Does deinstitutionalisation offer the best outcome for Africa’s 52 million orphans?

Does deinstitutionalisation offer the best outcome for Africa's 52 million orphans?

Chikondi Milosi has been under the care of Blantyre’s Chikondi Orphanage in the township of Ndirande for the past five years. Although his mother is still alive, he says he wouldn’t have been able to continue his schooling if he lived with her. He describes the centre as his “only hope”.

(Charles Pensulo)

When Chikondi Milosi’s parents split over a decade ago, his life spiralled downwards. Unable to receive proper care from his mother, he started doing piece work to support himself, which adversely affected his schooling and set him back several years. But things started to improve after he met Josophine Mussa in 2013.

“I was not able to go to school since I didn’t have clothes and it was also difficult to have food,” he tells Equal Times. “Staying here [at the orphanage run by Josophine, which is also named Chikondi] has helped me. I am able to attend school as well.”

Eighteen-year-old Chikondi is one of the more than 140 million *orphans aged 18 or under globally, the vast majority of which reside in low- and middle-income countries, including an estimated 52 million in Africa. The reasons for their orphaned status are numerous, complex and often intersecting: as well as high mortality rates from diseases such as HIV/Aids, malaria and tuberculosis, children are also left orphaned by pregnancy or childbirth-related causes, natural disasters and conflict. Other children or young people, like Chikondi, are abandoned in orphanages because their families can no longer afford to keep them or because their caregivers are mentally or physically unable to look after them.

Founded single-handedly by Mussa in 1997, the Chikondi centre, in the high-density township of Ndirande in Malawi’s commercial capital of Blantyre, has provided a home to thousands of children and young people over the years. Mussa says that she was shocked and upset by the sheer number of orphans and disabled children in the area, and opened the orphanage to protect them from destitution, physical and sexual violence, and to help them go to school. Over the years, many of the children and young people that Mussa (who herself lives with paralysis of the legs) has supported have ended up in special need’s schools, vocational training, starting small businesses, getting jobs and living independently.

However, the orphanage has no stable source of funding, and despite the urgent help it, and other projects like it, provides, Chikondi may soon have to close.

Since 2014, UNICEF has been helping the Malawi government to support the country’s 1.8 million vulnerable children and help reintegrate those currently residing in institutions into family-based care. Although it is still in the pilot stages, to date almost 300 children have been successfully reintegrated from institutions into family-based care, according to government officials.

“As a government, we recognise that the best place to raise a child is a family home and not in an institution,” says Dominic Misomali, the chief social welfare officer in the Ministry of Gender, Children, Disability and Social Welfare.

Global trend of deinstitutionalisation

Malawi’s foray into deinstitutionalisation is part of a recent global trend, particularly in Africa. According to advocates, children do better in family settings and by closing down orphanages and other large institutions, children will be better taken care of, either through family reunification, foster care, adoption or by moving into smaller establishments.

Afrooz Kaviani Johnson, who is the chief child protection officer at UNICEF Malawi, says there is a “large body of evidence which documents the negative and irreversible effects of institutional care on children’s development, especially during their first three to five years of life”.

According to the UNICEF official, research has documented the compromised and inconsistent quality of care, nutrition and education in many institutions. However, orphanages still remain a popular method of care for vulnerable children.

“Despite the international decline in institutional care, Malawi regrettably experienced an increase in the numbers of children in institutional care,” Johnson tells Equal Times. “Between 2009 and 2014, a 60 per cent increase in the numbers of children and institutions was registered.”

UNICEF Malawi is currently working with Hope and Homes for Children, an organisation which advocates for the abolition of orphanages, to provide technical expertise during the deinstitutionalisation process in Malawi.

Hope and Homes for Children was behind the design and implementation of the vulnerable child care reform strategy in Rwanda, which began in 2014 and has since seen over 3,000 children integrated into families.

According to the Ugandan newspaper, the Daily Monitor, the Ugandan government is also planning to transition the country’s 2.7 million orphans from institutional care to community or family-based care. Similar plans are underfoot, or have already been trialled, in countries such as Zambia, Zimbabwe, Sudan, Ghana and South Africa.

“Family and community care is the better, more cost-effective way to care for children,” says Epaphrodite Nsabimana, a learning and research manager for Hope and Homes for Children in Rwanda. He also suggests that by investing in early childhood development and family services instead of institutions, more children and families can be helped to make a positive contribution to the society.

“To increase the amount of funding allocated to the issue, Hope and Homes for Children has developed strong partnerships with national governments, civil society organisations, community groups, international agencies, corporate donors and committed individuals,” says Nsabimana, who names the European Union, the UK’s Department for International Development and USAid as some of the bodies that have committed funding to reintegrating vulnerable children into family and community settings.

Pushback to deinstitutionalisation

But there are many who question the current race towards deinstitutionalisation.

“There is a strong push by the United States government and other developed countries through UNICEF that orphanages in countries which receive funding should close,” says Kathryn Whetten, director of Center for Health Policy and Inequalities Research at Duke University who has conducted extensive research into children in institutions. “Unfortunately, there is no good evidence to show that children raised in institutional care are worse off,” she tells Equal Times.

Whetten says the evidence being used by proponents of deinstitutionalisation come from a study in Romania where children in hospital-style institutions experienced physical and emotional neglect which interfered with their brain development. However, in every study that looks at evidence where caregivers do show love, Whetton says that children who grow show no difference in behavioural development.

In a three-year study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and published in 2014, Whetten and her colleagues followed over 3,000 children, between the ages 6 to 12, living in institutional or family-based settings in Cambodia, Ethiopia, Kenya, India and Tanzania. The research showed no significant differences between the two groups with regards to various measures of physical health, cognition and emotional outcomes.

“These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in, and support for, family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting,” the study reads.

Speaking to Equal Times, Whetten adds: “There is no NIH study of older children that has found that they do poorly in orphanages or institutions. All of these rigorously peer-reviewed studies have found that children in need do as well or better in orphanages relative to family settings, and that orphanages can be the place where children who are going to drop out of school, have severe emotional difficulties and learn no job trade, are able to thrive.”

She notes that in Cambodia, the closure of orphanages and the return of children to their families led to cases of trafficking and children being forced into sex work. When governments “don’t have money to monitor the process, then that’s a problem,” she adds.

For experts like Whetten, the best solution for the care of vulnerable orphans is to create a family-like environment in institutions where a caregiver looks after small groups of eight to ten children. She says the issue is not that the concept of orphanages is bad because just as there are bad institutions, there are also bad homes.

Mussa, the founder of the Chikondi Orphanage in Malawi, agrees: “We have very few people who can raise other people’s children. When children come here, I take care of them as if they were my own and sometimes people out there don’t even know they are orphans. Some of these children don’t even know their actual homes as their relatives have abandoned them. Before we start talking about the closing of orphanages, think about how many children are homeless in this country,” she warns.

“I wouldn’t have been able to stay in school if I was still staying with my mother in the village,” says Chikondi, the young man who has been under Mussa’s care for five years. He adds that his mother is still struggling to feed herself. “I would still be working for food and clothes. This is my only hope.”

*According to UNICEF’s definition of the word, an orphan is a child under the age of 18 who has lost one or both parents to any cause of death.