People who say it cannot be done should not interrupt those who are doing it.

This quote has often been attributed to George Bernard Shaw, and accurately summarises the courage and spirit of our team in Rwanda.

In partnership with the government of Rwanda we have achieved a reduction of over 60% in the number of children confined to orphanages nationally. And some of these children might otherwise have died.

Earlier this week I met Joseph. He is nine.

It was a bumpy ride out to his village, and as we tramped through the rain from the car to his home his foster father, Albert, rushed out with hats to help keep us dry.

I was introduced to Albert, and his wife, Faith, as well as Joseph’s foster sisters.

Joseph is acutely disabled by cerebral palsy. There is widespread stigma associated with disability, especially one as profound as cerebral palsy.

Joseph was abandoned as a baby. His life has been one of confinement in an institution, marked by a lack of stimulation, so severe that it caused his condition to deteriorate. Because he was unable to coordinate his muscles he was laid on a mat from morning to evening, day in, day out. Year in, year out. His only stimulation was the mashed food that was spooned into his mouth – the same food every day. Leading to malnutrition.

Isolated in the institution, Joseph had no friends, no visitors. And because of the stigma associated with his disability, there was very little hope of experiencing the love of a family. He was dying.

Albert and Faith changed that.

Faith had been trained in basic physio therapy several years ago, and understood that disability was not a curse or a punishment, that it was not infectious.

Hope and Homes for Children has pioneered the development of family based services for disabled children in Rwanda, and identified Faith and Albert and their daughters as a potential foster family. They provided them with further training, invested in their home to make it suitable for Joseph and helped them to welcome him into their family.

Their home is a basic structure with a grass roof, but it is a home. Faith has worked hard to stimulate Joseph’s muscular development. He can now sit unassisted and look around. He very proudly did a rolly-poly for me on the bed, and rolled out of it with a smile so full of life that he could have lit up the universe. Apparently, when Faith turns her back, Joseph will mischievously crawl out of the house and up the bank to the path above, and triumphantly call out to proclaim his achievement. Faith will playfully admonish him.

His sisters have taught him how to turn the pages of a book with his feet, and he is becoming familiar with picture books and some words.

He is a courageous boy. He has been called cruel names by some of the other children in the village, but whenever any of them come into his home to visit his sisters he will determinedly make sure they greet him just as they do everyone else by following them around until they shake his hands. The name calling has reduced and he is becoming a part of the community. His prison of isolation has been removed.

Faith told me that when she and Albert went to register for social protection payments, they took Joseph with them. The secretary who registered them asked very candidly – but not in a cruel way – why they had chosen to take Joseph into their family, not least because he was “useless” and would not be able to do jobs or offer support to the family later in life. Faith’s answer was simple:

“He is our blessing”

The secretary looked at her, apparently smiled, and said that from thereon he would call him “Blessing”. And the name has stuck. He is called Blessing by many others in his family and his community.

Albert was clear that Joseph would never recover and that while he had made remarkable progress – including being able to eat proper food – he would remain deeply dependent on his parents and wider family for the rest of his life. But Albert was also clear that Joseph now had a life.

We have proven that even children with severely limiting disabilities like Joseph’s can live a fulfilling life with the protection and love of a family. And this matters because many of the children remaining in institutions in Rwanda live with disability. They are too easily left behind. Written off. And that is why there is an urgency to our work. For every day they remain in confinement, isolated, under stimulated, unloved, the more likely their disability will be amplified, or worse, deteriorate.

Hope and Homes for Children Rwanda is demonstrating how to change this and is using the results to advocate for continuing reform of the system.

We are only a few years away from eradicating institutional care in Rwanda, and this will serve as a platform for change throughout Africa.

I arrived in Uganda last night in advance of a conference we are holding next week to launch our African partners’ alliance. Thirty-six delegates from organisations from across the continent – including our own teams from Sudan, South Africa, and Kenya, and partners from Tanzania, Uganda, Zambia, and Ghana.

Momentum toward pan-African reform of child protection is growing.

Poverty, not the number of orphans, is feeding Europe’s state orphanage system.

We can fix it.

Real poverty exists in wealthy nations, not least in Europe. And its impact on children can be catastrophic.

Because poverty is ugly. And it is especially ugly for children.

Poverty means that children live in appalling housing conditions and regularly go hungry. Hungry children can’t concentrate and they find it hard to learn – even if they have access to education. Many do not.

Poverty slaps down the hope, aspirations and dreams children may have. It means that they don’t have the clothes they need to live comfortably and with dignity. This in turn affects their self-esteem as much as their health. And without proper access to the health care they need, the mortality rates of children who are living with poverty are much higher than average.

When the media report poverty, the focus is usually Africa or India. But poverty does not respect borders. It is deep rooted and widespread within Europe where it is a fundamental block to many children’s well-being throughout our continent.

Recent research by UNICEF¹ suggests that a country’s wealth and per capita GDP are not strongly related to child well-being. So, despite our relative wealth, the UNICEF research provokes questions about how the issue of inequality affects many children in industrialised nations.

The research found that children living with poverty are particularly susceptible to changes in government policies. This means that at a time of widespread austerity, government policies have a profound impact on the most vulnerable families and especially their children.

One proxy indicator of this is the continuing widespread use of institutional care for children throughout Europe. More than one million children are confined to state orphanages across the continent and the main reason they are growing up in institutions are related to poverty. Many parents who struggle to feed, clothe and educate their children, see orphanages as a care option. So it should be no surprise therefore that research undertaken by the University of Nottingham² has established that 96% of these children still have one or both parents alive. They are not orphans at all.

In the meantime, most European Government policies reflect a wholly erroneous view that orphanages are safe places for children, and that they are cost effective. They are neither.

All forms of institutional care destroy children’s lives, and the evidence for this is conclusive³. Institutional care is associated with high levels of violence (including torture), mortality and neglect. And research undertaken by Hope and Homes for Children as well as others shows that family-based care is actually more cost effective.

But what is really alarming is that while birth rates across Europe continue overall to reduce, the number of children confined to institutional care remains broadly static. This suggests that an increasing proportion of our children are ending up in state orphanage systems – a situation that is being driven by poverty.

Although this trend is unlikely to be an indicator of poverty becoming more widespread throughout Europe as a whole (the evidence suggests that Eastern European countries are beginning to close the gap with their Western counterparts), it might be an indicator that, under various policy regimes, poverty persists or even deepens for those who are already living with it.

This can be fixed.

The really exciting opportunity in all this is that the policies and subsequent services required to run a family-based care system help to both address some of the root causes of poverty as well as enable families to become more resilient to the effects of poverty – and in a way that improves the well-being of their children.

For example, we have worked with local authorities in Ukraine to re-house some families who have been living in conditions so appalling, they were unsafe for children. This work has prevented the separation of children from their parents to confinement in state orphanages.

In Romania we have developed services that are now run and funded by local authorities, which reunite children, previously confined to institutional care, with their families. These services help families to access housing allowances, provide food and cookers, help parents to find paid work and address the issues which led to them being separated from their children in the first place.

When we first commenced our work in Romania, more than 100,000 children were confined to institutional care. It is now less than 9,000.

These are not just statistics. They represent real people. People like Nistor.

Nistor knows from bitter experience the way in which poverty feeds the orphanage system in countries like Romania.

Nistor spent his own childhood in the state orphanage system. Consequently, as an adult, his health is now poor and he has learning difficulties. Married with three young children, providing for his family has always been a struggle.

Images: Poverty meant Nistor’s children, Ana and Lucian, were at risk of  growing up in an institution. Support from Hope and Homes for Children has kept their family together.

To add to their problems, two of their children suffer from epilepsy. At their lowest ebb the family was reduced to living in a tent. Desperate and scared, this is the point at which many poor families are pressured into surrendering their children to institutions.

But with even a modest amount of practical and emotional support, parents like Nistor can care for their own children – and they’re by far the best people to do so.

Today, with help provided through services developed by Hope and Homes for Children, Nistor’s family have a home, he has found work and the children have access to the medical care they need. We have helped them buy basic furniture and it’s clear they’re very house-proud. Their flat may be tiny but it feels like a warm and loving family home.

Without this kind of support, the chances are that Nistor’s son and daughters would now be living in an institution – denied the individual love, care and attention that all children need to thrive and be happy. They would have “aged out” of the state system, ill-equipped to care for themselves, and so the inter-generational transmission of poverty would have continued.

Instead, Nistor, his wife and his children are together. Their future remains fragile but they are far more resilient in facing it. And whatever it brings, they will face it as a family.

[1] http://www.unicef.org.uk/Latest/Publications/Report-Card-11-Child-well-being-in-rich-countries/

[2] Only 4% of young children in residential care have no biological parent living – Browne KD, Hamilton-Giachritsis C, Johnson R, Chou S, Ostergren M, Leth I, et al. A European survey of the number and characteristics of children less than three years old in residential care at risk of harm. Adoption and Fostering 2005;29:23-33.

[3] https://ceohopeandhomes.wordpress.com/2014/03/20/top-ten-bloopers-part-1/

Heroism is … a five year old girl called Tatiana

“Painting and rehabilitating orphanages is like re-decorating hell.” This is how Hope and Homes for Children’s Director of Programmes, Dr Delia Pop, described attempts to improve the physical conditions in orphanages.

Why? Well, it’s not so much the physical conditions that are the issue. It’s the human conditions, or more accurately, the inhuman conditions which damage and destroy children.

But not Tatiana.

Delia and I were in Moldova recently and met her.

Tatiana is five years old and one of the bravest children I have ever met.

Her mother was told that she would never be able to care for her properly and was coerced into giving her up to the state orphanage system. Tatiana has Down Syndrome, a condition that with the right support can be managed at home by a family.

By the age of four and a half Tatiana weighed just 10kg or about one and a half stone. Nothing to do with her condition. She had been confined to a cot all her life. Unable to walk, speak, clean her hands, she spent almost her entire life lying on her side bent in a V shape, staring at her knees.

At feeding time, meat and potatoes were liquidised along with the dessert into a slop and children in the orphanage were force-fed. Really force-fed, with one staffer holding the child’s nose and restraining her, and another jamming the bottle into her mouth. Tatiana would regurgitate it. A minor act of defiance against a system that was violating her on a daily basis.

She had learned not to cry. Learned not to cry! She was never held. Imagine never having had the experience of being held by someone who’s squeezing you because they just plain and simple love you.

Almost five years old, Tatiana had the cognitive and physical development typical of a five month old.

This is what orphanages do to children. Orphanage care is associated with high levels of neglect, which dramatically impairs the development of children. They are associated with violence and with high levels of mortality. Tatiana was hanging onto her life by her very finger tips.

Our partner organisation, CCF Moldova (also a team of heroes!), that has been trained and is funded by Hope and Homes for Children, went into fight for Tatiana. At first the staff in the state orphanage complained, “There is no point because Tatiana is disabled.” CCF would have had none of it.

They found her a foster family. By the time I met Tatiana a few weeks ago she had been free from the state orphanage for ten months.

Her weight had doubled, she had caught up with her cognitive and physical development by almost two years (adjusting for her condition), she was walking and dancing (!!!!). But above all, the love in that room was enough to fuel the happiness of a million people.

Tatiana is now learning to feed herself. Proper food. She can wash her hands and face. She has her own clothes and toys. She has an identity. And she is seeing a speech therapist. We fully expect her to be able to begin speaking within the next year. I bet she is a singer too.

I really cannot put into words the joy I felt at seeing Tatiana so happy, nor how inspired I was by her foster family – a couple in their sixties whose adult children also doted on her.

I have no doubt that Tatiana would be dead had Hope and Homes for Children and CCF not stepped in.

And there are many more children who are benefiting from our work. CCF Moldova have worked closely with the Government to develop, improve and roll out services such as day care for children with special needs, mother and baby units, small group homes, housing for vulnerable families, foster services as well as family support services. These services are developed to prevent children from being separated from their families in the first place and to provide alternative types of family care so that orphanages are not needed regardless of the circumstances of the child.

It is working. We have already seen the closure of a number of state orphanages like Tarigrad and Sarata Noua and we are progressing the closure of others. The Government and local authorities in Moldova are increasingly committed to eradicating the injustice of institutional care of children.

Now that we are working directly in and shaping the reform of child protection in some twenty five countries, it is our ambition to see the global eradication of institutional care of children. Check out: www.hopeandhomes.org

Cutting through the crap about British Aid

The British public generally view aid as a positive thing. This is repeatedly evidenced by research and by additional public giving during specific campaigns – from the outpouring of public generosity for victims of the Tsunami to Comic Relief, which have raised hundreds of millions of pounds.

However, many are unhappy with the increase in our aid budget, especially at a time of austerity and when the highest number of food packages – over a million in the 2014 to 2015 financial year – have been given out by food banks here in the UK.

On the surface, it’s a reasonable and natural position to take.

But this position sits within a context of widespread misconceptions about our aid budget and a lack of genuine propositions put forward for its purpose.

The misconceptions

1. We are spending too much on aid

According to an Ipsos Mori poll, over a quarter of the British public believe aid is one of the top three items among Government spending. In reality, although the budget has seen an increase, it is still only about 1% of Government spend (or 0.7% of Gross National Income). Nevertheless, many more than a quarter of us believe it is significantly higher than it really is.

We’re not alone.

In the US, the average estimate of the aid budget across the public is that it constitutes a massive 28% of Federal spending. But again, in reality, it is also about 1%. Interestingly, although it remains the one budget line that most people favour cutting, when asked if the aid budget was only 1% would they then favour cutting it, 28% said this would be too small an allocation to aid and 31% said that this was about the right amount. The majority are in favour of 1%.

Perhaps the lack of awareness of the actual proportion of the budget spent on aid is at the source of people’s unhappiness with the increase in the allocation to it.

2. Aid is ineffective

A YouGov poll across a number of European countries suggests the misgivings we have about aid might be rooted in perceptions that it is ineffective, with the British being the most sceptical.

But to what extent is this due to a lack of widespread awareness of what aid actually achieves?

Mark McGillivray’s paper for the Organisation for Economic Cooperation and Development (OECD) states the “overall message from the empirical literature is thus reasonably clear: to the extent that growth is good for poverty reduction, it can reasonably be inferred that poverty would be higher in the absence of aid flows.”

Adjusting for the growth that China was already experiencing, extreme global poverty was reduced by a third between 1990 and 2008. It is even less now, in no small part as a result of aid. And within all this there have been great leaps made in saving and positively transforming the lives of millions of people around the world. For example, we have seen a substantial decrease in child mortality from 11.7 million in 1990 to 6.8 million in 2011, and this is in the face of an increasing global population. Much of this kind of success is verifiably attributable to the deployment of aid through its support of health and other initiatives. There really is some great news on aid effectiveness. Have a quick look at some of the results posted by the Department for International Development (DFID).

Of course, not all aid is effective. And there is widespread recognition that aid must continue to improve its effectiveness. With this in mind, there is a great deal of work invested in seeking to improve the performance of aid, most recently in locking in the commitment of over 160 governments to five principles: ownership, alignment, harmonisation, mutual accountability and results. The commitment at the heart of these principles is to ensuring support for developing countries to strengthen their institutions and grapple with corruption.

But here’s a question. Would we reduce health and education budgets on the occasions those services are not as effective as they should be? When aid doesn’t work we need to review the polices behind it and improve them.

3. Most aid is lost to corruption

Corruption lies at the heart of the root causes of poverty. Cultivated by poor governance, weak institutions, low wages and a complex array of other factors, it denies people living with poverty access to fundamental services, food and medicine. It is ugly and it is an injustice.

And there is no doubt corruption is a serious problem to the aid sector.

But we can’t cherry pick the well-run countries to send our aid to. The people living with the most extreme poverty often live in countries where levels of corruption are high. This is the business end of the stick. And it’s bloody difficult.

Just because something is difficult does not mean we shouldn’t do it. We need to invest more in the capacity of DFID to undertake the research and pilot schemes to improve our ability to successfully forge development partnerships in these very challenging environments.

In the meantime, a significant proportion of aid is actually invested in building stronger institutions, helping to improve governance and in tackling corruption head on in many of these countries.

And a large amount of aid does exactly what it is intended to do. Robust processes are in place to undertake thorough due diligence on NGOs like Hope and Homes for Children, so funders like DFID can be confident that money is well managed and used to deliver world class projects. Most NGOs like ours will not fund governments nor offer bribes. We use the money we receive in the interests of the children we exist to serve and we can prove it.

So while recognising that there is a challenge, we also really do need to avoid exaggerating it. Our energy is better spent trying to overcome it.

4. Charity begins at home

The need for the distribution of one million food packages to families in the UK who cannot afford to feed themselves is not a consequence of allocating 1% of the national budget to aid. It is the consequence of inadequate Government social and economic policy. The UK remains one of the richest countries in the world and the injustice of people not being able to feed their families is derived from the inequality in our society more than anything else.

Yes, charity does begin at home. But the reasons for the need for charity at home will be left unaddressed if we cloak them with the increase in the aid budget. And let’s face it, the world is shrinking. Are we really so isolationist in our perceptions of ourselves? We are increasingly globalised citizens. The world is our home.

So what are the reasons why our aid commitment should have been increased?

A number of reasons have been put forward, not least by politicians in the run up to the elections. These range from the benefits of aid in helping to reduce the threat of terrorism, through reducing immigration, to enhancing our diplomatic clout around the world. But there is very little evidence that aid actually achieves any of these things.

Here are four reasons why we should stick to our increased aid allocation and continue to protect it.

1. Aid has a great value proposition

As aid increases it can deliver very significant economies of scale.

For example, as the US Government’s programme to combat HIV/AIDS (PEPFAR) was scaled it achieved a reduced cost per patient from $1,053 to $339. The Anti Retroviral Therapy it has supported is estimated to have saved 6.6 million lives between 1995 and 2012 and reduced the risk of transmission by 96%.

In making a significant contribution to addressing the AIDS pandemic as a global public health threat, this kind of aid programme has reduced the overall cost of care and has enabled millions of people to contribute to, rather than depend upon, their economies. The economic returns on the investment through increased labour productivity, reduced medical care and so on are variously estimated between 81% and 287%.

2. Aid is a vital component in the suite of responses to global issues that will affect us all

There are a number of global issues that threaten us all. Think Ebola. Try containing and responding to subsequent outbreaks without significant aid commitments.

And here’s another one. The funding required to address the impact of climate change in developing countries is massive. Aid has a critical role to play in enabling developing countries to adapt to climate change.

Climate change is a global phenomenon. It will in time affect everyone and it will affect us all differently. Depending on their location some people will experience much drier conditions, some wetter, some hotter and some colder. And many will experience increased variability across all these weather patterns, including greater occurrences of extremes.

Arguments have been made which suggest that developed countries will be least vulnerable to climate change, in no small part because of our ability to adapt to it. Almost everyone agrees the brunt of the impact will be felt in developing countries

This impact will range from mass public health challenges, including increases in respiratory and water borne diseases, through to widespread problems with food security. Public health and food security problems in developing countries pose a significant threat to developed countries, many of which are (or will be) net food importers. If developing countries can’t produce the food they need – and cheaply – because of climate change, then we all have a problem.

Because climate change occurs through the global meteorological system it can only be effectively tackled through global agreements and action. One country on its own cannot address it.

This is why international aid instruments are so important.

Aid funding has a very important role to play in addressing the impact – direct and indirect –climate change will have on all of us. Climate change is, largely, the consequence of approaches to development that are proving unsustainable.

So using aid to invest in developing countries to underwrite the risk associated with experimenting and finding new development pathways must be a priority in order to ensure that the causes of climate change do not compound the problem. This kind of investment will create the conditions in which local, national and international trade will have an improved chance to develop economies in a way that they can cover increasing proportions of the cost of adaptation for themselves.

But not all aid enables adaptation and nor should it (in the case of humanitarian support for example). Nor is all adaptation necessarily development: the costs of adaptation are more the province of political agreements and structural funding mechanisms than of aid.

Indeed, the costs of adaptation are enormous. The United Nations Development Programme estimates the global annual costs of dealing with the consequences of climate change are of the order of magnitude of $100 billion. And the longer it takes to negotiate and begin implementing global agreements at this scale, the more rapid will be the increase in the costs of dealing with the impact of climate change.

It is not for aid budgets to meet these costs directly, but aid does need to be of a scale to leverage adaptation funding as it comes on line. For example, aid can be used to pilot adaptation initiatives throughout development programmes in a way that presents new approaches that are scalable.

In the long run, the value of an increased aid budget that can achieve this kind of leverage will not only reduce the indirect impact to developed nations of increasing public health and food security challenges (among others) in poorer countries, but it will reduce the suffering and the increasing costs of dealing with it over the long term.

3. Aid is not largesse. It is our obligation.

It doesn’t matter which way you look at the growing cost of human suffering derived from climate change in developing countries, we are responsible for it. Europe. The US. All industrialised countries.

We continue to enjoy the benefits of being an industrialised economy. The consequences of this growth can be summarised by the increase in the levels of the of the three main greenhouse gases:

• Atmospheric Carbon Dioxide concentrations have increased by almost 40% since pre-industrial times. The current Carbon Dioxide level is higher than it has been in at least 800,000 years.

• Methane is more abundant in Earth’s atmosphere now than at any time in the past 650,000 years. Concentrations are now more than two-and-a-half times pre-industrial levels.

• Concentrations of Nitrous Oxide have risen by approximately 18% since the start of the Industrial Revolution.

It is people living in developing countries who will have to deal with the destructive impact of the industrialisation of our economies. With more than half of humanity living in developing countries then many will suffer at our expense.

So if a proportion of increased aid funding to 0.7% of GNI from developed countries can play a critical role in leveraging the capacity to enable the majority of humanity to adapt to climate change, then these are pretty modest wages to pay for our own “developed” status and comfort.

4. Future proofing

There are 2.2 billion children in the world. A quarter of humanity. Looking to the future, the majority of children will be born into developing countries.

Local authorities and governments in these nations struggle to find enough funding to provide for the basic rights of children to education and health and they allow or rely on damaging approaches to care and protection (see Hope and Homes for Children website). We cannot wait for one or two generations for their economies to develop.

If we do not help to address poverty in these countries now, the problem will be transmitted from one generation to the next with growing consequences for developed countries. And injustice will be at the centre of the inter-generational transmission of poverty, with conflict as its consequence.

If we view aid as an issue for the present only, then we are not seeing its value in the round.

We need to reframe how we see our aid contributions with the language of investment and a focus on the value of what we are paying for. And the legacy of this for future generations.

The billion baby time bomb

More than half of humanity now lives in cities. Many of the projections anticipate that this will rise to 70% by 2050 with the majority of the growth occurring in developing countries.

So what?

It’s often assumed that the concentration of health, education and other services, as well as the opportunity to find paid work and the investment that urban areas attract, endow an advantage on city dwellers.

An urban advantage.

And it’s further assumed that this makes them better off than rural communities, which are seen as sinks of poverty and beacons of development need (they undoubtedly are in many circumstances).

But the premise of this urban advantage is largely based on data sets of average household income, average health and education outcomes and so on.

The problem with this is that accurate household surveys of informal, unplanned settlements – slums – are difficult to carry out and so these communities are often ignored when the big counting exercises are in full throttle. This provides a statistical cloaking device that masks the true picture.

The relative wealth of many city dwellers skews the fact that the often deeply ugly impact of urban poverty, not least as experienced by many children, is not taken into account.

The crisis facing these children is further masked by comparisons between rural and urban poverty that are based on markers such as a dollar a day. Rent, transport, food, child care and nearly all services in cities require cash payment. Cash is hard to come by and – because of the high concentrations of people – city dwellers don’t have the space to grow their own food for consumption or for sale. And due to the higher cost of services in urban areas, a dollar a day in the city is worth less than a dollar a day in rural areas.

The lack of engagement of the urban poor in many developing countries means that services for their children are not planned or properly resourced. This sets up the inter-generational transmission that plays the problem forward.

There is no urban advantage for the urban poor.

For vulnerable families and their children it is an urban penalty.

Millions of street-living and street-working children face threats of violence and sexual abuse on an almost daily basis. A children’s focus group discussion undertaken in Manila (see the IIED report referenced at the end of this post) found that all the participants had witnessed AT LEAST one murder, usually of another child or a woman. This is terrifying for those children and a horror at scale if the same is true across many of the world’s cities.

As urban populations grow, the hazards faced by vulnerable children in particular are becoming greater: the leading cause of death among young people aged 15 to 29 are road traffic accidents (1.3 million deaths pa), and it is the second for children aged 5 to 24.

In Bangladesh, under-five mortality rates in slums are 79% higher than the overall urban under-five mortality and 44% higher than in rural areas. And in many Sub-Saharan African urban areas the gap in nutrition between rich and poor children is greater than between children in rural areas and children in the cities.

Children living in slums find it difficult to get access to clean water and often live among open sewers and garbage. Mumbai already has a population of 18.4 million and its multi-story trash mountains are rising. The city needs to spend $355 million on waste management alone in this coming year, which almost certainly won’t happen. In the meantime, there will be continuing and increasingly destructive consequences for children, not least in terms of their vulnerability to preventable diseases like diarrhoea.

I worked in Sierra Leone in the late nineties. A very difficult time for Saloneans. A very difficult time for that country. My friend, driven out of the town of Mile 91 by the conflict found himself and his family in what was already a crammed slum in Freetown. An open sewer ran in front of his home. Baby Joseph, who was born in Freetown, died before his second birthday because of diarrhoea. Joseph was a happy, playful child. He could have had a future.

This kind of tragedy though is not entirely a consequence of conflict. In fact, while migration into cities from rural areas continues – involving families, young people and adults mainly seeking paid work – 60% of growth in urban populations is actually due to children like Joseph being born into them. Consequently, children are rapidly becoming the majority demographic in many cities across most developing countries.

With 1.4 billion people expected to be living in slums within the next five years, and children likely to make up the majority demographic in these communities, then a billion or so babies – and many more with every passing year – are set to be locked into urban poverty in the near future.

This means we are going to see a rapidly increasing concentration of children living in slums.

This concentration factor – the very factor that is assumed to generate the urban advantage for the relatively well-off – could well lead to the corralling of children and the focusing of services like health, education and protection through institutional arrangements not dissimilar to orphanages.

But orphanages are associated with high levels of neglect, violence and mortality and they deliver very poor outcomes for children. By responding like this we would be throwing massive numbers of children out of the frying and into the fire. Such institutionalised “care” arrangements must be resisted.

Coping strategies among families will almost certainly and increasingly lead to more children accompanying their parents on the streets or working on the streets themselves to supplement household incomes. Many more children will end up living for extended periods without supervision and care, exposing them to ever greater risks. So the temptation among urban planners and authorities to pursue mass confinement policies through orphanage type care will be great. Let’s face it, this is more than likely given that over 1 million children are still confined to orphanage care in Europe, with the vast majority of them having one or both parents still alive.

The work of Hope and Homes for Children clearly demonstrates that orphanages are not necessary in the urban environment (or elsewhere). We have shown how the provision of family support services not only deliver better health, education and protection outcomes than orphanages, but how they are more cost effective in helping communities to deal with many of the root causes of the problems that they face.

Our ACTIVE Family Support Programme enables families that are vulnerable to separation and to the institutionalisation of their children overcome the challenges they face. Without this programme, 32% of the children who otherwise would not have been helped would have been placed in institutional care. The cost of these institutional placements – based on the average duration of the placement and the monthly total cost per child – would have been 9.3 times greater than the total cost of the ACTIVE Family Support programme that we implemented.

Our work with families enables them to address the challenges they face without compromising the care and protection they provide for their children.

The evidence is clear: the outcomes for children delivered through family-based care are so much better. And the cost effectiveness of this kind of support is critical to finding solutions for the scale of investment needed to benefit the hundreds of millions of children who are being excluded from fundamental services and placed at risk of urban hazards.

With India’s city populations expected to grow from approximately 400 million to around 600 million by 2030, the McKinsey Global Institute estimates that the cost of developing its urban infrastructure is $1.2 trillion.

With rapid population increase now expected to continue until the end of the century overlaid on a massive existing gap in infrastructure, Africa’s cities require twice this amount: $93 billion per year. But more of an immediate worry is that, according to the Economist’s Intelligence Unit, the current cost of Africa’s urban infrastructure is already driving up public debt across the continent.

And get this, six Africans out of ten already live in slums conditions. Can you imagine what this means for the millions of African children whose lives are being eaten away by the urban penalty?

Africa is only getting into its stride with urbanisation. Check out this infographic – Africa’s urban regions only really start to swell by 2030, suggesting that the cost of urban infrastructure will be an inter-generational challenge and that will need to be scaled up to a whole new order of magnitude.

But instead of viewing solutions in terms of huge costs, we should look at them in terms of huge investment opportunities.

If cleverly planned in a way that supports communities and families to generate the income they need and access the fundamental services they require to protect and care for their children, then the social and economic capital generated might well be significant enough to repay the investment. The dividends would tip the urban penalty into an urban advantage for vulnerable families, creating more opportunities for investment and, over time, reduce the cost burden.

So what’s preventing this from happening?

At the heart of the challenge is the issue of inequality. Many children have the opportunity to develop and grow up safely in urban settings. But many children do not. This inequality is for the most part a function of poor governance.

Indeed, we have a crisis of urban governance.

For example, one in three children born in cities worldwide are not formally registered and so do not have a birth certificate or identity card, which is the basic legal documentation required by a child to access fundamental services. They are, in effect, invisible children. Registration is denied them because the services to achieve this are not extended to families living in slum settlements. And where they are to be found the cost of accessing these services are prohibitive to many families.

Similarly, accommodation isn’t secure because slum dwellers are unable to assert their claims. In fact, it is many urban authorities that are actually guilty of mass evictions or removals, which disrupt lives and livelihoods, and displace the problem rather than address it.

And it is the very same urban authorities that lack the commitment to planning settlements for the most vulnerable because the most vulnerable have little if any representation or means of holding them to account.

Resolving this challenge must begin by undertaking regular surveys across slum districts to determine who and how many people live in them, what their challenges are and to begin to integrate their interests into urban planning. Data must be disaggregated so that the large numbers of people who are struggling are not masked by the circumstances of those who are not. In particular, these surveys must give voice to children who are the experts on their own circumstances and understand their vulnerabilities better than urban planners. And they will have many solutions that would otherwise be overlooked.

Such surveys must be planned intelligently. The findings should be actioned at the same time as the survey is being undertaken. The very people implementing the surveys could also be supported to register births while they are collecting data. They could also be referring families to existing services and providing advice on family planning, employment, housing and health issues, and spread immediate benefits to those families that need help – again, as they collect data. The insights generated through such action research can then be fed directly into the planning process, thereby making the data more meaningful and for longer.

Civil society organisations must engage urban authorities to improve transparency and build partnerships with and representation of the urban poor. Civil society organisations must work to empower slum dwellers to claim their rights and entitlements and hold urban authorities to account.

In a recent report, the World Bank presents the number of people dying from air pollution each year as a 7-million-a-year human tragedy. And it is. But on the other hand, for every dollar spent on air quality initiatives lives are saved and there is an estimated return on investment of $30. There are answers! Investment needs to be thoughtful, related to people’s interests and forward looking. True Governance.

So aid and central spending must be allocated and the appointment of officers to urban authorities must be made based on criteria that ensure high quality provision of services to slum dwellers and improved outcomes in terms of health, education, security and household income.

This really is an investment opportunity – an opportunity to invest in the futures of millions of people. But if this opportunity is not claimed then the layering of population growth and urbanisation will compound the problem and at a rate that will make it utterly unassailable. And “compound interest is the most powerful force in the universe”, as Einstein said.

Now is the time to act.

References and reading:

• Bloomberg, 2015, Mumbai Is Being Buried Under A Mountain Of Its own Trash
• IIED, 2014, Understanding children’s risk and agency in urban areas and their implications for child-centred urban disaster risk reduction in Asia
• McKinsey Global Institute, Urbanization, Urban Awakening in India
• Thierry Paulais, World Bank, 2012, Financing Africa’s Cities: The Imperative of Local Investment
• UNICEF, 2012, State of the World’s Children
• World Bank, 2015, Clean air and healthy lungs: enhancing the World Bank’s approach to air quality management

The future of our children lies with Africa

If the future of the world is with our children, then the future of our children lies with Africa.

Here’s why.

Population growth all but slid off the international policy dining table. For twenty years.

As we feast on the gains made toward achieving the Millennium Development Goals, there has been a widespread assumption that the world’s population would flatline at 9 billion by 2050 (we’re currently at around the 7 billion mark).

Not anymore.

New research from Washington University¹ suggests that there is a very high likelihood – 70% – that the world’s population will continue to grow well past the 2050 milestone to 11 billion by 2100. The fastest growth is expected in Sub-Saharan Africa.

Africa is already home to 25% of all the world’s children. According to UNICEF, by 2100 Africa will be home to half of the world’s children and this assumes continuing relatively high levels of child mortality as well as a reduction in fertility rates as prosperity rises.

So if the future of the world is with our children, then the future of our children lies with Africa.

Within a context of continuing rapid population growth – the number of people in Africa will quadruple to 4 billion by 2100 – the family unit and traditional means of care and protection of children will be super-stressed. It is likely that we will see children increasingly left on their own and at a younger age for longer. The policy and fiscal reaction to this will see child care and protection move out of the intimacy of the family environment and into institutional facilities like orphanages.

Families are the most effective means of providing a child with love, which under pins mechanisms such as serve and return that deliver the vital stimulation for neurological development (brilliantly explained here in this 1 min and 42 second video from Harvard University’s Center on the Developing Child). Even well run orphanages cannot provide this essential kind of nurture. This means that a child’s development can be severely impaired in orphanage settings. But worse than this, orphanages are associated with high levels of violence, neglect and mortality.

Unless we act now to prevent it from happening we are in danger of seeing large numbers of children in Africa condemned to institutions and their lives destroyed, just as we have seen in Europe.

According to UNICEF some 1.1 million children are still held in institutional care across Europe. So against a back drop of continuing high population growth, it is more than likely that Africa’s children will be herded – in their millions – into orphanages.

But it doesn’t have to be like this.

Hope and Homes for Children has developed a model of working which gets at the root causes of separation of children from their families. When we commenced our programme in Romania, for example, some 105,000 children were confined to institutional care there. As a consequence of our work there are now less than 8,000.

This gives us confidence that we can actually prevent children ever seeing their lives destroyed by orphanages in Africa.

Orphanages are not as cost effective as providing the family support services that enable communities to care for and protect their children in a way that delivers much better outcomes for them.

What’s more the poor developmental, health, educational and well-being outcomes associated with institutional care actually feed population growth and exacerbate the problem. For example, there is an established link between poor educational outcomes and the number of children a girl or woman will have: 28% of all girls in Nigeria still do not complete their primary education and according to UNICEF Nigeria alone is projected to register 1 in 12 of all the world’s births by 2100.

Hope and Homes for Children has proven that investing in families and communities in Africa gives them a fighting chance to care for and protect their children in a way that delivers hope – not fear – for the future. And it can be life-saving.

I was recently in Sudan, where up to two babies are abandoned on the streets of Khartoum every day because of the stigma associated with being born outside of wedlock. The mortality rate of babies abandoned on the streets is catastrophic at over 60%. They die from sun stroke, from dogs eating their limbs. Previously these children were referred to orphanages like Maygoma where the mortality rate reached 70%. Hope and Homes for Children’s Emergency Alternative Family services – which place abandoned babies with trained, loving foster carers – have consistently delivered a mortality rate of less than 1%. Over the last five years we have saved the lives of more than 2,000 children.

These statistics represent real children. Remi, aged four, was rescued from Maygoma. She was paralysed in one arm from severe epilepsy and was unable to walk. In fact she was only able to move by taking most of her weight on her chest on the floor. We placed her with an amazing foster mother, Fatmata, and when I was in Sudan I met them both. Fatmata has loved Remi as her own and this has had a profound affect. Remi walks normally now, she can read and write. And she has a wonderful smile.

The cost of care in Maygoma is 2,200 Sudanese Pounds per child per month. This does not include the value of donations from charities or foreign missions of capital items like washing machines. Nor does it include the costs of senior staff or medical staff.

But the costs of orphanage care are not limited to the expensive effort of confining children. They continue to accrue long after a child is released. A child that has been institutionalised will find it harder to develop relationships, get a job and hold it down. They are more likely to suffer from health issues, turn to alcohol or drug abuse and with those come increasing health and policing costs. These are costs that are borne by the whole community.

Just project forward and imagine those human and financial costs in a continent anticipating continuing population growth.

Here’s the good news. It only costs 700 Sudanese Pounds per month to support a child in our Emergency Alternative Family service, less than one third of the costs of institutional care. And the outcomes are so much better.

The Government of Sudan has agreed to scale up nationally the prevention services we have pioneered and integrate them. In fact these services not only prevent abandonment, they provide a mechanism through which family planning advice and support can be delivered and help ensure that children, especially girls, can access education. These are some of the factors that will in time lead to a reduction in population growth.

This kind of family-based child care and protection reform, which saves lives and promotes the completion of education and improved health of children, must be reflected in the Post Millennium Development Goals agenda. In facing continued rapid population growth, African governments must actively orchestrate the policy environment in which family support services can flourish. They must allocate resources to them in the way that Sudan has and donor agencies must support them to achieve this sustainably.

This must start with a commitment across the whole of Africa to close orphanages and all forms of institutional care and replace them with alternative family-based care. Eradicating institutional care of children should be a universal policy commitment, backed by national budgets and integrated in the planning and strategies of government departments and civil society organisations alike. It needs to be a standing agenda item for the conference chatterati.

Over the last few months we ran our Numb3rs appeal: when children are treated as nothing more than a number – as they are in orphanages – bad things happen to them. We raised £2.1 million. This will be matched pound for pound by the UK Government’s Department for International Development to provide funding to enable us to roll out our work regionally in Africa. We will be seeking to provide the support to governments and civil society organisations to eradicate institutional care of children and strengthen the resilience of families to deal with the impact of issues like population growth.

So here’s a massive thank you to everyone who supported us with the appeal. You are helping to safe guard the future of the world through our work with children. Really, thank you.

 

¹Gerland, P., Raftery, A.E. [co-first authors]; Ševčíková , H., Li, N., Gu, D., Spoorenberg, T., Alkema, L., Fosdick, B.K., Chunn, J.L., Lalic, N., Bay, G., Buettner, T., Heilig, G.K. and Wilmoth, J. (2014). World Population Stabilization Unlikely This Century. Science 346:234-237