Exclusion, cohesion and health Johnston HB Fig. Social exclusion and health equity: a diagrammatic representation SEKN Social Exclusion Framework International agencies State Civil society Social capabilities I n individuals ce r Economic capabilities a n s o i i n coh s Private enterprisePolitical capabilities g e e x c households Religious organizations l u g s n i i Cultural capabilities o s n a e r Labour movements c Global corporations n I Unequal social positions and social stratiﬁcation Health inequities Adapted and cited with permission from Popay J, Escorel S, Hernández M, Johnston H, Mathieson J, Rispel L. Progress report of the Social Exclusion Knowledge Network. Geneva: Commission on Social Determinants of Health, World Health Organization, 2007. 18 p ary School Stipend Project (FSP) is an example of a public sector social protection programme. Female Secondary School Stipend Project (16) Education is a basic right provided by the state. Higher levels of education are linked to greater social cohesion and to more informed decision-making and actions regarding health. The FSP is a condition- al cash-transfer programme originally implemented with the intention of increasing enrollment of girls in secondary schools anticipating higher levels of education for girls as an interim step leading to the individual and societal health benefit of delayed marriage and childbearing. The FSP provides par- ents of female students in secondary schools a por- tion of tuition, school fees, and monthly stipends up to class 10 conditional upon their daughter attending a recognized institution, remaining un- married, having 75% attendance, and securing 45% marks on annual examination. The project is not targeted to a particular group, i.e. provides bene- fits regardless of financial standing. The FSP was piloted in 1977 and, by 1994, had been scaled up throughout rural Bangladesh. The FSP has not been well-monitored and was im- plemented alongside several similarly-oriented pro- grammes; so, its impact is difficult to measure. How- ever, females as a percentage of secondary school Volume 27 | Number 4 | August 2009 enrollees increased from 33% in 1991 to 52% in 2005, and it is very likely that the FSP played a key role in the increased levels of education among girls. The FSP has not had its intended impact on delaying marriage and fertility—the trend of early marriage in Bangladesh remains unchanged (17). Has the FSP enhanced capabilities of girls? As an indicator, data from 2005 suggest that only 35% of students enrolling in secondary schools passed the secondary school examination, which implies that, in its current form, secondary school has limited transformative capacity; however, a slightly higher proportion of girls than boys pass, suggesting that the value of education for girls is being realized. By providing a stipend insufficient to cover the complete costs of education and that often ar- rives late, the FSP likely serves as an incentive for families with sufficient financial resources to send their daughters to secondary schools. The FSP may have less impact on families with fewer financial resources. (Indeed, two of the top three reasons for dropping out of school are finance-based). As the FSP incentives generally are not accessed by those who cannot afford to pay a portion of the educational cost of their daughters, the FSP has the potential to exclude the poor and ultra-poor and increase the gap in access to education and other societal resources, contributing to increased levels of social exclusion. 429