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Care for Orphans
A wide range of options exists for care of orphans. The most common types of orphan care include:
- A statutory residential care facility, serving primarily HIV infected children.
- A statutory adoption and foster care program, where a welfare society owns homes and appoints community mothers to care for a group of children (preferably no more than six).
- An unregistered residential care setting, which houses HIV+ and destitute mothers with their children and offers continued care for the children when the mothers are ill or die.
- Home-based care and support, where caregivers are identified and children are legally placed in foster care, and assistance is given through foster care grants.
- Community-based support structures, where grandparents or other close relatives care for their orphaned grandchildren, with no government support.
- Informal fostering or non-statutory foster care, where women in the community volunteer to care for orphans in a group home setting, with no government support
A 2001 study comparing the cost-effectiveness of these six models of orphan care in South Africa (See Desmond and Gow: The Cost-Effectiveness of Six Models of Care for Orphan and Vulnerable Children in South Africa) came to the following conclusions:
- The most cost-effective models of care are those based in the community, but often the quality of care was compromised due to the lack of adequate external support in the form of government grants to the caretakers.
- Community-based orphan care should ideally have a supervision component provided by an NGO or another more formal entity, to ensure that the caregiver receives some support and that children are protected against abuse and exploitation.
- Even when government grants exist, it is often too difficult for caretakers to access the support. This was especially true in rural areas. Therefore, government grant programs for foster families need to be relatively simple to access, while trying to minimize cases of fraud.
- Although it very high cost, statutory residential care for HIV infected orphans is necessary as a last resort, given the difficulty of placing these children in other care settings where they would be unlikely to have access to the medical attention they require.
A 2004 World Bank study (Subbarao and Coury: Reaching Out to Africa’s Orphans: A Framework for Public Action) concluded that each arrangement has its pros and cons, but “whenever possible, orphaned siblings should remain together and with their kin and in their community of origin. When relatives are not available, placement in families willing to adopt or foster a child is the most appropriate solution. Institutions should always be considered a last resort, and small-scale foster homes should be favored over residential placements such as orphanages.” (Subbarao and Coury pg. 39.). This study found that while 95 percent of orphans are currently taken care of by extended family and communities, many of these families and communities are over-extended and unable to ensure an appropriate quality of care. They present a methodology for determining whether a household is able to cope (Subbarao and Coury pg. 37-38.). For this reason, some form of foster care grant system is desirable if financial feasible.
For information on home visitor programs, please refer to the health section.
Box 1: The FOCUS Program in Zimbabwe
An example of an orphan care program built almost entirely upon community volunteers is the FOCUS (Families, Orphans and Children under Stress) program, inspired in 1993 by FACT (Family AIDS Caring Trust), Zimbabwe’s oldest AIDS service organization, and piloted by a Pentecostal congregation. FACT organized FOCUS in rural Mutare in the Eastern Highlands of Zimbabwe, when its home health care workers noticed that many of the children of sick parents were being left orphaned and un-cared for. FOCUS assists communities to care for these children in the following ways:
- identifying orphaned children in the community;
- assessing and prioritizing children in greatest need;
- visiting the most needy at least twice a month;
- establishing partnership and cooperation with other community groups, leaders, and organizations;
- maximizing community response, involvement and ownership of the project, thereby reducing dependence on FACT;
- increasing sustainability by limiting provision of material support, and encouraging maximizing community resources, where possible.
FOCUS started with 25 women volunteers in 18 villages. A 1999 evaluation of FOCUS found that it had grown to include 178 volunteers, 97 percent female, serving 6,500 orphans and close to 3,000 households at an annual cost per family of $10. Close to 1,000 children were able to attend primary school because the FOCUS program paid their school fees. The FOCUS model has proven to be low-cost, requiring a minimum of external support, effective in reaching even the poorest orphan households, and replicable. By 2003, the model had been replicated four times. (For more information on the FOCUS project and many other relevant projects, see page 22–24 in Family and Community Interventions for Children Affected by AIDS by Richter, Manegold & Pather.)
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How could a MAP support community-based care options?
A MAP could finance a formal, government-financed foster care program, whereby subsidies would be provided to households providing foster care. Like the conditional cash transfer program described below, these foster care subsidies could be tied to the child’s attendance at school. The desired level of transfer – whether in kind or cash — will have to be set in a way that prevents opportunistic behavior (families taking in orphans just to get the grant) and makes sustainability possible. The design of the program would need to include a supervision component to ensure that the children placed receive at least a minimum standard of care and are not abused or exploited. If trained social workers from the Social Affairs Ministry are present at the local level, they can perform the supervision function. However, this is unlikely to be the case in most Sub-Saharan African countries, and the function may have to be sub-contracted to NGOs. If the subsidies are tied to school attendance, monitoring and supervision should also involve school authorities.
If government is unable or unwilling to commit to a formal foster care support system, a MAP could establish a competitive grant fund targeting NGOs and faith-based organizations who are helping to establish low-cost, community-based care options that provide at least a minimal standard of care to orphans. These intermediary organizations would play the role of helping to stimulate the creation of community-based group foster homes, provide on-going training, support and supervision to caretakers as a means of ensuring an acceptable level of quality.
Two projects currently financed by the World Bank can serve as examples of ways in which MAPs can offer a multi-sectoral package of services that supports family and community-based responses to orphan care:
Box 2: The Ghana Queen Mothers’ Orphan Care Pilot Project
The Ghana Queen Mother’s Orphan Care Pilot Project builds on a traditional approach to orphan care, which it seeks to expand to two new districts, covering an additional 1,000 orphans. The Queen Mothers and male Chiefs or Kings are the traditional leaders in much of central and southern Ghana. In this culture, the Queen Mothers are responsible for the well being of children in their community when parents die or become too ill to care for their children. Acting on this tradition, the Queen Mothers have organized in the Manya Krobo district and have absorbed up to 6 orphans into each of their homes. The Queen Mothers Association of the Manya Krobo district now supports nearly 600 orphans in the district and is expanding its support to a further 400 orphans in the neighboring Hiro Krobo district. With support from the HIV-AIDS project, the Queen Mothers Association pays for the orphans basic education, medical care, and feeding, clothing and miscellaneous expenses. The total cost of the pilot is just over $77,000 or $386 per child. Based on experience so far, this model of care holds promise for replication across a large part of Ghana.
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Box 3: The Orphans Integration and Education Component of the Burundi MAP
The Orphan’s Integration and Education Component of the Burundi MAP seeks to provide social protection to highly vulnerable groups of orphans by strengthening traditional family and community systems for protecting and absorbing orphans. Specifically, the component makes investments to improve the basic education, social integration, and nutrition of the most vulnerable groups of orphans toward the levels of other children in the community. The following criteria have been established to target assistance to highly vulnerable orphans:
- orphans that have lost both parents and do not receive support from an adult, including orphans in orphan-headed households;
- children who live in refugee or displaced persons camps and in other places where they are separated from their father or mother;
- orphans that have lost one parent and whose surviving parent is unable to provide any assistance;
- orphans that have lost both parents and live with very poor families.
A contractor, usually an NGO or church, is responsible for meeting with the community to identify the children that meet these selection criteria. The contractor verifies the recommended list before it is finalized.
The project finances the following package of services:
- Tracing of extended family members.
- Placement of priority groups of orphans into families, when possible, with members of the extended family.
- Support for families that absorb orphans through revenue generating activities and activities that improve their food security.
- Primary education fees, uniforms, books, and school supplies for the most vulnerable groups of primary school-aged orphans. These school subsidies are passed through an intermediary that is responsible for verifying school attendance by the beneficiaries before paying the school.
- Training for informal market jobs for adolescent orphans, particularly in orphan-headed households. This component also helps organize vocational training graduates into productive cooperatives.
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