If there was ever a critical moment for a universal income support mechanism such as a Basic Income Grant (BIG), it is now. This becomes very clear when looking at social security through the lens of the Aids epidemic.
Nearly half of all South Africans live in poverty; half of these have no access to social grants.
Numerically speaking, South Africa has the largest HIV epidemic in the world, and it is likely that we’ll soon have the largest anti-retroviral treatment (ART) programme, too.
The two social security grants with the fastest increase in uptake in the absence of any policy change are both grants for which the greatest demand is a direct consequence of the HIV/Aids epidemic.
They are the foster child grant, valued at R530 a month, and the disability grant, which provides beneficiaries with a maximum of R740 a month.
In the absence of adequate social security alternatives, each of these grants currently plays a critical role in alleviating poverty of the households that they reach. However, they were not originally intended for this purpose.
Both grants were designed to support “special needs”. The foster child grant is a component of the child protection system, catering for children identified as “in need of care” and placed in the temporary care of a foster parent. In terms of the current Child Care Act, people caring for orphans automatically qualify to apply for their legal foster placement, and subsequently for the grant.
The disability grant is intended to provide for people who cannot enter the labour market because of medically-confirmed disability.
At first glance, the provision of these grants to the caregivers of orphans, and to people sick with Aids respectively, seems to be an appropriately sound and compassionate response on the part of the state. Dig a little deeper, though, and the inconsistencies appear. Take the foster child grant, widely touted by government as a cornerstone in its response to the impact of HIV on children.
But by conflating a child protection mechanism with poverty alleviation, this misses the point: firstly, the number of foster care applications in many parts of South Africa already far exceeds social workers’ and courts’ capacity to process them. The implications of continuing this way are clear — not only will vast numbers of orphans be unable to access the grants, but the country’s crucial child protection system will be brought to its knees.
Secondly, a social security system which provides grants to orphans up to 18 years without providing adequate and equal support to the many other impoverished children whose parents are alive is discriminatory.
Currently the child support grant is available to poor children only up to the age of 11 years, and carries a much lower nominal value of R170 a month.
To equate orphaning with material need in the context of widespread poverty is to mistarget poverty alleviation at a select few in a highly inequitable way and based on inappropriate assumptions.
Similar conclusions emerge when scrutinising the disability grant, for which uptake has increased rapidly over the last few years, to more than one million, probably as a result of our maturing HIV epidemic.
In most provinces these grants have been available to patients with evidence of advanced HIV disease.
Until the introduction of ART, a disability grant on the basis of HIV was, in practical terms, a grant until death. In response to the increase in uptake, the minister of social development has recently been at pains to reassert that the grant is not intended as a chronic disease grant.
Tightening up on the disability grant for patients with HIV is likely to have important consequences for the provision of ART. Firstly, patients delaying their testing and enrolment in care until severe illness has set in are likely to be eligible, whereas those who enrol in care early are the least likely to be given the grant.
Secondly, provinces with more established ART programmes are already withdrawing the grant from patients with HIV whose health has improved on ART. The consequences for patients in terms of continued care and adherence to medication are often dramatic — although they are technically fit to work, there are no jobs and the grant has been the lifeline enabling them to remain in care.
With more than 10% of adults in South Africa infected with HIV, and projections of between two million and 5,6-million orphans by 2014, attempts to target HIV-related vulnerability through the social security system are destined to be administratively impossible. Furthermore, the monetary value of the grants, while rational on one level, are highly distorting when accessed inequitably and on a large scale in communities with high levels of poverty and unemployment. Universal grants of a lower monetary value will do more to meet minimum needs across the board than grants provided on arbitrary bases — children’s parental status, or HIV patients’ latest CD4 count.
Other policies such as free access to ART would be much better aided if a universal poverty relief mechanism were in place, in addition to what is becoming an all-or-nothing lottery on disability grant access and retention.
Why, then, is there such hesitation around the extension of the child support grant to all children up to 18 years, and the implementation of a BIG, when both have been shown by researchers to be affordable?
It’s only with the implementation of such social assistance, as part of a package of comprehensive social security, that South Africans will be appropriately and equitably supported through the HIV epidemic.
Andrew Boulle is a specialist in the School of Public Health and Family Medicine at the University of Cape Town. Helen Meintjes is a senior researcher in the HIV/Aids programme at the university’s Children’s Institute