Beyond targeting
Making social protection work for women in Ghana
I feel like a human being now and the luckiest one as well.
(LEAP 1000 participant, Barrington et al. 2021)
The Government of Ghana launched the LEAP 1000 pilot – a ‘cash plus’ programme – targeted at pregnant women and those with infants living in poor households in 2015. The motivation of the pilot was to support children during the first 1000 days, a key period of physical and mental development, with the overall goal of reducing child malnutrition and improving child health outcomes.
Participant women received both a bi-monthly unconditional cash transfer (of approximately USD $10-18), as well as a premium waiver for the national health insurance scheme. Ghana is not unique in offering this type of social assistance — in fact, a 2016 mapping of 127 non-contributory social protection programs implemented by governments in Africa found that unconditional cash transfers were the most common type of assistance, and households with children were the most common target group.
Despite the clear benefits of putting cash directly in the hands of women, and meeting their practical needs during pregnancy, some questions remain: does LEAP meet and respond to the strategic needs of women or does it use women instrumentally to facilitate the goal of reaching and benefiting children? Furthermore, is targeting women enough to nudge participants towards better social and economic outcomes, or would the focus on women’s role as primary caregivers and mothers unintentionally reinforce gendered inequalities in the household?
Questions around the positive and negative effects of the pilot programme on women were integrated into a mixed-methods evaluation led by experts under the umbrella of the Transfer Project. The overall findings were encouraging. Women’s health and wellbeing improved across multiple domains, beyond the explicit objectives of the program. For example, women’s economic standing as measured by their personal savings increased, as did enrollment in the national health insurance scheme and health-seeking behaviors. LEAP 1000 also increased women’s social support in their own households and the larger community, as cash increased dignity, self-esteem, and confidence and allowed them to participate in savings groups and reciprocate support to others.
I couldn’t mingle with my colleagues but with the coming of LEAP I can now raise myself and be part of my colleagues (the other women). If I get to the market, I can buy salt or buy a few clothes for my children to wear. Even if don’t dress well myself I have been able to dress my children well so they can mix with their peers.
(LEAP 1000 beneficiary, de Milliano et al. 2021)
Alongside reductions in household poverty, improvements in women’s social and economic standing were important pathways that led to reductions in their experience of intimate partner violence, including reductions in experience and frequency of physical and emotional violence. Taken together, LEAP 1000 improved tangible development milestones, as well as meaningful improvements in the quality of women’s lives.
Truly speaking, at first the relationship between women and their husbands wasn’t good, but now it is better because of the LEAP support. I can say it is … poverty that caused all problems.
(LEAP 1000 participant, Barrington et al. 2021)
These findings, alongside broader positive impacts of the program on children and households contributed to the decision to integrate the program into the flagship social protection scheme nationwide in 2017. They also led to LEAP 1000 being touted as an example of a ‘gender-responsive’ program in the eyes of numerous stakeholders. But what does this mean in practice?
While the social protection community has increasingly recognized the value of paying attention to gender — and frameworks have been proposed unpacking a continuum from ‘gender- discriminatory’ to ‘gender-transformative’ — there is still debate and lack of clarity as to assessment criteria, and what qualifies a program as being truly transformative. Is placing benefits in the hands of women, and improving her wellbeing enough? It is a start, but ultimately the program needs to tackle the root causes of gender inequality and transform harmful gender norms — aspects that the qualitative work suggest were largely unchanged in the context of LEAP 1000. A challenge in understanding how to go about this is that there is no one-size-fits all template. Design and operational components that facilitate gender-transformative change, like gender norms and drivers of inequality, are often context-specific.
So, what lessons can be drawn from Ghana’s experience with LEAP 1000? A few reflections emerge:
- For gender-transformative change, start from a solid base: Long-term change starts with building a strong gender-responsive system and framework to guide growth. In Ghana, stakeholders are moving towards the development of a national framework that provides guidance and political backing for integration of gender in program design, implementation, and monitoring—this anchoring sets the stage for future progress and financing.
- Think beyond cash to address gendered constraints: While cash transfers have been effective in improving many dimensions of wellbeing, they are limited by contextual barriers that women and poor households face. In Ghana, new work is underway strategically linking participants to a range of complementary social protection and referral services to accelerate improvements in health, protection, and violence, all with explicit gender components. Stakeholders are working toward institutionalizing and scaling up these integrated social services nationwide to promote better outcomes for women and children.
- Address gender in human resources: It is critical to address the limited institutional capacity and lack of collaboration on gender issues at both the national and district levels. The lack of integration between gender focal points and social protection service providers at the local level is a missed opportunity for operational and impact synergies. We cannot forget the importance of investing in people if we want meaningful change in communities.
- Leverage face time for gender dialogue: Work towards better communication and more effective use of interface between service providers and program participants. Meetings or other face time create spaces and opportunities to discuss issues with communities on topics like social discrimination, exclusion, and gender inequality. These spaces have the potential to influence perceptions on gender norms, and through open dialogue women are able to seek support and exercise agency in their own communities.
Poverty cannot be sustainably reduced without tackling gender inequalities. Ghana’s experience shows that moving towards gender-transformative social protection must go beyond just reaching and benefiting women, using local learning and solutions. To truly change gender inequalities, we need political will, adequate financing, and support from broader social welfare services. For Ghana, the gendered evidence-to-action social protection journey is just beginning.
Acknowledgements: The LEAP 1000 Evaluation Team included researchers from ISSER at the University of Ghana, Navrongo Health Research Centre, UNICEF Ghana, UNICEF—Innocenti and the University of North Carolina. Learn more about the evaluation here. We thank Clare Barrington, Tia Palermo, Nyasha Tirivayi and Dominic Richardson for helpful comments and suggestions on this blog.
Authors: Christiana Gbedemah is a social policy specialist at UNICEF Ghana; Amber Peterman is an research associate professor at UNC Chapel Hill and a social policy consultant at the UNICEF Office of Research—Innocenti and Jennifer Yablonski is head of social protection unit and social policy specialist at UNICEF Ghana.
Read more:
- Impact evaluation of a social protection programme paired with fee waivers on enrolment in Ghana’s National Health Insurance Scheme
- More Evidence on the Impact of Government Social Protection in Sub Saharan Africa: Ghana, Malawi and Zimbabwe
- Crowding-out or crowding-in? Effects of LEAP 1000 unconditional cash transfer program on household and community support among women in rural Ghana
