the underlying cause for 35% of under-five child mortality, amounting to 3.5 million deaths, and 11% of global DALYs.21 Malnutrition undermines children’s ability to ward off infection, while disease itself decreases a children’s nutritional status. Children with malnutrition become trapped in a cycle of ill health; children who are malnourished may suffer up to 160 days of illness each year (Grantham-McGregor et al. 2007). Children specifically face devastating effects of lost development potential in their cognitive, motor and social-emotional development. It is conservatively estimated that more than 200 million children under 5 years fail to reach their cognitive development potential as a result of the effects of poverty, poor health and nutrition, and deficient care. The long-term effects on levels of health and poverty reduction are devastating, playing an intergenerational role in the transmission of chronic poverty (Grantham-McGregor et al. 2007). Productivity in adulthood is reduced through

21 DALYs for a disease are the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the health condition. The DALY is a health gap measure that extends the concept of potential years of life lost due to premature death (PYLL) to include equivalent years of 'healthy' life lost in states of less than full health, broadly termed disability. One DALY represents the loss of one year of equivalent full health (http://www.who.int/healthinfo/boddaly/en/).

38 both fewer years of schooling and less learning per year in school, resulting in a projected 20% loss in potential income associated with growth stunting and poverty (Grantham-McGregor et al. 2007).

Fig.1 Global distribution of cause-specific mortality among children under five, 2004

Source: UNICEF 2006a.

Fig. 2 Malnutrition as a crosscutting co-factor in under-five mortality.

Source: UNICEF statistics 2006.

Social health protection from health related livelihoods shocks and poverty- inducing effects of health expenditure

39 It is estimated that currently 1.3 billion people around the world are without access to effective and affordable health care services (ILO, GTZ, WHO 2007). Annually, 150 million individuals in 44 million households face financial catastrophe as a direct result of healthcare costs. 25 million households will be pushed into poverty this year as a result of paying for health care services (ILO, GTZ, WHO 2007). Health expenditure has been defined as catastrophic if greater than 40% of income after subsistence needs have been met (Xu et al. 2003; ILO 2007). Significant levels of expenditure result from the prevalence of out-of-pocket payments (OOPs), including public sector user fees, which continue to represent 50-80% of health expenditure across Africa, including the five country case studies in this study (WHO National Health Accounts Data 2005). OOPs weigh most heavily upon the poorest populations, contributing significantly to both new poverty and deepening chronic poverty (WHO 2000). Evidence shows a positive relation between the proportion of households with catastrophic health expenditures and the share of OOPs in total health expenditure (Xu et al. 2003). OOPs have the additional effect of decreasing health-seeking behaviour, as many poor households would not choose to seek care at the risk of becoming impoverished (Xu et al. 2003).

These factors undermine the prevention and treatment of childhood illness as the high cost of health care through user-fees and OOPs have led to declining use of health services amid poor populations (Jacobs and Price 2004). A decrease in health seeking behaviour is a significant co-factor in childhood mortality; poor or delayed care seeking has been identified as a contributor in up to 70% of child deaths (WHO 2001). Public investment in health care is critical, even before economic growth has occurred; the effects on health indicators from increased health spending are significant (Mehrotra, 2004).22

4.1 Scope of social protection strategies for health Block 4 will focus on the potential role and feasibility of health financing schemes as a means of providing social protection from the debilitating and life threatening health conditions faced by poor and vulnerable children in the region through the provision of critical essential health interventions and protection from poverty inducing catastrophic health care costs. Drawing on the framework outlined in Block 2 (see Figure 2.1), the scope of strategies included in this section will comprise the cross-section of social programmes in health and social protection schemes (such as school and supplemental feeding, targeted nutrition programmes, preventative health programmes including immunization, and social health insurance). We propose a two tier approach:

1) Identifying a baseline of current health status, coverage of services, and means of financing maternal and child health essential for child development, and 2) the current and potential role of various social health insurance and financing schemes in providing equitable access to essential health services.

Although a more comprehensive analysis could also address the potential transformative social protection role of health insurance schemes (such as the potential for community- based participation in health insurance schemes and greater involvement in health

22 Early investment in health care has enabled both Cuba and Vietnam to substantially reduce under-five child mortality. Cuba’s under-five mortality rate is similar to that of Portugal, despite a 10 times lower per capita income. In Vietnam, though per capita income is of a similar level as Haiti, the under-five mortality rate is three times lower (Mehrotra 2004).

40 sector policy and programming decision-making), this is beyond the scope and resource constraints of this project.

4.11 Analysis of current health status and health programming needs West and Central Africa currently has the highest regional under-five mortality rate in the world (UNICEF 2007), with 17 million children under-five underweight (UNICEF 2006). 15% of infants are born with a low-birth weight; 28% under-fives are moderately or severely underweight, and 35% of under-fives suffer from moderate or severe growth stunting, with devastating long-term child development effects (UNICEF 2007). Malaria, acute respiratory infections, diarrhoea, malnutrition and measles remain the leading killer diseases of children. While substantial progress has occurred in countries such as Ghana in which the infant and under-five mortality rates have steadily declined, hidden regional disparities remain a high priority (UNICEF 2007).

This section will begin with a desk review of health indicators in the West and Central Africa region of:  Regional and national level data (including regional breakdowns as available) for the five case study countries (Congo, Equatorial Guinea, Ghana, Mali and Senegal).  Data will be taken from both international (UNICEF MICS, WHO) and national (DHS surveys) sources for triangulation.  Analysis will also be conducted of current health expenditure data, service provision and accessibility for the five case study countries in order to generate an understanding of the priority gaps in coverage affecting child nutrition status, health and development.

Combining the poverty and vulnerability data collected in Block 1, the mapping of existing social protection strategies in Block 2, and the above analysis of existing data on health status and service provision, we will develop a baseline understanding of the extent to which the maternal and child health needs of vulnerable populations are being met. This analysis will be informed by a review of international experiences of good practices in child health and nutrition programming. Gaps in coverage will be identified by:  Population coverage (i.e. level of inclusion and exclusion errors from targeting),  Types of service provision (e.g. preventative and primary care, hospital care, nutritional support), and  Lifecycle gaps (i.e. care across pregnancy, first-year, early childhood, adolescence).

Methodology The analysis will be based on the data collected in Block 1 and the Social Protection Mapping (Block 2), as well as health indicator, expenditure and service provision data collected from both international and national level sources. Programming needs will be identified through a literature review of international experiences as well as of the five case study countries.

4.12 Health financing for vulnerable populations: the current and potential role of social health insurance and other health financing schemes Having established a baseline understanding of the current context of child and maternal healthcare provision in WCA, we will then move to the focus of this block: identifying the

41 most equitable and effective health financing schemes, with particular attention to the potential removal of user fees and scaled up role of SHI, for meeting the priority maternal and child health needs identified above. This section will begin with a literature review of international experience on the debates regarding health-financing schemes for vulnerable populations including tax-based systems, social health insurance, and demand side financing (e.g. competitive voucher schemes)23. Specifically, the literature review will examine the various types of health insurance organization mechanisms (e.g. social health insurance, community based health insurance, re-insurance), funding mechanisms (e.g. mixed funding, exemptions for insurance contributions) and types of coverage packages (e.g. hospital and primary care coverage, referral systems) with a focus on how such schemes would effectively meet the prioritised child and maternal health interventions above. Additionally, the literature review will draw upon international experience to understand the social, political and institutional conditions necessary for each type of scheme to be effective, including political feasibility (i.e. political preconditions for uptake), the social impact of SHI and other financing schemes (e.g. the empowering effects of SHI for vulnerable populations), and the institutional, resource and administrative capacity required for effective implementation.

The focus on the West and Central Africa region will begin with a review of existing health service provision schemes regionally, with a specific focus on the effects of user- fees24 User fees, particularly prevalent in WCA, are the most regressive form of health financing, taking a higher proportion of the income of poor households than wealthier ones in order to cover the expenses of health care. Additionally, the high costs of primary care for the poor may discourage health seeking behaviour until illness has progressed to a more serious degree, then exacting even higher costs of care. Services that are critical for public health (e.g. immunisation services, antenatal care) are often exempt from fees for the poor; however, mechanisms of exemption have proved largely ineffective and unable to ensure access to services for the poor (Gilson and McIntyre 2005). Although the removal of user fees is critical for the social protection of the poor, without supportive actions, the process of removal itself may contribute to already serious health systems problems. Most critically, the removal of user fees must be complemented by a replacement of funding to ensure continued provision of health services (ibid). Thus, we will address the potential removal of user fees in WCA within the context of an expansion of alternative health financing schemes, particularly social health insurance.

In the five case study countries we will aim to understand the potential role and feasibility of social health insurance schemes, in comparative perspective with other health financing schemes in providing adequate health service coverage for prioritised child health needs of vulnerable populations. Analysis will consider: equity, fiscal feasibility, the ability to target vulnerable groups, political preconditions necessary, the social impact of implementation on communities, and the administrative, resource and institutional capacity for implementation

Lastly, based on the analysis above, we will provide recommendations regarding the most equitable and effective means of providing access to necessary child health

23 See Appendix 2 for health financing definitions. 24 The mapping of existing health insurance schemes as social protection will be conducted through Block 2.

42 services for chronically poor and vulnerable populations, from which regional recommendations will be extrapolated25.

Methodology The analysis of this section will be based upon a literature review regarding health insurance schemes and implementation, analysis of health expenditure data from both national and international sources, and key informant interviews and focus group discussions. Key informants will comprise Ministry officials, administrative implementers, and health sector personnel, as well as critically, community-level end-users of health services in order to ensure voice is given to the needs of vulnerable populations.

25 It should be noted that the grouping of recommendations regarding health insurance schemes and health service provision may not fit the low/middle/high income and stable/unstable political context classifications potentially used in other blocks; health system status may prove to not correlate by these factors.

43 Block 5: Strengthening child protection services within broader social protection systems

5.1 Introduction This block will focus on the extent to which child protection services can be effectively strengthened within broader social protection systems. Given our definition of social protection for children which distinguishes between core actions focused on protecting livelihoods and mechanisms to provide targeted social service delivery for the poorest, and complementary actions, including improving the quality of basic service delivery for children, we depart from the framing of the TOR and view this block as part of the complementary actions required to address the multi-dimensionality of childhood poverty and vulnerability. We are aware that a case could be made for including child welfare policies typically overseen by ministries of social welfare and justice (e.g. oversight of juvenile justice, issues relating to the protection and care of orphans, prevention of violence, abuse and exploitation and related recovery services etc.) under the remit of social protection (Marcus, 2006). However, we think stretching the definition to include child protection would weaken the analytical and practical utility of our concept of social protection.

This is not in any way to argue against the urgency and importance of strengthening child protection systems, and the value of ensuring close linkages and synergies with child-sensitive social protection policies, programmes and implementing agencies. The right to protection from abuse and exploitation is not only one of the four core universal children’s rights26, but also overlaps and intersects in critical ways with the realisation of other aspects of children’s development, especially livelihoods, education and health. For example, children whose households are impoverished or vulnerable to risk, may be at increased risk of exploitation (sexual or physical) due to involvement in high risk survival strategies or neglect and abandonment. In the same vein, access to quality education can help provide children with the knowledge, skills and resources to mitigate against the risks of exploitation and abuse.27 Schools may also serve to detect and report cases of familial violence and child abuse, as well as to follow up on, protect or support children involved in existing protection systems (International Save the Children

26 Key child protection articles in the UN Convention on the Rights of the Child (CRC) are Articles 9 (family separation), 10 (family reunification across borders), 11 (illicit transfer of children), 16 (right to privacy, honour and reputation), 19 (protection from violence, injury, abuse, neglect, maltreatment or exploitation),20 (alternative care), 21 (adoption), 22 (refugee children), 23 (disabled children),24 (harmful practices), 25 (periodic review of alternative care), 32 (economic exploitation), 34 (sexual abuse and exploitation), 35 (abduction, sale or trafficking of children), 36 (other forms of exploitation), 37 (juvenile justice and protection from torture or other cruel, inhuman or degrading treatment or punishment), 38 (protection in armed conflict), 39 (recovery and reintegration) and 40 (children in conflict with the law). Articles that are not protection rights but represent important approaches to securing children’s protection rights include Articles 5 (support for the parent, extended family and community), 7 (birth registration and protection of identity), 18 (parental responsibility), 26 (social security), 27 (adequate standard of living and social protection), 28 & 29 (education), and 31 (play and leisure). In addition, Articles 2 (non-discrimination), 3 (the best interests of the child), 4 (accountability), 6 (survival and development) and 12 (children’s right to be heard) are all essential complements to the above articles.(The International Save the Children Alliance, 2007: 7).

27 This is however not universally the case. See 2000 UN Study on Violence against Children and forthcoming Plan International Study on Child Violence by N. Jones, K. Moore and Eliana Villar.

44 Alliance, 2007). Similarly, the linkages between child protection and health are multiple – health workers are frequently the first point of contact for sexual or physical abuse or neglect – and can play an important role in referring individual protection cases as well as identifying broader community trends (ibid: 47). In short, improving child protection systems are critically important to addressing childhood deprivations, as well as ensuring children can take advantage of basic education and health services.

The analysis for this block will be organised as follows: 1) a discussion of the definition of child protection and the constitutive elements of child protection systems; 2) an analysis of children’s protection needs in the WCA region, building on the care and protection deprivations identified in Block 1; 3) an analysis of existing child protection systems (legislation, norms, programmes, implementing agencies) and how they could be strengthened, building on the mapping of child protection programmes in Block 2, and 4) a discussion about how linkages between child protection systems and social protection systems of children could be established, and synergies maximised.

5.2 Defining child protection and protective environments Definitions of child protection have evolved significantly in recent decades away from an emphasis on child abuse to a focus on protecting children from the risk and actual practice of child violence and exploitation (Lawrence, 2004). In this research we will follow UNICEF’s definition of child protection as ‘preventing and responding to violence, exploitation and abuse against children - including commercial and sexual exploitation, trafficking, child labour and harmful traditional practices, such as female genital mutilation/cutting and child marriage’ (UNICEF, 2006). In order to achieve this, UNICEF calls for the creation of a protective environment that is the responsibility of multiple stakeholders: children, families, communities, schools, government agencies and civil society organisations. The Eight Elements of a Protective Environment28 incorporate preventative, protective, promotional and transformative dimensions as follows: 1. Attitudes, customs and practices: It is critical to tackle societal attitudes, customs and practices which condone harmful practices against children through either action or inaction. Research emphasises that children are more likely to be protected when all forms of child abuse are taboo (e.g. UN, 2001). This may require particular attention to working with the gatekeepers of some traditional practices (e.g. in the case of FGM) in order to promote a rethinking of cultured norms and gendered roles. 2. Children’s life-skills, knowledge of rights, and opportunities for participation: by developing children’s life-skills, awareness about child rights and facilitating their participation in decisions which affect their lives, children will be better placed to assert their own rights. However, given power imbalances between adults and children, this type of skill-building and education needs to be developed within a broader system of legal, community and institutional support. 3. Open discussion and engagement with child protection issues: in order to enhance the first two elements, encouraging open discussion and engagement around issues of child abuse, violence and exploitation is critically important. This may be through community sensitization programmes, the media, schools, religious institutions, community child/ youth groups etc.

28 Eight Elements of a Protective Environment: UNICEF: http://www.unicef.org/protection/index_environment.html

45 4. Monitoring and reporting: one of the key challenges facing policy and programming development in the area of child protection in developing country contexts is the lack of rigorous data about the incidence of child protection (Onyango and Lynch, 2006). Developing mechanisms for monitoring and reporting are therefore critically important in order to render the problem of child abuse more visible and to evaluate the efficacy of actions designed to tackle it. In order to promote greater community involvement in tackling the problem, participatory and community-based approaches to monitoring and reporting may be particularly effective. 5. Services for recovery and regeneration: although the emphasis on child protection systems is on preventing abuse, developing quality services so that children are provided with the expertise and support needed to recover from the physical, sexual or psychological trauma. 6. Protective legislation and enforcement: although legislation alone is insufficient to change attitudes and behaviours, it often constitutes a necessary first step. New legislation can serve to raise awareness about a problem and send a clear societal message that certain types of behaviours are not acceptable and should be reported. As important as legislative provisions, are their enforcement. Bringing perpetrators to justice requires commitment on the behalf of ministries of justice and police, as well as adequate investment in staff capacity building and the development of appropriate infrastructure. Ensuring that children are able to express grievances, are adequately listened to and protected within adult-centred justice systems is a particular challenge. 7. The capacity to protect children from those working amongst them: there is a growing awareness that children may be subject to abuse and exploitation by the very adults who are supposed to protect them: e.g. the military, police, teachers, NGOs etc. Clearer guidelines on hiring procedures, codes of conduct and reporting procedures are therefore critically important. 8. Governmental commitment to fulfilling children’s rights: if governments are to effectively enforce child protection legislation, develop and oversee monitoring and reporting mechanisms, promote education and awareness-raising on child protection within school and government agency environments (especially within ministries of social welfare, justice, police, health and education) and deliver quality recovery services, government commitment to and ownership of the agenda of fulfilling children’s rights is vital. If the agenda is only donor or NGO- driven, there is unlikely to be the requisite political will to developing and delivering the complex multi-agency coordinated system that child protection demands.

5.3 Children’s child protection needs in WCA Despite the growing number of organisations and institutions engaged in advocacy for children, knowledge of the nature, extent and severity of child violence and exploitation remains very limited. The violation of children’s rights is often ‘invisible’ by nature: violations such as sexual abuse may occur within ‘private’ or ‘secret’ contexts, often with people known by the child. This lack of visibility, combined with the reluctance of children to talk about their problems means that researching this area can be especially difficult. This is reflected in the lack of reliable data in the WCA region: data is often small-scale (such as Ebigbo’s [2003] study on street children in Nigeria); and admittedly based on anecdotal accounts (Save the Children’s [2006] study of Liberian refugee camps).

46 What evidence does exist, however, suggests that child protection deprivations are multiple, often overlapping and demand urgent policy attention (UN, 2001, 2005; Hirsh, 2001; Human Rights Watch, 2003; ILO, 2006).29 These deprivations may be grouped as follows30

 Children vulnerable to sexual abuse (trafficking and the sale of children, orphaned children, children in alternative care institutions, children in poverty working as prostitutes, school students, especially girls, within educational institutions [by peers and school authorities and teachers] and travelling to school, children in conflict and post-conflict zones, migrant children).

 Children vulnerable to violence and neglect (as above, girls subject to female genital mutilation, child marriages and other harmful traditional practices).

 Children vulnerable to harmful forms of child labour (children not attending school, children living in poverty, orphaned children, children living in conflict zones, migrant children).

Given the diversity and multi-dimensionality of the problem of child protection, this first section of Block 5 analysis will provide an overview of the general trends in the WCA region each of these three broad categories, drawing on the literature review from Block 1. In view of data limitations, for the country case studies, we will then select the main programmes in the three areas listed above in each country for which there is some available data as well as consensus regarding priority areas/ political feasibility among UNICEF staff officers and the country consultants at the Ivory Coast inception phase workshop in February 2008. Our analysis will focus on the extent and scope of the problem (drawing on published and grey literature), and the degree to which existing services are effectively tackling child protection issues (based on a desktop review and stakeholder interviews).

5.4 Analysis of existing child protection systems in WCA The next step in this Block will involve an assessment of the state of current child protection systems in WCA. Our analysis will be framed by the protective environment framework discussed above and a review of international best practice in the field. We will begin by mapping i) the legislative and policy frameworks on child protection 31, ii) the scope and coverage of governmental and non-governmental child protection-related prevention programmes and recovery services, and iii) the financing available to these programmes (see Block 6). Given a dearth of literature in WCA, we will then focus down to analyse the following questions in the context of our five country case studies and with respect to the main programmes identified in 5.3: iv) the extent to which there is inter- sectoral coordination, monitoring and evaluation among ministries of social welfare, women and children, justice, health and education, v) the extent to which there is coordination among GO and NGO service providers and vi) the way in which problems of child protection are framed by these respective agencies, as we would hypothesise 29 See the UN 2000-2001 Violence against Children Regional Consultation Report. 30Handbook for Parliamentarians on Child Protection. UNICEF 2004. 31 A preliminary review of existing legislation on child protection in the West and Central African region suggests that although many countries in the region are party to international human rights conventions affecting children (e.g. ECOWAS convention, UNCRC, CEDAW etc.), legislation tends to be rather piecemeal and focused on specific issues (such as child labour or child trafficking) rather than tied to a comprehensive child protection policy framework.

47 that varying definitions of child protection issues by different agencies may hamper effective inter-sectoral coordination. (See Table 5. 1 below)

In addition, stakeholder interviews will also be used to explore other variables that could either facilitate or hinder the development of an effective child protection system including: a) the degree to which there is national ownership of child rights principles in keeping with UNCRC; b) the extent to which systems are in place to address the heightened vulnerability children face in conflict and post-conflict environments, c) the role that the social transformation of the traditional family unit (brought about by e.g. HIV/AIDS, migration, urbanisation etc.) is playing in shaping children’s experiences of violence, exploitation, abuse and neglect (Onyango and Lynch, 2006).

Together this analysis will allow us to identify the key gaps in the provision of child protection services, and provide us with a clear baseline picture with which to assess how child protection services might be effectively linked with social protection services for children in order to better tackle childhood poverty and vulnerability.

Table 5.1 Child Protection Services in Country Case Studies Sexual Harmful forms of Physical and violence and child labour psychological trafficking violence, including harmful traditional practices Data availability Social attitudes and practices with respect to this issue Legislative and policy provisions Scope and coverage of governmental programmes Scope and coverage of NGO programmes Programme Financing (refer to Block 6) Coordination, M and E among government agencies for programme delivery? How are responsibilities divided? Is there an over-arching lead agency? Coordination among govt and NGO agencies for programme delivery? Framing of issue (definition of problem/ conceptual understanding)

5.5 Strengthening linkages between child protection systems and child-focused social protection This section will begin with a review of international literature to identify examples of best practice with respect to coordinated and synergistic approaches to child-focused social protection and child protection systems. Our knowledge of the limited literature on these

48 linkages in Latin America (Jones et al., 2007), Asia and Africa32 suggests that we will need to consider experience from developed country contexts, such as the UK’s Every Child Matters and Sure Start programmes (e.g. Varnava, 2005) and Australia’s Aboriginal and Islander Child Care Agency programme which links strategies to combat child abuse with social protection instruments to overcome socio-economic marginalisation. In addition, we will also review evaluations of social protection programmes towards OVCs, such as Kenya’s OVC-targeted cash transfer programme (Pearson et al., 2007)

We will then use our mappings and analysis from Blocks 2, 3, and 4 to identify areas of potential programming and institutional linkages, as well as scope for coordinated policy development. Depending on the institutional arrangements already in place for coordinating a) social protection and b) child protection systems we will discuss with key informants the merits and demerits of strengthening coordination and streamlining lines of responsibility. For example, in Latin America one of the major changes to child-related service delivery facilitated by the introduction of conditional cash transfers has been the development of a national database on children with the potential to cross-reference the types of services that individual children are accessing and related outcomes (e.g. Jones et al., 2007). To what extent are similar types of discussions or initiatives underway in WCA: for instance are other countries also seeking to foster linkages between National Social Protection Plans and Children’s Acts and Child Labour Acts as is the case in Ghana. Are there institutional capacity (including data collection), human resourcing, political and discursive constraints and if so, how could they be overcome?

Table 5.2 Child Protection and Social Protection Linkages in Country Case Studies Sexual Harmful forms of Physical and violence and child labour psychological trafficking violence, including harmful traditional practices Common government agency responsible for delivery? Included in PRSP in the context of social protection provisions? Included in national social protection policy framework? Joined up data collection with social protection programmes? Are there NGOs who are making links between social protection and child protection? Issue framing similarities? Issue framing differences?

32 Exceptions include: the implications the availability of credit as part of the social protection system (e.g. the Ghanaian Cash Transfer Programme) on school attendance and the lessening of child labour in Ghana (Blunch: 2002); and the UNCHR (2002) guidelines on how to protect child refugees, which emphasise how best to facilitate participation, education and non-discrimination within both IDP camps and asylum countries. These recommendations incorporate social protection strategies for the reduction of poverty in IDP camps (e.g. by cash or in-kind transfers).

49 Block 6: Fiscal space for strengthened social protection 6.1. Introduction Social protection systems have been historically weak and under-resourced in most of Sub-Saharan Africa, with total spending of around 0.1% of GDP, which is significantly below expenditure in the sector in other parts of the world, such as the Middle East and North Africa where the average is approximately 5.7 % of GDP (Coudouel et al., 2002). Drawing on findings and analysis in the other sections, and in particular focusing on expenditures on ‘core social protection actions’ defined earlier, block six examines the current situation in the WCA region with regard to the financing of social protection systems and individual programmes, assessing whether there is the potential to raise expenditure on social protection, and particularly on successful child-focused social protection programmes, in some or all of the countries in the region in a sustainable manner. In particular, it examines (as far as data availability permits):  current levels of spending at systemic and programme level;  the extent to which social protection programmes are taken into account in medium term budget planning.  comparability of spending with international benchmarks;  an assessment of the overall “fiscal space” – i.e. the potential for increased spending (in particular on social protection) given the prevailing fiscal and macroeconomic conditions and risks. The aim is to put social protection in macroeconomic, fiscal and budgetary context and examine how this context facilitates or constrains the provision of social protection (both actual and potential). As in other components of the study, block six will have two different levels of analysis: a general regional assessment and an in-depth assessment in the five case study countries. Below, we outline the general approach and key themes in this block. The methodology section clarifies at what level and by whom the themes will be researched. Note that there are clearly strong synergies between this block and block 2 (definition of social protection and identification of programmes) and block 3 (capacity and institutional analysis) that will require careful coordination.

6.2. Approach In order to develop a comprehensive assessment of the current state of financing for social protection systems and specifically those programmes that would be included in a ‘social protection package for children’ (as per the definition in block 2) in WCA, as well as identifying the fiscal space available for the expansion of and effectiveness in the use of resources to the sector, this component will include an analysis of the following: 6.2.1 How large are social protection budgets and expenditures? The delivery of increased spending on social protection through national systems and procedures relies on: (i) social protection being a sufficiently high priority to command additional resources, and; (ii) robust medium term budget planning in order to ensure that policy priorities are translated into credible medium term commitments and are matched to projected resource flows. Thus, we will ask ‘is social protection a priority?’ and ‘is social protection adequately captured in medium term budget planning?’ The former question will focus on the national budget, since this represents one of the key expressions of a country’s policy priorities (Wilhelm & Krause, 2007). The block will begin by establishing a clear picture of budget allocations for social protection systems. The analysis will go to the level of individual programmes, drawing explicitly on the

50 definition and mapping of programmes provided in block 2 and looking particularly at child-focused social protection. The analysis will provide a strong indication as to the degree of government commitment to social protection vis-à-vis other policy priorities. This analysis will also cover children’s social welfare programmes identified in block 5. In examining whether social protection is adequately captured in medium term budget planning, be it in the form of a Medium Term Expenditure Framework (MTEF) or some variant, we will examine the extent to which such plans are able to capture social protection expenditures. In addition, if social protection is not adequately reflected, there is a secondary set of questions to be addressed regarding where the key constraint lies: i.e. with capacity within the central agencies (Ministry of Finance etc.), within relevant line ministries (e.g. Ministry of Social Welfare)

Actual spending typically deviates from budget allocations, often quite substantially in LDCs where liquidity and capacity constraints, among other factors, constrain budget execution. It will therefore also be important to collect data on expenditure outturns in order to understand actual spending levels on social protection. Where there are substantial deviations between budget allocations and expenditure, attention will be paid to possible causes in order to make recommendations for more efficient use of resources. A crucial element of the budget and expenditure analysis is that of the composition of allocations and spending within social protection to determine which programmes are receiving more support, and thus assess the visibility of children in social protection financing. There are examples of middle to low income countries with relatively high total spending on social protection but with meagre allocations to children. Lastly, given that social protection in developing countries is often heavily externally driven and financed. The proportion of external finance provides an important indicator of national commitment to and ownership of social protection, as well as its longer term sustainability. It will therefore be important to capture the source of finance for social protection and, where possible, to provide an indication of how much of external financing is captured in the national budget as approved by parliament.33 If large proportions of social protection spending are ‘off-budget’ it provides an indication that they are weakly linked to the budget process (and hence national prioritisation, accountability and transparency processes) and weakly integrated into government systems and procedures (and hence of questionable sustainability). There are two additional issues that are significant in the context of financing social protection programmes: (i) the administrative costs of providing social protection programmes (a key factor affecting the affordability and medium-term sustainability of social protection systems, and; (ii) the degree of decentralisation in each of the five case study countries. However, given the time constraints for carrying out block 6 and the higher priority of the issues previously indicated, we will not analyse these two additional components. This section will focus on the case study countries as gathering data for the wider WCA region from desk-based analysis is likely to prove very difficult.

33 It is understood that the inclusion of external finance for social protection in the budget documentation approved by parliament (i.e. funds are ‘on parliament’) is only one dimension of the ‘on-budget’ question. Funds should also be included in plans, treasury accounts, government accounts, government audits and government’s ex post reports (Mokoro, 2007). Time and resource constraints preclude a more detailed investigation of this question.

51 6.2.2 How does social protection expenditure compare with other sectors and countries? In addition to the analysis of spending on social protection, an overview of total government spending as well as the overall composition of social sector spending will be provided. This will serve to provide a measure of the overall size of the public sector in relation to the economy, and the size of spending on social protection vis-à-vis other social sectors (in particular health and education) and government spending as a whole. In particular, an overview of social sector spending is crucial given the complementarity of basic service provision with some types of child-focused social protection programmes (such as conditional cash transfers), as well as potential competition for allocation of budgetary resources within social sector spending in cases where basic services are under-funded in comparison with international benchmarks. Comparison of key spending benchmarks with other countries will also be undertaken. Levels and composition of public spending are obviously determined by a multitude of country specific factors such as level of economic development, political considerations and demographic profile. Nonetheless, comparison of case study countries with countries in the WCA region, with countries in Sub-Saharan Africa (SSA), and with other selected low and middle income examples will help to provide a very rough guide as to how levels of spending on social protection compare internationally. For example, if countries with similar levels of national income per capita and similar demographic profile are spending markedly more on social protection than those studied, it may be that there is a case to be made for increased allocation of public resources towards social protection, or at least an important difference to explain. These comparisons may also reveal commonalities that suggest, for example, that there is an upper limit on social protection spending in low income countries. Comparisons will also be made, where possible, of administrative costs for implementing social protection in other countries. 6.2.3 How much room is there to increase social protection expenditures? Although there are different uses of the term ‘fiscal space’, in the case of this study, it is understood to mean the ‘room in a government’s budget that allows it to provide resources for a desired purpose without jeopardising the sustainability of its financial position or the stability of the economy’ (Heller, 2005). The basic rationale is that such space needs to exist or be created in order for governments to increase spending on national priority areas, which may include social protection, in a sustainable manner.34 Fiscal space is important to this study because, while the analysis in preceding blocks may conclude that scaling up of spending on social protection is both desirable from the perspective of poverty reduction and politically and institutionally feasible at sector level, it is crucial to have an indication of the overall feasibility of such a measure. That is, spending decisions need to be taken from a ‘whole of government’ perspective, explicitly taking into account the need to maintain fiscal and macroeconomic stability, which among other factors, can ensure the sustainability of social protection systems in the medium- and long-term.

34 In the long-term, the main source of additional fiscal space is economic growth. The concept of fiscal space is therefore often accompanied by the argument that the additional spending should be focused on areas that boost growth, thereby increasing future fiscal revenues and hence wholly or partially paying for itself. This is not explicitly considered here as increased spending on social protection does not necessarily boost national income growth rates but can have significant social benefits.

52 In order to assess whether such space exists (or might be created) in a given country, it is necessary to examine overall macroeconomic and fiscal aggregates and associated risks. This can be done with reference to a number of recognised indicators covering different dimensions of macroeconomic and fiscal sustainability. This will include reference to levels of public debt, tax effort as measured by levels of revenue as a proportion of GDP, levels and composition of external finance and the fiscal balance. Measures of overall public spending and social sector spending collated in the previous section will also provide a useful indication as to whether fiscal space might best be created through securing additional income (e.g. by increasing tax effort) or through reallocation from other areas.

In addition, since the expansion of fiscal space in low income countries in the short- to medium-term is likely to be strongly driven by the scaling up of external assistance, there needs to be an explicit consideration of donor practices. A first key area here is the predictability of aid flows. If these have not been reliable in the past, it is likely that governments will be reluctant to enter into long term social protection spending commitments (i.e. fiscal obligations) that are contingent on external finance. We will therefore briefly look at the historical predictability of aid flows in WCA countries. Second, the coordination of aid in recipient countries is of central importance. As one study has recognised, “Uncoordinated, off-budget and projectised aid contributes little to durable fiscal space.” (High-Level Forum on the Health MDGs, 2005). In coordination with block 2, we will therefore examine the present patterns of aid delivery for social protection, examining aid modality (i.e. general budget support, programmatic or projectised) (IDA, 2007). The study will therefore attempt to identify potential synergies and changes in practices amongst donors to provide more effective financial and technical support to the sector. The information will also be used to provide an assessment of the degree of donor-dependency, the medium- to long-term sustainability of external financing, as well as the potential for leveraging additional resources for social protection.

For countries in the region that have had more stable economies, positive growth trends – in some cases due to increased oil and mineral revenues – and improved public finances, we will also assess whether social sector expenditure has increased in absolute terms and as a percentage of GDP and public expenditure, looking in particular at whether higher levels of government spending have included more resources invested in social protection systems.

Finally, although out of pocket household expenditure on social protection programmes is likely to be quite a significant source of financing for social protection, this is primarily a question of how social protection is financed rather than how much finance is provided and does not therefore directly relate to the issue of available fiscal space. Furthermore, reliable data on the issue are likely to be scarce. However, more efficient spending of private resources on social protection (i.e. through small and predictable social insurance payments as opposed to large and unpredictable out of pocket expenditures) is potentially an important means of improving social protection provision and an area that should be considered by UNICEF when undertaking work on social protection in the region.

53 6.2.4 How visible are children in social protection budget allocations and expenditure? In addition to looking at governments in the region’s capacity and commitment toward financing of social protection systems, the last component of this block focuses more specifically on the visibility of children in budget allocations and expenditure on social protection systems and children’s social welfare programmes. In order to understand the priority being given to children, and according to the analysis of the programmes to reduce children’s poverty, risk and vulnerability presented in block 2, we will review the budgetary resources being channelled by governments in the region to these specific programmes, and the relative weight children’s social protection programmes receive within social protection systems.

One of the objectives of this study is to verify the extent to which social protection systemically protects and ensures the rights of all children and contributes to reducing child poverty. In particular, the Article 27 of the Convention on the Rights of the Child (CRC) states that every child has ‘the right to a standard of living adequate to his or her development’ and that requires states, ‘in accordance with national conditions and within their means, take appropriate measures to assist parents and others responsible for the child to implement this right and shall in case of need provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing’. Therefore, it is important to examine budgetary allocations of and spending on social protection programmes specifically targeted to children as well as those designed to impact indirectly on children through households, looking at whether resources for these programmes have been increasing in accordance to countries’ economic capacities (De Vylder, 2000). The Committee on the Rights of the Child has recommended carrying out budgetary analysis to identify and maximise the resources allocated to improve children’s benefits, recognising that national and sub-national budgets are more of a political than a technical tool that show where government’s policy choices lie (Robinson et al., 1997). Through this child-focused analysis of spending on social protection, we aim to estimate the proportion of resources which these systems channel to children in relation to the proportion of the poor they represent in the region

6.3. Methodology In order to obtain the information to underpin the foregoing analysis, this component of the study will use a combination of desk-based review and fieldwork, the latter focusing in particular on stakeholder interview. We must highlight from the outset that block 6 provides a comprehensive research framework to analyse the potential fiscal space to strengthen social protection. It is important to stress that this framework is premised upon the availability of comprehensive and sufficiently detailed budget and public expenditure data covering a five-year period. However, experience suggests that the reality in the case-study countries is more than likely to be very different, with a dearth of complete, consistent and credible information in most cases. As Barrientos notes, ‘at present the available data [on social protection expenditures] are limited in coverage and highly imperfect’ (Barrientos, 2007). Therefore, we will aim to address the questions set out in the research framework as far as is possible given the constraints imposed by data availability.

6.3.1 Desk-based review

54 A desk-based review of overall macroeconomic and fiscal indicators for each country in the region, including information on total revenue and grants, total expenditures, external finance, fiscal deficits and debt financing will be undertaken. In the case of the region, the analysis will draw on secondary sources including Public Expenditure Reviews (PER); Public Expenditure and Financial Accountability (PEFA) Performance Assessments; Poverty Reduction and Growth Facility (PRGF) reports, and; information on donor support to social protection schemes, to determine the amount of grants, duration of commitments, modes of financing and whether they are accounted for on or off-budget.

6.3.2 Fieldwork In the case of the five case study countries, we will conduct a desk-based review and analysis of primary data, which will include government and donor documents such as national development plans, sector policy priorities in the area of social protection, budget documents and budget execution reports, Medium Term Expenditure Framework (MTEF) programme documents or equivalent and associated data and Public Expenditure Tracking Surveys (PETS) where available. To complement the desk review in the case study countries, in depth key stakeholder interviews will be conducted. The focus will be on government and donor officials who may be able to provide insights into the weight social protection policies and programmes in budget and expenditure decisions in the country as well as providing an assessment of the effectiveness in spending on this sector. This will include:  Government officials from the Ministry of Finance, Ministry of Social Development (or equivalent) and Ministries of Health and/or Education where social protection programmes are targeted to supporting any of these two areas.

 Where possible and relevant, we will also interview members of parliament who might have an active role in approving budgets for social protection.

 In countries with advanced decentralisation, we will interview regional officials responsible for planning and implementing social protection programmes at the sub- national level. Other non-government stakeholders that we will interview include:  Donor agencies who might currently be financing social protection systems in these countries or that have programmes in the pipeline or that might be working with the government on improving public accounts and financial management systems.

 NGOs that might be financing social protection programmes or that are advocating for increased expenditure in the sector.

55 56 Table 6.1: Research Framework for Case Studies Research theme and Research questions Methodology Source Responsible Timeline scope author 6.1. How large are 6.1.1. What were budget allocations for: Analysis of national budget National budget documents Country case 31st May, first social protection i) total revenue; ii) total expenditure; in CS countries study author draft; 15th budgets and iii) the social sector (education, (collection) and August, Final expenditures? health, other social services); iv) the PP (analysis) draft social protection system; v) individual social protection programmes (as identified in Block 2), and; vi) children’s social welfare, for the 5 year period FY2002 to FY2006? (Tables 1, 2 and 3) 6.1.2. What were actual expenditure Analysis of government Government budget Country case 31st May, first outturns for the same categories and budget execution reports execution reports in CS study author draft; 15th over the same period (Table 1 and countries (collection) and August, Final Table 2) PP (analysis) draft 6.1.3. If there are significant deviations In depth stakeholder Stakeholder interview, Country case 31st May, first between budget allocations and total interviews and analysis of budget execution reports, study author draft; 15th expenditure on social protection, government budget donor reports in CS (collection) and August, Final what are the key drivers of this execution reports and donor countries PP (analysis) draft problem? reports 6.1.4. Does medium-term budget Analysis of medium term Medium term budget Country case 31st May, first planning (in the form of an MTEF or budget framework (e.g. framework (e.g. MTEF or study author draft; 15th similar document) exist? If so, what MTEF or similar) and similar) and underlying data (collection) and August, Final time period does it cover? If underlying data if necessary if necessary in CS countries PP (analysis) draft available, present projections on total revenue, total expenditure, social sector expenditure, total social protection expenditure, individual social protection programmes. (Table 3) 6.1.5. If social protection spending Stakeholder interview Stakeholder interview in CS Country case 31st May, first projections are not reflected in (Ministry of finance, line countries study author draft; 15th medium term budget planning ministry, social protection (collection) and August, Final instruments, why is this the case? programme and donor PP (analysis) draft (i.e. lack/partiality of such planning officials) instruments due to weak capacity within MoF, poor submissions from sector due to weak capacity within line ministry, poor reporting of external programmes)

57 Research theme and Research questions Methodology Source Responsible Timeline scope author 6.1.6. What proportion of overall social Analysis of national budget, National budget, Country case 31st May, first protection/children’s social welfare government budget government budget study author draft; 15th and individual social execution reports, other execution reports, other (collection) and August, Final protection/children’s social welfare budget documents, donor budget documents, donor PP (analysis) draft programmes (in terms of budget reports reports in CS countries allocations and expenditure outturns) are externally (i.e. donor) financed? (Tables 2 and 3) 6.1.7. Are there externally financed In depth stakeholder Stakeholder interview, Country case 31st May, first social protection/children’s social interviews and analysis of national budget, government study author draft; 15th welfare programmes that are not national budget, government budget execution reports, (collection) and August, Final captured (either partially or wholly) in budget execution reports, other budget documents, PP (analysis) draft the national budget and/or other budget documents, donor reports in CS government budget execution donor reports countries reports? (Tables 2 and 3). 6.1.8. How and at what level of In depth stakeholder Stakeholder interviews Country case 31st May, first government are allocation decisions interviews study author draft; 15th regarding expenditure on social (collection) and August, Final protection/children’s social welfare PP (analysis) draft made? 6.2. How much room 6.2.1. What is the present composition In-depth stakeholder, Stakeholder interview, Country case 31st May, first is there to of aid modalities to externally analysis of national budget, national budget, government study author draft; 15th increase social financed social protection? government budget budget execution reports, (collection) and August, Final protection execution reports, other other budget documents, PP (analysis) draft expenditures? budget documents, donor donor reports in CS reports countries 6.2.2. What are the potential synergies In-depth stakeholder Stakeholder interview, Country case 31st May, first and changes in donor practices that interview, government government budget study author draft; 15th might make for more effective budget execution reports, execution reports, other (collection) and August, Final financial and technical support to other budget documents, budget documents, donor PP (analysis) draft social protection? donor reports reports in CS countries 6.2.3. Have there been changes in the In-depth stakeholder Stakeholder interviews and Country case 31st May, first patterns of government spending on interviews in Ghana and IMF International Finance study author draft; 15th social protection systems in Senegal; Desk based Statistics (IFS), IMF (collection) and August, Final countries whose economies have assessment using analysis Government Finance PP (analysis) draft been performing better? If not, what on fiscal space from 6.3.2 Statistics (GFS), World have been the sectors most with a focus on changing Bank World Development favoured by public spending in this trends in government Indicators (WDI) period? expenditure in best performing countries.

58 Research theme and Research questions Methodology Source Responsible Timeline scope author 6.3. How visible are 6.3.1. What proportion of total Analysis of national budget, National budget, Country case 31st May, first children in social expenditure on social protection government budget government budget study author draft; 15th protection budget comprises child-focused social execution reports, other execution reports, other (collection) and August, Final allocations and protection programmes? (Table 4). budget documents and budget documents, PERs, PP (analysis) draft expenditure? Are budget allocations and PERs, audits, donor report audits, donor reports in CS expenditures to these programmes countries clearly identifiable in budget reports? 6.3.2. Are child-focused social In-depth stakeholder Stakeholder interview, Country case 31st May, first protection programmes given interview, analysis of national budget study author draft; 15th specific priority in budget decision- national budget (collection) and August, Final making processes? Are they PP (analysis) draft prioritised by donors?

59 Table 6.1: Research Framework for Case Studies Research theme and Research questions Methodology Source Responsible Timeline scope author 6.4. How much 6.4.1. Explain the Brief desk-based literature review Heller (2005), Heller et al. GH 30th April, First room is there concept of (2006), Roy et al. (2007), draft, 30th July, to increase ‘fiscal space’ High-Level Forum on the Final draft social with reference Health MDGs (2005) protection to the relevant expenditures? literature. 6.4.2. What is the Desk-based research (Data for all countries in west IMF International Finance GH 30th April, First overall picture and Central Africa on overall macroeconomic and Statistics (IFS), IMF draft, 30th July, with regard to fiscal indicators, ideally for 1990 to present (GDP, Government Finance Final draft ‘fiscal space’, GNI, population, total imports, total exports, capital Statistics (GFS), World Bank as assessed formation, money stock (broad money), domestic World Development Indicators against a inflation rate, credit to the private sector, current (WDI), IMF Article IV number of account deficit, total revenue, total aid (grants), non- consultations, Poverty indicators, in renewable resource revenue, total expenditure, Reduction and Growth Facility the WCA current expenditure, capital/investment expenditure, (PRGF) reports for WCA region? wage expenditure, fiscal deficit/surplus, total debt countries and selected stock, domestic debt stock, external debt stock, Net international comparators Present Value (NPV) of external debt, debt service/interest payments) 6.4.3. How Desk-based analysis of total aid flows, aid flows for OECD DAC and OECD CRS GH 30th April, First predictable are social expenditure online databases for WCA draft, 30th July, external countries and selected Final draft assistance international comparators flows? 6.5. How does 6.5.1. What is Desk-based research IMF International Finance GH 30th April, First social total GDP, Statistics (IFS), IMF draft, 30th July, protection government Government Finance Final draft expenditure spending, and Statistics (GFS), World Bank compare with the World Development Indicators other sectors composition of (WDI), IMF Article IV and social sector consultations, Poverty countries? spending in Reduction and Growth Facility the WCA (PRGF) reports for WCA region and countries and selected other selected international comparators international case studies?

60 6.5.2. What is the Desk-based research Database on UNFPA website GH 30th April, First demographic for CS countries and selected draft, 30th July, profile of CS comparators Final draft countries and selected comparators? 6.5.3. Can any Desk-based research IMF International Finance GH 30th April, First data on Statistics (IFS), IMF Article IV draft, 30th July, administrative consultations, Final draft costs of social protection programmes in the WCA region and in selected international comparators be found?

61 Table 6.2: Budget Allocations and Actual Outturns for Country Case Studies – Aggregate Level All data in (nominal) local currency FY2002* FY2003 FY2004 FY2005 FY2006 Budget Outturn Budget Outturn Budget Outturn Budget Outturn Budget Outturn Total Revenue Of which Total Grants Total Expenditure Of which Social Sector Education Health Water and Sanitation Social Protection Children’s Social Welfare Fiscal Balance (Surplus/Deficit)

Table 6.3 Budget Allocations and Actual Outturns for Country Case Studies – Programme Level All data in (nominal) local currency FY2002* FY2003 FY2004 FY2005 FY2006 Budget Outturn Budget Outturn Budget Outturn Budget Outturn Budget Outturn Social Protection (as in Table 1) Of which Internal finance (except GBS) Of which Programme 1 Value of transfers Administrative costs Programme 2 Value of transfers Administrative costs Etc. External finance Of which Programme 1 Value of transfers Administrative costs Programme 2 Value of transfers Administrative costs Etc.

Off-budget social protection spending** Programme 1 Value of transfers Administrative costs Etc. Note: *FY = Financial Year. Please indicate what dates the Government financial year follows (e.g. 1st January - 31st December). ** “Off-budget” defined as not captured in budget document approved by parliament.

62 Table 6.3: Budget Allocations and Actual Outturns for Country Case Studies – Programme Level All data in (nominal) local currency FY2002* FY2003 FY2004 FY2005 FY2006 Budget Outturn Budget Outturn Budget Outturn Budget Outturn Budget Outturn Children’s Social Welfare (as in Table 1) Of which Internal finance (except GBS) Of which Programme 1 Value of transfers Administrative costs Programme 2 Value of transfers Administrative costs Etc. External finance Of which Programme 1 Value of transfers Administrative costs Programme 2 Value of transfers Administrative costs Etc.

Off-budget social protection spending** Programme 1 Value of transfers Administrative costs Etc. Note: *FY = Financial Year. Please indicate what dates the Government financial year follows (e.g. 1st January - 31st December). ** “Off-budget” defined as not captured in budget document approved by parliament.

Table 6.4 Medium Term Budget Framework Allocations for Country Case Studies All data in (nominal) local currency FY2007 Budget (Outturn if available) FY2008 Budget FY2009 Budget FY2010 Budget Total Revenue Of which Total Grants Total Expenditure Of which Social Sector Education Health Water and Sanitation Social Protection Children’s Social Welfare Fiscal Balance (Surplus/Deficit)

63 Table 6.5: Composition of allocations and spending within social protection programmes All data in (nominal) local currency FY2008 FY 2005 FY 2006 FY 2007 Budget/ Outturn Outturn Budget MTEF Social Protection (as in Table 1) Of which Pensions (old age, disability, ) Work related schemes (food for work, agriculture subsidies) School based programmes (scholarships, school meals) Consumption subsidies (food, energy, etc.) Cash transfer programmes Household cash grants / family assistance Health insurance / fee waivers Food transfers Social funds

64 Block 7: Policy Engagement on Social Protection for Children This section is concerned with understanding UNICEF WCARO’s experiences to date in engaging with social protection debates and policy and programming initiatives, and making recommendations (drawing on the insights from the findings from Blocks 1—6) as to how UNICEF’s policy-focused work on social protection can best be strengthened. In order to do this, we begin with a brief discussion on the effective ingredients of policy engagement, drawing on the evidence-based policy literature. This then provides the framework for the discussion of policy engagement around social protection and children more broadly, as well as specifically in the WCA region.

7.1. Effective ingredients of policy engagement In order to develop an effective policy advocacy and programming strategy on child- friendly social protection in WCA, it is critical that UNICEF WCARO not only develop a strong evidence-base (discussed in Blocks 1-6), but also translate and communicate these findings and their policy implications in a manner which is context-sensitive and politically feasible. A growing body of research on evidence-informed policy processes has identified a number of key ingredients for effective policy engagement.35

First, an appreciation of the political context, including formal institutional processes and rules as well as informal political values and practices is critical for effective communication and identifying the opening and closing of political windows. As Spray (2003: 2) argues, no matter how strong the research, ultimately “politics rather than research changes policy”. Any policy engagement strategy will have to weigh up carefully what type of policy impact goal is feasible, given a particular political context. This may range from a desire to shift the parameters of the policy agenda to encouraging policy actors to introduce procedural changes (e.g. greater community consultation); from the introduction of new policy positions, legislation or budget increases through to influencing policy implementation and securing behavioural change (Keck and Sikkink, 1998).

Second, evaluations of why some research ideas revolutionalise policy thinking (e.g. social capital and the sustainable livelihoods approach) and others fail, all point to the critical importance of quality evidence and its effective communication (e.g. Court et al., 2005; O’Neill, 2005). Research-informed evidence needs to be not only methodologically sound, but to also address policy-relevant questions and to provide operationally useful ideas. If a concern with policy and practice is not embedded in the research design from the outset, the likelihood that the results will speak to policy shapers will be significantly diminished.

The positioning and credibility of the messenger are also critical: due to the complexity of political processes, diverse political issues are more effectively communicated by different actors. For instance, where channels of communication between domestic actors and the state are precarious, international networks may serve to amplify domestic groups’ claims, bring pressure of international bodies and media attention to bear on domestic politics and thereby prise open new political spaces. In other cases, new ideas championed by northern NGOs may find much greater cultural resonance if they are communicated through local partners because of strong national discourses (e.g indigenous rights, trade policy impacts). Working as part of a network also serves to

35 The following discussion draws on Jones, 2005.

65 hone an individual institution’s understanding of different perspectives and to develop greater communication versatility (e.g. Tarrow, 1995). In addition, knowledge brokers need to be able to frame messages in context- appropriate ways. The first step involves securing a shared agreement with other stakeholders on the definition of the problem so that the focus of debates is increasingly around the ‘how’ rather than the ‘what’ (Taylor, 2005). By involving policy actors in discussions about research design and purpose from the outset, this type of convergence can be greatly facilitated (Court et al., 2005). Debates also need to be framed in culturally resonant language so as “to make possible the previously unimaginable, by framing problems in such a way that their solution comes to appear inevitable” (Keck and Sikkink, 1998: 40-41).

A third key ingredient is less tangible but no less important and is concerned with the intent to shape policy. Although ideas and new knowledge may percolate into policy circles gradually over time (Weiss, 1980), empirical evidence suggests that due to the dynamic and often unpredictable nature of the policy process, research that is informed by an intent to influence policy debates is more likely to be successful. This is because there is likely to be greater investment in the critical interpretative task of translating research findings into specific, context-appropriate and measurable indicators and policy recommendations required by government officials and donors alike.36 In practice, this also entails developing a wide repertoire of communication strategies and mechanisms, ranging from print policy briefs, reports and academic papers, through to audio and multi-media products and events such as community radio programmes, documentaries, websites; from regular one-to-one meetings with key decision makers through to workshops and public seminars.

7.2. Policy engagement around social protection and children As discussed in Blocks 1-3, although a number of social protection policy and programming approaches target children in a variety of ways, for the most part social protection in developing country contexts has not been conceptualised from a child- sensitive perspective (see also Minujin et al., 2007). Instead the focus has largely been on the unit of the household or population groups below the poverty line (e.g. Holzman and Jorgenson, 2000). Debates have been primarily framed in terms of ‘social risk management’ and providing safety nets for the poor to address market failures, and more recently by some advocates in terms of ‘social transformation’, i.e. going beyond material deprivations and addressing social inequalities more systemically from a political contract or rights perspective.

An important part of the analysis of Block 7 will therefore focus on investigating the discursive tactics employed internationally, in both developed and developing country contexts, by governmental and non-governmental agencies who have sought to promote social protection for children. In addition, it will be important to explore what kind of advocacy coalitions between civil society, international and line ministry actors were forged.

 How were debates introduced onto the policy agenda? For example, was the focus on orphans and other particularly vulnerable groups of children, such as street children, or was there a concern with children’s well-being more broadly? Does a focus on the dynamic and evolving nature of childhood poverty help to

36 See Jones et al., 2005.

66 progress debates beyond concerns about how best to target the chronic versus transient versus deserving poor?  What framing tactics worked in different contexts and why, and how did these conceptual underpinnings translate into programme design and programme implementation? For instance, in Latin America the focus has been on conditional cash transfers in order to secure buy in from the middle class (e.g. Adato, 2007), whereas in South Africa there has been a greater emphasis on achieving a social minimum for all in line with constitutional rights and in particular addressing the potentially irreversible effects of (especially early) childhood poverty (e.g. Hall, 2007). To what extent were they conceptualised as stand alone programmes, versus part of a broader social protection and/or poverty reduction framework?  What role did different types of evidence play in this process? NGOs such as Save the Children UK and Plan International have drawn heavily on evidence from pilot programmes and participatory research findings (e.g. Devereux et al., 2005), while the World Bank and IFPRI, as well as some national governments, have placed greater weight on more rigorous impact evaluation studies (eg. Blomquist, 2003; Adato, 2007).  Were these policy agendas led by child-specific coalitions or did they involve a wider range of actor groups such as advocates for the elderly, women or the chronically poor? Given concerns about the financial viability of social protection programmes in low income countries, children’s rights advocates have been aligning with a broader range of stakeholders in order to ensure that debates are framed in terms of poverty reduction and social justice, rather than the demands of a special interest group (e.g. Save the Children UK, Help Age and IDS, 2005).

The methodology used for this part of the analysis will be a desktop review, complemented by some telephone key informant interviews with policy analysts from organisations say as Save the Children UK, the Chronic Poverty Research Centre, Plan International, Help Age International.

7.3. UNICEF and Social Protection Against the international context mapped out in Section 2 above, the third component of Block 7 analysis will entail a closer focus on UNICEF’s work in the field of social protection. Our starting point will be the edited book arising from the 2006 international conference that UNICEF NY organised on Children and Social Protection: Policies, Programmes and Partnerships37 to review the thinking, programmatic and policy engagement work of UNICEF and some partners regarding social protection for children. This will provide useful insights into key debates in UNICEF and partner programmes internationally surrounding social protection for children, as well as examples of best practice.

The 2006 conference concluded that the role of international and NGO actors should be to help national governments and other partners create, expand and/or reform social

37 The workshop was held in conjunction with the international Conference on Social Protection for Children, Women and Families, jointly hosted by UNICEF and the Graduate Programme in International Affairs at The New School. At the conference, eighteen papers by academics and practitioners were presented (available on www.unicef.org/policyanalysis.index_36230.html). A selection of these papers comprise an edited volume by Minujin et al., 2007.

67 protection not as a separate, new work area, but rather as instrumental in facilitating progress towards both the MDGs and the realisation of the UNCRC’s social and economic rights commitments. UNICEF’s role emerged as primarily two-fold in this context: a unifying/convening role in order to achieve a unified voice on social protection for children and ensure donor and national buy-in; and an advisory/capacity-building role at the national level to ensure that children benefit from policies and programmes. Given that no updates are available on either the UNICEF or UNICEF Innocenti Research Centre websites as to how UNICEF has taken forward these recommendations within the institution, we will begin by undertaking a select number of key informant interviews with UNICEF staff in New York, Florence and WCARO to gain an understanding of institutional perspectives and positions re social protection policy agendas. It will be particularly important to ascertain to what extent this agenda follows a centralised approach or shaped by regional policy and programming strategies and priorities.

We will then focus our attention on the experiences of the WCARO country offices. Following consultation with the project manager in Senegal, we will identify key staff members with a particular interest or expertise in social protection issues working in offices other than our five country cases and undertake a brief structured survey as presented in table 7.1 below (to be distributed by WCARO Regional Office and returned to ODI via email). The bulk of our work will however focus on the five country case studies.

Table 7.1 UNICEF WCARO Prioritisation of and Capacity to Engage with Social Protection Policy Processes UNICEF Is social If not, are If yes, what Is there an Does your Are there Have staff WCARO protection there plans proportion adequate CO have dedicated had part of your to develop a of CO research good staff access to CO social programme base upon linkages responsible training on programme protection funding is which to with govt for social social programme? devoted to develop a agencies protection protection- SP? child- responsibl programming related focused SP e for social ? If so, how issues? programme protection? many? in your country? Benin Burkina Faso Cameroon Cape Verde Central African Republic Chad Congo, DR Congo Republic Cote d'Ivoire Equatorial Guinea Gabon

68 Gambia Ghana Guinea Guinea- Bissau Liberia Mali Mauritania Niger Nigeria Sao Tome e Principe Senegal Sierra Leone Togo

As mapped out in the project TOR, we will draw on UNICEF programme documentation and key informant interviews with relevant staff members to develop an inventory of information on the types of programming (e.g. pilot projects) and policy engagement undertaken to date, including whether this has been at a national policy development level, e.g. involvement in the formulation of national social protection strategies, integration of social protection into PRSPs, policy work on health insurance or the development of cash transfer programmes.

We will be particularly interested in discussing with UNICEF country office staff (in the regional workshop in Mali in April as well as in the 5 case study countries), potentially through focus group discussions with UNICEF country office staff, perspectives on the experience gained, the constraints or difficulties encountered (including UNICEF capacity for work in this area), and the opportunities for future programming and policy engagement in this field. We will draw on the policy engagement framework outlined in section 1 and explore:

 The type of evidence base upon which UNICEF WCARO social protection work has been carried out: e.g. to what extent have regional and international findings been helpful in advancing policy debates in WCARO countries? How useful have pilot programme evaluations (esp. in the cases of Ghana and Senegal) been?

 The framing strategies used and the extent to which they are informed by a multi-dimensional rights-based conceptualisation of childhood poverty: Devereux and Sabates-Wheeler (2007) have for example argued that because children can serve as a unifying force, the common prioritisation of children may serve to soften the ideological divide between social protection ‘instrumentalists’ and ‘activists’ and thereby encourage a fruitful way forward. What has been the experience in WCA?

 The type of partnerships and networks UNICEF has developed to date in this field with governmental, non-governmental, academic and donor agency actors at the sub-national, country, regional and international levels: has for example a focus on the inter-generational dimensions of childhood poverty and vulnerability

69 opened up opportunities for alliances with advocates for social protection for women and the elderly?  The communication strategies and tools employed to engage with children, communities, civil society groups, service providers and policy makers: in order to secure buy-in for social protection policies and programmes what approaches have been adopted to communicate with key stakeholders, and how could these be strengthened?

Table 7.2 Stakeholders Policy Engagement Approach to Social Protection and Children Name of Level of Level of Evidence Framing Partnerships Strategies Communications actor and support support needs and of issue with other for approach institution for social for social preference policy and change protection protection s civil society and for actors re rationale children social and protection rationale

UNICEF (global) UNICEF (WCARO)

Donors

70 Concluding Remarks

Both the desktop review and the individual country reports will draw out the main conclusions from the analysis. However, only in the synthesis report will cross-country comparisons be drawn and key themes be highlighted that might also be of relevance to the other countries in the country sub-categories identified in Block 1. Similarly, in the case of the desktop review which is regional in focus, we anticipate that there will be some gaps due to data limitations that will only be able to be addressed through the country case study findings. This triangulation of data and analyses will also be undertaken in the synthesis report. Lastly, we anticipate that the feedback from UNICEF on the desktop review and 5 country case study reports, will provide us with a useful steer as to the issues to be highlighted in the final synthesis report and presentation.

71 Annex 1: References

Block 1 References

African Development Bank (2007) African Development Indicators 2007

DHS Statcompiler database

DHS (2001) Mali report

DHS (2003a) Burkina Faso report

DHS (2003b) Nigeria report

DHS (2006) Niger report

Harper, C. (2004) Breaking poverty cycles – the importance of action in childhood, CHIP Policy Briefing 8, Childhood Poverty Research Centre, London, 2004. www.childhoodpoverty.org

IFAD (2001) West and Central Africa Rural Poverty Report

Ould el Hadj, S. and Diakhate, M. (2005), UNICEF-WCARO Policy Analysis Paper prepared for UNICEF/The New School conference “Social protection initiatives for children, women and families: an analysis of recent experiences”, October 30-31, 2006, New York

Sabates-Wheeler, R. and Kabeer, N. (2003) Gender equality and the extension of social protection, ESS wp16, ILO, Geneva

Sahel and West Africa Club/OECD (2006) The socio-economic and regional context of West African migrations, Sahel and West Africa Club /OECD Working Document 1, November 2006, OECD: Paris.

UNCTAD (2002) Escaping the poverty trap: least developed countries report 2002

World Bank (2007) World Development Report 2008

72 Block 2 References

Barrientos, A. and Holmes, R. (2007) Social Assistance in Developing Countries Database. DFID, London

Devereux, S. and Sabates-Wheeler, R. (2004) ‘Transformative Social Protection’ IDS Working Paper 232 Institute of Development Studies, Brighton

Guenther, B., Huda, K. and Macauslan, I. (2007) Broadening social risk management: risks, rights and the chronic poor. Debating Social Protection IDS Bulletin Vol 38 (3)

Guhan, S., 1994, ‘Social security options for developing countries’, International Labour Review Vol 133 No 1: 35–53

Hickey, S (2005) - Thinking about the politics of social protection in Africa: towards a conceptual and theoretical approach. Manchester: IDPM

Holzmann, R. and Jørgensen, S. (2000) ‘Social Risk Management: A New Conceptual Framework for Social Protection and Beyond’, Social Protection Discussion Paper 0006, Washington DC: World Bank.

Jones, N., Mukherjee, M. and Galab, S. (2007) Ripple effects or deliberate intentions? Linkages between women’s empowerment and childhood poverty in Andhra Pradesh, India. Delhi and Oxford: UNICEF India and Young Lives Oxford University Working Paper.

Minujin, A., Delamonica, E., Davidziuk, A. and Sweet, E. (2007) Notes of social insurance and protection policies for children, women and families. New York: Social Protection.

Ould El Hadj and Diakhate (no date) Social Protection Schemes In West And Central Africa: A Proposal For Renewal – Draft. UNICEF

Sabates-Wheeler, R. and Kabeer, N. (2003) ‘Gender equality and the extension of social protection’ Extension of Social Security Paper no. 16, ILO

Slater, R. and Tsoka, M. (2007) Social Protection in Malawi: A Status Report. (Forthcoming) World Bank country Working Paper

UNICEF (2007) The State of the World's Children. URL: http://www.unicef.org/publications/index.html

UNICEF (2006) Children and Social Protection: Policies, Programmes and Partnerships, UNICEF Workshop, 1-3 November 2006, meeting report, New York, 18 December.

Adato, M. (2000). The Impact of PROGRESA on Community Social Relationships. September. International Food Policy Research Institute, Washington, D.C.

Adato, M., B. de la Brière, D. Mindek, and A. Quisumbing. (2000). Final Report: The Impact of PROGRESA on Women's Status and Intrahousehold Relations. July. International Food Policy Research Institute, Washington, D.C.

Barrientos, A., 2004, ‘Financing Social Protection’, Draft Theme Paper 2, report prepared for DFID, Institute of Development Policy Management (IDPM), Manchester

Barrientos, A. and DeJong J. (2006) Reducing child poverty with cash transfers: a sure thing? Development Policy Review Vol 24 (5) pp537-553

Barrientos, A. (2006) International Experiences and Lessons on Conditional Cash Transfer Programmes - and Checklists for Countries in Africa. Institute of Development Studies, IDS, Brighton.

Barrientos, A. and Lloyd-Sherlock, P. (2002) Non-contributory pensions and social protection. Paper for the series ‘Issues in Social Protection’, published by the Social Protection Sector, International Labour Organization.

Barrientos, A. and DeJong, J. (2004) Child poverty and cash transfers. CHIP report 4

Britto, T. (2005) Recent Trends in the Development Agenda of Latin America: An Analysis of Conditional Cash Transfers.

Coady, D, Grosh, M and Hoddinott, J (2004) Targeting of Transfers in Developing Countries: Lessons and experience. Washington DC: World Bank and IFPRI

DFID (2005) Why we need to work more effectively in fragile states. DFID, London.

Devereux, S., Marshall, J., MacAskill, J., and Pelham, L. (2005) Making Cash Count: Lessons from cash transfer schemes in east and southern Africa for supporting the most vulnerable children and households. Save the Children UK, HelpAge International and Institute of Development Studies.

DFID (2005) Social Transfers and Chronic Poverty: Emerging Evidence and the Challenge Ahead. A DFID Practice Paper. Department for International Development, London

DFID (2006) Eliminating World Poverty, Making Governance Work for the Poor: A White Paper on International Development. Department for International Development, London UK

DFID (2007) Social protection and financial services: Enhanced payment options for social transfer schemes. DFID Social Protection Briefing Note Series, 5. UK

74 Ezemenari, K. and Chaudhury, N. (2002) Gender and Risk in the Design of Social Protection Interventions. Social Protection Discussion Paper Series 0231, World Bank, Washington

Farrington, J., Sharp, K. and Sjoblom, D. (2007) Targeting approaches to cash transfers - comparisons across Cambodia, India and Ethiopia. DRAFT ODI

Gertler, P., Barungi, B. Woolard, I. (2005) The impact of conditional cash transfers on human development outcomes: a review of evidence from PROGRESA in Mexico and some implications for policy debates in South and Southern Africa. Southern African Regional Poverty Network

Handa, S. and Davis B. (2006) Conditional Cash Transfers in Latin America and the Caribbean. Development Policy Review Vol. 24 (5) pp513-537.

Harvey, P. and Holmes, R. (2007) The potential for joint programmes for long-term cash transfers in unstable situations. HPG Commissioned Report. DFID

Harvey, P. (2006) Cash-based responses in emergencies. HPG Report 24

Hickey, S. (2006) The politicsof what works in reducing chronic poverty. A synthesis for the Ministry of Foreign Affairs, The Netherlands. CPRC Working Paper 91

Hodges, A. et al (2007) Child benefits and poverty reduction: evidence from Mongolia’s Child Money Programme. Maastricht University (Maastricht Graduate School of Governance) - UNICEF Policy research paper.

Holmes, R. and Jackson, A. (2007) Cash Transfers in Sierra Leone: Appropriate, Affordable and Feasible? EPRU, Ministry of Finance, Sierra Leone, ODI, London. Draft.

Jones, N., Vargas, R. and Villar, E. (2007) Cash Transfers for Children in Peru: Tackling the Multi-Dimensionality of Poverty and Vulnerability in Alberto Minujin (ed.) Social Protection Initiatives for Families, Women and Children: An Analysis of Recent Experiences. New York: New School and UNICEF.

Longley, C., Christoplos, I. and Slaymaker, T. (2006) Agricultural Rehabilitation: Mapping the Linkages between Humanitarian Relief, Social Protection and Development. Humanitarian Policy Group, ODI London

Lund, F. (2006) Gender and social security in South Africa. Human Sciences Research Council, South Africa

Marcus, R. and Wilkinson, J. (2002) Whose Poverty Matters? Vulnerability, Social Protection and PRSPs. CHIP report 0

McCord, A. (2006) An Overview of Social Protection Interventions in Kenya. UNICEF Kenya

McCord, A. (2005a) Public works in the context of HIV/AIDS: innovations in public works for reaching the most vulnerable children and households in east and southern Africa.

75 Southern African Labour and Development and Research Unit, University of Cape Town (UCT)

McCord, A. (2005b) Win-win or Lose? An Examination of the Use of Public Works as a Social Protection Instrument in Situations of Chronic Poverty. Paper presented at the conference on Social Protection for Chronic Poverty, University of Manchester, 23-24 February 2005

Molyneux, M. (2007) Change and continuity in social protecion in Latin America: Mothers at the service of the state? UNRISD, Geneva, Switzerland

Nigenda, G. and Gonzalez-Robledo, L.M., 2005, 'Lessons Offered by Latin American Cash Transfer Programmes, Mexico's Oportunidades and Nicaragua's SPN: Implications for African Countries', UK Department for International Development's (DFID's) Health Systems Resource Centre (HSRC), London

Pauw, K. and Mncube, L. (2007) Expanding the Social Security Net in South Africa: Opportunities, Challenges and Constraints. Country Case Study 8. International Poverty Centre

Pelham, L. (2007) The politics behind the non-contributory old age social pensions in Lesotho, Namibia and South Africa. CPRC Working Paper 83

Reimers, F., De Shano da Silva, C., Trevino, E. (2006) Where is the "education" in conditional cash transfers in education? UNESCO Institute for Statistics, Montreal, Canada

RHVP (2007) Lessons from Ethiopia on a scaled-up national safety net programme. Wahenga.net, Regional Hunger and Vulnerability Programme

Sadan, M. (2005) Gendered Analysis of the Working for Water Programme: A Case Study of the Tsitsikama Working for Water Project. Institute for Democracy in South Africa

Schubert, B. (2005) The Pilot Social Cash Transfer Scheme Kalomo District – Zambia. CPRC Working Paper 52.

Schubert, B. and Huijbregts, M. (2006) Social Protection Initiatives for Children, Women and Families: An Analysis of Recent Experiences. UNICEF

Schubert, B. and Slater, R. (2006) Social Cash Transfers in Low-Income African Countries: Conditional or Unconditional? Development Policy Review Vol 24 (5) pp571- 579

Sharp, K., Brown, T., and Teshome, A. (2006) Targeting Ethiopia's Productive Safety Net Programme (PSNP). DFID

Teruel, G., and B. Davis. (2000). Final Report: An Evaluation of the Impact of PROGRESA Cash Payments on Private Inter-Household Transfers. August. International Food Policy Research Institute, Washington, D.C.

76 Thomas, P. (2005) Ending child poverty and securing child rights: the role of social protection. Plan International

UNICEF (2005) The 'rights' start to life. UNICEF

Veras Soares, F.and Britto, T. (2007) Confronting Capacity Constraints on Conditional Cash Transfers in Latin America: The Cases of El Salvador and Paraguay. Working Paper 38. International Poverty Centre

Veras Soares, F., Perez Ribas, R. and Guerreiro Osório, R. (2007) Evaluating the Impact of Brazil’s Bolsa Família: Cash Transfer Programmes in Comparative Perspective. IPC Evaluation Note 1.

Wietler, K. (2007)The Impact of Social Cash Transfers on Informal Safety Nets in Kalomo District, Zambia. GTZ

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88 Annex 2 Health Financing Definitions38

Community Health Insurance: a particular form of voluntary private health insurance that has often emerged in environments where other financial risk protection mechanisms only have a limited impact. Contributions are not risk-related, and there is generally a high level of community involvement in the running of such schemes.

Demand side financing: an innovative financing strategy involving a government subsidy directly to households, often through mechanisms such as competitive voucher schemes.

National Health Accounts: an accounting system that describes the expenditure flows in both the government and non-government sectors; it describes the source of all funds utilised in the sector and the destination and uses of those funds.

Private Health Insurance: generally voluntary, premiums are paid directly from employers, associations, individuals and families to insurance companies, which pool risks across their membership base. Private insurance includes policies sold by commercial for profit firms, non-profit companies, and community health insurers. Premiums are based on individual risk.

Social Health Insurance: compulsory insurance based on pooled contributions from workers, employers, the self-employed, enterprises and government; premiums are based on income level and not related to risk levels; these funds typically contract with a mix of public and providers for the provision of a specified benefit package.

Tax-based Financing: individuals contribute to the provision of health services through taxes on income, purchases, property, capital gains, and a variety of other items and activities. These are typically pooled across the whole population, unless local governments raise and retain tax revenues. Health services are purchased by government, usually from a mix of public and private providers.

38 Adapted from WHO Health Financing Policy Website, accessed Jan. 2008.

89 90 Appendix 1: Research methodology and sources for the desk-based review

Research Research questions Methodology Sources Coordinating theme and Author and scope timeline Block 1: Review of the poverty situation and types of vulnerability and risk affecting children in WCAR

Household How does income and access to Literature Review 1. DHS reports, 2. TB poverty and public services correlate? CPRC country studies Feb/March 2008 deprivation in and regional overview the region What is the relationship between Literature Review 1. DHS reports, 2. TB household composition (e.g. female CPRC country studies Feb/March 2008 and child headed households) and and regional overview. income poverty? 3. other grey literature (ILO) How do poverty rates vary with Literature Review 1. DHS reports, 2. TB occupation? CPRC country studies Feb/March 2008 and regional overview How is poverty related to social To be finalised exclusion (e.g. people affected by HIV/AIDS, migrants) What is government commitment to Literature Review 1. Public spending TB social sector public services? figures from WB, IMF Feb/March 2008 Household How many households are in high Literature Review To be finalised TB vulnerability vulnerability occupations or regions Feb/March 2008 in the region Child poverty What are the particular characteristics Literature Review DHS reports TB and of child under-nutrition in the region? Feb/March 2008 vulnerability in the region

91 What is the distribution, and what are Literature Review DHS reports; 2. MICS TB the determinants, of low maternal data; 3. locally available Feb/March 2008 weight? studies and data Which children miss school? Literature Review To be finalised TB Feb/March 2008 What factors affect child nurture? Literature Review 1. qualitative studies of TB domestic division of Feb/March 2008 labour, social norms e.g. Plan International Status of Girls in Africa report; 2. locally available studies and data Are there particular vulnerable and/or Literature Review 1. DHS reports; 2. MICS TB deprived groups of children that need data; 3. UNICEF and Feb/March 2008 special attention? Investigate for child other child specialist labourers; fostered children; child agencies' work on child combatants protection What causes children to miss school? Literature Review 1. DHS reports, 2. other TB qualitative studies Feb/March 2008 How does child labour affect schooling Literature Review 1. DHS reports, 2. ILO TB and nurture? understanding child Feb/March 2008 work data What is impact of HIV/AIDS on child Literature Review 1. DHS database TB poverty and vulnerability? Feb/March 2008 How are children affected by political Literature Review 1. analyses from TB and governance processes in the specialist child-focussed Feb/March 2008 region? Do they have a voice? agencies Is there a system for registering Literature review 1. UNICEF documents TB children’s births? How effective is this and data Feb/March 2008 system in ensuring children have an official identity and in turn access to basic services?

92 Block 2: Assessment of existing social protection systems and their impact on children

Analysis of Is there a joined up approach Data from mapping; Data from mapping on EB / RH political, among multiple agencies or are regional literature institutional Feb/March 2008 institutional and programmes implemented in a arrangements implementation piecemeal fashion? constraints PRSPs, national policy Institutional documents arrangements Are influential sectors (e.g. Data from mapping; Data from mapping on EB / RH Ministries of economics, labour, regional literature institutional Feb/March 2008 planning and investment) involved? arrangements Are there adequate policy/legal Literature review PRSPs; national policy EB / RH frameworks in place? documents Feb/March 2008

Political support Are social protection programmes Data from mapping; PRSPs; national policy EB / RH adequately embedded in PRSPs Literature review documents Feb/March 2008 and their equivalent? Are donors supportive of these Data from mapping Data from mapping on EB / RH programmes? institutional and funding Feb/March 2008 arrangements Are regional bodies supportive of Literature review regional policy EB / RH social protection initiatives? documents Feb/March 2008 Linking women’s To what extent are potential Data from mapping Data from mapping on EB / RH empowerment synergies between measures to programme design Feb/March 2008 and reduction in improve women’s empowerment childhood poverty and improvements in child well- being built into programme design? Service supply What are the supply side Data from Block 1 Data on service EB / RH constraints? Literature review provision in Block 1 Feb/March 2008 State of the World's Children

93 Block 3: Assessment of the potential role of social transfers in reducing poverty and vulnerability among children

Does targeting What are the politics around targeting? 1. International 1. International RH / EB make sense in (e.g. debates around universalism and literature review literature: Farrington, Feb/March 2008 the WCA targeting; targeting to female headed Sharp and Sjoblom context or child headed households) (2007); McCord, A. 2. Regional literature (2005); McCord (2006); review Hodges et al (2007)

2. Analysis from Block 1 data What administrative capacity is 1. International 1. E.g. Coady et al. RH / EB required for different targeting literature review (2004) Feb/March 2008 mechanisms? Does this capacity exist in WCA countries? 2. See institutional capacity analysis below What are the social implications of International literature International literature : RH / EB different targeting mechanisms? Do review Molyneux (2007) ; Feb/March 2008 cash transfers empower women and Adato et al. (2000); achieve better welfare results for Ezemenari. And children, or create an additional Chaudhury (2002); burden on women? Sharp et al. (2006); Lund (2006); Sadan (2005); Devereux et al. (2005); Nigenda and Gonzalez-Robledo (2005); RHVP (2007); Jones et al. (2007); Schubert and Slater (2007)

94 What is the impact of formal cash 1. Literature review 1. International literature: RH / EB transfer programmes on traditional and Wietler (2007); Teruel Feb/March 2008 customary systems of protection? How and Davis. (2000); have family structures affected (e.g. in Devereux et al. (2005); the context of HIV) informal transfers Longley et al. (2006) between households? Are demand What social service provision and International International literature: RH / EB side infrastructure is necessary for literature review Gertler, Barungi and Feb/March 2008 approaches implementing cash transfers? Woolard (2005); Harvey appropriate in and Holmes (2007); WCA? Harvey et al. (forthcoming 2007); Harvey (2006); Reimers et al. (2006); Handa and Davis (2006); Schubert and Slater (2006); Holmes and Jackson (2007) To what extent could the supply of Regional literature Regional literature: e.g. RH / EB services respond to increased demand data on health and Feb/March 2008 (quantity and quality) education service provision/quality/access Do countries What are the necessary institutional 1. International 1. Veras Soares and RH / EB in WCA have capacities required to implement cash literature review Britto (2007); Pauw and Feb/March 2008 the transfers? And what are the implications Mncube (2007); Harvey administrative of social protection being implemented and Holmes (2007); and through “weak” ministries? Britto (2005); Nigenda governance and Gonzalez-Robledo conditions for (2005); Devereux et al. effective (2005); Barrientos delivery of (2006); Schubert and cash Huijbregts (2006); transfers? Barrientos and Lloyd-

95 Sherlock (2002); Veras Soares et al. (2007); Veras Soares and Britto (2007); Pauw and Mncube (2007); Britto (2005); Hodges et al (2007) What is the institutional strength of the 1. Regional literature 2. E.g. Wilibald RH / EB public sector in the region? (in particular review (2006); Holmes and Feb/March 2008 for potential implementing Ministries) Jackson (2007)

To what extent is the risk of corruption a 1. International 1. Harvey (2007) RH / EB problem for delivering cash transfers in literature review Feb/March 2008 the region? 2. Regional literature 2. Data from Block 1: review governance indicators; Transparency International

96 What is the extent to 1. Data from Block 1. 1. Data from Block 1. RH / EB which birth registration Feb/March 2008 systems exist and are utilised by the populace? To what extent can/do 1.International literature 1. International literature: DFID (2007); RH / EB low income households review Harvey (2006); Schubert (2005); Feb/March 2008 have access to financial Holmes and Jackson (2007) services? What might alternative delivery mechanisms be? What does international International literature International literature: Hickey (2006); RH / EB evidence tell us about the review Devereux et al. (2005); Barrientos Feb/March 2008 necessary preconditions (2006); Pelham (2007); Pearson et al. for cash transfers to be (2006); Britto (2005); McCord (2005b); politically accepted? Schubert and Huijbregts (2006); Britto (2005); Schubert and Slater (2006); Hodges et al (2007); Holmes and Jackson (2007) What is the interest and 1. International literature 1. International literature: Marcus and RH / EB relative influence of review Wilkinson (2002); DFID (2006); Feb/March 2008 various governmental, Barrientos (2004); Holmes and donor and non- Jackson (2007) governmental actors involved in cash 2. Regional literature 2. Block 2 analysis on government and transfers? review donor commitment to cash transfers in PRSPs, national development strategies etc.

97 Block 4: Assessment of potential role of strengthened social insurance in reducing poverty and vulnerability among children

Basic health What is the current health Analysis of regional NICEF statistics, State of the CW needs and status of children in the health data. World’s Children 2007, WHO health Feb/March health country? indicator statistics; National level 2008 interventions to data (Ministries of Health); UNICEF secure the What are the most pressing MICS; DHS Surveys. social health issues for children? protection of children What essential health services Literature Review UNICEF and WHO documents CW must be provided for childhood Feb/March development and to ensure 2008 social protection of children (including maternal health)? Current basic What are the current Mapping of existing Block 2 EB health services programmes operating to meet social protection Feb/March for children: essential maternal and child programs 2008 Current health health needs? programming What are the gaps in Analysis of Block 1 Block 1 TB coverage? poverty and Feb/March vulnerability data 2008 What prevents poor Literature Review Academic and Grey Literature CW populations from seeking Feb/March medical care? 2008

Current What are the current social Mapping of current Block 2 Analysis RH/EB targeted social protection programmes in social protection Feb/March protection health targeted to children programmes 2008 health (e.g. nutritional programmes; programmes for health fee exemptions for the

98 vulnerable poor)? children What are their strengths and Literature review Academic literature review CW weaknesses? May 2008

Current health What types of funding Literature review Ministries of Health, UNICEF, WHO, CW financing mechanisms and insurance ILO, GTZ-ILO-WHO Consortium on May 2008 schemes schemes currently exist for Social Health Protection in operating accessing health care? (i.e. Developing Countries; Country Case regionally and SHI, private insurance, Study Literature (e.g. Mutuelles de la country specific community based insurance santé in Senegal) case studies; schemes, user fees/out of how equitably pocket payments, are child health taxation/public expenditure, needs are donor funding and also financed traditional health providers and currently? community care structures39). What are the strengths and weaknesses of each in the WCA context?

What health services are covered by health financing schemes? For which services are user fees incurred? What types of insurance Literature review Ministry of Health policy documents CW subsidies and/or user fee Mapping of existing May 2008 exemptions are available social protection Block 2 through the government? programs From external agencies? 2. RH Feb/March How helpful are existing 2008

39 See Appendix 2 for health financing definitions.

99 subsidies and exemptions? Are these easy to access? Potential for What does international Literature Review 1. Ensor (1999) analytical framework CW expanded evidence tell us about the for feasibility of SHI May 2008 health service necessary preconditions of financing: SHI to be politically accepted? 2. Academic and Grey Literature Political What does international (e.g. Gottret & Schieber 2006, Carrin Analysis evidence tell us about the 2002, Gilson & McIntyre 2005, necessary preconditions of Gilson 1997, Wilkinson et al. 1997) other progressive health financing schemes (e.g. 3. Case study literature (Uganda, Community Based Health South Africa, Kenya, Zimbabwe) Insurance, Demand side financing) to be politically accepted?

What does international evidence tell us about the transition process of removing user-fees? What is the interest and 1. International 1. International literature (e.g. Bhatia 1. CW relative influence of various literature review and Mossialos 2004; Kutzin 2001) May 2008 governmental, donor and non- 2. Regional health 2. National Health Accounts; governmental actors involved expenditure data Ministries of Health Data in health financing schemes? Do various actors have 2. CW preferences for particular Feb/March financing schemes and if so, 2008 why? What would be the political International International literature CW response, including from elite literature review Feb/March groups in the population, to 2008 implementing insurance

100 subsidies for the poor? Social Analysis What are the potential Literature review Academic and grey literature CW unintended consequences for May 2008 the poor in implementing a SHI system? (e.g. high co- payments, sporadic coverage due to poor administrative capacity) Do insurance schemes International Academic literature and case study CW empower care-givers (e.g. literature review literature May 2008 increasing control over child health care decisions and expenditures) or create an additional burden on them (e.g. in the case of community- based health insurance, managed by women’s unpaid labour)? How can health care provision 1. Literature review 1. Literature review 1. CW schemes be made inclusive of May 2008 largely rural/informal sector 2. Poverty 2. Block 1 populations? vulnerability analysis 2. TB Feb/March 2008 What is the impact of formal Literature review Literature Review CW health insurance schemes (for May 2008 Western health care coverage) on traditional health care provision? Could health insurance schemes be designed so as to improve synergies?

101 Capacity and In a SHI system, could 1. Literature review 1. Academic and policy literature 1. CW Implementation measures be taken to ensure (e.g. Carrin 2002, Obermann et al. May 2008 Analysis that the extreme poor can 2006, Carrin et al. 2005) afford to pay their premiums 2. Fiscal space 2. Block 6 2. GH, PP and deductibles? analysis Feb/March 2008

Is it fiscally feasible to provide subsidies for the poor and exemptions from co- payments? Is there sufficient capacity to 1. Literature review 1. Academic and policy literature 1. CW generate the necessary (e.g. Ensor 1999, Gottret & Schieber May 2008 revenue to cover child health 2006, Carrin 2002). care costs through the 2. GH, PP proposed SHI or other health- 2. Fiscal space 2. Block 6 Feb/March 2008 financing scheme? analysis

Is there sufficient revenue for the scheme to be sustainable? Does the government have the Regional literature Case study literature, Health Sector CW administrative capacity to review Financing and Service Delivery Data Feb/March 2008 implement SHI? To what degree is the health 1. Literature review 1. Academic literature CW sector equipped to meet May 2008 increased demand for 2. Health sector data 2. Ministry of Health Data; WHO essential child health analysis Data services? (in terms of infrastructure, supplies, human resources etc.)?

What is the impact of donor 1. Literature review 1. Academic literature CW

102 funding on health financing May 2008 mechanisms (e.g. role of 2. Health sector data 2. Ministry of Health Data; WHO SWAPs)? To what degree can analysis Data this be used to support health- financing schemes for child health services? Block 5:The strengthening of child protection services within broader social protection systems

Child protection What are the main child Lit Review UNICEF Humanitarian Action NJ/EB priorities protection priorities in the Desktop Review report, UN Violence Study region? Block 1 (Regional report), Issue-specific What data is available? documents such as Ebigbo (2003) and HRW Trafficking in Togo report (2003) NJ/EB Literature as above; Save the Children (2006) Liberia study on sexual exploitation; UNICEF (2005) report on FGM, World Bank country data, ILO country data on child labour, IITA report on Cocoa farm labour in Ghana, Nigeria TB

Block 1: Vulnerabilities and Risks

What are the prevailing social Literature Review UNICEF, Save the Children, NJ/EB attitudes and practices with World Bank Social Protection respect to major child protection discussion papers, ECPAT issues? (Aboriginal communities) Human Right Watch reports, Ogunyemi (2000)

103 Existing child What current state-funded child Literature Review Country-specific legislation (e.g. NJ/EB protection system protection programmes exist? Mali’s National Plan, Ghana’s Children’s Act and Child Labour Are there educational / Act); ECOWAS reports. awareness-raising programmes to sensitise communities to these problems and to address cultural norms that condone abuse?

Which government agencies are Literature Review Individual pieces of NJ/EB responsible for these respective legislation/on programmes (e.g. programmes? GAIN school-feeding programme in Ghana), newspaper reports in-country/on web

What type of staff capacity Desktop Review for Block 2 Matrix of SP RH exists to address child Block 2 Interventions (specifically child protection issues? grants and child protection)

Are these programmes adequately financed? What NGO programmes exist? Literature Review (I)NGO documents/websites NJ/EB such as UNICEF, Human Rights Watch, Save the Children on current projects, national programmes, partnerships with government; in-country regional news (e.g. on school-feeding) for local-level reports Desktop Review for RH

104 Block 2 Block 2 Matrix (specifically on child grants and child protection) To what extent are NGO and Literature Review As above NJ/EB GO child protection programmes coordinated? Desktop Review for Block 2 matrix (Child protection RH Block 2 specifically); Block 2: existing social protection systems

What types of monitoring and Desktop Review Block 2 Matrix RH evaluation mechanisms exist? Literature Review Review of specific programmes NJ/EB (e.g. child-protection aspect of LEAP in Ghana) How are these programmes Desk-based Block 2 Mapping RH framed by different Review Block 1 analysis identifying implementing agencies? Desk-based vulnerable groups TB What are the gaps in coverage? Review

Literature Review Specific information in key NJ/EB programmes (e.g. Save the Children’s work with refugees in Liberia) UNICEF overview – Hadi and Diakhate (2005) In practice, what are the Literature Review World Bank SP DP, Save the NJ/EB problems with the existing Children reports, UNICEF system as a whole and how reports, Mulinge (2002), child-friendly is it? Onyango and Lynch (2005)

What changes could be made to Literature Review SNAICC report, UNICEF/UN NJ/EB

105 make the programmes more recommendations, Save the effective/comprehensive? Children, Human Rights Watch What are the institutional, World Bank SP DP docs, political and social constraints to Mulinge (2002), Onyango & scaling up child protection Lynch (2006), NSPCC programmes? International guidelines, UNICEF (2004) Handbook for Parliamentarians Targeting By what mechanisms are Block 1 analysis of Desk-based review TB vulnerable current child protective vulnerability children and measures targeted at vulnerable implementing groups? (especially children mechanisms affected by HIV/AIDS, migrant which are children responsive to their particular needs What are the specific needs and Desk-based Block 1 analysis of vulnerability TBS obstacles in child protection Review access for vulnerable Issue-specific documents (e..g populations? And rural/informal Literature Review Blunch, 2002 on child NJ/EB groups (e.g. no school labour/school attendance in attendance, street children, child Ghana) laborers)? International What examples of best practice Desk-based Block 2 mapping (specifically RH experiences with in child protection system Review child protection) child protection development and systems implementation from other Literature Review World Bank SP DPs, specific NJ/EB countries can be found (Latin project literature (e.g. Juntos in America, Asia, Europe)? Peru) or legislation (such as the Children’s Act in Kenya and Uganda) What types of social, Literature Review As above + country-relevant NJ/EB

106 institutional and political information (e.g. Save the conditions are necessary for Children report on Liberian success? refugee camps) What are the international Literature Review Documents from NSPCC, EU, NJ/EB examples of best practice in British Columbia Child integrating child-focused social Protection Evaluation system, protection systems with child Save the Children (2007) protection systems? guidelines on implementing child protection Promoting What is the scope for promoting Literature Review Hadi & Diakhate (2005), Guhan NJ/EB synergies synergies between child- (2004), Devereux and Sabates- between child focused social protection and Wheeler (2006), Kamerman & focused social child protection systems? Gabel (2005), UNICEF (2004) protection What types of reforms would Handbook for Parliamentarians, systems and child this entail? (e.g. legislative, NSPCC (2007) guidelines, protection policy framework development, Delaney (2006), Dottridge systems staff capacity building, (2007) establishment of an oversight agency)

What could be done to enhance Lit Review Paris Declaration (2005) NJ/EB national ownership of child protection programmes?

Block 6: Fiscal space for strengthened social protection

107 How much room Explain the concept of Brief desk-based literature Heller (2005), Heller et GH is there to ‘fiscal space’ with review al. (2006), Roy et al. March/April increase social reference to the relevant (2007), High-Level protection literature. Forum on the Health expenditures? MDGs (2005) What is the overall picture Desk-based research (Data for IMF International GH with regard to ‘fiscal all countries in west and Central Finance Statistics (IFS), March/April space’, as assessed Africa on overall macroeconomic IMF Government against a number of and fiscal indicators, ideally for Finance Statistics (GFS), indicators, in the WCA 1990 to present (GDP, GNI, World Bank World region? population, total imports, total Development Indicators exports, capital formation, (WDI), IMF Article IV money stock (broad money), consultations, Poverty domestic inflation rate, credit to Reduction and Growth the private sector, current Facility (PRGF) reports account deficit, total revenue, for WCA countries and total aid (grants), non-renewable selected international resource revenue, total comparators expenditure, current expenditure, capital/investment expenditure, wage expenditure, fiscal deficit/surplus, total debt stock, domestic debt stock, external debt stock, Net Present Value (NPV) of external debt, debt service/interest payments) How predictable are Desk-based analysis of total aid OECD DAC and OECD GH external assistance flows? flows, aid flows for social CRS online databases March/April expenditure for WCA countries and selected international comparators How does social What is total GDP, Desk-based research IMF International GH

108 protection government spending, and Finance Statistics (IFS), March/April expenditure the composition of social IMF Government compare with sector spending in the Finance Statistics (GFS), other sectors and WCA region and other World Bank World countries? selected international case Development Indicators studies? (WDI), IMF Article IV consultations, Poverty Reduction and Growth Facility (PRGF) reports for WCA countries and selected international comparators What is the demographic Desk-based research Database on UNFPA GH profile of CS countries and website for CS countries March/April selected comparators? and selected comparators Can any data on Desk-based research IMF International GH administrative costs of Finance Statistics (IFS), March/April social protection IMF Article IV programmes in the WCA consultations, region and in selected international comparators be found? Block 7: UNICEF engagement on social protection

Framing debates How have debates on social 1. International 1. e.g. Barrientos and Jong, NJ protection and children been literature review 2004; Budlender, et al., 2005; March-April framed in other country Devereux et al., 2005; Marcus, contexts? What have been the 2006; Hall, 2007; Kakwani et al., strengths and weaknesses of 2006; Norton, et al., 2001; these approaches? How have Edstrom, 2007; Jones, Villar and conceptual underpinnings been Vargas, 2008; Streuli, 2007 translated into programme and 2. Telephone key

109 policy realities? informant 2. Jennifer Jablonski, Poverty interviews Advisor, SC-UK; Rachel Marcus, (international) CPRC consultant; Cesar Bazan, Policy Advocacy Advisor, Plan International; Enrique Delamonica; Michelle Adato; IFPRI; Stephen Deverux; IDS. 3. Telephone key informant 3. Jenny Marshall, SC-UK West interviews - see Africa; other KIs recommended Table 7.2 by UNICEF project manager (WCARO region)

Evidence and What type evidence base has 1. Telephone key 1. Jennifer Jablonski, Poverty NJ policy influence been effective in shaping policy informant Advisor, SC-UK; Rachel Marcus, March-April debates? Where are the key interviews CPRC consultant; Cesar Bazan, knowledge gaps? How if at all (international) Policy Advocacy Advisor, Plan are these starting to be International; Enrique addressed? Delamonica; Michelle Adato; IFPRI; Stephen Deverux; IDS.

2. Telephone key 2. Jenny Marshall, SC-UK West informant Africa; other KIs recommended interviews by UNICEF project manager (WCARO region)

Actor coalitions What types of advocacy 1. Telephone key 1. Save the Children UK, Plan NJ, PP, EV coalitions have been formed in informant International, Peruvian Juntos order to promote child protection interviews Programme Staff. Mexican for children? What are the (international) Progressa Progrmme Staff relative strengths and NJ weaknesses of a child-only 2. KIs recommended by UNICEF March-April

110 focused alliance vs a multi- 2. Telephone key project manager stakeholder alliance? What informant potential is there for interviews strengthened links with these (WCARO region) and other key actors? Communication What types of communication 1. Telephone key 1. Save the Children UK, Plan NJ, PP, EV strategies and strategies have been adopted informant International, Peruvian Juntos tools with key policy and civil society interviews Programme Staff. Mexican actors? How effective have (international) Progressa Progrmme Staff these been? How could they be NJ strengthened? 2. KIs recommended by UNICEF March-April 2. Telephone key project manager informant interviews (WCARO region)

UNICEF country What are the strengths and 1. Short structured 1. All WCARO offices to be EB to coordinate office capacity weaknesses of UNICEF questionnaire facilitated by WCARO Regional to engage with WCARO country offices in terms (see Table 7.1) Office social protection of engaging with and advocating policy debates for social protection for children? 2. Key informant 2. KIs with UNICEF CO country and processes What capacities would need to interviews (country case study staff be developed in order to case studies) improve UNICEF’s regional role in this field?