Around one billion people receive conditional cash transfers today, which have been praised as the magic bullet for poverty eradication. Such programmes are being implemented in Latin America and Africa. But they raise numerous ethical questions
La main qui donne est toujours au dessus de celle qui reçoit - Amadou Hampâté Bâ
‘It is justice, not charity, that is wanting in the world’- Mary Wollstonecraft, ‘A Vindication of the Rights of Woman’ (1792)
Bodies of evidence have shown that Conditional Cash Transfers (CCTs), as a form of social protection, can reduce inequality and poverty (DFID, 2011; World Bank, 2009). Conditional Cash Tranfers are payments made to poor households on the condition that they comply with a set of requirements and invest in their children’s human capital. CCT programmes have led to an uptake in health services, health outcomes and nutritional status of children as well as school enrolment and attendance (Lagarde et al., 2009; DFID, 2011; World Bank, 2009).
Around one billion people receive Conditional Cash Transfers in the world today. The largest programmes, Mexico’s Oportunidades and Brazil’s Bolsa Familia, started in the 1990s and have since been replicated in Chile and Turkey to focus on the extremely poor, in Bangladesh and Cambodia to focus on gender inequalities and in Sub-Saharan Africa to improve the living conditions of orphans and vulnerable children and their carers (World Bank, 2009).
Conditional Cash Transfers are said to be ‘as close as you can come to a magic bullet in development’ (Shibuya, 2008:789) yet I cannot help but feel uneasy about CCT programmes. They embody all the dilemmas I have with development as a discipline and as a field of practice. Development is understood as the creation of ‘enabling environments for people to enjoy long, healthy and creative lives’ and to ‘enlarge people's choices’ (UNDP, 1990). Its underlying principle, to me, is to recognise others as fellow human beings. But I feel that power relations at stake between humans distort most forms of genuine concerns, and by extension, respect. Consequently, I wonder about the legitimacy of development interventions.
A wealth of literature has been published on CCTs and its outcomes (DFID, 2011; World Bank, 2009). It will not be reviewed here. The aim of this reflexive note is to discuss development ethics by using Conditional Cash Transfers as a case study. Development ethics is defined as:
‘a space of analysis, evaluation and action regarding the trajectory of societies, with special reference to suffering, injustice and exclusion within societies and between societies at a global scale. Its typical focus on humans in their own right, irrespective of location, rather than as abstract functioning units in an economy, supports a politics of social change that accepts human dignity as a priority.’
Gasper and Truong, 2005: 373
I will question whether CCT prioritise human dignity by first giving an overview of the methodology and underlying principles of CCT programmes in alleviating poverty and then analyse them in the light of ethics. I will conclude with personal reflections on development.
1- CCT: PRIORITISING HUMAN DIGNITY?
Conditional Cash Transfers propose to alleviate destitution though direct, non-contributory, regular cash transfers to poor households. Beneficiaries of cash transfers have to comply with prescribed investments in the human capital of their children. The conditionalities mostly involve health check ups; nutrition and immunization programmes; health information talks for parents and school enrolment and attendance. Most CCT programmes make payments to the mother of the household (or alternatively to the student).
Cash transfers are understood as short-term strategies that increase household incomes and smooth their consumption. These demand side subsidies are also meant to remove indirect costs ( cost of transport, hospital fees…etc) and opportunity costs (e.g. loss of income) perceived as obstacles to accessing health or education services.
Cash transfers are also direct long-term investments in human capital and an incentive for behaviour change. Indeed, health and education hold positive externalities and can enhance sustainable livelihoods. They can break intergenerational transmission of poverty, increase skills on the labour market and decrease criminality (World Bank, 2009). This ‘quiet revolution’ (Dfid, 2011:i) consequently ‘becomes part of a strategy to secure greater economic competitiveness’ (World Bank quoted in Molyneux, 2008: 8).
This utilitarian approach to social protection is further enhanced by ‘attaching a constraint on the behaviour of people one is trying to help’ (World Bank, 2009:8). The rationale for delivering cash transfers conditionally is based on (1) the argument that investment in children’s human capital is too low and (2) on political economy.
First, conditionality may become a push factor when parents have imperfect information and therefore hold misguided beliefs about education and health. Conditionality can also play a role when, due to incomplete altruism, parents discount their children’s future or, as theorised by behavioural economics, parents take myopic decisions against their children’s human capital (World Bank, 2009).
Second, conditionality may be perceived as a ‘social contract’ rather than a ‘pure hand out’ by taxpayers and voters. Behavioural science has demonstrated that people may be ready to incur financial losses to reward ‘those poor households who are ready to make the effort’, that is, ‘the deserving poor’ (World Bank, 2009:60). States are therefore considered as partners to recipients who can decide freely on their consumption on the condition that they take actions to improve their lives. Some countries talk about ‘co-responsibility’ rather than ‘conditionality’.
In brief, I have attempted to give an overview of the definition and rationale of Conditional Cash Transfers. It intended to give readers background information to assess moral questions raised by CCT programmes.
2. REFLECTIONS ON THE ETHICS OF CCTS
Conditional Cash Transfer programmes provide a good illustration of developmental processes and ethical issues at stake in development. I will attempt to demonstrate that CCT programmes fail to adequately meet ethical principles. Questions of moral principles and ethics appear to not to be taken into consideration yet CCT programmes are praised as ‘a magic bullet against poverty’.
2.1 PERCEPTIONS OF THE ‘OTHERS’
Individuals are entitled to make informed decisions about their personal matter. Autonomy is considered as a reaction against paternalism. The latter is defined as the ‘practice on the part of people in authority of restricting the freedom and responsibilities of those subordinate to or otherwise dependent on them in their supposed interest’ (Oxford dictionary). Paternalism can be related to an abuse of power and a restriction of freedom. The World Bank (2009:51) explicitly makes use of paternalism when justifying conditionality. It states:
‘The idea that poor people need the push (or nudge) of government ‘incentives’ to behave in ways that are ‘good for them’ is a very old notion. It seems to imply that if left to their own devices, these agents somehow are not capable of choosing what is in their best interests…. Paternalism well may be justified if the individuals in question hold persistently erroneous beliefs.’
The UN Department for Social and Economic Affairs (2010) is critical of the assumption that conditionality is necessary because poor people are engaged in irrational behaviour and do not understand their own best interest. It overlooks structural factors and suggests that poverty is an individual phenomenon. UNDESA further suggests that it blames poor people and ‘roots poverty in individual pathologies’. This further contradicts the ethical principle of non-maleficence.
2.2 CAN WE POTENTIALLY ‘DO GOOD’?
Development practitioners themselves hold prejudices and enforce stigma upon CCT recipients. Their use of language is quite meaningful (See Foucault in Lukes, 1974). A review of reports and articles on Conditional Cash Transfers better demonstrates the state of mind of development practitioners.
There is a strong rhetoric on control, enforcement and punishment of beneficiaries. Whereas the World Bank (2009:7) suggests to carefully monitor ‘compliance’ to conditionalities, Lagarde et al. (2009:11) state that ‘it is essential to define as requirements some behaviour or actions that are easily controlled*’. It is further recommended that programmes should ‘minimize the potential for manipulation and abuse*’ (World Bank, 2009:24) and that ‘the degree to which non complying households are penalized*’ can ensure better compliance and consequently better outcomes (World Bank, 2009:23).
As mentioned above, poverty-stricken people appear to unequivocally hold the responsibility for being poor. It is argued that taxpayers will preferably support ‘those who are seen to be helping themselves than other equally poor people who are seen to be lazy or careless*’ (World Bank, 2009:60). There is a general belief that poor people are idle. Thus, one of the fears when launching CCT programmes was to distort labour markets ‘either because beneficiaries would choose to consume more leisure at higher income levels or because they would cut back in work in order to continue to appear ‘poor enough*’ to be eligible for transfers’ (World Bank, 2009:16). It explains further why it is politically more acceptable to target children, as it is believed that ‘it is hard to blame children for being poor’ (World Bank, 2009:11).
Concerned about creating dependency, most Conditional Cash Transfer programmes in Sub-Saharan Africa target people who are ‘labour constrained’ or ‘incapacitated’ and can therefore not be part of the labour market. CCTs target ‘ultra poor’; ‘extreme poor’; ‘hardcore poor’ or ‘non viable households’ (McCord, 2009). However there is no empirical or ethical justification, when, in some countries, most of the population lives under the poverty line, to select some people and leave others without any form of social protection. The fragmentation of society further excludes poor people (McCord, 2009b).
In this regard, Dfid (2011:v) mentions that ‘targeting choices need to be determined by contexts rather than one-size-fits-all approach’. However the roll out of CCT programmes in 27 countries by 2009 was heavily incentivised by external funding. In some sub-Saharan African countries for example, CCT programmes reflect donors’ priorities without real governments’ ownership and support (McCord, 2009a). CCT programmes are thus implemented as an inflexible blueprint that does not take multiple contextual influences into account. A qualitative research undertaken in El Salvador, Mexico, Nicaragua and Turkey (Adato, 2011) has shown that socio-cultural and structural factors influence health care decisions and may lead to an under participation in CCT programmes. Among different issues cited, Adato et al. (2009) mentioned that beliefs around traditional medicine contradicted the biomedical approach to child and maternal health used by CCTs. Another issue was the asymmetrical power relations with service providers and the perception by beneficiaries that medical staff looked down upon them. Finally, gender norms and relations strongly influence CCT programmes.
Many CCT programmes only include women (Adato, 2011). It is assumed that they ‘will put funds to better use than will men’ (World Bank, 2009:11) and it further intends to empower them thanks to increased financial autonomy. Indeed, they are provided with financial support for their care work and offered opportunities to participate in community activities. Workshops and talks are meant to give them better access to health and parenting information as well as enhance their self-esteem (Holmes and Jones, 2010). Holmes and Jones (2010:5) therefore state that the co-responsibility approach places responsibility on women but has the merit to empower programme participants to become involved in supporting themselves and their families to exit poverty and extreme vulnerabilities over time. Critics have, however, argued that targeting women conditionally to their maternal responsibilities reinforces gender roles and stereotypes. Indeed, cash transfers rely on women’s social identity as mothers (Molyneux, 2008). It thus reinforces gender divisions within households, expecting mothers to selflessly undertake reproductive chores. Time poverty is another issue. CCT beneficiaries have mentioned that fulfilling programme demands is difficult and may conflict with their income-generating activities. Certain programmes further expect women to volunteer in community activities. It can thus be argued that ‘these women are converted into a new social category with more obligations for the simple reason that they receive a subsidy’ (Bey, 2003 quoted in Molyneux, 2008:52). Furthermore, whereas the international community has recognised the need to work with men and boys to achieve gender equality, the exclusion of men from CCT programmes is notable. Antagonizing men and women overlooks the complexity and dynamics of gender relations. Molyneux (2008: 58) concludes that ‘an underlying problem with the design of CCT is that they not only depend on the conditions that make women vulnerable but they may actively reinforce them’.
3. CONCLUDING REFLECTIONS
I have attempted to highlight here some issues in development as a discipline and practice. Whereas CCT programmes appear to be successful in meeting health and education outcomes, they raise a series of concerns regarding their underlying principles and methods. Generally does the end ever justify the means? Based on this case study, I wonder whether we can accept to alienate and paternalize others, to stigmatize people, to impose foreign interventions and to potentially increase harm in the name of ‘doing good’ or in the name development?
I navigate in between institutional and activist spaces that promote contradicting world views on power and development. I am sometimes tempted to ‘do good’ and acquire privileges but I am then reminded that ‘the gains of some groups have been directly conditional on planned sufferings of others’ (Gasper: 2011:1). I find it terribly difficult to reconciliate their different narratives. I therefore locate myself in a constant state of tension and discomfort.
It sometimes leaves me numb and powerless. Like Mr Brown in The Comedians (Greene, 1966), I feel that ‘somehow, somewhere [to have] completely lost the capacity to be concerned’. I am overwhelmed and feel disconnected. This de-linking from humanity appears as a smoothing feeling. After all life just goes on and there is not much I can do. But Goulet (1976, quoted in Gasper, 2008: 13) reminds me that
‘Ethicists themselves constantly vacillate between ethical paralysis or compromise in the face of power, and energetic creativity newly released whenever they catch a faint glimpse of the power of ethics itself... the power of ethics to counter the power of wealth, of politics, of bureaucratic inertia, of defeatism, of social pathology.’
At an individual level, I find the power of ethics and its ‘energetic creativity’ in literature. George Orwell, Jack London, John Steinbeck have taught me to think critically. James Baldwin and Romain Gary have stroke me with their brutal honesty and have reminded me to find the human in every person. The philosophy of Ubuntu has connected me to others and has reminded me that ‘I am because you are’. I cannot exist without you.
I derive agency from the sense of togetherness. I have drawn my strength and articulated my dreams around feminist principles. Third wave and post colonial feminism have offered me analytical tools to understanding the intersectionalities of power relations. It has further given me methodological tools to reflect and to take action. Feminism has taught me the power of collective action. Indeed, power is the strength required to bring about change. Belonging to sisterhood and collectively reflecting and dreaming the world, crossing the line and reclaiming power create solidarity.
True solidarity is based on recognising others as fellow human beings. I will therefore conclude with Kant who reminds us to ‘act in such a way that you treat humanity, whether in your own person or in the person of any other, never merely as a means to an end, but always at the same time as an end.’ (Kant, 1785). I would like to suggest that there can be no development without putting people at the centre. CCT programmes may reach their intended targets but fail to improve humanity.
* Claire Ichou considers herself a lucky global citizen. After extensive travel in Southern Africa and the Caribbean, amazing encounters and two masters degrees in development studies and public health, she has decided to go back to France and live according to her principles of feminism and solidarity. She promotes an intersectional understanding of inequalities and dreams about radical changes.
 Interestingly ‘intervention’ comes from the Latin verb intervenire which signifies ‘to come between’ or ‘to interrupt’
 Emphasis added
Adato, M., Roopnaraine, T. and E. Becker (2011) Understanding use of health services in conditional cash transfer programs: Insights from qualitative research in Latin America and Turkey, Social Science and Medicine 72: 1921-1929
Dfid (2011) Cash Transfers: Literature Review, Policy Division, London: April 2011
Gasper, D. and TD Truong (2005) Deepening Development Ethics: From Economism to Human Development to Human Security, The European Journal of Development Research, Vol.17, No.3, September 2005, pp.372 – 384
Gasper, D. (2008) Denis Goulet and The Project Of Development Ethics: Choices In Methodology, Focus And Organization, Institute for Social Studies, Working Paper 456
Gasper, D. (2011) Development Ethics- What? Why? How? Paper for conference on “Rethinking development: Ethics and Social Inclusion” Mexico City: 17-18 August 2011
Greene, G. (1966) The Comedians, London: Bodley Head
Holmes, R. and N. Jones (2010) Cash Transfers and gendered risks and vulnerabilities: lessons from Latin America, ODI Background Note, London: Overseas Development Institute
Holmes, R., Jones, N., Vargas, R. and F. Veras (2010) Social Protection Programming: the need for gender lens, ODI Briefing Paper 63, London: Overseas Development Institute
Kant, I  (1993). Grounding for the Metaphysics of Morals 3rd ed.. Hackett
Lagarde, M., Haines, A. and N. Palmer (2009) The impact of Conditional Cash Transfers on health outcomes and use of health services in low and middle income countries, Cochrane Database of Systematic Review 4
Lund, F., Noble, M., Barnes, H. and G. Wright (2008) Is there a rationale for Conditional Cash Transfers for children in South Africa? Working Paper 53, Durban: SODS
Lukes, S. (1974) Power a radical approach. London, MacMillan.
McCord, A. (2009a) Cash Transfers and Political Economy in Sub-Saharan Africa, ODI Project Briefing 31, London: Overseas Development Institute
McCord, A. (2009b) Cash Transfers: Affordability and sustainability, ODI Project Briefing 30, London: Overseas Development Institute
Molyneux, M. (2008) Conditional Cash Transfers: a ‘Pathway to Women’s empowerment? Working Paper 5, Brighton: Institute of Development Studies
Shibuya, K. (2008) Conditional Cash Transfer: a magic bullet for health? The Lancet 371:789-791
UNDP (1990) Human Development Report 1990: Concept and measurement of human development, New York: UNDP
UNDESA (2010) Rethinking Poverty: Report of the World Situation 2010, New York: UNDESA
World Bank (2009) Conditional Cash Transfers: reducing present and future poverty, Washington D.C.: World Bank