Social Inclusion: What Can We Do Social Inclusion: What Can We Do? Designing Inclusive Programs and Policies February 24, 2015 | 9:00 AM EST Speaker: Maitreyi Bordia Das Lead Social Development Specialist, World Bank Group

Outline Basics on social inclusion Main messages Case example Stylized steps to “doing” social inclusion Final reflections on the nature of change towards social inclusion

What is social inclusion? The process of improving the terms for individuals and groups to take part in society The process of improving the ability, opportunity and dignity of people disadvantaged on the basis of their identity to take part in society Social inclusion is… Specific to time, place and identities Multidimensional Related to poverty and inequality, but goes beyond these Both an outcome and a process

Inclusion in Markets, Services and Spaces Taking part in society Improving the terms

We can influence change towards social inclusion Examples of change Institutions can change (e.g. local justice in Bangladesh) Framing of an issue can change (e.g. race in Brazil) Cultural practices can change (e.g. foot-binding in China) Outcomes can change (e.g. education of women in Jordan) Change is inevitable. It could be towards inclusion or exclusion Policies, programs and activism play a crucial role Change may well be political but that’s not necessarily bad Change needs multiple actors Policies for social inclusion don’t always do more. They do things differently.

Example Understanding high maternal mortality among tribal women in India ‘Asking why’ and diagnosing the problem is often the first step toward social inclusion No female provider 1% 80% of Adivasi women deliver their babies at home, versus 60% of all Indian women. They do not trust facility 2% Facility not open 5% High maternal mortality among tribal women in India Husband, family do not allow 5% They don’t deliver babies in health institutions Not customary 7% (One of the reasons) (One of the reasons) (Most frequent reason) They don’t think it necessary 72% They are not treated with dignity Why? Why? Too costly 23% Why? Too far, no transport 17% Improve public & private transport Provide vouchers, grants Hold providers accountable for their behavior in addition to their technical expertise Source: World Bank team adapted from World Bank, 2011 based on National Family and Health Survey 2005 in India. Note: Percentages denote reasons for not delivering at health institutions by respondents who delivered their babies at home. mitigating measures

Create avenues for recourse and feedback loops Stylized steps to social inclusion Diagnose 'Ask Why?' Design Action Monitor Progress Create avenues for recourse and feedback loops

1. Diagnose: ‘Ask why’ Why do a large majority of tribal women say they don’t think it’s necessary to give birth in health facilities? If the reason is poverty, why are these women overrepresented among the poor? If the reason is lack of knowledge, why are they not better informed? If the reason is remoteness, why are they not connected? Through: Conducting innovative ex-ante analysis Holding meaningful consultations, including through the use of information and communications technology (ICT) to allow women to respond to questions anonymously

2. Design action Provide vouchers, grants, and culturally appropriate incentives Launch education/awareness campaigns in local language and idiom Register births and deaths Involve the community in health surveillance Use tribal systems of knowledge Establish links to other programs Make innovative use of private providers, including private transport agencies, while regulating their quality Hire more female staff from tribal communities Require cultural competency training for service providers Hold providers accountable for their behavior as well as technical skills Create incentives to providers to reside in remote areas

3. Monitor progress Establish a monitoring framework that can be accessed by tribal people Create community monitoring mechanisms Establish third-party monitoring mechanisms Use social audits and hold public meetings Conduct “verbal autopsies” Mandate citizen report cards Publicly disclose results of monitoring, including through electronic channels Use ICT to solicit anonymous feedback

4. Create avenues for recourse and feedback loop Establish an empowered ombudsman-like institution that enforces tribal rights Empower tribal women through legislation and provide them with legal assistance Create independent help-lines Establish local tribal health committees with access to district administration Form empowered grievance redress committees Establish systems to report back to communities on action taken

Maternal deaths are a somber symptom Deeper institutional issues lie beneath Alienation from traditional lands and forests Low voice Efforts have been made to address these: Legislation that gives tribal areas some measure of autonomy Special programs and special budgetary arrangements Quotas in jobs and education But implementation has been patchy: Same institutional issues have prevented adequate progress Elites have taken better advantage of quotas even as seats remain vacant due to lack of qualified candidates

The case example can be more generally applied e.g. Land Reforms; Fair Wages; Access to Credit e.g. Child Care; Transport Vouchers; Cultural Competence of Service Providers e.g. Language Policy; Safety; National Statistics 13

Promising initiatives Cultural competency training by the professional nursing and social welfare practices in the US Tailored programs for the Maori in New Zealand On-boarding programs for migrants in Norway Supra national institutions to enforce the rights of the excluded – EEOC in the US

Final reflections Social inclusion is a long term agenda – there can be long gestation periods “One stroke of the pen” changes are few; incremental changes are more common Change is often non-linear Policies may have unintended consequences Lasting change builds on inclusive settlements and institutions with appropriate incentives Social inclusion is usually “work in progress”