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Can social protection improve health-related sustainable development goals for adolescents?

Author: Lucie D. Cluver, Franziska Meinck, Mark E. Boyes, Alexa R. Yakubovich
Institution: University of Oxford
Type of case study: Research

About the research

In January 2016 the 17 Sustainable Development Goals (SDGs) of the 2030 Agenda for Sustainable Development officially came into force. These goals aim to ensure that countries all over the world mobilize efforts to end all forms of poverty, fight inequalities and tackle climate change over the next fifteen years. One of the targets to achieve Goal 1: Ending poverty in all its forms everywhere is the implementation of national social protection systems. Definitions of social protection vary, but often follow Devereux and Sabates-Wheeler: ‘Social protection describes all public and private initiatives that provide income or consumption transfers to the poor, protect the vulnerable against livelihood risks, and enhance the social status and rights of the marginalised;with the overall objective of reducing the economic and social vulnerability of poor, vulnerable and marginalised groups’ (UNICEF, 2004).

A key vulnerable group are adolescents in Africa, who suffer from low life expectancy, and health and gender inequalities. Government-provided cash transfers are currently being implemented and have been shown to improve health, education and sexual health. However, cash transfers may not be enough and there may be a need for programmes that also take care into account. State adoption of broader social protection policies – as outlined in the SDGs – would represent a considerable political and fiscal undertaking and there is a need to know whether cash alone, care alone or ‘cash plus care’ have potential impact on health-relevant SDG outcomes.

This study assesses whether social protection provision can impact 17 indicators of five key health-related SDG goals amongst adolescents in South Africa and whether social protection shows different patterns of effect for boys and girls. The 17 indicators include food insecurity, HIV-risk behaviours, mental health, school dropout, sexual violence, amongst others. The aim of the research is to test:

  • the associations between social protection and indicators for health-relevant targets of five SDG goals, amongst highly deprived South African adolescent boys and girls
  • for potential interactions between social protection and socio-demographic co-predictors of adolescent health
  • where ‘cash’ and/or ‘care’ forms of social protection are effective, or where combined ‘cash plus care’ can provide additive benefits

This work was supported by the Economic and Social Research Council and the National Research Foundation [grant number RES-062-23-2068], UNICEF, the National Department of Social Development, the Claude Leon Foundation, the Nuffield Foundation [grant number OPD/31598], the Health Economics and HIV/AIDS Research Division at the University of KwaZulu-Natal [grant number R14304/AA002], the John Fell Fund [grant number 103/757], the Leverhulme Trust [grant number PLP-2014-095], the University of Oxford’s ESRC Impact Acceleration Account, the Community Care study funded by Sweden-Norad, Helpage and UNICEF, and the European Research Council under the European Union’s Seventh Framework Programme [FP7/2007-2013, grant agreement 313421].


The researchers conducted a longitudinal survey of adolescents aged 10–18 between 2009 and 2012. The adolescents (56.7% female) were interviewed at baseline (2009–10) and followed up at one year (2011–12). Two urban and two rural health districts, all low-income, high HIV-prevalence and majority black African, were selected within two South African provinces: Mpumalanga and the Western Cape. Within each health district, census enumeration areas were randomly sampled until sample size was reached. In each area, every household was visited and included in the study if they had a resident adolescent. Household receipt of social protection in the form of ‘cash’ (economic provision) and ‘care’ (psychosocial support) social protection, and health-related indicators within five SDG goals were assessed. Gender-disaggregated analyses included multivariate logistic regression, testing for interactions between social protection and socio-demographic covariates, and marginal effects models.

The dataset, ‘Young carers for AIDS-ill parents: social, health and educational impacts’, has been deposited with the UK Data Service and is available for download to all registered users under End User Licence.

Findings for policy

Findings showed that social protection is associated with significant adolescent risk reductions in 12 of the 17 SDG health-related indicators, spanning:

  • SDG 2: hunger
  • SDG 3: AIDS, tuberculosis, mental health and substance abuse
  • SDG 4: educational access
  • SDG 5: sexual exploitation, sexual and reproductive health
  • SDG 16: violence perpetration

For six of the 17 indicators, combined ‘cash plus care’ social protection showed enhanced risk reduction effects. Two interactions showed that effects of care varied by poverty level for boys’ hunger and girls’ school dropout. For tuberculosis, and for boys’ sexual exploitation and girls’ mental health and violence perpetration, no effects were found and more targeted or creative means will be needed to reach adolescents with these challenging burdens.

The research shows that social protection has the potential to positively impact multiple domains of adolescent health and wellbeing and therefore to contribute to multiple aspects of the SDG agenda. Findings suggest that a combination of ‘cash plus care’ social protection may be an effective way to maximise health and well-being benefits for at-risk adolescents. The authors emphasis that “the findings highlight the value of providing ‘care’ as well as ‘cash’, suggesting the importance of resource allocation to psychosocial care in a time of global cuts and reliance on NGO and soft providers. It is clear that social protection does not solve every societal problem and that for key outcomes such as tuberculosis and mental health we will need additional, targeted investments. But the wide-ranging impacts of social protection also provide a major opportunity“.

Read the report:

Cluver, L.D., Orkin, F.M., Meinck, F., Boyes, M.E., Yakubovich, A.R., Sherr, L. (2016) ‘Can Social Protection Improve Sustainable Development Goals for Adolescent Health?’, PLoS ONE, 11(10): e0164808. doi:10.1371/journal.pone.0164808

The research findings were used for the Policy Brief: Social Protection and the Sustainable Development Goals by the Young Carers South Africa research group which conducts quantitative and qualitative research to generate evidence that informs social policy and intervention design on the best ways to care for and support young people and families living in AIDS-affected communities in South Africa.

The report has been highlighted as a useful resource in the November 2016 edition of the Bangladesh Adolescent Health Newsletter by The Evidence Project.