This article draws together unusual characteristics of the legacy of apartheid in South Africa: the state-orchestrated destruction of family life, high rates of unemployment and a high prevalence of HIV/AIDS. The disruption of family life has resulted in a situation in which many women have to fulfil the role of both breadwinner and care giver in a context of high unemployment and very limited economic opportunities. The question that follows is: given this crisis of care, to what extent can or will social protection and employment-related social policies provide the support women and children need?

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The South African state awards unconditional means-tested cash transfers to the caregivers of some eight million poor children. Amidst increasing demands on the state for social assistance, the question has been asked: should the Child Support Grant (CSG) be made conditional on education or health related behaviour to enhance its effectiveness? Issues relating to the popular Latin American conditional cash transfer programmes for children are summarised. The history, current reach and impact of the CSG are described, as well as administrative strengths and weaknesses in delivery. We argue that, to be in line with South Africa's Constitution, the structural problems of the supply side of education and health provision should be addressed, as well as problems with the delivery of the CSG, rather than considering whether to impose conditionalities that could further exclude poor children and their caregivers from this modest but vital form of support.

Abstract. This article examines care‐worker hierarchies in South Africa, notably since the HIV/AIDS pandemic and the structural changes it has brought. The nurses, social workers, home‐based care workers and volunteers are mostly women, of varying racial, socio‐economic, demographic and educational backgrounds; they work in the public, private, and not‐for‐profit sectors. Recent changes in care provision have brought improved earnings for some, but the “care penalty” remains, and task‐shifting because of the epidemic has been mostly downwards, increasing the burden on the lowest paid – or even unpaid – in the worst working conditions, thus increasing inequality between women.

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