Equity Case Study: South Africa - Influencing national policies to advance equity
South Africa has one of the most comprehensive cash transfer programmes on the African continent.
By Abhijit Shanker
21 September 2011 - While South Africa has made significant progress in fulfilling the rights of children since the end of apartheid in 1994, the country remains one of the most unequal societies in the world and nearly two-thirds of children still live in poverty. Yet South Africa’s development challenge is not so much a lack of financial resources. Indeed, the country enjoys middle income status. It also provides considerable resources to development, especially the social sector. The outcomes, however, are not commensurate with the quantum of resources invested. The major challenge is how to translate resources into desired outcomes for children – to ensure a more accelerated drive to redress inequities from the past as well as confront the substantial barriers that the poorest children still face today.
UNICEF South Africa pursues a deliberate equity strategy aimed at building evidence about the dimensions and causes of inequities among children. The organization also assists the Government of South Africa to adopt (or modify) policy instruments and at-scale programmes to reduce disparities in the provision of essential services.
Key pieces of analytical work produced in collaboration with national partners are informing strategic policy discussions about how to accelerate the reduction of disparities in the provision of essential services for children. UNICEF is also bringing much needed attention to specific groups of vulnerable and excluded children who have been largely absent from the public policy discourse, such as children with disabilities. Furthermore, particular attention is being given to the design of policy instruments on the “how-to” of overcoming inequity and on the North-South and South-South exchange of knowledge in this regard.
Since the end of apartheid in 1994, South Africa has made significant progress in fulfilling the rights of children through the introduction of new laws, progressive public spending and reorganisation of administrative systems. The social grants system has been growing in strengths from year to year and over ten million children are currently benefiting from the Child Support Grant. Primary healthcare is free for pregnant women and children under the age of six. Recent changes in government’s response to HIV have also been far reaching and contributing to a reduction in paediatric infections. In addition, South Africa’s poorest children are exempt from paying school fees and near-universal access to primary education has been achieved. The Children’s Act and the Child Justice Act provide a solid foundation for advancing child protection in the country.
However, despite progressive policies by the state, South Africa remains one of the most unequal countries in the world and income inequality, as measured by the Gini coefficient, has increased since 1993. Nearly two-thirds of children live in income poverty and face substantial barriers to the fulfillment of their rights. Poverty intersects with other causes of vulnerability, including the country’s severe AIDS epidemic, high unemployment and the inadequate delivery of basic services in several parts of the country. This creates a web of deprivation for millions of South African families that struggle to provide the basics for children. Compared to a child growing up in the richest 20 percent of households, a child in the poorest 20 percent of households is two times less likely to have access to adequate sanitation and water; two times less likely to be exposed to early childhood development programmes; three times less likely to complete secondary education; seventeen times more likely to experience hunger; and twenty-five times less likely to be covered by a medical scheme.
The existence of such large disparities points to a critical policy challenge - a challenge requiring a more accelerated drive to redress inequities from the past as well as confronting the substantial barriers that the poorest children still face today.
Strategy and Implementation
South Africa’s development challenge is not so much a lack of financial resources. Indeed, the country enjoys middle income status. It also provides considerable resources to development, especially the social sector. The outcomes, however, are not commensurate with the quantum of resources invested. The major challenge is how to translate resources into desired outcomes for children.
UNICEF South Africa therefore builds on its comparative advantage to strengthen national policies, budgets and institutions toward bridging deep-seated equity gaps in almost part of the country. In doing so, UNICEF works with the various levels of government, national, provincial and local, as well as with Parliament, to address the systemic constraints in achieving child outcomes. These constraints include: (a) policies that are not backed by evidence and therefore fail in implementation; (b) systemic weaknesses in cross-sectoral planning and programming at high levels of governance; (c) resource allocation patterns not backed by evidence and not directly linked to plans; and, (d) severe weaknesses in the evaluation capacity of government and civil society.
In support of the equity agenda, UNICEF South Africa is significantly enhancing its support to the state and its partners in evidence generation and dissemination of data related to the most vulnerable children; policy and budget analysis and leveraging to strengthen social protection for poor children and address bottlenecks which impede current policies to reach those children left behind; and engagement in strategic advocacy support toward accelerating the fulfillment of child rights in South Africa.
UNICEF has strengthened its posture as a leading voice for children in the country and has emerged as a trusted source of policy advice as well as convener. The convening role of UNICEF South Africa is supported by solid analytical work and extensive technical advice to government departments. Moreover, UNICEF continues to bring global knowledge to inform policy considerations in the country. North-South and South-South cooperation models have led to the deepening of policies for children.
Progress and Results
Evidence-based advocacy on reducing deep inequities. A combination of high quality analytical work and structured advocacy around the nature of inequities and how to overcome these has been central to UNICEF South Africa’s approach. Two key reports, entitled, Discussion Paper on Equity and Child Rights in South Africa and South Africa’s Children: A Review of Equity and Child Rights are informing strategic policy discussions about how to accelerate progress in the fulfillment of child rights in the country.
Participants at a national stakeholders meeting, including senior officials from government and civil society, reviewed the Discussion Paper on Equity and Child Rights in South Africa and agreed on strategies to overcome policy constraints in October 2010.
A strategic partnership arrangement with the South African Human Rights Commission (SAHRC) and the Department of Women, Children and People with Disabilities and Children’s Institute has also ensured wide consultations on the second report, The South African Child: A Review of Equity and Child in South Africa. A declaration, the Midrand Declaration, that highlights what needs to be done to reduce inequities has subsequently been adopted by the SAHRC and civil society partners. Furthermore, the report has been tabled for presentation at Cabinet, thus ensuring adequate attention is given to inequities in the realisation of child rights in the highest circles of Government.
UNICEF is also collaborating closely with the SAHRC to support the different segments of the country’s legislature on issues around equity. Discussions with the National and Provincial Speakers of Parliament and relevant Portfolio Committees have led to increased interest and commitment to provide structured oversight for laws, plans and budgets on issues affecting vulnerable children and children left behind.
Additionally, UNICEF has strengthened its engagement in national policy planning and formulation processes to help ensure that the country’s development strategies prioritize pro-equity policies and programmes. UNICEF, for example, provided direct inputs into the preparation of the National Planning Commission’s Diagnostic Report and subsequent Long Term Plan for the country.
Reaching the most vulnerable children with social protection programmes. South Africa has one of the most comprehensive cash transfer programmes on the African continent. The child grant (known as the Child Support Grant) reaches over 10 million children each month. Yet some 2.1 million eligible children, mainly the most vulnerable, do not receive the grant due to administrative bottlenecks. This is a classic case of the bottom quintile being left behind in the implementation of a sound policy instrument. UNICEF has supported the Government in a combination of ways to reach these children. An investigation into the feasibility of removing the means-test and accompanying administrative bottlenecks is currently underway. When completed in September 2011, the feasibility study will provide fiscal and institutional options for making the child grant available to all children, especially those in the remotest parts of the country.
UNICEF has also provided support to the Department of Social Development and the South African Social Security Agency for the development of child-friendly communication material and expansion of their enrolment drive for increased uptake of social grants by eligible children and their families. The plan is to reach some 100,000 eligible family members who are not receiving social grants in one year.
Furthermore, UNICEF has strengthened its advocacy around the impact of the economic recession on child well-being. Two studies, using both quantitative and qualitative techniques , have formed the basis of strong advocacy by UNICEF to expand access to social protection by poor families and children. The outcome is the adoption of the recommendations by the Department of Social Development for consideration by cabinet. Furthermore, on the basis of a 2009 study , UNICEF is currently engaged in government on expanding the coverage of social insurance to poor families and children, especially those who have experienced the loss of a bread-winner.
UNICEF has been supporting the Isibindi model, which is an innovative, professional, and highly relevant model for children infected and affected by HIV and AIDS in South Africa. Isibindi has been providing quality services for children living in extremely difficult circumstances; this support includes caring for children affected by HIV and AIDS, helping them access social grants, facilitating access to HIV testing and counseling, providing psycho-social support to the families, etc. In 2010, UNICEF supported establishment of three Isibindi sites in the Northern Cape and thereby strengthened provincial capacity in developing a social development workforce to address the needs of vulnerable children in highly deprived communities. UNICEF is now working with the Northern Cape Province to scale up the model.
Promoting access to education and health services for disadvantaged girls and boys. UNICEF has been supporting the roll-out of child-friendly schools (CFS) in South Africa for several years. In 2010, 820 schools were supported to integrate CFS principles to improve both quality and safety for learners; these schools are amongst the most disadvantaged in the country. A CFS evaluation concluded in mid-2011 notes that CFS principles have been fully integrated into the national “Caring and Support for Teaching and Learning” framework, which will help to ensure the sustainability and scale up of the CFS concept. The CFS principles are also the core strategy for developing the Department of Basic Education’s Social Cohesion Toolkit and school functionality through the Education Sector Action Plan 2014 and the Schooling 2025 initiative.
Within the broader CFS approach, UNICEF has promoted two initiatives that have specifically been targeted at the most disadvantaged children and adolescents. Techno Girls aims to promote disadvantaged girls’ advancement in sciences and technology. Girls, especially from poor families, are particularly disadvantaged when it comes to technical professions. They are not encouraged to study or do well in traditionally male-dominated sciences subjects. Techno Girls identifies committed and good achievers aged 15-18 from disadvantaged communities to be placed in corporate mentorship and skills development programmes where many have benefited from academic scholarships for tertiary education, or been provided with learnerships. They are then placed in the companies for a week, three times a year over a three-year period. This programme was piloted in 2006 but did not progress as expected at the time. Revitalized with the help of UNICEF in 2010, it has grown from two provinces to five with over 4,000 girls participating. Plans are under way with the National Youth Development Agency to set up a Techno Girls Trust Fund to ensure its sustainability in years to come.
Similarly, through its Sports for Development programme, UNICEF and partners are working to help disadvantaged adolescents overcome their sense of marginalization and increase their self-confidence through access to sports, coaching and mentoring. In addition to providing access to life-skills information around HIV and violence prevention, the programme also provides opportunities for these learners to feel that they are part of a team, engaged in constructive play and sport for a common goal, which helps them feel more confident in themselves, more connected to their peers and their community, and less marginalized.
Global evidence shows that quality early childhood development (ECD) is essential for bridging equity gaps as well as overcoming intergenerational poverty. In this context, UNICEF has enhanced its role as a major strategic partner for government in expanding coverage of quality early childhood services in South Africa. Access to ECD services in the country was for a number of years at an all-time low of 16%. Support was provided to Department of Social Development (DSD) towards the amendment of the Children’s Act to define children’s entitlement to critical ECD services. A government subsidy to ECD community-based sites has increased coverage to about 43% in the last two years. However, a recent UNICEF-government expenditure tracking study on ECD services shows that many poor children are yet to be reached by government subsidies for ECD. In light of this fact, UNICEF is working with government on a comprehensive policy review that guarantees more equitable provision of ECD services.
The policy review includes assessing the implementation of the key plan for the sector, the National Integrated Plan for ECD 2005-2010, as well as developing feasible options to expand quality services to especially poor communities in the shortest possible time. Specifically, the policy review will provide insight into a national vision for quality ECD; the institutional arrangements required for an effective equitable provisioning and the government funding modality required. UNICEF has also provided extensive support for the finalization and validation of the National Early Learning Development Standards (NELDS) and is currently working with counterparts and civil society partners to develop the curriculum to operationalize the NELDS.
With respect to health services access and given the scope of the HIV pandemic in South Africa, children’s vulnerability and marginalization can result from their HIV status or that of their caregivers. In order to help reduce vertical transmission, UNICEF supports the integration of preventing mother-to-child transmission (PMTCT) services into maternal, neonatal and child health (MNCH) programming at community and facility level. This is done as part of a broader effort around the finalization of a national policy framework for community-based maternal, neonatal and child nutrition service provision in the context of a re-engineered primary health care system. Nationwide, 88 percent of HIV+ pregnant women receive antiretroviral (ARV) drugs and 54 percent of children in need of treatment have access to antiretroviral therapy (ART), an estimated 50-60 percent of HIV-exposed infants are tested for HIV at six weeks. UNICEF supported initial piloting of down referral of maternal ART and pediatric ART to primary care, and this is now being scaled up nationally.
Integration and scale-up of comprehensive quality community-based MNCH services was initially supported in one highly disadvantaged district (Illembe), and led to a sustained improvement in MNCH and PMTCT performance. The framework (C-framework) guiding this effort, which was developed with UNICEF support, is being implemented at scale in Kwa Zulu Natal province, which has among the highest rates of HIV in the country and 71 percent of its children living in poverty. It is also being adapted for implementation nationwide. Furthermore, an initiative to improve the quality of neonatal care first introduced in Limpopo (which has 83 percent of its children living in poverty – the highest rate in the country) is now being rolled out to a national programme with UNICEF support.
Making excluded children visible. UNICEF placed the rights of socially excluded children at the forefront of discussions around advancing the country’s social protection agenda. Children with disabilities constitute one of the most excluded groups in the country. Official data does not reveal the extent to which they are deprived of essential services and are free from discrimination and stigma. Anecdotal evidence, however, suggests that many children with disabilities are prevented from enjoying the opportunities that the state has provided (for all children).
UNICEF has almost completed the first-ever Situation Analysis (SITAN) of Children with Disabilities in South Africa in partnership with the Department of Social Development and the Department of Women, Children and People with Disabilities. The objective is to bridge critical knowledge gaps regarding: childhood disability prevalence rates and types of impairment; factors contributing to childhood disability; and inequalities faced by children with disabilities. The SITAN also discusses state obligations under UN Conventions; examines the national policy response to challenges faced by disabled children; and makes recommendations to reduce barriers faced by children with disabilities. The final SITAN is expected by October 2011 while a separate publication on ‘voices’ of children with disabilities and their caregivers has already been issued.
In addition, UNICEF South Africa is undertaking preparatory work to examine one of the issues that are likely to deepen disparities in child well-being in the near future, that is, the considerable and far-reaching impacts of climate change on the world’s poorest and most vulnerable. Essentially, climate change is about intergenerational equity and justice. Projections for South Africa, as the largest emitter of GHG (greenhouse gas) emissions in Africa, point to serious implications for livelihood security among poor children and families. These impacts are likely to further exacerbate wider development pressures such as population growth, natural resource management and food, thereby changing rural/urban dynamics.
UNICEF in collaboration with national partners has therefore commenced a study to analyse the likely impacts of climate change on children in South Africa, by building evidence around children’s vulnerability and the adaptive capacity of their families, communities and society as a whole. In doing so, the study will also analyse the country’s national policy response to examine whether children’s issues are sufficiently considered and addressed. The report is expected by end October 2011.
Policy-oriented knowledge hub on child rights and equity. UNICEF has established a partnership with the Human Sciences Research Council (HSRC) – South Africa's statutory social science research agency – to build a knowledge hub on the how of scaling up programmes to reduce disparities in the provision of essential services for children. The knowledge hub aims to provide practical programming information on interventions to address child poverty, inequities and systemic bottlenecks by drawing on national and international good practices and lessons, especially from (middle-income) countries similar to South Africa. Importantly, it will strengthen the dialogue between suppliers and users of child-related evidence in order to bridge the gap between the information needs of policy and decision makers in South Africa and evidence offered by research and evaluation bodies. The hub is expected to be launched in December 2011.
In addition, HSRC and UNICEF launched a new research report on Government-funded Programmes and Services for Vulnerable Children in South Africa in February 2011. For the first time in one source, this report identifies within each relevant department what the available government-funded statutory services and programmes are that are offered to vulnerable children, or which have a beneficial impact on vulnerable children. It also highlights any overt policy legislative gaps and any gaps in the delivery of the programmes and services to vulnerable children and their families.
Giving children a voice in decision-making. UNICEF is supporting civil society partners toward establishing more effective mechanisms for the participation of children in decisions that affect their well-being. One notable result has been the publication of the South African Child Gauge on Child Participation with the Children’s Institute of the University of Cape Town in August 2011. As a key advocacy tool for policy makers and programme managers, the Gauge consolidates and analyses primary data and presents this empirical information in an accessible manner for tracking progress on advancing the participation of children in decision-making. The 2011 South African Child Gauge examines how child participation can be achieved in a range of different contexts and identifies current barriers and what support is required – for both adults and children – in order to facilitate meaningful participation. UNICEF has also produced a child-friendly version of the publication. The Child Gauge catalyzes child participation as a means to claim civil, political and socio-economic rights. As such, it intends to enable vulnerable and marginalised children to understand and claim their rights.
Comprehensive data that tracks inequality among children and inequities in access to services are not readily available. UNICEF will therefore strengthen its partnership with South African Statistical Agency (Statistics South Africa) for better incorporating equity considerations into national statistical systems.
Furthermore, there is very limited knowledge about the ‘how’ of reaching deprived children in a sustainable manner and reducing inequities. These gaps are being addressed through policy and institutional analyses that point the way to overcoming systemic bottlenecks. It is also necessary to ensure that overall policy design takes into consideration the reality of capacity bottlenecks, particularly the weak capacity of managers at provincial level.
From a budget reform perspective, capacity gaps exist in the preparation and results-based budgets to achieve set targets. The interface between different levels of governance is also weak in the budgeting of essential services.
Furthermore, there are institutional difficulties in ensuring that national priorities are adequately backed by provincial budgets, and there is a strong need for expenditure and institutional reviews in sectors that have large budgets yet low performance in terms of delivering results for children.
The oversight role of Parliament and provincial legislatures over child rights fulfillment also requires enhancement, which should also extend to supporting meaningful participation of children in decision-making in the country. Presently, child participation is largely tokenistic; vulnerable children have the least access to information that would allow them to claim their rights.
The Isibindi model is in synergy with the Children's Act, the OVC (orphaned and vulnerable children) policy framework and the home and community-based care model of the country. Yet although Isibindi has scaled up to over 60 sites across the country, thousands of children still require its services. UNICEF, in an effort to reach more children and to achieve a more comprehensive approach, is supporting provincial planning to ensure that these community-based programmes, which are largely donor funded, will be sustained.
The key lesson is the need to continue to use multiple channels of decision-making to advance the equity agenda in South Africa. Equity gaps in South Africa have their roots in racial discrimination, a politically sensitive issue. Strategic partnerships with key state institutions as well as the use of a combination of decision-making channels have been crucial for the achievements so far.
Both the Isibindi and Techno Girls models are innovative approaches meant to address structural inequities in a unique and indigenous way. The challenge is now to take them to scale and ensure their transition from pilots to institutionalized, fully resourced and Government-supported programmes.
Techno girls has expanded from two to five provinces, and the partnership with the National Youth Development Agency will scale it up nationwide to include another four provinces. The strength of this partnership is that with the establishment of the Trust, UNICEF will no longer have to provide financial support, although technical support will continue to be a part of the package. Partnerships with regional bodies will also help to expand the programme in the region and perhaps the continent.
UNICEF has shown the results that can be achieved when decentralized data driven programming for health that includes a strong community component is applied. As the country transitions to a more primary care-led system, empowering district management teams to better lead and manage MNCH and PMTCT services and effectively engage and build the capacity of the community systems will be critical to sustained improvement in the health and development of the children of South Africa.
The evidence around child deprivation points to spatial inequities as one of the causes. Spatial inequities from the apartheid era still persist and contribute a great deal to widening income inequality in the country. UNICEF will strengthen partnerships with government departments and municipal authorities to reduce inherent equity gaps in local plans, budgets and by-laws.
Advocacy on advancing the rights of children with disabilities will also continue. The output will be a government action plan to systematically implement the recommendations from the Situation Analysis and to monitor the fulfillment of the rights of children with disabilities.
Tracking progress in the reduction of child poverty will be stepped up. On the basis of new official data and in partnership with the Statistics South Africa, UNICEF South Africa will build the case for more effective approaches to achieve an accelerated reduction of child poverty in the country
Advocacy on the impact of climate change on vulnerable children will also be planned to inform deliberations at the Seventeenth Conference of the Parties (COP 17) of the UN Framework Convention on Climate Change (UNFCCC) from 28 November to 9 December 2011 in Durban. Findings from the UNICEF-led study will be used to advocate for child-sensitive design and implementation of climate change policies and programmes and to strengthen child participation in the national discourse on climate change.
Plans are underway with the National Youth Development Agency to set up a Techno Girls Trust Fund to ensure its sustainability. Tracker, a renowned security company in South Africa, plans to partner with Techno Girls and to use the same job shadowing and mentoring approach to start a Techno Boys programme. Destiny magazine, a widely circulated magazine for professional women, has committed to feature human interest stories.