​The Care Dependency Grant (CDG) for children with disabilities in South Africa is insufficient to meet the needs of these children and to ensure the social protection of their families. For families with minimal or no other income, the CDG cannot cover the additional costs of managing childhood disability and even those who gain access are at risk of extreme poverty.

This is according to Dr Zara Trafford from the Institute for Life Course Health Research in the Department of Global Health at Stellenbosch University (SU).

“None of the South African government's cash transfer (“grants") programmes are intended to serve as standalone social protection, but there is a particularly dire lack of responsibility for disability and support for disabled children from government bodies beyond the Department of Social Development," says Trafford who received her PhD in Psychology on Monday 11 December 2023 at SU's December graduation. For her doctorate, she explored the perspectives of different stakeholders regarding the implementation and administration of the CDG.

According to Trafford, the CDG is a greatly under-researched topic compared to the Child Support Grant (for poverty alleviation) and the adult Disability Grant. She adds that the CDG is not top of mind for politicians because Government has not prioritised disability enough.

As part of her study, Trafford interviewed parents who receive the CDG, South African Social Security Agency (SASSA) officials, doctors who conduct CDG assessments, social workers, activists, academics and adults with disabilities. She also held focus group discussions with some of the parents.

Trafford says that although the CDG provided much-needed support to families, it was simply not enough to support children with disabilities due to high unemployment, the lack of respite care, and a lack of complementary services and provisions from other government departments.

“All stakeholders were aware of the excessive costs involved with childhood disability but knew that the CDG was usually absorbed into an income pool and used to care for everybody in the household, and to pay for other services that should be free or heavily subsidised by Government, such as accessible transport, appropriate education and disability-inclusive healthcare for their child with disability."

She adds, however, that stakeholders differed in their understanding of the intended purpose of the CDG.

“Caregivers felt that because they often had to stay away from work to provide proper care to their child, the CDG should provide for all of their disabled child's needs, at the very least.

“Doctors saw the CDG as a fund that would allow families to cater to the developmental needs of their disabled child but were also aware that state budgets were strained and worried that there might be problems with fairness across the country.

“SASSA officials saw the CDG as an acknowledgement of the full-time care often required for children with disabilities, but also emphasised that the CDG was not intended as total income replacement."

Excluded

Trafford says these different interpretations stem, in part, from the vagueness of the Social Assistance Act, which defines the CDG as being for the primary caregiver of a person under 18 who requires “permanent care or support services due to their physical or mental [sic] disability". The nature and extent of the care and services in this definition is not otherwise detailed, leaving room for conflicting interpretations and confusion, she adds.

“Partly because of the confusion around purpose and eligibility and the gatekeeping power available to frontline administrators and health workers, many children who would benefit from the CDG (and should technically be eligible) seem to be excluded."

Trafford points out that social workers and assessing doctors also indicated that families struggled to access the CDG early enough for optimal effects on the health and wellbeing of recipient children.

“Government entities are concerned about 'inclusion errors' (i.e., people who are ineligible for specific grants gaining access to those grants fraudulently), but it seems that for the population that should benefit from the CDG, exclusion errors are a much larger problem."

“While the caregivers who participated in my study had eventually gained access to the CDG, this had often been delayed for many years. In most of these cases, parents had only gained access after repeated rejections from frontline SASSA officials, although these officials are not technically supposed to make these decisions."

Trafford says the implementation of this grant is also hampered by the assessment process to determine if a child is eligible to receive it.

“The doctors I interviewed were all specialists in paediatric development and felt well-equipped to conduct these assessments. However, this is not necessarily the case in rural areas and less well-resourced provinces, where the lack of available doctors adds to waiting times and frustrations around (perceived and actual) unfairness in the distribution of these grants. There are also ongoing delays in registering births, which can impede access to sources of state-subsidised support."

Trafford mentions that parents were also worried about their children's transition to adulthood because the adult Disability Grant is not automatically given to those who previously received a CDG.

She calls for intersectoral collaboration and the prioritisation of disabled children's rights to enhance the impact of the CDG and ensure children with disabilities have a better quality of life.

• ​Photo: Dr Zara Trafford at the graduation ceremony. Photographer: Stefan Els

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