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Tackling Social Exclusion in Health and Education

Author: J Gardener and R Subrahmanian
Date: 2006
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Summary

In many Asian countries, poverty reduction is undermined by inequality and insecurity. Achieving the Millennium Development Goals in these countries requires effort from governments and development agencies to help excluded groups access health and education services. This paper from GHK International and the Institute of Development Studies uses examples from across Asia to identify ways of tackling social exclusion.

Case studies from India, Nepal and Bangladesh show how ethnic minorities, disadvantaged castes, the ultra-poor, women and migrants are excluded from education and health provision. Projects across Asia have sought to understand processes of exclusion and find ways of including these groups:

• The Community-based Education Management Information System (C-EMIS) in Nepal has taken a participatory, child-centred approach to data-collection and planning. Access to education has widened and quality of provision improved.
• Residential care centres in Orissa, India are run through state-NGO partnership. They use local volunteers to provide care and education for children of migrant workers who would otherwise be taken out of school for long periods.
• The Female Stipend Programme in Bangladesh is a government-led initiative using incentives and conditions to increase school enrolment among girls. While there have been gains in female enrolment and fertility control, poverty continues to be an excluding factor.
• Urban Primary Health Care in Bangladesh has had some success in improving the health of the urban poor through more accessible services. Negative perceptions, cultural factors, travel costs and limited mobility still contribute to exclusion.
• The Specifically Targeted Ultra-Poor Programme in Bangladesh is part of an effort from BRAC to combat exclusion in healthcare. It acts on livelihoods, social capital and access to health services to improve the health of the ultra-poor.
• The Women Centred Health Project in Mumbai, India, is part of the public health care system addressing exclusion through better delivery and monitoring of services for women. Reproductive health remains a sensitive area for men.

Tackling social exclusion requires a multi-dimensional and integrated response which takes account of the local context and wider influences. While each case study uncovers different processes of exclusion and specific lessons on inclusion, some common themes emerge:

• Inclusive good practice relies on some key mechanisms: empirical evidence of exclusion, needs-based responses, integrating supply and demand, community-based approaches, field-based support and inclusive accountability mechanisms.
• Mechanisms for addressing exclusion must be supported by wider changes in institutions, behaviour, scale and funding. Targeted mechanisms within overall reform can support the particular needs of excluded groups.
• Drivers of inclusion should be identified and engaged. These include a favourable policy environment and Government-NGO-donor partnerships.
• Sustainability of social inclusion requires local and national systems of accountability and continued quality of service.
• Incentives that enable communities to work together can overcome aspects of discrimination. Incentives are also important to make sure elites or non-excluded groups support change.
• Reforms are time and effort intensive but can offer quick gains in reaching excluded people and long-term sustainability.

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Source: Gardener, J. and Subrahmanian, R., 2006, 'Tackling Social Exclusion in Health and Education: Case Studies from South Asia', Report prepared for the Department for International Development (DFID), GHK International
Author: GHK International, http://www.ghkint.com