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Introduction
One of the weaknesses of rural poverty reduction strategies is the fact that they do not reach the poorest of the poor. This failure is to a large extend the result of conceptual deficits in poverty assessments and of subsequent targeting. Poverty reduction strategies tend to address “the rural poor” as if they were a homogenous group while in fact different categories of poor households require different types of interventions.
When disaggregating “the poor” into more homogenous “recommendation domains” and analysing which categories of the poor are reached by which interventions it becomes evident that most interventions of existing rural poverty reduction strategies like small scale credit, infrastructure development or access to land in many cases benefit the non-poor more than the poor and by-pass the poorest of the poor. Labour scarce households are one of those categories, which are unreached unless properly targeted.
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Relevance to Rural Poverty Reduction
The prevalence rate of HIV/AIDS affected persons and households has reached dimensions of more than 20 % in many sub-saharan African countries and is also increasing in other regions. In addition to the human tragedy caused for the affected persons in terms of suffering and early death, AIDS is causing labour scarcity especially because it affects mostly people in the age groups 15 – 45. It reduces the labour force leaving many rural households in a situation characterised by high dependency rates. At the same time the capacity of rural service providers including the agricultural extension service is significantly reduced. In this way HIV/AIDS has become in many countries one of the main causes of poverty and will continue to increase poverty for many years to come.
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Key policy issues
Rural strategies for poverty reduction therefore have to address the following issues:
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HIV/AIDS prevention has to be explicitly integrated into poverty reduction strategies. It cannot be left to the health sector alone but has to be addressed as a crosscutting issue, which requires a coordinated approach implemented by all organisations, programmes and projects in the rural sector.
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Gender equality has to be seen as the guiding principle of the response to HIV/AIDS. Equal rights of men and woman in the family and household sphere (divorce, inheritance rights), in the economic sphere (property rights, dismantling of labour-market discrimination) and in the political realm (representation) will contribute to HIV/AIDS prevention (reduction of sexual abuse and prostitution) and will facilitate coping strategies for female-headed households.
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Labour extensive crops, cropping systems and farming systems as well as labour saving technologies have to be developed and introduced. At the same time it has to be realised that the impacts of research and extension are long term while the food and nutrition insecurity of labour scarce households requires immediate intervention.
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In the short and medium term extremely poor households with high dependency ratios (resulting from AIDS or other causes) are in most cases not able to benefit significantly from the traditional catalogue of self-help oriented poverty reduction interventions. In order to ensure their survival they require transfers until their household structure has improved (e.g. until children have reached working age thus reducing the dependency ratio). Depending on circumstances such transfers may be channelled through informal or formal safety nets as long as they are cost-effective and well targeted.
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Review of DONOR Cooperation Strategies
UNAIDS, UNICEF, the World Bank, the European Development Fonds, bilateral Financial Cooperation Agencies (like KfW) and Technical Cooperation Agencies (like GTZ) and numerous NGOs run programmes which aim at:
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changing sexual practices through awareness creation
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providing access to information and to means for family planning and for protection against infections (social marketing)
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promoting voluntary counselling and testing (VCT)
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providing access to antiretroviral (ARV) therapy, prevention against other infections, and prevention of mother-to-child infections
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supporting initiatives for home based care and for the support of AIDS orphans
Interventions to prevent new HIV infections have reduced prevalence rates in some countries (e.g. Uganda and Senegal) where they have been supported by government commitment. In countries were the political will is lacking (e.g. Malawi) the impact of international cooperation efforts was marginal.
Access to ARV therapies is still out of the reach of the vast majority of infected poor people in rural areas. Even though international activism has led to dramatically reduced drug prices, adequate health infrastructures for drug delivery is lacking and HIV gradually becomes resistant to ARVs. In addition resistance develops more quickly if drugs are not taken regularly or inadequate drug combinations are taken and drug resistant HIV can be transmitted to other people.
Efforts to care for orphans are mostly restricted to NGOs and concentrated in urban areas e.g. targeting street children. Few high prevalence countries have social assistants programmes which transfer purchasing power to secure the survival of extremely food incure AIDS households.
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Best Practices
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Information alone is not sufficient for changing behaviour, because sexual behaviour and gender roles are deeply rooted in social and cultural norms. According to UNAIDS the “Community approach” (community groups analyse their own situation and identify options for how to react) and the “Peer Group Approach” (persons from the same age group, social background and sex are trained as communicators) have shown promising impacts.
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Rural development programmes and projects of many organisations have integrated the HIV/AIDS issue into activities, which target self-help groups, especially women groups, village meeting, parent-teacher groups, committee meetings, and agricultural-, nutritional- and health trainings. They observed that it is important not to address the HIV/AIDS topic in isolation but to integrate it into a broader range of issues. In some countries were AIDS is regarded as a taboo, the use of theatre, songs and dance have been assessed as an effective means of communication.
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Social marketing of condoms partly combined with family planning, and malaria and diarrhoea prevention has been promoted on a very large scale by international organisations like Population Service International (PSI), financed by bi- and multilateral donors. Combined with Private-Public-Partnership these efforts have made low priced condoms available even in remote areas, and are especially targeting high-risk groups like sex-workers, truck drivers, migrant and seasonal workers, cross-border traders, fishermen and fish traders. Many development co-operation agencies ensure that their staff and the staff of counterpart organisations has ready access to information and to condoms and have introduced social marketing or free distribution at the work place in spite of the resistance from the Catholic Church.
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The author found it difficult to find information on best practices with regard to tailoring research and extension efforts on a significant scale to the recommendation domain labour scarce households. It will be highly welcome if participants of the discussion group can provide such information.
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Efforts to promote the transfer of income in cash or kind to ensure the survival of AIDS affected households are also not well researched. There are, however, best practises available for cash transfers to extremely poor and labour scarce urban and semi-urban households e.g. in Mozambique.
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Looking Forward
While HIV/AIDS prevention is increasingly successful in some countries and while AIDS treatment is slowly becoming less costly and more affordable, the number of AIDS affected households is still growing. FAO (FAO 2001) estimates that the loss of agricultural labour in % (compared to the labour force in 1985) will amount to:
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2000
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2002
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Namibia
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- 3.0
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- 26.0
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Botswana
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- 6.6
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- 23.2
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Zimbabwe
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- 9.6
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- 22.7
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Mozambique
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- 2.3
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- 20.0
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South Africa
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- 3.9
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- 19.9
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This leads to:
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a growing number of households headed by children or elderly people not fit for agricultural work
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a reduction of cultivated areas
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a shift to less labour intensive crops or enterprises
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a shift to less labour intensive crops or enterprises
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a reduced ability to cope with external shocks like droughts
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an overstretching and eventual collapse of traditional family and community based social safety nets.
An increasing number of households will experience that one or more adult members are affected by AIDS which will drag them into a poverty cycle: Reduced productivity with simultaneously increasing medical expenditures leads first to loss of all savings, often to the sale of animals and land. Resulting undernutrition increases susceptibility to additional infections and further reduces labour productivity. Schooling of children will be discontinued to save costs and substitute adult labour. Coping strategies like migration to urban areas or prostitution in turn leads to additional risks of HIV infections. Orphans as well as weak elderly persons will burden other households increasing their dependency ratio or are left to starve. A large share of the 24.000 persons which – according to FAO statistics – die on the average every day from hunger, are members from households suffering from AIDS induced labour scarcity.
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Policy Recommendations
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Integrate HIV/AIDS prevention as a crosscutting task into the designs of all rural development programmes and projects
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Finance research – extension interventions aiming at promoting appropriate crops, cropping systems, farming systems and labour saving technologies for labour scarce households.
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Assist partner countries to strengthen informal and formal social safety nets targeting those rural households, which because of labour scarcity are not able to secure the survival of their household members. As experience with strengthening or establishing rural informal and formal safety nets is scarce, pilot schemes to test options are highly recommended.
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References
Relevance of HIV/AIDS to Rural Poverty Reduction
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FAO-Committee on World Food Security: The Impact of HIV/AIDS on Food Security, CFS: 2001/3
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HIV/AIDS, poverty and development. Summary of a meeting held at ODI 29 November 2000
Best Practices
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UNAIDS, Best Practice Collection, Key Material
(www.unaids.org/bestpractice/index.html)
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The national Strategic Framework for HIV/AIDS Activities in Uganda (1998 – 2002)
(www.aidsuganda.org)
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B. Schubert, Targeting Social Security Programs. In: Uwe Kracht, Manfred Schulz (eds), Food Security and Nutrition, New York 1999, p 517-530, ISBN 3-8528-3166-3
Integration of HIV/AIDS in Agricultural Interventions
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FAO/UNAIDS, Adressing the Impact of HIV/AIDS on Ministries of Agriculture: Focus on Eastern and Southern Africa. Discussion Paper 2001
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(www.unaids.org/bestpractice/index.html)
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E. KСЊrschner et al., Incorporating HIV/AIDS Concerns into Participatory Rural Extension. A Multi-Sectoral Approach for Southern Province, Zambia. Berlin, 2000
ISSN 1433-4585; ISBN 3-8236-1340-5
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H. Braun et al., HIV/AIDS Prevention in the Agricultural Sector in Malawi. A Study on Awareness Activities and Theatre. Berlin, 2001
ISSN 1433-4585; ISBN 3-8236-1359-6
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