Final Summary Report

Assessment of Residential Care
Afghanistan
Implemented by:
In partnership with:
This publication has been produced with the assistance of the European Union. The contents of
this publication are the sole responsibility of Children in Crisis and can no way be taken to reflect
the views of the European Union.

Assessment of Residential Care Afghanistan
2
Contents
1 Executive Summary..............................................................................................................................3
2 Chapter One: Introduction...................................................................................................................6
2.1 Background ...................................................................................................................................6
2.2 Some basic definitions ..................................................................................................................6
2.3 The Context of Afghanistan ..........................................................................................................6
3 Chapter Two: Methodology.................................................................................................................7
3.1 Research Design............................................................................................................................7
3.2 Data Collection Tools ....................................................................................................................7
3.3 Monitoring....................................................................................................................................8
4. Chapter Three: Profile of Residential Care in Afghanistan ...............................................................8
4.1 Target Institutions.........................................................................................................................8
4.2 Government and Private Institutions ...........................................................................................8
4.3 Residential and Non-Residential Institutions................................................................................8
4.4 Growth of Private Institutions ......................................................................................................9
5 Chapter Four: Profile of Children in Residential Care........................................................................10
5.1 Parental Status............................................................................................................................10
5.2 Gender ........................................................................................................................................10
5.4 Disabilities...................................................................................................................................11
6. Chapter Five: Standards of Residential Care.....................................................................................11
6.1 Contact with Parents and Family ................................................................................................11
6.2 Existence of Records and Individual Care Plans..........................................................................12
6.3 Assessment upon Entry into Institutions....................................................................................12
6.4 Education ....................................................................................................................................13
6.5 Staff to Child Ratio ......................................................................................................................13
6.6 Management and Oversight .......................................................................................................14
7 Chapter Six: Cost/Benefit Analysis.....................................................................................................14
7.1 Background .................................................................................................................................14
7.2 Comparison with Neighbouring States.......................................................................................16
7.3 Cost Benefit Analysis...................................................................................................................17
7.4 Cost Benefit Analysis Conclusions and Recommendations ........................................................20
8 Chapter Seven: Conclusions and Recommendations ........................................................................21
8.1 Conclusion...................................................................................................................................21
8.2 Recommendations......................................................................................................................22

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1 Executive Summary
Introduction
This paper provides a comprehensive
overview of the situation of residential care in
Afghanistan. Through providing a firm
evidence base of the current situation, the
report aims to provide recommendations to
the Government of Afghanistan and other key
stakeholders to develop a child protection
system for Afghanistan that acts in the best
interests of all children in line with the UNCRC
and the Constitution of Afghanistan. The
report is based on data collected from six
provinces across Afghanistan through a
variety of data collection techniques including
a literature review, key informant interviews,
questionnaires, focus group discussions and
community meetings. A total of eight
government orphanages and 36 private
institutions were covered by this study within
the six target provinces.
Findings
Profile of Residential Care
The total number of non-residential children
in the orphanages covered by the study
exceeds the number of residential children.
Seven of the private institutions have no
resident children at all and one of the
institutions registered as an orphanage
actually only provides cash transport and food
support to families in their communities.
Profile of Children in Residential Care
Parental Status
Within the residential institutions, the
majority of children (64%) are single paternal
orphans followed by 16% of children who are
single maternal orphans and 12% who are
double orphans, 8% of those children in
residential care in the target provinces have
both parents living. This demonstrates the
need for support within the community and
family setting for women whose children have
lost their father. This should build on the
religious duty of other male family members
to assume guardianship of the child when a
child’s father dies.
Age
Accurate age data for children was
unavailable in many of the institutions due to
a lack of record-keeping. Estimates were
gained from staff based on their work with
children. These estimates show that there
were 101 children across the sample
institutions in residential care under the age
of five. The institution staff also revealed that
there are at least 12 resident young people
over the age of 18.
Those are the young people who were
officially reported, it is clear that there are
many more. In one of the orphanages in
Kabul, it was recently estimated that there
were over 70 men aged 18-28 living within
the institutions.
Standards of Residential Care
Existence of records and individual care plans
It is clear, from the study, that there is not
systematic use and review of care plans
within the institutions. The lack of adequate
care-planning appears to be symptomatic of a
wider lack of record-keeping.
Education
All of the institutions had some educational
facility either inside the institution or outside.
All government institutions with the
exception of Herat and Badakhshan had non-
resident children who only come during the
day to attend education classes. It is clear,
therefore, that the Ministry of Labour and
Social Affairs Martyrs and Disabled
(MoLSAMD) is covering the cost of education
provision for children who have families and
stay with them during the evenings. It is not
MoLSAMD’s role to provide education, this
should be fulfilled by the Ministry of
Education
Staff to child ratio

4
The staff to child ratio in some of the
institutions is a serious concern. In the
government institution in Nangarhar the ratio
is one staff member to thirty-four children
and in Kandahar it is one staff member to
every thirty-two children.
‘The number of staff is so few here
that many times children have to help
out with the daily activities of the
orphanage’
Head of Government Orphanage
Cost Benefit Analysis
Current Expenditure
Within the public institutions, the expenditure
varied widely from $US 444 to $US 1,388 with
an average of $1,247. According to data
provided by MoLSAMD in informant
interviews during the gathering of data for the
cost-benefit analysis, there are an estimated
6,216 resident children in 36 orphanages
across the whole of Afghanistan1
meaning
that the annual spend for MoLSAMD on
residential children is around $US 7,751,352.
The expenditure data from the private sector
also shows a wide variation in the unit cost
from $US 125 to $US 3,337 giving an average
spend of $1,230 which is very similar to the
public sector. The variation in the private
sector is likely to be as a result of the range in
quality and provision of services for children.
Alternatives
In comparison with neighbouring states,
Afghanistan has relatively few children living
in residential care. This is significant in
relation to the scope for redeployment of
financial resources in a reform programme.
There are a variety of different alternatives to
residential care which could be explored
within Afghanistan to look at the most
culturally acceptable solution. It is estimated
that a shift to day-care support would allow
1
This differs from the data provided by MoLSAMD
at the start of the project which listed a total of 31
Government institutions nationwide caring for
5,903 resident and non-resident children.
MoLSAMD to use the resources for a
residential place to fund 2.5 day-care places2
.
Conclusion
There is a huge variation in institutional care
that exists currently in Afghanistan. It is
simply inaccurate to describe all institutions
covered by the study as residential care since
many of them do not have children staying
overnight. The description of these
institutions as ‘orphanages’ is also inaccurate
since a significant proportion of children
registered in public and private institutions
have both living parents.
The majority of public and private institutions
provide good quality education. Providing
public or private education either within the
institutions or outside is standard. It is the
only feature which is consistent across all
institutions in the study, although certain
private institutions were not forthcoming in
the type of education which was being
provided. This does beg the following
question: why does MoLSAMD have
responsibility for the oversight of private
institutions providing only education and no
residential facilities? And why are some of the
public institutions only providing education
and not residential care?
There are some serious concerns in relation to
the number of children in lower age groups in
care, which highlight the need to focus on
primarily supporting children within their
families wherever possible and safe.
Within Afghanistan, the challenge is not the
re-building of a child protection and family
support system where previously one existed
which has been destroyed by the war, but the
building of an affordable and sustainable
community-based child protection and family
support system where none previously
existed.
Recommendations
2
This is less than the figure above because it takes
into account the education of children which still
needs to be paid for.

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The evidence from this study demonstrates an
overarching lack of oversight of the
institutional care system by MoLSAMD thus
the majority of recommendations refer either
to MoLSAMD itself or encourage support of
MoLSAMD to ensure a fully functioning child
protection system. In order to put these
recommendations in place, a sustained
capacity building and mentoring programme
needs to be developed for MoLSAMD in a
variety of areas such as financial planning and
management, strategy development and
implementation.
1. Review of State Protective Care for
Children
The Government of Afghanistan is mandated,
as a signatory of the UNCRC, to provide care
for children at risk. This should primarily be
through support to vulnerable families and in
a situation as close to a family environment as
possible and includes state care for those
children who do not have any family or in
whose best interest it is not to stay with their
family. MoLSAMD needs to ensure that state
protective care is provided for those children
who do not have a responsible adult to care
for them or those who are placed at risk by
staying with their family or a responsible
adult.
2. Reintegration of Children
There are clearly a huge number of children
currently staying in government institutions
who could be returned to their families.
MoLSAMD and DoLSAMD staff need to be
supported to conduct assessments of these
children and their families to ensure that
those children who do not require state
protective care are returned to their
communities to reduce the negative impact of
residential care upon them.
3. Education
There are both public and private institutions
within the study that only attract daily
attenders which suggests that they are only
attending to access education. MoLSAMD
needs to collaborate closely with the MoE to
ensure that they are providing adequate
educational support to vulnerable children.
The private institutions providing education
are obviously highly valued by children and
their families but responsibility for oversight
of these institutions should not lie with
MoLSAMD and should be handed over to the
Ministry of Education. This would free up
resources within MoLSAMD which could be
directed towards support for the most
vulnerable children and their families.
4. Alternative Care
There are, and always will be some
particularly vulnerable children in Afghanistan
who require state protective care. This should
not, however, mean that these children have
to be in large-scale residential institutions.
These are damaging to children’s physical,
intellectual and emotional development and
are also expensive. To lessen these impacts,
children should be placed within small-scale
care which, as far as possible, resembles
family life.
In order to successfully establish this,
additional research should be conducted into
which community-based alternatives are best
suited to the culture and situation of
Afghanistan. Community based alternatives
have been found in other countries to cost on
average 15 to 30% of the cost of residential
care, even including education3
.
5. Private Orphanages
The growth in private orphanages in recent
years has been steady. It is clear that
investment in capital resources is a popular
focus of donor-funding across the world in
order to give tangible results; this is given
despite the evidence of damaging effects of
3
EveryChild’s (Carter, 2005, p.8) assessment of the
evidence in Central and Eastern Europe and CIS
countries indicates that on average, institutional
care in that region is twice as expensive as the
most costly alternative: community
residential/small group homes; three to five times
as expensive as foster care (depending on whether
it is provided professionally or voluntarily); and
around eight times more expensive than providing
social services-type support to vulnerable families.

6
institutional care. Since any shift to
alternatives to residential care will require
additional substantial investment which is
unlikely to be available to MoLSAMD, efforts
should be made to divert support from the
Afghan diaspora in donor countries to
supporting a range of alternatives rather than
directing their investment solely towards
residential care.
2 Chapter One: Introduction
2.1 Background
There continues to be a growth in the use of
residential care throughout the world despite
evidence dating back to the 1940s which
states that institutional care has a negative
impact on the development of children no
matter what their age (Williamson and
Greenburg, 2010; Delap, 2011; Browne, 2009;
Carter, 2005). Children growing up in
residential care are more likely to suffer from
health problems, underdevelopment and
developmental delay. As a result, children in
residential care grow up with less developed
intellectual, social and behavioural abilities
than those children growing up within a
family environment. Separation from parents,
particularly in the case of institutional care,
can threaten a child’s right to development.
Of particular concern are large-scale
residential institutions where children receive
a lack of individual care. Children need to
form an attachment to at least one carer and
a lack of this attachment can have an impact
on ‘self-esteem, confidence and ability to
form relationships’ (Delap, 2009). These
institutions if poorly managed can harbour
abuse and neglect and create isolation for
children from surrounding communities
(Delap, 2011).
In addition to its detrimental effect on the
well-being of children, institutional care is
expensive. It diverts resources away from
provision of support to families or alternative,
family-based forms of care. It is estimated
that caring for children within residential care
is three to five times more expensive than
foster care and eight times more expensive
than providing social service type support to
vulnerable families (Carter, 2005).
This study provides a representative
assessment of the situation of residential care
in Afghanistan. It provides a profile of the
types of governmental and private residential
care as well as reasons why children are
entering residential care and includes a cost
benefit analysis which compares Afghanistan
with neighbouring countries and reviews how
Government of Afghanistan funding could be
used to better ensure that the best interests
of children in Afghanistan are being served.
2.2 Some basic definitions
The Guidelines for the Alternative Care of
Children provide a definition of Residential
Care as: ‘care provided in any non-family-
based group setting, such as places of safety
for emergency care, transit centres in
emergency situations, and all other short and
long-term residential care facilities including
group homes’ (United Nations, 2009). The
situation in Afghanistan is slightly complicated
since all institutions irrespective of size or
parental status are referred to as
‘orphanages’. Within the study they will be
referred in the majority therefore either as
institutions or as orphanages since that is how
they are registered with MoLSAMD.
2.3 The Context of Afghanistan
For the past thirty years Afghanistan has been
in a situation of chronic instability and
conflict. More than half of the country’s
population are under 18 and have
experienced nothing but instability. Children
have borne the brunt of the effects of both
on-going conflict and poverty, only 60% of
school-aged children are enrolled in school.
Children have also been forced to work to
support their families either on the streets or
in workshops working long hours often
subject to exploitation and abuse.
The widespread use of residential care in
Afghanistan originally emerged under the
Soviet Regime between 1978-1992.
MoLSAMD was originally established at this
time and was tasked with the oversight of
residential care. This responsibility was re-
affirmed in the Orphanage Regulations

7
developed by the Interim Government of
Afghanistan in 2002.
This supports the Constitution of Afghanistan
which states that the Government of
Afghanistan will aid orphans. These are the
children, therefore, that the MoLSAMD is
mandated to support and that should come
under the protective care of the state. It was
found during the development of the National
Strategy for Children ‘at-risk’ (NSFCAR) in
2004, however, that as a result of the
breakdown of community mechanisms and
extended family networks throughout the
conflict, institutional care was being used as a
‘coping mechanism to replace the kinship and
social networks that were traditionally
resorted to in Afghanistan to combat poverty,
unemployment and homelessness’
(MoLSAMD 2004). As a result institutions
were only caring for a small number of
vulnerable and ‘at-risk’ children. In order to
improve the level of care for at-risk children,
the NSFCAR sought to provide a ‘Strategic
plan for the transformation of children’s
institutions into Child and Family Resource
Centres to support the care of children within
their families and reduce reliance on
residential care. The Afghan National
Development Strategy (ANDS) Social
Protection Strategy (2008-2013) also stated
that institutionalized children who have family
would be reintegrated. Despite this plan and
the allocation of funds and efforts by both
national and international NGOs, MoLSAMD
estimate that the number of public and
private orphanages has increased from 30 to
70 since 2008 and according to MoLSAMD,
now accommodates almost 11,000 children.
The UNCRC Concluding Observations Report
on Afghanistan also raised concerns about the
level of institutionalisation of children and the
quality of care provided to children within
institutions.
In order to inform future MoLSAMD policy,
this project will use learning from other
countries which share religious, political or
cultural similarities with Afghanistan to
conduct an assessment of the costs of large-
scale institutional care against preventative
interventions and small-scale or other
alternatives to care.
3 Chapter Two: Methodology
3.1 Research Design
Sample Provinces
At the start of the project data was gathered
from MoLSAMD on the number of
government and private institutions.
Provinces were selected from this data on the
basis of criteria including: security (whether
data could feasibly be collected), number of
government and private institutions,
geographical spread (one province from each
region plus Kabul), number of children
residing in government and private
institutions and links with CiC’s previous work.
One province per region was chosen in order
to ensure a mix of the different ethnic groups
within Afghanistan. The target provinces
were: Badakhshan, Ghazni, Kabul, Kandahar,
Herat and Nangarhar.
Sample size
A total of 44 orphanages (government and
private) were covered in all the six provinces.
The differences between the actual numbers
of institutions in comparison with the
MoLSAMD data will be explored in more
detail in chapter three.
3.2 Data Collection Tools
A range of quantitative and qualitative data
collection tools were used as follows:
 Questionnaires
 Finance-related data
 Focus group discussions
 Community Meetings and in-depth
interviews

8
3.3 Monitoring
A project Advisory board was established
which included: MoLSAMD, MoE, the General
Director of Orphanages, a representative from
the Ministry of Justice Human Rights Support
Unit (which is mandated to follow up on the
UNCRC), Terre des Hommes, UNICEF and
Ecorys. Meetings were held at regular
intervals throughout the project. The
members advised on data collection, analysis
and inputted into drafting of the final report.
4 Chapter Three: Profile of Residential
Care in Afghanistan
4.1 Target Institutions
MoLSAMD is responsible for the management
of state-run orphanages in Afghanistan. In
each of the six target provinces of this study
there is at least one state-run facility and in
Kabul and Herat there are two, one for girls
and younger boys, and one for older boys. A
total of eight public institutions were included
in the study.
In addition to the government orphanages, 36
private institutions were covered by the study
which were all either registered with
MoLSAMD as orphanages or which described
themselves as orphanages. These institutions
are defined as private but are mainly run by
Afghan or international non-governmental
organisations and are not fee-paying
institutions. A total of 44 institutions were
therefore covered by the research.
4.2 Government and Private Institutions
Prior to conducting the study, data was
gained from MoLSAMD regarding the number
of private and state-run orphanages in
Afghanistan. MoLSAMD estimated that the
total number of public institutions in the
country was 31 covering 5,903 residential and
non-residential children. Within the private
orphanages, MoLSAMD data showed a total
of 40 institutions across the country reaching
5,449 children (resident and non-resident).
The study covered eight public institutions
and 36 private institutions giving a ratio of
1:4.5.
Within the target provinces the number of
government institutions found in the study
was the same as the MoLSAMD data although
the MoLSAMD data did not make clear that
the institution in Herat is actually split into
two institutions, one boys’ and one girls’. The
MoLSAMD data for the target provinces
showed a total of 33 institutions reaching
4,131 children (residential and non-
residential) in contrast to the 36 institutions
actually found during the study. The figure
from the study includes four additional
private orphanages found in Kabul which
were not included in the original MoLSAMD
list. One private orphanage, Fatimatu-zohra in
Badakhshan, which was on the MoLSAMD list
has actually closed and yet neither DoLSAMD
in Badakhshan nor MoLSAMD centrally had a
record of this institution closing.
Inaccuracies in the number of orphanages
registered by MoLSAMD and those in actual
existence raises questions about the level of
oversight provided by MoLSAMD of these
private institutions. This is further questioned
in relation to the process of registration and
the categorisation of institutions. All of the
institutions in the study were registered with
MoLSAMD as orphanages but they clearly
provide a range of different services for
children and their families. Indeed not all
institutions registered as orphanages have
children residing within them.
4.3 Residential and Non-Residential
Institutions

9
In this study, residential children are defined
as those who stay within the institution
overnight and receive 24-hour care. Some of
these children will go home to their families
at the weekend or during holidays but they
spend the majority of their time within the
institution. Non-residential children are those
who visit the orphanage only during the day
to use the facilities within the institution but
do not stay overnight.
Within the 44 institutions covered by the
study there were a total of 3,469 residential
and 3,766 non-residential children in both
public and private institutions. The total
number of non-residential children exceeds
the number of residential but mainly due to
the large proportion of non-residential
children in the private orphanages. It
shouldn’t be ignored, however, that the
proportion of non-residential children in the
state-run orphanages is also around one third.
This raises initial concerns about the purpose
of these institutions if children are not staying
overnight.
The graph below includes both private and
public institutions and demonstrates the
residential nature of all institutions covered
within the study:
Whilst the majority of institutions covered by
the study (51%) are residential, there is a
significant number (33% or seven institutions)
which do not have any residential facilities at
all. One of them, Peace Tent, does not have a
building that children or families attend but
rather provides cash transfers and food
support to children and families within their
communities. This reinforces the need for a
more accurate way of registering institutions
with MoLSAMD. Within the target provinces
33% of the institutions provide no residential
facilities, if this proportion is indicative of the
entire country then based on the existing
statistics provided by MoLSAMD they could
have 13 institutions providing for almost
2,000 children registered as orphanages that
actually have no residential facilities.
4.4 Growth of Private Institutions
Within the study sample, private institutions
were also found that cater to
children/families of a particular type.
Missionaries of Charity in Kabul provides
educational support to children with
disabilities as well as outreach work in
communities. The Women for Women Shelter
only supports children whose mothers are in
prison. The wide variety of purposes served
by these institutions suggests that the term
‘orphanage’ is unhelpful and should not be
used. Whilst these services could be sub-
contracted to NGOs, the legal responsibility
still remains with the state in the absence of
parental or family care and the funding for
this should come from the state.
It appears from the data collected that if the
proportion of public to private orphanages is
replicated across the country, that the private
sector cares for more than twice the number
of residential children than the public sector.
MoLSAMD estimates that the private sector
cares for 5,449 children nationwide but the
research suggests that the actual number
must far exceed this and is possibly as high as
10,000 children since MoLSAMD is under
estimating the number of private institutions.
There were mixed views amongst Community
Members about the growth of private
orphanages, at one Community Meeting in
Herat, one of the fathers stated that: ‘in
private orphanages there are no needy
children, because these kinds of orphanages
take money from people and organizations
and even from children’s parents, but in
Government orphanages there are vulnerable,
needy and orphan children.’ As previously
stated, officially the private orphanages
included in this study are all established by
NGOs, and are non-fee paying although in this
case the private orphanages appear to be
taking money from parents to allow their
children to stay. In Nangarhar when discussing
Graph 1: Residential Nature of
Orphanages Residential Boys and
Girls
Non-residential Boys
and Girls
Both Residential and
Non-residential Boys
and Girls
33%
51%
16%

10
one of the private orphanages, community
members were much more positive stating
that: ‘this orphanage should be here forever, if
it is not here then what will happen to our
children?’ and ‘the orphanage is a very
valuable place, here our children are
prevented from bad things and they will be
directed or invited to live in a good way, they
can learn here, so they will be something in
future’.
5 Chapter Four: Profile of Children in
Residential Care
5.1 Parental Status
As stated in the introduction, there are
various interpretations of the term orphan.
The outcome of community discussions in this
project suggest that in Afghanistan although
children who have lost either their father or
mother or both are all considered orphans,
paternal single orphans were considered
particularly vulnerable. This is likely to be in
relation to the inheritance rights of sons in
Sharia law. The data for parental status is split
between residential and non-residential
children.
Graph 2 shows the parental status of children
in residential institutions (public and private).
The majority of children, 64%, are single
paternal orphans followed by 16% of children
who are single maternal orphans and 12%
who are double orphans. 8% of children in
residential care have both parents living. This
demonstrates the need for support to
families, within the community, particularly
women whose children have lost their father.
One of the explanations for the high number
of single paternal orphans in residential care
is that in many cases when widowed women
marry again the new husband will not accept
children from the previous husband and that
they are therefore placed in residential care.
Graph 3 demonstrates that 90% of non-
residential children in institutions are single
parent orphans and in total 2% of children are
single maternal orphans or double orphans.
8% of the non-residential children have both
living parents. This graph highlights that the
vast majority of non-residential children have
at least one living parent and suggests the
need to explore in more detail the reason why
children are using these non-residential
services.
5.2 Gender
The proportion of boys in both the non-
residential and residential institutions is more
than three times the proportion of girls. In
discussions with communities and residential
staff, two reasons were highlighted for this: 1.
after a certain age it is culturally not
acceptable for girls in Afghanistan to stay in
an out-of-home/family setting and 2. Boys’
1% 8%
90%
1%
Graph 3: Profile of Non-Residential
Children
Double Orphan
Both parents
living
Single Paternal
Orphan
Single Maternal
Orphan
12%
8%
64%
16%
Graph 2: Profile of Residential
Children
Double Orphan
Both parents
living
Single Paternal
Orphan
Single Maternal
Orphan

11
education is more valued thus they are sent
away to institutions whereas girls stay at
home and help with housework. This
highlights the need to provide educational
infrastructure closer to these girls’ homes and
to work with families to ensure that they are
allowing their children to attend school.
During one of the Focus Group Discussions in
Herat, a community member stated that
‘Islam doesn’t allow us to keep our girls
outside of home after they grow up’.
‘Boys need to find a job and hence
need to be educated properly; girls
would be married and have to take
care of their families’
Community member- Herat
5.3 Age
Data on the age of children in the institutions
is estimated since the records of children are
not regularly updated.
The estimates suggest that there are
approximately 101 residential children under
five years of age across the sample of
institutions. This needs to be explored very
carefully because the admittance of children
under the age of 5 into residential care should
be avoided at all costs. The Guidelines for
Alternative Care of Children refer specifically
to children under 3 but also states that ‘In
accordance with the predominant opinion of
experts, alternative care for young children
should be provided in family-based settings’. It
is very important for young children to make a
bond with their caregivers otherwise this can
seriously harm their development Within a
residential care environment there is a danger
that the children may have multiple
caregivers or be neglected and this situation
should be used as a last resort, when all other
possible options have been exhausted for very
young children. Children under three years
old face the risk of permanent damage to
their physical and mental development as a
result of institutional care (Browne, 2009).
There are also at least 12 resident children
who are living in the institutions after the age
of 18 and based on experience CiC would
estimate that the actual number is higher
than this. Orphanage staff in Badakhshan
stated that since regular individual plans are
not maintained for children, their exact ages
are often not known and as a result children
remain in the institutions after 18 years of
age.
‘The children are expelled from the
orphanage on the observation of the
physical age of the child’
Orphanage Staff
In Tahai Maskan orphanage in Kabul, older
children who were over 18 had become
caregivers within the institution.
5.4 Disabilities
Children with disabilities appear to be
accepted into a few specialised institutions
such as Missionaries of Charity in Kabul which
is a school for children with disabilities and
provides residential care for a small number
of children. In Kabul there are three children
and young adults with disabilities living within
the institutions but the payment of their
caregivers is supplemented by other
organisations since it is not completely
provided by MoLSAMD. There is a four-
bedroom unit for children with disabilities
within one of the institutions in Kabul. This
was only established after extreme pressure
placed on MoLSAMD and after a boy was
admitted to hospital since he was not being
cared for within the institution. The
Institutions in Kabul have also refused to
admit children with severe disabilities despite
this category of children being included in the
orphanage regulations. In a focus group
discussion within one of the government
institutions in Kabul, researchers observed the
staff behaving negatively with a child with a
mental disability and called him derogatory
names.
6 Chapter Five: Standards of Residential
Care
6.1 Contact with Parents and Family
The majority of children covered by the study
are non-residential meaning that they are
staying with their families each evening. It

12
should also be noted that the majority of
residential children also return home to their
families for holidays and/or at weekends. The
majority of public orphanages are also closed
down during school holidays and children are
sent to their families for up to 3 months in the
winter and up to a month in the summer,
indicative that the primary purpose of
orphanages is to provide education. All of the
orphanages with the exception of one of the
private orphanages in Badakhshan had a plan
for when family members would visit children
which varies normally from two times per
month to once per month.
When the Children in Crisis researchers
discussed the option of children staying with
their families with one of the managers of a
course run at an institution in Kabul to
supplement resident and non-resident
children’s education, he stated:
‘If families of children are provided
with financial support it is good for
the children to be at home, because
Islam and the law give this right to
children’.
This is a very important finding and an
important point since families, communities
and the Government of Afghanistan need to
acknowledge the right of children within
national and international law and within
Islam to stay with their families.
6.2 Existence of Records and Individual Care
Plans
Records refer only to basic information on all
of the children within institutions which
should be provided when a child is introduced
to an institution. Individual care plans are
detailed case records of children that record
the age at orphanage entry of a child and day-
to-day updates of progress of the child
including educational achievements,
disciplinary issues and records of contact with
the child’s family. They should also detail the
plan for the children’s future care and
education, detailing what arrangements
would be in the best interests of the child
following discussion and agreement with the
child, their family and caregivers.
In those institutions which have received
support through the Social Work Coaching
project (Kabul, Ghazni and Herat) children
have care plans and records are well kept. In
Badakshan and Kandahar however, none of
the children had care plans.
It is clear that whilst some of the government
institutions have children’s records and care
plans, there is not a systematic culture of use
and review of care plans within the
government institutions and demonstrates a
lack of investment and commitment by the
state to upgrade its capacities and service
provision.
6.3 Assessment upon Entry into Institutions
Each of the institutions had different methods
through which children would gain entry. In
the government orphanages, 70% required a
recommendation from the MoLSAMD/
DoLSAMD whilst 30% required only a
recommendation from a family member or
community leader to prove that the child
warranted being placed in the institution.
According to the rules and regulations for
residential care, children should be accepted
based on adequate documentation and
approval of these documents by the
Governor. At the government institutions, it is
the role of M/DoLSAMD and the community
leaders to prove the need for a child to enter
the institution. In the private institutions, 17%
of them are the reverse where survey teams
from the institutions actively go out into
communities to find children from vulnerable
families to enrol in the institutions.
The number of non-residential children
admitted has increased dramatically from
only 93 children in 2002 to 1,179 children in
2011. This growth in admittances of non-
residential children mirrors the growth of
private institutions in Afghanistan and is
demonstrative of the number of families
enrolling their children in these institutions.
In discussions with parents about why they
send their children to the private institutions,

13
a mother who has one daughter currently
enrolled in an institution in Kabul and another
who has graduated stated that:
‘If there was no orphanage, our
children would have been deprived of
education; it’s been five years since
my child is in this orphanage, if the
orphanage was not here, I would not
be able to enrol them in school and
they would be deprived from
education and suffering from various
diseases because I don’t have the
capability to buy medicine or do their
treatment.’
The mother added: ‘this orphanage should be
there forever, because it builds the future of
poor children like mine’. The lack of records
within institutions and review of children’s
care plans results in the existence of children
who are over 18 continuing to attend or
reside in institutions as described previously.
There is also a lack of planning and
preparation for what support young people
will have when they are forced to leave
institutions.
6.4 Education
Within the private orphanages which have
residential facilities, 44% of institutions have a
private school inside, 21% cover the cost of
sending resident children to a private school
outside of the institution and 35% send
resident children to a government school
outside of the institution.
Among the government institutions, all of
them have government schools inside with
the exception of the two institutions in Herat
which have private schools inside. In all of the
Government Orphanages with the exception
of the two in Herat and the orphanage in
Badakhshan there are non-resident children
who appear only to be enrolled in the
institution for educational purposes. This is a
more serious issue than the private
institutions since MoLSAMD is bearing the
load of covering the costs of an entire
institution and all associated staff for these
non-residential children solely to attend
education.
The view of orphanages only as schools
appeared to be shared among parents and
children during focus group discussions. In
Badakhshan a 12 year old boy stated that:
‘Our uncle brought us to orphanage,
because his economic situation was
not good and this place is very good
for education’
Also in Kandahar an 11 year old boy reported
that: ‘I like this second place (orphanage),
because I study here and then I like home,
because my father and mother are there, both
my father and mother are alive and are here
in the orphanage.’ This child’s parents are
both alive and both work in the orphanage.
He studied in the institution and then would
return home to live with his parents.
6.5 Staff to Child Ratio
Within the institutions covered by the study
there was an overall ratio of 14.4 children to 1
staff member (educators, administrative staff,
management, cooks, cleaners, gardeners and
security staff). This is a reasonable ration and
does not reveal the disparities in the figures
from the various institutions.
The government institutions have quite
shocking children: staff ratios. In the
government institution the ratio is 1 staff
member to 34.5 children and in Kandahar it is
1 child to 32.4 children. This was reflected in
conversations with the head of the
government orphanage in Kandahar who told
researchers that:
‘The number of staff is so few here
that many times children have to help
out with the daily activities of the
orphanage’.
This presents a serious child protection risk to
the protection of children. Another issue
which isn’t apparent from the ratios is the
difference between the number of staff on
duty during the day and night. Allaudin

14
Orphanage in Kabul has a relatively good
staff: child ratio of 1 staff member to every
5.5 children but in previous visits, CiC staff
have been told that there are only two care
staff on duty during the night for all 270
children. This is a child protection concern
particularly in light of the fact that young
people over the age of 18 are being housed in
the same building as very young children. In
the community surrounding Tahai Maskan
Orphanage in Kabul, community members
complained at the lack of supervision of
children which meant boys were escaping
from the orphanage by climbing over the
boundary walls.
The education provision within government
institutions also suffers from poor staff ratios;
the director of the government institution in
Ghazni stated that:
‘We have only 4 teachers for 120
children. We have demanded for more
teachers but have received no
response’.
At the government orphanage in Nangarhar
there are only 10 teachers responsible for 500
students. In Kandahar the government
orphanage has only one teacher for all 271
children.
In Allaudin orphanage in Kabul, there were
reports of high levels of staff on the payroll
that have never actually showed up for work
or do not come on a regular basis. This is an
area that was difficult to pursue in any level of
detail but it is assumed that this may also be
the case in other government orphanages
since the level of oversight by the Central and
Provincial Government appears weak.
6.6 Management and Oversight
At present the private orphanages report
directly to DoLSAMD in the Provinces and
MoLSAMD centrally rather than through the
General Director of Orphanages. There is no
monitoring unit within the General
Directorate of Orphanage and appears to be
very little monitoring of both the public and
private institutions by representatives from
M/DoLSAMD.
The administration, management and line of
reporting of orphanages are anomalous.
NGOs running private orphanages are
required to be registered with the
Department of NGOs within the Ministry of
Economy and report to them financially on a
quarterly basis. Since they are also caring for
vulnerable children then they are also
required to be registered with MoLSAMD and
submit technical reports to them. The private
orphanages appear to prioritise their
reporting to the Ministry of Economy because
without this they run the risk of losing their
NGO status and do not report to MoLSAMD.
7 Chapter Six: Cost/Benefit Analysis
7.1 Background
In this context cost benefit analysis implies a
pattern of expenditure which provides
services giving the optimum available
outcome for beneficiaries, in this case
children and families, in the best available
cost effective way. Costs refer to capital and
recurrent costs such as staff salaries, utilities
and food. All costs presented in this chapter
are in USD for ease of comparison. The
benefit to children and families can relate to
both the increased productivity of children
when they become adults and the
improvement of their environment leading to
an improvement in physical and mental
health and an improved nutrition.
Data within this chapter is sourced from both
public and private orphanages. The analysis
and conclusions which flow from this data are
indicative, i.e. useful as a planning guide but
not definitive - it being clear from the
limitations chapter that gathering accurate
disaggregated cost data for orphanages in
Afghanistan is a challenge.
For each of the Government and private
orphanages, data was gathered on the
number of resident and non-resident children
present during 2011 and the expenditure
during the 2011 financial year. Expenditure
data used in this chapter is the best available.
Not all data provided was comprehensive, nor
relating precisely to the same period. The
data for all institutions does, however, relate

15
to expenditure incurred and not to budgeted
expenditure.
When calculating the unit cost per annum, the
cost for non-resident children (essentially
education) assumes one third of cost for a
child fully resident. This calculation is based
on previous experience conducting a study of
residential versus community-based services
for children in difficulty in Moldova in 2005
(Larter and Veveritsa, 2005).
Government Institutions
Data was gathered for each of the eight
Government orphanages covered in the
study. During the financial year 2011, there
were a total of 1,491 resident children and
451 non-resident children across the eight
institutions. Of the two orphanages with non-
resident children one, Abdul Ahad Karzai in
Kandahar has a majority of non-resident
children (271 non-resident, 53 resident) while
at the other, Amam Bokhary in Nangarhar the
numbers of resident and non-resident
children are approximately equal (220 non-
resident, 180 resident). It might also be noted
that of these 1,941 children only 32 are
considered as disabled.
The variation in unit cost, i.e. the cost of a
resident place for one child year, is
remarkable. The range in this study is from
$US 444 to $US 1,388, with a mean of $US
1,247.
Information gathered during the study from
DoLSAMD Offices in the Provinces
demonstrated that the system of budgeting
for Government orphanages is top down.
This was also confirmed during a meeting with
MoLSAMD in Kabul. Institutions do not have
their own accounting unit or any input into
the preparation of annual budgets. This is a
matter entirely for MoLSAMD. Salaries are
paid centrally while there are centrally
determined contracts for food and other
supplies. Utility bills are paid centrally. Thus
Government institutions have not only no
input into budget preparation but virtually no
control over their spending. Given this
position the wide variation in unit cost per
annum indicates a lack of effective financial
management by MoLSAMD. It is reasonable
to assume from that that the Ministry’s
overall management of its residential
institutions is also deficient.
Overall Public Orphanage Expenditure
Extrapolating from the data it is possible to
derive an approximate figure of overall
expenditure on public residential care.
According to MoLSAMD there are 36 public
institutions in the country caring for 6,216
children, giving an overall annual spend of
$US 7,751,352 (6,216 x $US 1,247). As
previously indicated this calculation should be
treated with caution due to the wide variation
on expenditure in public orphanages. This is
actually double the figure provided by the
Ministry of Finance as total expenditure on
orphanages in 1391. The comparison between
the amounts provided by the provincial
institutions and the centralised figures from
the Ministry of Finance further calls into
question the oversight of the financial system.
MoLSAMD and UNICEF estimate that there
are about 8,000 children in residential care
(public and private institutions) – this is only a
tiny proportion of the number of children
under 17 (Less than 0.1%). In neighbouring
CEE/CIS countries on average about 2% of the
child population under 17 need protection
and therefore some form of care or support
outside their families (Larter and Veveritsa,
2005, 3). The proportion of the child
population in need of some form of care or
protection would be likely to be higher in
Afghanistan, given the higher levels of
poverty, insecurity and other forms of
adversity, suggesting that there are likely to
be at least 250,000 children in such need in
Afghanistan.
Thus the resources devoted to residential care
are, at present, only providing for less than
3.2% of children in need of Government
assistance. The sum of money currently
expended on residential care is, therefore,
inadequate to do more than make a modest
start toward the development of a nation-
wide network of family and child-focussed

16
services able to support all children in need of
assistance. 4
Private Orphanages
In common with institutions in the
Government sector, there are wide variations
in unit cost in the private sector, the range
being $US 125 to $US 3,337. With 1,449
resident children and overall expenditure of
$US 1,782,437 within the residential
institutions only, the average unit cost is $US
1,230. This figure is remarkably close to the
average unit cost per child in the Government
sector. However, the data for Hazrat Mhd. in
Ghazni Province at the lowest extreme, $US
125 must be regarded as suspect since it is so
low that the data appears inaccurate. The
range in the private sector probably indicates
variations in the range and quality of services
offered by individual organisations.
7.2 Comparison with Neighbouring States
Observations can be made about similar
aspects and social phenomena in a range of
other countries by way of comparison of the
costs of residential care in Afghanistan and
those other countries with a view to achieving
a cost-benefit analysis as between residential
and alternative forms of care.
To the extent that direct comparisons
between Afghanistan and other nations are
possible, comparisons here are drawn
between the position in Afghanistan and the
position in Tajikistan, Kyrgyzstan, Azerbaijan
and Moldova. Tajikistan is a near neighbour
of Afghanistan while a significant proportion
of the population of Afghanistan is ethnic
Tajik. Kyrgyzstan has been chosen because it
has a number of comparable characteristics.
Azerbaijan is a Muslim country, albeit less
overtly observant than Afghanistan, but has
some social problems common to
Afghanistan, notably forced and early
4
A first step in developing services for children and
families is often initiating pilot projects, e.g. the
government in Kazakhstan is developing a community-
based protection system pilot for children aged 0 to 3 in
three districts of the country. This is then more
attractive to donors as the country can demonstrate
results.
marriages5
and their attendant consequences.
Moldova has been chosen because as the
poorest country in Europe it also offers some
comparisons.
It has been noted that the proportion of the
0-17 Afghan population in residential
institutions is 0.1%. This proportion is
remarkably low. In Tajikistan the proportion
is 0.33%, in Kyrgyzstan 1.1%, in Azerbaijan,
which has a relatively advanced reform
programme in place, 0.66% (Larter and
UNICEF Azerbaijan). In Moldova the figure in
2007 was 1.22%. The significance of these
data is relevant to the scope for the
redeployment of financial resources in the
process of a reform programme, an important
element in considering cost effective
expenditures and cost benefit analysis. Given
the comparison countries cited it can be seen
that Moldova has potentially the greater
scope for financed reform programmes. In
terms of percentage of GDP Moldova’s
education expenditure is among the highest in
the world (Rank 7), while 8% of that
expenditure was dedicated to residential care.
Kyrgyzstan also has some flexibility. Of the
countries cited Tajikistan has the least
available flexibility and will need to find new
money to develop alternative services.
Azerbaijan’s reform programme is largely
contained within existing education
expenditures6.
Sources: At home or in a home? Formal care and
adoption of children in Eastern Europe and Central
Asia -UNICEF Regional Office for Central and
Eastern Europe and the Commonwealth of
Independent States (CEE/CIS) - September 2010;
and Global Facts about Orphanages - Better Care
Network Secretariat - August 2009
5
The Nirzami Rayon centre, Baku, has a pilot project
seeking to reduce the incidence of illegal early marriage,
exploiting their access to applicants for social benefits.
Country % 0-17 in
Residential Care
% of children in
residential care
with at least
one parent alive
Afghanistan 0.1 85-90%
Kyrgyzstan 1.1 80%
Tajikistan 0.33 80%
Azerbaijan 0.66 -
Moldova 1.22 -

17
There are however other differences. Each of
the countries cited is a former Soviet republic
and has the range of types of institution
including some catering for children with
specialist needs, characteristic of the Soviet
system. These are frequently the
responsibilities of Ministries other than
Education, Health for example in respect of
children with mental disability or neurological
disorders. Each has public finance regimes in
which some institutions are financed from the
State budget and others from regional
budgets. All have a significant number of
pupils who attend as day students.
All of the comparison countries include
Guardianship7
, a form of kinship care, as one
of the few alternatives to institutional care.
Guardianship is the formal placement of a
child deprived of parental care in the formal
custody of a part of its extended family.
Azerbaijan and Tajikistan make allowances to
Guardians, Kyrgyzstan does not. In Kyrgyzstan,
as in Afghanistan, children are often sent to
institutions hundreds of kilometres from their
home communities, resulting in the child’s
definitive separation from its family and
community.
Commonly, the criteria used for making
decisions which determine the future of
children and specifically their admission or
not into residential institutions have utilised
loose criteria, while there has been, in some
locations, anecdotal evidence or
commonplace belief of their corruption.
These programmes typically focus upon
proper assessment of needs ahead of decision
and include the rationalisation of the work of
Commissions. Such reforms are most likely to
be effective and sustained when they involve
the development of a single gate-keeping
mechanism to avoid children being taken
unnecessarily into residential care, gate-
keeping being a coordinated system of multi-
disciplinary assessment and decision making,
7
The definition and use of the term ‘guardianship’
varies significantly around the world. Guardianship
may confer parental rights and responsibilities to
adults who are not parents, but it does not
necessarily imply that the guardian is also the
child’s caregiver (Save the Children, 2007).
led by a single agency, that guides effective
and efficient targeting of services for children
(Bilson and Harwin, 2003).
7.3 Cost Benefit Analysis
Cost
The unit cost for a child year in a residential
institution providing both care and education
must be divided into the education element
and a care element in order to establish the
volume of financial resource theoretically
available for redistribution in the event of a
reform programme to replace residential care
with community alternatives. It is suggested
here that this division should be
approximately 70% for care and 30% for
education. This division is necessary because
whatever alternatives to residential care are
provided the child beneficiary remains
needing to be educated within a community
based education system. The division is based
on a previous cost/benefit exercise addressing
residential care in Moldova (Larter and
Veveritsa, 2005, 2).
Equally, when considering the cost benefit of
particular expenditures i.e. the relationship
between expenditure and beneficial outcome,
it is necessary to take into account the total
expenditure per beneficiary. Thus in order to
determine the overall cost of the provision of
a particular service it is necessary to multiply
the annual unit cost by the number of years
during which the service is delivered to an
individual beneficiary. Thus, for a child
entering a residential institution at, say, age
seven, and graduating at, say, age seventeen,
the overall unit cost is ten times the annual
unit cost. For expenditure on Government
institutions with an annual care cost of $US
873 ($US 1,247 x 70%), the overall
expenditure per beneficiary, in the example
given, will be $US 8,730. In terms of cost
benefit the question is: does this pattern and
scale of expenditure produce a beneficial
outcome for the child?
Options for Alternative Care
The National Strategy for Children at Risk
advocates for the reform of residential care
and one of its focuses is on transforming the

18
present Government Institutions into ‘Child
Family Resource Centres’. Whether
transformation is the appropriate course
should, in practice, be subject to a number of
tests. Perhaps the most important is location
i.e. is the institution’s location close to a
centre of population such that its
transformation would be viable in terms of
access for potential beneficiaries. For example
Aschiana Samar Orphanage in Jaghori District
is in a very remote and insecure area of the
province where families would not wish to
travel to leave their children each day.
Other tests relate to the suitability of sites
and buildings and to the capital costs of
securing the transformation. These issues
include the range of buildings in any given
campus and their suitability; their condition
and their proposed future use. The viability of
the transformation option should take into
account the impact of required (and available)
capital to meet the costs of the
transformation and the downstream impact
on revenue budgets of significant capital
expenditure. The results of these tests should
be evaluated against the alternative costs,
capital and revenue, of closure and the
provision of alternative services at other more
appropriate locations.
A cost benefit analysis of Child Protection
policies for Tajikistan, conducted by the
Government of Tajikistan (2009) with UNICEF
and the University of Maastricht, concluded
that the policy of residential care was the
most costly option in the long term. Policy
options based on deinstitutionalisation were
less costly (between 10 and 25% of the cost of
residential care) in the medium and long term
and alternative options to residential care
were found to provide better outcomes for
children and families.
The traditional alternatives canvassed in
association with deinstitutionalisation policies
are, in the main, a range of day care options
to support children with families, plus kinship
or guardianship care and foster care as
alternatives to residential care for children
deprived of parental care.
Guardianship:
There is a tradition in many Former Soviet
countries of Guardianship, in which a child’s
extended family undertakes the formal
responsibility for the care of a child, i.e.
formally appointed by the state. Some
countries e.g. Azerbaijan, pay allowances to
Guardians or Trustees while others, e.g.
Kyrgyzstan do not. In either event
Guardianship is the least costly of all formal
alternative care options for children deprived
of parental care.
Foster Care:
The running costs of foster care, based on
experience in Central and Eastern Europe and
the Former Soviet Union, are approximately
one fifth to one third of state institutional
care (Carter, 2005, p.35). However,
establishing a safe and sustainable system of
foster care requires considerable time and
investment at the outset, but even if the
initial unit cost is initially closer to the cost of
maintaining large state institutions, the
argument in favour of foster care over
residential care generally can be clearly made
on the grounds of more beneficial outcomes
for the child8
. An additional financial
advantage may be argued in that foster care
placements are typically of shorter duration
than enrolment in a residential institution, in
particular when a child has a clear care plan
with support services to enable reintegration
to the care of a parent or relative, or
placement for adoption or long term foster
care if this is not possible.
However, when arguing a case for either
kinship care or a form of guardianship, or
8
Evidence cited in Carter (2005): An analysis of 75
studies, incl. more than 3,800 children in 19
countries found that children reared in large-scale
residential care had, on average, an IQ 20 points
lower than their peers in foster care (Barth 2002).
A longitudinal study by the Bucharest Early
Intervention Project found that young children
who were moved from
large-scale residential care to supported foster
care before the age of two made dramatic
developmental gains across several cognitive and
emotional development measures compared to
those who continued to live in residential care and
whose situation worsened considerably (Nelson et
al 2007).

19
more formal forms of foster care, in
additional to the legal, policy and budgetary
and capacity building requirements for
developing such services, the question of local
cultural traditions relating to substitute family
care for children unable to be cared for by
their parents needs to be taken into account.
Kafalah:
Within Sharia law, adoption is seen as set
against the natural order of society and is thus
haram (forbidden). The preservation of blood
ties and inheritance rights mean that
adoption is not permitted. Within the Koran,
however, the importance of orphans and their
protection is stressed. Orphan children should
be treated as a biological child but not
entitled to the same rights as the latter. In
cases where Kafalah is used, the caregiver has
parental authority and is obliged to care for a
child but the child’s original family bonds and
family status continue to exist. The way in
which Kafalah is interpreted throughout the
Muslim world is highly varied. It is necessary,
therefore, to put any practice of Kafalah
within its national context in order to fully
understand it.
Day Care Support:
When it is safe for a child to stay at home
then day care support may be sufficient for
children and families. The costs and unit costs
of day care which provide education,
expressed in terms of the annual cost of a
place are generally about 30% of the costs of
residential care (Larter and Veveritsa, 2005,
2). Given that 30% of $US 1,247 is $US 374
while the unit cost shown for some of the day
units in the private sector are in the range
$US 350/395 it seems a reasonable estimate
that the cost of a day care place would fall
within this range.
However, that estimate is net of any set-up
costs which might include site acquisition,
architectural fees and capital costs. These
costs must be evaluated and taken into
consideration at the planning stage.
The unit cost in terms of cost per beneficiary
is not necessarily the same as the cost of a
place. Such unit costs are a function of the
purpose and utilisation of day care by
beneficiaries. That in turn is a function of the
purpose of any specific centre. A
rehabilitation programme with a finite period
of attendance has a different unit cost
calculation to a long term centre for say,
children with a mental disability. Equally, the
average number of days per week in which a
centre is used by beneficiaries also affects the
calculation of unit cost per beneficiary. It is
generally unusual for a beneficiary child to
attend for an extended period for each day
that a centre is open so that the calculation of
unit cost is dependent not upon the number
of places available but the overall number of
beneficiaries to whom the centre is able to
provide a service.
Overall the cost of a place will depend upon
the level of supervision required by
beneficiary users (staffing ratio) and the range
of specialist workers employed either full or
part-time by the centre. Nonetheless day care
services, when they enable children to remain
in the care of their parents or relatives, are
likely to provide better outcomes in the long
term, avoiding the negative effects on
children of residential care, and delivered at
lower unit cost.
The Maastricht study cited above also argues
that alternative policies are on average 50 to
70% cheaper than institutional care. It
equally argues that a system of alternatives
needs to be in place ahead of a
deinstitutionalisation programme.
Although the cost data gathered in this study
may not be entirely accurate, it is still
reasonable to suggest, for example, that the
resources used for a residential place are
capable of providing two and one half day
care places ($US 873 divided by $US 350 =
2.49).
Even with the development of universal
services, and with a re-profiling of child care
services from large-scale institutions to family
and community-based care, it is likely,
however, from the experience of other
countries including the UK that have shifted
child care provision almost completely from
residential care to foster care, that some

20
highly specialised small-scale residential care
units would need to be retained. These would
be for children with particular difficulties,
including those with challenging behaviour
and young people who have experience
multiple rejection and abuse in families and /
or many years of life on the street and in mid
to late adolescence may resist any attempt to
introduce them to a new substitute family.
Reform of private residential care
institutions in Afghanistan
In recent years there has been an explosion of
private sector institutions particularly since
2007. A very high proportion of these
developments are financed by resources
provided by expatriate Afghan individuals and
organisations, for example AFCECO, (Afghan
Children’s Education and Care Organisation)
and The Afghan Women’s Organisation of
Canada. These initiatives have their origins in
a wide variety of countries, including, for
example, Egypt and Japan. They represent
initiatives by Afghans in making their own
efforts to improve the future of Afghan
children.
The question must be asked as to whether the
MoLSAMD has any policy toward these
developments, in particular given the earlier
observations with regard to the registration of
orphanages and the apparent lack of any
oversight regime for supervising private
initiatives of this kind.
Consideration should be given as to how this
kind of private initiatives can be encouraged
to contribute to a government driven reform
programme as envisaged within the National
Strategy for Children at Risk. This will need
careful lobbying, information and advocacy
work in the donor countries with the Afghan
diaspora.
It has been noted above that this study covers
25 private residential institutions, i.e.
excluding those establishments not properly
orphanages. They care for 1,449 children.
The probability is that the private sector cares
for more children than the public sector,
perhaps even by a factor of ten, i.e. over
60,000 children. Even that figure implies
possible coverage of no more than 25% of the
probable number of children in need of some
kind of formal care or protection service
(based on projection from similar studies in
Moldova, Larter and Veveritsa, 2005, 3).
7.4 Cost Benefit Analysis Conclusions and
Recommendations
In general the development of appropriate
community based child care and protection
services will require additional funding and, in
the initial phase of development, only a small
part of this funding will be available from the
early cost savings from the first stages of
phasing out of residential care. Consideration
should be given to recommending two or
three local pilot initiatives to demonstrate
what can be done in development of a
continuum of child care and family support
services in individual districts, so that the
results of facilitate further fundraising for the
initial cost investment.
1. MoLSAMD:
The analysis has shown that, not only is
Afghanistan short of the resources it needs to
provide appropriately and adequately for
children in need of protection and assistance,
but that its principal Ministry, MoLSAMD,
lacks both the policies and competencies to
discharge its current responsibilities, let alone
the competencies to initiate and drive a
reform and development programme.
A prior requirement before any programme of
development and reform can proceed is to
improve the competencies and commitment
of the principal responsible Ministry, the
MoLSAMD. Sustained capacity building and
mentoring initiatives are needed in a number
of areas. Financial planning and
management are key, as are strategy
development and implementation, change
management and even day to day
management and control.
2. Education
It should be noted that any reform
programme directed toward residential
institutions should acknowledge and provide
for the transfer of responsibility for education
to the Ministry of Education together with the

21
financial resources currently deployed by the
MoLSAMD in educating children to the
Ministry of Education.
3. Private Orphanages:
At present it appears that developments in
the private sector are being made without
reference to any kind of policy framework.
Investment in capital resources is popular
among donors world-wide because the
existence of an orphanage is tangible
evidence of the use of the donation providing
a focus for the donor, this despite the wide
spread understanding in child protection
organisations of the damaging effects of
residential care upon the growth and
development of children.
Given the need for alternatives to residential
care, it is suggested that efforts are made to
build a partnership with the private sector
and in particular with the Afghan diaspora in
donor countries, perhaps initiated by the EU
or UNICEF in order to encourage the private
sector and the donor community to think
more widely about the nature of their
development i.e. toward expanding the range
of their development and investment into a
range of services beyond residential
institutions.
4. Alternatives:
The challenge facing Afghanistan is not the re-
building of a Child Protection and Family
Support system destroyed by decades of war,
civil unrest and dislocation; but rather, the
community-based Child Protection and Family
Support system where none previously
existed. This means that an important part of
the funding will need to be new funding from
international donors.
It will be important to do research as to which
community based alternatives are best suited
to Afghanistan.
Community based alternatives are on average
15 to 30% of the cost of residential care, even
including education9
. It is important to note
that 85 to 90% of Afghan children currently in
residential institutions have at least one living
parent, so one of the paths to explore will be
social protection systems for poor parents
and also to aid foster parents or guardians.
There has been considerable
We need to understand which of these causes
and what others are important in Afghanistan.
Having understood and assessed the causes
and drivers of institutionalisation, the next
step would be the development of a single
coordinated gate-keeping system, to prevent
unnecessary admission of children to
residential care, and to divert children multi-
agency assessment and planning to any one of
a continuum of community-based family
support and child care services.
8 Chapter Seven: Conclusions and
Recommendations
8.1 Conclusion
There is a huge variation in institutional care
that currently in Afghanistan. It is simply
inaccurate to all institutions covered by the
study as residential care since many of them
do not have children staying overnight. Even
within the state-run institutions there are still
non-residential children and the situation
within the private sector is even more
extreme with some institutions acting simply
as food distribution centres. The description
of these institutions as ‘orphanages’ is also
inaccurate since a significant proportion of
children registered in both public and private
institutions have both living parents.
The majority of public and private institutions
provide education and education appears to
be a major pull factor towards residential
9
EveryChild’s (Carter, 2005, p.8) assessment of the
evidence in Central and Eastern Europe and CIS
countries indicates that on average, institutional
care in that region is twice as expensive as the
most costly alternative: community
residential/small group homes; three to five times
as expensive as foster care (depending on whether
it is provided professionally or voluntarily); and
around eight times more expensive than providing
social services-type support to vulnerable families.

22
care. This does beg the following question:
why does MoLSAMD have responsibility for
the oversight of private institutions providing
only education and no residential facilities?
And why are some of the public institutions
only providing education and not residential
care? These institutions should either come
under the remit of the Ministry of Education
and residential children should be returned
home and have access to MoE education
closer to their homes.
There are some serious concerns in relation to
the number of children in lower age groups in
care, which highlight the need to focus on
primarily supporting children within their
families wherever possible and safe. What
this study could not do is provide evidence
that those children who are using these
institutions are the most vulnerable children
in Afghanistan. The NRVA shows that there
are many single and double orphans who stay
within their extended families rather than
living in residential care. There is no data
from this study or other studies to date that
demonstrates that children within orphanages
need to be there at all.
Within Afghanistan, the challenge is not the
re-building of a child protection and family
support system where previously one existed
which has been destroyed by the war, but the
community-based child protection and family
support system where none previously
existed.
8.2 Recommendations
The evidence from this study demonstrates an
overarching lack of oversight of the
institutional care system by MoLSAMD thus
the majority of recommendations refer either
to MoLSAMD itself or encourage support of
MoLSAMD to ensure a fully functioning child
protection system. In order to put these
recommendations in place, a sustained
capacity building and mentoring programme
needs to be developed for MoLSAMD in a
variety of areas such as financial planning and
management, strategy development and
implementation.
1. Review of State Protective Care for
Children
This study has demonstrated that there are
many children living within institutions who
have living family and could actually be at
home. Residential Care in Afghanistan is
currently used as a first rather than last resort
for a variety of reasons primarily lack of
access to education.
The Government of Afghanistan is mandated,
as a signatory of the UNCRC, to provide care
for children at risk. This should primarily be
through support to vulnerable families and in
a situation as close to a family environment as
possible and includes state care for those
children who do not have any family or in
whose best interest it is not to stay with their
family. MoLSAMD needs to ensure that state
protective care is provided for those children
who do not have a responsible adult to care
for them or those who are placed at risk by
staying with their family or a responsible
adult.
It is only these children who should come
under the protective care of MoLSAMD and
who require alternative care, outside of their
immediate family environment.
The development of these criteria should
form part of the development of the Child Act
in Afghanistan and should be informed by the
UNCRC.
Following establishment of these criteria,
future admission to residential care should be
limited only to those children who qualify for
state protective care. This will require training
and investment into government Institution
staff to ensure effective gate-keeping.
2. Reintegration of Children
There are clearly a huge number of children
currently staying in government institutions
who could be returned to their families.
MoLSAMD and DoLSAMD staff need to be
supported to conduct assessments of these
children and their families to ensure that
those children who do not require state

23
protective care are returned to their
communities to reduce the negative impact of
residential care upon them.
Reintegration of children with their families is
a long process and should not be done
without adequate funding for pre-planning,
assessments and follow-up of children.
Children who have been reintegrated should
be linked with other non-governmental
and/or governmental services available in
their communities to provide the services
required to them.
3. Education
There are both public and private institutions
within the study that only attract daily
attenders which suggests that they are only
attending to access education. MoLSAMD
needs to collaborate closely with the MoE to
ensure that they are providing adequate
educational support to vulnerable children.
The private institutions providing education
are obviously highly valued by children and
their families but responsibility for oversight
of these institutions should not lie with
MoLSAMD and should be handed over to the
Ministry of Education. This would free up
resources within MoLSAMD which could be
directed towards support for the most
vulnerable children and their families.
4. Alternative Care
There are, and always will be some
particularly vulnerable children in Afghanistan
who require state protective care. This should
not, however, mean that these children have
to be in large-scale residential institutions.
These are damaging to children’s physical,
intellectual and emotional development and
are also expensive. To lessen these impacts,
children should be placed within small-scale
care which, as far as possible, resembles
family life.
In order to successfully establish this,
additional research should be conducted into
which community-based alternatives are best
suited to the culture and situation of
Afghanistan. Community based alternatives
have been found in other countries to cost on
average 15 to 30% of the cost of residential
care, even including education10
. It is
important to note that 85 to 90% of Afghan
children currently in residential institutions
have at least one living parent, so one of the
paths to explore will be social protection
systems for poor parents and also to support
foster parents or guardians. There will not be
one solution suitable for all families, what is
needed is a continuum of services available to
vulnerable families at community level which
keep vulnerable children safe and protected
within their families and provide support to
families to ensure children can remain in their
homes.
5. Private Orphanages
The growth in private orphanages in recent
years has been steady. It is clear that
investment in capital resources is a popular
focus of donor-funding across the world in
order to give tangible results; this is given
despite the evidence of damaging effects of
institutional care. Since any shift to
alternatives to residential care will require
additional substantial investment which is
unlikely to be available to MoLSAMD, efforts
should be made to divert support from the
Afghan diaspora in donor countries to
supporting a range of alternatives rather than
directing their investment solely towards
residential care.
10
EveryChild’s (Carter, 2005, p.8) assessment of
the evidence in Central and Eastern Europe and
CIS countries indicates that on average,
institutional care in that region is twice as
expensive as the most costly alternative:
community residential/small group homes; three
to five times as expensive as foster care
(depending on whether it is provided
professionally or voluntarily); and around eight
times more expensive than providing social
services-type support to vulnerable families.

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