Research That Matters (January 17 - 20, 2008)

Background: Over 80% (12 million) of the world's children orphaned by HIV/AIDS live in sub-Saharan Africa (Kaiser Foundation, 2005). By the year 2020 the number of orphans and vulnerable children (OVC) in the region is expected to double (Hecht, et al., 2006). The sheer numbers of OVC has overwhelmed the traditional response system of placing children with extended family members, however, the alternative of placing children in orphanages, and removing them from their home communities has been broadly criticized both for the high costs and detrimental effects on OVC (Foster, 2000). In order to fill the gap between family and institutional placements, communities throughout the region are responding by developing new community based alternatives that care for children in their home communities.

Objectives: This study represents an evaluation of a community based alternative to care at the Godfrey Children's Center in Idweli, Tanzania. Through a hybrid approach of institutional placement and community-based support for OVC, a residential facility was created that allows children to maintain integration with village life. However, little is currently known about the effectiveness of these alternatives, therefore researchers evaluated this program to determine if living at the Center positively impacts the psychosocial well-being of resident orphans while also being economically sustainable.

Methods: The study utilized a combination of quantitative and qualitative instruments that provided for a robust analysis of children's well-being. A total of 209 children — representing comparison groups of Center orphans, village orphans and village children living with both parents — participated in the study. Statistical tests included analysis of variance, t-tests, Pearson correlations and Chi-squares.

Results: Outcomes at the psychosocial level indicate that Center orphans faired well in terms of emotional functioning, school performance, and social integration. Center orphans were significantly less depressed than orphans living in the village with extended family members or children living with both parents (T=-3.45, p>.01; T=-2.31, p>.01). School attendance of Center orphans was better than village orphans and Center orphans (F=2.73, p>.05) and, in qualitative interviews, they expressed greater optimism and hopefulness about being able to shape a positive future for themselves, specifically through knowledge and study. Finally, Center orphans reported as many social supports as the other groups of village children, and expressed no sense of being stigmatized or isolated (x2=5.42, p>.05). Although the cost of maintaining a child at the Center appears to be somewhat greater than maintaining a child in a home environment, expenses are consistent with other community-based alternatives, and are signifi¬cantly less than placements in traditional orphanages.

Conclusions: Community-based alternatives offer a promising response to the challenge of meeting the needs of a growing population of OVC in sub-Saharan Africa. Alternatives that allow children to stay within their home communities and in contact with family and friends can provide significant psychosocial health benefits and can be more cost effective than traditional institutionalized placements. Development of these alternatives should be encouraged and supported within interested communities.