Speakers
Dr Gianfranco Rotigliano - Regional Director, UNICEF, West and Central Africa Region
Rebecca Holmes - Research Officer, Social Development and Social Protection programmes, ODI
Dr Nicola Jones - Research Fellow, Social Development and Social Protection programmes, ODI

Discussants:
Anthony Hodges - Regional Chief, Economic and Social Policy, UNICEF, West and Central Africa Region
Robert Yates - Senior Social Policy Advisor, DFID

Chair:
Dr Caroline Harper - Programme Leader, ODI

1. 1. Caroline Harper – Welcome and introductions

• This research series first of its kind in region and relevance of this is critical as social protection agenda is becoming more prominent, due also in part to the search for responses to the global financial crisis.
• Research also incorporates child protection issues (that are often sidelined), challenges the perception that income will trickle down to children at household level, and provides implications for macro-level policy interventions
• 5 thematic studies released on national social protection systems, cash transfers, health equity, synergies with child protection systems and fiscal space for social protection. In addition, 5 country case studies , based on local research partnerships, conducted in varying contexts, were undertaken  and national stakeholder consultations in each country analysis have been undertaken. These reports are also forthcoming.

2.     Gianfranco Rotigliano – Alternative approaches to social protection for health in Central and West Africa

• Discussed the huge challenges regarding childhood poverty alleviation in West and Central Africa, such as highest under 5 mortality and slow progress in reaching MDGs.
• Household coping strategies mainly limited by 1. Monetary poverty, 2. Low net food income
• Region characterized by weak social protection, with limited health insurance and traditional mechanisms under strain
• However, the Social Protection agenda is taking off – National Policies in Burkina Faso, Cape Verde, Ghana (with National Health Insurance System), Mali, Senegal
• Role of UNICEF is to provide government assistance in planning and rollout, to coordinate building of bridges in  similar country contexts, and knowledge generation
• Impact: raising awareness on agenda - opened forum in Mali (attended by Prime Minister), forum in Equatorial Guinea (opened by deputy PM). Also succeeded in developing broad consensus on general demand side, and enhanced operational design and rollout

Conclusions

·      Cash transfers – big potential impact for reducing child poverty, improving access to services. Furthermore, simulations show that they are affordable – but require big initial investments

·      Access barriers  are perpetuating health care inequities. Abolition of user fees are a useful step to confront these inequities, but this process requires phased preparatory measures

3.     Rebecca Holmes – presentation on theoretical and conceptual aspects of child-sensitive social protection

• Review of the definitions, general dimensions and mechanisms of social protection
• Building on existing systems: Ghana, Mali and Senegal have designed National Social Protection strategies focused on health.
• Social protection programmes have been characterized by limited funding and scale, as well as fragmented collaboration and delivery. Governance and administrative capacity – low governance indicators and weak implementation capacity. Also, Social Protection programmes are dispersed across ministries and coordination is weak. Serious capacity constraints for scale-up which need to be recognized – may be aided through a simplification of systems in the short term
• Affordability – an issue of growth rates e.g. Equatorial Guinea and Congo enjoy high growth, less so in Ghana, Mali and Senegal, but the issue of competing priorities and potential investments is also a deciding factor in the allocation of social protection resources. Although Equatorial Guinea and Congo are special cases as they show the lowest proportions of public spending and institutional performance (suggests other factors as barrier, rather than affordability). In the other 3 countries, affordability is more of an issue.
• Engaging in policy processes is hindered by limited resources and a lack of information with which to engage governments. Therefore, developing strategic evidence-based strategies are needed that examine existing systems and suggest the implications for building upon these

1. Nicola Jones

This presentation highlighted key findings around social protection programming in the region, illustrated by the 5 country case studies.

• There are concrete opportunities for Social Protection in West Africa – e.g. tackling human capital deficits through social transfers. There has been extensive learning and exchanges occurring within region and across from South America (Mexico). LEAP programme in Ghana is the largest and includes a design with linkages to complementary services.
• However, there are challenges – government commitment is limited – reflected in small-scale of programmes. Also, targeting the most vulnerable is cost-intensive, and categorical targeting is not necessarily going to reach poorest children. Also spatial clusters not always addressed e.g. LEAP –northern districts.
• Child and maternal health vulnerabilities – opportunities: the region is off-track on MDGs, but growing momentum on the movement for user-fee abolition, global maternal mortality campaign, STC campaign. The NHIS in Ghana also offers a number of lessons.
• Challenges – user fees campaign need to be matched by high-level support, as well as donor support. Governance and capacity constraints are evident in coping with long-term demand. Social Health Insurance may be more feasible – but also regressive, doesn’t reach lower health quintiles
• Vulnerability to violence, abuse and neglect – opportunities: 2006 UN study on violence raised awareness and there are increasing social equity measures in place, plus important synergies with some cash transfer programmes – including soft conditionalities related to birth registration, child labour and child trafficking.
• Challenges (more than other areas) include legislative alignment: UNCRC has not been harmonized, fragmented service provision and very limited resources. Lack of cross-sectoral coordination means that many opportunities for awareness raising and interventions are missed, and that the efficacy of social protection programmes are also potentially undermined.
• Complementarities on informal social protection - opportunities: informal SP is not new and ranges from remittances to kin-based systems, and trade and credit associations to religious organizations. It differs from formal systems in two important ways – not time-bound and  more flexible. The challenges  are that informal mechanisms are eroding as close family relationships decline and responses must complement informal systems, not undermine them.

5.     Discussants

Rob Yates – DFID

• Highlighted the importance of putting social protection on the current agenda as during the previous large economic downtown it was quite the opposite – the market-based solutions were favoured. UNICEF has a role in making sure a similar market fundamental discourse is not promoted.
• Increased cash transfers interest through South-South linkages is commendable, and although these have improved access to services, they may not necessarily be targeting the poorest. Universalism, under a rights-based approach, is often the best approach – as learned from great improvements on MDG3 on education
• Monetary poverty is rightly highlighted in presentations. It is agreed that financial concerns are often the decision-breaker in households. In this respect, user fees exclude the poorest and benefit middle-classes. This ODI-UNICEF package has already influenced discussions on user fees at DFID with regard to the initial phasing-in of free health care for women and children. In Ghana, recent provision of maternity services showed rapid expansion up to 440 000 in 6 months.

Anthony Hodges

UNICEF WA

• Although this ODI-UNICEF package is a general knowledge product, it also has affected processes such as policy development and concrete operational programme development, particularly in case study countries. In Senegal for instance, the feasibility planning for universal child benefit used this info for strategic development. In Mali, a 5 year action plan on strengthening of social protection was agreed after a forum, opened by the president, was convened to discuss these issues. The 5 year plan is likely to include a cash transfer project and mandatory health insurance programme. In Equitorial Guinea, the deputy Prime Minister opened the discussions that ended in a commitment to promote social protection. In Ghana, the monitoring and evaluation systems on social protection are being enhanced to increase evidence-base for policy effectiveness. In Congo, a large forum brought together a number of ministries which ended in an agreement to promote universal child benefit. These reports have therefore played a pivotal role in moving the agenda forward in West and Central Africa.
• Have also been useful in taking agenda forward at UNICEF regional offices – Social Policy staff at UNICEF are now further encouraged to work with government and to build effective operational programmes across the region.
• A common thread in the presentations is that the multi-dimensional aspect of childhood poverty is repeatedly emphasized. Indeed, although the economic aspect is critical, the social is also particularly important, including socio-cultural practices such as early marriage and other cultural barriers to entry
• Two contextual factors of Western Africa can be highlighted, the first is that the extent of poverty is so widespread that it is difficult to tell who should be targeted given high poverty statistics. A universal approach avoids administrative complexity, while targeting may reach narrowly defined groups only, such as extremely vulnerable ultra-poor, OVC’s, disabled, destitute. Second contextual issue is fiscal space – although new threats from economic downturn have been noticeable, constraints need not be exaggerated, e.g. cost of LEAP in Ghana is 0.01% of GDP – it is possible to extend this to 18% of the population for less than 1% of GDP.

6.     Panel Questions

·         Universalism and political commitment – targeting is not rights-based and can be regressive, divisive and costly. On the other hand, universalism is politically acceptable – but cost is a political issue.

A – The diversity of countries must not be underemphasized – Ghana has shown notable successes on cash transfers, while in other contexts fiscal space analysis has shown potential for universal approaches. It may be that a judicious blend of these approaches can be used to cover the excluded.

• Is there work available on multiplier effects from financial perspective?

A - ODI is 2nd phase  of coordinating research on the long-term cross-sector (e.g. agriculture, labour markets) impacts of social protection

• Is it worth considering a development bargain? That is, conditional transfers that can cover many of the aspects presented in the ODI-UNICEF papers?

A - Debate on (un)conditional transfers is quite polarized. There are also ‘soft’ conditions with no enforcement in Ghana. Peru and Latin American countries have done work on this too, as has the World Bank recently.

• Regarding the linkages of social protection and child protection, have there been any examples of UNICEFs work with street-children?

A – there are a number of examples, but these tend to be concentrated in urban areas. Some successful models have been notable in Senegal.

• Firstly, is there a definitional issue of safety nets, social protection and socio-economic security – each with their own ideological underpinnings? Secondly, could it be that fiscal viability is not prominent issue, but rather the political drive?

A - political commitment is critical, but it is important not to lose sight of fiscal space as these countries are very poor – the trade-off must be country-specific. Also, it is easy to get caught up in definitions, and although some conceptual clarity is required, relating to country-specifics is the most important activity

• There are other factors that affect health and affects on productivity. Did the project include these aspects?

A: Yes, gender, intra-household allocations, time poverty and many more were considered. However, there remains much work to be done in developing coherent health indicators to establish robust correlation information

• Is there a role for DFID and UNICEF in ensuring policies are not abandoned during regime change? How can we ensure these changes are minimized

A: Ghana is encouraging example of continuum and strengthening on previous initiatives. Moreover, it conducted this process under economic pressures, and introduced new programmes. Such aspects on medium to long-term aspects of policy are being promoted in the case study countries

• Should the issue of leveraging focus on political will – interest and drive in social protection has been shown by African heads of state where they agreed on range of considerations in Windhoek Declaration – how best to take this forward?

A-     The focus could be on tangible SP measures. There is a tendency for governments to sign-up to large packages, but the monitoring and implementation becomes difficult. It might be better for CSOs to focus on rights and issues, ticking each off and not hopeful of big overnight wins.

• Can civil society be supported to promote and achieve political drive?

A - Data, info and evidence is critical. In Equatorial Guinea the affordability issue is not central, but rather the low understanding of concepts and administration. It also important to think about sequencing – not all interventions possible at same time. Expectations must be realistic about what people can do with given capacities.

• How far does the ODI-UNICEF research address political economy dimensions in the analysis?

B-      These were examined on sector and national/sub-national levels, and will be highlighted in the forthcoming five country case study reports