Towards Universal Coverage and Transformation for Achieving the Millennium Development Goals

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Social Policy in South Asia:

Towards Universal Coverage and Transformation for Achieving the Millennium Development Goals

Analytical Report

Based on the workshop on transformative social policy in South Asia, held in Kathmandu, Nepal, 24-25 May 2006

sponsored by the UNICEF Regional Office for South Asia (ROSA),

the UNICEF Innocenti Research Centre (IRC), and the

United Nations Research Institute for Social Development (UNRISD)

August 2006


Gabriele Köhler and Jennifer Keane

with thanks to Cecilia Lotse, David Parker, Liz Gibbons, Peter Utting, Katja Hujo, and Karuna Nundy for crucial contributions, inputs and comments, and to all participants for a lively and productive two-day workshop.


584 million children and young people live in South Asia1, the largest number of children and young people under 18 in any region, constituting between 35 to 50 per cent of the population in the individual countries. Paradoxically, the region features several highly successful, technologically advanced economies, but is performing extremely poorly in terms of social development in general, and child development and well-being in particular. Taking the Millennium Development Goals (MDGs) as a point of reference, most of South Asia’s countries are unlikely to meet the targets by 2015. Child poverty and deprivation are among the worst levels globally, affecting as many as 330 million children or 59 percent of the child population in the region.2 Child malnutrition, infant and child mortality, and maternal mortality levels surpass those of every other region in the world, and school enrolment and literacy rates remain dismally low.3 South Asia averages indicate that 46 percent of children under 5 are underweight, primary school enrolment is at 74 percent, and adult literacy is at 58 percent total and 45 percent for women. 4 Disaggregation of these indicators by gender, caste, ethnicity, and location within countries reveals even poorer outcomes and attests to the layers of social exclusion that exist institutionally and at the community and inter-personal levels. Social exclusion is seen by some to be the most entrenched in South Asia than in any other area globally and is considered an underlying reason for the failure to meet the Millennium Development Goals. 5

The governments of the region have made commitments to enhance child well-being, as expressed in human rights instruments, including the Convention on the Rights of the Child, and their reflection in national legal frameworks, as well as in the Millennium Declaration, the United Nations General Assembly 2005 Summit, the South Asian Association of Regional Cooperation (SAARC) Decade on the Rights of the Child, and in national Constitutions and development plans. There has also been a significant effort in some countries to increase budget allocations for basic social services. However, despite best intentions, the MDGs and other child-related development objectives remain under-delivered in most countries. As a consequence, the rights of the child are grossly violated.

It is in this context that social policy is especially pertinent, and indeed critical, for the achievement of the MDGs and for the wider realisation of child rights. A consensus on the definition of social policy does not exist, but it can be considered a series of public policies designed to promote equitable development. It includes measures that affect people’s well-being, through the provision of quality social services, such as health or education, and interventions which impact upon livelihoods more generally. It also comprises social protection measures, through social service provisioning, transfers and social security. Social policy also influences economic development, through productive capacity building and generating consumer demand; equity, through redistribution and gender justice; social reproduction, by assisting with care; and last but not least social and national cohesion, and the fostering of democracy.6

If it addresses these multiple roles, social policy can be considered transformative. Transformative social policy aims to enable all people to equally access their fundamental entitlements, secure and sustain a decent quality of life, and realise their full potential. It addresses the root causes and multidimensionality of poverty, inequality, and social exclusion. Ideally, it is not divisive, but rather fosters an inclusive and cohesive society. Through the creation of new shared values and social norms, it promotes a society founded on gender equality and equality for all, one that is free from all forms of discrimination and social exclusion. Transformative social policy is based on the human rights principles of universalism, equality and non-discrimination, inter-dependence and inter-relatedness, accountability and the rule of law, participation and inclusion, and indivisibility. A human rights based approach to social policy strengthens the capacities of rights-holders to claim their entitlements and duty-bearers to fulfil their obligations,7 and is therefore empowering. Lastly, transformative social policy addresses redistributive commitments, considers not only access to, but also the quality of social services, and is both financially and politically sustainable in order to create conditions for longer term change.

Transformative social policy improves the well-being of children by aiming to ensure that basic social services are universal in principle, and are indeed accessible by all in practice. It recognises that some children who are from low income families, live in remote rural areas, or are part of a socially excluded group may require support in the form of “special efforts” to confront the challenges they face in accessing such services as health or education. By making “special efforts” to ensure social inclusion and universal access to basic social services, social policy can create new traditions and values that respect the rights of all – for example, a stipend distributed to all female students can increase female enrollment and foster a positive attitude towards educating girls, or raising awareness among health workers of the need to treat all persons with respect will ensure that women from a so-called lower caste no longer avoid receiving antenatal care from a health clinic because they expect to be treated poorly. Effective social policy also builds the capacity of civil society to hold the government and service deliverers, such as teachers or health workers, accountable for provision of quality services. Moreover, because social policy addresses issues that improve the well-being of families (health, unemployment, housing, access to food), it thereby increases the prospect of a brighter future for children.

Finally, social policy is critical for children because their developmental needs are urgent and cannot be postponed.8 If a child does not have uninterrupted access to proper nutrition, care and health services in the early stages of life, the detrimental effects are irreversible. If children do not receive a quality education, they are more vulnerable to child labour, exploitation, abuse, and trafficking, and will remain trapped in a vicious cycle of poverty that will easily extend to their own children. It is thus clear that in order to advance progress towards the MDGs and the wider realisation of child rights in South Asia, the time to renew attention to foundation principles and implementation measures of social policy is now.

MDG Achievement in South Asia: The Social Exclusion Challenge

Academic literature and UNICEF’s work in the countries of South Asia suggest that social exclusion9 in the form of factors such as caste, ethnicity, religious affiliation, disability, language group and geographical remoteness, as well as gender, are the underlying cross-cutting reasons for the Millennium Development Goal commitments not being met. It has been argued that social exclusion is more entrenched in South Asia than anywhere else globally. Discrimination has resulted in inequalities in access to land, assets, education, health, and other social services; compulsory occupations; social hierarchical relationships; restrictions on use of public space and public services, and skewed participation in decision-making. While all aspects of social exclusion need to be confronted and addressed, exclusion affiliated with gender, ethnicity, caste, language, geographical remoteness, and income inequality in South Asia repeatedly arose during the workshop.


Caste-based exclusion and discrimination are not historical artifacts but are constantly reinvented through present day social institutions and relationships. For example, in India, micro level studies in Andhra Pradesh, Gujarat, Orissa and a fairly extensive study on untouchability covering 11 states and 514 villages, done by Action Aid, an international NGO, confirm continuing caste based discrimination and exclusion. These studies found that children who are from the Dalit community – also referred to as the “oppressed’ or “untouchable” caste in India and Nepal – are seated separately in schools and treated poorly by teachers, forced to run errands for them and perform menial labour in the schools. In many cases, the school curriculum devalues the culture and experiences of lower caste groups, perpetuating discriminatory attitudes. Additionally, one study found that in 48.3% of schools surveyed, dominant caste parents refuse to let their children participate in Mid-day Meal schemes if the cook is a Dalit10, just one more example of how deeply-rooted caste discrimination can greatly affect the quality and outcomes of interventions for children.

Similarly, caste based discrimination persists in the labour market. The Action Aid study found that lower caste groups were denied jobs in agriculture and construction, were prevented from buying and selling milk in cooperatives and from selling in local markets, and were denied access to irrigation facilities and grazing land. In 25% of villages surveyed, members of lower castes received lower wages for their work than other groups. This labour market segmentation also affects prospects of schooling for children who are from so-called lower castes or groupings. For example, in Pakistan one of the lowest ‘biraderi’ (professional) groups is the “sweeper group”. Despite the fact that many have passed their school leaving exams, due to discrimination they are still unable to obtain any other job except that of a sweeper. Thus, it is difficult for many parents and children in so-called lower caste groups to recognise the merits of investing in an education if it does not yield increased opportunities for livelihood improvement.11

In addition, violence against members of so-called lower caste groups is prevalent. In India, for example, over 33,000 crimes against Dalits were registered in 2001 alone; these were serious abuses such as rape, murder, abduction, kidnapping, burning of houses, and boycotts from villages. There is a very broad national framework of constitutional and legal remedies such as the right to equality, prohibition of the practice of untouchability, and prohibition of discrimination but implementation and monitoring of these remedies has been very weak. This atmosphere of impunity fosters a culture of silence, as groups that are discriminated against refrain from speaking out about abuses due to a fear of reprisal. 12


South Asia has among the worst indicators of gender disparity in the world. In some regions, disadvantage starts even before birth and it remains pervasive from birth onwards. For example, in India,13 the mortality rate among children ages 1-5 is 50% higher for girls than for boys. If India closed this gender gap, it would save an estimated 130,000 lives, reducing its overall child mortality rate by 5%.14 Discrimination on the basis of gender poses a threat to girls’ education, nutrition, protection and survival. Its effects extend well beyond the childhood years, and often persist throughout the lifecycle. Moreover, the impact of gender discrimination tends to be intergenerational, as girls denied their rights as children become women with daughters and granddaughters whose potential also remains unfulfilled. Gender inequality affects all women and children, but it affects the economically poor and socially excluded disproportionately and gender oppression and discrimination increase and are compounded with exclusion.15

Geographical remoteness

Rural-urban disparities persist in South Asia. A recent study on social exclusion in Nepal by the World Bank and DFID found that there are urban/rural differences in access to markets, services, information and political influence.16 In India, extreme poverty is concentrated in rural areas of the northern poverty-belt states and at the national level, rural unemployment is rising. In Pakistan the rural-urban gap in school attendance is 27 percentage points, and as expected, indicators are even lower for those who are females and live in rural areas: the school attendance gap between rural girls and urban boys is 47 percentage points.17 There are often less schools and health clinics in rural areas along with a lack of health workers and teachers, as many prefer to work and live in urban areas than in remote locations.

Income Inequality

In addition to horizontal inequalities such as discrimination, vertical inequalities are prevalent in the region.18 As a result of economic growth in the past decade, South Asia has experienced increasing income inequality within countries.19 In Sri Lanka, the benefits of growth have not reached most of the population outside the capital city of Colombo and its surrounding areas. In India, uneven growth has increased disparities between fast-growing states in the South and West and lagging states in the North.20 Rising inequality also compounds social exclusion, as socially disadvantaged groups such as the Scheduled Castes and Tribes in India, the rural landless in Pakistan and Nepal or the plantation workers in Sri Lanka, are deprived of the benefits of economic development.21 Groups such as these, who were already economically disadvantaged, face persistent poverty and are less able to afford costs associated with health care or education services. Additionally, income inequality is a problem because unequal opportunities make it much more difficult for people to realise their full potential, including economic potential that could help to achieve the Millennium Development Goals.22

Key issues in social policy thinking and practice for attaining the MDGs

Social Norms and Social Processes

Discrimination and social exclusion are very much outcomes of social norms. While there is a need to formulate policies that address and redress the effect of social norms on disadvantaged groups’ access to quality social services, assets and markets and their ability to actively engage in political processes, there is also a need to promote progressive longer-term behavioural change. This would include discursive processes to question and gradually instil changed attitudes and values, so that social norms and institutions at the personal, household and community levels move in favour of children, and in favour of socially excluded groups. This is a highly delicate and complex process.

The fundamental legal basis of rights as well as legal frameworks and processes can play an important role in codifying, guiding and/or challenging social norms. To use an example from Latin America, the effort to reform national legislation to meet the minimum standards established by the Convention on the Rights of the Child (CRC) in Guatemala proved to be a catalyst for social change in favour of children and has fostered progressive social policies consistent with international human rights law. For example, the reform of the juvenile justice system in accordance with human rights principles stipulated in the CRC, radically altered a culture in which children could be jailed indiscriminately “for their own protection” because of “anti-social behaviour” or because they were “abandoned”, i.e. could not demonstrate adequate material resources. New legislation and processes of implementation can also serve to reduce exclusion from the social and economic benefits of citizenship, not only of children, but of other marginalised groups as well.23

In order for national legislation founded on human rights principles to have the potential to transform social norms, however, civil society must be aware of its rights and have the power to claim them. Awareness and action to claim rights is a political as well as a social process, requiring social mobilisation and effective accountability mechanisms. When information campaigns inform citizens of the government’s commitments, through media and mobilisation, this can then create a “social ethic.” Violations of such an ethic would then help create a demand for government accountability and corrective action.

Changing social norms also requires attitudinal and behavioural change towards marginalised groups at various levels. Service providers, such as health workers and teachers, should be trained and sensitised on the need to treat all persons with respect, regardless of caste, ethnicity, gender, religion, geographical origin or income. In Nepal, when UNICEF started supporting maternal health issues, initially less than 3% of women who needed obstetric emergency care went to clinics to receive services. Interventions introduced to change the behaviour of health workers increased women’s use of these services to 25% in two to three years.24 Another example comes from Guatemala but also offers insight for South Asia. After the peace accords, there was an enormous effort to extend the primary health care system into indigenous areas by constructing new health clinics, but attendance was extremely low. The government assumed this was because indigenous groups did not value health care. Yet, when a team of foreign doctors under a foreign assistance programme assumed management of these health clinics, they were suddenly flooded with clients because the foreign doctors displayed a more positive attitude towards indigenous patients.25 Universalism of services, therefore, means making services available to all on terms that respect their dignity. Social policy is thus not simply about having policies in place for universal access but about changing attitudes, practices and behaviours within society.

To achieve universalism of services, attitudinal and behaviour change is also required at the household level. In South Asia, most societies are patrilineal and so men exercise a great deal of decision making power within families. There is however an increasing recognition of the importance and implications of the “politics of the household”. It is acknowledged that women have generally been far more responsible than men in managing household budgets responsibly and equitably, and this needs to be kept in mind as it has important implications for children’s well-being.26 There is also a growing perception of the need to focus resources on changing not only men's attitudes but also their behaviour in relation to women’s health. A study in India showed that young wives’ access to health services was dependant on the awareness of other family members, particularly husbands, about the need for care. Intervention programmes aimed at influencing the extent of men’s knowledge and participation in their wives’ maternal care were associated with their wives’ increased use of antenatal care services.27 Similarly, programmes that focus on child mortality need to address the importance of investing equal time and household resources in girls. In Bangladesh, the Female Secondary Stipend Programme has created a positive attitude among communities towards female secondary education and enrolment has risen so much that girls are now in the majority at the secondary school level.

The engagement of religious leaders, stakeholders and advocacy groups can also be valuable in developing new social norms, both within households and in society at large. A recent high level meeting of religious leaders in South Asia on HIV/AIDS (Compassion and Breaking the Silence) made a significant contribution towards generating awareness, opening debate, and developing a new way of thinking about this issue in the region28. Building on this example, it would be beneficial to mobilise religious leaders and enlightened thinkers in South Asia to develop a strategy for addressing social exclusion more widely.

NGOs can also play a role in fostering conditions for collective action that lead to new social norms.29 The Bangladesh Rural Advancement Committee (BRAC), which provides group credit and employment opportunities for women, has strengthened their bargaining power in the household and the community. Moreover, through collective action, women successfully persuaded community elders to refrain from criticizing and ridiculing women who work outside of the home.30 This has contributed to new norms of gender relations. According to these women, respect no longer depends on being in seclusion but instead on being an income earner, working outside the home, and being mobile.31

Even children’s groups can play a role in creating new norms. Children have been involved in changing attitudes by drawing attention to issues like child marriages and trafficking.32 In the Baluchisthan province of Pakistan, 20,000 Boy Scouts devised motivational and communication strategies to strengthen girls’ education and health. In a short span of one year, girls’ enrolment and immunisation rates, as well as women’s and girls’ access to toilets, improved dramatically as a result of this programme.33

Thus, the involvement of respected community and religious leaders, stakeholders, and advocacy groups can be instrumental in fostering social processes that remove attitudinal barriers and promote recognition, respect, and tolerance.

In addition to considering social norms and contributing to the creation of new norms, social policy also needs to build on an understanding of social processes – how discrimination develops and reinvents itself and how this affects marginalised groups. The tendency for marginalised groups to develop a culture of silence and a fear of reprisal, as well as to internalise dominant images also has implications for policy and programme design.34

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