Targeted and Universal Social Protection

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TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

ARCHITECTURE OF AID (809AF) CANDIDATE NUMBER: 47274

APRIL 19, 2010.


TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

INTRODUCTION The distribution of economic outputs of any nation has always been a concern to governments whether on a minimal or extensive scale. The industrial revolution marks the inception of the presently held idea of a middle‐class when non‐royalty connected individuals began to have access to wealth accumulation on a greater scale than ever before. The increased wealth of nations through the industrial process no doubt brought about the decline of poverty levels and increased health standards from the European territories to the New World. Accompanying this success was the realisation of capitalism’s potential to create a new classification of poverty, one that is established and perpetuated through a tight control of capital and the production process by a minority. Indeed, the threat of such power to the underlining fabric of society building led to various postulations that only institutions working on behalf of the general population should be vested with such authority and control. This was an opposite extreme but rooted in the abuses of the production process by the new capitalist class. It was not until the mid‐twentieth century, exactly after the stock market crash and Second World War that states embraced the idea of protecting against the possible excesses of capital‐controlled production process. The high rate of growth required for the sustainability of the welfare state was not forth coming in many of these new states and by the mid‐1980s when the debt crisis hit, many had to abandon the that model as pre‐condition for economic help. Social risks were altogether abandoned with the introduction of economic reforms as a condition for recovery. Subequently, social policy debate in realtion to developing countries focused on one thing: economic risk and cost. The failures of Structural Adjustment Programs (SAP) highlighted the vulnerability of many individuals in these states to economic liberalization

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TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

prompting attention towards addressing poverty related economic risks. The focus on poverty alleviation brought the ascendancy of programs which exclusively target the poor. The proliferation of this approach across many developing countries has pitched existing universal programs against the new push to give special attention to the most vulnerable. Some universal programs have been subsequently modified to exclude rich beneficiaries as means of bridging socio‐economic inequalities. However, targeting has not proven to be a ‘magic bullet’ for poverty alleviation and has raised more questions about addressing the phenomenon than the answers it claims to provide. This essay is situated within an argument that social programs must combine the need to aggressively reduce socio‐ economic inequalities through targeting with the morality of leaving no individual uncovered whether rich or poor. Replacing universal programs with targeting weakens the ability of governments to adequately provide strong measures to ensure that all citizens are treated equally in the delivery of social services. At the same time, universalism without direct intervention in addressing existing inequalities will only mean that the poor and vulnerable only remain slightly above poverty levels rather than taken out of poverty completely. The arguments begin by focusing on the ascendancy of targeting programs in the next section. The literature, in which the debates between universalism and targeting are situated, is presented before addressing the limitations of choosing one over the other. These limitations are presented in the third section through the analyses of one of the biggest targeting programs in the world. The Bolsa Familia Program (or BFP) is the Brazilian cash and asset transfer scheme targeting the very poor and ensuring use of social services through a set of conditionalities. The fourth section presents some examples of the need to

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TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

conceptualize, design and implement social protection programs with a vision of a using targeting as a means towards achieving universal coverage rather than an end in itself. Lastly, attention is turned towards concluding remarks that re‐iterate the dangers of centralizing social protection debate on whether the poor deserve a special attention or should be provided for as part of a larger population. What matters ultimately is that poverty alleviation must utilize social protection measures across economic, political, cultural, racial and indeed social causes and must be implemented as a socio‐economic right and not a privilege. POVERTY ALLEVIATION AS AN OBJECTIVE OF SOCIAL PROTECTION Social Protection discourse is steeped in notions of universality and targeting with respect to which individuals to be covered and for how long. The origins of the debate can be traced primarily to the role of governments in providing social services either through taxes and redistributive measures (in developed countries) or through channelling of various forms of development assistance (Gentilini, 2009; Timmer, 2007). Further contributing to this debate is the discussion on the best possible use of development assistance towards the alleviation of poverty (Barrett & Swallow, 2006; Easterly, 2006; Sachs, 2006; Sachs, 2009). Poverty alleviation has thus taken the centre stage as the default objective of social protection. The centrality of poverty alleviation stems from the increased attention the phenomenon has received in the last two decades as one of the major impediments to development. Its multi‐dimensional nature extends beyond economic conditions to underlining structural contributions to the vulnerability of more than 1 billion people around the globe to both man‐made and natural disasters (Zupi, 2007; Qizilbash, 2004). There is however, much debate about the best possible way to address poverty in its multifaceted nature through

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social programs. Suggestions have included the need to focus on the economic and labour market causes of poverty (Holzmann & Grosh, 2008; ILO , 2004), health risks associated poverty (GTZ, 2007) and natural disaster induced poverty (Davies et. al., 2008; Vakis, 2006). Others have advocated for focusing on the relationship between the unreliability of agricultural practices ‐ i.e. seasonality ‐ (Longley et. al., 2006; Farrington et. al., 2007) and the importance of addressing poverty related disempowerment and rights denial (Devereux & Sabates‐Wheeler, 2004). Common to all these various ideas on addressing poverty has been the debate on the level of coverage for the poor under each proposition. Some of these arguments are steeped in the need to target available resources to the most affected by these poverty‐inducing factors while others have advocated for total coverage of all citizens towards addressing the vulnerabilities of the poor and ensuring that the rich are also guarded against falling into poverty (for example, in the event of natural disasters). Informing this direction of the debate is the need to balance resources with capacities of developing countries to deliver on ensuring adequate social support for their citizens whether rich or poor. Essentially, how can these countries ensure that they can meet the short‐term needs of the poor and yet have enough resources to plan for long‐term investments in qualitative social services (Devereux, 2003)? Universalism has been the basis for the welfare state model that permeated almost every corner of the globe between the 1950s and the late 1970s. It promotes equal distribution of resources by ensuring that the rich helps to subsidise the cost of providing social services/programs for the poor. Ultimately a reduction in inequality should result in increased national productivity because the risks associated with labour production are mitigated against by the assurance that labourers would be looked after in the event of undesired loss of wages (Lautier, 2006).

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TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

Universalists maintain that this trade‐off need not occur because access to social services and social protection programs should be a matter of right for every individual and not a privilege from their governments. Their argument is rooted in the Universal Declaration of Human Rights which states that “Everyone, as a member of society, has the right to social security” and that “…the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond [an individual’s] control” must be protected by the state (UN, G.A. res. 217A (III), 1948, Art. 22 & 25). These clauses form the basis of the claim that the existence of poverty is inherently a violation of fundamental human rights and its eradication must be pursued with such vigour. This can be ensured through the adoption of social minimum standards that ensure that individuals’ livelihoods do not deteriorate beyond a certain set standard (Thomson, 2007). This process of entitling individuals to social programs has however been on the decline since the neo‐liberal assault on the role of the state due to fiscal constraints and change in conditions for development aid and attention is more pronounced towards targeted approaches (Mkandawire, 2005). Some of the reasons for this decline are not limited to over bloated budgets especially in developing countries. Some universal programs entrenched levels of inequality through discrimination both within individual and community social service users (Lisenda, 2004; Bategeka et. al., 2004). Also, many universal programs failed to adequately address issues of poverty and inequality in a comprehensive manner. Programs were established within different ministries, many of which lacked inter‐ ministerial cooperation to address areas where services overlap and complement each other. Therefore, alleviating poverty cannot be reduced simply to universal access to social programs but must include dealing with areas where poverty and vulnerability factors are

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inter‐related. Opposed to the idea of universalism, a notion that sounds more ideal than practicable, targeted social programs advocate that poverty and inequality may only be removed if limited resources can be directed towards individuals most affected and thus most vulnerable to poverty related shocks. The stock of targeted programs rose as many developing countries were forced to scale back their social spending as a condition for development assistance under the SAP arrangements of the 1980s and 1990s. The idea is rooted in the believe that governments can focus their limited resources on the most needy by subsidising private sector managed social services like healthcare and education (Besley & Kanbur, 1990; van de Walle, 1998; Ravallion, 2009). Delivering poverty reduction to the poor can also be done with more precision and accuracy by pin‐pointing beneficiaries through means‐testing (Akhter & Bouis, 2002; Gelbach & Pritchett, 2002), self‐targeting (Kevane & Conning, 2002) and geographic targeting (Baker & Grosh, 1994; Elbers et. al. , 2008). Targeting programs have thus become increasingly popular from Latin America to Sub‐Saharan Africa and South Asia and form the basis for many poverty reduction schemes like the Millennium Development Goals (MDGs), Poverty Reduction Strategy Papers (PRSP) and direct development assistance (Maxwell, 2003). However, these programs have been criticised because of the varying results from different types of targeting and the possibility that the underlying cost‐saving assumptions may not hold true as most of these programs work best in richer countries (Coady, Grosh, & Hoddinott, 2004). The most popular targeting programs engage in one form of asset transfer or the other, be it cash, livestock, agricultural input or any form of assets that can guarantee a form of income generation. The biggest of the asset transfer programs are Bangladesh Rural Advancement Committee (BRAC) in Bangladesh and the Bolsa Familia

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program in Brazil. As the Bolsa Familia or BFP (which is further analysed below) indicates, targeting has the potential of zeroing in on the poor to provide social protection (or services) on both a large scale and a comprehensive manner. It also subsequently is not free of the limitations of targeting and its role in enhancing neo‐liberal ideas into social service provision. CONDITIONAL TRANSFERS: THE BOLSA FAMILIA IN DEPTH AND SCOPE The most popular targeting social protection programs have been some form of transfers or the other to selected vulnerable groups. Brazil’s history with targeted social protection programs dates back to the early 1990s when SAP debilitated the country’s capacity for social services provision (Hall & Midgley, 2004). The austere measures required that the government cut back on such spending which further damaged its capacity to fully address the new socio‐economic vulnerabilities created by an overreach of economic liberalization. Facing financial crises, budget cuts and increasing incidence of poverty levels both before and more so after the introduction of the SAP agreements (Conway, de Haan, & Norton, 2000), universal social programs were out of the question. The government’s response was to adopt the thinking along the line of its benefactors (the Washington institutions). A shift to targeted, measured and more calculated social programs was affordable under the budget cut proposals but more so, would allow for “means‐tested approach for addressing mass poverty” (Hall, 2006, p. 2). The poor in Brazil thus became test subjects, in a “natural laboratory” (Lindert et. al. 2007, p. 7), for the Washington Consensus' poverty reduction strategy through conditional cash transfer (CCT) programs.

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TARGETED AND UNIVERSAL SOCIAL PROTECTION: CHANCE FOR A MIDDLE COURSE?

BFP was launched in October 2003 as a consolidation of pre‐existing CCT programs to take advantage of their complementarity. Specifically, it was meant to improve targeting mechanisms, reduce overlapping inefficiencies and most importantly, take advantage of the complementarity that exists among those CCTs and the social services they utilize (Lindert et. al., 2007). The Bolsa Familia is a conditional cash transfer program that requires beneficiaries to uphold certain responsibilities to fully qualify for cash receipts with the hope of addressing both immediate and intergenerational poverty‐related vulnerabilities. Included in the new mega but more comprehensive program were the Bolsa Escola (or conditional grant based on school attendance), the Bolsa Alimentacao (food subsidy conditioned upon health services use like maternity care), the Programa de Erradicao do TrabalhoInfantil (to eliminate use of child labour), the Cartao Alimentaqcao (gas subsidy) (MDS, 2006). BFP included changes to the administration of these programs beginning with the merging of the Ministry of Food Security and Fight Against Hunger and the Ministry of Social Welfare to create a new Ministry of Social Development (MDS) which now housed the administrative headquarters of the scheme. Additionally, the scheme changed its focus from individual beneficiaries to family group and family earning as a base indicator for selecting beneficiaries. Qualification as a beneficiary of BFP is premised on being identified as either being ‘poor’ or ‘extremely poor’. The extremely poor (who are automatically included in the program) are classified as families who earn at most R$70 per capita per month while the poor are those earning between R$ 70.01 and R$140 per capita per month. Whether families become beneficiaries by automation or by qualification, all beneficiaries are required to be listed in the Unified Register for Social Programs (MDS, 2006). Qualified beneficiaries receive cash

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transfers per family member up to a maximum of five children only three of which can be between the ages of 0‐15 while the rest are between 16‐17 years of age. Extremely poor families receive a minimum of R$ 68 and a maximum of R$ 200 depending on the age distribution of the children within the family. The minimum transfer is R$ 22 per month for poor families reaching a maximum of R$ 168 also contingent on the number and age structure of children within the household. The conditionalities as set out in the legislative act that created the scheme and enforced through the MDS according to the government (MDS, 2006) are:

i.

Education: school attendance of at least 85% for children and adolescents aged 6 to 15 years and a minimum of 75% for adolescents between 16 and 17 years.

ii. Health: Monitoring the immunization schedule and the growth and development for

children less than 7 years and prenatal monitoring of pregnant women and nursing mothers aged 14 to 44 years. iii. Social Assistance: frequency of at least 85% of the workload on services for children

and adolescents up to 15 years at risk of, or withdrawn from child labour The government claims to have monitoring procedures in place to assess whether families follow these conditions or not though the receipt of funds by families depends on monthly qualification for the program (MDS, 2006). Brazil is not new to heavy social spending but the profile of BFP belies the trend in the total ratio of its social spending as a percentage of its GDP. In the period immediately after the BFP consolidations (from 2004 to 2006), the total share of social spending a percentage of the GDP fell from 14.1% to 12.7%, though figurative spending rose from R$ 249 billion to R$

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293 billion (Hall, 2008, p. 802). As the GDP allocation for social spending dropped, the BFP scheme received increased funding and became the major recipient CCT program. It jumped from 26% to 36% of the total social assistance budget between 2003 and 2004 before climaxing at 38% which further represented a 0.03 point increase in total social spending as a percentage of GDP, i.e. from 0.2% to 0.5% (Lindert, 2005). Funding is provided through a partnership of the Brazilian government and international development agencies. The initial budget for the program was R$ 3.4 billion in 2003 which quickly expanded to more than R$ 8.2 billion as at 2006. The government was also able to secure a funding instrument from the World Bank (WB) to the tune of US$ 570 million spread between 2004 and the 2009 ending. The interest of the WB may in fact be an important factor to explain why the funding for BFP has been on the increase while spending for overall social spending declined. The Bank’s interest may be motivated by the sheer size of beneficiaries under the scheme. When launched in 2003, BF brought together a total of four million families which quickly rose to 6.5 million by December of 2004 (Hall 2006, 2008). There are gains in terms of the program’s reach through a robust system of task sharing coordinated by MDS. The scheme is implemented over all 5,564 municipalities in the country through an agreement between municipal governments and the MDS. The agreement requires that “municipalities maintain a local BFP coordinator (local point‐of‐ contact), register potential beneficiaries [and supervise information consolidation on conditionalities compliance” (Lindert et. al., 2007, p. 25). A key component of the agreement which acts to solidify the comprehensive aspect of BFP is that beneficiaries are granted priority access in the demand and use of complementary social services (schools and health centres in this instance) to facilitate a horizontal integration. Remarkably, the

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result of the decentralization has been a rapid increase in the number of beneficiaries to 11.6 million families representing more than 44 million Brazilians. It currently stands as the most elaborate, wide reaching and most funded CCT in the world (Lindert et. al., 2007; Glewwe & Kassouf, 2008). The World Bank and the Brazilian government presently tout the successes of the BFP program towards the reduction of poverty and income inequality. Most of these are measured through the rise in the demand for social services and increase in per capita income of beneficiary families (Hall, 2008). Similarly, MDS reports that as at 2006, three years after the launch of BFP, 4.9% of beneficiaries were no longer classified as being ‘poor’ while 31.1% moved from being ‘extremely poor’ to being ‘poor’ (MDS, 2006). A 2006 assessment of the Bolsa Escola component of the scheme to assess school attendance rates concludes that the school attendance rate increases as at 2005 indicate a potential long run effect of 0.7% among the target population and 0.3% among the populations as a whole (Glewwe & Kassouf, 2008). Despite the scope and reach of BFP, there are certain questions that must be answered particularly relating to how much structural change it has brought to about 44 million Brazilians since inception. A close examination of these merits reveals that BFP in particular and CCTs in general leave more questions about issues of poverty than they tend to answer. First, the program does little to address structural causes of poverty. An increase in social service demand like the school attendance rates for instance says little about any possible improvements in quality of education received. The potency of inter‐service linkages in fighting poverty is only measurable when beneficiaries’ lives are meaningfully impacted by services received. Indeed BFP has been bogged down by serious supply‐side impediments (Rocha, 2009). Second, the horizontal complementarity touted by the program amounts to a half‐baked

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cookie scenario. BFP exists without close consultations with other social security arrangements under the supervision of the MDS. The Beneficio Prestacao Continuada (BPC) pension scheme for disabled and over‐65 individuals for example, is operationalized separate of the BFP but overseen by the same ministry (Glewwe & Kassouf, 2008). This creates a very serious problem in the selection criteria for beneficiaries because transfers from the BPC may have been counted as a source of income creating the possibility of exclusion for disabled families whose per capita receipts lies above the BFP threshold (Madeiros, Britto, & Soares, 2008). These are families with disabled and retired members who can’t earn enough and yet may have been excluded from the biggest program in the world designed to take care of folks in such conditions. Sustainability also presents an issue for BFP. Its legal status is effectively tied to the political situation and therefore susceptible to political manoeuvring and positioning. The BFP was created by President Lula upon assuming office in 2003 and though ratified by an act of parliament and a presidential decree (MDS, 2006), it does not carry a constitutional status. It is in fact established as a program within the presidency (Madeiros, Britto, & Soares, 2008). As a result, the ‘extremely poor’ and the ‘poor’ in Brazil are receiving privileged assistance and not one based on a right to survival. Unlike the constitutionally enshrined BPC, the BFP is not a ‘rights’ based program and has in fact been subjected to political manipulation at the local level and has been used as a propaganda scheme at the federal level (Hall, 2008). Its financial sustainability is also unpredictable and is thus vulnerable to fiscal adjustments, and economic downturns. Other questions that remain include, where the increase in service providers is coming from since government’s social spending as a percentage of GDP has continuously declined since

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BFP began. Are social services being provided by the private sector as part of the ‘mini economies’ created around the scheme? If this increase can be accounted for through the rising budget of the BFP, what does that translate into for the rest of the population who are not on BFP benefits but yet require access to educational, health and home heating services? What are the provisions being put in place to ensure that for example, a young school graduate who was a BFP beneficiary is not encouraged to start a family so as to keep receiving BFP benefits as a way out of joblessness? In other words, are children who go through the program guaranteed of suitable jobs upon graduation? The answers to these questions may come in the near future as further studies are carried out on the BFP but can targeted social programs be reconciled with universal principles of coverage? Universal programs focus on setting minimum standards that define levels of acceptable living standards for the entirety of the population. In this regard, social programs are regarded as entitlements and become rights which every citizen must have access. This principle is missing in targeting programs and seriously undermines their long‐term sustainability. The lack of certainty for citizens’ access to social protection as a matter of right exposes targeting programs to various forms of manipulation. TARGETING AS A FOUNDATION TOWARDS UNIVERSALISM Social policy however remains a contested ground for both universal and targeting programs. Most programs incorporate aspects of both though there are no clear admissions from either governments or policy theorists. The BFP case discussed above for example covers all ‘extremely poor’ and ‘poor’ people in Brazil and is backed up by a legislative act, though the act does not make it an entitlement program. Beneficiaries cannot legally ask for the cash transfers if denied to them through an act of government policy. On the other

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hand, universal programs which are established as entitlements have been subjected to targeting strategies as well. For example, the Canadian pension system is listed as universal but in fact restricts the payment of pension to retired individuals with certain ceilings of income by taxing their pension entitlements at 100% (Hoddinott, 2007). Similarly, the Namibian Old Age Pension Scheme which is a constitutionally instructed program has since been amended to allow for means‐testing. The amendment added that income and assets, in addition to the age, residency and citizenship requirement, would determine the entitlement of any individual to the pension scheme.The amendments were inspired by costs more than an ideological push towards granting poor Namibian retirees special attention (Devereux, 2001). The close linkages and traces of elements of both approaches in some programs inform two crucial lessons: First, there is a need to implement social policies as a means towards achieving universal coverage of all citizens. Only by focusing on the need to address underlying structural causes of poverty (in its various manifestations) will social programs achieve the necessary transformative conditions essential for the success of universal social policies. The focus towards the implementation of universal social programs as a right for every individual must begin somewhere. Targeted programs offer such starting points presently. Their existence will immensely benefit existing universal programs if structurally overlapping areas of social services are jointly operated. Targeting if done properly also allows for the improvement in social service quality if the increase in demand is not simply augmented by increased personnel but further matched with infrastructural provision. This can be done by targeting resources as a start (Hoddinott, 2007) to improve on existing levels of poverty and inequality before opening up access to every citizen.

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Secondly, but even more to the heart of the debate is that social programs may not always follow the ideological presentations in the policies that inspire their creation. The implementation of such programs, if to be successful will need to conform to certain conditions which may or may not be important, or indeed be politically expedient for governments. Therefore, there is a need to assess local conditions including the level of inequality and poverty that exists, the level of social service access, possible history of the country with any form of social protection and affordability of entitlement schemes. The focus of the debate on issue of definition (Barrientos & Holmes, 2007)(Sabates‐Wheeler & Haddad, 2005) impact on growth (World Bank, 2007) and ultimately cost/sustainability (Devereux, Marshall, MacAskil, & Pelham, 2005; ILO, 2008) belittle the varying experiences of countries with different forms of social protection programs. These debates also fail to address the often occurring phenomenon of both targeted and universal social programs within the same country. Botswana for instance has a Universal Primary Education which entitles all its citizens to a minimum of primary level schooling (Lisenda, 2004) but at the same time operates the vulnerable groups feeding and Destitute Persons programs (Banjo, 2009). Consequentially, social programs should be highly contextual, designed and implemented according to the dynamics of the vulnerability issues being tackled (Gentilini, 2009). CONCLUSION The decline of universal social programs premised on the argument of cost ineffectiveness has partly brought about the need to pay more attention to poor and vulnerable individuals as recipients of social assistance. Targeting programs have also been instituted on the claims

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that they are the best way towards reducing socio‐economic inequalities and achieving poverty alleviation, and perhaps eradication. However, debating the moral underpinnings of social policy and potential costs must be accompanied by a debate on how best to deliver qualitative social policies either to a general population or selected beneficiaries. It is important for social programs to be centrally concerned about the quality of delivered services and buoyancy of social protection methods to cover the complexity and multiple linkages of social issues with wider political and economic issues. Targeting seems to be able to address these linkages and complexity by increasing the demand for social services through conditioning recipients of government assistance to utilize multiple services at the same time. The result is like a cocktail of prescriptions which an individual must go through before qualifying for relief even if his/her socio‐economic condition presents a serious level of vulnerability. The Brazilian Bolsa Familia presents a good case for such multidimensional approach but it also falls short of improving the quality of services received by its beneficiaries though it succeeds in raising the number of users. It therefore, gives some reason to pause and re‐think the assumption of targeting programs as the ultimate solutions in solving the poverty question. The program’s impressive reach – 44 million people to be precise – and its attempt to tackle poverty from many fronts – cash, healthcare, cooking gas, food access and education – has no doubt achieved certain successes. Those successes include increase in school attendance rate, more frequent maternity visit by nursing mothers and perhaps improved markets for food and gas distribution. The questions that it leaves unanswered however overshadow those successes and more generally point to the need to reconsider the assault on universal approaches. Universalism is not free of its problems and in fact (as noted above) may have

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contributed to increases in levels of inequality in certain circumstances but it does offer dignity and a tolerance level for poverty and inequality situations. Social protection and by extension policies may therefore benefit from a strategy of implementing targeting programs as bridging schemes to address existing levels of inequality and poverty incidence before expanding coverage to the general population. This approach will also benefit from a strategy of contextualising the conceptualization, design and implementation of social protection programs in particular and policies in general to ensure adaptability to localised conditions. The failure of the universalism/targeting debates to capture this nuance reveals an obsession over idealisation rather than practicality and may undermine the possibility of finding appropriate solution to specific incidences of poverty and inequality in quite often distinct localities across developing countries. In this respect, a system of listening to the poor and intended beneficiaries like those proposed by the participatory approaches must become essential elements of social policy planning and implementation to build bottom up solutions and not ideologically dictated ones. If we fail to listen to those we seek to help, we can be sure of the very high possibility of compounding their worries rather than dismantling them.

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