Abstract
Families in the Occupied Palestinian Territories face political and social problems that reinforce poverty and undermine well-being. Since the limited self-governance era, Palestinian National Authority implemented anti-poverty reforms, including national cash transfers; yet, little is known about how social assistance is perceived by beneficiaries. This exploratory study analyzed transcripts from interviews with Palestinian heads of households. Families were unclear about eligibility requirements and frustrated with funding changes. Cash transfers did not cover basic living requirements, forcing painful budget choices. Participants characterized social workers as generally effective but offered suggestions for program improvement. Implications for policy and future research are discussed.
Introduction
In the Occupied Palestinian Territories, social problems such as high rates of poverty, unemployment, and food insecurity – combined with the daily pressures of military occupation, periodic war, and daily violence – represent direct threats to the well-being of Palestinian families. In only one decade, for example, the absolute consumption poverty rate increased from 20.3 percent (1998) to 34.5 percent (2007) in the West Bank and Gaza (Palestinian Central Bureau of Statistics [PCBS], 2009). Nearly one-fourth (23.8%) of all Palestinians live in extreme poverty, and the overall unemployment rate in 2008 was 26 percent (PCBS, 2009). Moreover, almost one-fourth of Palestinian families (22%) in the West Bank (and 52% of families in Gaza) suffer from food insecurity (World Food Programme/Food and Agriculture Organization [WFP/FAO], 2011).
Throughout recent history, traditional anti-poverty programs – designed by foreign and colonial powers (Safadi and Easton, 2014) – have provided services to impoverished, marginalized Palestinians. A decade after assuming governance in 1994, the Palestinian National Authority (PNA) instituted a series of anti-poverty reforms and attempted to transition to a social protection approach. In 2010, the Ministry of Social Affairs (MoSA) developed and implemented the Palestinian National Cash Transfer Program (PNCTP), an initiative that remains in effect (Jones and Shaheen, 2012; Safadi, Easton and Lubben, 2015). Despite the theoretical and strategic intentions of the new social protection approach, little is known in the scholarly literature about the ramifications of such programs on the lives of everyday Palestinians. This knowledge is important as it could inform the design of anti-poverty initiatives in the Occupied Palestinian Territories and identify important areas for future research. Thus, the purpose of this exploratory study is to understand the process and impact of social assistance from the perspective of program recipients: Palestinian families.
Social protection programs and poverty
Social protection programs in developing countries emerged in the past few decades as an alternative to the traditional safety net approach to social welfare. Sometimes characterized as residual and paternalistic (Devereux and Sabates-Wheeler, 2004), safety nets provide assistance through means testing to deserving individuals from designated groups (e.g. widows, orphans, older adults, and people with disabilities; Harrick, 2008). The World Bank (2001b) initially used the term social protection to encompass a new generation of safety nets in the context of labor markets and risk management. These programs were designed to enhance the capacity of impoverished, vulnerable groups, help them move out of poverty, and empower them in responding to periodic shocks (e.g. job loss, major illness, natural disaster; Organization for Economic Co-operation and Development [OECD], 2009). In contrast to traditional programs with short-term goals, social protection programs include broader, long-term goals, such as accumulation of human capital and reduction of structural inequalities and causes of poverty (Jones and Shaheen, 2012; Rawlings, 2004).
Social protection strategies consist of a wide variety of programs, such as social transfers (cash or in-kind), access to basic services, pension programs, and empowerment programs (Barrientos and Hulme, 2008; McConnell, 2010). The most common type of social transfers in developing countries – cash transfers – provides cash allowances to vulnerable households with little income on the condition that recipients invest in the human capital of their children, including education, health, and nutrition (Drolet, 2014; Fiszbein and Schady, 2009). As an innovative approach to social welfare, conditional cash transfers are designed to help offset economic shocks and promote positive social and health-related outcomes for children (Fernald, 2013). The target group is usually families living in extreme poverty that have school-aged children (Buenrostro, 2011), as these households are most vulnerable to economic crises. The underlying assumption of cash transfer approaches is that targeting families in extreme poverty produces more benefits than would policies with a universal approach (Fiszbein and Schady, 2009; World Bank, 1990). An increasing body of evidence supports the efficacy of cash transfer programs in advancing social protection (Arnold et al., 2011; Drolet, 2014; Ranganathan and Lagarde, 2012; Rawlings, 2004).
Other scholars, however, contend that social protection programs reduce suffering rather than accelerate economic growth or advance equality. Instead of addressing a nation’s long-term poverty problems, these programs are more effective at providing basic short-term services (Devereux and Sabates-Wheeler, 2004). Cash transfers have also been criticized as unsustainable, dependent on international donor priorities, and inefficient in targeting (McCord, 2009). Some targeting strategies miss sizable numbers of vulnerable sub-populations (e.g. older adults, childless couples, and families with older children; Fiszbein and Schady, 2009; Robertson et al., 2012). Although evidence supports the effectiveness of cash transfers in several Latin American countries, it is unclear whether such programs can be successfully replicated in regions with environmental circumstances such as war or lack of autonomy (Rawlings, 2004), as in the case of Palestine.
Anti-poverty programs in Palestine
Anti-poverty programs in the Occupied Palestinian Territories were historically developed by colonial (e.g. England) and administrative (e.g. Egypt, Jordan) powers. These programs provided basic services to needy Palestinians, but did not include broader goals such as promoting citizens’ well-being. The programs simultaneously failed to meet citizens’ needs or empower members of society experiencing poverty (Safadi and Easton, 2014). For nearly 30 years (1967–1994), social welfare programs in Palestine were administered by occupying Israeli authorities (Jones and Shaheen, 2012). At the start of the era of limited self-governance in 1994 (Safadi et al., 2015), the PNA inherited social programs from the Israeli government. These programs provided basic services to specific groups, but were insufficient in meeting the broader needs of Palestinians living in poverty (Safadi and Easton, 2014).
The PNA later implemented Social Hardship Cases as its central poverty alleviation program (PNA, MoSA, 2010). As the largest social assistance program operating in the West Bank and Gaza, this program provided cash and in-kind assistance to eligible families that met general income criteria. The primary targets were households in which the primary breadwinners were absent or partially or fully incapacitated (e.g. older adults, divorced/widowed women, and persons with disabilities; PNA, MoSA, 2010). According to the World Bank (2001a), the coverage of this program was modest and only reached about 30 percent of Palestinians living in poverty by 1998. The level of assistance was insufficient to move families out of poverty; 40 percent of households that received social assistance continued to live below the poverty line. Moreover, social assistance suffered from large-scale misallocation to the individuals who were not living in poverty (World Bank, 2001a). Because eligibility was determined by social workers during home visits, critics charged that the selection criteria were unclear, subjective, and biased (Jones and Shaheen, 2012).
Sources of informal support have also diminished in recent years. With increased restrictions on travel and the flow of services and goods in and out of the West Bank and Gaza, families’ relatives and friends have been unable to provide adequate support to vulnerable families (Jones and Shaheen, 2012; World Bank, 2011). Other challenges to combating poverty in Palestine include several structural factors: a weak economy, high unemployment, lack of coordination among service providers, periodic war, and continued Israeli occupation (PNA, MoSA, 2010). A PNA, MoSA (2010) report stated that MoSA’s mission was obstructed by the ongoing ‘exposure of … Palestinian families to severe repetitive shocks and fluctuations’, including regular military actions by the Israeli army and economic and social restrictions (p. 5). These dynamics, coupled with the service provision problems outlined earlier, created the context in which the PNA introduced major anti-poverty policy initiatives.
In an attempt to reform the Social Hardship Cases program and create clear eligibility criteria for measuring family need, MoSA developed the Social Safety Net Reform Project in 2005 (Shalabi and Ladadweh, 2009). The target groups were households with no (or very low) income and families with disabled members, the ‘poorest of the poor’ (PNA, MoSA, 2010: 12). Using objective statistical measures to calculate household consumption, the program identified beneficiaries based on the results of a proxy means test formula. The program goal was to provide assistance to 45,000–55,000 families living in poverty at a cost of US$240m over a 2-year period (2006–2008). However, because the World Bank funded this program with US$10m, only 5% of the eligible families received assistance (FAO, 2008).
In 2010, the PNA merged earlier anti-poverty programs into the PNCTP, thereby instituting a unified approach to social protection. The PNCTP provided cash assistance to families living in extreme poverty based on eligibility criteria that measured family need in a clearer, objective manner (Jones and Shaheen, 2012; PNA, MoSA, 2010). After a family completes a targeting application the information is entered into a MoSA database, which then calculates household consumption using a World Bank (2012) regression formula. The formula is based on 31 indicators of human consumption and census data collected by the Palestinian Census Bureau of Statistics (Jones and Shaheen, 2012). MoSA staff inform applicants of their eligibility and enroll families in the program. Although the MoSA vision is based on comprehensive and sustainable social development, relief services are still its main focus due to high demands for emergency aid from families (Birzeit University, Development Studies Programme, 2005). In addition to cash transfers, MoSA provides in-kind support packages related to health, education, and nutrition (Jones and Shaheen, 2012).
Gaps in knowledge base
Other than agency reports and government documents, very little scholarly work has been conducted recently in the Occupied Palestinian Territories to understand anti-poverty programs as experienced by aid recipients. Numerous questions remain, including how families negotiated the application process, what types and levels of assistance were received, how families evaluated relations with MoSA employees, and what was the perceived impact of the assistance on family lives. More research is needed to amplify the voices of these marginalized, vulnerable stakeholders (Safadi and Easton, 2014), one of the many purposes of qualitative research (Maton et al., 2011). The objective of the current study was to increase understanding of the process and impact of Palestinian social assistance from the perspective of aid beneficiaries.
Methodology
This exploratory study was a qualitative analysis of data gathered during semi-structured interviews with Palestinian families in the West Bank. The interviews were part of a larger research project that examined the formulation of anti-poverty policies in Palestine (see Safadi, 2012). All data were collected by the second author (N.S.S.) during the summer of 2010. The current study received human subjects approval from the Institutional Review Board of an American research university in the Northeast. Extensive efforts were taken to protect the privacy of study participants.
Sampling and participants
Given numerous pragmatic obstacles to data collection, ranging from personal safety concerns to local distrust of researchers, this study relied on purposive sampling of Palestinian families receiving social assistance from the PNA. To access this population, N.S.S. contacted MoSA officials at their office in the West Bank city of Ramallah. As the main provider of social services for economically marginalized groups within Palestinian society, MoSA leads ‘… national efforts aimed at combating and reducing poverty on one hand, and of developing and empowering the poor for self-reliance, on the other’ (PNA, MoSA, 2010: 2). After a series of meetings with ministry officials in the Directorate in Ramallah and Al-Bireh, MoSA approved the project. The researcher then met with a senior social worker from MoSA who was formerly responsible for the Social Hardship Cases Program and currently helping administer the PNCTP. This key informant provided names of seven families who (1) were currently receiving assistance through the PNCTP, (2) had received assistance for several years in the recent past, and (3) lived in or near Ramallah. All but one of the seven families chose to participate in the study.
The final sample consisted of heads of households of six Palestinian families receiving social assistance from MoSA at the time of this study. Four of these participants were married men; two heads of households were women living without a spouse due to death or abandonment. Most participants were in their middle to late 30s and had less than a high school education. Most men were unemployed at the time of the study; previous jobs or occupations included car mechanic, restaurant kitchen worker, blacksmith, and khadraji (street vendor). Except for one couple who experienced infertility, each household included three to six children. Three men suffered from mental health disabilities which they self-reported as schizophrenia, depression, and ‘manic-depression’. For these cases, interviews were conducted with both the head of household and his spouse.
Procedures
Data were collected through semi-structured interviews with heads of households. Prior to each interview, the researcher explained the reasons, format, and content of the study and reviewed confidentiality safeguards (e.g. removal of personally identifiable information from dataset, assignment of code numbers to participants, and reporting results in anonymous forms). Participants then signed informed consent documents. Interview protocol included a series of questions in topic areas, including family background information, application process for receiving assistance, effects of assistance on family well-being, and impressions of the assistance process. The protocol was designed to allow the researcher to take detailed notes during the interview (Creswell, 2007). It was also designed to ease administrative burden on participants, promote privacy and trustworthiness, and provide the researcher with flexibility to pursue topics that emerged in the interviews.
All of the interviews were conducted in the first language of the participants (i.e. Arabic) and lasted 45–60 minutes. Three of the families authorized the researcher to audiotape interviews, which were later transcribed verbatim by a graduate assistant fluent in Arabic. For the other three families who did not authorize recording of interviews, the researcher took copious notes in Arabic following each question. She also periodically checked with participants to verify the accuracy of the recorded notes. Additionally, the researcher recorded observations about participants and their environments both during and immediately following interviews. All interview transcripts and research notes were then translated from Arabic into English by a nationally certified college language instructor in the United States with more than 20 years of translation experience. To promote accuracy, the translation expert used standard techniques such as adaption, transposition, modulation, and back translation (Fawcett, 1997).
Data analysis
Researchers took steps during data analysis to ensure trustworthiness of results (Shenton, 2004). As articulated by Lincoln and Guba (1985), trustworthiness in qualitative research is established using four criteria: credibility, transferability, dependability, and confirmability. Each of these criteria is described below in the context of the current study.
Credibility
Lincoln and Guba (1985) define credibility as confidence in the accuracy of findings. Using qualitative conventional content analysis (Hsieh and Shannon, 2005), researchers read the translations multiple times to identify primary themes and ideas. This method of analysis is recommended when a field of study lacks extensive literature or theoretical models (Hsieh and Shannon, 2005). During this process, researchers took notes, highlighted passages, and identified codes (Miles and Huberman, 1994) that captured key ideas related to our primary research question: ‘How do Palestinian families perceive the process and impact of receiving social assistance?’
Transferability
Transferability refers to the ability to apply findings to other contexts (Lincoln and Guba, 1985). The focus of this study is on Palestinian families receiving social assistance from a government social service agency. From one perspective, the study is particular to this vulnerable population and designed to help inform practice with this population. However, findings may also be relevant to families experiencing poverty who receive assistance in other Arab countries, particularly those whose social backdrop includes armed conflict or military occupation.
Dependability
To be trustworthy, results from qualitative studies must be consistent and replicable (Lincoln and Guba, 1985). Toward these ends, a thorough audit trail (Rodgers and Cowles, 1993) was kept. The audit trail consisted of audio recordings, original transcripts and researcher notes in Arabic, translation materials and documents, and notes on analytic decisions.
Confirmability
Confirmability means that results are neutral in nature and not subject to researchers’ biases or interests (Lincoln and Guba, 1985). In a series of analytic meetings (both in-person and internet-based) and regular electronic conversations, the researchers discussed, reviewed, and refined the codes to highlight the main ideas expressed by participants. These codes were then grouped into domains, and supportive participant quotes were identified.
Findings
Application process
All participants indicated they had little information about the various social programs administered by MoSA or the actual program from which they were receiving benefits. For example, one respondent stated, ‘The [MoSA worker] did not say the type of assistance. I don’t know the name of the program that I receive assistance from’. Additionally, respondents did not know many program details such as eligibility criteria or other MoSA services available to families. Each participant was able to articulate their experience of poverty and the reason for seeking assistance, such as disability due to mental illness for the head of household. One woman explained,
We needed assistance for my husband because he is sick. The doctors diagnosed him with depression, hallucinations, and manic-depressive disorder. I was pregnant and needed health insurance. I was so thin that I couldn’t even nurse my daughter.
To apply to the programs, respondents reported that they traveled to the MoSA directorate office. At the office, participants were required to complete application forms and provide required documents. Some of the documents included copies of medical reports, children’s birth and school certificates, and a document proving that the family did not own property or have equity in a house. A respondent explained, ‘They told us to bring medical reports that showed [the head of household] was ill and the status of our house, whether we own it or not’. The next step involved multiple visits from a MoSA social worker who collected additional information through in-home interviews and observations. The woman continued,
When [the MoSA worker] came to visit our house, they asked a lot of questions like whether we own the house or not. They also asked about the number of children and rooms in the house. Also, they asked if we were receiving any kind of assistance and if it was enough or not.
Most respondents reported that after completing the application and providing documentation, it took more than a year before they started receiving assistance (one respondent reported that it took 3 months and another respondent did not remember). To continue receiving assistance after the first year, families completed additional paperwork and were revisited by MoSA social workers.
Types and levels of assistance
Households received various types of in-kind assistance, including small quantities of basic cooking supplies. A respondent stated, ‘From time to time, [we receive] two or three bags of flour, two kilos of sugar, six kilos of chickpeas, and one box of butter’. Additionally, all respondents reported that household members received health benefits, including access to health clinics, coverage for hospitalizations, and free medication. Furthermore, tuition waivers for education were provided to children. To start each academic year, MoSA provided families with modest school supplies: ‘We receive at the beginning of the school year things like school uniforms, a pair of pants, a backpack and notebooks.’
In addition to basic health, education, and in-kind services, respondents reported that they received cash assistance from MoSA every 3 months. Prior to June 2010, the value of the cash assistance for most respondents was 1000 shekels (approximately US$300). However, participants reported that they experienced a recent change in the amount of cash assistance. In June 2010, the level of cash assistance decreased substantially to between 600 shekels and 750 shekels (approximately US$180–225) every 3 months. One participant elaborated,
I used to receive 1000 shekels, but at this time I receive 600 shekels for three months. And maybe after one more year, they will cancel this assistance … We went and asked the social services [why the assistance decreased]. They said that these decisions are not theirs. They don’t even issue these checks. So I take and don’t ask.
Another participant said, ‘We don’t know why [MoSA] decreased the amount of money, and we didn’t ask’. Although they were frustrated with reductions in assistance, respondents expressed larger concerns about rumors that assistance would be terminated in the near future. Given the period of data collection in 2010, this perception may be related to the use of the proxy means test that estimates eligibility based on census data, rather than on the previous method of social work interviews.
Perceived impact of assistance
Respondents indicated that benefits were helpful to their family and grateful for the assistance. One woman stated, ‘The amount of assistance is little, [but] it is better than nothing. It helps people’. Another participant said that although the assistance does not cover all of the family’s needs, ‘… anything is better than nothing’. More specifically, the structure of the cash assistance program was appealing. The single mother continued, ‘Everything was easy … I will go and buy everything for two or three months … rice, tomato sauce, pasta, and everything we need from washing soap for clothes and for dishes’.
However, the level of the assistance was inadequate to meet the everyday needs of the families. Most respondents reported that assistance was insufficient to buy essential food items or pay bills for basic services such as electricity or water. As a result, respondents were forced to make severe changes in everyday life (e.g. dietary restrictions) and make extremely difficult budgetary choices. One woman explained, ‘I cook chicken once a week and I cook meat [only] when someone sends it to us; I do not buy meat’. Another respondent stated, ‘I do not buy many things that we want. For example, I do not buy some kinds of food such as fruits’. Some respondents had to forgo purchases of clothing and basic services:
I postpone some things; for example, children’s beds are very bad, but I can’t change them. I do not buy everything we need. I give priority to food, electricity, and water. But clothing is not important. I dress my children in anything. Also, I have a card for electricity. If I have money I add value to it. If I don’t, I will not.
To compensate for the gap between the level of family need and government assistance, families often relied on financial support from akareb al-osra (close relatives) or extended family members. One participant said that in the past year ‘… brothers of my husband had paid the electricity and water bills and my brother has paid the phone bill’. Another participant said, ‘My husband’s brother spends [money] in the house. He gives us symbolic assistance, but this amount of money is not enough to take care of our necessities’. Despite helping her husband manage the effects of severe mental illness and raising five children, one woman started a nursery in her home to increase their household income.
Regardless of the strategy used to supplement household income and assistance from MoSA, each participant reported that their family was still suffering and in great need. Although many medications were available most of the time, expensive medications (e.g. anti-psychotics) were sometimes not available and had to be purchased by the family. Respondents said, ‘Yes, but sometimes, there’s no medicine. So we buy it from our own pocket’ and ‘My mother-in-law sold her gold to buy medicine’. One participant clearly appreciated the school supplies provided by MoSA, but went on to explain:
At the beginning of school, each boy gets a pair of pants, two erasers, sharpeners, notebooks pencils. [They also get] one backpack for two kids [to share]. This is not enough. The school supplies cost between 100 to 150 shekels, not including school clothes … Their help is not very significant. It’s not enough.
Finally, one spouse summarized her family’s despair:
[I hope] that my husband gets better and starts to work so he can cover our expenses with dignity. I feel so down and that I owe people. Sometimes, I can’t give anything to my guests when they come to visit. And other times, I don’t have detergent to wash. We eat frozen meat. Not even once I brought it home fresh.
Interactions with ministry workers and MoSA
Most respondents reported that they had an effective working relationship with social workers from the MoSA directorate and a positive view of the agency. According to participants, workers were generally helpful, informative, caring, and friendly. One person elaborated,
My experience with the social services is good. When we ask questions, they answer us very gently. The staff members are respectful. If there’s a field trip for the children, they call us. There’s an annual trip for the orphanage to the amusement park [in Baitouna City]. So they call the kids to go. They know our problems and what happened to us, so they help us.
A mother commented that MoSA workers provided key support during a critical period in her life: ‘Honestly, I thank MoSA because they stood with me in the crisis when no one else [would]. At that time I could not find [even] a closest relative to be with me.’ Other respondents noted that the approach of MoSA social workers was based on respect and dignity. A respondent reported,
When there’s assistance, they say ‘you have assistance’, so we go and take it. They make us feel that it is our right and we are going to take it. Other institutions like xxx and yyy [private charity organizations] don’t treat people with respect.
During times when assistance was delayed or suspended, participants stated that MoSA workers played a pivotal role in getting it resumed.
The positive evaluations of ministry employees were not unequivocal. One respondent expressed some dissatisfaction with the quality of workers:
It depends on the social workers … and who we deal with. Some … who have a conscience, examine and investigate, and don’t depend on the opinions of other people. But others ‘want to get bigger off of your back’.
This participant also noted that lengthy delays in receiving services and assistance heightened their frustration with MoSA and its workers.
Beyond interactions with social workers, participants offered suggestions for improving the MoSA-administered program. Suggestions included varying the types of in-kind aid (e.g. different foods each month), changing the annual payment schedule for cash transfers (e.g. quarterly to monthly), and abandoning in-kind food assistance and increasing the cash transfers. One man noted,
Three months ago, a social worker came and asked whether the assistance is enough or not. She also asked if the quality of the flour is good or not. But if [MoSA] gives us money instead of food assistance, we [would] benefit more.
Another respondent felt that the assistance level should be increased to have more impact: ‘In order to live with dignity, we need 1500–2000 shekels [per payment].’
Hopes for the future
Most respondents expressed hope that their family’s well-being would improve in the future. Two participants indicated that new employment opportunities and increased levels of cash assistance would be helpful in the immediate future. Other participants focused on educational and occupational training for their children. For example, when asked ‘What would make your life better?’, a single mother said, ‘That I raise the children and educate them so they can start helping me. That they learn a handcraft so they don’t need anybody because my children have no father to guide them and help them …’. Another mother echoed these sentiments: ‘The one thing that [would make] my life easier is education. Education is better than a vocation. When you are educated, you will be secure and your salary will be steady. Education is the key!’ Putting a great deal of faith in alinaya bil-mosnnen, the cultural expectation of caring for one’s elders, a widowed mother stated, ‘When my children grow up and become adult, my situation will be different. They will take the responsibility’.
Discussion
The purpose of this study was to understand the process and impact of Palestinian social assistance programs from the perspective of aid beneficiaries. Despite efforts to transition from a traditional anti-poverty approach to more integrated social protection strategies, our findings suggest that recent anti-poverty reforms adopted by MoSA remain inadequate to meet the essential needs of Palestinian families. Study participants simultaneously expressed gratitude for cash transfers and concerns that the assistance was insufficient for food, clothing, and daily living requirements.
The goals of social protection programs include protecting families against periodic economic shocks and empowering them to move out of poverty (OECD, 2009). According to study participants, the PNCTP had yet to accomplish either of these goals at the time of writing. Similar to other critiques of cash transfer programs (Devereux and Sabates-Wheeler, 2004), the PNCTP resembled short-term relief efforts that modestly reduced suffering for recipient families facing dire conditions.
It is important to note, however, that evaluations of social assistance programs in conflict regions are severely constrained by environmental conditions in which the programs operate. Fiszbein and Schady (2009) wrote that conditional cash transfer programs ‘… require careful consideration of local conditions’ (p. 200). In the Occupied Palestinian Territories, residents face ongoing Israeli military occupation and the daily threat of political violence. Furthermore, internal factors (e.g. divisions between Palestinian political parties), Israeli policies (e.g. roadblocks and withholding of tax revenues), structural issues (e.g. weak economy and high unemployment), and shifting international funding threaten even the most carefully constructed cash transfer program (PNA, MoSA, 2010; Safadi and Easton, 2014; Safadi et al., 2015). Rather than the exception, periodic shocks and fluctuations appear to be the norm for Palestinian families in poverty.
Another key finding was that participants experienced significant confusion surrounding their initial (as well as ongoing) eligibility for the PNCTP. Some families expressed high levels of concern that their assistance would be terminated in the near future. The uncertainty and confusion may have emerged when prior anti-poverty programs were combined and the PNCTP was implemented. In an effort to increase accountability, fairness, and transparency within PNA ministries (Jones and Shaheen, 2012), MoSA utilized a standard targeting formula developed by the World Bank (2012). The complexity of the proxy means test, however, along with an apparent lack of understanding of how and why the means test works, appears to have caused genuine distress among aid beneficiaries. Recipients’ concerns seemingly reflect more than transitional growing pains and represent an unintended consequence of program reform.
The findings also provided evidence that MoSA workers are generally forming effective working relationships with recipient families, so long as the social workers approach families with a spirit of humility. The data suggest that these social workers predominantly care for and respect the client families and feel responsible for promoting their well-being. Since these workers play a pivotal role in implementing social assistance programs, this finding represents an important organizational asset that could be leveraged in future attempts to improve the PNCTP.
Policy implications
Given the exploratory nature of this study, we offer the following tentative policy recommendations for consideration based on the perspectives of beneficiaries. To advance the goals of the PNCTP, findings suggest that assistance levels are inadequate and should be increased considerably, or varied to include other types of support that reflect beneficiaries’ needs. To generate sufficient program funding, PNA will need to continue its efforts to form effective partnerships and collaborations with contributors, such as international donors, non-governmental organizations, and private sector entities, as noted by others (Safadi et al., 2015). Additionally, effective cash transfer programs require complementary actions, including other social protection programs and services (e.g. pensions, empowerment programs; Barrientos and Hulme, 2008; McConnell, 2010). MoSA should work to develop a full array of complementary services that include these additional measures of social protection and promote greater integration with other service areas, such as elderly, orphans, and disabilities programs. Greater collaboration with community-based organizations, such as charitable associations, could also support a more integrated service approach for beneficiaries.
Beyond programmatic suggestions, the findings also support changes in implementation. MoSA staff members received mostly favorable evaluations from study participants, substantiating their ability to form effective working relationships with families. This resource represents an excellent opportunity from which to address other issues, such as the confusion and distress surrounding the PNCTP, proxy means tests, and funding eligibility. With knowledge of the PNCTP, MoSA workers could lead outreach efforts to educate Palestinian households on program goals, application processes, and eligibility requirements. After gaining trust and access to family households, workers can also be valuable in terms of program monitoring, evaluation, and research efforts. Conversely, as consumers of cash transfers, families can provide valuable program feedback to MoSA. In our study, families had numerous suggestions that workers could convey back to ministry leadership. Workplace training programs for MoSA employees should incorporate strategies and techniques for educational outreach, evaluation research, and client feedback.
All policy recommendations could be enhanced with a reduction of the shocks and constraints faced by Palestinian families, realities endemic to the political conflict between Palestine and Israel. Scholars have noted that effective and sustainable social welfare reforms require a stable, independent political system that can maintain reforms and advance national priorities (Farazmand, 2002). Although the topic of moving from limited self-governance to full autonomy or Palestinian statehood is beyond the scope of this article, progress in this arena would create new opportunities for implementing effective anti-poverty programs in Palestine.
Future research
The findings have important implications for future research on poverty and social protection efforts in Palestine. Additional studies are needed to understand more fully the impact of cash transfer programs on Palestinian households. A key condition of such programs is that recipients invest in human capital within their household, especially with regard to children’s education, health, and nutrition (Drolet, 2014; Fiszbein and Schady, 2009). Researchers should explore difficult investment choices faced by Palestinian heads of households and the extent to which assistance is allocated between short-term needs and longer-term development. Beyond serving as a buffer to economic shocks, cash transfers are intended to promote positive social and health-related outcomes for children (Fernald, 2013), and reduce structural inequalities and poverty (Jones and Shaheen, 2012; Rawlings, 2004). Through qualitative and quantitative methods, future studies should assess a broad range of health outcomes for Palestinian children living in recipient households. Longitudinal studies, which track Palestinian families over time, could evaluate whether programs such as the PNCTP have an actual effect on rates of poverty. Conditional cash transfers could also be implemented with selected households to evaluate whether assigning conditions results in improved health and social outcomes for children, above and beyond simply receiving cash (Robertson et al., 2013).
More research is also needed to assess the targeting efficiency of cash transfers in Palestine. Scholars have critiqued cash transfers for being inefficient in identifying potential beneficiaries (McCord, 2009) and for overlooking needy sub-populations (Robertson et al., 2012). With evidence of widespread deprivation in the West Bank and Gaza, it is likely that impoverished, marginalized segments of Palestinian society do not qualify for the PNCTP. This may be due to the cash transfer strategy of empowering the ‘poorest of the poor’ (PNA, MoSA, 2010: 12). While the World Bank (2012) has indicated that proxy means testing is largely effective in targeting extremely poor Palestinians, anecdotal evidence suggests that beneficiaries and MoSA staff experience confusion and anxiety about this approach. Research with other low-income Palestinian families (e.g. case studies, needs assessments) may shed further light on whether the PNCTP is actually meeting needs of the most vulnerable households. This research would magnify marginalized voices and inform comprehensive poverty reduction efforts that meet the complex needs of beneficiaries.
Finally, scholars should explore the effects of socio-political environment on the effectiveness of Palestinian social assistance programs. Since most research on cash transfers has been conducted in middle-income, Latin American countries, scholars have called for research that examines the impact of unique contextual conditions on program outcomes (Fiszbein and Schady, 2009; Rawlings, 2004). For Palestinians, existential realities, such as lack of self-determination and statehood, impose severe constraints on policymaking and program efficacy (PNA, MoSA, 2010; Safadi and Easton, 2014). These environmental realities need to be examined more thoroughly and incorporated into the design of country-specific cash transfer programs.
In interpreting the findings of this study, several limitations should be kept in mind. Due to many issues including security concerns and difficulties accessing beneficiaries, data collection was limited by location and number of interviews: six families residing in Ramallah, Palestine. There is a distinct possibility that experiences with social protection programs could vary based on location (e.g. West Bank/Gaza and rural/town/city), family characteristics (e.g. size and education level), or other factors. Beyond transferability concerns, data were collected through one-time, in-person interviews. Qualitative research techniques, such as multiple interviews, member checking, and prolonged engagement (Creswell, 2007; Rubin and Babbie, 2008), could have reduced potential bias and increased the depth and trustworthiness of findings. Due to logistical and security constraints, these techniques were not employed.
Additionally, this study and the interpretation of results have been shaped by the position and perspectives of the researchers (Lincoln and Guba, 1985). The first author (S.D.E) is Arab-American and completed a Rockefeller Fellowship in the West Bank for one year, N.S.S. is Palestinian and works in Jerusalem, and the third author (T.M.C.) has consulted for MoSA in Ramallah and Nablus. These perspectives influenced the questions asked of families and the weight given to responses as related to social protection in the Palestinian context. Nevertheless, the different perspectives of researchers were complementary and provided richness to the analysis and interpretation of results.
Finally, our analysis was based on data collected from a single source: Palestinian heads of households currently receiving cash transfers. To understand the impact of social assistance more fully, it would be helpful to triangulate data through multiple sources (e.g. program administrators, extended family members, and religious or civic leaders). Similarly, the collection of quantitative data through a mixed methods approach, including rigorous program evaluations, would enhance understanding.
Despite these limitations, this study represents one of the first attempts to understand the process and impact of the PNCTP from the perspective of Palestinian families. The research study has several strengths: interviews were conducted in naturalistic settings, the primary interviewer was a Palestinian scholar residing in the West Bank, transcripts were translated by a nationally certified language instructor, and each author has prior experience conducting research in Palestine. Beyond offering preliminary policy recommendations, the study identified specific areas for future research, a primary goal of exploratory studies (Rubin and Babbie, 2008). Future studies can build on these findings and contribute to the nascent knowledge base on Palestinian social assistance programs. Together, these efforts may contribute to the design and implementation of even more potent cash transfer programs that promote the health and well-being of vulnerable Palestinian families.
Footnotes
Acknowledgements
The authors would like to acknowledge the helpful staff at the Ministry of Social Affairs and the Ministry of Planning and Administrative Development in Palestine for their assistance with recruitment. The authors also wish to thank the Palestinian families for generously agreeing to complete the interviews and Mrs Ikram Estefan Easton for her translation efforts.
Funding
This study received funding from the US Agency for International Development, the Open Society Institute, and America-Mideast Educational and Training Services (AMIDEAST).
Author biographies
Scott D Easton, Ph.D., ACSW, LMSW, is Associate Professor and chair of the Department of Mental Health in the Boston College School of Social Work. His research focuses on social protection policies and practice in the Middle East and risk and protection factors for the long-term mental health of survivors of child sexual abuse.
Najwa S Safadi, Ph.D, MSW, is an Assistant Professor, Head of the Department of Social Work, and Coordinator of the MSW program at Al-Quds University, Palestine. Her research interests are poverty and social policy with an emphasis on anti-poverty policies, international aid, government performance, civic engagement and social welfare in Global South countries.
Thomas M Crea, PhD, MSW, is Associate Professor, Chair of Global Practice, and Assistant Dean of Global Programs. His areas of research include effectiveness of social interventions in the context of humanitarian aid and international development, and the integration of immigrants, refugees and other vulnerable populations in the United States.