The generally accepted strategy for reduction of long-term poverty comprises three components: pro-growth macroeconomic policies, human capital development, and social safety net programs. While most countries depend primarily on the first two, some countries, including some very poor countries, also have substantial safety net programs that attempt to provide assistance directly to the poorest households. An important question for all such programs is how to identify the households that need help most. Even a brief summary of the extensive literature on targeting is beyond the scope of this volume. However, it is important to note that a number of countries at different income levels and at different stages of the epidemic already have in place targeted safety net programs that could help poor households that suffer a prime-age adult death. In some of these, including prime-age adult death as a specific targeting criterion along with other criteria may help to identify the neediest families. Box table 4.9 describes five such programs.
Prior to the AIDS epidemic, prime-age adult death was rare, perhaps too rare to warrant including it as a targeting criterion. Sadly, it is now common enough that countries with targeted poverty reduction programs should consider whether and how to include it as a targeting criterion. Because this is a new area, impact evaluation of programs that attempt to do so would generate important new knowledge.
Using prime-age adult death as a targeting criterion is likely to have several advantages. Compared with providing help to families with a death from HIV/AIDS, it is fairer, since it will include families with prime-age adult deaths from other causes. Combining this criterion with others that identify the household as poor may help identify the neediest families. Since the death of a prime-age adult is usually well known to everyone in the community, using this as a targeting criterion may help program administrators identify destitute families that might otherwise be missed. For the same reason, such a criterion may be effective in minimizing opportunistic responses: feigning a household death to obtain the benefits of the targeted program for surviving household members would be very difficult. Finally, including prime-age adult death as a targeting criterion may help to increase the political acceptability of safety net programs among those who do not benefit, since many people will readily understand that poor households suffering such a death—and especially the children in such households—are likely to face severe hardship.
Sources: Besley and Kanbur 1988; Subbarao and others 1996; van de Walle and Nead 1995.
Box Table 4.9 Social Safety Net Programs in Which Prime-Age Adult Death Could Be Used as an Additional Targeting Criterion, Five Countries
| Country and state of the epidemic | Program and existing targeting criteria |
| Zimbabwe (generalized) | Feeding program. Targeted to children in drought-prone areas using nutritional surveillance data. Uses locally grown food and includes nutrition education. |
| India (concentrated) | Food grain distribution Through publicly operated "ration" shops, the states have distributed grain to anyone requesting it, but under a new government program they are required to limit distribution to those below the poverty line. |
| Honduras (concentrated) | Food stamps. Distributed through health centers to low-income children under 5 and pregnant and lactating mothers, and through schools to poor mothers and their children grades 1–3. |
| Bangladesh (nascent) | Microcredit program. Targeted to households owning less than 0.5 acre of land; group lending and peer monitoring serve the poor without collateral and ensure repayment. |
| Chile (nascent) | Cash transfer. Targeted to rural and urban poor based on their answers to a computer-scored questionnaire. |
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