33368 World Bank Social Safety Nets Primer Notes 2005 No. 18 Reaching out to Africa's Orphans A Framework for Public Action Conflicts and the HIV-AIDS pandemic are generating While focused on orphans, the analytical content is a major humanitarian crisis in Sub-Saharan Africa: relevant to all vulnerable children. the number of children who have lost one or both parents is expected to rise to 35 million by 2010. Sources of Risk Even prior to the death of parents, children are vul- The study identifies five sources of risk for orphans in nerable as prolonged sickness of a parent robs them Africa. First, the death of an earning family member of their childhood, often forcing them to become is likely to drive a family into penury because of the breadwinners. The risk of orphanhood is no longer a costs of the funeral, the loss of regular income, and randomshockaffectingafewfamilies;itisasystemic theriskoflosingone'sproperty. Evidencealsoshows shock affecting whole communities and large seg- that care of orphans often tends to fall on the poor- ments of the population. est homes ­ for example, those headed by the elder- ly or women. While fostering helps, evidence from The recent Bank study, Reaching Out to Africa's Or- panel data for Uganda indicates that the households phans, provides an overview of the particular risks fostering children often experience a significant and vulnerabilities to which orphaned children are reduction in consumption and income per capita, exposed. Its primary aim is to collate and organize household savings and investment. Findings from the available but scattered information, delineate a Rwanda are similar, where the entry of an orphan profile of orphans and the risks they face, assess the induces a 21 percent decline in the estimated adult pros and cons of interventions and offer guidance equivalent per capita consumption. on what might work in a given country context or situation. Erosion of human capital is another major risk iden- tified from an analysis of various micro studies. Relative to other children in the household, fostered children are under-enrolled in schools, work longer hours doing household chores, have lower immuni- zation coverage, and these disadvantages are more pronounced for fostered girls than for boys. Chil- dren who live with sick parents or whose parents are deceased are often exploited. Several micro studies confirm the risks of abuse, neglect and exploitation of orphaned children. Further, the psychological risks, though often not visible, are extremely high. The death of a parent often leaves the child in a state ___________________________________________________________________________________________ This note is based on Subbarao, Kalanidhi and Coury, Diane. 2004."Reaching Out to Africa's Orphans ­ A Framework for Public Action."Africa Region Human Development Series.World Bank.Washington, D.C. of trauma, lacking nurture and guidance. When the average access to services is high, but the difference in access to services between the Interventions poor and the non-poor, and between orphans and Effective interventions depend on knowing the spe- non-orphan children is quite large, direct measures cific risks faced by orphans and their specific needs, such as cash transfers conditional upon children at- which vary by age, gender, household and country tending the school seem appropriate. The appropri- circumstances. But the data needed to come up ate delivery mechanism for such transfer assistance with specific conclusions are often missing, and so may vary from country to country ­ it could be the additional context-specific research is needed on fostering household, the school, or the local non- the treatment of orphans, with particular emphasis governmental organization. Whatever the nature of on female orphans. Equally imperative is the need to the transfer, targeting method, and delivery channel, assess current interventions to learn what works and such transfers should be made in a non-stigmatizing does not work in different settings. manner. Appropriate checks and balances must be in place. This should include oversight by NGOs or Prevailing interventions fall into two groups: house- community-based organizations. hold-based care and institutional care. Household care is provided by a living parent, the extended Monitoring and Evaluation family, a household headed by an adolescent child, Onereasonfortheinabilitytoassesswhatworksand or by unrelated households. Institutional care is pro- does not work is that past and current interventions vided by a foster home or surrogate family group in- have not kept credible monitoring and evaluation tegrated into a community, a children's village or an systems in place. The study provides a short outline orphanage. Thestudyexaminestheprosandconsof of the issues related to an appropriate monitoring each of these interventions. While a ranking of these and evaluation strategy for programs aimed at as- interventions is difficult (because of quality varia- sisting orphans and vulnerable children. It includes tions and other comparability problems), placing a check list of what needs to be monitored such as orphaned children in household settings appears critical indicators for assessing the impact and out- preferable to placement in institutional care. If in- come of interventions. stitutional care is the inevitable solution in a certain situation, it appears best to place children in group homes located close to the community with which they are familiar. To facilitate the placement of an orphaninadesirablesetting,publicactionshouldbe supportive of community action: support for com- munity-based intervention will contribute greatly to resolving the placement problem. Any arrangement is preferable to an orphanage, which must be the "last resort" option when no other arrangement is possible. The study sets out some general principles for scal- ing up the more promising interventions. In coun- tries where the access to basic services (education and health) is low, sectoral and economic policies including waiving of school fees and uniform obli- gations would have the desired effect of increasing enrollment rates of all children, including orphans. TheWorld Bank Social Safety Nets Primer series is intended to provide a practical resource for those engaged in the design and implementation of safety net programs around the world. Readers will find information on good practices for a variety of types of interventions, country contexts, themes and target groups, as well as current thinking on the role of social safety nets in the broader development agenda. World Bank, Human Development Network Social Protection, Social Safety Nets http://www.worldbank.org/safetynets