Reflections on How Social Protection and Social Welfare Policies are Unfolding in Low- and Middle-Income Countries around the World

Introduction

Social protection policies are at the forefront of global responses to reduce poverty and inequality in low- and middle-income countries. Unconditional cash transfer policies are the dominant form that social protection policies are taking followed by conditional cash transfers (these have behavioral conditions attached to the receipt of benefits), public employment programs, and feeding schemes. Social protection responses to the COVID-19 pandemic accelerated the growth of cash transfer policies and programs in 2020 at the start of the pandemic. This development is often described as the “big idea” that evolved in countries in the Global South with positive income and social development effects. While these are laudatory developments embraced by national governments and international development organizations, a key challenge is how social protection policies are delinked from wider welfare and development programs including labor market policies in many countries. This article explores this challenge concerning the social development approach’s focus on the interconnectedness between social and economic development and its application to social protection and social development policies and strategies in the Global South (Patel & Midgley, 2023).

The article commences by tracing the rise of cash transfers to reduce poverty and inequality in Southern countries over the past three decades. Section two reflects on the nature and direction that social protection is taking and reviews its achievements. The gaps in social protection coverage are then discussed. A significant gap is the bifurcation between social protection policies as an economic development intervention and social welfare and development programs in low- and middle-income countries. This challenge is discussed in section three. Next, the movement toward cash-plus complementary policies is considered with examples from Eastern and South Africa. The article draws to a close by identifying the lessons learned from the cross-country examples. It provides pointers on how the bifurcation between social and economic development may be overcome conceptually through complementary cash-plus policies, thereby strengthening social development theory, policy, and practice.

The Rise of Social Protection

Social welfare provision in developing countries has a long history of family and community support and philanthropic initiatives (Midgley, 2017). Public provision of social welfare fashioned largely on colonial models, emerged in response to urbanization, poverty and underdevelopment, and rising social problems and needs. Many countries adopted a residual or minimalist approach to social welfare, which was also reactive and treatment-oriented. Emerging social assistance strategies were wholly inadequate in addressing the underlying structural causes of poverty and the social challenges facing these societies (Patel & Midgley, 2023).

A significant shift occurred from the late 1990s onward toward the adoption of social assistance strategies such as cash transfers to reduce poverty. This shift coincided with democratization and political change in some countries and regions of the world (Barrientos, 2013). For instance, in Latin America, Brazil is a good example while in Africa, South Africa played a leading role in social assistance and social development policy innovation (Patel, 2015). The adoption of national constitutions upholding social rights was a key driver of cash transfers as a poverty reduction instrument. Later, international organizations also played a leading role in the promotion and adoption of cash transfers in low- and middle-income countries (Leisering & Böger, 2019). Leisering describes cash transfers as “a quiet revolution, an unlikely idea that has taken root in the Global South” (Leisering, 2019, p. 4). These policy solutions were also a response to the negative impact of structural adjustment policies of the IMF and the World Bank and the diffusion of neo-liberal ideas in social policy in the North (Surrender, 2019).

However, there is now little doubt that the rise of social protection and cash transfers in particular reshaped welfare and social development thinking and policies. It placed poverty reduction on the political and social agenda of many individual countries as well as globally. The success of social protection policies led to their incorporation in the UN Sustainable Development Goals (SDGs) on poverty eradication, which includes social protection policies. Goal 1 advocates social protection as one of the key

strategies to reduce and prevent poverty across the life cycle and to promote social inclusion. It intersects with other SDGs, such as achieving zero hunger (Goal 2), good health and well-being (Goal 3), gender equality (Goal 4), and reducing inequality (Goal 5) (Patel, forthcoming).

This new turn in the social protection field questioned earlier views held by Northern scholars that social welfare and social protection policies were neither feasible nor affordable in developing countries. They pointed to the vast challenges of poverty and inequality, political conflict, low rates of economic growth and employment creation, and limited institutional capacity. Despite these barriers, countries in the Global South such as Brazil, China, and South Africa pioneered and incubated large-scale anti-poverty transfers (Barrientos, 2013). Even in low-income countries, we see experimentation through pilot programs supported by international donors. By 2018, over 140 countries implemented social protection policies in different regions of the world (World Bank, 2018). As evidence began to mount of the impact of these programs, many more countries adopted these policies (Bastagli et al., 2016). As these policies took root, new political constituencies began to coalesce around social protection policies with more countries now including social protection rights in their constitutions than before (Brooks, 2023; Leisering, 2019). The growth of social protection is also contributing to state-building and the slow, but progressive realization of social rights (Patel & Midgley, 2023). The cross-country evidence on whether voters are rewarding political parties for welfare programs is still sparse.

Finally, the COVID-19 pandemic exacerbated poverty rates in many countries in the Global South due to lockdowns negatively affecting people’s livelihoods, and psychosocial well-being with a significant impact on women, and worsening gender inequalities. The pandemic triggered an unprecedented social protection response expanding the number of social protection beneficiaries by 249% between 2020 and 2021 (UN Women and UNDP, 2022). Southern countries largely built on their existing infrastructure of social protection while new temporary social relief measures were introduced. Social assistance continued to be the main response followed by labor market interventions which is well documented by Gentilini et al. (2022).

The Nature and Direction of Social Protection Policies

A global survey by the World Bank in 2018 highlighted the following features of these programs:

1. A preference for unconditional cash transfers (70%) in the global South. This was followed by conditional cash transfers (30%) with behavioral conditions attached to benefits—such as children’s school attendance and parents ensuring that children have health checks.

2. Policy preferences beyond cash transfers favored school feeding schemes (80%), public employment programs (67%), and fee waivers (56%).

3. Social insurance schemes are confined to small sections of the population that are in formal employment. This is because formal labor markets and social insurance schemes are limited in low-income countries. However, more insurance schemes are prevalent in middle- and upper-middle-income countries as formal employment is growing.

4. Many countries adopted a combination of social protection strategies, including programs to promote the productive capacity of beneficiaries through livelihood support, education, and training for specific population groups, with some targeted at specific stages of the life cycle.

There is a growing body of evaluations of impact through country-level studies and cross-country systematic reviews. The evidence is mixed in some country studies with critiques about the lack of generosity of benefits and inclusion and exclusion errors arising from targeting of the most deserving. The debates about targeting versus universal access are reviewed by Slater (2023) who points out that the debate has reached an impasse, which could lead to nothing being done about poverty reduction. She argues for a change in focus because all countries use a hybrid approach. Countries need to work out what are the best mechanisms that can “work in tandem toward more effective social protection” (Slater, 2023, p. 202).

Still, there is consensus that social protection has positive benefits on poverty reduction. For instance, a third of the world’s population escaped absolute poverty while the poverty gap was reduced by 45% (World Bank, 2018). Social protection rights too are advancing. Countries that are faring better had more expansive coverage and higher benefit levels. Finally, cash transfers not only reduced poverty but also had multiplier welfare and developmental effects, such as improved nutrition outcomes for children and school attendance (Bastagli et al., 2016; World Bank, 2018). There are no meta-studies at this stage to assess the impact of social protection on poverty during and after the COVID-19 pandemic across low- and middle-income countries.

Much more research is needed to demonstrate the efficacy of different types of social protection programs such as cash, public employment schemes, and school feeding on its own and when offered in combination with other services and programs (Schüring, Barca, & Sivanu, 2023). These authors point out that the evidence is skewed to cash transfers with less focus on other programs. We also need to understand better what drives success.

Gaps and Linkages between Social Protection and Welfare Services

Much more needs to be done to expand coverage and benefit levels. For example, only 18% of the poorest quintile in low-income countries are covered by social protection, while coverage in lower middle-income countries is less than 50%.

Food and voucher programs cover on average 20% of the population across 108 low- and middle-income countries (World Bank, 2018). Further, a huge gap exists for social provision for informal sector workers who do not have access to contributory social insurance schemes. Low levels of formal employment of women and youth are critical challenges in middle- and upper-middle-income countries, leaving behind large sections of the population. Although there is evidence that social protection leads to a reduction in the gender poverty gap, its potential to promote women’s empowerment is mixed (Patel, 2019) due to socio-cultural and gendered beliefs about the role and status of women in society. In some countries, the design of social protection programs was found to increase rather than alleviate women’s productive and reproductive burdens. Finally, while social protection for children and families has grown, coverage is still low due to poor integration with social services (UNICEF, 2017).

Low- and middle-income countries have different levels of development of formal and informal systems of social support. A focus on formal public social protection negates other resource flows and systems of support and care that exist at both household and community levels. An understanding of how these systems work together could provide important insights into how to develop complementary social interventions beyond the provision of cash only. The links between social protection and welfare services remain weak (Patel, Plagerson, & Chinyoka, 2023). We need to explore more fully on some of the successful case examples of how these connections are being made using social workers, care workers, and community health workers, for example. The design of social protection systems needs to be refashioned to improve its linkages with welfare services, health, education, and labor market programs. In this way a more integrated system of social provision may be realized. The gaps in social protection and its lack of integration into a wider system of social welfare provision warrant further policy-related research and action on how best to achieve this.

Examples and lessons learned from innovation from African countries combining unconditional cash transfers with complementary services may be instructive for other countries that are attempting to redesign their social assistance policies and programs. These are known as Cash Plus programs and are considered below.

The Cash Plus Movement in Social Protection

The rationale for cash plus social welfare and development programs stems from a realization that poverty is multidimensional, material well-being is just one aspect of human well-being. In short, people experience multifaceted risks and vulnerabilities across the life cycle requiring a multifaceted approach.

Hochfeld (2022, p. 90) illustrates the multidimensionality of poverty, gender, and social and economic exclusion of a young woman beneficiary of a cash transfer. She narrates Nandi’s story of poverty. Nandi is a beneficiary of South Africa’s child support grant, which reaches 82% of poor children. The story illustrates the complexity of human needs, risks, and vulnerabilities that she faces as a young woman, a story that is not dissimilar to the situation of some of the young women recipients of cash transfers in South Africa. This is how Hochfeld describes it:

Nandi is 23 years old… all conversation with Nandi is basic… Her schooling ended after Grade Nine, and she has no wish to further her education. Nandi’s history is one of trauma and emotional deprivation. Nandi reports that at the age of five, she was raped by a landlord’s son…later she experienced a brutal gang rape when she was 16. Certainly, Nandi has felt cyclically rejected by society since her childhood. She comes from a home where excessive use of alcohol, intense conflict, domestic violence, and periodic rejection were common. It is from this context that Nandi has developed into an emotionally and intellectually immature woman.

Nandi’s children are both girls aged three and one and a half. They have the same father, a man whom Nandi describes in idealised terms…he was murdered in a stabbing at work. A few years later, Nandi had moved through several relationships, ending up with her third child, also a little girl. Baby Poppy died of pneumonia when she was only 20 days old. Nandi, her two girls, and her partner lived in a small room above a garage a few blocks from her parent’s flat until they were evicted and returned, again to live with Nandi’s parents.

Nandi occasionally assists her mother with domestic work contracts but has no other means of income aside from the Child Support Grant which she is getting for both her children. Her partner is unemployed.

In this story, Hochfeld draws our attention to the benefits of cash transfers in supporting vulnerable children and caregivers materially as well as its limits. She argues that cash is necessary as it addresses income shortages, but its transformative potential is reduced when no psychosocial support services are offered to beneficiaries experiencing gender-based violence. Failure to provide services to women such as Nandi constitutes a lack of social recognition of her plight. In the story Hochfeld alludes to unemployment and its structural roots, low levels of education and skills of young women to compete in the labor market, overcrowding, a lack of housing and violence in marginalized communities in the city of Johannesburg. In these circumstances, cash transfers for women like Nandi address basic consumption needs and improve food security but fall short in addressing other crucial psychosocial and structural barriers to Nandi living a better life and in faring well. Nandi’s story is not unlike that of thousands of young women like her in the Johannesburg environment. Hochfeld concludes that cash-plus care services are needed to advance social and gender justice.

Similarly, Handa, Ibrahim, and Palermo (2023, p. 277) contend that “comprehensive social protection systems (composed of public and private systems of protection) require much more than cash to address the multifaceted and complex risks and vulnerabilities across the life cycle.” Research evidence is fairly well established of the positive impact of cash on food security and in meeting consumption needs, that is first-order outcomes, but its impact on second-order outcomes is dependent on many other factors such as access to jobs, quality education, and health care and socio-cultural beliefs and practices about gender to mention a few. Cash could increase purchasing power on the one hand, but choices about what food to buy require nutrition knowledge to make healthy food choices. It is these limitations of cash transfers, despite their positive effects on poverty, that are driving the cash plus movement which is advocating for linkages between cash transfers with other nonmonetary social protection and wider social welfare and labor market policies.

Examples are discussed from three countries in Eastern and Southern Africa that are experimenting with innovative ways of combining cash plus programs (Huijbregts, Spadafora, & Patel, 2023). Most of the country examples bring together different programs delivered by different ministries with explicit coordination between them. A single program offering the different components is not common. In the Ethiopian case, public employment is the focus of the program combined with a cash transfer component to address seasonal income shortages. This was later linked to community-based health insurance and the integrated nutrition cash transfer for households with children. The integrated nutrition program aimed to improve service uptake and promote behavior change to achieve better outcomes. These multicomponent programs are facilitated by social workers and health extension workers. Ghana’s Leap program has three main components: health and nutrition, increased school enrolment, and livelihood empowerment of caregivers to improve productive capacity. Kenya’s program combines cash and health service access and education. Several pilot programs of cash-plus care and services for children and families are delivered in Mozambique, Tanzania, and South Africa. A diversity of innovative complementary services is offered such as parenting programs, access to social services, and psychosocial support.

Cash-plus interventions for children and families are popular, but few of those programs incorporate a livelihood component such as supporting the working-age population. A study by a group of postgraduate students at the Center for Social Development in Africa at the University of Johannesburg in South Africa provides some recommendations to improve the linkages between grant beneficiaries to livelihood opportunities (Patel, Dikoko, & Archer, 2023). These include training and skills to improve the quality of their informal income generating businesses, access to micro loans and enabling local authority policies to aid micro enterprises. Research on youth employment programs suggests combining demand side strategies (job placement) with supply side strategies such as job search skills. Youth employment programs that included both features in its design were found to be more effective than offering only support services (Khan et al., 2023).

The examples of the cash plus movement in African countries demonstrate the potential to transcend the divide between cash transfers and services in development contexts. For these types of programs to grow, skilled intervention teams are needed for scale up. Enabling organizational environments and cultures are needed to support innovation supported by committed leaders. This could aid the adoption of new ways of working across sectors and disciplines. Enabling policies, procedures, and cooperation agreements could aid the institutionalization of cash-plus programs. Crucially, appropriately trained human resources are needed at different levels. Interdisciplinary collaboration, working in teams and across work streams, coordination between ministries, and partnerships between government and non-state actors coupled with appropriate levels of funding and infrastructure could go some way in translating cash-plus policies and programs into practice (Huijbregts, Spadafora, & Patel, 2023).

Conclusions and New Directions

The article captures the powerful policy ideas and shifts that are occurring in social protection, social welfare, labor markets, and social development in low- and middle-income countries. These policy ideas emanate from the need to overcome how social protection policies are delinked from the wider system of social welfare and development programs in low- and middle-income countries (Patel & Midgley, 2023; Patel, Plagerson, & Chinyoka, 2023). A similar delinking of cash transfers from formal and informal labor markets has been observed; fewer programs deliberately link beneficiaries with active labor market policies and programs. This disconnect is a conceptual one where poverty reduction and eradication are conceived of only as a lack of income (Patel & Midgley, 2023) while other dimensions of poverty are underplayed. A focus on social assistance policies that prefer cash only, could mean that services such as health, education, housing, social services, and employment programs among others are crowded out in public provision.

This is not to undermine the critical role of cash transfers, which has many advantages over, say, food aid only (Alderman, Gentilini, & Yemtsov, 2018). Cash transfers are easier to deliver, provide recipients with greater flexibility to use money as they need, it acknowledges their agency in deciding on what and how much to spend on goods and services and its positive income effects on consumption and food security are well documented above. However, breaking intergenerational cycles of poverty will require a more comprehensive conceptualization and response. In short, it requires much more than only cash to address the multifaceted needs of people in different stages of the life cycle. The choices are not easy given the resource and institutional constraints in low-income countries where welfare services are underdeveloped. Carefully designed programs that combine different components to achieve particular outcomes could be a first step toward the development of comprehensive social protection and welfare systems in the Global South (Handa, Ibrahim, & Palermo, 2023). These pointers may help researchers, policymakers, and social development practitioners to think about how to “build back better” after the devastating effects of the COVID-19 pandemic and the need to regain lost ground in human development. But as the pandemic subsided, new risks and vulnerabilities surfaced such as economic crises, and new and ongoing armed conflict that compounded and deepened preexisting risks and vulnerabilities in different parts of the globe. Alongside these developments, natural disasters caused by climate change increased the vulnerability of millions of people increasing poverty (OECD, undated).

Given these risks and wide-ranging intersecting crises and challenges, social protection and social development policies are beginning to feature prominently in policy discourses and statements to mitigate the impact of climate change (Bagolle, Costella, & Goyeneche, 2023). These ideas may also be useful in further research and action around “just transition” policies that are the subject of much deliberation in many countries as they develop plans to shift from high carbon emitting industries to renewable and clean energy. Social protection and cash plus policies could play an important role in developing new responses to climate change.

Finally, what does this mean for social development theory and practice? Social development as an approach to social welfare has advanced significantly over the past three decades. It has received recognition by organizations such as the International Association of Schools of Social Work (Patel, 2015) and the International Council of Social Welfare (Zelenev, 2018) to mention a few. There is agreement that the approach needs to be strengthened theoretically and in practice. This reflection on the nexus between cash transfers, a macro economic development policy intervention, and welfare and development programs has demonstrated the interconnection between social and economic development, a central tenet of the social development approach to social welfare. In this regard, Patel and Midgley (2023, p. 21) argue that “notwithstanding the economic rationale of social protection, social development has retained a strong social rationale for social protection through its commitment to human rights, equality, and social justice.” Social transformation may therefore be advanced through combining social policies and programs that link social and economic development underpinned by a rights-based framework to social protection and social development.

Acknowledgment

This article is based on a lecture delivered by the author at the 23rd biennial conference of the International Consortium for Social Development (ICSD) in honor of Shanti Khinduka, one of the founders of the ICSD. The lecture paid tribute to his commitment to fostering global dialogue, knowledge exchange, and mutual learning. Shanti has been a catalytic force and advocate for social development around the world. I am deeply honored to have delivered the Shanti Khinduka lecture on August 25, 2023 at the University of Gävle, Sweden. The lecture is based on the theme of a book published by Patel, Plagerson, and Chinyoka (2023).