Targeting Mechanisms and Eligibility Criteria

As mentioned above, the overall trend as concerns social assistance in the Arab region is that general subsidies are being reduced or abolished and that more targeted measures, particularly CT programmes, are given a more important role in the effort to reduce poverty. Simultaneously, there is a shift in how targeting for such programmes is carried out: whereas categorical targeting has historically been predominant, governments are increasingly turning towards proxy means testing (PMT), whereby a household’s level of poverty is estimated based on a number of factors such as educational attainment and whether it has access to electricity. Similar targeting methods are also used to select beneficiaries for non-contributory health insurance programmes.

One of the first social assistance schemes in the Arab region to utilize PMT on a large scale was the State of Palestine’s PNCTP, which was introduced in 2009. It replaced two previous programmes of which the biggest one had relied on categorically targeting groups deemed vulnerable, including persons with disabilities.[1] The overhaul of the main CT programme in Iraq is another telling example of the regional trend.[2]

Sudan has recently begun reforming its SIP. This undertaking includes elaborating a new PMT formula, which will serve to identify beneficiaries for the CT programme as well as for the public works scheme that will also form part of the SIP. There will also be an element of community-based targeting, meaning that members of the local community will play a role in evaluating who should receive the benefits.[3] In Mauritania, similarly, eligibility for the new Tekavoul programme will be determined through a combination of PMT and community targeting.[4]

In Egypt, meanwhile, the Takaful and Karama programme is based on a combination of categorical targeting and PMT. Eligibility thus requires belonging to a certain demographic category and passing the poverty test. Persons with disabilities, as the statistics cited above suggest, constitute one of the main targeted groups (the other one being the elderly) of the Karama component, whereas the Takaful component targets families with children.[5] Morocco’s Tayssir programme, on the other hand, relies exclusively on categorical and geographic targeting, the beneficiary group consisting of families with children in the poorest parts of the country. However, within the coming years, the Moroccan authorities intend to extend the programme to the entire country, and start selecting beneficiaries through PMT.[6]

Among CT programmes in the region, the Palestinian one is noteworthy since disability has been directly incorporated in the PMT formula as part of a “vulnerability” variable. This was done in 2011 after stakeholders raised concerns about persons with disabilities and other vulnerable groups being excluded.[7] There are indications that other programmes in the region are moving in a similar direction. For instance, the Moroccan Ministry of Health will review the eligibility criteria of RAMED to make the programme more disability inclusive.[8] In Sudan, the SIP targeting formula will be adjusted to take into account disability related costs.[9]

In Tunisia, a targeting process which incorporates disability is used to select beneficiaries for the PNAFN and for the AMGI.[10] A household’s adjusted annual income, which according to the programmes’ joint criteria must not exceed 585 dinars, is calculated according to a formula taking into account its declared revenue, its size, the number of persons with disabilities within it, and whether accommodation is rented.[11] For instance, if a family’s annual revenue is 5,000 dinars, if it consists of six persons of whom two are persons with disabilities, and if it rents its accommodation, its adjusted income will be calculated as ((5,000 – (600 x 2)) – 500) / 6 = 550. The family, thus, will have passed the revenue test and be eligible for CTs as well as non-contributory health insurance, whereas it would not have done so if it had not included any persons with disabilities. However, it is unclear exactly how much weight the adjusted revenue is given in the eligibility process as relative to other factors which are also considered, including absence of the household’s head and work incapacity of its members.[12]

Beneficiaries of Morocco’s RAMED programme are selected by means of a combination of PMT, through which a score measuring a household’s life conditions is distilled,[13] and an adjusted measure of its income (in urban areas) or a score based on its assets (in rural ones).[14] These measures are used to determine whether a household is eligible for RAMED, and if it is, whether it is eligible for the variety that is fully free or merely for the one requiring a small annual contribution.[15] It does not appear that disability is specifically taken into account at any stage of the targeting process. However, the income/PMT targeting is complemented with an element of community-based targeting carried out by permanent local committees, which may consider “other information provided by applicants such as their health status and health care-related expenses.”[16]

While the old schemes based on categorical targeting have frequently been labelled ineffective and regressive for their alleged propensity to benefit the rich rather than the poor,[17] it is possible that this critique has been somewhat overstated, at least with regard to categorical targeting of persons with disabilities. If the poverty level among persons with disabilities was calculated in a way that took into account the added expenses they face, instead of looking only at income or assets, the findings would likely show that their standard of living is considerably lower than has been thought.

The risk, then, is that the shift from categorical targeting methods to poverty-based ones, if the latter do not sufficiently take into account disability related costs, will imply that persons with disabilities who were previously deemed eligible for support lose this entitlement, with the result that they are pushed below, or further below, the poverty line. In contexts where no specific measures targeted to persons with disabilities existed in the first place, the risk is that the exclusion of this group in large part continues even as CT programmes or the like are rolled out. Complementing the PMT process with community targeting could theoretically serve to rectify this, if the community members who carry out the targeting are aware of who the persons with disabilities are and what costs they face. However, it is far from certain that they do, and it is at any rate worth asking whether the degree of arbitrariness that community based targeting entails is compatible with the rights-based approach.

In many countries, including Egypt, Morocco and Mauritania, new social protections schemes are being implemented in parallel with the establishment of social or single registries. A social registry is essentiually a registry of poor and vulnerable individuals or housholds, which can be used by a variety of social assistance programmes, as well as by non-contributory health insurance schemes, in order to identify beneficiaries. A single registry is more comprehensive and more complex, as it collects information from contributory as well as non-contributory programmes, i.e. from the social protection system as a whole.[18] While registries like these may potentially serve to enhance the efficiency, transparency, complementarity and consistency of social protection programmes, the risk is that if disability related costs are not (sufficiently) taken into account by them, this oversight will be generalized across all social asstsance programmes or throughout the social protection system (depending on the nature of the registry). For example, if a social registry does not contain information on disability, no social assistance programme using the registry to target beneficiaries will be able to take disability into account either.[19]

Notably, when disability is regarded as synonymous with work inability, and when targeting formulas do not take into account disability related costs, persons with disabilities who are able to work and are successfully included in the labour market risk being deemed ineligible for support both because they are able to work and because they may earn too much to be considered poor – even though their disability related costs may be very high and even exceed their incomes.