Summary

Latin America has been particularly hard hit by the COVID-19 syndemic, including the associated economic fallout that has threatened the livelihoods of most families. Social protection platforms and policies should have a crucial role in safeguarding individual and family wellbeing; however, the response has been insufficient to address the scale of the crisis. In this Viewpoint, we focus on two policy challenges of the COVID-19 syndemic: rapidly and effectively providing financial support to the many families that lost livelihoods, and responding to and mitigating the increased risk of intimate partner violence (IPV). We argue that building programmatic linkages between social protection platforms, particularly cash transfers, and IPV prevention, mitigation, and response services, creates synergies that can promote freedom from both poverty and violence.

Introduction

Intimate partner violence (IPV) is a core facet of the COVID-19 syndemic.^1, 2, 3 A pandemic even before COVID-19,⁴ risk of IPV—including emotional, physical, or sexual violence from an intimate partner—increased with lockdowns and impoverishment. Government responses have focused on bolstering emergency helplines and other reporting mechanisms, shelters, and police or judicial responses.⁵ However, continuity of services has been challenging, and reports from law enforcement and health providers indicate barriers to help seeking, suggesting that violence has often gone unreported and untreated.⁶ A patchwork of policy responses emerged as some governments closed presential emergency services or offered inconsistent online assistance, whereas others classified at least some IPV programmes as essential.⁷An effective syndemic response should simultaneously address deteriorating socioeconomic conditions and co-occurring risk factors, such as IPV, by identifying effective interventions and implementation platforms, and combining them in ways that target multiple goals and promote synergies. The diagonal approach to global health and health system strengthening^8, 9 seeks to overcome barriers between vertical and horizontal programming by leveraging systemic health-care programmes and policies, and linking them with interventions specific to risk factors or disease. The social protection or cash transfer (CT)-plus model is a similar approach, in which complementary programmes are explicitly linked to or embedded in CTs (ie, direct monetary payments to eligible populations), often to alleviate non-financial barriers and to catalyse more sustainable impact.¹⁰Although social protection encompasses various economic programmes and policies, CTs stand out for their effectiveness and scalability.¹¹ Decades of rigorous evaluation show that CTs, in both conditional and unconditional forms, are effective in improving maternal and child health, increasing educational attainment,¹² reducing household poverty, and building resilience to crises.^11, 13 Additionally, CTs can provide operational platforms at scale for imbedding IPV reduction efforts, help to prevent IPV, and offer crucial economic support for survivors of IPV; however, these linkages are rarely operationalised.¹⁴ In Latin America, CTs are well placed to reach women, given that they typically target mothers as caregivers of children, focusing on poor and vulnerable segments of the population. The COVID-19 syndemic has offered an essential juncture to re-examine these synergies and to reimagine future policy and programming.

A diagonal and social protection plus approach to meet the challenges of the COVID-19 syndemic: cash transfers and intimate partner violence interventions in Latin America Blofield, Merike et al.The Lancet Global Health, Volume 10, Issue 1, e148 – e153