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Tackling Exclusionary Processes

Author: Jennie Popay, Sarah Escorel, Mario Hernandez
Date: 2008
Size: 69 pages (1.1 MB)

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Summary

What can be learned from existing policies and actions that aim to address social exclusion? This section of a report from the World Health Organisation’s Social Exclusion Knowledge Network (SEKN) examines state-led policies, strategic initiatives for policy development and coordination, and the roles of civil society and the private sector. Donors need to develop ways of enabling universal systems of social protection and essential services (free at point of use) to be funded in low and middle income countries.

The advantages of comprehensive systems of social protection and universal public provision of services are again being recognised. Their introduction in Venezuala, South Africa and Brazil has been associated with improvements in access and use of services, reductions in poverty levels, and evidence of positive health and educational outcomes and greater social cohesion. However, lack of capacity and infrastructure severely restricts programmes aiming to extend rights to basic services, particularly but not exclusively in low-income countries.

The SEKN identified three types of community action relevant to action to address exclusionary processes: (i) large scale social movements typically aiming for political change and social transformation; (ii) policies and actions, which may be sponsored by the state, NGOs or others, that seek to promote community involvement in decision making and/or community empowerment, and (iii) action by formal non-governmental organisations (NGOs) to address exclusionary processes such as delivering services. The SEKN also recognised that social movements and community actions, such as those characterised by xenophobia, can be strongly exclusionary so appropriate state regulation of civil society action in all its forms is important. Community involvement in action to reverse exclusionary processes can only be effective when embedded in effective state action to provide decent living standards and essential services.

Donors can provide incentives for governments to work effectively with communities and NGOs, resource capacity building for non-governmental organisations, community action and community involvement, and simplify regulations for grants so that smaller community and voluntary groups can access funds and hence develop capacity. At an international and national level they also have a powerful advocacy role.

While there is a role for the private sector to help extend access to basic services, it involves contradictions and constraints. These include incentives for private providers to increase throughput rather than focus on outcomes, which can increase exclusionary processes, and the limitations of insurance-based approaches in protecting populations experiencing severe poverty.

The added value of conditionality in state-led processes to address exclusion remains unproven. Conditionality is expensive and potentially stigmatising and does not offer the ‘social cohesion’ bonus of unconditional universal approaches. Other findings relating to state-led policies include the following:

• Universal and selective approaches to reversing exclusionary processes can generate multiplier effects in local economies, particularly when these are consciously designed into programmes through, for example, mandating the use of local enterprise to provide services.
• Selective programmes (conditional and/or non-conditional) can have positive impacts but can also involve significant problems.
• Such problems include: low take-up amongst eligible groups and leakages to the non-eligible; inefficiencies due to complex administrative systems; and lack of attention to the quality of services.

Several multi-lateral and pan-regional agencies are proposing new more collective approaches to policy development and coordination. These emphasise universal strategies with some targeting of particularly disadvantaged groups, in contrast to the individualist market neoliberal approaches dominant over the past 30 years. Such initiatives will work more effectively if the following conditions are in place:

• Monitoring systems that combine objective indicators with experiential understandings and aim to capture the dynamics of exclusionary processes.
• Strong and senior political commitment and leadership.
• Credible, authoritative institutions to take the initiative forward independent of the state.
• Formal mechanisms to manage the political processes that address exclusion. The aim should be to establish social exclusion and poverty as bi-partisan issues.

The main authors of this report were: Jennie Popay, Sarah Escorel, Mario Hernández, Heidi Johnston, Jane Mathieson, Laetitia Rispel on behalf of the WHO Social Exclusion Knowledge Network. A full list of contributors and their affiliations are provided on pages 3-4 of the main report.

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Source: Popay, J. et al., 2008, 'Tackling Exclusionary Processes', in Understanding and Tackling Social Exclusion, Final Report to the WHO Commission on Social Determinants of Health from the Social Exclusion Knowledge Network, Part 3.
Author: J Popay , j.popay[at]lancaster.ac.uk
Organisation: World Health Organisation (WHO), http://www.who.int