A Village Far, Far Away: Do We Really Understand the Underlying Causes of Exclusion?


This page in:

 Definitions cloudA while back, I visited a village in a country whose economy has been grown rapidly over the past decade. The country has been moving quickly from its lower income status to become classified as a lower-middle income economy. The village I visited was only some 50 kilometers from a bustling provincial capital on the border, but it might as well have been 500 kilometers away. The village took four hours to reach because we had to traverse three rivers or streams, and the roads were riddled with potholes the size of lunar craters. The shoulders of the road sometimes reached up to the top of the car windows. 
There was no internet, no phone, and most definitely no technology superhighway and ‘push-one-button solution’ to development. As we went from house to house, it seemed as though everyone in the village was sick. Children were running a high fever. In one household we visited, I asked the mother who was cradling her ill son whether she had been to see a doctor. She said yes. She had managed to borrow money from her neighbor and taken three van rides to the closest health clinic with her son. One month later, however, the child had not recovered and was still running a high fever.  He could no longer go to school, and the mother was having difficulty tending her fields because she had to care for her son. I asked her if she was considering taking her son back to the clinic, and she said that even if she had the money, she would not go back. The health staff had treated her and her son badly, talking down to them and belittling them because they were poor ethnic minorities.  She and her son only felt worse after the visit, and vowed not to return, no matter how sick the child became.
Variants of this story of marginalization and social exclusion abound. In other countries, it may be the single female head of household who is stigmatized because of her lowly status, or the internally displaced person who falls through the cracks of national safety nets and household surveys, or the ethnic minority villager who cannot speak the official language and consequently is unable or ashamed to speak up at community meetings.

At times like these, I am reminded of the adage that a society will not be judged by how it treats its wealthiest members but by how it treats its weakest and most marginalized people. At the root of these issues is not so much a macro-economic diagnosis and solution but the need to recognize that the causes and effects of marginalization and disenfranchisement require a deeper understanding of the “micro”, the local contexts, and belief structures. Development works best when we understand the multi-faceted realities on the ground and take the time to explore how poor people view their world. How do they think of development, and the contours of their realities? How do we, as development partners, embrace local knowledge and understand the underlying, interdependent causes of marginalization and exclusion? And finally, are we willing to support long-term endeavors that often require deeper social and cultural understanding and multi-faceted interventions? 
These are some of the questions which the new report Inclusion Matters: The Foundation for Shared Prosperity tries to address. The report aims to kick-off a discourse within the World Bank Group and with partners on how should we approach these issues of marginalization. It argues that progress towards inclusion can be made by enhancing the three related channels of ability, opportunity, and dignity, and discusses the ways in which different countries have pursued social inclusion. Let’s start having these important conversations on how we can tackle some of the toughest, most complex and entrenched forms of exclusion. 
This blog serves as an introduction to the Social Inclusion report, to be launched during the event Social Inclusion: The Foundation for Shared Prosperity at the World Bank Group/IMF Annual Meetings on October 9.


Susan Wong

Sector Manager, Social Development

Join the Conversation

John Troughton
October 10, 2013

Great article. Diliberate economic exclusion especially by the World Bank hurts. No sure I saw any solution in the article.

Priti Ambani
October 09, 2013

Great post Susan. You rightly bring up that "..progress towards inclusion can be made by enhancing the three related channels of ability, opportunity, and dignity". I see many ways for increased private sector involvement to improve all three channels and the first step is by not thinking about these underserved populations as just another market expansion with huge ROI.
Thank you.

Robert Oelrichs
October 04, 2013

Great post, Susan. It was remarkably telling that the mother you met would rather risk her child’s serious ongoing illness than return to a clinic where she had felt alienated and devalued. This may well have been a rational choice – the technical quality of health care surely correlates with such “softer” indices. But how often does an individual fail to access services that might have been beneficial, because they fall outside the mainstream as individuals, or because the concerns of their entire community are not included in nationally tailored plans? Parents may be reluctant to immunize their children because they mistrust the intentions of a government which does not acknowledge them. Homosexual men and sex workers may shun effective HIV prevention and treatment services, rather than visit a clinic where they have been ridiculed or vilified. We indeed need to do much better across the spectrum of health to understand and measure the impact of exclusion – and to learn how to address it. I’m very much looking forward to seeing your report.

Rima Mourtada
October 05, 2013

I loved the post. I have encountered a similar situation while conducting my PhD thesis fieldwork on Syrian women's access to antenatal health care services. Many women failed to access health services or follow-up with their care because of mistrust issues as well as being devalued and mistreated by doctors and staff, and above all because the health system often failed to understand the belief structures of the communities to which women belonged. In short there were many disparities between the nature of antenatal provision and the women’s expectations, which resulted in the lack of continued engagement in health care.