Introduction

Social Protection (SP) is defined differently by different Social Protection actors, depending on their areas of emphasis, targeting methods, or outcomes sought. The African Platform for Social Protection (APSP) defines Social Protection as a set of policies and programmes designed and implemented by the state and other stakeholders to reduce poverty and vulnerability by cushioning people’s exposure to risks, and enhancing their capacity to protect themselves against shocks and interruption or loss of income, and promoting their ability to come out of poverty.

HIV and Social Protection: The Link

HIV and Social Protection are closely interlinked. Evidence has shown that having in place interventions that address HIV automatically contributes towards realizing the goal of social

protection. Gender, age, access to information, and social status are amongst some factors that contribute heavily to the vulnerability of people. This calls for special attention to the elderly, gender concerns, and issues like access to healthcare and food to ensure that Social Protection achieves its intended goals. It is hence recommended that actors in social protection put in place policies that mainstream HIV into Social Protection.

Background

Since 2011, the APSP, together with HelpAge, The Coalition on Children affected with AIDS

and University College London (UCL), has been implementing the programme Strengthening

Universal Access to HIV and Social Protection Services to Prevent and Mitigate the Impact of

HIV and AIDS and Poverty in sub-Saharan Africa each delivering different results of the projects whose objectives were:

1. Increase access to HIV and Social Protection services for the most vulnerable;
2. Increase policies and budgets of national and regional actors so as to include the most vulnerable and marginalized;
3. Increase the participation of Civil Society Organisations in the formulation, implementation and monitoring of national and regional HIV and Social Protection policies and strategies and
4. Increase research and learning that will inform global, regional and national HIV and SP policies and programmes.

APSP mandate was around CSOs /platforms participation in Social protection programmes in

Africa, to achieve this the following approaches were initiated:

Approach:

• National Level Awareness;
• Raising and Capacity Building;
• Establishing National Platforms and Coalition Building;
• Information Sharing and Research;
• Peer Support & Learning Events;
• Annual Delegates Conference.

Results

Some of the results from this programme include:

• Development of various guiding documents on how to incorporate HIV into Social Protection work;
• Establishment and Training of National Platform members. Over 560 members of 23 National Platforms were trained in Social Protection and Policy Engagement skills. National level coalition activities were supported in 10 countries: Liberia,
• Sierra Leone, Kenya, Malawi, Rwanda, Uganda, Zambia, the Gambia, Zimbabwe and Niger;
• Advocacy and Raising SP Awareness through Annual Delegates Conferences;
• Learning and Sharing through Peer Learning Events.

Lessons Learnt

The link between Social protection, HIV and related outcomes are:

• Cash transfers and gender dimension: reliable and predictable income reduces poverty and vulnerability that may lead to risky choices and behavior due to poverty (HIV prevention and negotiation skills).
• Illness-related costs prevent people from seeking health services promptly. Social protection measures targeting access to health care reduces this barrier and thus enables the provision of a range of timely interventions which help to improve the health status of people, including prevention, treatment, and rehabilitation.
• Social cash transfers, food transfers/vouchers have corresponding nutrition effect on PLHIV/ Recovery as well as compliance to treatment (taking medicine and food intake are inter related), lack of food may lead to skipping of drugs as prescribed, compromising the health outcomes.
• Well targeted health measures in Social protection prevents out of pocket (OOP)household expenditure that is catastrophic and impoverishing.
• In countries where patients are required to pay substantial user charges or co-payments, the financial burden associated with medical care can spell economic ruin for whole families, especially if hospital treatment is needed. Faced with illness-related costs, people in poor households often sell productive assets, cut down expenditures on other basic necessities such as food and clothing, and take their children out of school. These types of risk coping mechanism strongly contribute to the persistence of poverty. Their substitution by effective social health protection systems has a positive impact on cross-sectoral poverty issues such as nutrition and education.
• Stable and predictable social protection measures increases people’s productivity: By improving the health status of people and by substituting inefficient risk coping mechanisms, social health protection augments people’s productivity, which in turn promotes employment and economic growth and further facilitates increases in income levels. Additionally, Social protection promotes social stability and social cohesion: Social health protection is firmly grounded on values such as solidarity and equity thereby strengthening the bonds of cooperation and reciprocity, enhancing social stability and social cohesion within a society (reduction in poverty related stigma).
• There is need to provide guidelines for mainstreaming HIV into Social Protection work and ensuring that future social protection interventions are HIV sensitive.
• Participation of national platforms, CSOs, the grassroots and the citizens in social protection programmes including PLHIV, PWDs and older person reduces fraud, improves efficiency and ownership. This should be the gold standard approach for future Social protection programmes in Africa.

Conclusion

Evidence has shown that there is a causal relationship between HIV and poverty. HIV prevalence aggravates conditions of poverty, and conversely, conditions of poverty aggravate prevalence of HIV. Evidence from various evaluations of the programme indicates that Social Protection initiatives were successful in increasing access to HIV and Social Protection services therefore reducing poverty and marginalization.