For more than 15 years, you have worked as a social policy researcher and policy advisor for international organisations including UNCDF, UNICEF and WHO. Please explain briefly what your area of expertise entails.
Barbara Rohregger: My areas of expertise entail on the one hand, the design and development of social policies, in particular cash and other transfers to the poor. I have also done a lot of work as to how social protection policies may strengthen other sector outcomes, such as health or agriculture or benefit specific population groups, such as children. On the other hand, I do a lot of work on governance aspects of delivering social protection, in particular at the local level. Currently I am working on an international research project on social protection policies in Kenya and Ghana at the International Centre for Sustainable Development (IZNE) at the Hochschule Rhein-Bonn. The project is a cooperation between the University of Ghana and the University for Development Studies in Tamale, Ghana, the University of Nairobi, the University of Amsterdam and EADI. It looks – among other things – at the political economy of social protection in Ghana and Kenya, i.e. how politics and specific institutional settings at the national and local level influence and curb the programme design and implementation.
As an expert in the area of social protection, can you please explain how it correlates with health?
BR: One, there is a direct link to health because social protection also encompasses social health protection mechanisms, such as social health insurance which allows people to gain access to health care without incurring financial risks. This is especially important for poor people who face major health risks. But also, other social protection mechanisms have important health impacts. This is what we call the social determinants of health. Cash transfers or passive income support enables people to spend more on food and improve their nutrition. They allow people to improve their housing situation and send their children to school, because they are able to buy pencils, books or soap and pay for transfer. Some of these expenditures have immediate effects on health, such as people being less often sick. Others have more long term, but not less important effects. We know that children, who do not face severe material and social deprivation during their early years, are healthier, live longer, have a better cognitive development which in turn has positive impact on their educational attainments and their productive lives. They are also in a better positon to develop positive social relations and are happier – all aspects that increase their material and emotional resilience against future health risks. If we thus, support parents in better combining their productive and reproductive roles better by providing material support and social services, as well as improve their economic situation through adequate labour market policies, we are also doing a lot for health.
What are the main challenges you came across when developing comprehensive social protection schemes?
BR: Many social protection measures are still programme based, meaning that they are not anchored in a legal framework. Without a legal framework, it is impossible to establish a right to social protection. Social protection policies usually have a long-term character. It sometimes needs a generation to materialize long-term effects. Against this background, a legal framework is important in order to guarantee the political commitment regardless of change of political leadership.
Another issue is that donors often do not want to engage with how programmes are implemented. Despite the fact that there is a lot of talk about how to avoid “one fits all- approaches”, this continues to be common practice in most donor agencies. Aspects, such as specific needs or political, social economic, institutional settings continue to be set aside.
July the 11th marks World Population Day. The United Nations estimates that 225 million women, mostly from the Global South, don’t use safe and effective family planning methods. As a former consultant for the World Health Organisation, why do you think this is the case in 2017?
BR: There is a lack of knowledge on part of many women with regard to family planning methods in many parts of the world. There is a huge gap between those women who would like to use family planning methods and express a need, but do not have access to it. One reason is that in many countries women cannot decide over family planning matters, usually being in the hands of their husbands or other members of the family, including elderly women within the household. Women often do not have the money to simply buy them – apart from the cultural barriers that still exist of women going and buy contraceptives in pharmacies. However, I think it is not only about individual or societal behaviour change. Politicians should also pay more attention to this aspect. Because family planning is not only a goal in itself but is an important means to improve maternal and child health. We know that high fertility behaviour is a major reason for child death: Children born to women with high birth intervals, i.e. within less than two years after the preceding child, show a significantly higher mortality rate than children born later. In addition, children, whose mothers have already given birth to three or more children, face a higher risk of dying in early childhood than their siblings. Family planning would thus, allow women to stay healthier and enable them to manage their education and economic empowerment more autonomously. Women, who have control over their reproductive capacity, have the power to plan better for their education and their productive impact on society.
What motivates you in the morning and how do you think about it in the evening?
BR: I like to understand how people think and what motivates them to do things the way they do or react the way they do. I think we often underestimate people, especially in a development context where we have all these experts, who know, how things should be done and organised and who then, are surprised when people do not behave accordingly. There is always a rationale behind why people are doing or not doing things and it is on us to understand why things have not worked out.
I like to understand differences because looking at these “differences” you actually realise that there are many similarities in the way people behave, act and react across cultures, countries, the North and the South. I sometimes think that it would help to think more in similarities than emphasize differences. This would help a lot to improve our cooperation.
In the evening, I sometimes think that I never get to the bottom of things, because money and time constraints are strong even in research nowadays. Sometimes, I think that we are spending more energy and expertise in looking for money than actually doing what we are supposed to do…
Which question would you like to answer that you have never been asked before?
BR: Why do we continue doing the same things over and over again although there is so much evidence that doing it differently would have so much more impact?
The interview was conducted by Nteboheng Phakisi