Improving Care Options for Children in Ethiopia through Understanding Institutional Child Care and Factors Driving Institutionalization

Family Health International

01 Jun 2010

Factors underlying the vulnerability of children and lack of appropriate parental care include HIV and AIDS, natural disasters, internal migration, and chronic poverty. These factors have been documented as the main reasons children lack parental care on a global level and, more specifically, on the African continent. The same paradigm may be applied to the situation in Ethiopia. With approximately five million orphaned and vulnerable children, the need for alternative care options for vulnerable children is growing. The increase in the number of children requiring alternative care has contributed to the emergence of many new child care institutions. Ironically, this increase in institutional care has coincided with increasing awareness of and research into the negative effects of institutionalization on children’s physical, emotional, and cognitive development. Given this environment and the need to provide children with
quality care, FHI, under the leadership of the Ministry of Women’s Affairs (MOWA), in collaboration with the United Nations Children’s Fund (UNICEF), and with funding from the Children’s Investment Fund Foundation (CIFF), initiated a national study of child care institutions, institutionalized children, and factors driving institutionalization.

This study was developed through consultations between the MOWA, FHI, and UNICEF, and is the first of its kind to take an in-depth look at institutional care in Ethiopia. The overall objective of this study is to understand the scope of the information on institutional care practices in Ethiopia, as well as the quality of this information and the gaps therein, with the purpose of informing efforts to improve the quality of alternative care—including institutional care—for children in Ethiopia.

Specific objectives include the following:

Assess the primary factors that leave children without parental care.
Document the main reasons institutionalization is chosen as alternative care for children.
Determine the scale of institutionalization and the number of child care institutions in Ethiopia.
Assess current practices within child care institutions, including quality of care, in relation to nationally and internationally recognized standards of care.
Document good alternative care practices for children.

Conclusions
Major findings of the study include the following:

The main factors influencing the number of orphaned and/or unaccompanied children in Ethiopia are HIV and AIDS and related illnesses, and severe poverty.
The development of new child care institutions (by nongovernmental and/or faith-based institutions) has been increasing over the past several years, but the development of other alternative care options has not been growing at the same pace.
Little emphasis has been placed on developing other alternative care options, such as kinship care or foster care.
Community members, child care management and staff, and some authorities have a positive perception of institutional care, and are not aware of the negative effects caused by institutionalization.
There are limitations in supervision of child care institutions by authorities and minimal knowledge of and adherence to the minimum care standards outlined in the NGAC.
There are limitations regarding uniform structures of accountability and oversight from the three main governmental institutions involved in the child protection system (MOWA, MOLSA, and MOJ).
The government oversight bodies (mainly BOWA and BOLSA) do not have the financial and human resources to implement their mandated responsibilities, and their relationship with child care institutions is mostly confined to reporting.
Quality care is compromised in many child care institutions, due to limited financial resources, lack of supervision, and minimal awareness about child development issues.
Children residing in institutions are subject to discrimination from community members, experience psychosocial problems, and are frequently subjected to physical, sexual, and psychological abuse and exploitation while in institutional care.
Current procedures within institutions inhibit interaction between children and their families. This results in an increase in the likelihood of extended institutionalization and limits possible reunification.
A significant number of child care institutions (62.1 percent did not have adequate documentation or case planning for each child. The limited emphasis on the temporary nature that institutionalization should have increases the likelihood that children will not be reintegrated or placed in a family-based care situation.
Children who have left institutional care frequently feel they do not have the necessary skills to cope with life outside of the institution.
Implementation of family preservation initiatives that combine parent education and family income strengthening appear to have positive effects on preventing institutionalization of children.
Foster care strategies, whereby an institution identifies, trains, and supports a family willing to take in an unaccompanied child with regular financial and material support from the institution, is found to be an acceptable form of alternative care and readily fits into current cultural practices.
There is a general lack of understanding of the relevance of domestic adoption (i.e., the relevance of legally formalizing the relationship between a caregiver and an unrelated child for whom they are caring on a permanent basis). Current domestic adoption procedures also are perceived to be difficult and financially limiting for Ethiopian families interested in national adoption.
Efforts targeting the creation of a family-like atmosphere, through self-contained homes within the child care institutions, community integration of institutions and institutionalized children, training of institutional staff, and clear understanding of and adherence to minimal standards of care appear to have a more positive effect on children.

Recommendations
Based on the aforementioned findings, it is apparent that an effort to improve the quality of institutional care is an important beginning point. Given the well documented and widely known negative effects of institutional care, it is also important that this “transformation” of institutions be implemented jointly with the development and scaling up of family-based alternatives, such as family preservation or reunification, kinship care, temporary foster care, and domestic adoption.

Based on the study findings, specific recommendations within three categories—policy, care within institutions, and no institutional alternative care—should be set forth and should include the following:

Policy

Key government ministries should work collaboratively to develop protocols pertaining to specific processes and responsibilities, such as accreditation, supervision, and monitoring.
Accreditation standards and procedures should be developed to provide useful information and ensure that quality organizations are providing institutional care. The focus should be on promoting noninstitutional alternative forms of care and improving current institutions, not creating new institutions.
Sufficient human and financial resources should be provided to the responsible government institution to facilitate timely supervisory visits to every institution operating in Ethiopia.
In the past year since the Institutional Care Study was conducted, the NGAC have been substantially revised, and MOWA endorsed and disseminated the revised version in September 2009. There is a need to ensure distribution of the revised guidelines and training of management and staff at child care institutions, other local institutions/organizations involved in alternative care or its facilitation (e.g., kebele, idir), and government oversight bodies in the application of the revised guidelines. As the revised guidelines are used, it is recommended to collect feedback from stakeholders involved in the implementation of alternative care services for vulnerable children and government oversight bodies, and possibly to obtain input from international experts, to ensure they are in accordance with current internationally recognized standards, use appropriate terminology, and reflect the desired emphasis on family-based care.

Care within institutions

Appropriate and efficient database systems should be used by responsible government institutions, as well as all child care institutions. At a minimum, data should include name; date of birth; how, where, and why (i.e., reasons given for institutional care need) the child entered the protection system; family history; case plan; special needs (if appropriate); exit date; and follow-up.
At a minimum, every child care institution must have a case plan for every child. A case plan should promote the temporary nature of institutionalization and include steps for reintegration and placement in a family-like, permanent situation or an independent living arrangement.
Those involved in institutional care, as well as community members and parents of vulnerable children, should be made aware of the negative effects of institutionalization via public awareness campaigns.
Child care institutions should be encouraged to improve their level of care for children, based on internationally and nationally recognized standards. Such changes could include incorporating small homes or rooms suitable for groups; promoting linkages and participation in local communities; ensuring that a child protection policy and accompanying mechanisms are in place; providing appropriate psychosocial support, education, and developmentally appropriate care; and providing support and skills training to facilitate successful transitioning for children exiting care.

Noninstitutional alternative care options
In an effort to promote domestic adoption, information as to requirements and procedures should be readily accessible to nationals interested in adopting, as well as more understandable. Public awareness campaigns to promote domestic adoption should be conducted.

Minimum standards of care should be developed for each form of alternative care and should be based on the NGAC. The minimum standards should be distributed to all responsible government officials, child care institutions, and local organizations involved in alternative care. They should be translated into Amharic and other local languages, as needed, so as to be understandable by all.