Berkley Center

Background: World Vision’s core mandate centers on vulnerable children, but its approach has evolved over time, drawing both on its direct experience and on individual country circumstances. The HIV and AIDS pandemic has increased the numbers of orphans but also highlighted the multiple causes of vulnerability in East Africa. Timothy Musombi, HIVAIDS and infectious diseases advisor for the East Africa region at World Vision International, met Nava Friedman in Nairobi in June 2014 to discuss World Vision’s evolving approaches toward its work on orphans and vulnerable children. The discussion focused on what drives vulnerability for children and how World Vision defines the children it serves and seeks to avoid the stigma that often accompanies vulnerability. It also touches on the ways in which World Vision works with the Kenyan government, and how the organization can ensure that aid truly reaches children in need. Musombi highlights the challenges of institutionalizing orphans and vulnerable children, and why World Vision strongly favors a community or family model of care as opposed to orphanages.

How did you get into health work with World Vision?

World Vision Kenya advertised a vacancy for a manager to run their Child Survival project and I applied. I had the knowledge, skills, and experience needed for the position advertised. My undergraduate degree is in environmental health, which is basically public health. Later I studied community health and did my masters in control of infectious diseases. I worked for the government of Kenya, Ministry of Health for 15 years before coming to World Vision. I have a lot of experience working with the government, in different places at different levels. When I left the ministry to come here, I was working with the National Malaria Control Program. That’s when I got the opportunity to join World Vision. After four years working for World Vision Kenya, I moved to the East Africa regional office. Right now I work on infectious diseases, East Africa region.

How has faith played into your career or your choice to work for World Vision?

In fact that was the motivation. There were many organizations that I could have joined, but as a Christian, I wanted to work with a faith-based organization. When World Vision made an offer to me, in fact two days down the line another organization made me an offer (with a better salary than World Vision), but I chose to stick with World Vision, because it’s a Christian organization. That would resonate very well with my values. And I am enjoying it. I have no complaints. I have been here for ten years.

World Vision seems to work with the community, not just individuals. Do you prefer this model?

I have had experience working right in the community but also working with the partners at a higher level.

In terms of going to the community, for me if something is not happening at the community level, then I don’t think it is happening. So I really put emphasis on seeing what is happening in the community. Like last week, when I was in Ethiopia, I went down to meet one association of people living with HIV, because I was training them on prevention of mother to child transmission of HIV. So we went to meet a group of mothers, whom we have been supporting. They could share with you very clearly that before World Vision “I had two children who were HIV positive. But after [being a part of the program], now I have a child who is HIV negative.” So, these are the kind of stories that motivate me to work.

How has HIV and AIDS affected your work with vulnerable children in Kenya?

We have been in the business of care and support of orphans and vulnerable children as an organization for about 10 years now. When we started supporting orphans and vulnerable children, the first question was are we going to focus only on children who are affected by HIV/AIDS? Not necessarily infected but who are affected—meaning you have a parent or a person in the family who is HIV positive. This is not only the case in Kenya, but across the region.

Our definition of an orphan and vulnerable child includes those affected by HIV and AIDS, but we also see that there are many causes of vulnerability in the community. One thing we try to avoid—and so are the other development partners—is the issue of just focusing on HIV-affected families, because stigma has been very high and has not gone down much. So we don’t want to stigmatize these children. So right now we talk of orphans and vulnerable children regardless of the causes of vulnerability. It could just be that they are poor, or it could be due to cause of death by a family member from another illness—not necessarily HIV and AIDS. So, now they meet the criteria and definition of who is an orphan and vulnerable child.

Beyond children affected by HIV and AIDS, how do determine if a child is an orphan or vulnerable?

Within the communities, they have been able to agree and in fact, they set parameters. When you talk to local communities, particularly where we are working, the parameters are well set as to who is a vulnerable child. This looks particularly at economic levels of the household. Households affected by HIV and AIDS come in. But also where there has been deaths in family, particularly of parents due to other causes, even including road accidents that have claimed so many people in Africa, particularly here in Kenya. So if a child is orphaned by one or both parents, regardless of the cause of death, the child falls in the category of a vulnerable child.

What about poverty as a factor in vulnerability?

Poverty is one other indicator. That is where now the community really knows how to define who is poor and who is not. Because you could be looking at somebody having money, but in the local community the measure of economic level is totally different. So that’s why we really involve the local community in terms of defining which child is vulnerable and which one is not. Particularly when you are considering those poverty levels.

When or how did World Vision become engaged with OVC in Kenya?

World Vision started working on OVC in 2002-3 as an organization, and in 2005-6, we engaged with the government, because we thought we did not have nationally agreed definition of an orphan and vulnerable child. We also did not have guidelines as to what form of care these children need to be given.

What would you define to be support?

Together with the other partners, we sat down and defined the guidelines for OVC care and support. And the government went ahead and has now refined those guidelines—much better than what we agreed on initially. But basically there remain about seven or eight areas of support that have been defined. For you to say that you are providing care and support to an orphan, then you needed to provide at least three out of these services. Not just one item and you move away.

Please tell me about the issue of institutionalizing orphans and vulnerable children—placing them in orphanages, for example.

In terms of institutionalizing OVC within the region, we are not encouraging institutionalizing children. And whoever wants to institutionalize children must have a very good justification. Some of the children who are being allowed to go into institutions would be children who have no other person within their community, where they come from, who would actually adopt him or take them up for care and support.

When you go to these institutions, most of these children are those either abandoned in health facilities, or children who are picked by the roadsides abandoned somewhere. Or they are children that the administration felt that someone in their community would not actually care for. They assess the individual case, but sometimes they realize that the community or people willing are not able to take good care of these children. That’s why we still have institutions running.

I know some of [these institutions] could be doing things against the guidelines that have been provided by the government. But for us, and many organizations like World Vision who are working with communities supporting vulnerable and children, we are not encouraging this. We are not even working directly with the institutions, like orphanages. This is because we really want to have children cared for in their own environment.

To what degree does money affect the choice of how to help an OVC? Would financial support allow a vulnerable child to stay with their family or extended family? Would that money really be spent on the child?

Sure. That has come up very strongly in issues of child protection, particularly orphans and vulnerable children. But again, that is to a small degree. There aren’t many people who do that. The majority of the people in the community are ready to give support to these children.

We also know that people who are running institutions know very well that for them to get funding, that funding (from outside donors) would be determined by the number of children they have. They actually sometimes talk to these children to prepare them, telling them exactly the same thing: “You know, if you stay there nobody is going to care for you. If you come in, we provide better care for you.” But even then, if you are to calculate the amount of money that is going directly towards these children, what percentage is that?

I can assure you from our own experience that some of these people are keeping these children as a means of earning money. In reality, if you are to follow it up, some of these children are not supposed to be institutionalized. They have people outside who could care for them, but these institutions are taking advantage of ignorance in the community (about the national guidelines) and telling them all sort of things that result in having these children being institutionalized.

I can’t really quantify the number of children who have run away from their home, just to end up in these institutions. But we have a number of children who are there. If you are to trace, they could have one or both parents who would have cared for them—or a close relative, who would have taken care of them.

Yes, we know that outside there, there are people who have misused the support that was meant for these children. That’s why the government has modified some of these guidelines so that you are not focusing on an individual child, but you are focusing on the household. The other problem of focusing on an individual child is subjecting them to stigma. Because when you are focusing on individual child, you are actually bringing stigma. Your action is leading to a child being stigmatized by others in the household but also from the community.

So, right now in OVC care and support, you are supposed to focus on the household, not on the individual child. So, when you do that, you minimize the misuse of resources that is meant to support these children. That’s what the government and all of us partners are working towards.

In the case of World Vision, how do you place OVC with families? How do you monitor them?

Right now, in terms of numbers, for World Vision Kenya, we are actually supporting over 400,000 children out there in the community. But then when you look at some of the programs we are running, which are actually meant to impact children even if indirectly (the 254, 815 counts only children we work with directly), indirectly we are talking of a million plus. In terms of policies, in terms of changing the practices in the community, we are reaching so many children.

Yes, of course we monitor these children. Using Kenya as an example, it has a government structure known as the Area Advisor Council (AAC). It is comprised of members working within the area, and these members have people who are providing support to the children down at the household level. You could have one person working with about 20 households. This AAC is mandated with a monitoring function to ensure that the services meant for these children are actually reaching them. And to ensure that nobody is actually taking advantage of these vulnerable children. It also ensures that the organizations that are operating are actually following the policies and guidelines as you provide care and support. So that element of monitoring, yes it is there. It is quite strong.

In Tanzania we have, what they call “the most vulnerable children committees” (MVCC). If you go to Ethiopia we have CCC (Community Care Coalition). So all the structures are there to provide support.

Do you find that the AACs provide consistent oversight for OVC throughout Kenya?

AACs are at different levels. We have implementing AACs, which is right at the grassroots level. Then you have supervising AACs, which is at divisional or district level. So I guess right now, because of change in the government structure, we would also need now to form AACs that are covering a county. A county covers more than what district was previously.

Does World Vision work with or through the government’s Area Advisory Councils?

At World Vision, we came up with a very good structure that we were excited about. Those are the Community Care Coalition, here in Kenya. We started popularizing that idea with other partners. So we went about sharing that idea with organizations that deal with children. And I remember in one meeting with UNICEF, when we presented this structure to them, they asked us a question: “Are you aware of the children’s act here in Kenya? It has structure called AAC, Area Advisor Council, which has the same composition and mandate that you have stated here.” Actually we were not aware.

We went back to the government, the children’s department in the government to talk to them. We asked them, saying we are a big player in terms of support and care for children, yet we have never heard about [AACs]. They said, “yes, we have it. Our biggest problem has been rolling it out.”

So, what we accepted to do immediately, as an organization that is interested in the welfare of children, was to work with the government in terms of preparing guidelines for rolling out of the [AAC] structure. We even prepared the training materials. First of all we started by bringing onboard children officers within the Children’s Department within the government (at the time it was under the Ministry of Home Affairs and Social Services).

We realized even their officers in the field had no idea of the content. I think some of the partners just worked with the national level staff in the children’s department. They prepared this policy guideline document that had never been disseminated. So, we came in and the first thing was to have a meeting with provincial children officers at the very senior level. We facilitated the meeting where now the national team together with our team came in and disseminated this document. Now we asked them to go to the district level and cascade that dissemination until it reaches to the ground.

Again, we took a leading role in working with the government because we have a program; at World Vision we work through what we call Area Development Programs. This is a combination of several projects that have been implemented in the community over a period of time. The aim is to bring about the desired transformational change, particularly around poverty alleviation. What we did is using those programs on the ground; we actually helped the government to roll it out up to that lowest level as an organization. That was in 2006 up to 2008. In some of these places, activities are still going on.

Can you say a bit more about programs with vulnerable children?

At World Vision we have been funded to work with orphans and vulnerable children in the community (through USAID and PEPFAR). Here in Kenya, World Vision is working with them also in handling the social determinants of health. That is touching the lives of so many orphans and vulnerable children. So right now the issue of institutionalizing is not there, but we are all working to keep children in their own environment but also giving them the support they require.

The government has tried another program on cash transfer to OVC households. So, OVC households are receiving between Ksh1,000 and Ksh1,500 on a monthly basis. It may look like a little money but at least creates some good change down there in the community level.

Have cash transfers been successful at reaching households? Or are there issues of corruption?

Corruption issues have been there, but they are also individuals who are doing a very clean job. There are several OVC households that are benefiting; right now they have even included households for the elders. The houses are getting some amount of money. If you were to visit most of these OVC households, you realize that they are living with the elderly. So, support is there and it is reaching them. There are few cases of corruption here and there. But again, that has not stopped the intention of the government to roll out this program, neither has it stopped OVC’s from receiving the support they need.

In light of these other programs and AAC oversight, what about the need for orphanages?

Let me tell you one thing. If I was a donor or the government today, I would like to close down 80 percent of the homes, because they are existing illegally. And they are taking advantage of the ignorance in the community. If you were to go ask the institutions about such things, the moment you ask, “Do you have money to run this home?” they will think why you are asking this question. Could you have social funding somewhere that you could give? That’s why asking equals promising. So they have learned a language of survival.

I am not saying that some of these homes are not necessary; there are those that are necessary but a very small percentage. When you look at most of the children who are in orphanages, they are supposed to be back in the community. There are those that if you ask them, they don’t know where they came from. They were picked from hospitals. Somebody dumped them in a government place and disappeared. So there are no records to trace the home of these children. I mean, there are homes that definitely would take care of those children.

You really need to dig out information and monitor the activities that go within that home for you to say “yes, it is a genuine thing.” A lot of people are using it as a means of raising money. There are those that deserve to be funded, but there are also some that don’t. Sometimes when you go to a website or when you read through documentation of some of these homes, they have a lot of stories with very high numbers of children they are taking care of. But when you go on the ground, you can hardly get half of those children.

For me the point I am stressing here is that for institutionalizing children, there are definitely children who qualify to go to these institutions. But there are also children within institutions who don’t qualify to be there, meaning that we have some institutions that ideally should not be there.

Is the government monitoring or closing these illegal institutions?

The government has not done enough. If it was to do the work as it was supposed to, then a lot of these homes would not be in existence. I also know that they have registered some homes—where they registered some years back when they had very good justification. But as of now, they actually ought to be deleted from the registry. But yet they are still doing work; they are still running. And those are some of the homes that are bringing children on board, who don’t deserve to be institutionalized.

If you are supporting an orphanage, what kind of an orphanage? Have you done due diligence to say that, “Yes, this is a deserving orphanage?” That’s all you need to do. If you did that, and you are not just relying on some information they are giving you—because if the donors then are very sensitive and looking for all of these guidelines, then some homes will even just close down quietly by themselves. But as long as there is a donor that is still giving them money, they will really want to justify by all means.

Does or has World Vision worked directly with orphanages on this issue specifically or just in general?

No, World Vision does not work with orphanages. We work with children who are in the community. But we are very much aware of the guidelines for OVC care in the country. So that is what we go for. Even in some very deserving orphanages, we are not still working with them. There are far fewer children there. There is a huge population of people in the community who actually need services. There are other organizations that specialize in providing care and supporting institutionalized children. For us, let’s work with children in the community because for one, they are the majority. If you provide support and care for them, you will stop a huge number from getting into institutions, where some of them do not even meet the standards.

What about faith communities working with orphans and vulnerable children? Do you know of any working for deinstitutionalization?

Just across the street, we have an orphanage here. I think it is supported by a church. So we have churches that are running some of these orphanages, but there are few.

They are also so-called faith-based organizations that are running orphanages. Their credibility is questionable.

As an example, there was a time when we were supporting such faith-based efforts, providing care and support for orphans and vulnerable children. That was right when I joined the organization in 2004. We gave them good support, but now in our monitoring role, when we went out to see some of these orphanages and what exactly they were doing, by the time we came back to the office, we had already struck some of them off the list. I’m talking from experience. There are people who give you very good numbers, but when you go on the ground, there is nothing. You don’t see a home. You don’t see an institution. There are no children. And yet, in terms of documentation, they have gone to the government. They have a certificate.

So, that’s why for me, when you talk about these orphanages, you really need to do due diligence to know what kind of an orphanage it is. Don’t go by the papers, don’t go by the website. Go to the ground and see what is happening.

When we went to a pastor’s home, there is a pastor who said to us he is running an orphanage. We gave him support. One day we just decided to go and visit them without notice. So on the record, this guy was taking care of 40 orphans. But when we went, we found that it was just his house. There was a room set aside there, but 40 children could not even sleep in that room! Even when you looking at the number of beds that are there, it could not accommodate 40 children. Basically he had gotten children from his relatives who were living with him. That’s why for me on the issue of children in institutions, we really need to look at them carefully.

And yet this is a pastor—this is a faith-based organization, so to speak. They are linked to the church. When you go on the ground what is there? Nothing. So that is why for me, whether it is faith or another motivation, you really need to establish.

That is my experience. And that is why at World Vision we are not wasting time with children at institutions. We know that there are children outside there we need to take care of, and that is what we are doing.

Are there organizations that are visiting orphanages to see whether they actually exist?

That is the mandate of the government. But we also know that some of these government officers are issuing certificates—not that they inspected, but somebody got them information. The same people who are corrupt with donors, they are also corrupt with government officers. To do this so it looks like they have legal backing from the government, with the right papers. That is the unfortunate situation.

If you visit an orphanage, it also depends on who you are talking to. If you talk to the person running the orphanage, you will get a totally different picture. And if they have certificates for registration from the government, check its authenticity. The authenticity of these certificates is questionable. Some are forging.

So many organizations talk about the same thing. That’s why many organizations would actually prefer taking care of the children in the community, following the government guidelines.