Empowering destitute people towards transforming communities

5.2Institutional problems

5.2.1State failure

In South Africa, as in the world, many problems are associated with the system of aid (and/or welfare). It would seem that the state cannot keep up with the growing problem of poverty. The bigger the problem, the larger the necessary system of aid and welfare must be. This is part of the problem facing institutions using a “deficiency-based approach”, also called a “needs-based approach”. In such approaches, the state is seen as, and must act as, a saviour and helper. In opposition to this, asset-based approaches facilitate communities assisting themselves. Such approaches would actually lighten the load on state welfare systems. This is discussed in detail in later chapters.
The success and/ or failure of the state in South Africa can be much debated, and the current government is evaluated by the “Country Report on Human Rights Practices of 2006”. However, “state failure” reflects a global and local challenge to government to make good on its stated intentions, and as such must be seen as advocacy to challenge the state, rather than criticize the state.
Narayan and Petesch (2002:487-493) define state failure in this context as a failure to serve poor people. They focus on states rather than on other developmental actors, because governments lay down the essential policy environment that affects the speed and quality of development. Government policy shapes the actions of poor people, the private sector, NGO’s and donors. These authors add that a difficult lesson of development has been that it matters not only what actions are taken to reduce poverty, but also how these development decisions are made, acted upon, and evaluated.
They continue by stating that the problem is poverty, not poor people. This statement separates the issues in an important way. Those who care most about reducing poverty are the poor people themselves. Therefore, effective poverty reduction must tap into the motivation, desire, determination, imagination, knowledge, networks, and organizations of impoverished men, women and children. This necessitates asset-based approaches as opposed to needs-based approaches. Given the scale of the problem, any poverty reduction strategy must mobilize the energy of poor people to take effective action and make them essential partners in development. From the findings of their research the said authors suggest five actions to reorient states to become more effective agents of poverty reduction. They call these actions an “Empowering Approach to Development” (Narayan and Petesch, 2002: 487-493). These actions include (1) promoting pro-poor economic policies; (2) investing in poor people’s assets and capabilities; (3) supporting partnerships with poor people; (4) addressing gender inequity and children’s vulnerability and (5) protecting poor people’s rights

5.2.2Lack of appropriate social assistance and services

Often services are simply not available, especially in developing countries that cannot afford services, and where the destitute cannot pay for those services. Also, the destitute often struggle to gain entry into services, for a variety of reasons (such as the lack of a permanent address). In addition, services are often not accessible, or appropriate to the problems of the destitute (Morse, 1992:3–14). This includes the lack of (1) mental health care and policies; (2) of integrated care for convicts (after leaving prison); (3) of coordination and cooperation between helpers (organizations and services) and (4) of affordable health care.

Regarding the last mentioned, this remains a challenge for families and individuals struggling to pay the rent: a serious illness or disability can start a downward spiral into destitution, beginning with a lost job, depletion of savings to pay for care, and eventual eviction. Most, if not all people in South Africa living in poverty carry no health insurance of any kind, because it is simply too expensive, especially in our country. And while public hospital services are available, people are often obliged to wait more than a day to be helped, after they have struggled to reach the hospital in the first place, since health services are not readily accessible to people, especially the poor.

Now bring HIV/ AIDS into the picture: a sickness leading to numerous health problems, necessitating continued high-cost health interventions.

There are numerous barriers to treatment and recovery opportunities. Barrett (2004:2-3) explains the challenges of health care in South Africa as follows:

The most pressing (challenges) include: low pay for health workers; despair about AIDS and the government's reluctance to provide clear treatment guidelines; lack of basic infrastructure such as roads and telephones in remote rural areas, which makes TB testing difficult (South Africa has the highest TB rates in the world, fanned by HIV); and the growth of multi-drug resistant TB, which has already killed health workers. To add to this, there is a high incidence of poverty-related illnesses, including TB, malaria, cholera, hepatitis B, and measles. Malnutrition is rife – stunting affects up to 27% of children. About 2.5 million people are malnourished and a further 14 million at risk. There is concern that the massive poverty-alleviation program, together with improvements in water supply, sanitation, nutrition, and vaccination, could be submerged by the tidal wave of HIV. Already AIDS patients fill 40% of beds in some hospitals. (2004: 2-3)

5.2.3Difficulty accessing systems of help

“Systems of help” encompass welfare systems and services, even NGO’s and CBO’s, including case management, health services, housing services etc. Often the destitute cannot access these services of help; because (1) they do not know about available services; (2) experience transport problems; (3) some services require a valid ID and/ or address to be accessed; (4) services are simply not available.
According to Bhorat et al. (2006:47) there has been an increase in the delivery of government services between 1993 and 2004 in South Africa. However, African, rural and female-headed households remained particularly vulnerable, with the bottom group of households witnessing relatively slower increases in their access to services and assets between 1993 and 2004. Hence, poor people still experience severe problems accessing these services.