The lack of efficient social securitysystems, the presence of large informal sectors, and thepace at which the population is aging in some Sub-SaharanAfrican countries are red flags warning of a potentiallong-term problem: that is, the inability of countries toprovide old-age income security to all. Many adults in theregion have difficulties accessing health care and otheressential services, increasing their vulnerability and theirlikelihood of becoming impoverished as they age. Since thecoverage of contribution-based pension schemes has remainedlow for decades, direct cash grants (henceforth, universalsocial pensions) are increasingly proposed as a way toaddress the coverage gap and to fight poverty among theelderly. This paper explores the role of universal socialpensions in 12 Sub-Saharan African countries, showing thatthey may be part of the answer to the coverage gap inpensions and may be important from a human rights lens.However, they have limited impact on poverty because asignificant share of the elderly population is found not tofall into the poorest and most vulnerable segments ofsociety. Universal social pensions can also be quite costly,difficult to sustain in low-income settings, and lesscost-effective at fighting poverty compared topoverty-targeted cash transfer programs. Implementationerrors are quite prevalent in universal social pensionschemes, contradicting the apparent simplicity ofidentifying program beneficiaries. The report’s mainfindings are that a discussion of poverty targeted programsvis-à-vis universal programs is less relevant forpolicymakers than how to design and implement a policy or amix of coordinated and harmonized policies under a robustsystem that allows governments to reach their mainobjectives of meeting the basic needs of their mostvulnerable citizens.