Social Services Delivery through Community-Based Projects

SP DISCUSSION PAPER NO.0118 Social Services Delivery through Community - I|k c)4Based Projects Dinah McLeod and Maurizia Tovo July 2001 cial rot t on BOR MARKETS, PENSIONS, SOCIAL ASSISTANCE T H E W O R L D B A N K Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Social Services Delivery through Community-Based Projects Prepared by: Dinah McLeod Maurizia Tovo Social Protection Team Hunan Development Network World Bank July 2001 Table of Contents Executive Summary................................... I I. Introduction ................................... 10 II. Why are CBSCS Projects Important.................................... 15 III. Stocktaking - Bank Financing of CBSCS Projects.................................... 20 IV. Lessons Learned ................................... 25 V. Conclusions ................................... 61 List of Boxes Box 1: Social Risk Management .13 Box 2: Community Participation Yields Significant Results .18 Box 3: Fighting Malnutrition with a Community Approach.22 Box 4: What does a CBSCS project look like . 23 Box 5: Good law, bad enforcement: Section 498A of India's Domestic Violence Code .26 Box 6: Recommendations from the Bangladesh Integrated Nutrition Project .29 Box 7: Cost-Sharing Arrangements in ECD Projects across three countries.35 Box 8; Service is Always Included - The Moldova Social Investment Fund.37 Box 9: The Operational Manual Statement on Bank Financing of Recurrent Costs (OMB 1.21) .39 Box 10: Difficulties in Measuring Impact in Bolivia.41 Box 11: Comparative Costs Per Beneficiary, Four ECD Programs.43 Box 12: It takes a village, and it takes time: The Indonesia Kecamatan Development Project (KDP).44 Box 13: Fighting Social Stigma in Haiti.45 Box 14: Creating Demand for Social Care in Malawi.47 Box 15: The Romania Social Development Fund (RSDF): Targeting by Disadvantaged Group.49 Box 16: Services for Street Children in Istanbul.50 Box 17: When NGOs are the only Game in Town: The Palestinian NGO Project. 53 Box 18: Getting at the Difficult Groups Using Difficult NGOs: AIDS/HIV Control Projects.54 i List of Figures Figure 1: Financing for projects with social care services by year.......................... 19 Figure 2: Number of projects with social care services by region........................... 20 Figure 3: Financing for projects with community-based social care delivery by region. 20 Figure 4: Target groups for social care services............................................... 24 List of Annexes Annex 1: Projects with Community-Based Social Services................................. 64 Annex 2: Description of Social Services....................................................... 69 Annex 3: Albania Social Service Delivery Project - Social Assessment Form........... 76 Annex 4: Excerpts from the Malawi Social Action Fund - Sponsored Sub-Projects Component Implementation Handbook................................................ 79 Annex 5: Suggestions on Determining Program Costs, Early Child Development 82 Centers. Annex 6: Bibliography............................................................... 86 ii Executive Summary Objectives While community-based care has been the norm in developed countries for many years, it is only recently that the largest aid agencies have begun to design projects delivering social services at the local level through community-centered approaches. This study has two objectives: (1) stocktaking, to determine the extent and nature of World Bank involvement in this type of projects, and (2) learning lessons, to identify good practices and common pitfalls so as to provide recommendations on how to improve social care service provision in future community-based projects. Definition Rather than looking at the whole universe of community-based services, the study focuses on projects providing social care services, defined as projects that supply services to vulnerable individuals and families to reduce or escape poverty and exclusion, and to lead a fuller and more satisfying life, where most decisions on how to run a subproject and responsibility for its implementation rest at the community level, either with local government or civil society. Social care, along with other types of safety nets, represents a long-term investment to preserve human and social capital. More importantly, it addresses those dimensions of poverty that are the hardest to tackle: exclusion, powerlessness, shame, hopelessness. How are CBSCSs different? Social care services have several characteristics that make them distinct from other community-based services: (a) They often provide services in which governments have had little or no experience, which means that the policy framework may not be developed or may require significant overhaul; (b) Implementing agencies and service providers generally need much more capacity building than in more established sectors; (c) They are more time-intensive, than infrastructure projects because communities may need more time to agree on something new, and results may take longer to be seen; and (d) The bulk of the expenditures are recurrent. Stocktaking Trends. Community-based social care services (CBSCS) is a fast-growing field. World Bank lending for community-based social care has grown from $33.4 million in 1985 to at least $1.6 billion (cumulative) in 2000. The Latin America and Caribbean region has the I largest portfolio of projects offering community-based social care, followed by Asia. Africa was somewhat of a latecomer, but increasing involvement in post-conflict situations and the emergence of the AIDS crisis have contributed to a considerable growth in the late 90s. As of December 2000, Africa had caught up with Latin America in terms of number of projects with a community approach to social care delivery (31), although dollar-wise its portfolio remained considerably smaller because of the lower average project size. Services Provided. The largest number of community-based projects providing social care cover areas that are closely related to typical human development sectors: nutrition, maternal and child care, literacy and vocational training. In many cases, however, this fairly traditional focus has been expanded in response to client demand to include services such as early childhood development (ECD), child care for low-income working mothers, non-formal education for school drop-outs, and career placement for the disabled. Transfers are one of the most frequent forms of social assistance that has received little support through Bank projects in the past, but are now becoming more common in CBSCS projects. Beneficiaries. Intended beneficiaries for social care are predominantly children and women (almost half of the projects specify children as their beneficiaries). In many cases, though, the targets are narrowly defined sub-groups of children and women, such as street children or prostitutes. Other target groups include: youth at risk, the elderly, conflict victims, the disabled, institutionalized people, and ethnic minorities. A number of projects do not specify a particular target group, leaving it up to the community to determine who may need assistance or focusing on community-wide prevention (e.g., for AIDS/HIV). Implementing Agencies. Forty-two percent of the projects relied on communitv-based organizations (CBOs), sometimes supported by local NGOs, while 20% used local governments. The remainder of the projects allowed either option. The level of government decentralization appears to have a considerable effect on the choice of implementing agencies. In countries with weak local government structures, as in many African countries, there are many more projects relying on CBOs or NGOs. By contrast, in Eastern Europe and Latin America, where decentralization is more advanced, there are several projects in which local governments are in charge. It is also interesting to note that countries with strong, 2 centralized administrations, such as China, had few or no community-based social service projects. Procedures. Projects that delivered only a certain type of social service, such as nutrition interventions, were more likely to be more specific in describing both procedures and products. On the other hand, projects that had a fairly open menu of social care services tended to be more general, thus allowing more flexibility in responding to demands. Project appraisal documents for projects financing both infrastructures and services, such as social funds, tended not to be as detailed in outlining how to design a social service project as they were in discussing how to design a social infrastructure project - a definite project design issue. Initial Lessons Policy context. It is important that social care projects fit within the overall policy framework, so that demand-driven subprojects are complemented and guided by a larger system of norms and standards that can help ensure quality, facilitate monitoring, and promote consistency across the country. Unfortunately, there are few countries with an adequate policy framework for social care. Recognizing this problem, many of the newer CBSCS projects have subcomponents to assist governments in data collection initiatives, as well as in developing norms and standards. LESSON: Ensure that social care standards (if they exist) are adequate and followed. If not, help the authorities formulate or revise the standards. Decentralization issues. The level of government decentralization appears to have a considerable effect on the choice of implementing agencies. In countries with weak local government structures, there are many more projects relying on CBOs or NGOs. By contrast, in areas where decentralization is more advanced, there are several projects in which local governments are in charge. Decentralization may create perverse incentives for the provision of social care in countries where fiscal responsibility for existing social care facilities is kept at the national level, while new care services have to be paid by municipal budgets. A solution to this problem is demand-side financing (also known as the capitation system), whereby the needs 3 of the client are determined first, and budget is provided to procure services in response to needs rather than being allocated up-front to residential institutions offering a standard menu of services. LESSON: Avoid perverse financing incentives using demand-side financing. Local authority involvement. Many community-based projects providing social care have not worked closely with local governments, yet securing "buy-in" from governments is essential. If a project is working with NGOs and CBOs, it is especially important to ensure that social care projects occur with the consent, whether formal or informal, of governrent at the lowest possible level. The best situation is one in which local governments agree to take on recurrent costs, since they will remain in a community while NGOs may not and CBOs may disband. Since support from local elders and other leaders can impart greater legitimacy to a social service initiative, it is beneficial to include local governments or village authorities in the decision-making process even when local governments do not have the money or "official" authority to finance recurrent expenditures or make policy decisions. LESSON: Secure the support and involvement of local authorities, regardless of their financing role. Recurrent costs Social services, by definition, consist primarily of recurrent costs. Community-based service projects handle recurrent cost financing in different ways depending on whether this responsibility rests with the local government or with NGOs and CBOs. In general, projects that deal with local governments find it easier to introduce plans for recurrent cost financing, because they have more sources of revenues (including taxation). In NGO or CBO-implemented projects, the tax option is not available, and user fees may be hard to collect if the beneficiaries are extremely poor. However, community- based projects have the advantage of mobilizing other resources, including volunteerism. LESSON: Think about recurrent costs from the very start, and spell out arrangements during project design. Each subproject, whether NGO/CBO or local government implemented, should be required to have a realistic plan for recurrent cost financing. Economic analysis. Economic analysis of community-based projects is doubly difficult because projects are very small, and the outputs sought are hard to measure. Unit costs are difficult to determine, and the issue of time, which is in itself a "cost" that should be 4 measured (since services as opposed to infrastructure take more time to implement), is not often taken into consideration. Using a cost-per-beneficiary ratio based on national shopping among different service organizations, and factoring in the greater amount of time associated with social service subprojects, is recommended. LESSON: Determine cost per beneficiary, factor in time, and compare costs of many different service providers. Public information and awareness-raising. Public awareness and information & education campaigns (IEC) play a crucial role in the delivery of social care services in two main ways: (a) they alleviate the sense of shame or taboo that might be associated with certain problems (e.g., domestic violence, mental illness) or groups (e.g., street children, prostitutes, drug addicts), thus giving legitimacy to social care efforts in their direction, and (b) they reach out to potential clients and help disseminate information about issues and services. It is therefore not surprising that many projects have a large amount of funding allocated to IEC. LESSON: Without active information dissemination, most projects cannot reach vulnerable groups. Reach out to vulnerable groups through well-designed publicity campaigns. The demand-driven dilemma. Many community-based projects are demand driven. This approach. however, may be problematic for social care provision. To begin with, communities may not ask for a social care service even though they may need it. They may think that it is not eligible or worthy of financing, and instead request projects that they know can receive funding and are "worth the effort". Further, it is often more difficult for a community to identify services as needs. One solution is for project's community outreach officers to put in extra work in order to create informed demand. Another possibility is to adapt the rules of the game and allow social care subprojects to be requested not by communities but by NGOs or special interest groups (e.g., families of drug addicts). LESSON: Plan and budget generously for creating informed demand -it's worth it. Targeting. The three basic mechanisms for targeting in a social care project are: (a) geographic targeting, (b) targeting on the basis of individual characteristics, and (c) self- targeting. A targeting approach that includes geographic targeting implies the availability of poverty indicators and, ideally, of detailed poverty maps. In addition, by their very nature 5 social care services aim at reaching the most vulnerable groups within communities, so that even when highly disaggregated data are available, there will often still be a need for targeting mechanisms that complement geographic targeting. Many projects therefore also target by pre-determining groups eligible for social care. Means-testing has been used successfully in many countries to target transfers to the poor, but it may be inappropriate when the target group is characterized not just by low income. Social care service projects lend themselves to self-targeting more than other projects because they tend to finance services that would not be attractive to non-target population. It is also important that projects keep a flexible attitude toward targeting, combining different methods to respond to changing situations, such as the emergence of a new risk, or project implementation reports, such as the disproportionate funding in favor of a particular group. LESSON: Do your homework to determine the best targeting combination, keeping in mind that geographic targeting is seldom appropriate or enough. Self-targeting services and locally deterrnined means-testing are probably better. Implementing agencies and service providers. Many community-based social care subprojects are financed through agencies or projects that were designed primarily to deliver community infrastructure. In these cases, social care services have generally been afterthoughts, and represent only a small fraction of the project's overall work portfolio. Results have been uneven: recurrent cost financing plans have generally not been put mn place for social care projects, local governments have seldom been consulted, and basic social care indicators for cost-benefit analysis, monitoring and evaluation have not been well-developed. However, some projects, particularly the newest ones, are showing promise. Whether service providers and managers are local governments or NGOs, chances are they will have limited experience in executing social care subprojects. This fact was recognized by most of the projects reviewed, which earmarked funding for capacity building. The skills requirements are both generic (business, project management, accounting) and subproject-specific (how to estimate recurrent costs of social care services, how to mnonitor social care delivery, etc.). The skills of those sub-contracted to deliver services are also important. Indeed, project documents suggest that one of the largest factors affecting 6 subproject performance is the quality of social service providers themselves, rather than simply the implementing agency. Also, while many projects provide training opportunities for implementing agencies, few include other services that can play an important role in improving project implementation, such as clearing houses or periodic meetings among stakeholders. LESSON: Staff the project with social care specialists, or train existing staff in social care projects. Prepare to do a lot of capacity building for implementing agencies and service providers, and build it into the project cycle. NGOs as service providers. In many countries, NGOs play a large role in social service provision. In some countries, NGOs and CBOs may be the only viable alternative for social care provision, because governments lack the means or the capacity to take on that role. As a rule, the poorer the country, the more likely that service delivery would be entrusted to NGOs, because governments tend to be weak and the private care industry undeveloped. Relying on NGOs for service delivery has its advantages but also its downside. On the positive side, these organizations can be quite innovative, serving up empowerment, consciousness-raising, savings and income generation along with social services. On the negative side, the large numbers of NGOs that have sprung up in response to donor interest call for careful scrutiny to ensure that the NGOs chosen as service providers have the skills needed to do a good job. LESSON: Do rely on NGOs, but check them out first and don't expect miracles. Building capacity. Whether implementing agencies are local governments, CBOs or NGOs, chances are they will have limited experience in executing social care subprojects, or may be dramatically under-skilled in basic business or accounting techniques. The challenge, therefore, is to build their capacity to work in a businesslike manner, as much as it is to deliver the social service itself. LESSON: Prepare to do a lot of capacity building for implementing agencies and service providers, and build it into the project cycle. Sharing the wealth: using the experience of CBSCS projects to build sectoral ministries. Financing social care services not through line agencies or central governments, but through stand-alone projects that work at the community level has undeniable benefits: 7 closer matching of products to local needs and preferences, leaner bureaucracy and faster delivery. Further, having a local approach makes it easier to implement multi-sectoral solutions that would be almost impossible if the project implementation unit were housed within a particular ministry. On the other hand, favoring flexible & efficient independent project structures over central administration may undermine the institutional capacity of line agencies. The question, however, is not whether stand-alone projects should be financed or not, because the experience gained in this way would not be possible within the confines of a project that simply supported line ministries in their social care services efforts. What matters is how lessons learned from these stand-alone projects can be used to inform and improve the ability of governments, including line ministries and central agencies responsible for policy planning, to respond to their most vulnerable citizens. LESSON: Share knowledge and experience with central government, as it will have to be part of the long-term solution.l What difference does it make? Monitoring and evaluation. In many of the projects reviewed, indicators and plans for monitoring and evaluation were not adequately spelled out. Probably, the main reason is that developing countries seldom have norms and standards of care already established by the national government, and most World Bank staff are relatively new in the business of social care delivery. As a result, CBSCS projects are often charged with developing their own indicators. Comparisons within and across countries can provide a starting point to determine acceptable inputs and outcomes. LESSON: Determine in advance what you are trying to achieve, and at what price. Use international standards of best practice. Develop an MIS that will make monitoring and evaluation easier. Conclusions Over the last fifteen years, there has been a tremendous growth in the number of CBSCS projects financed by the Bank. The increase has been fuelled in part by a greater capacity and willingness of the Bank to finance such projects, but also by a tremendous boost in demand from client countries. Greater demand, in turn, has to be attributed to some extent to the ravages of AIDS or the spectacle of the horrific conditions found in many residential institutions. 8 When social services are properly "marketed" to communities, that is, if project outreach officers are able to lead communities to conclude that services rather than infrastructure will help to address their development priorities, the results can be promising. Provided that the services are well-designed (and tailored to the capacity of the implementing agency), and that a plan for recurrent costs is in place, social care services can have a real impact on vulnerable people. However, there is often going to be a tradeoff between maintaining a "demand- driven" approach (the typical goal of most community-based services) and targeting certain groups or certain issues. This balancing act is set to continue. It is difficult to measure progress in the area of social care service lending, despite the large increase in the project portfolio, because little research has been done to evaluate the quality or impact of such projects. As the Bank continues to lend in this area, more research is needed to assess this growing field. In the meantime, we have offered lessons learned based on the information available, encouraging readers to draw their own conclusions as to what would work best in their particular situation. 9 I. Introduction In industrialized countries, local groups play an important role in the delivery of social services, either through private contributions or government contracts. Ordinary citizens volunteer their services through parent-teacher committees, neighborhood associations, and other informal organizations. Literally thousands of non-government and other private groups provide a wide variety of social services, ranging from food delivery programs for the homeless and elderly, to shelters for battered women, legal representation for poor people, and childcare centers for low-income preschoolers. The central governments of many developing countries, too, have acknowledged the importance of community-based services. From fifty years ago, for example, when residential institutions were the only care option for people with disabilities, there are now daycare facilities and community-based residences as alternatives to centralized care. Community-based care has been the norm in developed countries for many years, but it is only recently that the largest aid agencies have begun to design projects delivering social services at the local level through community-centered approaches. Initially, community- based operations financed by the World Bank tended to focus on construction or rehabilitation of small infrastructure through social funds and rural infrastructure projects, but in the last decade financing for community-based social services has increased dramatically. However, while there have been considerable efforts to take stock of experiences with community-based infrastructure projects, and especially social funds,' there has been no systematic stocktaking of the Bank's experience to date with community-based social service provision. 2 This is an effort to fill such gap. I See, for example: (a) Bigio, Anthony, ed. 1998. Social Funds and Reaching the Poor: Experiences and Future Directions. World Bank EconomicDevelopmentInstitute,Washington,DC. (b) Frigenti, Laura, and Alberto Harth. 1998. Local Solutions to Regional Problems: the Growth of Social Funds and Public Works and Employment Projects in Sub-Saharan_Africa. The World Bank, Washington, DC. (c) Glaessner et al. 1996. Poverty Alleviation and Social Funds: The Latin American Experience, World Bank Discussion Paper. (d) Goodman et al. 1994. Social Investment Funds in Latin America: Past Performance and Future Role. Inter- AmericanDevelopment Bank DiscussionPaper.(e) WorldBank.2001. Social Funds:A Reviewof WorldBank Experience (draft).Operations EvaluationDepartment, Washington, DC. 2 Initialwork includes:Julie Van Domelen,Presentation at the 1998Human Development Week,availableon the social funds website under www.worldbank.org/sp; as well as Paola Ciardi and Laura Frigenti, "Issues Paper: Social Funds in SSA beyond the year 2000", World Bank internal document, January 20, 1999, Washington,DC. 10 Objectives. This study has two main objectives: * stocktaking: to review and categorize the extent, scope and mechanisms of social service subprojects in the current Bank portfolio of community-based projects, and learning lessons: to identify good practices and common pitfalls across the sampled projects, and to provide recommendations on how to improve social service provision in future community-based projects. 3 An additional goal is to help teams involved in community-based projects get in touch with other practitioners who can provide the sort of practical suggestions that hands-on experience generates. To go a step further in the direction of cross-fertilization, the paper also reviews selected non-Bank lending projects that have been successful in providing social services through community-based arrangements. This paper is not an exhaustive review, and does not include mainstream community- based health and education interventions. Project descriptions in Bank appraisal documents and other literature are not always as detailed as one might wish, and Task Managers are not always available for interviewing; as a result, it is likely that we overlooked some projects and erroneously included others. Moreover, since most of the projects reviewed are still ongoing, there are very few ex-post evaluations available on their impact or sustainability. We will be grateful for corrections and clarifications. When is a project community-based? The first hurdle in finding working definitions for this study is that there is no one meaning of the word "community" that will satisfy all those involved in community-based projects. Social funds tend to define "community" in fairly loose terms to indicate people who live in the catchment area of a specific subproject, generally organized in some sort of community-based organization (CBO). In other community-based projects, however, "community" can mean that the local government, as opposed to a centralized authority, manages projects and funds (and might contract non- government organizations to undertake work), with or without input from local constituents or other stakeholders. We will accept both definitions, and consider that a community-based project is one in which decisions about a specific sub-project are made at the lowest possible level, that is, in accordance with the subsidiarity principle. In practical terms, this means that 3Preliminary research on this issue was outlinedby Paola Ciardi and Laura Frigenti in their issues paper, "Social Funds in SSA Beyond the Year 2000," op. cit. 11 the decision on whether to fund a particular subproject may be taken at the regional or national level, but most -if not all- decisions on how to run the subproject and responsibility for its implementation are at the local level. Because the implementation of a subproject involves countless decisions, control at the community level may go from absolute to very little. Holding consultations with the community is insufficient, because doing so may influence how a specific subproject is shaped or administered, but in itself does not provide real power over the subproject. 4 For a subproject to be "community-based", therefore, communities have to be able to actually control at least some of the key aspects of the subproject, e.g., decide which services will be delivered, and to whom. Clearly, there may be overall project limitations and guidelines as to eligible groups or services, but communities should have the freedom to decide within those boundaries. Social services and social care services. As with "community" and "community-based", a hard-and-fast definition of "social service" is difficult. Social services may be defined as interventions whose main outputs are improved human or social capital (as opposed to improved physical or financial capital). However, this definition is too broad, because it might include mainstream health, education and water supply projects. We therefore propose a stricter definition based on the notion of social care service. Social care services are services supplied to vulnerable individuals and families to help them reduce or escape poverty or exclusion, and lead a more full and satisfying life. Training and capacity-building may constitute a form of social care, as they might equip the individual to avoid poverty or exclusion. These services contribute to social risk management primarily through coping mechanisms, but may also include elements of prevention and mitigation (see Box 1). Vulnerable individuals are usually considered to be: * children (minors) deprived of parental/family care, usually because of absence, illness or death of parents . children (minors) and adults who are disabled (temporarily or permanently), including the frail elderly and AIDS-affected 4 These concepts are clearly explained in the participation literature. See, for example: World Bank. 1996. The World Bank Participation Sourcebook, Environmentally Sustainable Development, Washington DC. 12 * children (minors) and adults deprived of basic needs and/or at immediate risk of physical or mental abuse, harm, social exclusion, or neglect (such as victims of domestic violence, drug abusers, or prostitutes). Box 1: SocialRisk Management "The main idea behind social risk managementis that all individuals,households,and comniunities are exposed to multiplerisks from different sources,whether they are natural (such as earthquakes, floods, and illness) or manmade(such as discriminatorypractices, unemployment,enviroiimental degradation,and war). Poor people are more vulnerablethan other populationgroupsbecause they are typically more exposed to risk and have little access to appropriate risk management instruments... Risk managementcan take place at different moments-both before and after the risk occurs. The goal of ex-antemeasuresis to prevent the risk fromoccurringor, if this cannotbe done,to mitigateits effects. Individual efforts, such as migration,can prevent risks, but in many cases they require governmentsupport (for example, disaster prevention). Mitigatingthe effects of risk through risk poolingby definitionrequiresinteractionamongindividuals,and poorpeopleare typically less able to participatein formal and also informal arrangements. This leaves most poor households with the residualoptionof copingwith the risk once it has occurred. Theyare normallynot preparedto do this and, therefore,often experienceirreversiblenegativeeffects. For this reason, there is a great deal of public intervention in risk coping. * PreventionStrategies. These strategiesare implemented beforea risk occurs. Reducingthe probability of an adverse risk increases people's expected income and reduces income variance, and both of these effects improve welfare. Preventive social protection interventionstypically form part of measuresdesignedto reduce risks in the labor market, notably the risk of unemployment, underemployment, or low wages resulting from inappropriate skills or malfunctioning labormarkets. * MitigationStrategies. As with preventionstrategies,mitigationstrategiesaim to addressthe risk before it occurs. Whereas preventive strategies reduce the probability of the risk occurring, mitigation strategies help individualsreduce the impact of a future risk event through pooling assets, individuals, and time. For example, households may "pool" uncorrelated risks through informal and formal insurance mechanisms. While formal insuranceinstrumentsprofit from a large pool of participants,which leadsto less correlated risks, informal insurance has the advantageof all participantshaving access to almost the sameamountof information. * CopingStrategies. These strategiesare designedto relievethe impactof the risk once it has occurred. The main forms of copingconsist of individualdis-saving,borrowing,or relying on public or private transfers. The government has an important role to play when individualsor householdshave not savedenoughto handlerepeatedor catastrophicrisks." Source: World Bank. 2001. Social Protection Sector Strategy: From Safety ANet to Springboard. Washington, DC. 13 Putting all the pieces of the puzzle together, in this study when we write of a "4community-based social service project," we mean a "community-based social care project" (CBSCS); that is: A social care project which supplies services to vulnerable individuals and families to reduce or escape poverty and exclusion, and lead a fuller and more satisfying life, where most decisions on how to run a subproject and responsibility for its implementation rest at the community level, either with local government or civil society. The sample of projects reviewed, therefore, are operations which, to the best of our understanding, provided community-based social care services either through a sub- component or as the main project activity. When information was not enough, we used our common sense to decide. See Annex I for details on the methodology used. 14 II. Why are CBSCS Projects Important? "It is possible to provide all communities with proper water supply and toilet facilities, relieve them of overcrowding and unemployment, provide them with educational facilities, and still be faced with a malnourished population, angry, unable to learn and prone to all manner of communicable diseases. " (Dennis Brown, former Head of the Social Policy Unit, Planning Institute of Jamaica). Communities at the center. Experience has proven that with the right policies, fiscal authority and institutional support, decentralized provision of services and infrastructure can improve services. 5 Further, community participation in development projects can help to improve project impacts, enhance accountability, lessen corruption, and promote sustainability. 6 As the Bank finances more and more community-based projects, it is becoming clear that there is a growing need for projects which not only build facilities and renovate buildings, but also fund the activities -the services- that take place within them. There are five main reasons for this: * Better development outcomes. While infrastructure is important to achieve a lasting impact, the services that are provided within that infrastructure are perhaps even more important to achieve better development outcomes. * Cost effectiveness. The marginal cost of providing social services in a "traditional" way can be extremely high for the service provided. A recent Bank study estimated that for developing countries at average income levels, a large portion of under-five deaths could be avoided with interventions costing between $10 and $1000, but that the real cost for each death averted through traditional public health spending averaged between $50,000 and 100,000.7 Further, evidence is now showing that devolving control to communities is an effective method of delivering social services 5 See, for example:(a) Aiyar et al., "Decentralization: A New Strategyfor Rural Development," Agricultureand Natural ResourcesDepartmentDissemination Note Number 1, WorldBank. August 1995,p.3. (b) Humplick, Frannie. "Fiscal Decentralization in Developing Countries: Innovative Approaches to Decentralized InfrastructureFinance",paper deliveredat Fiscal Decentralization in DevelopingCountriesSeminar,NMay 6-7, 1997. 6 For more informationon communitycontractingand other community-based projectdesignsuggestions,refer to the World Bank's Community Driven Development and SocialFundsWebsitesat www.worldbank.org. For more informationon participatoryprocess,see "The Powerof Participation: PRA and Policy," in IDS Policy Briefing, Issue #7, Summer 1996, available at http://www.ids.ac.uk/ids/bookshop/briefs/brief7.html. Other articlesinclude: Robb, Caroline. 1999. Can the Poor InfluencePolicy?Participatory PovertyAssessrnents in the Developing World. Washington,DC: The World Bank. The InteramericanDevelopmentBank Resource Book on Participation is available at http:!/www.iadb.org/exr/english/POLICIES/participate/index.htm Additional information is available on the World Bank's Participation homepage at http://www.worldbank.org/participation/PRSresources.htm 7Filmer, Deon and Lant Pritchett. 1997 "Child Mortalityand PublicSpending on Health: How Much Does MoneyMatter?",WorldBank PolicyResearchWorkingPaperno. 1864,pp. 3-4. 15 because it is cheaper and faster than "traditional" forms of lending. 8 Clearly, the method by which a service is delivered influences the price and impact of the service. 9 . Services that fit the client. A community-based approach to social services provision can help to ensure that they are relevant to the local context and tailored to local preferences. . Widening the net to include vulnerable groups. For task managers already involved in community-based projects, including social service components in their projects can increase the likelihood of their reaching the poorest and most vulnerable groups within a community who may otherwise be hard to target. Community-based projects tend to focus on geographic regions that meet certain indicators of poverty or risk. * Growing demand. Tragically, the need for more social care services is being fuelled by growth in the number of people who are vulnerable, particularly due to the ravages of AIDS. In 1990, in the 34 countries most affected by AIDS there were an estimated 22 million orphans aged less than 15; ten years later, that number was 35 million and projections put it at 44 million by 2010.'° The African sub-continent will be particularly hard hit, with the number of orphans set to treble over the next ten years.' Effective social care for groups such as these will be a critical challenge for governments and multilateral investors. Social care for poverty reduction. Development practitioners have traditionally drawn a sharp distinction between "relief' and "development", with the former being the business of charitable organizations and the latter the concern of more far-sighted institutions. This distinction, however, has been challenged. Social care (the more modern word for "relief') is not just charity but a means to raise the welfare of the most poor and vulnerable, and as such should be an integral part of poverty reduction strategies. Along with other types of safety nets, social care represents a long-term investment to preserve human and social capital, both of which are crucial for development. More importantly, social care addresses those dimensions of poverty that are the hardest to tackle: exclusion, powerlessness, shame, sNarayan,Deepa."DesigningCommunity-Based Development," Environment Department Dissemination Note no. 17,June 1995. 9 WilliamJack,"SocialInvestment Funds:An Organizational Approachto ImprovedDevelopment Assistance," WorldBankmimeo,January,2000,p. 1. 10 Hunter,Susanand John Williamson. 2000. Childrenon the Brink. Washington: USAID. t1 KalanidhiSubbarao,AngelMattimore,and KathrinPlangemann,"SocialProtectionof Africa's Orphansand Vulnerable Children: Issues and Good Practice Program Options" (World Bank Africa Region Human Development WorkingPapersSeries,Forthcoming). 16 hopelessness." 2 Benefits accrue not only to those who receive the services, but to their families and communities as well. How are CBSCSs different? Social care services have several characteristics that make them distinct from other community-based services: . They provide new services. Unlike "mainstream" community-based health or education projects, CBSCS projects often provide services in which governments have had little or no experience and for which responsibility may be spread between many ministries. This means that the social care policy framework may not be developed, or, as in Eastern Europe, may require significant overhaul. In a similar vein, implementing agencies and service providers generally need much more capacity building than in more established sectors. On the other hand, since social care services are typically delivered by NGOs, social care projects provide a good opportunity to develop partnerships between governments and private service providers. * They tend to take more time. There are three reasons why CBSCSs may take more time than other projects: (1) because of the novelty and complexity of the project, communities may need more time to agree on what is needed and how it should be delivered; (2) the extra training usually required both for implementing agencies and the service delivery agencies is a pre-condition for implementation; and (3) project results may not be visible for a while (e.g., in a literacy project, it may take as much as two years for people to learn to read). * The bulk of the expenditures are recurrent. Unlike infrastructure projects, where most expenditures are up-front in the form of capital investments, most of the investment in social care services are in recurrent costs such as training and staff salaries. Social Care Service Lending: A Fast Growing Field Community-based social care services have been financed by international NGOs and other donors for many years. However, they are a relatively new area for the World Bank. Lending in this field began in earnest only in the mid-1980s, when the first health projects and social investment funds began lending to communities for social welfare, early childhood development, daycare programs, nutrition, and other services. The Tamil Nadu nutrition project in India provides one of the earliest examples of Bank project success in community- based social services provision (see Box 2). 12 The multidimensionality of poverty has been discussed in many documents. See, for example: Narayan, Deepa, Robert Chambers, Meera Kaul Shah and Patti Petesch. 2000. Crying Out for Change. Newv York: OxfordUniversityPress. 17 In 1990, the groundwork was l Box 2: Community Participation Yields Significant laid for a large boost in the Bank's |Results social sector lending through the "In Tamil Nadu, India, a community-basednutrition publication of the . World outreachprogramin 9,000 villagesresultedin a one-third decline in severe malnutrition. A group of twenty Development Report on poverty women interested in health issues was hired in each village as part time communityworkers accountableto which advocated poverty, the community.The women's groups,formedinitiallyto alleviation through greater | "spreadthe word," subsequently branchedoff and started a food productionactivitieson their oNvn. Earlierprograms economic opportunity, humanr focusing only on the creation of health infrastructure I were unable to make any difference in the nutritional capital development, and the | status of children." establishment of safety nets. In Source: DeepaNarayan, "Designing Community-Based Development." Environment Department Dissemination Note.No. 17, 1990, the Board approved eight June 1995. projects financing the delivery of social care with a community-based approach, up from only a handful in the 1 980s. Meanwhile, the Cold War was ending, and the movement toward decentralization gained momentum. Governments in client countries from Latin America to Eastern Europe began to assign to local authorities the spending and management responsibilities for various activities that the central levels had previously managed. According to World Bank research, by 1995, 84% (63 out of 75) of transitional and developing countries had transferred, or planned to transfer, power to local governments.' 3 At the same time, the horrible specter of residential institutions in Eastern and Central Europe called for social service solutions as far away from centralized systems as possible. More generally, the seemingly worldwide increase of serious social problems such as elderly abandonment, drug abuse and street children, along with a recognition of previously taboo subjects such as domestic abuse, prostitution, discrimination of indigenous populations, and, especially, AIDS, fuelled the trend toward more social care service lending. As the number of stand-alone social service projects increased due to these and other reasons, many Bank-financed community-based projects that originally concentrated on social infrastructure projects (such as schools, health posts, and water and sanitation facilities) began to expand the scope of their work into social services. Community-based 13 Aiyaret al.,"Decentralization: ANewStrategy forRural Development," Agriculture andNatural Resources Department Dissemination NoteNumber 1, August1995, p. 2 . 18 projects took off, including nutrition programs, AIDS awareness and prevention campaigns, training of health and education staff, literacy campaigns, and programs for specific vulnerable groups such as street Figure 1 children, women, ethnic Financing for projects with social care minorities, and disabled people." 4 services by year US$ millions Figure 1 showsthe upwardtrendin 1400 777 1200 social services lending, with a cumulative lending figure of at 8000 least $1.6 billion by FY2000. 400 200 0 Yearof Board approval 14 Van Domelen,Julie. 02/98."It's Not Only AboutInfrastructure: Social Funds and Social Services,"Human Development Week Presentation, March1999. 19 III. Stocktaking - Bank Financing of CBSCS Projects How many? How much? The Bank is estimated to have financed 99 projects with at least a component providing community-based social care services. Of these, 44 projects were social investment funds, and the majority of projects occurred in the Human Development sector. The first community-based projects including social care services were in Asia and Latin America (specifically, Indonesia and Bolivia). Bank financing of this type of projects has remained consistent throughout the last decade for Latin America, which each year had at least one project Figure 2 approved by the Board, totaling 31 Numberofprojectswithsocialcare services by region projects by 2000 (see Figure 2). As 35 Figure 3 shows, LAC is also the 30 - region with the largest portfolio of 20 15 projects which include community- 10 based social care (US$ 2.5 billion), 0 AFR Asia ECA LAC MENA followed by Asia (US$ 2.2 billion).' 5 Although in many projects it is impossible to determine which shar