The general objective of this study was to compare the psychological well-being of orphan and non-orphan children in Addis Ababa and to explore the conditions or situation that could promote the psychological wellbeing for the orphan. Both quantitative and qualitative methods were employed to achieve the research objectives. Three groups of respondents, recruited from three randomly selected schools in Yeka Sub-city of Addis Ababa, participated in the study. The participants were: 120 orphan children, 120 non-orphan children, and 3 representatives of charity clubs in the selected schools. The orphan and non-orphan children were selected using systematic random sampling technique while the three representatives were purposively taken as a sample. A demographic questionnaire, a psychological wellbeing scale and interviews instruments was administered. Data from the quantitative survey were analysed using percentages, t-test, and Pearson correlation. The qualitative data were analysed using inductive thematic analysis. Using mean split technique on the psychological wellbeing scores of orphan and non-orphan children, orphan had low psychological wellbeing whereas the non-orphan had high psychological wellbeing. T-test for group mean difference on psychological wellbeing revealed that orphans were found to have a significantly lower psychological wellbeing as compared to the non-orphan children. Results from Pearson correlation analysis revealed that grade level was significantly and positively correlated with psychological wellbeing whereas parental status was significantly and negatively correlated with psychological wellbeing. Gender and age were not significantly related with psychological wellbeing. From the analysis of the qualitative data, encouraging the orphan’s individuality and autonomy and enhancing their self-esteem, and respect and care by adults were identified as the major themes that could promote orphan children’s sense of well-being.

The following is a guest blog from Vilma Ilic (MSW), Program Manager at the International Center for Child Health & Asset Development, Columbia University School of Social Work. 

Asset-building programs as social protection for OVC in sub-Saharan Africa

As Fred Ssewamala continues his research on economically strengthening HIV/AIDS-affected children and families in southern Uganda – a region of the country most severely impacted by the AIDS pandemic – the youth population in Uganda swells to global notoriety. Indeed, during the launch of the 2012 State of Uganda Population Report published by the Population Secretariat and the United Nations Population Fund, the Ugandan Minister of Finance Maria Kiwanuka warned of a “demographic disaster” in the country. According to the report, 78% of Ugandans are below 30 years, with 52% being below 15 years of age. Moreover, Uganda’s 18-30 year-olds are projected to reach 25% of the country’s total population by 2015. With a more optimistic and clairvoyant spin, in 2004, Dr. Ssewamala asked, “How can we shape social protection and economic strengthening programs for Orphaned and Vulnerable Children (OVC) such that these young people do not remain socially and financially excluded, and a demographic dividend can be realized?”

Ssewamala’s salient inquiry nearly ten years ago prompted him to test creative economic empowerment interventions aimed at social protection for the burgeoning young and poor population, and also at empowering these young people to be financially included and economically productive, potentially avoiding the demographic disaster Minister Kiwanuka warned of, and rather, harnessing youth potential to achieve a demographic dividend. Overall, the effects of these efforts have been very positive, clearly indicating that with political will and good child and youth investment policy in the country (and probably much of sub-Saharan Africa) there may be economic and social benefits to the current youth bulge. But realizing these potential dividends will take nation-wide programs beyond the well-documented pilot programs that Ssewamala and colleagues have been testing for nearly a decade.

In any society, there are four key players: 1) the state, 2) the family, 3) civil society, and 4) the private sector. How cohesively these players collaborate with one another varies by locality. Ssewamala has, however, created programs that, at their core, economically empower young people (including OVC) and their families by bridging the gaps between these four sectors of society: the state, the family, civil society, and the private sector. Government-funded schools, children and families, religious institutions and non-governmental organizations, and formal private financial institutions have come to rely on one another in this work – proving how integral these multi-sector interdependencies are, in order to create something substantive and sustainable. Throughout this work, Ssewamala’s economic empowerment programs place nearly 50% of the onus on the participating children and their caregiving families (to deposit into the matched savings accounts and to start microenterprises). This kind of arrangement certainly contributes to the sustainability of the intervention, especially in a context where poor families are donor-weary.

Unlike other randomized controlled trials conducted in sub-Saharan Africa, Ssewamala weaves his research into the fabric of society and designs programs that are context-specific, and as a result, embraced by the communities in which he works. Below, highlights from one of Ssewamala and colleagues’ 2013 publications illustrates why the group approaches their work the way they do.

Statistical analyses from Ssewamala and colleagues’ recent publication out of the Suubi-Maka study, funded by the National Institute of Mental Health (NIMH), demonstrate significant improvement in mental health functioning among participating children who received an economic empowerment intervention, comprised of: a matched child savings account, financial education and microenterprise development training, and mentorship from a near-peer vs. participants in the control condition (who did not receive the economic empowerment intervention) (Han, Ssewamala, & Wang, 2013). Specific to this analysis, hopelessness and depression levels were the outcome measures of child mental health functioning. The Suubi-Maka study collected data over a three-year period (baseline assessment, and 12- and 24-month post-intervention initiation).

The other important finding from the Suubi-Maka study is with regard to children’s physical health. Multivariate analysis showed that children with lower depression scores reported good to excellent physical health. These findings are consistent with an earlier study called Suubi-Uganda (the study preceding Suubi-Maka) which used the same economic empowerment intervention and found that children with matched savings accounts were likely to have higher levels of self-esteem compared to children in the control condition (Ssewamala, Han, & Neilands, 2009). Similar findings have been reported from Ssewamala and colleagues’ studies over the years, including positive educational outcomes, family stability and functioning, and positive attitudes toward protection against sexual risk- taking behaviors, which can influence healthy living and family planning.

Taken as a whole, the rigorous research Ssewamala and his colleagues have been engaged in – in Uganda – clearly point to the positive outcomes of economic strengthening programs regarding financial, health, and developmental impacts on young people (including OVC) and their families. When an economic strengthening program is delivered as part of a comprehensive intervention package, as it has been, the health and developmental impacts may be more demonstrable and significant compared to when young people receive only a savings account (for example see preliminary results from YouthSave). The crucial difference between the programs implemented by Ssewamala and colleagues in Uganda, compared to the approach of other youth savings promoting programs is that in Ssewamala’s model, the matched child savings accounts are accompanied by financial education, microenterprise development training, and mentorship: components that serve as the hands-on instruction manual for the tool. Otherwise, how would children become financially capable, understand the importance of an education, how to go about investing in education, and the steps needed to start an income generating project, without the training? Indeed, without the critical knowledge delivered by these intervention components, the social protection piece is nearly missing, and the tool – the matched savings account – would be less useful.

Ongoing research

Recognizing that Ssewamala’s intervention package is creating statistically significant results on four outcome measures, there may not be a pressing need to tamper with what works. However, in an effort to tease-out the incentive needed to induce saving and depositing, Ssewamala and colleagues are currently carrying-out a National Institute of Child Health & Human Development-funded study, Bridges to the Future, in which they will conduct a cost-effectiveness analysis of two varying match rates, 1:1 and 2:1; in other words, two varying incentives. The study will also measure the health and developmental impacts on OVC wellbeing, of the intervention package over a five-year period.

Conclusion

Policy makers and multi-lateral organizations ought to seriously consider well-structured economic empowerment programs when laying out their regional and national policy frameworks for social protection (see FAO policy brief on Oct 16, 2012). The evidence-base, thus far, created by the studies that Ssewamala and colleagues have conducted, point to a clear association between economic empowerment programming and positive health and developmental impacts on young people, including OVC.

Uganda is not the only country experiencing its largest youth bulge in history: developing regions across the globe are facing a disproportionately large youth demographic. These youth, who will number over one billion within this decade, are the future of their countries. Governments, in partnership with other sectors of society, are responsible for ensuring that young people burgeoning in their countries have a future filled with opportunities and continued access to protective factors, such as education. An economic empowerment program (for example a savings account opened at a young age), combined with financial education and mentorship, has the potential to provide a foundation for a life of financial inclusion and asset-building which, as current research by Ssewamala and colleagues has highlighted, may be among the most promising tools and programs needed for healthy child development, thereby increasing the likelihood that youth will create dividends as they engage in society, productively.

REFERENCES

Han, C.-K., Ssewamala, F. M., & Wang, J. S.-H. (2013). Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: Evidence from a randomised evaluation in southwestern Uganda. Journal of Epidemiology & Community Health, 67(3), 225-230.

Ssewamala, F. M., Han, C.-K., & Neilands, T. B. (2009). Asset ownership and health and mental health functioning among AIDS-orphaned adolescents: Findings from a randomized clinical trial in rural Uganda. Social Science & Medicine, 69(2), 191-198.