Final Summary Report

Assessment of Residential Care Afghanistan

Implemented by:

In partnership with:

This publication has been produced with the assistance of the European Union. The contents of this publication are the sole responsibility of Children in Crisis and can no way be taken to reflect the views of the European Union.


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Contents 1 Executive Summary .............................................................................................................................. 3

2 Chapter One: Introduction ................................................................................................................... 6

2.1 Background ................................................................................................................................... 6

2.2 Some basic definitions .................................................................................................................. 6

2.3 The Context of Afghanistan .......................................................................................................... 6

3 Chapter Two: Methodology ................................................................................................................. 7

3.1 Research Design ............................................................................................................................ 7

3.2 Data Collection Tools .................................................................................................................... 7

3.3 Monitoring .................................................................................................................................... 8

4. Chapter Three: Profile of Residential Care in Afghanistan ............................................................... 8

4.1 Target Institutions ......................................................................................................................... 8

4.2 Government and Private Institutions ........................................................................................... 8

4.3 Residential and Non-Residential Institutions ................................................................................ 8

4.4 Growth of Private Institutions ...................................................................................................... 9

5 Chapter Four: Profile of Children in Residential Care ........................................................................ 10

5.1 Parental Status ............................................................................................................................ 10

5.2 Gender ........................................................................................................................................ 10

5.4 Disabilities ................................................................................................................................... 11

6. Chapter Five: Standards of Residential Care ..................................................................................... 11

6.1 Contact with Parents and Family ................................................................................................ 11

6.2 Existence of Records and Individual Care Plans .......................................................................... 12

6.3 Assessment upon Entry into Institutions .................................................................................... 12

6.4 Education .................................................................................................................................... 13

6.5 Staff to Child Ratio ...................................................................................................................... 13

6.6 Management and Oversight ....................................................................................................... 14

7 Chapter Six: Cost/Benefit Analysis ..................................................................................................... 14

7.1 Background ................................................................................................................................. 14

7.2 Comparison with Neighbouring States ....................................................................................... 16

7.3 Cost Benefit Analysis ................................................................................................................... 17

7.4 Cost Benefit Analysis Conclusions and Recommendations ........................................................ 20

8 Chapter Seven: Conclusions and Recommendations ........................................................................ 21

8.1 Conclusion ................................................................................................................................... 21

8.2 Recommendations ...................................................................................................................... 22


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1 Executive Summary Introduction This paper provides a comprehensive overview of the situation of residential care in Afghanistan. Through providing a firm evidence base of the current situation, the report aims to provide recommendations to the Government of Afghanistan and other key stakeholders to develop a child protection system for Afghanistan that acts in the best interests of all children in line with the UNCRC and the Constitution of Afghanistan. The report is based on data collected from six provinces across Afghanistan through a variety of data collection techniques including a literature review, key informant interviews, questionnaires, focus group discussions and community meetings. A total of eight government orphanages and 36 private institutions were covered by this study within the six target provinces. Findings Profile of Residential Care The total number of non-residential children in the orphanages covered by the study exceeds the number of residential children. Seven of the private institutions have no resident children at all and one of the institutions registered as an orphanage actually only provides cash transport and food support to families in their communities. Profile of Children in Residential Care Parental Status Within the residential institutions, the majority of children (64%) are single paternal orphans followed by 16% of children who are single maternal orphans and 12% who are double orphans, 8% of those children in residential care in the target provinces have both parents living. This demonstrates the need for support within the community and family setting for women whose children have lost their father. This should build on the religious duty of other male family members

to assume guardianship of the child when a child’s father dies. Age Accurate age data for children was unavailable in many of the institutions due to a lack of record-keeping. Estimates were gained from staff based on their work with children. These estimates show that there were 101 children across the sample institutions in residential care under the age of five. The institution staff also revealed that there are at least 12 resident young people over the age of 18. Those are the young people who were officially reported, it is clear that there are many more. In one of the orphanages in Kabul, it was recently estimated that there were over 70 men aged 18-28 living within the institutions. Standards of Residential Care Existence of records and individual care plans It is clear, from the study, that there is not systematic use and review of care plans within the institutions. The lack of adequate care-planning appears to be symptomatic of a wider lack of record-keeping. Education All of the institutions had some educational facility either inside the institution or outside. All government institutions with the exception of Herat and Badakhshan had non-resident children who only come during the day to attend education classes. It is clear, therefore, that the Ministry of Labour and Social Affairs Martyrs and Disabled (MoLSAMD) is covering the cost of education provision for children who have families and stay with them during the evenings. It is not MoLSAMD’s role to provide education, this should be fulfilled by the Ministry of Education Staff to child ratio


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The staff to child ratio in some of the institutions is a serious concern. In the government institution in Nangarhar the ratio is one staff member to thirty-four children and in Kandahar it is one staff member to every thirty-two children.

‘The number of staff is so few here that many times children have to help out with the daily activities of the orphanage’ Head of Government Orphanage Cost Benefit Analysis Current Expenditure Within the public institutions, the expenditure varied widely from $US 444 to $US 1,388 with an average of $1,247. According to data provided by MoLSAMD in informant interviews during the gathering of data for the cost-benefit analysis, there are an estimated 6,216 resident children in 36 orphanages across the whole of Afghanistan1 meaning that the annual spend for MoLSAMD on residential children is around $US 7,751,352. The expenditure data from the private sector also shows a wide variation in the unit cost from $US 125 to $US 3,337 giving an average spend of $1,230 which is very similar to the public sector. The variation in the private sector is likely to be as a result of the range in quality and provision of services for children. Alternatives In comparison with neighbouring states, Afghanistan has relatively few children living in residential care. This is significant in relation to the scope for redeployment of financial resources in a reform programme. There are a variety of different alternatives to residential care which could be explored within Afghanistan to look at the most culturally acceptable solution. It is estimated that a shift to day-care support would allow

1 This differs from the data provided by MoLSAMD

at the start of the project which listed a total of 31 Government institutions nationwide caring for 5,903 resident and non-resident children.

MoLSAMD to use the resources for a residential place to fund 2.5 day-care places2.

Conclusion There is a huge variation in institutional care that exists currently in Afghanistan. It is simply inaccurate to describe all institutions covered by the study as residential care since many of them do not have children staying overnight. The description of these institutions as ‘orphanages’ is also inaccurate since a significant proportion of children registered in public and private institutions have both living parents. The majority of public and private institutions provide good quality education. Providing public or private education either within the institutions or outside is standard. It is the only feature which is consistent across all institutions in the study, although certain private institutions were not forthcoming in the type of education which was being provided. This does beg the following question: why does MoLSAMD have responsibility for the oversight of private institutions providing only education and no residential facilities? And why are some of the public institutions only providing education and not residential care? There are some serious concerns in relation to the number of children in lower age groups in care, which highlight the need to focus on primarily supporting children within their families wherever possible and safe. Within Afghanistan, the challenge is not the re-building of a child protection and family support system where previously one existed which has been destroyed by the war, but the building of an affordable and sustainable community-based child protection and family support system where none previously existed. Recommendations

2 This is less than the figure above because it takes

into account the education of children which still needs to be paid for.


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The evidence from this study demonstrates an overarching lack of oversight of the institutional care system by MoLSAMD thus the majority of recommendations refer either to MoLSAMD itself or encourage support of MoLSAMD to ensure a fully functioning child protection system. In order to put these recommendations in place, a sustained capacity building and mentoring programme needs to be developed for MoLSAMD in a variety of areas such as financial planning and management, strategy development and implementation.

1. Review of State Protective Care for Children

The Government of Afghanistan is mandated, as a signatory of the UNCRC, to provide care for children at risk. This should primarily be through support to vulnerable families and in a situation as close to a family environment as possible and includes state care for those children who do not have any family or in whose best interest it is not to stay with their family. MoLSAMD needs to ensure that state protective care is provided for those children who do not have a responsible adult to care for them or those who are placed at risk by staying with their family or a responsible adult.

2. Reintegration of Children There are clearly a huge number of children currently staying in government institutions who could be returned to their families. MoLSAMD and DoLSAMD staff need to be supported to conduct assessments of these children and their families to ensure that those children who do not require state protective care are returned to their communities to reduce the negative impact of residential care upon them.

3. Education There are both public and private institutions within the study that only attract daily attenders which suggests that they are only attending to access education. MoLSAMD needs to collaborate closely with the MoE to

ensure that they are providing adequate educational support to vulnerable children. The private institutions providing education are obviously highly valued by children and their families but responsibility for oversight of these institutions should not lie with MoLSAMD and should be handed over to the Ministry of Education. This would free up resources within MoLSAMD which could be directed towards support for the most vulnerable children and their families.

4. Alternative Care There are, and always will be some particularly vulnerable children in Afghanistan who require state protective care. This should not, however, mean that these children have to be in large-scale residential institutions. These are damaging to children’s physical, intellectual and emotional development and are also expensive. To lessen these impacts, children should be placed within small-scale care which, as far as possible, resembles family life. In order to successfully establish this, additional research should be conducted into which community-based alternatives are best suited to the culture and situation of Afghanistan. Community based alternatives have been found in other countries to cost on average 15 to 30% of the cost of residential care, even including education3.

5. Private Orphanages

The growth in private orphanages in recent years has been steady. It is clear that investment in capital resources is a popular focus of donor-funding across the world in order to give tangible results; this is given despite the evidence of damaging effects of

3 EveryChild’s (Carter, 2005, p.8) assessment of the

evidence in Central and Eastern Europe and CIS countries indicates that on average, institutional care in that region is twice as expensive as the most costly alternative: community residential/small group homes; three to five times as expensive as foster care (depending on whether it is provided professionally or voluntarily); and around eight times more expensive than providing social services-type support to vulnerable families.


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institutional care. Since any shift to alternatives to residential care will require additional substantial investment which is unlikely to be available to MoLSAMD, efforts should be made to divert support from the Afghan diaspora in donor countries to supporting a range of alternatives rather than directing their investment solely towards residential care. 2 Chapter One: Introduction

2.1 Background There continues to be a growth in the use of residential care throughout the world despite evidence dating back to the 1940s which states that institutional care has a negative impact on the development of children no matter what their age (Williamson and Greenburg, 2010; Delap, 2011; Browne, 2009; Carter, 2005). Children growing up in residential care are more likely to suffer from health problems, underdevelopment and developmental delay. As a result, children in residential care grow up with less developed intellectual, social and behavioural abilities than those children growing up within a family environment. Separation from parents, particularly in the case of institutional care, can threaten a child’s right to development. Of particular concern are large-scale residential institutions where children receive a lack of individual care. Children need to form an attachment to at least one carer and a lack of this attachment can have an impact on ‘self-esteem, confidence and ability to form relationships’ (Delap, 2009). These institutions if poorly managed can harbour abuse and neglect and create isolation for children from surrounding communities (Delap, 2011). In addition to its detrimental effect on the well-being of children, institutional care is expensive. It diverts resources away from provision of support to families or alternative, family-based forms of care. It is estimated that caring for children within residential care is three to five times more expensive than foster care and eight times more expensive than providing social service type support to vulnerable families (Carter, 2005).

This study provides a representative assessment of the situation of residential care in Afghanistan. It provides a profile of the types of governmental and private residential care as well as reasons why children are entering residential care and includes a cost benefit analysis which compares Afghanistan with neighbouring countries and reviews how Government of Afghanistan funding could be used to better ensure that the best interests of children in Afghanistan are being served.

2.2 Some basic definitions The Guidelines for the Alternative Care of Children provide a definition of Residential Care as: ‘care provided in any non-family-based group setting, such as places of safety for emergency care, transit centres in emergency situations, and all other short and long-term residential care facilities including group homes’ (United Nations, 2009). The situation in Afghanistan is slightly complicated since all institutions irrespective of size or parental status are referred to as ‘orphanages’. Within the study they will be referred in the majority therefore either as institutions or as orphanages since that is how they are registered with MoLSAMD.

2.3 The Context of Afghanistan For the past thirty years Afghanistan has been in a situation of chronic instability and conflict. More than half of the country’s population are under 18 and have experienced nothing but instability. Children have borne the brunt of the effects of both on-going conflict and poverty, only 60% of school-aged children are enrolled in school. Children have also been forced to work to support their families either on the streets or in workshops working long hours often subject to exploitation and abuse. The widespread use of residential care in Afghanistan originally emerged under the Soviet Regime between 1978-1992. MoLSAMD was originally established at this time and was tasked with the oversight of residential care. This responsibility was re-affirmed in the Orphanage Regulations


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developed by the Interim Government of Afghanistan in 2002. This supports the Constitution of Afghanistan which states that the Government of Afghanistan will aid orphans. These are the children, therefore, that the MoLSAMD is mandated to support and that should come under the protective care of the state. It was found during the development of the National Strategy for Children ‘at-risk’ (NSFCAR) in 2004, however, that as a result of the breakdown of community mechanisms and extended family networks throughout the conflict, institutional care was being used as a ‘coping mechanism to replace the kinship and social networks that were traditionally resorted to in Afghanistan to combat poverty, unemployment and homelessness’ (MoLSAMD 2004). As a result institutions were only caring for a small number of vulnerable and ‘at-risk’ children. In order to improve the level of care for at-risk children, the NSFCAR sought to provide a ‘Strategic plan for the transformation of children’s institutions into Child and Family Resource Centres to support the care of children within their families and reduce reliance on residential care. The Afghan National Development Strategy (ANDS) Social Protection Strategy (2008-2013) also stated that institutionalized children who have family would be reintegrated. Despite this plan and the allocation of funds and efforts by both national and international NGOs, MoLSAMD estimate that the number of public and private orphanages has increased from 30 to 70 since 2008 and according to MoLSAMD, now accommodates almost 11,000 children. The UNCRC Concluding Observations Report on Afghanistan also raised concerns about the level of institutionalisation of children and the quality of care provided to children within institutions. In order to inform future MoLSAMD policy, this project will use learning from other countries which share religious, political or cultural similarities with Afghanistan to

conduct an assessment of the costs of large-scale institutional care against preventative interventions and small-scale or other alternatives to care.

3 Chapter Two: Methodology

3.1 Research Design Sample Provinces At the start of the project data was gathered from MoLSAMD on the number of government and private institutions. Provinces were selected from this data on the basis of criteria including: security (whether data could feasibly be collected), number of government and private institutions, geographical spread (one province from each region plus Kabul), number of children residing in government and private institutions and links with CiC’s previous work. One province per region was chosen in order to ensure a mix of the different ethnic groups within Afghanistan. The target provinces were: Badakhshan, Ghazni, Kabul, Kandahar, Herat and Nangarhar. Sample size A total of 44 orphanages (government and private) were covered in all the six provinces. The differences between the actual numbers of institutions in comparison with the MoLSAMD data will be explored in more detail in chapter three.

3.2 Data Collection Tools A range of quantitative and qualitative data collection tools were used as follows:

Questionnaires

Finance-related data

Focus group discussions

Community Meetings and in-depth interviews


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3.3 Monitoring A project Advisory board was established which included: MoLSAMD, MoE, the General Director of Orphanages, a representative from the Ministry of Justice Human Rights Support Unit (which is mandated to follow up on the UNCRC), Terre des Hommes, UNICEF and Ecorys. Meetings were held at regular intervals throughout the project. The members advised on data collection, analysis and inputted into drafting of the final report.

4 Chapter Three: Profile of Residential Care in Afghanistan

4.1 Target Institutions MoLSAMD is responsible for the management of state-run orphanages in Afghanistan. In each of the six target provinces of this study there is at least one state-run facility and in Kabul and Herat there are two, one for girls and younger boys, and one for older boys. A total of eight public institutions were included in the study. In addition to the government orphanages, 36 private institutions were covered by the study which were all either registered with MoLSAMD as orphanages or which described themselves as orphanages. These institutions are defined as private but are mainly run by Afghan or international non-governmental organisations and are not fee-paying institutions. A total of 44 institutions were therefore covered by the research.

4.2 Government and Private Institutions Prior to conducting the study, data was gained from MoLSAMD regarding the number of private and state-run orphanages in Afghanistan. MoLSAMD estimated that the total number of public institutions in the country was 31 covering 5,903 residential and non-residential children. Within the private orphanages, MoLSAMD data showed a total of 40 institutions across the country reaching 5,449 children (resident and non-resident). The study covered eight public institutions and 36 private institutions giving a ratio of 1:4.5. Within the target provinces the number of government institutions found in the study was the same as the MoLSAMD data although the MoLSAMD data did not make clear that the institution in Herat is actually split into two institutions, one boys’ and one girls’. The MoLSAMD data for the target provinces showed a total of 33 institutions reaching 4,131 children (residential and non-residential) in contrast to the 36 institutions actually found during the study. The figure from the study includes four additional private orphanages found in Kabul which were not included in the original MoLSAMD list. One private orphanage, Fatimatu-zohra in Badakhshan, which was on the MoLSAMD list has actually closed and yet neither DoLSAMD in Badakhshan nor MoLSAMD centrally had a record of this institution closing. Inaccuracies in the number of orphanages registered by MoLSAMD and those in actual existence raises questions about the level of oversight provided by MoLSAMD of these private institutions. This is further questioned in relation to the process of registration and the categorisation of institutions. All of the institutions in the study were registered with MoLSAMD as orphanages but they clearly provide a range of different services for children and their families. Indeed not all institutions registered as orphanages have children residing within them.

4.3 Residential and Non-Residential Institutions


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In this study, residential children are defined as those who stay within the institution overnight and receive 24-hour care. Some of these children will go home to their families at the weekend or during holidays but they spend the majority of their time within the institution. Non-residential children are those who visit the orphanage only during the day to use the facilities within the institution but do not stay overnight. Within the 44 institutions covered by the study there were a total of 3,469 residential and 3,766 non-residential children in both public and private institutions. The total number of non-residential children exceeds the number of residential but mainly due to the large proportion of non-residential children in the private orphanages. It shouldn’t be ignored, however, that the proportion of non-residential children in the state-run orphanages is also around one third. This raises initial concerns about the purpose of these institutions if children are not staying overnight. The graph below includes both private and public institutions and demonstrates the residential nature of all institutions covered within the study:

Whilst the majority of institutions covered by the study (51%) are residential, there is a significant number (33% or seven institutions) which do not have any residential facilities at all. One of them, Peace Tent, does not have a building that children or families attend but rather provides cash transfers and food support to children and families within their communities. This reinforces the need for a more accurate way of registering institutions with MoLSAMD. Within the target provinces 33% of the institutions provide no residential facilities, if this proportion is indicative of the

entire country then based on the existing statistics provided by MoLSAMD they could have 13 institutions providing for almost 2,000 children registered as orphanages that actually have no residential facilities.

4.4 Growth of Private Institutions Within the study sample, private institutions were also found that cater to children/families of a particular type. Missionaries of Charity in Kabul provides educational support to children with disabilities as well as outreach work in communities. The Women for Women Shelter only supports children whose mothers are in prison. The wide variety of purposes served by these institutions suggests that the term ‘orphanage’ is unhelpful and should not be used. Whilst these services could be sub-contracted to NGOs, the legal responsibility still remains with the state in the absence of parental or family care and the funding for this should come from the state. It appears from the data collected that if the proportion of public to private orphanages is replicated across the country, that the private sector cares for more than twice the number of residential children than the public sector. MoLSAMD estimates that the private sector cares for 5,449 children nationwide but the research suggests that the actual number must far exceed this and is possibly as high as 10,000 children since MoLSAMD is under estimating the number of private institutions. There were mixed views amongst Community Members about the growth of private orphanages, at one Community Meeting in Herat, one of the fathers stated that: ‘in private orphanages there are no needy children, because these kinds of orphanages take money from people and organizations and even from children’s parents, but in Government orphanages there are vulnerable, needy and orphan children.’ As previously stated, officially the private orphanages included in this study are all established by NGOs, and are non-fee paying although in this case the private orphanages appear to be taking money from parents to allow their children to stay. In Nangarhar when discussing

Graph 1: Residential Nature of Orphanages Residential Boys and

Girls

Non-residential Boysand Girls

Both Residential andNon-residential Boysand Girls

33% 51%

16%


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one of the private orphanages, community members were much more positive stating that: ‘this orphanage should be here forever, if it is not here then what will happen to our children?’ and ‘the orphanage is a very valuable place, here our children are prevented from bad things and they will be directed or invited to live in a good way, they can learn here, so they will be something in future’.

5 Chapter Four: Profile of Children in Residential Care

5.1 Parental Status As stated in the introduction, there are various interpretations of the term orphan. The outcome of community discussions in this project suggest that in Afghanistan although children who have lost either their father or mother or both are all considered orphans, paternal single orphans were considered particularly vulnerable. This is likely to be in relation to the inheritance rights of sons in Sharia law. The data for parental status is split between residential and non-residential children.

Graph 2 shows the parental status of children in residential institutions (public and private). The majority of children, 64%, are single paternal orphans followed by 16% of children who are single maternal orphans and 12% who are double orphans. 8% of children in residential care have both parents living. This demonstrates the need for support to families, within the community, particularly women whose children have lost their father. One of the explanations for the high number of single paternal orphans in residential care is that in many cases when widowed women marry again the new husband will not accept children from the previous husband and that they are therefore placed in residential care. Graph 3 demonstrates that 90% of non-residential children in institutions are single parent orphans and in total 2% of children are single maternal orphans or double orphans. 8% of the non-residential children have both living parents. This graph highlights that the vast majority of non-residential children have at least one living parent and suggests the need to explore in more detail the reason why children are using these non-residential services.

5.2 Gender The proportion of boys in both the non-residential and residential institutions is more than three times the proportion of girls. In discussions with communities and residential staff, two reasons were highlighted for this: 1. after a certain age it is culturally not acceptable for girls in Afghanistan to stay in an out-of-home/family setting and 2. Boys’

1% 8%

90%

1%

Graph 3: Profile of Non-Residential Children

Double Orphan

Both parentsliving

Single PaternalOrphan

Single MaternalOrphan

12% 8%

64%

16%

Graph 2: Profile of Residential Children

Double Orphan

Both parentsliving

Single PaternalOrphan

Single MaternalOrphan


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education is more valued thus they are sent away to institutions whereas girls stay at home and help with housework. This highlights the need to provide educational infrastructure closer to these girls’ homes and to work with families to ensure that they are allowing their children to attend school. During one of the Focus Group Discussions in Herat, a community member stated that ‘Islam doesn’t allow us to keep our girls outside of home after they grow up’.

‘Boys need to find a job and hence need to be educated properly; girls would be married and have to take care of their families’ Community member- Herat 5.3 Age Data on the age of children in the institutions is estimated since the records of children are not regularly updated. The estimates suggest that there are approximately 101 residential children under five years of age across the sample of institutions. This needs to be explored very carefully because the admittance of children under the age of 5 into residential care should be avoided at all costs. The Guidelines for Alternative Care of Children refer specifically to children under 3 but also states that ‘In accordance with the predominant opinion of experts, alternative care for young children should be provided in family-based settings’. It is very important for young children to make a bond with their caregivers otherwise this can seriously harm their development Within a residential care environment there is a danger that the children may have multiple caregivers or be neglected and this situation should be used as a last resort, when all other possible options have been exhausted for very young children. Children under three years old face the risk of permanent damage to their physical and mental development as a result of institutional care (Browne, 2009). There are also at least 12 resident children who are living in the institutions after the age of 18 and based on experience CiC would estimate that the actual number is higher

than this. Orphanage staff in Badakhshan stated that since regular individual plans are not maintained for children, their exact ages are often not known and as a result children remain in the institutions after 18 years of age.

‘The children are expelled from the orphanage on the observation of the physical age of the child’ Orphanage Staff In Tahai Maskan orphanage in Kabul, older children who were over 18 had become caregivers within the institution.

5.4 Disabilities Children with disabilities appear to be accepted into a few specialised institutions such as Missionaries of Charity in Kabul which is a school for children with disabilities and provides residential care for a small number of children. In Kabul there are three children and young adults with disabilities living within the institutions but the payment of their caregivers is supplemented by other organisations since it is not completely provided by MoLSAMD. There is a four-bedroom unit for children with disabilities within one of the institutions in Kabul. This was only established after extreme pressure placed on MoLSAMD and after a boy was admitted to hospital since he was not being cared for within the institution. The Institutions in Kabul have also refused to admit children with severe disabilities despite this category of children being included in the orphanage regulations. In a focus group discussion within one of the government institutions in Kabul, researchers observed the staff behaving negatively with a child with a mental disability and called him derogatory names.

6 Chapter Five: Standards of Residential Care

6.1 Contact with Parents and Family The majority of children covered by the study are non-residential meaning that they are staying with their families each evening. It


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should also be noted that the majority of residential children also return home to their families for holidays and/or at weekends. The majority of public orphanages are also closed down during school holidays and children are sent to their families for up to 3 months in the winter and up to a month in the summer, indicative that the primary purpose of orphanages is to provide education. All of the orphanages with the exception of one of the private orphanages in Badakhshan had a plan for when family members would visit children which varies normally from two times per month to once per month. When the Children in Crisis researchers discussed the option of children staying with their families with one of the managers of a course run at an institution in Kabul to supplement resident and non-resident children’s education, he stated:

‘If families of children are provided with financial support it is good for the children to be at home, because Islam and the law give this right to children’. This is a very important finding and an important point since families, communities and the Government of Afghanistan need to acknowledge the right of children within national and international law and within Islam to stay with their families.

6.2 Existence of Records and Individual Care Plans Records refer only to basic information on all of the children within institutions which should be provided when a child is introduced to an institution. Individual care plans are detailed case records of children that record the age at orphanage entry of a child and day-to-day updates of progress of the child including educational achievements, disciplinary issues and records of contact with the child’s family. They should also detail the plan for the children’s future care and education, detailing what arrangements would be in the best interests of the child

following discussion and agreement with the child, their family and caregivers. In those institutions which have received support through the Social Work Coaching project (Kabul, Ghazni and Herat) children have care plans and records are well kept. In Badakshan and Kandahar however, none of the children had care plans. It is clear that whilst some of the government institutions have children’s records and care plans, there is not a systematic culture of use and review of care plans within the government institutions and demonstrates a lack of investment and commitment by the state to upgrade its capacities and service provision.

6.3 Assessment upon Entry into Institutions Each of the institutions had different methods through which children would gain entry. In the government orphanages, 70% required a recommendation from the MoLSAMD/ DoLSAMD whilst 30% required only a recommendation from a family member or community leader to prove that the child warranted being placed in the institution. According to the rules and regulations for residential care, children should be accepted based on adequate documentation and approval of these documents by the Governor. At the government institutions, it is the role of M/DoLSAMD and the community leaders to prove the need for a child to enter the institution. In the private institutions, 17% of them are the reverse where survey teams from the institutions actively go out into communities to find children from vulnerable families to enrol in the institutions. The number of non-residential children admitted has increased dramatically from only 93 children in 2002 to 1,179 children in 2011. This growth in admittances of non-residential children mirrors the growth of private institutions in Afghanistan and is demonstrative of the number of families enrolling their children in these institutions. In discussions with parents about why they send their children to the private institutions,


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a mother who has one daughter currently enrolled in an institution in Kabul and another who has graduated stated that:

‘If there was no orphanage, our children would have been deprived of education; it’s been five years since my child is in this orphanage, if the orphanage was not here, I would not be able to enrol them in school and they would be deprived from education and suffering from various diseases because I don’t have the capability to buy medicine or do their treatment.’ The mother added: ‘this orphanage should be there forever, because it builds the future of poor children like mine’. The lack of records within institutions and review of children’s care plans results in the existence of children who are over 18 continuing to attend or reside in institutions as described previously. There is also a lack of planning and preparation for what support young people will have when they are forced to leave institutions.

6.4 Education Within the private orphanages which have residential facilities, 44% of institutions have a private school inside, 21% cover the cost of sending resident children to a private school outside of the institution and 35% send resident children to a government school outside of the institution. Among the government institutions, all of them have government schools inside with the exception of the two institutions in Herat which have private schools inside. In all of the Government Orphanages with the exception of the two in Herat and the orphanage in Badakhshan there are non-resident children who appear only to be enrolled in the institution for educational purposes. This is a more serious issue than the private institutions since MoLSAMD is bearing the load of covering the costs of an entire institution and all associated staff for these

non-residential children solely to attend education. The view of orphanages only as schools appeared to be shared among parents and children during focus group discussions. In Badakhshan a 12 year old boy stated that:

‘Our uncle brought us to orphanage, because his economic situation was not good and this place is very good for education’ Also in Kandahar an 11 year old boy reported that: ‘I like this second place (orphanage), because I study here and then I like home, because my father and mother are there, both my father and mother are alive and are here in the orphanage.’ This child’s parents are both alive and both work in the orphanage. He studied in the institution and then would return home to live with his parents.

6.5 Staff to Child Ratio Within the institutions covered by the study there was an overall ratio of 14.4 children to 1 staff member (educators, administrative staff, management, cooks, cleaners, gardeners and security staff). This is a reasonable ration and does not reveal the disparities in the figures from the various institutions. The government institutions have quite shocking children: staff ratios. In the government institution the ratio is 1 staff member to 34.5 children and in Kandahar it is 1 child to 32.4 children. This was reflected in conversations with the head of the government orphanage in Kandahar who told researchers that:

‘The number of staff is so few here that many times children have to help out with the daily activities of the orphanage’. This presents a serious child protection risk to the protection of children. Another issue which isn’t apparent from the ratios is the difference between the number of staff on duty during the day and night. Allaudin


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Orphanage in Kabul has a relatively good staff: child ratio of 1 staff member to every 5.5 children but in previous visits, CiC staff have been told that there are only two care staff on duty during the night for all 270 children. This is a child protection concern particularly in light of the fact that young people over the age of 18 are being housed in the same building as very young children. In the community surrounding Tahai Maskan Orphanage in Kabul, community members complained at the lack of supervision of children which meant boys were escaping from the orphanage by climbing over the boundary walls. The education provision within government institutions also suffers from poor staff ratios; the director of the government institution in Ghazni stated that:

‘We have only 4 teachers for 120 children. We have demanded for more teachers but have received no response’. At the government orphanage in Nangarhar there are only 10 teachers responsible for 500 students. In Kandahar the government orphanage has only one teacher for all 271 children. In Allaudin orphanage in Kabul, there were reports of high levels of staff on the payroll that have never actually showed up for work or do not come on a regular basis. This is an area that was difficult to pursue in any level of detail but it is assumed that this may also be the case in other government orphanages since the level of oversight by the Central and Provincial Government appears weak.

6.6 Management and Oversight At present the private orphanages report directly to DoLSAMD in the Provinces and MoLSAMD centrally rather than through the General Director of Orphanages. There is no monitoring unit within the General Directorate of Orphanage and appears to be very little monitoring of both the public and private institutions by representatives from M/DoLSAMD.

The administration, management and line of reporting of orphanages are anomalous. NGOs running private orphanages are required to be registered with the Department of NGOs within the Ministry of Economy and report to them financially on a quarterly basis. Since they are also caring for vulnerable children then they are also required to be registered with MoLSAMD and submit technical reports to them. The private orphanages appear to prioritise their reporting to the Ministry of Economy because without this they run the risk of losing their NGO status and do not report to MoLSAMD.

7 Chapter Six: Cost/Benefit Analysis

7.1 Background In this context cost benefit analysis implies a pattern of expenditure which provides services giving the optimum available outcome for beneficiaries, in this case children and families, in the best available cost effective way. Costs refer to capital and recurrent costs such as staff salaries, utilities and food. All costs presented in this chapter are in USD for ease of comparison. The benefit to children and families can relate to both the increased productivity of children when they become adults and the improvement of their environment leading to an improvement in physical and mental health and an improved nutrition. Data within this chapter is sourced from both public and private orphanages. The analysis and conclusions which flow from this data are indicative, i.e. useful as a planning guide but not definitive - it being clear from the limitations chapter that gathering accurate disaggregated cost data for orphanages in Afghanistan is a challenge.

For each of the Government and private orphanages, data was gathered on the number of resident and non-resident children present during 2011 and the expenditure during the 2011 financial year. Expenditure data used in this chapter is the best available. Not all data provided was comprehensive, nor relating precisely to the same period. The data for all institutions does, however, relate


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to expenditure incurred and not to budgeted expenditure. When calculating the unit cost per annum, the cost for non-resident children (essentially education) assumes one third of cost for a child fully resident. This calculation is based on previous experience conducting a study of residential versus community-based services for children in difficulty in Moldova in 2005 (Larter and Veveritsa, 2005).

Government Institutions

Data was gathered for each of the eight Government orphanages covered in the study. During the financial year 2011, there were a total of 1,491 resident children and 451 non-resident children across the eight institutions. Of the two orphanages with non-resident children one, Abdul Ahad Karzai in Kandahar has a majority of non-resident children (271 non-resident, 53 resident) while at the other, Amam Bokhary in Nangarhar the numbers of resident and non-resident children are approximately equal (220 non-resident, 180 resident). It might also be noted that of these 1,941 children only 32 are considered as disabled. The variation in unit cost, i.e. the cost of a resident place for one child year, is remarkable. The range in this study is from $US 444 to $US 1,388, with a mean of $US 1,247. Information gathered during the study from DoLSAMD Offices in the Provinces demonstrated that the system of budgeting for Government orphanages is top down. This was also confirmed during a meeting with MoLSAMD in Kabul. Institutions do not have their own accounting unit or any input into the preparation of annual budgets. This is a matter entirely for MoLSAMD. Salaries are paid centrally while there are centrally determined contracts for food and other supplies. Utility bills are paid centrally. Thus Government institutions have not only no input into budget preparation but virtually no control over their spending. Given this position the wide variation in unit cost per annum indicates a lack of effective financial management by MoLSAMD. It is reasonable

to assume from that that the Ministry’s overall management of its residential institutions is also deficient.

Overall Public Orphanage Expenditure

Extrapolating from the data it is possible to derive an approximate figure of overall expenditure on public residential care. According to MoLSAMD there are 36 public institutions in the country caring for 6,216 children, giving an overall annual spend of $US 7,751,352 (6,216 x $US 1,247). As previously indicated this calculation should be treated with caution due to the wide variation on expenditure in public orphanages. This is actually double the figure provided by the Ministry of Finance as total expenditure on orphanages in 1391. The comparison between the amounts provided by the provincial institutions and the centralised figures from the Ministry of Finance further calls into question the oversight of the financial system. MoLSAMD and UNICEF estimate that there are about 8,000 children in residential care (public and private institutions) – this is only a tiny proportion of the number of children under 17 (Less than 0.1%). In neighbouring CEE/CIS countries on average about 2% of the child population under 17 need protection and therefore some form of care or support outside their families (Larter and Veveritsa, 2005, 3). The proportion of the child population in need of some form of care or protection would be likely to be higher in Afghanistan, given the higher levels of poverty, insecurity and other forms of adversity, suggesting that there are likely to be at least 250,000 children in such need in Afghanistan. Thus the resources devoted to residential care are, at present, only providing for less than 3.2% of children in need of Government assistance. The sum of money currently expended on residential care is, therefore, inadequate to do more than make a modest start toward the development of a nation-wide network of family and child-focussed


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services able to support all children in need of assistance. 4

Private Orphanages In common with institutions in the Government sector, there are wide variations in unit cost in the private sector, the range being $US 125 to $US 3,337. With 1,449 resident children and overall expenditure of $US 1,782,437 within the residential institutions only, the average unit cost is $US 1,230. This figure is remarkably close to the average unit cost per child in the Government sector. However, the data for Hazrat Mhd. in Ghazni Province at the lowest extreme, $US 125 must be regarded as suspect since it is so low that the data appears inaccurate. The range in the private sector probably indicates variations in the range and quality of services offered by individual organisations.

7.2 Comparison with Neighbouring States

Observations can be made about similar aspects and social phenomena in a range of other countries by way of comparison of the costs of residential care in Afghanistan and those other countries with a view to achieving a cost-benefit analysis as between residential and alternative forms of care. To the extent that direct comparisons between Afghanistan and other nations are possible, comparisons here are drawn between the position in Afghanistan and the position in Tajikistan, Kyrgyzstan, Azerbaijan and Moldova. Tajikistan is a near neighbour of Afghanistan while a significant proportion of the population of Afghanistan is ethnic Tajik. Kyrgyzstan has been chosen because it has a number of comparable characteristics. Azerbaijan is a Muslim country, albeit less overtly observant than Afghanistan, but has some social problems common to Afghanistan, notably forced and early

4 A first step in developing services for children and

families is often initiating pilot projects, e.g. the government in Kazakhstan is developing a community-based protection system pilot for children aged 0 to 3 in three districts of the country. This is then more attractive to donors as the country can demonstrate results.

marriages5 and their attendant consequences. Moldova has been chosen because as the poorest country in Europe it also offers some comparisons. It has been noted that the proportion of the 0-17 Afghan population in residential institutions is 0.1%. This proportion is remarkably low. In Tajikistan the proportion is 0.33%, in Kyrgyzstan 1.1%, in Azerbaijan, which has a relatively advanced reform programme in place, 0.66% (Larter and UNICEF Azerbaijan). In Moldova the figure in 2007 was 1.22%. The significance of these data is relevant to the scope for the redeployment of financial resources in the process of a reform programme, an important element in considering cost effective expenditures and cost benefit analysis. Given the comparison countries cited it can be seen that Moldova has potentially the greater scope for financed reform programmes. In terms of percentage of GDP Moldova’s education expenditure is among the highest in the world (Rank 7), while 8% of that expenditure was dedicated to residential care. Kyrgyzstan also has some flexibility. Of the countries cited Tajikistan has the least available flexibility and will need to find new money to develop alternative services. Azerbaijan’s reform programme is largely contained within existing education expenditures6.

Sources: At home or in a home? Formal care and adoption of children in Eastern Europe and Central Asia -UNICEF Regional Office for Central and Eastern Europe and the Commonwealth of Independent States (CEE/CIS) - September 2010; and Global Facts about Orphanages - Better Care Network Secretariat - August 2009

5 The Nirzami Rayon centre, Baku, has a pilot project

seeking to reduce the incidence of illegal early marriage, exploiting their access to applicants for social benefits.

Country % 0-17 in Residential Care

% of children in residential care with at least one parent alive

Afghanistan 0.1 85-90%

Kyrgyzstan 1.1 80%

Tajikistan 0.33 80%

Azerbaijan 0.66 -

Moldova 1.22 -


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There are however other differences. Each of the countries cited is a former Soviet republic and has the range of types of institution including some catering for children with specialist needs, characteristic of the Soviet system. These are frequently the responsibilities of Ministries other than Education, Health for example in respect of children with mental disability or neurological disorders. Each has public finance regimes in which some institutions are financed from the State budget and others from regional budgets. All have a significant number of pupils who attend as day students. All of the comparison countries include Guardianship7, a form of kinship care, as one of the few alternatives to institutional care. Guardianship is the formal placement of a child deprived of parental care in the formal custody of a part of its extended family. Azerbaijan and Tajikistan make allowances to Guardians, Kyrgyzstan does not. In Kyrgyzstan, as in Afghanistan, children are often sent to institutions hundreds of kilometres from their home communities, resulting in the child’s definitive separation from its family and community. Commonly, the criteria used for making decisions which determine the future of children and specifically their admission or not into residential institutions have utilised loose criteria, while there has been, in some locations, anecdotal evidence or commonplace belief of their corruption. These programmes typically focus upon proper assessment of needs ahead of decision and include the rationalisation of the work of Commissions. Such reforms are most likely to be effective and sustained when they involve the development of a single gate-keeping mechanism to avoid children being taken unnecessarily into residential care, gate-keeping being a coordinated system of multi-disciplinary assessment and decision making,

7 The definition and use of the term ‘guardianship’

varies significantly around the world. Guardianship may confer parental rights and responsibilities to adults who are not parents, but it does not necessarily imply that the guardian is also the child’s caregiver (Save the Children, 2007).

led by a single agency, that guides effective and efficient targeting of services for children (Bilson and Harwin, 2003).

7.3 Cost Benefit Analysis

Cost

The unit cost for a child year in a residential institution providing both care and education must be divided into the education element and a care element in order to establish the volume of financial resource theoretically available for redistribution in the event of a reform programme to replace residential care with community alternatives. It is suggested here that this division should be approximately 70% for care and 30% for education. This division is necessary because whatever alternatives to residential care are provided the child beneficiary remains needing to be educated within a community based education system. The division is based on a previous cost/benefit exercise addressing residential care in Moldova (Larter and Veveritsa, 2005, 2). Equally, when considering the cost benefit of particular expenditures i.e. the relationship between expenditure and beneficial outcome, it is necessary to take into account the total expenditure per beneficiary. Thus in order to determine the overall cost of the provision of a particular service it is necessary to multiply the annual unit cost by the number of years during which the service is delivered to an individual beneficiary. Thus, for a child entering a residential institution at, say, age seven, and graduating at, say, age seventeen, the overall unit cost is ten times the annual unit cost. For expenditure on Government institutions with an annual care cost of $US 873 ($US 1,247 x 70%), the overall expenditure per beneficiary, in the example given, will be $US 8,730. In terms of cost benefit the question is: does this pattern and scale of expenditure produce a beneficial outcome for the child?

Options for Alternative Care The National Strategy for Children at Risk advocates for the reform of residential care and one of its focuses is on transforming the


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present Government Institutions into ‘Child Family Resource Centres’. Whether transformation is the appropriate course should, in practice, be subject to a number of tests. Perhaps the most important is location i.e. is the institution’s location close to a centre of population such that its transformation would be viable in terms of access for potential beneficiaries. For example Aschiana Samar Orphanage in Jaghori District is in a very remote and insecure area of the province where families would not wish to travel to leave their children each day. Other tests relate to the suitability of sites and buildings and to the capital costs of securing the transformation. These issues include the range of buildings in any given campus and their suitability; their condition and their proposed future use. The viability of the transformation option should take into account the impact of required (and available) capital to meet the costs of the transformation and the downstream impact on revenue budgets of significant capital expenditure. The results of these tests should be evaluated against the alternative costs, capital and revenue, of closure and the provision of alternative services at other more appropriate locations. A cost benefit analysis of Child Protection policies for Tajikistan, conducted by the Government of Tajikistan (2009) with UNICEF and the University of Maastricht, concluded that the policy of residential care was the most costly option in the long term. Policy options based on deinstitutionalisation were less costly (between 10 and 25% of the cost of residential care) in the medium and long term and alternative options to residential care were found to provide better outcomes for children and families. The traditional alternatives canvassed in association with deinstitutionalisation policies are, in the main, a range of day care options to support children with families, plus kinship or guardianship care and foster care as alternatives to residential care for children deprived of parental care.

Guardianship:

There is a tradition in many Former Soviet countries of Guardianship, in which a child’s extended family undertakes the formal responsibility for the care of a child, i.e. formally appointed by the state. Some countries e.g. Azerbaijan, pay allowances to Guardians or Trustees while others, e.g. Kyrgyzstan do not. In either event Guardianship is the least costly of all formal alternative care options for children deprived of parental care. Foster Care: The running costs of foster care, based on experience in Central and Eastern Europe and the Former Soviet Union, are approximately one fifth to one third of state institutional care (Carter, 2005, p.35). However, establishing a safe and sustainable system of foster care requires considerable time and investment at the outset, but even if the initial unit cost is initially closer to the cost of maintaining large state institutions, the argument in favour of foster care over residential care generally can be clearly made on the grounds of more beneficial outcomes for the child8. An additional financial advantage may be argued in that foster care placements are typically of shorter duration than enrolment in a residential institution, in particular when a child has a clear care plan with support services to enable reintegration to the care of a parent or relative, or placement for adoption or long term foster care if this is not possible. However, when arguing a case for either kinship care or a form of guardianship, or

8 Evidence cited in Carter (2005): An analysis of 75

studies, incl. more than 3,800 children in 19 countries found that children reared in large-scale residential care had, on average, an IQ 20 points lower than their peers in foster care (Barth 2002). A longitudinal study by the Bucharest Early Intervention Project found that young children who were moved from large-scale residential care to supported foster care before the age of two made dramatic developmental gains across several cognitive and emotional development measures compared to those who continued to live in residential care and whose situation worsened considerably (Nelson et al 2007).


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more formal forms of foster care, in additional to the legal, policy and budgetary and capacity building requirements for developing such services, the question of local cultural traditions relating to substitute family care for children unable to be cared for by their parents needs to be taken into account. Kafalah: Within Sharia law, adoption is seen as set against the natural order of society and is thus haram (forbidden). The preservation of blood ties and inheritance rights mean that adoption is not permitted. Within the Koran, however, the importance of orphans and their protection is stressed. Orphan children should be treated as a biological child but not entitled to the same rights as the latter. In cases where Kafalah is used, the caregiver has parental authority and is obliged to care for a child but the child’s original family bonds and family status continue to exist. The way in which Kafalah is interpreted throughout the Muslim world is highly varied. It is necessary, therefore, to put any practice of Kafalah within its national context in order to fully understand it. Day Care Support: When it is safe for a child to stay at home then day care support may be sufficient for children and families. The costs and unit costs of day care which provide education, expressed in terms of the annual cost of a place are generally about 30% of the costs of residential care (Larter and Veveritsa, 2005, 2). Given that 30% of $US 1,247 is $US 374 while the unit cost shown for some of the day units in the private sector are in the range $US 350/395 it seems a reasonable estimate that the cost of a day care place would fall within this range. However, that estimate is net of any set-up costs which might include site acquisition, architectural fees and capital costs. These costs must be evaluated and taken into consideration at the planning stage. The unit cost in terms of cost per beneficiary is not necessarily the same as the cost of a

place. Such unit costs are a function of the purpose and utilisation of day care by beneficiaries. That in turn is a function of the purpose of any specific centre. A rehabilitation programme with a finite period of attendance has a different unit cost calculation to a long term centre for say, children with a mental disability. Equally, the average number of days per week in which a centre is used by beneficiaries also affects the calculation of unit cost per beneficiary. It is generally unusual for a beneficiary child to attend for an extended period for each day that a centre is open so that the calculation of unit cost is dependent not upon the number of places available but the overall number of beneficiaries to whom the centre is able to provide a service. Overall the cost of a place will depend upon the level of supervision required by beneficiary users (staffing ratio) and the range of specialist workers employed either full or part-time by the centre. Nonetheless day care services, when they enable children to remain in the care of their parents or relatives, are likely to provide better outcomes in the long term, avoiding the negative effects on children of residential care, and delivered at lower unit cost.

The Maastricht study cited above also argues that alternative policies are on average 50 to 70% cheaper than institutional care. It equally argues that a system of alternatives needs to be in place ahead of a deinstitutionalisation programme. Although the cost data gathered in this study may not be entirely accurate, it is still reasonable to suggest, for example, that the resources used for a residential place are capable of providing two and one half day care places ($US 873 divided by $US 350 = 2.49). Even with the development of universal services, and with a re-profiling of child care services from large-scale institutions to family and community-based care, it is likely, however, from the experience of other countries including the UK that have shifted child care provision almost completely from residential care to foster care, that some


20

highly specialised small-scale residential care units would need to be retained. These would be for children with particular difficulties, including those with challenging behaviour and young people who have experience multiple rejection and abuse in families and / or many years of life on the street and in mid to late adolescence may resist any attempt to introduce them to a new substitute family. Reform of private residential care institutions in Afghanistan In recent years there has been an explosion of private sector institutions particularly since 2007. A very high proportion of these developments are financed by resources provided by expatriate Afghan individuals and organisations, for example AFCECO, (Afghan Children’s Education and Care Organisation) and The Afghan Women’s Organisation of Canada. These initiatives have their origins in a wide variety of countries, including, for example, Egypt and Japan. They represent initiatives by Afghans in making their own efforts to improve the future of Afghan children. The question must be asked as to whether the MoLSAMD has any policy toward these developments, in particular given the earlier observations with regard to the registration of orphanages and the apparent lack of any oversight regime for supervising private initiatives of this kind. Consideration should be given as to how this kind of private initiatives can be encouraged to contribute to a government driven reform programme as envisaged within the National Strategy for Children at Risk. This will need careful lobbying, information and advocacy work in the donor countries with the Afghan diaspora. It has been noted above that this study covers 25 private residential institutions, i.e. excluding those establishments not properly orphanages. They care for 1,449 children. The probability is that the private sector cares for more children than the public sector, perhaps even by a factor of ten, i.e. over 60,000 children. Even that figure implies

possible coverage of no more than 25% of the probable number of children in need of some kind of formal care or protection service (based on projection from similar studies in Moldova, Larter and Veveritsa, 2005, 3).

7.4 Cost Benefit Analysis Conclusions and Recommendations

In general the development of appropriate community based child care and protection services will require additional funding and, in the initial phase of development, only a small part of this funding will be available from the early cost savings from the first stages of phasing out of residential care. Consideration should be given to recommending two or three local pilot initiatives to demonstrate what can be done in development of a continuum of child care and family support services in individual districts, so that the results of facilitate further fundraising for the initial cost investment.

1. MoLSAMD:

The analysis has shown that, not only is Afghanistan short of the resources it needs to provide appropriately and adequately for children in need of protection and assistance, but that its principal Ministry, MoLSAMD, lacks both the policies and competencies to discharge its current responsibilities, let alone the competencies to initiate and drive a reform and development programme. A prior requirement before any programme of development and reform can proceed is to improve the competencies and commitment of the principal responsible Ministry, the MoLSAMD. Sustained capacity building and mentoring initiatives are needed in a number of areas. Financial planning and management are key, as are strategy development and implementation, change management and even day to day management and control.

2. Education

It should be noted that any reform programme directed toward residential institutions should acknowledge and provide for the transfer of responsibility for education to the Ministry of Education together with the


21

financial resources currently deployed by the MoLSAMD in educating children to the Ministry of Education.

3. Private Orphanages:

At present it appears that developments in the private sector are being made without reference to any kind of policy framework. Investment in capital resources is popular among donors world-wide because the existence of an orphanage is tangible evidence of the use of the donation providing a focus for the donor, this despite the wide spread understanding in child protection organisations of the damaging effects of residential care upon the growth and development of children. Given the need for alternatives to residential care, it is suggested that efforts are made to build a partnership with the private sector and in particular with the Afghan diaspora in donor countries, perhaps initiated by the EU or UNICEF in order to encourage the private sector and the donor community to think more widely about the nature of their development i.e. toward expanding the range of their development and investment into a range of services beyond residential institutions.

4. Alternatives: The challenge facing Afghanistan is not the re-building of a Child Protection and Family Support system destroyed by decades of war, civil unrest and dislocation; but rather, the building of an affordable and sustainable community-based Child Protection and Family Support system where none previously existed. This means that an important part of the funding will need to be new funding from international donors. It will be important to do research as to which community based alternatives are best suited to Afghanistan. Community based alternatives are on average 15 to 30% of the cost of residential care, even

including education9. It is important to note that 85 to 90% of Afghan children currently in residential institutions have at least one living parent, so one of the paths to explore will be social protection systems for poor parents and also to aid foster parents or guardians. There has been considerable We need to understand which of these causes and what others are important in Afghanistan. Having understood and assessed the causes and drivers of institutionalisation, the next step would be the development of a single coordinated gate-keeping system, to prevent unnecessary admission of children to residential care, and to divert children multi-agency assessment and planning to any one of a continuum of community-based family support and child care services.

8 Chapter Seven: Conclusions and Recommendations

8.1 Conclusion There is a huge variation in institutional care that currently in Afghanistan. It is simply inaccurate to all institutions covered by the study as residential care since many of them do not have children staying overnight. Even within the state-run institutions there are still non-residential children and the situation within the private sector is even more extreme with some institutions acting simply as food distribution centres. The description of these institutions as ‘orphanages’ is also inaccurate since a significant proportion of children registered in both public and private institutions have both living parents. The majority of public and private institutions provide education and education appears to be a major pull factor towards residential

9 EveryChild’s (Carter, 2005, p.8) assessment of the

evidence in Central and Eastern Europe and CIS countries indicates that on average, institutional care in that region is twice as expensive as the most costly alternative: community residential/small group homes; three to five times as expensive as foster care (depending on whether it is provided professionally or voluntarily); and around eight times more expensive than providing social services-type support to vulnerable families.


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care. This does beg the following question: why does MoLSAMD have responsibility for the oversight of private institutions providing only education and no residential facilities? And why are some of the public institutions only providing education and not residential care? These institutions should either come under the remit of the Ministry of Education and residential children should be returned home and have access to MoE education closer to their homes. There are some serious concerns in relation to the number of children in lower age groups in care, which highlight the need to focus on primarily supporting children within their families wherever possible and safe. What this study could not do is provide evidence that those children who are using these institutions are the most vulnerable children in Afghanistan. The NRVA shows that there are many single and double orphans who stay within their extended families rather than living in residential care. There is no data from this study or other studies to date that demonstrates that children within orphanages need to be there at all. Within Afghanistan, the challenge is not the re-building of a child protection and family support system where previously one existed which has been destroyed by the war, but the building of an affordable and sustainable community-based child protection and family support system where none previously existed.

8.2 Recommendations The evidence from this study demonstrates an overarching lack of oversight of the institutional care system by MoLSAMD thus the majority of recommendations refer either to MoLSAMD itself or encourage support of MoLSAMD to ensure a fully functioning child protection system. In order to put these recommendations in place, a sustained capacity building and mentoring programme needs to be developed for MoLSAMD in a variety of areas such as financial planning and management, strategy development and implementation.

1. Review of State Protective Care for Children

This study has demonstrated that there are many children living within institutions who have living family and could actually be at home. Residential Care in Afghanistan is currently used as a first rather than last resort for a variety of reasons primarily lack of access to education. The Government of Afghanistan is mandated, as a signatory of the UNCRC, to provide care for children at risk. This should primarily be through support to vulnerable families and in a situation as close to a family environment as possible and includes state care for those children who do not have any family or in whose best interest it is not to stay with their family. MoLSAMD needs to ensure that state protective care is provided for those children who do not have a responsible adult to care for them or those who are placed at risk by staying with their family or a responsible adult. It is only these children who should come under the protective care of MoLSAMD and who require alternative care, outside of their immediate family environment. The development of these criteria should form part of the development of the Child Act in Afghanistan and should be informed by the UNCRC. Following establishment of these criteria, future admission to residential care should be limited only to those children who qualify for state protective care. This will require training and investment into government Institution staff to ensure effective gate-keeping.

2. Reintegration of Children There are clearly a huge number of children currently staying in government institutions who could be returned to their families. MoLSAMD and DoLSAMD staff need to be supported to conduct assessments of these children and their families to ensure that those children who do not require state


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protective care are returned to their communities to reduce the negative impact of residential care upon them. Reintegration of children with their families is a long process and should not be done without adequate funding for pre-planning, assessments and follow-up of children. Children who have been reintegrated should be linked with other non-governmental and/or governmental services available in their communities to provide the services required to them.

3. Education There are both public and private institutions within the study that only attract daily attenders which suggests that they are only attending to access education. MoLSAMD needs to collaborate closely with the MoE to ensure that they are providing adequate educational support to vulnerable children. The private institutions providing education are obviously highly valued by children and their families but responsibility for oversight of these institutions should not lie with MoLSAMD and should be handed over to the Ministry of Education. This would free up resources within MoLSAMD which could be directed towards support for the most vulnerable children and their families.

4. Alternative Care There are, and always will be some particularly vulnerable children in Afghanistan who require state protective care. This should not, however, mean that these children have to be in large-scale residential institutions. These are damaging to children’s physical, intellectual and emotional development and are also expensive. To lessen these impacts, children should be placed within small-scale care which, as far as possible, resembles family life. In order to successfully establish this, additional research should be conducted into which community-based alternatives are best suited to the culture and situation of Afghanistan. Community based alternatives have been found in other countries to cost on

average 15 to 30% of the cost of residential care, even including education10. It is important to note that 85 to 90% of Afghan children currently in residential institutions have at least one living parent, so one of the paths to explore will be social protection systems for poor parents and also to support foster parents or guardians. There will not be one solution suitable for all families, what is needed is a continuum of services available to vulnerable families at community level which keep vulnerable children safe and protected within their families and provide support to families to ensure children can remain in their homes.

5. Private Orphanages

The growth in private orphanages in recent years has been steady. It is clear that investment in capital resources is a popular focus of donor-funding across the world in order to give tangible results; this is given despite the evidence of damaging effects of institutional care. Since any shift to alternatives to residential care will require additional substantial investment which is unlikely to be available to MoLSAMD, efforts should be made to divert support from the Afghan diaspora in donor countries to supporting a range of alternatives rather than directing their investment solely towards residential care.

10

EveryChild’s (Carter, 2005, p.8) assessment of the evidence in Central and Eastern Europe and CIS countries indicates that on average, institutional care in that region is twice as expensive as the most costly alternative: community residential/small group homes; three to five times as expensive as foster care (depending on whether it is provided professionally or voluntarily); and around eight times more expensive than providing social services-type support to vulnerable families.

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