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                            DISCUSSION PAPER: EMERGING ISSUES 1
                               By Miriam Temin ** January 6, 2010

The Inter-Agency Task Team on Children and AIDS (CABA) carries out their work through
three working groups.2 One of these, the Social Protection Working Group (SP WG), comprising
UN agencies, bilateral donors, NGOs and academic institutions, convened by UNICEF,
commissioned a mapping exercise of child sensitive social protection to generate better inter-
agency understanding on what SP WG members and other major actors are doing on social
protection programming relevant to children affected by HIV and AIDS. In line with the IATT s
mandate, the goal of the mapping is to inform more systematic and harmonised programming at
global, regional, and country level, with an emphasis on action for vulnerable children living in
countries most affected by the epidemic.

This short paper aims to set out key issues emerging from an analysis of the matrices and reflects
the perspectives of the consultant; it aims to stimulate further discussion within the IATT on
CABA and beyond. The document also draws on discussions with individual members of the SP
WG at a meeting held in London in December 2009 (minutes for this meeting are available from

Accompanied by detailed and summary matrices reflecting the results of the mapping, this
discussion paper summarises the main findings and recommendations.

1. General Observations
1.1 Timeliness of the Child-Sensitive Social Protection agenda: As the SP WG mapping has
developed, several related social protection developments are unfolding, making this is an
exciting time for those interested in social protection and an enormous opportunity for vulnerable
children. The global economic crisis, further undermining weak family and community safety
nets, makes this agenda all the more timely. In addition to the work of the SP WG, UNAIDS has
a growing interest in the area through their new outcome framework, with Social Protection as its
9th priority area. UNAIDS convenes a Social Protection Technical Group, which is meeting to
define their business plan and workplan early in 2010. Work on the Social Protection Floor is
also unfolding, led by the ILO and WHO for the UN system and piloted in Burkina Faso and
elsewhere. The AU highlights social protection as one of the pillars of their new Social Policy
Framework (ratified 2/09).

Additionally, the quantity of child-sensitive social protection (and general social protection)
programming has greatly increased outside of Latin America specifically in sub-Saharan Africa
  in recent years. The last few years have seen the emergence of greater focus on evidence and

  The ideas in this discussion paper are those of the consultant. Although the paper reflects contributions by a range
of actors within and outside of the IATT Social Protection Working Group, the author takes full responsibility for its
contents and errors.
  The other working groups focus on Monitoring & Evaluation and Communities & Resource Tracking.

sharing of lessons than in the past, especially at global level. Many new actors are entering the
fray, e.g., the Ford Foundation, bringing their respective comparative advantages.

1.2 Models exist for improved harmonization: It is clear that even where ideological
differences in definitions of social protection exist, collaborations abound. There is enough joint
action to demonstrate that more unites us than divides us. The SP WG provides an important
forum for identifying opportunities to expand collaboration.


Ø Kenya s cash transfer pilot project for vulnerable children is benefitting from financial and technical
  support from UNICEF, DFID, SIDA and the World Bank.
Ø DFID and World Bank are jointly supporting Ghana s LEAP program.
Ø USG and GFATM have coordinated to support OVC activities in different parts of Rwanda.
Ø Zimbabwe s Programme of Support (POS) for OVC, including cash transfers, is jointly funded by DFID,
  AusAid, New Zealand Aid, SIDA, GTZ and managed by UNICEF. This innovative model is working to
  harmonise funding and reporting, thereby increasing aid effectiveness by making funding for beneficiary
  organizations more predictable.
Ø In Malawi, donors pooled funding for more predictable flows to grantees.
Ø The Joint Statement on Advancing Child-Sensitive Social Protection, developed by UNICEF, has been
  endorsed by DFID, HelpAge, Hope & Homes for Children, IDS, ILO, ODI, Save the Children-UK, UNDP,
  and the World Bank. The Statement provides a useful strategic framework for advancing harmonised
  country level action.

2. What we are Collectively Doing on CSSP
   (see Annex for details on respondents)

2.1 Content Analysis of Matrix: The mapping provides a useful picture of major actors child-
sensitive social protection programming at global, regional and country level, the results of
which are summarized below. Readers should note that the mapping is not comprehensive in
terms of coverage and information, but gives a general sense of the clusters of interest and the
major gaps.

Respondents included Social Protection Working Group members and others making important
contributions/scaling up in this area. In the majority of cases the HIV/AIDS and OVC/CABA
focal points were responsible for filling in the matrix, consulting with colleagues at HQ and
national level however some activities may have been omitted by particular agencies.
Therefore the matrix is not comprehensive for given countries or organizations but indicates
clusters of interest and relative priorities/balance of effort in relation to AIDS and child-sensitive
social protection. Contents are based on respondents' interpretation of instructions regarding
what to report on, i.e., activities in line with the multi-agency statement on Child-Sensitive
Social Protection. Respondents coded activities themselves. Interventions working across social
protection systems may encompass multiple types of activities. There may also be duplication of
some reported activities between funding agency and implementer. The information is a
snapshot of current activities (as of the end of 2009); it should be updated regularly to remain

                                              The picture that emerges from the mapping of child-
 SUMMARY OF ACTIVITY RANKING                  sensitive social protection is varied with common
 Activities supported by the 20               themes emerging. The frequency with which different
 respondents, from most frequently to least   types of activities were reported, described in the box at
 frequently reported, are:                    left, shows the greatest focus of action on child-
 1. Child Sensitive Social Protection         sensitive social protection services, which includes
     Services (84 mentions)
 2. Social Transfers (82)
                                              primarily: establishment and building capacity of
 3. Policies/legislation (61)                 community based child protection mechanisms
 4. Capacity building (57)                    providing integrated assistance to OVC and their
 5. Research (39)                             families, promotion of OVC schooling, and family
 6. Social insurance (27)                     strengthening activities. There are a few examples of
                                              assistance to families and individuals to access benefits.

There were nearly as many descriptions of social transfer activities as there were of services.
Social transfers include food support for specific population groups (e.g., OVC or PLWHA) and
  as highlighted below cash. Because of the rapid expansion of cash transfer programming and
the compelling evidence on benefits for children, it is discussed in some detail below.

The next most frequently reported activity               COUNTRIES WHERE ACTIVITIES CLUSTER
category, support for relevant policies and              The fourteen busiest countries, ranked from those
legislation, mostly includes the development             with the most reported activities to those with
and implementation of national OVC plans and             fewer reported activities.
policies, along with some support for the                 1. Kenya                  (tied for 1st place)
development and implementation of monitoring              2. Mozambique             (tied for 1st place)
                                                          3. Zambia                 (tied for 1st place)
and evaluation framework for national plans.              4. Malawi                 (tied for 2nd place)
There were also several mentions of quality               5. Tanzania               (tied for 2nd place)
standards to improve care and support for                 6. Uganda                 (tied for 3rd place)
vulnerable children. A few countries are                  7. Zimbabwe               (tied for 3rd place)
involved with school fee abolition policies, and          8. Ethiopia               (tied for 4th place)
                                                          9. Ghana                  (tied for 4th place)
similarly, a few are in the process of developing         10. Rwanda                (tied for 4th place)
national social protection policies/strategies.           11. Botswana              (tied for 5th place)
Some respondents described advocacy and                   12. Lesotho               (tied for 5th place)
support to increase civil society engagement in           13. Namibia               (tied for 5th place)
these policy areas.                                       14. South Africa          (tied for 5th place)

Capacity building, widely recognized as one of the critical strategies for building social
protection systems, ranked only fourth on the list of supported actions. The mapping revealed
some interesting examples of work to strengthen the capacity of the lead ministry responsible for
social protection, and fewer examples of efforts to build a cadre of social work professionals. In
light of the important bottleneck that limited capacity causes, and the insufficient attention to
capacity building described in the mapping, this topic is discussed further in detail below.

Turning to the final two categories of action, respondents reported far fewer examples of
research and social insurance. The lack of attention to the generation of strategic information is
concerning, particularly in terms of knowing what works and why in this rapidly moving area.
There are few examples exploring how social protection is or can contribute to broader HIV and

AIDS outcomes including treatment access and HIV prevention. The knowledge gaps are an
important opportunity for the Working Group, and therefore are discussed in detail below.

The few examples of social insurance reported included community based insurance and micro-
insurance, a nascent area without demonstrated impacts for vulnerable children yet. It is worth
noting that interest in this type of health financing is increasing, which may indicate a potential
role for the SP WG in future. For now, the role of the SP WG vis a vis social insurance has not
been defined, therefore the topic is not discussed in further detail here.

In the broadest terms, the most notable change in recent years at country level, and since the last
IATT mapping was undertaken in 2006, is the emergence of cash transfers as a programming
area; additionally, SADC and the AU are now prioritizing social protection in social policies and
declarations of commitment. However, there is not as much system strengthening or national
strategy development as one might hope, and the bulk of activities reported involve direct
support for specific sub-populations rather than sustained nationally-owned programmes with
broad coverage. That said, at global level, the reported research, syntheses, guidance
development, and technical assistance will hopefully translate to more evidence-based, scaled up
programming at country level in future, assuming the links are forged between global, regional
and national levels. Detailed and summary matrices are available for further details on activities.

2.2 Highlighting social transfers: Most of the social transfer activities reported on take the
form of cash transfers. Building on the AU s Social Policy Framework, there are many countries
where WG members are involved with cash transfer pilots (planned or ongoing), expansion, or
scaled up programming, including: Djibouti, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Liberia,
Malawi, Mozambique, Nepal, Papua New Guinea, Senegal, South Africa, Uganda, Zambia,
Zimbabwe. Many of these are nominally pilots, although in some cases they are lacking the
measurement components that would differentiate them from projects. Though there are
exceptions, many pilots lack baselines and robust monitoring arrangements that would be
required to move from pilot to expansion.

There is multi-country research to build upon in this area, for example, a joint Save the Children-
UK and UNICEF study on operationalising child sensitive cash transfers in a number of East and
Southern African countries, which, subject to funding, will move from a design phase to the full
research phase.

Social Transfer Recommendations:
· The SP WG should contribute to broader efforts to promote nationally owned and sustainable
   programmes as opposed to multiple country level pilots.
· With the rapid proliferation of cash transfer projects and programmes, the SP WG should
   exploit the huge opportunity to learn and inform planning to ensure that children benefit.
   More resources should be dedicated to developing a typology of approaches on what works
   where and why, including targeting methodologies that are AIDS sensitive but not AIDS
   exclusive, combination packages of food and cash transfers, and the impact of social
   transfers on broader AIDS outcomes.
· Many additional recommendations on social transfers relate to strengthening the evidence
   base; details follow as part of the discussion on research.

2.3 Highlighting capacity building: Strengthening social welfare and social protection systems
to deliver social transfers and services is widely espoused as a priority. However, as the matrix
reveals, there is insufficient work on system strengthening, particularly in sub-Saharan Africa.
In promoting system building and capacity development, it is important that we continue to focus
on the component parts of the systems involved (e.g., social workers, family services e.g. those
that respond to abuse, legislation that protects the inheritance of orphans and widows, social
transfers such as pensions or child benefit or nutritional supplementation, etc.) rather than getting
distracted by different agency and government terms. Focusing on individual AIDS and child
sensitive social protection components is necessary but not sufficient; in order to have sustained
impact, it will be important for agencies to address broader systemic constraints faced in scaling
up social protection programmes, including the lack of predictable funding for ministries
responsible for social welfare/social protection and systemic human resource constraints.

A particular area of synergy in the matrix is the area of social welfare services; much of the
ongoing work seeks to build a human resource base (especially social workers/para-social
workers) to improve service delivery. There are also examples of ministry gap analyses,
planning assistance, and capacity building of planners etc.

Capacity Building Recommendations:
· The surge of cash transfers cannot distract from the need to strengthen capacity to build
   systems. Building on existing work in countries such as Namibia and Malawi, which have
   assessed capacity gaps, the SP WG can contribute to broader efforts to strengthen systems to
   deliver CSSP.
· There are specific opportunities to work together on human resource capacity building,
   especially social worker training (e.g., collaboratively supporting the University of Kwa-Zulu
   Natal Social Worker Distance Learning Programme; planned meetings in third quarter of
   2010 on social worker capacity building).
· There are opportunities to jointly promote the use of a new child protection system
   assessment and mapping tool UNICEF is currently piloting.
· The SP WG should explore the opportunities to bring together the disparate interest (by the
   World Bank, UNICEF WCARO, others) in building up regional capacity building resources
   for government officials from relevant ministries.

2.4 Highlighting Research and Monitoring and Evaluation: The mapping reveals a serious
gap in the area of research, including operational research, rigorous impact evaluations, and
lesson learning, in regions where social protection is expanding. At global level, there are also
concerns about how to measure coverage of child sensitive social protection in order to be able to
show progress against UNGASS targets. This is especially a concern in relation to cash transfers,
but other aspects of CSSP also need a stronger evidence base.

Strategic Information Recommendations:
· The SP WG can play a role in promoting, supporting and conducting more multi-country
    studies on priority research questions, including building operational research into ongoing
    and planned programming where possible. Examples of priority research and monitoring and
    evaluation questions include:

    Ø how to ensure national ownership and strategic approaches rather than piecemeal
      provision moving beyond pilots to national system development, involving research
      partners beyond the child/AIDS community?
    Ø How to scale up cash transfers without losing the impact achievable through pilot
    Ø What types of social transfers and other SP interventions make sense in different types of
      countries where different risks/vulnerabilities are dominant? What combinations of
      interventions can maximize wellbeing outcomes for children affected by AIDS?
    Ø What are the HIV prevention, treatment and wider care and support (e.g., access to home
      based care) benefits of cash transfers for families and children in particular?
    Ø How to turn the global recommendations on combining protective services with cash
      transfer delivery into action, exploring possibilities in some of the southern African
      countries with well functioning national transfer programmes (e.g., Lesotho)?
    Ø Consider an additional mapping CSSP activities in countries with high HIV prevalence
      and little social protection programming.

·   Promote consistent monitoring and evaluation approaches across organizations using better
    approaches to effectively measure the following:
    Ø the outcomes and impact of social protection for vulnerable children affected by AIDS
       for systematic monitoring and evaluation purposes?
    Ø scale up of social protection at a national and global level to feed into broader UNGASS

·   In 2010, UNGASS indicators will be reviewed and revised where appropriate. This provides
    an opportunity for incorporating a measure of scale up of CSSP as a way to show increased
    coverage of care, protection, and support of children affected by AIDS.

·   UNICEF plans to commission a consultant to review completed and on-going research on
    children affected by AIDS, culminating in a stakeholder meeting to identify outstanding
    research needs and knowledge management strategies to ensure these inform policy and
    practice. There are good opportunities for the SP WG to inform this discussion to ensure key
    social protection research needs are highlighted.

·   DFID is working on reviews of evidence and their own policy stock-take with uses for the
    IATT and beyond. It will be important to build in lessons on maximizing outcomes for
    children affected by AIDS through support to social protection systems.

3. Reflections from the matrix on improving Social Protection Aid
                                                CURRENT SITUATION ON SOCIAL PROTECTION IN
                                                SOUTHERN AFRICA
Despite the increasing interest in social
protection and the proliferation of social      Ø Despite regional policy development, current provision is
protection programming, concerns about aid        fragmented, piecemeal, not systemic, very low coverage,
effectiveness especially harmonisation,           most of poor are excluded from social protection provision.
coordination and government ownership           Ø Some notable 'successes', but social protection is currently
                                                  in an impasse in much of the region, few countries actively
abound, as indicated in a recent review of        developing a strategic approach to the development of social
social protection Southern Africa described       protection policy or significantly extending provision.
at right. For example, there are global and     Ø National ownership of many donor led social protection
regional fora for coordination in the context     interventions remains limited.
of HIV/AIDS through the IATT and various        Ø Current donor approaches are not resulting in the
                                                  development of social protection strategies at national level.
RIATTs but many countries do not have a         Ø Donors and agencies are perceived as promoting their own
parallel mechanism at national level to bring     favoured instruments, rather than promoting the
together important social protection              development of strategic social protection provision more
stakeholders. Many countries have OVC             broadly at national level.
coordination mechanisms, with varying           Ø Unless government ownership, little prospect of
                                                  sustainability or large scale implementation.
degrees of functionality, but as these are      Ø Lack of leadership in social protection debate in the region.
currently child-focused, they are not the
obvious home for social protection              From McCord, Anna, "Accelerating Action on Social Protection. Regional
                                                Scoping Assessment DFID Southern Africa. Presentation of Draft Findings",
coordination.                                   ODI, 13 Nov 2009.

The concern is especially acute with the increasing number of design missions; as the number of
donor actors grows, the demands on busy, weak ministries increase. For example, the World
Bank alone is planning up to 10 social protection design missions in sub-Saharan Africa. Models
of collaborative design work exist to build upon. Upstream joint technical work recently took
place in Zimbabwe, where a World Bank Social Protection design mission benefitted from
participation by UNICEF representatives, which resulted in a greater focus on AIDS and child
sensitive social protection.

Aid Effectiveness Recommendations:
· The SP WG can promote more efficient structures around social protection at country level to
   increase aid effectiveness and promote joint working in line with key Paris Principles.
   Existing national OVC co-ordination structures may provide a forum for this in some
   countries, yet the SP WG needs to consider its remit within the broader agenda as there are
   parallel efforts for wider social protection systems development.

·   Building on successful existing collaborations between UNICEF and the World Bank, the SP
    WG can promote joint technical missions to ensure children and AIDS are considered in the
    Bank s planning for the Rapid Social Response Fund support.

·   The SP WG can play a role in engaging new actors to promote child and AIDS sensitive
    social protection through their emerging programming. For example:
    Ø UNAIDS: As the Social Protection Technical Group defines the work plan for the
        UNAIDS co-sponsors, take advantage of overlapping membership with the IATT to

        ensure their plans are child sensitive. UNAIDS is planning a meeting in February 2010
        with George Washington University (and possibly IDS) to bring together their plans and
        the evidence. The SP WG can engage in these meetings to ensure there is no duplication
        of effort nor missed opportunities.
    Ø   GFATM: Social protection will appear in more country proposals as it is increasingly
        recognized as an effective response to AIDS. It is not clear that the Technical Review
        Panel (TRP), which assesses country proposals for technical merit inter alia, includes
        expertise on social protection including what types of SP make the most sense for AIDS
        impact mitigation (and HIV prevention). The SP WG could approach GFATM about
        informing and providing TA to the TRP on these issues, highlighting the lessons learned
        on SP that benefits vulnerable children in heavily AIDS affected regions.
    Ø   KfW and GTZ are developing a new strategy to bring together AIDS impact mitigation
        and social protection work; the SP WG can work with them to ensure their strategy and
        subsequent plans are child-sensitive.
    Ø   The World Bank is not a new actor in the area of OVC and social protection. However,
        their social safety net spending quadrupled from 2008-2011 and under the new Rapid
        Social Response Fund, increasing funding will be flowing to support social protection
        (safety nets, labor markets/employment, protecting access to basic social services for the
        poor including nutrition, health and education). At a global level World Bank have a key
        role to play within the IATT, SP working group. At country level, engagement with the
        World Bank will be critical to ensure benefits for children.
    Ø   The WB and GFATM are significant actors in AIDS and both have considerable SP
        funding for children and AIDS. The SP WG would clearly benefit from their participation
        in the WG.

·   At global level there are opportunities to improve technical harmonization. For example,
    UNICEF with support from the broader IATT will be updating the guidance document to the
    Framework of Care, Protection and Support of Children Living in a World with HIV and
    AIDS. A section is likely to be on social protection. IATT members should use this
    opportunity to integrate key lessons on child sensitive social protection to inform the

·   The mapping exercise and its recommendations will have limited use unless they inform
    country level action. The East and Southern Africa Regional IATT (RIATT) has an interest
    in social protection, which could expand to take up some of the global recommendations.
    The RIATT could usefully serve as a channel to communicate the results of the global
    mapping to countries. UNICEF s South and East Asia and Pacific office is also planning a
    similar mapping exercise, which this global exercise could inform.


Information submitted by:

   1. DFID
   2. KfW
   3. GFATM
   4. GTZ
   5. Growing up Free from Poverty
   6. HelpAge International
   7. HSRC
   8. IFPRI
   9. IHAA
   10. ILO
   11. SIDA
   12. SOS
   13. USAID (on behalf of USAID, PEPFAR, PL 109-95)
   14. UNAIDS
   15. UNDP
   16. UNICEF (including Child Protection, ESARO,WCARO)
   17. World Bank
   18. WFP (AIDS-specific not reflecting broader SP work)
   19. WHO
   20. World Vision


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