Institutional care is considered the least appropriate model of care in Africa, and can lead to long-term developmental delays. Children in orphanages and residential homes risk:

• Losing contact with their extended families and communities;
• Missing out on opportunities to develop meaningful relationships with adults, which can lead to poor social and practical skills;
• Developing a poor sense of identity and culture;
• Having poor social support networks beyond the institution;
• Being abused: physically, psychologically, and sexually;
• Being easily stigmatized;
• Not having their psychological needs adequately met.

Institutional settings often fails to meet the developmental and long-term needs of children. Children need more than good physical care. They need the affection, attention, security and social connections that families and communities can provide. Countries with long-term experience with institutional care for children have seen the problems that emerge as children grow into young adults and have difficulty reintegrating into society. In Ethiopia, Rwanda and Uganda, for example, evaluations of children’s long-term stays in orphanages led these governments to adopt policies of de-institutionalization and support for family-based care.

Orphanages are more expensive to maintain than providing direct assistance to existing family and community structures. Institutional care would be prohibitively expensive for the vast majority of countries. The annual cost per child tends to be from $500 upwards in Africa. Research by the World Bank in the United Republic of Tanzania, for example, found that institutional care was about six times more expensive than foster care. Cost comparisons conducted in Uganda showed the ratio of operating costs for an orphanage to be 14 times higher than those for community care. Other studies have found a ratio of 1:20 or even up to 1:100. (Children on the Brink 2002)

There is a justification for institutional-type care when there is no one available to take them into their home; and especially when applied to those in an emergency status that are in need of protection or medical care. This placement would be best utilized if the child could be referred and placed into a welcoming home within 3 to 6 months. Those children whom are chronically ill or developmentally disabled may too be in need of a managed care facility when there are no “Safe Families” programs or other viable options available.

The magnitude of orphans due to HIV/AIDS is so large that an institutional response – besides not being in the best interests of the child – will never be the answer. Orphanages for more than the tens of millions of orphans simply cannot be built and sustained. The nurturing family setting will always be this best long-term placement for the wellbeing of any child.