A sometimes mind-blowing firsthand account of an ambitious attempt to improve the care of orphaned and vulnerable children in Uganda.
It started in a cramped government office in Kampala
There are at least 50,000 children in residential care in the Uganda, a huge number by any standard. Uganda has been called the NGO capital of the world, and while some of these organizations are doing tremendous work, in 2011 it was just a handful of us gathered in a cramped government office in Kampala to talk about alternative care for children outside of parental care. Alternative care refers to practices designed to keep children, as much as possible, in families and communities rather than putting them in residential care. That first day we had no handle on who was doing what, why, and where.
Three years later and we have made significant progress, and I give the government immense credit for being passionate and pushing for change! The result was “The Alternative Care Framework,” guidelines for working with children outside of parental care with a strong emphasis on family preservation and reintegration of children back into families. These guidelines have potential to improve the lives of children and families throughout Uganda. The challenge is to get organizations to know and follow the guidelines, and to make them aware when the changes are working.
While developing the Alternative Care Framework, we looked at child care facilities in Uganda. We knew the number had increased exponentially in the previous ten years, but beyond that too little was known. How many existed? What services did they offer? How well (or poorly) were they run? Why were so many children going into residential care? What we learned was more startling that we anticipated (summary of the results). Child care institutions have become the default solution for children outside of parental care with worrying trends as to why children end up in care in the first place. Here are some troubling facts we learned about those institutions:
- Over 80% of child care institutions do not have a child protection policy
- Over 85% of children in such institutions have known parents and family members
- Less than 25% of institutions make any attempts to trace the families of the children in their care and/or engage with family members
- Over 50% of institutions have unacceptable care standards with poor infrastructure, sanitation, diet, accommodation, health provisions, and supervision
- Less than 30 child care institutions are currently legally licensed and recognised by the government
What we saw was in sharp contrast with internationally accepted best practices which prioritize community and family-based alternative care and specifically state that residential care should be a temporary and last resort.
Educating care providers
Starting in August, 2013, the government (working with SUNRISE OVC, a USAID program run by AIDS Alliance), conducted workshops in each region of Uganda to connect with practitioners and explain the Alternative Care Framework. We developed the training materials with support from UNICEF. The main topics were family preservation, child resettlement and reintegration, and family-based alternative care. The workshops were a huge opportunity to engage with stakeholders at all levels, including working directly with care-providers.
More than two hundred care providers and about fifty district workers attended. All told it was a fantastic mutual learning experience.
Boarding schools and pitfalls
Besides training participants, we also asked questions. One session explored why children end up in institutional care in the first place. In every region of the country, participants said one of the biggest reasons children are placed in orphanages is for access to the free services, and they acknowledged that nearly all the children in their facilities have known families.
We debated whether many “orphanages” could be more accurately identified as free boarding schools. (In the words of one director: “I couldn’t get funding for my boarding school unless I packaged it as an orphanage.”) Ironically, some good private schools which have been forced to close because of the “free” education funded by western donors, so the amazing Ugandan entrepreneurial spirit is being squashed by NGO’s thinking they are helping.
Even worse, we realized that less vulnerable parents are often able to admit their children into the higher quality institutions with the best services, whereas the most vulnerable parents, who perhaps truly need support, are more likely put their children in the nearest and lowest quality institutions. One such mother was so desperate, having found out she was HIV positive and losing her job in the same week, that she took her child to the most easily accessible residential care facility—after being referred there by a nurse who was on the orphanage’s payroll. The standards there were appalling, and since it had an international adoption program, her child was put up for international adoption. So in the midst of tremendous trauma she nearly lost her son who she loved. THANKFULLY, someone was tipped off (by the potential adoptive family actually), saw some glaring inconsistencies, and raised the alarm. The mother was eventually reunited with her son after a lengthy process of wresting the boy from the clutches of the orphanage and adoption agency.
That was in 2012 and her life has been transformed. Now she is happy, healthy and financially independent due to the interventions, education, and support she received.
Fulfilling needs or filling beds
The participants also confessed that children often end up in institutions simply “because they exist.” Interestingly, communities that do not have orphanages, including some of the poorest in Uganda with high rates of HIV infection and poverty, tend to have lower rates of child abandonment compared to similar communities that do have orphanages. Not surprisingly, participants pointed out many of the obvious reasons why children are separated from their families: emergencies, the death of a parent, extreme poverty, and child protection issues. We explored these and began to think about alternatives. For example, we looked at ways to address poverty rather than allowing poverty to split families apart. We also challenged participants about the justice of removing a child from his or her home due to abuse but doing nothing about bringing the abuser to justice.
A government worker noted we often have things backwards. Children are removed from society while the perpetrators of crimes against them go free. She argued that government and institutions should work together to ensure children can stay safely in their own communities and to remove those committing crimes against them. An incredible admission by some institutions was that they are under constant pressure from donors to “fill the available beds.” Empty beds equal no child sponsorships. For such institutions, the vision of the donor is a driving factor even above the best interests of the children and their families.
Positive and negative responses
Some institutions did not take the workshops seriously. One well known home for babies in Kampala sent their gardener claiming to be a social worker. In my view, those who took the workshops least seriously were the organisations with active international adoption programs. This confirms what many of us suspect: organisations focused on international adoption do not seriously pursue resettlement and other domestic solutions despite evidence that these solutions are effective and in line with government policy.
But there were encouraging responses as well. One organisation in Jinja that has undertaken many international adoptions decided to abandon their international adoption program. They felt their integrity had become increasingly compromised by agency after agency continually offering ‘rewards’ and ‘partnerships’ in return for providing them with children. (Receiving money or donations as a part of any adoption process is illegal in Uganda, so you will be hard pressed to get any organization to admit doing it.) They have now thrown their full weight and vision behind the alternative care framework.
Another organisation in Hoima fully embraced the new framework. When we sat down and explored the financial implications of keeping 60 children for 18 years versus resettling them in family-based care, the director was literally “blown away.” He realized that he could support nearly 1,000 children in family-based care for the same cost as raising just 60 children in his residential facility. Another organisation decided to reduce the number of children in residential care and invest in more community-based support for families: vocational skills training, livelihood support, family counselling, and referral services. These activities strengthen families and help keep them together.
One of the greatest achievements of the workshops was the commitment to work better together that many organisations gave to the government staff. There was a needed realignment of organisations back to the local government officials as opposed to being dictated by their donors. A Probation and Social Welfare Officer from the north of Uganda eloquently expressed her feelings about the workshops this way.
We have sadly allowed Child Care Institutions too much power and they have become the default solution for children. But we know children thrive better in families, and most of the children in institutions have families. We need to get children back into families, and institutions need to change their models to support families not their own institutions. These workshops have helped communicate this message and explicitly outlined government policy and best practices. Now there are no excuses.
Time to respond
From a ragged beginning transformation is slowly coming to Uganda, and those of us who begun this journey and others who joined along the way are committed to making the alternative care “movement” work. Today we have an increasing number of organisations delivering high quality resettlement, family-based alternative care, and other services that support families and keep them together.
Despite limited resources, Ugandans and the government of Uganda are proving they can lead for change, and key partners such as UNICEF and USAID are providing assistance to inform and educate the care providers and organizations that need to get on board. A number of other programmes are starting in 2014 to support the alternative care framework. Terre des Hommes Netherlands are about to launch a significant programme that could impact 1000’s of children’s lives and create a blueprint for the rest of Uganda and beyond.
I am under no illusions. We have a long way to go, and the government needs to get tougher with organizations that are not meeting standards or following the child care policy. But as we say in Uganda: “Hope never runs dry!” And now the river is rising. Donors and child care organizations – this is your time to stand up and be counted or be left behind!