1. There are estimated to be at least 1.1 million orphans in Ghana. many more are vulnerable to the same circumstances orphans face even though they may still, for the time being, have at least one of their parents alive.

2. About 4,500 of these children are in orphanages. Orphanages face many challenges, but a descriptive study on orphans and vulnerable children (OVC) in the Central region of Ghana indicates that the many OVC who live in households are less likely to have access to education, nutrition and health than those children living in orphanages.

3. Ghana has made strides to help those who care for these children, but more progress remains to be made. What are the challenges these caregivers face and what can be done to help them?

4. The introduction of the national health insurance scheme in 2004 has afforded many households ready access to health care services. Under the current scheme, children under age 18 in a household are covered by the health insurance once parents or guardians subscribe to the scheme. However many caregivers are not registered because they cannot afford the premium and therefore the children living with them are also not covered.

5. “We don’t have the money to go and register for the health insurance. When the children get sick, I wait till it gets really serious before I go to borrow money to send them to the hospital.” – Female caregiver living with 4 children.

6. Most caregivers were able to afford 3 meals a day for their children. However, many of them alluded to the inadequacy of the meals given and its lack of nutritional value.

7. “Every day the children eat 3 times. It’s not satisfying though but they seem to understand my situation. I know that if they get more than they have now, they would eat.” – Female household head living with 3 children

8. Government’s provision of free compulsory basic education enabled caregivers to enroll their wards in school. However being in school requires money for transportation, uniforms, notebooks, food, and a host of other items that are not free. Caregivers say that providing these extras for school are a major difficulty.

9. “Yes, they are in school. However I had to borrow money to buy their books, bags and uniforms. I am yet to repay that loan.” Female caregiver of 2 vulnerable children

10. Some possible solutions

11. Interventions that build the capacity of caregivers can provide long lasting income to sustain households with OVC

12. OVC --whether in orphanage or households-- need more support to access the full benefits of government's Free Compulsory Universal Basic Education and the National Health Insurance Scheme

13. Involving all stakeholders and policy makers in setting country specific research agenda is vital in influencing policy through research.

14. Produced by the Research and Development Division, Ghana Health Service In collaboration with the ABBA RPC Other members of the ABBA RPC are : The ABBA RPC is generously funded by DfID Photos by Kwadwo Anakwah, Ato Selby, Kelly Hallman