Category: Blog: News, Events and Opinion

Radical decision to close down country’s 34 institutions has been fraught with difficulties.

“Kathryn Whetten, a professor at Duke University in the US, followed 1,357 children in institutions, and 1,480 in families in Ethiopia and Tanzania, to compare the effect of living in orphanages with family care.

Whetten published her conclusions in the scientific journal  PLOS ONE in 2014, saying that without substantial improvements in care and support, placing children back with families will not significantly improve their welfare.”

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Editor’s Note: In our September 2013 newsletter, we solicited responses from our readers regarding three articles recently published in The Economist, The Washington Post and the Huffington Post, which discuss the deinstitutionalization of orphanages. Below is a response by Kyle Hamilton (MTS), Editor of OVC Wellbeing’s “News & Opinion Blog,” to The Economist article, “Children’s homes: the nanny state” (published August 17, 2013).

The author of “Children’s homes: the nanny state” argues that orphanages should be shut down because: “big institutions are poisonous”; “orphanages can prevent children living with what family they have”; and “institutions are costly.” In developing these arguments, the author misuses information and cites inadequate sources in supporting their assertions.

First, the article makes broad generalizations about orphanages without providing sufficient evidence. The author describes poor conditions orphans encounter in big institutions like Sarata Noua orphanage and Chisinau Municipal Institution for Babies in Moldova and implies that 2 million children are living in large, “poisonous” institutions like these orphanages without citing a source to undergird this claim. Yes, there have been and continue to be large orphanages that neglect children. Yet, in reality, not all orphanages or residential institutions are big and not all orphanages are the same. Instead, orphanages around the world are marked by diversity: orphanages employ a wide variety of models in caring for children, including family-style homes, and orphanages do not automatically result in the same outcomes for children. On the one hand, some orphanages, for a variety of reasons, neglect children or worse, resulting in array of developmental delays, malnutrition, etc. On the other hand, some orphanages are able to provide children with loving and nurturing environments.

Second, the article also misuses information and does not use adequate sources to substantiate its arguments. Secondary sources are used without examining the original study. For example, this article cites a report produced by the Better Care Network in order to claim that “for every three months that a child stays in an institution he or she loses one month of development.” Yet, it’s unclear how the Better Care Network arrived at this conclusion, as the three resources cited makes no such claim. Fortunately, however, one of the sources cited in the Better Care Network report did lead me to the author of the original claim. In their study of children from eastern Europe living in hospitals or orphanages, “International Adoptions: Implications for Early Intervention,” Dana Johnson and Kathryn Dole argue, “[o]verall , children fell behind 1 month of linear growth [weight-by-length] for each 3.4 months in the orphanage.” Clearly this study indicates that the specific demographic examined falls outside the normal range for growth (weight-by-height), but the author of “Children’s homes” fails to perform due diligence in making their argument. The author not only cited an inadequate source, but also employs this statistic in order to make a broad claim that exceeds the conclusions of the original study by Johnson and Dole. While the original study is describing “growth” (weight-by-height) among children with the average age of 28 months from Eastern Europe, the author of “Children’s homes” distorts this information by asserting a broad claim about the “development” of a child of any age residing in any orphanage. In short, The Economist article misrepresents the claims and limitations of the original study.

Additionally, “the nanny state” article argues that up to 90% of children living in orphanages around the world have living parents, citing Georgette Mulheir, Chief Executive at Lumos, an organization that promotes deinstituionalization. I am sure that Ms. Mulheir is an intelligent person, but she is not an authoritative source. Again, the article makes another sweeping, global claim without citing an adequate source. Nevertheless, even if most children living in orphanages have living parents, this does not mean that these parents are able or suitable caregivers. Moreover, the author fails to consider the counter factual: where would these kids have been had they not been in the orphanage? And correspondingly, what would the development of these children have been like if these children were not in orphanages, but on the streets or being used for forced labor, etc.?

“The nanny state” article argues, “institutions cost between six and ten times as much as supporting a child within a family.” This claim is difficult to assess and would require further investigation. Do the studies use the same measures and standards of care when calculating their cost? Is the cost of the institutions per child compared to the minimum standard of care in those same communities?

Finally, “the nanny state” article fails to engage the NIH-funded Positive Outcomes for Orphans (POFO) and the OSCAR Health and Wellbeing studies which challenge the article’s narrative.

“A Comparative Study of Psychological Wellbeing between Orphan and Non-orphan Children in Addis Ababa: The Case of Three Selected Schools in Yeka Sub-city”  by Afework Tsegaye


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 focus in this edition of The State of the World’s Children (2013) is to promote the inclusion of children with disabilities as equal participants in society. Inclusion goes beyond just integration, however. Inclusion requires that the current framework change in fundamental ways to help mitigate the institutionalized barriers to normal life associated with being disabled.

Often treated as objects of pity, or even worse as targets of discrimination and abuse, children with disabilities face many challenges. According to the report, they are more likely to live in poverty and are less likely to attend school or to have access to health clinics.  Around the world, only 51% of children with disabilities complete primary school, as compared to 61% of those without disabilities. 1 in 20 of those aged 14 or younger live with a moderate or severe disability of some kind. Girls, who are disabled, often face even more discrimination than boys, which can lead to malnutrition, low school attendance, and even infanticide. Beyond neglect and exclusion, children with disabilities can face verbal and physical abuse. Children with disabilities are three to four times more likely to be victims of violence. Caregivers of children with disabilities face the added strain of caring for a disabled child, and this strain increases the risk of abuse. To add to this problem, these estimates of abuse may be an underestimate as children with communication disabilities struggle to find ways to report their abuse.

 Despite these structural disadvantages, children with disabilities are capable of participating in society and contributing equally to the life of that community. Inclusion of children with disabilities around the world is possible if perceptions regarding the disabled change from those of shame and mistrust to those of solidarity and encouragement: “What is needed is a commitment to these children’s rights and their futures, giving priority to the most advantages- as a matter of equity and for the benefit of all.” Many countries have taken steps to emphasize the importance of greater equity for the disabled, signing and ratifying the Convention on the Rights of the Child and Convention on the Rights of Persons with Disabilities. The conventions demand recognition of each child as a full member of his or her community rather than as passive recipients of care and protection. These Conventions are indicative of a growing global movement dedicated to the inclusion of children in community life.

This report includes seven chapters detailing the current challenges to achieving greater equity for the disabled as well as future actions that might be taken to confront these challenges. The report also includes perspectives and personal accounts from both individuals living with disabilities and individuals advocating on their behalf around the world.

Follow this link to read the full report and find other interactive media.

Miracle MountainMiracle Mountain: Hidden Sanctuary for Children, Horses, and Birds off a Road Less Traveled

by Richard McKenzie

Dickens Press, 2013

196 pages ($18.95)

ISBN: 978-1880741-12-2

Orphanages of an earlier era, say, before the 1960s, are widely believed to have been hell holes that cruelly worked and starved the children in their care, as portrayed in Charles Dickens’ Oliver Twist.  To this day, Dickensian images of orphanages continue to throttle the public debate over how to best care for children of deprivation, neglect, and abuse.

Richard McKenzie spent much of the fall of 2011 embedded in a self-proclaimed “modern-day orphanage,” The Crossnore School, which is home for close to a hundred children in a remote corner of North Carolina’s Appalachian Mountains.  Miracle Mountain: A Hidden Sanctuary for Children, Horses, and Birds Off of a Road Less Traveled is his account of life there, as related through the eyes of the children in residence who have heartbreaking and heartwarming stories of childhood traumas and recoveries.  McKenzie explains why children who enter The Crossnore School today have more problems than those in orphanages of the past—with their problems ranging from severe deprivation brought on from drug- and alcohol-addicted parents to physical and sexual abuse. Many of these children have also suffered from cycles of foster-care placements and then reunification with parents who all too often pour on more abuse and neglect.

McKenzie found The Crossnore School to be a beautiful, peaceful place apart (literally, in the middle of nowhere) where hurting children can find a sanctuary in which they can renew and redirect their spirits and lives. The school has an equestrian center with horses that also have been rescued from abuse and neglect. The equestrian center provides two-way therapy, with the horses helping the children overcome their problems while the children help the horses to restore their trust in human beings.   The reference in the book’s title to Crossnore being a sanctuary for birds comes from the many birdfeeders and birdbaths scattered across the Crossnore campus, which are tended by crews of small children.

No account of Crossnore would be complete without coverage of its head Phyllis Crain who, in her twelve years at the school’s helm, transformed the campus.  She guided the school with a down-to-earth philosophy and with a passion for children rarely found in child welfare circles.

Miracle Mountain has been written for a general audience, especially readers who are attracted to heartwarming stories from one of the most unlikely of places, an “orphanage.” However, the book has a larger policy purpose, to reignite the debate over the place of children’s homes in a menu of childcare options.

A short video on The Crossnore School can be found on YouTube.  Richard McKenzie can be contacted by email and (949) 463-2604.

McKenzie is the Walter B. Gerken Professor Emeritus in the Merage School of Business at the University of California, Irvine.  He has written more than thirty books, including The Home: A Memoir of Growing Up in an Orphanage, a deeply personal account of his own childhood that helps explain his continuing interest in the fates of today’s disadvantage children.

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.


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.

In March 2011, USAID released a report titled Early Childhood Development for Orphans and Vulnerable Children: Key Considerations, providing an overview of important early childhood development (ECD) interventions and current evidence of ECD programs implemented to support orphans and vulnerable children (OVC). The report details critical elements of ECD programs as well as provides key findings from prior literature and evaluations. It also includes answers to common questions, resources on how to learn more about ECD, and examples of well-developed ECD programs that target OVC.

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