Innocent Habimfura remembers meeting a shy three-year-old girl in an orphanage in Rwanda, where he’s working with the government to end institutional care. She barely spoke and could only walk very slowly — odd for a child of that age. The girl then left the orphanage to be reunited with her father and siblings. She quickly started speaking, and within a few months was running around with her sisters.

That’s a common story, said Habimfura, regional director for Hope and Homes for Children, a charity which helps countries move children from orphanages back into society. Orphanages can cause grave problems for child development. But in Rwanda, following the genocide in 1994 when 800,000 people died, aid organisations set up dozens to deal with thousands of newly-orphaned kids.

Now Rwanda has pledged to become the first nation in Africa to be orphanage-free, and is on track to do so by 2022. Since 2012, the country has closed 25 of 39 orphanages by implementing the lessons which Hope and Homes for Children learned in eastern Europe, where they’ve helped to shut down hundreds of institutions.

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So how does their strategy work, and what can governments do to implement it?

The worst of starts

Orphanages can be severely damaging for child development. Children in them often develop physical and psychological problems due to the neglect, abuse and lack of care they frequently experience. But with the right support in place, many of these kids could be reunited with family — around 70% of orphaned children in Rwanda still have relatives — or find foster families.

The list of problems for young children growing up in orphanages is extensive. At their root is a lack of attachment, which is essential to forming positive relationships. A study in Romania found that only 3.2% of institutionalised children had a clear attachment to a caregiver, compared to 100% of those living with parents.

The perception of safety in orphanages is also a “myth”, explained Delia Pop, Hope and Homes for Children’s Director of Programs and Global Advocacy. They are more likely to be abused, neglected and suffer from sexual violence in such institutions, she added. More than half of kids in institutions have psychiatric disorders, which can be caused by maltreatment.

Children in orphanages are 40 times more likely to gain a criminal record

Ultimately, orphanages can have a significant impact on kids’ life chances. On average, children growing up in them have an IQ of 20 points lower than those in foster care, and are far less likely to find employment as young adults. When children eventually leave they are 10 times more likely to enter prostitution and 40 times more likely to gain a criminal record. They can even be hampered physically: for every three months a child spends in an orphanage, it’s thought they [lose around one month of growth](https://books.google.co.uk/books?hl=en&lr=&id=LhSuBAAAQBAJ&oi=fnd&pg=PA113&dq=Johnson,+D.E.+(2001%29+Medical+and+developmental+sequelae+of+early+childhood+institutionalization+in+Eastern+European+adoptees.&ots=zdwtUPlJ6q&sig=W8eDTKIV5luc3W7Qg-WlH0jY). Encouragingly, though, the evidence suggests this growth can be recovered if they leave institutions early enough.

Changing the system from Romania to Rwanda

In Romania, where Hope and Homes for Children have worked closely with the government since 1998, there were once over 100,000 children in orphanages. Today there are less than 7,200. This inspired a 2010-2012 pilot in Rwanda, in which one orphanage was successfully closed, which was followed by a new new national policy based on the Hope and Homes for Children model.

The model finds ways to transition children into normal life, such as moving in with existing family members or foster families, Pop explained, “whilst in parallel building prevention, strengthening communities and developing alternative care”. The model needs to be adapted to different contexts. Unlike the state-regulated institutions of eastern Europe, in Africa orphanages developed in an ad hoc manner in response to the AIDS crisis, poverty, and conflicts, like Rwanda’s 1994 genocide.

“We need to solve the access to education problem, not send kids away to be abused and traumatised by separation”

The first step is making sure that no new institutions are created. Their presence has “a real pull effect,” said Habimfura, as they create a demand for institutional care amongst the community. For example, Zambia has the highest per capita orphanage rate in the world, in part because orphanages supply education for kids. “We need to solve the access to education problem,” Pop said, “not send kids away to be abused and traumatised by separation.”

In Rwanda, community networks have been created to support families to stay together, “rather than waiting until the family is in crisis,” said Habimfura. Two volunteers in each village are trained as gatekeepers to proactively identify vulnerable families, provide support and where necessary refer them to local services.

Importantly, the vast majority of children in orphanages have extended families they could potentially go to. In partnership with the Rwandan government — along with UNICEF, USAID and DFID — Hope and Homes for Children helps to identify new homes for orphanage children. Usually, Habimfura said, of 10 children who leave institutional care, around seven will go to live with family, two will enter foster care, and one to live independently in society with specialist young adult support. So far, the charity has worked successfully with over 1,300 children and their families in Rwanda, assisting directly in 16 of Rwanda’s 25 closures.

Returning to the community

Reintegration into normal life after leaving the orphanage requires a community-wide approach. “These kids have been invisible for many years,” said Pop, so everyone in the community needs to be made aware of their return.

To help with the transition, Rwanda’s government has had to create a social workforce, something which was largely already in place in eastern Europe. This involved recruiting volunteers and trained professionals who work to improve kids’ access to health, education and employment. Hope and Homes for Children has trained more than 13,360 Rwandans to support the deinstitutionalisation process.

“If there is commitment at the top level then change will happen”

Admittedly, such changes take time and resources. Rwanda’s prior aim of closing all orphanages by 2020 was overly optimistic. But progress has been dramatic — around two-thirds of orphanages in the country have been closed. There were 3,323 Rwandan kids in orphanages on the eve of the policy, but are now only around 450.

And after initial costs, closing orphanages can save money in the long term. While it’s difficult to calculate, estimates suggest that caring for kids in the community is several times cheaper than running institutions: studies from the World Bank and Save the Children suggest it costs about six to 10 times less.

Rwanda’s government now shares notes with several others in Africa including Ghana and Uganda, which have also made significant strides. And with the political will in place, many more thousands of children around the world could leave institutions and find new family homes. “If there is commitment at the top level,” said Pop, “then change will happen."

(Picture credit: Flickr/Julien Harneis)

Jack Graham
jack.graham@apolitical.co