“It's not enough:” Local experiences of social grants, economic precarity, and health inequity in Mpumalanga, South Africa

South Africa has received international recognition for taking an active role in addressing extreme poverty by establishing a national social grant program. Lauded as one example to alleviate poverty, the operating assumption is that these strategies provide alternatives to mainstream development assistance. Notwithstanding their potential effects, the pathways generating livelihood change and their long-term implications for processes of citizenship formation and state society relations remain unclear. Drawing from an interdisciplinary study of social and economic change in Mpumalanga Province, South Africa, we analyze household surveys and qualitative interviews to examine how individuals manage their limited income through a balance of social grants, economic remittances, labor migration and strategic task-shifting. Though more than half of the households receive some form of pension support from the national government, many continue depending on remittances from household members living elsewhere. Social grants additionally interrelate with health maintenance in complicated ways, evidenced by high HIV rates within the study region. We argue that while the distribution of grants helps alleviate financial stress, the structure of assistance programs is more symbolically than materially significant for many families. Despite government assistance, families require social network mobilization and resources to access and secure healthcare and other basic needs.