By: Martin Hayes
There is an abundance of global evidence demonstrating the serious harm associated with the placement of children in residential care institutions, such as orphanages. Residential institutions consistently fail to meet children’s developmental needs for attachment, acculturation and social integration. Extended periods of time in residential care, particularly for younger children, may stunt brain development.
The overall aim of USAID’s Displaced Children and Orphans Fund (DCOF) is to reduce the number of children outside of family care by supporting community and family capacities to care for children and by strengthening national child protection systems to better regulate residential child care institutions and to provide adequate services for children to stay in family care. DCOF currently supports national child care reform efforts in 10 countries with different contexts. Eastern Europe and the Caucasus region have almost exclusively government run facilities, while Africa and Asia include almost entirely privately run and financed institutions. We compare programs in two countries, Armenia and Uganda, to illustrate the challenges to reform in these different contexts. 
There are approximately 4,500 children residing in state-run residential child care institutions. There are three types of residential child care institutions in Armenia: orphanages (24-hour institutions taking care of children officially considered as not having parents); night-care institutions (a service for parents unable to provide for children’s basic needs); and special needs residential schools (boarding schools for children with disabilities). About 90% of children in Armenian orphanages are considered “social orphans.” That is, they have living parents who are unable to care for them due to poverty or lack of support services. The government of Armenia spends up to $6,000 US per child per year for residential care. So this is an expensive and harmful approach to child care.
DCOF is supporting UNICEF and the government of Armenia directly to implement Armenia’s National Strategy for Child Rights Protection, which includes:
- Assessing and planning to ensure that adequate community- and family-based support services are established or expanded.
- Increasing the number of eligible foster families and providing a range of different types of foster care arrangements when reunification with families of origin is not in children’s best interest.
- Supporting the Ministry of Education to make mainstream schools more inclusive, allowing children with disabilities to live with their families and attend schools in their communities.
- Encouraging legal and regulatory reform to clarify roles and responsibilities of each actor, including local structures, in gatekeeping and preventing institutionalization.
Risks/Challenges for Reforms in Armenia
The current Minister of Labor and Social Affairs and the Minister of Education have been champions for child care reform and have been leading efforts to get children back into family-based care. However, there’s been recent political instability and frequent reshuffling of cabinet members, so this poses a risk that the reform momentum will be lost if these Ministers leave their positions.
In addition, unemployment in Armenia is relatively high and there is quite a bit of pressure at the district level to save the stable jobs provided by residential child care institutions. Some institutions may be adapted to serve the needs of communities. However, not all will need to be repurposed and repurposing institutions simply to save job could take public funds away from other critical services.
There has been a dramatic increase in the number of children in residential care in Uganda over the past 20 years – from under 3,000 in 1992 to 57,000 children today. All but a few are in private institutions supported mainly by faith-based organizations in the US and Europe. Over 80% of children in these institutions have at least one living parent and are in residential care due to poverty or attempts to access services such education.
In 2012 the Government of Uganda (GoU) adopted the Alternative Care Framework. The goal of the Framework is to promote family preservation, reunification, alternative family care and reintegration. DCOF is supporting the GoU’s national child care reform efforts through the work of ChildFund International and partners to:
- Strengthen the capacities of government district level officials and social workers;
- Establish alternative care panels to inspect residential care centers;
- Serve as gatekeepers to prevent new children from entering; and
- Recommend closure of centers as needed.
At the community level, efforts are being made to engage faith-based and traditional groups to map household challenges and vulnerabilities, and encourage communities to establish or support existing community-based mechanisms to prevent unnecessary family separation.
Risks/Challenges in the Ugandan Context
The Ministry of Gender is responsible for implementing the GoU’s Alternative Care Framework, but is severely under resourced. Case management needs to be strengthened and support for alternative care panels are needed to ensure that the new flow of children into centers is halted. District level officials also need to be trained on the Framework to ensure that they are not simply continuing referrals to residential care facilities.
The economic incentives for institutionalizing children are significant. This is a business for many of the people running the estimated 1,000 private institutions in Uganda and they have a stake in keeping them open and filled with children.
Unfortunately, the best interest of the child is often not the primary consideration for making decisions about placements. We have to address the incentives for institutionalizing children to facilitate lasting reform.
In Armenia, the government has resources that could reach more children more effectively through community-based services that support families to care for their own children. However, there are pressures on local governments to save jobs provided by these institutions. DCOF is supporting a financial assessment of the costs for transitioning or closing residential care facilities and the costs of community-based services. This will contribute to the development of a detailed roadmap for national child care reform in Armenia.
In Uganda, substantial private resources come into the country for residential care facilities and therefore children’s institutionalization is profit-driven. The process of redirecting these resources to community- based services in this context is far more challenging. DCOF is interested in learning more about the business model of private residential child care institutions, including their sources of funding, in order to ultimately influence how resources are used. In addition, efforts are being made to engage donors of private residential care institutions.
Martin Hayes is Technical Consultant to USAID's DCOF. He has twenty years of professional experience in the child protection sector including work in Africa and Asia.
 The views expressed in this blog do not necessarily reflect the views of the United States Agency for International Development or the United States Government