Like many girls in sub-Saharan African families, Naomi helped nurse her father when he became ill with HIV. The 11-year-old girl's gentle hands and soft words seemed to make a difference at first and, without complaint, she stopped attending school. When Naomi's father died one morning at the beginning of the rainy season, Naomi helped her mother bathe his wasted body. They wrapped him in a blanket for burial and the family mourned. The last of their chickens provided just enough meat for the small group of relatives, who mourned that day and the next.
As if this were not enough tragedy to bear, just two year later, Naomi found herself repeating the process for her mother. Already thin from overwork and the responsibility of caring for four children, she had become ill quickly. Naomi watched helplessly as she drew her last breath. Tears filling her eyes, feeling utterly alone, there was no blanket or family gathering this time. Instead of ritual singing, distant relatives came and took everything of value, including pots and pans. Tragically, like many other children, Naomi and her brothers had become orphans.
By 2010, it is estimated that South Africa alone will have an orphan population of two million.1 In 2003, the African continent had 12.3 million children orphaned from HIV and AIDS alone. All causes considered, Africa has a total of 43.4 million orphans. Asia, with a larger population, has 87.6 million orphans.2 So great is the problem that in 2003, UNICEF estimated the presence of 143 million orphans under 18 years of age in 93 countries.2 Naomi is one of 7.7 million double orphans in Africa, having lost both parents. In some areas of sub-Sahara Africa, almost an entire generation of parents is missing, leaving behind double orphans who are far more disadvantaged in terms of school attendance,3 nutrition, personal security and mental health. They experience more stigma, depression, anxiety, psychosomatic reactions and post-traumatic stress disorder symptoms than other orphans.4 What is the best way of caring for so many orphans? According to the World Bank, the most common types of orphan care for HIV affected children are:
1. A statutory residential care facility, serving primarily HIV-infected children.
2. A statutory adoption and foster-care program, where a welfare society owns homes and appoints community mothers to care for a group of children.
3. An unregistered residential care setting, which houses HIV-positive and destitute mothers with their children, and offers continued care for the children when the mothers are ill or die.
4. Home-based care and support, where caregivers are identified, given grants and children are legally placed in foster care.
5. Community-based support structures, where grandparents or other close relatives care for their orphaned grandchildren with no government support.
6. Informal fostering, where women in the community volunteer to care for orphans in a group home setting, with no government support.5 What works best? Researchers reviewed the costs of care using six models, ranging from formal children's homes to community-based networks.
The researchers concluded: “Resources should be concentrated on the more informal community-based structures supervised by a Non-Government Organisation (NGO) or more formal entity, to ensure the caregiver support and to minimise the risk for children of abuse and exploitation.1 In a 2004 World Bank report, entitled “Reaching Out to Africa's Orphans: A Framework for Public Action,” the authors point out various models of orphan care have their own pros and cons. However, they suggest that “whenever possible, orphaned siblings should remain together and with their kin, 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 favoured over residential placements such as orphanages. The report found that in Africa, 95 per cent of orphans are cared for by extended family and communities, the majority of whom are “overextended and unable to ensure an appropriate quality of care.”6 The influential “Children On The Brink” (2004) report is scathing of orphanages. According to the authors: there are often too few caregivers; children miss out on affection, attention and social connection; children are more likely to be segregated by age and sex; institutional life promotes dependency; social and cultural skills are missed; and children are isolated from important social-security nets.
The report argues that long-term vulnerability of children may increase; families may use orphanages as an economic coping-mechanism; cost of care per child is high; less formal models are neglected; and orphans may lose access to family land and resources.
In short, placement in residential institutions “is best reserved as a last resort where better care options have not yet been developed or as a temporary measure pending placement in a family.”2 So can the pitfalls of institutionalised orphan care be avoided? International Children's Care (ICC) Australia is a small, Christian child sponsorship NGO based in Victoria and is affiliated with ICC International.
Recently, I interviewed Merilyn Beveridge, international program manager for ICC Australia in the Asia Region.
You have been involved with ICC since it was established in Asia in 1991. What makes ICC's orphan care model unusual?
In the late 1970s, ICC chose a model that was much more than just food and shelter. Each campus has up to 10 homes and each family home has house parents—usually a married couple— to model family life. Children are only placed in the ICC village when there are no other options for them.
Do ICC children miss out on affection, attention and social connectedness?
We believe children need care in a family environment, so we don't place children in impersonal dormitories.
Instead, we use a cottage, group-home plan, where children are placed in individual homes, located on our small acreages. Local couples parent a group of 10 to 12 children, who socialise, work and play together.
How critical are house parents?
It is always a challenge to find suitable, committed house parents to foster children and model loving, caring family life. They need to have the right motives and they need support and training to do their job well. In Thailand and Cambodia, our house parents stay for 10 years or more, which is fantastic for the children there.
Does ICC segregate children by age and sex?
No we don't, except in countries where the law demands it. It's important that our family homes blend children of different ages and sex, just like any normal family. We try to prepare orphans for the day when they will have families themselves. The ICC model, using local house parents and educating children in a local school, provides good social and cultural skills.
Does institutional care create dependency?
Yes, it can. Children need to know how to engage with their culture and society, and they need the skills to function outside the ICC village when it comes time to leave. Vocational skills are an important part of the ICC philosophy, which is why we have farms and workshops, as well as formal schooling.
Between 1991 and 2007, we've had about 60 children graduate from ICC homes. Most have gone to university, direct employment or skills training and some have established their own businesses.
I would say we have a good track record but really, it is early days yet because of the long-term nature of what we do.
It is said that institutional care isolates children from social-security nets. How do you respond?
In our ICC Australia program, we try to keep children connected to their own communities. However, we need to keep in mind that many of the children we support have no social-security net at all. In the Philippines, for example, some may have been traumatised, abandoned and even on the verge of death. The ICC home and village becomes their net. It is like a real family.
Do some families use orphanages to cope with tough times?
ICC homes should be a last resort.
We screen children to see if other care options in their best interest are available in their communities. We also have to be on guard because sometimes families just want a child cared for until they become a productive asset.
ICC centres are not cheap to establish or run, are they? Why persist?
The ICC village is designed to cater for children who fall through the cracks of broader community-development programs and informal family-care networks.
There is no doubt the ICC village model of care involves higher costs and we have high standards. But when calculating costs, you have to compare the needs of the children and the quality of care, not just the unit cost for each child.
ICC Australia is committed to community- based programs in areas surrounding our centres, with training in micro-enterprise, vocations, health education, intervention, agriculture and others.
Do you support orphaned children in their communities?
Some governments encourage foster parenting in local families. We use our centres to help families in extreme poverty.
As researchers recommend, ICC Australia actively supports local communities by caring for orphaned and vulnerable children.
What do you like about ICC's centres?
We have a personalised, family-care model. Each home functions as a family unit and our house parents are supervised and resourced. What we do is monitored and the staff are carefully screened. You don't get this in an informal community network.
Our children have very good healthcare and psychological care. Also, I have observed benefits in bringing children together who have had similar experiences and circumstances. Relatives are encouraged to visit homes. When vulnerable children return home, we support them so they are not exploited.
The elementary schools on the site ensure the children have added support in gaining a good education.
What do you see in the future?
We have become convinced that our future direction will be to keep our centres for those who have no other options. But our centres will provide programs to enable poverty-stricken extended families in the community, who love their orphaned relatives, to be released from extreme poverty and be able to care for these children.
ICC has developed orphan-care programs, in which children who are orphaned live with local foster families— extended family or loving local families—supported by development initiatives and monitoring by ICC.
This will enable ICC to care for many more orphans, while keeping them within their local culture structure.
It is terribly important to meet the social, physical, spiritual and emotional needs of orphaned children.
Doing this well is challenging but it is something ICC Australia is committed to. Quality care can't be measured in terms of the number of children divided by the cost.