Faculty Publication Spotlight: Tom Crea on Children’s Health & Social Protection in Africa

Thomas Crea, Associate Professor, Global Practice and Children, Youth & Families  Chair, Global Practice

Thomas Crea, Associate Professor, Global Practice and Children, Youth & Families
Chair, Global Practice

In the most recent installment of Innovate’s series highlighting research publications from faculty members at the Boston College School of Social Work, we highlight a paper from Tom Crea on the ”Effects of cash transfers on children’s health and social protection in Sub-Saharan Africa.” The paper was first published in BMC Public Health, and was recently selected from nearly 1,000 articles to be featured in UNAIDS’ monthly newsletter.

The Issue: Since first instituted in Mexico through the Oportunidades social assistance program, governments in various countries have given cash transfers to the poorest of the poor, to significant success. It’s been widely reported that early results show that both unrestricted and conditional cash transfer programs are effective in bringing people out of abject poverty.

Crea and colleagues (including BCSSW PhD students Drew Reynolds and Aakanksha Sinha) decided to look at cash transfers from a unique angle, in order to learn more about the prospects of orphaned children in Sub-Saharan Africa, as compared to poor children with parents.

The Idea: Crea’s team analyzed existing datasets of more than 5,000 children across Eastern Zimbabwe, designing models to predict health vulnerability (child chronic illness and disability) and social protection (birth registration and 90% school attendance). Three main groups of children were included in the datasets: those living in families without cash transfers, with unconditional cash transfers, and with conditional cash transfers. They then cross-referenced health vulnerability and social protection with orphan status, to determine if orphaned children living in foster homes benefited from cash transfer programs in a similar manner as those children living with their biological parents.

The Findings: In short, the paper found that orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based settings. “This study forced us to raise the question, why are children in Zimbabwe not doing better, uniformly, when provided new opportunity through cash transfer programs?” explains Crea. “Orphan status, even when the child is living with a family and not an institution, remains a significant hurdle to even the slightest social mobility.”

The Next Steps: Crea says that an ethnographic study following up on the data could be useful to determining the specific barriers orphans face in Sub-Saharan Africa, and why government social assistance programs don’t seem to help them in the way they impact other children.

In the meantime, Crea is working on a similar project investigating food transfers in Guatemala and the impact of school-based nutrition on literacy in third and sixth graders. The project is being conducted in partnership with Catholic Relief Services and the U.S. Department of Agriculture.

The Takeaway:  “Family-based care, versus orphanages, is considered best practice in the field of international child protection,” says Crea. “However, since cash transfers target households but seem to, according to our study, inequitably affect the prospects of children living within families, it raises the question if we should be instituting more child-specific targeted models of social protection.

“The key is: How do we ensure that as many vulnerable children in Sub-Saharan Africa, regardless of orphan status, benefit from social safety nets as possible? It’s a important issue given the magnitude of the HIV/AIDS crisis.”

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