Africa VAC and Care Report Single Page

Violence Against
Children and Care

in Africa
A Discussion Paper
Violence Against
Children and Care
in Africa
A Discussion Paper
June 2017
Acknowledgment
This discussion paper was prepared for the Better Care Network by Isabel de Bruin Cardoso, with
contributions from Kelley Bunkers, both from Maestral International, L.L.C, and Ghazal Keshavarzian.
Significant input was also provided by Florence Martin, Maria Herczog, and Shimelis Tsegaye.
We are also grateful to Delia Pop and Julia Kragulj, in addition to all the key informants who shared their
perceptions, ideas and experiences on the need to strengthen linkages between the VAC and care sectors
in the discourse, and in practice. Warm thanks also go to the Without Violence team for their fantastic
support in making this report visually accessible and communicating key findings effectively.
Suggested citation: Better Care Network. (2017). Violence Against Children and Care in Africa: A
Discussion Paper. New York.
2017 Better Care Network
This publication may be freely used, quoted, reproduced, translated or distributed in part or in full by any
non-profit organization provided copyright is acknowledged and no fees or charges are made.
This paper was possible thanks to the support of Oak Foundation.

Forewords
Marta Santos Pais

Special Representative of the Secretary-General
on Violence against Children
Over ten years ago the United Nations General in prevention, urging States to provide effective
Assembly adopted the UN Study on Violence support to families in their child-rearing
against Children. The Study provided for the responsibilities to ensure a violence-free home
first time a global overview of the pervasiveness and avoid the risk of child abandonment.
of violence in childrens lives, and it set forth in Furthermore, it urged the provision of a range
its recommendations an action-oriented policy of family and community based alternatives to
agenda to prevent and address all forms of avoid the placement of children in institutions,
violence against children. and to ensure that such an exceptional option is
truly used only as a measure of last resort. And
The UN Study gave special attention to the for those children who may end up in alternative
protection of children from violence in the home, care, the Study called for effective measures for
and in care and justice institutions. Violence is their protection to be put in place.
often a continuum. It may force children to run
away from home and be used as a reason for These measures are embedded in the UN
placing a child in an institution. When placed in Convention on the Rights of the Child and in
residential care, children may be left with poorly- the African Charter on the Rights and Welfare
trained, ill-paid and frustrated staff, and at times of the Child and to further advance their
be left unattended and unsupported often in implementation, the UN General Assembly
inhumane conditions. Children with disabilities adopted the UN Guidelines for the Alternative
may be locked away or tied up allegedly for their Care of Children in 2009.
own protection, and they may be beaten and
medicated to avoid disturbing other children or These legal instruments recognize the imperative
the staff. The chances for physical, verbal and of always safeguarding the best interests of the
psychological abuse are high and yet more often child, as well as the critical role of the family
than not there is no effective monitoring of their alongside States responsibility to support
living conditions, or evaluation of the reasons for parents in their child rearing responsibilities.
the childrens placement. Together, these treaties and guidelines help
to promote a nurturing environment for each
Recognizing that incidents of violence taking and every child, while preventing childrens
place behind the walls of institutions are often abandonment and separation in the first place.
hidden, concealed and under reported, as well
as how seriously they compromise childrens As this report highlights, while much progress
development and wellbeing, the Study urged has been made, there is still a long way to go. In
all States to break this invisibility and address times of poverty and hardship and when other
it as a priority in their policy agenda. The Study risk factors aggravate childrens vulnerability,
called upon States to prohibit by law all forms the separation or removal of children from their
of violence against children in all settings, families is often not a measure of last resort and
to consolidate data to assess the magnitude is rarely only temporary.
and incidence of child neglect, abuse and
maltreatment, and to identify children most The harmful impact on the development of
at risk, both to inform policy making and to babies and infants from placement in non-family
monitor progress. It also called for investment care is deep and long-lasting. Very young children
who are neglected and deprived of cognitive And in this process, it is critical to join hands with
stimulation may suffer the severely negative the children concerned. Children are best placed
and irreversible effects of institutionalization. to assess the effectiveness of implementation
They lack the individual attention, parental efforts, and their voices and experiences need to
warmth and interaction with supportive adults inform the work ahead.
that every child needs for optimal development.
Growing up deprived of a nurturing environment Thanks to States commitments and our collective
and exposed to high levels of insecurity affects action and advocacy over the past decade,
childrens ability to experience and explore the promotion of childrens rights and their
their environment with confidence, living with protection from violence has evolved from a
increased anxiety and fear and being less able largely neglected topic into a global concern; a
to deal with stressful situations and adversity. concern that is now included as a clear priority
Children may live in poor physical conditions, and a distinct target in the 2030 Agenda for
deprived of safety and nutritious food, lacking Sustainable Development.
quality education and genuine opportunities to
develop their talents and abilities to their full Yet this is an area where much more action is
potential. needed to translate into reality the shared vision
of the Convention on the Rights of the Child, the
Indeed, children in institutional care already UN Guidelines, the 2030 Agenda, the African
vulnerable as a result of the circumstances that Charter on the Rights and Welfare of the Child,
led to their separation from their families are AU Agenda 2063 and the African Childrens
at high risk of violence, neglect, abuse and Agenda 2040.
exploitation. And yet, more often than not, safe,
confidential and child-sensitive complaint and We urge government, civil society, donors,
reporting mechanisms are weak or non-existent partners and all other stakeholders to work
and they do not provide children with sufficient together to realize the opportunity this report
independent support to pursue their concerns. As affords to improve the care and protection of all
a result, child victims feel pressured to conceal children in Africa and to build a continent that is
what has happened to them, fearing further truly free from fear and from violence.
stigmatization, harassment and reprisal.
Despite the significant national data surveys

conducted in Africa on violence against children
in many countries across the continent, we know
little about children in alternative care. There
is scarcely any data on the reasons and length
of childrens placement, about the facilities and
providers of care services, or about those being
reintegrated with their families or leaving care.
We lack information on the mechanisms set up
to ensure oversight and independent monitoring
of childrens conditions and wellbeing, or on how
well the quality standards to secure childrens
care and protection are being enforced.
More robust legal frameworks on child protection

and child care reform are being developed,
or further strengthened to align them with
international standards, but these efforts are
insufficient when effective implementation
and monitoring mechanisms and long-term
predictable funding are lacking.
As this report highlights, it is urgent to end

the conspiracy of silence and strong sense of
impunity surrounding incidents of violence
against children who lack parental care. Violence
against Children and Care in Africa provides clear
recommendations of how progress can be made
in ensuring the comprehensive and effective
implementation of the UN Guidelines in Africa.
These recommendations are indispensable to
secure the protection of childrens rights and
must be acted upon immediately.
Benyam Dawit Mezmur
Chairperson ACERWC, and Associate Professor of
Law, Dullah Omar Institute for Constitutional Law,
Governance, and Human Rights, University of the
Western Cape.
In 2006, the UN Study on Violence against This Disucssion Paper is informed by the
Children recommended, no violence against international and regional child rights frameworks.
children is justifiable and all violence against If we agree that the CRC and the ACRWC are not
children is preventable. Such a statement neither a wish list but a to do list, States should pay
contained a but nor an if. It did not need to close attention to the imperatives contained in
make a differentiation of the various settings these instruments that are aimed at preventing
within which violence against children takes and addressing violence against children in
place. It was not made with a view to make it all settings. The importance of prevention of
a slogan to serve as a bumper sticker, but the need for alternative care finds its rightful
more as a statement of fact, so that all policy and emphasis in the paper. An evidence based
law makers, families, communities, civil society approach, including disaggregated data, for
organizations including faith based organizations, planning, programming, implementation, and
persons that work for and with children, as well as monitoring is identified as a leitmotif for effective
children themselves can join hands in making this action. The provision of a functioning regulatory
recommendation a reality. system, including gatekeeping, is critical. So is
the extent to which the principles of necessity
More than a decade later today, the state of and suitability are followed and applied, as it
violence against children in care, including has direct implications and links to the risk of
alternative care, still has significant room for violence against a child in alternative care. While
improvement globally. In fact, truth be told, it still many African countries operate in a resource
looks distressingly similar in some quarters. This constrained environment and need a more skilled
is so despite the fact that what is contained in the and well-resourced social service workforce, there
Convention on the Rights of the Child (CRC), and are a number of good examples from the region
the African Charter on the Rights and Welfare of that can be replicated to address this gap.
the Child (ACRWC), as well as the UN Guidelines
on Alternative Care, is directional enough to help Reading this Discussion Paper, I cannot help but
us make tangible progress on the issue. ponder over the words of James Baldwin that
[n]ot everything that is faced can be changed,
Violence against children is prevalent in all but nothing can be changed until it is faced.
settings. The UN Committee on the Rights of This Discussion Paper helps us face our reality on
the Child, for instance, has identified children violence against children and care in Africa, and it
not living with their biological parents, but in constitutes a stimulating and useful resource for
various forms of alternative care as one of decision makers, bureaucrats, service providers
the groups of children who are likely to be and practitioners alike.
exposed to violence. Children in care in Africa
are no exception in this regard, and no amount
of deflection alters this inconvenient truth.
One should just let the figures contained in the
Discussion Paper speak for themselves to get a
sense of the magnitude as well as nature of the
challenges that we face. Just to take a leaf out
of it, in Africa, at least 50 per cent of children
between the ages of 2 and 17 years experienced
one or more forms of severe violence in the past
year in all settings (Hillis et al. 2016).
The links between violence and care are

multifaceted. So are the potential solutions to
preventing and addressing violence against
children in all care settings.
Table of contents
ACRONYMS 9
1. INTRODUCTION 10
Methodology 13
2. BACKGROUND 16
2.1 Understanding violence against children 16

2.2 The CRC and ACRWC on the responsibility to care and
protect children 19
2.3 The AC guidelines on ensuring children outside of
parental care are protected from violence, exploitation and
neglect 20
2.4 The legal and policy framework in africa on protecting
children from violence, exploitation and neglect in the home
and alternative care settings 21
3. VIOLENCE AGAINST CHILDREN IN FAMILY AND

ALTERNATIVE CARE SETTINGS 22
3.1 Violence against children in the home 26

3.2 VAC and care in alternative care 32
Kinship care 32
Foster care 34
Residential care 35
3.3 VAC upon leaving alternative care 41
4. CONSIDERATIONS FOR POLICY AND SERVICES 42
4.1 Preventing VAC in the family and the need for placement
of children in alternative care 42
4.2 Generating a stronger evidence base on VAC in
alternative care settings 45
4.3 Adopting policies that address the links between
violence in the home, family separation, and placement of
children in alternative care 46
4.4 Establishing effective regulatory systems to oversee the
use of alternative care 47
4.5 Investing in a skilled and well-resourced social service
workforce 49
5. CONCLUSION 51
GLOSSARY OF TERMS 54
ENDNOTES 56
ANNEX 1: LIST OF KEY INFORMANTS 66
ANNEX 2: BIBLIOGRAPHY 67
Colin Crowley/Save the Children
Acronyms
AC Alternative care
ACPF African Child Policy Forum
ACERWC African Committee of Experts on the Rights and Welfare
of the Child
ACRWC African Charter on Rights and Welfare of the Child
AU African Union
BCN Better Care Network
CRC Convention on the Rights of the Child
DHS Demographic Health Survey
EAC East African Community
FGM Female genital mutilation
MICS Multiple Indicator Cluster Survey
NGO Non-governmental organization
NPA VAWC National Plan of Action on Violence against Women and
Children (Tanzania)
PoA Plan of Action
SADC Southern Africa Development Community
SDG Sustainable Development Goal
SRSG Special Representative of the Secretary General
UN United Nations
VAC Violence against children
VACS Violence against Children Study
WHO World Health Organisation
At least 50 per cent of children between the ages
of 2 and 17 years experienced one or more forms
of violence (excluding spanking, slapping and
10
shaking) across Africa in the past year.1 When
including these forms of violent discipline, 82
per cent of children in the same age group had
experienced violence across Africa in the past year.2
Younger children, and particularly those between
the ages of 2 and 14 years, experienced significantly
higher rates of any form of violence (87 per cent)
than children between the ages of 15 and 17 years
Violence Against Children and Care in Africa | A Discussion Paper
(51 per cent).3 Over the past several years across

Africa, governments, civil society, and academia
have aimed to generate understanding on the why,
where, and how of violence against children
(VAC) in order to strengthen violence prevention
interventions, and particularly to inform service
delivery that is accessible, appropriate and effective
to prevent and respond to VAC.4
INTRODUCTION
1
11

1. INTRODUCTION
Research has shown that stable and secure family prevent unnecessary family separation are being
environments, and particularly where there is designed and rolled out to varying degrees in
positive attachment between a child to a parent Africa, with the aim of strengthening caregivers
or caregiver, are powerful sources of protection capacity to care appropriately for their children
from violence, neglect and exploitation.5 They and protect children from violence, neglect, and
also strengthen resilience in children who have exploitation in the home. To prevent the child
experienced violence.6 Strong families translate from being placed in inappropriate and harmful
to better outcomes for child well-being and alternative care arrangements there has been
development that last into adulthood, positively increased investment in reforming childcare
impacting on the health and productivity of systems, promoting deinstitutionalization, and
societies. Stable and secure care environments can strengthening and expanding family-based
be provided by a range of different family types as alternatives.13
well as in different care settings.7
The recognition of the essential role a protective,
When strong and positive family care is lacking, stable, and nurturing family environment plays
and bonding, attachment, and the resulting on a childs well-being and development is at
protective relationships are weak or do not exist, the core of the Convention on the Rights of
there is an increased risk of children being exposed the Child (CRC) and the African Charter on the
to violence, abuse or neglect in the home and in Rights and Welfare of the Child (ACRWC). In
other care settings. Being exposed to violence, 2009, the United Nations (UN) General Assembly
neglect and exploitation can impact on children adopted the Guidelines for the Alternative
thriving in school or on school retention, physical Care of Children (hereafter referred to as the
and mental health, and difficulties in negotiating AC Guidelines). The Guidelines provide essential
healthy interpersonal relationships in adolescent policy and practice guidance to support the
and adult life.8 In particular, sustained exposure implementation of the CRC and other relevant
to violence has long-term negative impacts on a international and regional standards regarding
childs physical, cognitive, social / relational, and the care and protection of children deprived
emotional health, and reinforces the argument of parental care, or who are at risk of being so.
that VAC can be cyclical: exposure to violence as Enabling children to remain in the care of their
a child heightens the risk of perpetrating or being parents or extended families, or being returned
a survivor of violence in adulthood, impacting on to that care safely, is set out as a clear priority.
12 the quality of protection and care received by the To make this possible the Guidelines call for the
next generation.9 The risks of domestic violence State to ensure that families have access to forms
and VAC pose a serious socio-economic and public of support in the caregiving role to decrease
health problem, impacting families, communities, the likelihood for the child to be unnecessarily
and countries, and can reach across generations, and inappropriately separated.14 It is increasingly
undermining the gains made by rapid economic being recognized globally, and within the African
transformation in many African contexts.10 region, that the general lack of family support
services accessible to families can and does result
The high prevalence of violence against children in children being placed unnecessarily in out of
in Africa, and globally, clearly points to the reality family care.
that families are not always safe and nurturing
environments for children. In some instances,
removing children from abusive or neglectful
families is in the childs best interest. The child
who is exposed to violence at home can be, and

frequently is, the child who is separated from
the home and is moved into alternative care. A
growing evidence base, however, demonstrates
that removing a child from an abusive home
and placing them into alternative care does
not always result in improved and sustained
wellbeing for that child; violence, neglect and
exploitation can and does occur in all forms
of alternative care. Research has shown that
children placed in institutions (orphanages or
other types of residential care facilities) face a
higher risk of violence and neglect, particularly
the younger the child.11 Violence in family based
alternative care settings, including kinship
placements and foster care has also been
documented.12 Accordingly, programmes and
strategies to strengthen and support families and
1. INTRODUCTION
However, to date, initiatives to address VAC and This discussion paper is divided into four main
to reform alternative care systems have not sections:
been explicitly or directly linked in policy and
programming. Consequently, family strengthening 1. Background, including an overview of the
interventions are often lacking coordination and evidence on VAC in the African region,
missing important areas of synergies. VAC and regional and international frameworks related
care programs work independently of each to prevention and response to VAC, and the
otherthey are distinctly labelled as such [as a provision of alternative care.
VAC or alternative care initiative], and there has 2. VAC in different care settings, including a
been little merging of approaches to date.15 discussion of VAC in the home as a push
This discussion paper explores the interlinkages factor for family separation and removal of
between VAC and childrens care in the African children into formal care, VAC in alternative
context, including in legal and policy frameworks, care, and the different types of violence
data collection and use for decision making, facing care-leavers.
service delivery, and public awareness to ensure 3. Considerations for policies, programs, and
families can be supported and empowered to other interventions to ensure a coordinated
provide protective, stable, and appropriate care approach between the VAC and care sectors
for children. The paper will do this by: to address violence in all care settings,
strengthen family care, prevent unnecessary
Presenting the evidence from Africa about family separation, and support family
VAC in the family to highlight how violence is reintegration or placement in family based
a key contributing factor to family separation alternative care.
and placement of children in alternative care. 4. Key findings and recommendations, including
Discussing VAC in various forms of alternative how the existing evidence base, as well as
care in Africa, as well as VAC after care, identified gaps in data and research on VAC
to inform and instigate strategic action to and care in Africa can be utilized to help
address it. inform critical and coordinated actions at
Highlighting the gaps in knowledge and the continental, regional and national levels
interventions that need to be addressed to through the legal and policy framework;
ensure a stronger coordinated and multi- service delivery, training and supporting all
sectoral response to realise childrens rights to levels of the social service workforce; and
care and protection. increasing public awareness and engagement 13
at levels in efforts to addressing both
prevention and response of VAC within all
forms of care.
Methodology

The findings and recommendations included in the discussion paper are a
result of a literature review of more than 140 documents. This discussion
papers primary limitation is that the evidence base on the direct linkages
between violence in the home, family separation, and placement of children
in alternative care is relatively weak. We do, however, know that different
forms violence against children in the home exists, and there is a nascent
evidence from Africa on the different types of violence that children can
be exposed to in alternative care, as well as upon leaving care. Evidence
about interventions to prevent violence and family separation is limited to
small-scale projects or programs currently being piloted or scaled-up, but
generally lacking in terms of rigorous research or evaluation. In addition,
there is a paucity of evidence, lessons learned, or promising practices
about interventions to address VAC in alternative care in the literature. To
redress this limitation, in-depth key informant interviews with 16 people, the
majority of whom are regional experts working in the field of VAC and/or
alternative care were conducted to try to fill evidence and/or analysis gaps
(see Annex 1 for the list of key informants).
Jonathan Hyams/Save the Children

Research has shown
that stable and secure
family environments, and
particularly where there
is positive attachment
between a child to a
parent or caregiver, are
powerful sources of
protection from violence,
neglect and exploitation.
2.1 Understanding violence against
children
The United Nations Convention on the Rights of the
16
Child (CRC) and the African Charter on the Rights
and Welfare of the Child (ACRWC) recognize every
childs right to survival, development, protection,
and participation. Article 19 of the UNCRC places
the responsibility on States to take all appropriate
measures to protect children against all forms
of physical or mental violence, injury or abuse,
neglect or negligent treatment, maltreatment or

exploitation, including sexual abuse while in the
care of parent(s), legal guardian(s) or any other
person who has the care of the child. The ACRWC,
in Article 16, also places the responsibility on States
to protect children from violence. All States in sub-
Saharan Africa have ratified the CRC, while only six
States in the region have yet to ratify the ACRCW.16
BACKGROUND
2

17
2. BACKGROUND
The Optional Protocol to the CRC on the Sale of Children, Child

Prostitution, and Child Pornography; the Optional Protocol to the CRC
on the Involvement of Children in Armed Conflict; and General Comment
13 and General Comment 18 on the CRC articulate States obligations in
relation to specific forms of VAC to shift attitudes in many cultural settings
towards respecting the physical and psychological integrity of children in
order for violence against them to be reduced.17
Violence against children has been defined in the World Health

Organisations (WHO) World Report on Violence and Health (2002): the
intentional use of physical force or power, threatened or actual, against
a child, by an individual or group, that either results in or has a high
likelihood of resulting in actual or potential harm to the childs health,
survival, development or dignity.18 WHO has specifically identified all
forms of physical and emotional ill-treatment, sexual abuse, neglect, and
exploitation to be forms of violence against children.19 INSPIRE, a set of
seven strategies that have a proven success record in reducing violence
against children, highlights that violence against children takes different
forms at different ages.20 See Figure 1.
5 5-10 11-17 18+
Child maltreatment
Bullying
18
Youth violence
Intimate partner violence
Sexual violence
Emotional or psychological violence and witnessing violence

Figure 1 Violence against children takes different forms at different ages
Child maltreatment, as included in Figure 1, typically includes physical,

sexual and emotional violence, as well as neglect. However, neglect is
often overlooked in interventions to address VAC, despite evidence that
it is the most prevalent form of child maltreatment. Neglect is particularly
important to consider in terms of its relationship to care. Nelson et. al
(2012) and Stoltenborgh et. al (2013) advocate for more time, attention,
and resources to be placed on better understanding neglect as a particular
form of child violence against children, especially in low income settings,21
considering that chronic neglect has pervasive long-term impacts on
children.22 See Text Box A.
2. BACKGROUND
Text Box A
Understanding neglect as a form of violence against children
Nelson et. al (2012) describe neglect as understood by researchers to mean deprivation i.e., the
absence of sufficient attention, responsiveness and protection appropriate to the age, stage and
unique needs of the child.23 In addition, several types of neglect have been identified and described:
Neglect or negligent treatment means the failure to meet childrens physical and psychological
needs, protect them from danger or obtain medical, birth registration or other services when those
responsible for their care have the means, knowledge and access to services to do so. It includes:
Physical neglect: failure to protect a child from harm, including through lack of supervision, or
to provide a child with basic necessities including adequate food, shelter, clothing and basic
medical care;
Psychological or emotional neglect, including lack of any emotional support and love, chronic
inattention, caregivers being psychologically unavailable by overlooking young childrens cues
and signals, and exposure to intimate partner violence or drug or alcohol abuse;
Neglect of a childs physical or mental health: withholding essential medical care;
Educational neglect: failure to comply with laws requiring caregivers to secure their childrens
education through attendance at school or otherwise; and
Abandonment.24
2.2 The CRC and ACRWC on

the responsibility to care and
protect children 19
Text Box B provides an overview of what the CRC and ACRWC establish in
terms of responsibility to protect children from violence, exploitation and
neglect in family and alternative care settings.
Text Box B
What do the CRC and ACRWC say about responsibility to protect children from violence,
exploitation and neglect in the family and in alternative care settings?

The role of the family in protecting children from violence, exploitation and neglect in the family
Articles 5 (CRC) and 20 (ACRWC) place the primary responsibility for the upbringing and
development of the child on the family, including the responsibility by the family to protect
children from all forms of violence, abuse, exploitation, and neglect.
The role of the State in protecting children from violence, exploitation and neglect in the family and
alternative care settings
Articles 18 (CRC) and 20 (ACRWC) require the State to provide support and services to parents
and others responsible for the child in their child-rearing roles.
Article 19(2) (CRC) and Article 16(2) (ACRWC) require the State to establish protective
measures, such as through social protection programs, for both the child and those who care for
the child, as a form of prevention, including against violence.
Articles 20 (CRC) and 25 (ACRWC) note the role of the State to ensure and provide appropriate
alternative care for children whose families are unable or unwilling to care for them.
2. BACKGROUND
2.3 The AC Guidelines on

ensuring children outside of
parental care are protected
from violence, exploitation
and neglect
The Guidelines for the Alternative Care of Children, endorsed by the UN

General Assembly in 2009, provide guidance on how children under the
age of 18 years without parental care, or who are at risk of being so, should
be provided care. Alternative care decisions should be based on the
principles of necessity and appropriateness, i.e., whether it is necessary to
20 place a child in alternative care and whether the particular alternative care
option is appropriate for the individual child.25 The AC Guidelines are clear
in placing the responsibility on the State, through competent authorities,
to ensure the supervision of the safety, wellbeing and development
of any child placed in alternative care, and the regular review of the
appropriateness of the care arrangement provided.26
The AC Guidelines also recognize that children can be exposed to violence

in alternative care, and accordingly, make specific recommendations for
States to address VAC in all alternative care settings. They make clear
that the State and other actors are responsible for the quality of care
and fulfilment of their rights: children must be treated with dignity and
respect at all times, and must benefit from effective protection from
abuse, neglect, and all forms of exploitation, whether on the part of care
providers, peers or third parties.27 They require a strict prohibition of all

disciplinary measures and behaviour management constituting torture,
cruel, inhuman or degrading treatment as well as other forms of physical
or psychological violence.28 Accommodation provided should protect
children against abuse,29 trafficking and all other forms of exploitation30,
stigmatization31, without placing unreasonable constraints on their liberty.32
In addition, children in alternative care should never be sanctioned from
seeing or having contact with family or people of special importance33 and
should have access to a person of trust in whom they may confide in total
confidentiality.34
The general environment and quality of care in all alternative care settings
should meet the developmental needs, secure the well-being, and ensure
the rights of all children of all ages, maturity, and degree of vulnerability.35
The AC Guidelines further emphasize the need for the State and other
actors to consider HIV and other special needs of children in alternative
care in the assessment and development of an individualized response for
children requiring specific care and protection measures.36
2. BACKGROUND
2.4 The legal and policy framework
in Africa on protecting children from
violence, exploitation and neglect
in the home and alternative care
settings
The legal and policy framework in Africa is also Several countries across the region, including
very clear on the role of the State in supporting Ghana,42 Kenya,43 Liberia,44 Morocco,45 Namibia,46
families to prevent family separation. The African Rwanda,47 Tanzania,48 Uganda,49 and Zambia50
Union Plan of Action on the Family in Africa have developed national frameworks, policies,
(hereafter referred to as the AU PoA on the or guidelines recognising the impact of VAC on 21
Family) also underlines the role of families as childrens care, and placing the responsibility
the prime mechanism for coping with social, upon the State and other actors to ensure the
economic and political adversity.37 It recognizes availability and accessibility of preventive and
that some families are under unprecedented family support services to reduce factors, such
strain, including those caring for orphans, as violence, exploitation and neglect that lead to
vulnerable children, abused or neglected children, unnecessary family separation. They further call
and accordingly urgent attention is needed by on the State to implement effective gatekeeping
States to strengthen these families resiliency.38 measures, to ensure placement in alternative care,
The AUs Social Policy Framework for Africa and particularly residential care, is appropriate
accordingly recommends States to provide and necessary. However, more progress needs to
social protection programs to support poor or be made to ensure children are fully protected
otherwise vulnerable families to strengthen the under the law against corporal punishment in all
capacity of the family to holistically care for their care settings. Only 8 per cent of children in Africa

children.39 This has been restated by the Addis are fully protected from violent punishment in
Ababa Declaration on Strengthening the African their home and all other settings. Seven states
Family for Inclusive Development, which calls on out of 55 in the region have outlawed corporal
member states to define a minimum package of punishment in all settings; 48 States have yet
social protection and allocate resources for social to prohibit corporal punishment of children
protection for families with children, in the form in the home and 47 States have yet to outlaw
of cash and services, to strengthen the capacities corporal punishment in alternative care.51 On a
of families to care for children.40 Africas Agenda hopeful note, 18 African states have expressed
for Children 2040 has also established goals commitment to prohibition in all settings.
to support vulnerable families and children to
care for children, and particularly families with
unemployed parents, orphans, and children with
disabilities.41
The UN Secretary-Generals Study on Violence
against Children (2006) (hereafter the UN Study
on VAC) was the first comprehensive global study
to document the reality of the different forms of
violence against children around the world in all
22
settings, including in the family and in alternative
care.52 As a direct outcome of the UN Study on
VAC, and spearheaded by the Together for Girls
partnership, over the past decade several countries in
Africa53 launched national population-based studies
to generate much needed evidence on the numbers
of boys and girls exposed to the various forms of
violence within different contexts. The Violence

Against Children Surveys (VACS) apply an ecological
framework to highlight that there are underlying
interpersonal, community, and institutional factors
that contribute to and influence how VAC is played
out, understood and affects members, including
children, of the household. See section 3.1 for data
and discussion on VAC in the family.
AGAINST
VIOLENCE
3
FAMILY AND
CHILDREN IN
ALTERNATIVE
CARE SETTINGS

23
3. VIOLENCE AGAINST CHILDREN IN FAMILY AND ALTERNATIVE CARE SETTINGS
As the VACS are household based surveys, they do not reflect the
situation for children who are outside of households, either living on the
streets or in residential care facilities, even though research has shown
that these children are often most at risk and exposed to violence.
Some efforts are ongoing in the region to map who these children are,
where they are, and their situations and experiences, as in Burundi,
Ethiopia, Kenya, Rwanda, Uganda, and Zambia, but evidence of the
numbers, characteristics, and experiences of children on the streets and
in alternative care continues to be very limited.54 The considerable gaps in
data on children outside family care, despite clear obligations on States
to ensure and oversee their care and protection, means their situations
are often hidden, undermining efforts to effectively influence policy and
programming interventions, and further increasing their exposure to
violence.55
The data that is available highlights that across Africa, as in the rest of the
world, VAC happens across race, gender, ethnicity, religion, and income
levels. This indicates that there remains a general social acceptance of
violence,56 as evidenced by VAC occurring in all settings where children
should be cared for, including biological and extended families, alternative
care settings, and for children and young people after exiting care.57
Violence in these settings can take on varying forms to include physical
violence, including harmful corporal punishment; sexual violence, including
harassment and abuse; emotional violence, including verbal abuse and
bullying; and neglect.58 The age and gender of children can and will affect
their level and type of vulnerability to violence, yet few rigorous studies
unpack the disparities of violence.
Some children are more likely to experience violence; children with

disabilities face a distinct and increased risk for VAC in both the family and
alternative care settings, as Text Box C highlights.
24
Text Box C
Children with disabilities are at increased risk for violence
The World Health Organisation has noted that disability and violence often go hand in hand, with up
to one quarter of disabilities being a result of injuries and violence.59 Children with disabilities are far
more likely to experience physical, psychological or sexual violence than children with no apparent
disability, including infanticide,60 beatings, bullying and emotional and verbal abuse.61 Children with
physical and emotional (e.g., those considered aggressive, withdrawn or stubborn) disabilities can be
at risk for being accused of witchcraft.62 There are reports of child witchcraft allegations from Nigeria
where children are burnt, poisoned, slashed, chained to trees, buried alive, or beaten and chased off into
the bush.63 Children suffering from mental illness or intellectual impairments appear to be among the
most vulnerable, and are five times more at risk of sexual violence compared with non-disabled peers.64
In Kenya, it is estimated that 15 to 20 per cent of children with disabilities experience severe levels of
physical and sexual abuse, with girls who have intellectual impairments being particularly vulnerable.65
A study of child disability in Cameroon, Ethiopia, Senegal, Uganda, and Zambia revealed that children
with disabilities reported only 45 per cent of physical abuse and rape and that only 12 percent of these
perpetrators were held accountable.66 Children with disabilities are overrepresented in residential care
facilities, likely because of the added financial burden, stigma and social isolation facing families in caring
for a child with disabilities.67 A study on placement of children in residential care in Zambia highlights
Jonathan Hyams/Save the Children
25
that approximately 40 per cent of children in the accessed Catholic-affiliated residential care facilities

had a disability, while an additional 10 percent suffered from a chronic illness.68 Additional studies have
shown that disability-related behavioural patterns are often mistaken for misconduct, leading to corporal
punishment and emotional abuse. For instance, in situations where staff are not properly trained,
apparent behavioural patterns which are otherwise linked to the childs impairment such as not paying
attention, poor learning performance, hyperactivity, non-compliance, stereotyped mannerisms, persistent
screaming, and eating inedible objects may lead to staff/carers stress. Impaired communication among
hearing-impaired children might often be a source of considerable frustration for staff.69
The 2013 State of the Worlds Children clearly called for the end of institutionalization of children with
disabilities, and stressed the UN Convention on the Rights of Persons with Disabilities that in no case
shall a child be separated from parents on the basis of a disability of either the child or one or both of
the parents. Community-based rehabilitation is increasingly being considered as a promising practice to
support families who are affected with a disability, and seen as an intervention to prevent the separation
of families affected by disabilities.70
3.1 Violence against

children in the home 71
Figures 2 to 4 below use data from the VACS to highlight the degree to which boys and girls in several
countries across Africa witness physical violence in the home; boys and girls are sexually abused in the
home; and parent, family members or adult caregivers are perpetrators for physical and sexual violence
against boys and girls.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
MALAWI
NIGERIA
Girls Boys
26
Figure 2 Percentage of boys and girls who witness physical violence in the home, in Malawi and Nigeria72
100%
90%
80%
70%
8,3
60%
28,7 9,2
50%
27,9 49
40% 45,7
3,8 10,6
30% 13,9 31,6
13,6
20%
21,3
18,8
10% 14,9
0%
MALAWI NIGERIA TANZANIA

Figure 3 Percentage of boys and girls who are sexually abused in home settings73
MALAWI NIGERIA
Girls
12,4
10,4 Boys
11,7 3,2
24,3 22,9
24,4%
26,2%
36,7%
33,3%
14,5 21,2
TANZANIA ZIMBABWE
14,5%
14,1%
Sexual Violence
14,1 14,5
7,1%
7,1
Physical Violence
27
Figure 4 Percentage of boys and girls who identify parents, family members or adult caregivers as the perpetrator
of physical and sexual violence74
100% Girls
90%
Boys
80%
11,3 70%
8,3

60%
35,6
28,7 9,2 7,2
50%
27,9 11,8
40%
37,9 Own Home
30%
31,6
27,1
20%
21,3 Perpetrators Home
10%
0% Other Home
KENYA ZIMBABWE
The African Report on Violence against Children75 looked at social,

cultural, and economic trends in the region in order to understand how
boys and girls are raised to determine if and how care arrangements can
lead to VAC. Financial insecurity, lack of community support systems and
family-focused services, and societal attitudes and practices around VAC
are all factors that can influence or exacerbate violent behaviour, including
neglect of children, by family members and in alternative care settings.
Politically and environmentally insecure environments, migration, changing
family structures, harmful cultural practices including child marriage
and initiation rites, and harmful attitudes, particularly towards children
with disabilities, are key institutional drivers of VAC within the family.
Coupled with nascent and often weak violence prevention and response
mechanisms, particularly at the community level, unemployment, poverty,
and health epidemics, these stressors can negatively impact on families
resiliency, and can increase the likelihood of VAC occurring within the
family.76 See Text Box D for additional evidence on VAC in the family.
Text Box D
Evidence on violence against children in the family
Physical abuse in family settings
In Ghana, an estimate of 90 per cent of children have experienced physical violence in the home
and at school.77
In the United Republic of Tanzania, 74 per cent of females aged 13 to 24 said they experienced
physical violence before age 18 at the hands of a relative or intimate partner.78
28 Neglect in family settings
In Botswana, 56% of working families living on less than $10 a day cannot afford to leave their
children in safe day care or hire a caregiver during the day, raising the risk of child neglect and
household accidents.79
A qualitative study on sexual violence against children with disabilities in Burundi, Madagascar,
Mozambique, and Tanzania (Zanzibar) suggests that it was often the fact that children with
disabilities were left alone at home, which gave perpetrators the opportunity for sexual abuse.80
A study testing the association between parental absence and sexual violence in 13 countries in
Sub-Saharan Africa, noted that paternal orphaning or paternal absence is significantly associated
with girls experiencing sexual violence.81
Understanding how VAC in the family psychologically impacts on boys

and girls highlights the link to possible future exposure or perpetration of
violence. For example, young adolescent boys tend to leave their homes as
a result of being a victim of violence; more often than not, they end up on
the streets where they might resort to crime and participate in violent acts
primarily as a means of protecting themselves, which then further exposes
themselves to police violence and possible placement in detention centres
or residential care. Conversely, girls tend to internalize violence, negatively
impacting on their confidence levels and ability to negotiate healthy
relationships.82 A study from Burundi further found that the more violence
and adversity experienced by both boys and girls during childhood, the
higher the likelihood that they would become a perpetrator of violence
as adults.83 See Text Box E on the nascent evidence base from Africa as
to how VAC in the family can be considered a key contributing factor to
family separation and placement of children in alternative care.
Text Box E
VAC as a push factor to family separation and placement into alternative care
A two phased, mixed methods study in Tanzania highlighted mistreatment, defined as neglect,
discrimination and physical and emotional abuse, as reasons children left parents to go and
live on the streets.84 Poverty, alcohol, stress and discrimination of children led to violence in the
home which resulted with the child running away to live on the street.85
Similar findings were identified in a study in South Sudan, which asked approximately 200
children who sleep on the streets to fill out a questionnaire as to why they are there: 81% of
the children had one or both parents alive but domestic violence; physical aggression between
parents and physical punishment of children, was found to be directly linked with children
working and sleeping in the streets.86
Retrak, an organization specializing in work with children on the streets, asked a selection
of children who have been part of their programs in Uganda and Ethiopia on the reasons
why children leave home and come to the streets. Of the boys interviewed in Uganda, 63 per
cent and 57 per cent left home because of emotional and physical abuse respectively.87 In
addition, 20 per cent left home because of abuse by a stepparent. In Ethiopia, 43 per cent cited
emotional abuse, 30 per cent cited physical abuse, and 30 per cent cited abuse by a step-
parent.88
A recent study of Catholic-affiliated residential care in Zambia found that abuse, maltreatment
or neglect in the household was one of the top six reasons provided for placement of the child
in residential care.89
Escaping abuse in the household was also a self-reported reason noted by children who had
self-referred to residential care in Malawi.90
The African Child Policy Forum (ACPF) noted that nine per cent of girls of interviewed girls in a
number of residential care facilities cited violence, and eight per cent noted family breakdown.91 29
A study of residential care in Sierra Leone found that five per cent of all children in residential
care were there due to abuse, abandonment or neglect in the household,92 findings which were
mirrored in a study of children in residential care in the Western Cape in South Africa.93

Although the data in Textbox E illustrates that violence, exploitation or
neglect in the home can contribute to family separation and subsequent
placement of children into alternative care, families not being able to
access social services is often the starting point that creates vulnerability
within a family context; household poverty can compound reasons
that can lead to family separation. For example, poverty can impact on
the emotional wellbeing and stability of the caregiver; negative coping
mechanisms such as alcohol abuse can consequently increase the risk
of violence in the household, whether in the form of domestic violence
or violence against children.94 It is critical, especially when trying to
understand the push factors that result in a child being separated from the
family, that a holistic approach be taken to understand how vulnerabilities
are interlinked and compounded, and consequently influence or compound
reasons for children being separated from their families.
Jens Honor for SOS Childrens Villages

Research on kinship care
globally has illustrated
that care within family
networks, especially where
it is part of the social and
cultural norm, can provide
better opportunities for
lasting attachments and
continuity, and better
health, education, and
wellbeing outcomes,
than many other forms of
alternative care.
3.2 VAC and care in

alternative care
Kinship care
Kinship care95 is the most common form of family-based alternative care
in Africa. Extended family members have supported children of kin for
millenia, and it offers an informal socio-economic support system in many
African communities.96 Research has increasingly focused on the role of
kinship care across Africa as family structures have changed and been put
under increasing strain as a result of the socio-economic impact of HIV and
AIDS.97 In addition to the impact of HIV and AIDS, and other epidemics,
such as Ebola, conflict, instability, food insecurity, and natural disasters,
have impacted access to resources such as land and water, challenging
traditional rural livelihoods and lifestyles, resulting in high levels of
migration and rapid urbanisation. Much of the migration is that of individual
parents, as the mother or father searches for employment, and not of entire
families.98 This impacts on traditional family structures, as children are left
in the care of a single parent, a step-parent or care of another caregiver,
when parental attention is diverted to job seeking and survival. Access to
education is also a common reason for children being placed in kinship
care, with children from primarily rural areas moving to live with wealthier
relatives in towns and cities.
32 Protection and risk factors which influence positive and negative outcomes for children
living in kinship care include:
choice or obligation to care for a child which is influenced by patriarchal or
matriarchal decision making processes (i.e. choosing to foster vs. being forced to
foster);
maternal vs. paternal relatives;
strength of kinship relationship;
whether the child is welcomed in the family;
motivation to care for the child and the degree of closeness between the child and
caregiver;
families financial situation;
childs behavior being polite and hardworking or undisciplined;
regular communication and support with parents or other relatives;
relationship between the parent and caregiver; and
a childs individual circumstances (e.g. child born out of wedlock, child with disability,
whether or not the child has been living with parents) and community reactions
Research on kinship care globally has illustrated that care within family
networks, especially where it is part of the social and cultural norm, can
provide better opportunities for lasting attachments and continuity,
and better health, education, and wellbeing outcomes, than many other
forms of alternative care.99 Kinship care with grandmothers has been
documented as being particularly positive, in most cases, with attachment
(i.e., companionship) a sense of belonging and continued connections with
family identified as positive factors.100 In addition, a qualitative study on
alternative care practices in Ethiopia found that Ethiopian families appear
to be willing to provide care and support to orphaned nieces and nephews,
as long as a formal agreement is not insisted upon, illustrating a preference
for the informal approach commonly being utilized.101
Despite kinship care being the most common form of alternative care,
the focus within legal frameworks is on formal alternative care options,
including foster care (by relatives or non-relatives), guardianship,
adoption, and placement of a child in a residential care facility, with less
guidance being given to regulating informal kinship care.102 That said,
the AC Guidelines do prioritise informal kinship care over other forms of
alternative care, and particularly spotlight kinship care by close family
members as the ideal form of alternative care.103 The AC Guidelines
recognise that particularly kinship carers need to be supported to ensure
they are able to adequately care and protect for their kin, as it can be
challenging for kinship carers to access social services and support as they
are not formally recognised in their caregiving role by the State. The AC
Guidelines call on States to encourage kinship or informal carers to notify
the State of informal care arrangements to ensure informal carers access
to all available and necessary services and benefits likely to assist them in
their role.104 In addition, the AC Guidelines call on States to devise special
and appropriate measures to protect children in informal care from abuse,
neglect, child labour, and other forms of exploitation, with a particular
focus on informal care arrangements with distant and non-relatives, out
of recognition that the vulnerablity of children in kinship care to abuse,
neglect and exploitation increases the less related the child is to their
caregivers.105 (See Text Box F).
33
As a result of kinship cares informal nature, States do not routinely collect
statistics on the number of children in this type of care. However, data
gathered by the Demographic and Health Surveys (DHS) and Multiple
Indicators Cluster Surveys (MICS) illustrate the scale of kinship care across
Africa: in 40 out of 54 countries in Africa, an average of 15% of children
under 15 in households are living outside of parental care.106 The clear
majority (95.2%) of these children living in households and outside of
parental care are in kinship care, and mostly live with their grandparents
or uncles/aunts. Highlighting further the significant and complex role that
kinship care plays for children, most of these children (92%) have at least
one biological parent alive, and 72% have both parents alive. In Eastern
Africa, over 19 million children are living in kinship care (14%) and 89% of
them have a living parent.107 In West and Central Africa, an estimated 16%

of children do not live with their biological parents. While, only a very
small number (0.002%) of these children live in formal alternative care the
majority is considered to live in kinship care.108 In other words, kinship care
is clearly not the result of parental death or orphanhood for the majority
of these children; other factors are at play in those care arrangements.
While kinship care plays a significant role in ensuring children who cannot
be cared for by biological parents remain in family care, children in
kinship care can also be at risk for exposure to violence, abuse, neglect,
and exploitation.109 This concern may be elevated especially when family
resources are stretched thin. See Text Box F for examples of VAC in kinship
care.
Text Box F
VAC in kinship care
Kinship care for labour purposes was studied in Ethiopia and differences related to gender and
rural/urban contexts were found.110 There is a preference for girls in urban areas primarily for
labour purposes. Older boys are not preferred in urban areas as they are associated with trouble.
Conversely, girls in rural areas are not preferred as they do not come with an inheritance, whereas
boys in rural areas are preferred as they are seen as able to help with farming, and potentially come
with an inheritance.111
Evidence suggests that the vulnerability of children in kinship care to abuse, neglect and
exploitation increases the less related the child is to their caregivers, as they may resent care for
orphans, or prioritize their own children.112 Research found that a significant number of children
and their caregivers in kinship situations can go through cycles of misunderstanding, if they do
not already know each other well. Deeply distressed children becoming withdrawn and aggressive,
and caregivers feel resentful at childrens lack of gratitude, consequently withdrawing their love
and affection, and increasing the likelihood of the child being neglected or abused.113 Children living
with disabilities and children affected by HIV are especially shown to face stigma and discrimination
within kinship households, as well as subject to abuse and neglect.114 Conversely, a study on
differential treatment between children being raised by kin and biological children in the caregivers
household in Uganda shows that the closer the biological relationship of the child to the caregiver,
the least likely the child is to experience violence by the caregiver, the more evenly distributed the
work is among children living in the household, and the equal opportunity for the child of kin to
attend school.115
A study estimating the lifetime prevalence and annual incidence of potentially traumatic events by
orphaned or separated children living in institutional care and family-based care in five different
lower and middle income countries, which include Ethiopia, Kenya, and Tanzania, suggested that
annual incidence of physical or sexual abuse was higher in family-based settings (19%) than in
institutions (13%), although this finding has been questioned due to the fact that the comparison
34 was made with vulnerable families that did not receive any support. The same study also found that
over half of orphaned or separated children in institutions (50%) and family-based care (54%) had
experienced physical or sexual abuse by age 13.116
The informal nature of kinship care also limits any type of monitoring or
oversight by bodies mandated to protect children. Mathamboa and Gibbs
(2009) described the informal kinship care system most aptly when they
describe it as a social safety net with holes illustrating that it plays
an important role in child care but many variables influence the kind of
response provided.117 This tension between informal care practices, and
the inherent benefits and challenges that it presents versus how much
to formalise the practice, is something which many governments and
practitioners across Africa and beyond are grappling with. There is nascent
evidence base from the African region on efforts to strengthen linkages
between community-based child protection mechanisms and statutory
structures as a means to support kinship carers to care and support the
children in their care.118
Foster care
Foster care119 is another form of family-based alternative care for children,
which is increasingly being used across Africa. As care reform efforts
across Africa take root, foster programs are being piloted to strengthen
family based care interventions as part of a response to deinstitutionalise
care systems and reintegrate children from residential care. Formal
foster care programs are being piloted primarily by non-governmental
organizations (NGOs) in coordination and with oversight from relevant
government authorities. There are some examples of how foster programs
have acted as a response intervention for children who have experienced
violence; children affected by violence, either in the home, on the streets
or in residential care, have been identified as potential beneficiaries of
foster care. In Benin, for example, child survivors of trafficking and sexual
abuse were identified as in need of foster care.120 In Ethiopia, Bethany
Christian Services has piloted a foster to adopt program, utilising the
faith based network to identify, recruit and support foster families and
potential adoptive ones.121 In Rwanda, orphaned children as a result of the
genocide, or in the most recent care reform effort, were also identified
as in need of foster care.122 Other examples include Retraks work to link
children living on or who had been living on the streets, and children
affected by HIV and AIDS in South Africa, to foster carers.123 In Sudan, 500
emergency families, i.e. foster care givers, were identified as part of the
process to deinstitutionalise children under the age of three years, as per
the AC Guidelines.124 Foster care can also play a crucial role in emergency
settings where short-term family based care is needed, or when family
reintegration is being assessed, such as was the case of linking Burundian
unaccompanied refugee children in Rwanda to foster parents.125 In all of
these cases, there was a recognised need to provide an alternative family-
based environment for children whom had suffered violence, either at the
household and / or community level, to prevent their exposure to further
violence and strengthen their resiliency and wellbeing.
Violence, exploitation and neglect within the context of foster care has
not been readily documented in African contexts. Evidence from the
United Kingdom and the United States shows that children in foster care
can be at risk of physical, sexual, and emotional abuse by their caregivers
as well as potential stigma and discrimination.126 However, there remains
very little information on VAC within foster care in the African context
illustrating a clear need to address this evidence gap.
35
Residential care
The AC Guidelines recognise residential care as part of the continuum
of alternative care options but underline that its use should be limited
to cases where such a setting is specifically appropriate, necessary
and constructive for the individual child concerned and in his/her best
interests.127 In recognition of the particular harm placement in residential
care can cause to babies and infants at their critical stage of development,
the AC Guidelines also state that residential care should only be used for

children under three in emergency situations and for a very short time
duration.128
Research has consistently shown that the majority of children in residential

care are not orphans.129 One of the biggest myths is that children in
orphanages are there because they have no parents. This is not the case.
Most are there because their parents simply cant afford to feed, clothe and
educate them. For governments and donors, placing children in institutions
is often seen as the most straightforward solution.130 A review of national
level studies on residential care aimed to identify the top reasons for
placement of children into residential care. The reasons included poverty
(which is specifically mentioned in the AC Guidelines as not a valid reason
for placement of children into alternative care);131 violence, abuse or
neglect of children in the household and / or conflict in the household;
abandonment; the pulling effect of residential care; and the death of a
parent. Figure 5 highlights the full list of reasons reported in five countries
across Africa, and shows that VAC in the family can and does result in
children entering residential care.132
Reason for placement in RWANDA UGANDA GHANA MALAWI MADAGASCAR

residential care
Poverty
Recruitment by care centre or

pulling effect of residential
care because they are present
Violence, abuse, neglect of

child/children in household,
conflict in household
Abandonment
Death of parent(s)
Children lack access to

education, education available
is of poor quality
Reconstituted household (e.g.,

following divorce, remarriage/
new partnership)
Disability of child or in
household
Children are affected by

36 harmful traditional practices/
stigma**133
Death of breadwinner
Inadequate shelter/insecure
housing
Migrant parent(s)
Incarcerated parent
Elderly caregiver
Caregivers face challenges in

managing childrens behaviour
Illness/mental illness in
household, i.e. HIV/AIDS
Child illness or malnutrition
Child in conflict with the law
Figure 5 Reasons reported for children being placed in residential care

In resource-constrained contexts where services and social support
may not be available or accessible by families, the establishment and
maintenance of residential care facilities pull or recruit children
from vulnerable families into residential care.134 Public opinion, often
propagated by the media and religious institutions, present residential care
centres as offering care, support, and services, where families, communities,
and governments cannot. Although many individuals, communities,
agencies, donors and States act with the intention of protecting and
caring for these children, a clear understanding of what that means is
often lacking; there is a common belief that the provision of basis services
including food, shelter, education and some form of health care is all the
care needed by children.135 Families caring for children with chronic illnesses
and who require support and medical attention, such as children affected
by HIV and children living with disabilities, are often referred to these
facilities by case managers or by caregivers themselves when other options
do not seem to be available.136 For example, a desk review on children with
disabilities in Zambia noted that approximately one-third of children placed
in residential care in Zambia have a form of disability, as a result of limited
community support for families caring for such children.137 In Uganda,
institutional care is deemed to have become an industry, with boarding
school facilities masquerading as orphanages to attract funding from
donors through school sponsorship.138
The funding of residential care in Africa is often from private or faith based
groups, and more rarely government based. Donor support tends to be
focused on providing material support or supporting individual childrens
access to basic services, rather than contributing to the strengthening of
systems that would enable these services to be delivered to children in
their families. Rather than supporting a quality system to care and protect
for children, sponsors are encouraged to give money for materialsWhile
materials are certainly important in a context where there is little, there is
no focus in fundraising strategies on ensuring overall quality of care is high. 37
Because how do you report back on that? Sponsors dont want to hear
about trainings that staff have undergone, they want to see that their child
is now clothed and fed thanks to their donations. They want to see that they
have saved a child from poverty.139
As such, the resources that have gone into creating and sustaining these
residential care centres takes the pressure off States responsibility to
deliver services that families and communities need like education, health,
social protection, etc.140 Instead, the pulling effect of residential care creates
a gap by drawing resources away from families and communities. This
reduces the investment and emphasis on developing community-based
services, which can keep families together, and deprives children of their
right to grow up in their family.141

Despite a solid evidence base from Eastern Europe and burgeoning
one from Africa on the negative and long-lasting impacts of residential
care on the physical, emotional and cognitive development of children,
children continue to be pulled into residential care across Africa for a
range of reasons as highlighted in Figure 5.142 See Text Box G for examples
of the type and magnitude of violence that children in residential care can
face.
Text Box G
Examples from Africa of VAC in residential care
A study of children in institutional care in Tanzania highlighted that 93% of children and 87%
of caregivers reported physical and emotional maltreatment of children by the institutions
caregivers.143 A longitudinal study of prevalence and incidence of traumatic experiences among
orphaned and separated children in five low-and-middle income countries, to include Ethiopia,
Kenya, and Tanzania highlighted that there was no difference between boys and girls experiencing
physical or sexual abuse in institutional care; rather younger age groups experienced both more
physical and sexual abuse than their older peers.144
These findings are also supported by a study of children in an institution in Tanzania, which
compared reports for children who were institutionalised between 0 to 4 years with those of 5 to
14 years: 89% of 5 to 14 year olds reported at least one experience of abuse while in the institution,
while children institutionalized from birth reported more adverse experiences during their time in
institutional care and a greater variety of mental health problems; they reported more depressive
symptoms and more aggressive behaviour.145 Yet another study of children in a residential care
centre in Tanzania showed that children who had experienced violence and / or neglect prior to
their placement in the residential care centre were more likely to engage in violent and aggressive
behaviour when in care than those children who were not exposed to violence or neglect before
their placement.146
A study undertaken in Morocco on quality of care in residential care centres highlights that
physical violence is the most used means of discipline.147
Some studies have found that violence in residential institutions is six times higher than violence in
foster care, and that children in group care are almost four times more likely to experience sexual
abuse than children in family-based care.148 Meintjes et. Al (2007)149 and Brown (2009)150 have
argued that cases of abuse are largely due to untrained staff members as perpetrators of abuse, in
addition to staff instigating abuse amongst peers.151
38
A careleaver noted his experience that children in residential care are often lumped together
regardless of whether they are a survivor of sexual abuse, a juvenile offender, a child living with
HIV, or a child that has special needs, impacting on how the emotional needs of children are being
addressed. Due to the low staff to children ratio, the weak capacity of staff to comprehensively
address the needs of already traumatized children with psychosocial care and counselling, and
coupled with the attitudes and behaviours of staff working with vulnerable, stigmatized or
marginalised children, staff can fuel humiliating and degrading treatment of children in residential
care.152 Frequently staff within residential care are themselves from vulnerable settings and have
not necessarily been trained, supported or invested in to enable them to do their job properly.
Rampant peer-on-peer bullying has also been noted by a careleaver to take place in residential
care, increasing the risk for children to be exposed to emotional abuse in addition to physical and
sexual abuse.153
While not considered common, there is some evidence from Kenya that residential care centres
can act as a source and transit point for the trafficking of children.154
Despite the seriousness of these findings, it is likely that violence against

children in residential care is widely underreported due to the lack of
or weak child protection policies and mechanisms, non-existent, non-
functioning or inaccessible reporting and complaint mechanisms, as well
as fear by children of the repercussions of reporting.155 For example, a
government audit of social services in Ghana found that approximately
96 per cent of the childrens homes in four sampled regions were
unlicensed, operating illegally and were not monitored to ensure that they
were operating within national minimum standards, placing children at
risk of abuse and neglect. 156 In addition, A study assessing residential
care institutions in Uganda showed that of the 40 institutions surveyed,
80% did not have safeguarding or child protection policies, 98% had no
social worker, 48% had poor or very poor child care standards, 52% of the
institutions had children without a current care order, and 53% lacked any
resettlement plan.157 Weak or non-existent regulatory systems to ensure
all residential care facilities are registered and a system of independent
oversight is in place, leaves children in these facilities without any
protection.
Ignoring the fact that violence, exploitation and neglect can take place
in residential care can heighten the harm of residential care on childrens
mental health; children face a double burden of being placed in residential
care if exposed to abuse and the abuse being ignored.158 As one key
informant summed up, the institutionalization of children is in itself an act
of abuse, and abuse, including its impacts, will be propagated the longer
the child is institutionalized. 159 This has led some experts to argue that
institutionalization could be considered to be a form of neglect and as such
a form of violence against children.160 See Text Box H for more on neglect in
residential care.
Emnet Dereje/Save the Children

39

Text Box H
Neglect and institutional care
While there has been some initial evidence of the different types of violence against children
within residential in Africa, this has primarily focused on physical and sexual abuse. Sherr (2017)
recognizes two types of violence against children. The first is commission wherein violence
is actively perpetrated and the second is omission, meaning the intentional withholding of
attention and care as seen in neglect.161 Globally, the topic of neglect, especially the type found
within residential care, especially large institutional type settings, has been identified as a leading
contributor to longer term negative impact on cognitive, emotional and physical development.162
Van IJzendoorn (2011) has proposed the term structural neglect to describe what is often found
in institutional care settings and captures many elements of the aforementioned definitions. This
includes the trifecta of: 1) infrastructure issues (i.e., the structure of a building such as large scale
dormitory like settings; 2) staffing patterns (i.e., shifts); and 3) limited and inadequate child and
caregiver interactions frequently due to low caregiver to child ratios. For example, in Tanzania,
specific Temporary Holding Centers have been established to be safe houses for children with
albinism, to keep children with albinism safe from the widespread but underground practice of
ritual attacks and killings.163 However, these centres were deemed by the African Committee of
Experts on the Rights and Welfare of the Child (ACERWC) to propagate marginalization, social
exclusion, and ultimately neglect of children with albinism.164
The First International Conference in

Africa on Family-Based Care (2009)
recognized that VAC in alternative care,
particularly in residential care, is a serious
concern and called on governments in the
region to enact appropriate minimum
40 standards to regulate institutional care, as
well as other forms of alternative care.165
The Declaration adopted at the conference
also strongly emphasised the need
to ensure accessible and appropriate
services to prevent family separation, and
highlighted the importance of family and
community-based care as a means of
supporting children when initial families
are not able to.166 Accordingly, increasing
efforts to deinstitutionalize children are
taking place in Africa, out of recognition
of the detrimental impacts on childrens
wellbeing. The experience in Rwanda has
shown, in particular, that government

ownership and commitment to the reform
process through a single implementation
framework is crucial to advocate for
stronger investments, and to increase
awareness of all actors of the benefits of
family-based care over institutionalized
care.167
3.3 VAC upon leaving
alternative care
While we know that childrens exposure to VAC within
alternative care negatively impacts their wellbeing, less
robust evidence is available, both globally and from
Africa, about how violence in care impacts on young
peoples health and socio-economic outcomes after
they leave care. There is some research and documented
experiences from care leavers that highlight the risk

I have unpleasant
memories of life in the
Gambella child care
of being exposed to violence after leaving care, but institution. I saw with my
these do not differentiate between care leavers who own eyes an adult member
experienced violence when in care and those that did of the institution rape a
not. four-year-old friend of mine.
Boys and girls also had to
The available evidence shows that care leavers share rooms. Given all that
are likely to be among the most socially excluded I have seen, I do not trust
young people in society, and are more likely to be men and have not had a
underemployed, homeless or living below the poverty good relationship with any
line.168 Economic factors and lack of social support man.
may predispose care leavers to become victims of
violence while looking for income, such as participating Family Health International,
in sex work or being forced to live on the street. Other Childrens Investment Fund, &
UNICEF (2010). Improving Care
studies have highlighted care leavers to be more likely Options for Children Through
to become young parents, to be dependent on social Understanding Institutional
assistance, have a higher risk of mental illness and Child Care and Factors Driving
substance abuse,169 be more vulnerable to stigma and Institutionalization.
discrimination,170 in addition to having a higher chance in
41
experiencing violence.171
In a survey with Child and Youth Care Centres

(CYCCs) in Western Cape, South Africa, 91% of
CCYCs noted high levels of concern for children
who leave care, as there are no appropriate support
systems available in communities for these children
after they leave care, especially as CCYCs capacities
to care for children once they leave are extremely
limited.172 As a care leaver noted, at the age of

18, institutions terminate their relationship with
young people as children, and they instantly lose
any support they may have had when in care. 173
Care leavers in Ethiopia from residential care also
highlighted that a lack of informal social support
systems, limited access to educational opportunities,
and financial social skill deficits increased the risk of
violent victimization.174
A recent study in Zimbabwe highlights what can

be done before children leave care, to ensure care
leavers successfully transition into the community:
the authors argue for the need to develop a service
delivery model that provides a continuum of support
specifically to adolescent girls when they are still
in residential care, to ensure they have the skills to
meet their livelihood needs, and not resort to risky
behaviours, after leaving care.175
Tommy Trenchard / Save the Children

4.1 Preventing VAC in the family and
the need for placement of children in
alternative care
42
The most common approach used to date to
implement policies, guidelines and standards
to prevent VAC in the home and to strengthen
families focus on combined parenting and family
support interventions. Research has taught us to
date, that social protection schemes can prevent
family separation,176 as it addresses household
poverty, which is one of the factors contributing to

family separation. However, social protection does
not impact on the capacity of families to protect
their children from violence and abuse; they do not
reduce harsh discipline practices, improve positive
discipline, or reduce the risk of children being
exposed to violence within the home.177
FOR POLICY
4
AND SERVICES
CONSIDERATIONS

43
4. CONSIDERATIONS FOR POLICY AND SERVICES
A combination approach to strengthening families At the same time, deinstitutionalization programs

financially and through parenting programs i.e., are picking up speed across Africa, and there is an
cash plus care interventions are increasingly increasing evidence base on the positive change
generating evidence on decreasing childrens in protection and wellbeing of reintegrated
risk to exposure of violence, abuse and neglect children. Research from Ghana187 and Zimbabwe188
within the home.178 A combined approach can on child wellbeing between children in residential
increase parenting skills and knowledge of child care and reintegrated children underscores
development (through training), link parents to that reintegration has clear positive impacts
professionals or para professionals (the training on children: reintegrated children are generally
facilitators), and connect parents to support happier, and report fewer emotional, conduct,
groups to encourage peer to peer learning. For hyperactive and peer problems, and greater
example, data from Retrak Ethiopias mid-term agency and attachment than children who remain
review of reintegration of street children and in residential care. To address the unique needs
community-based child protection reflects that of children being reintegrated into a family based
involvement by caregivers in both saving and setting, caregivers need to be supported with
loan groups, and self-help groups increases the better access to social services, appropriate
parenting and child protection skills of caregiving, training, supervision and ongoing monitoring.
resulting in children being less prone to child For example, Terre des Hommes developed and
labour and increasing school attendance rates.179 utilized a caregiver training that specifically
addressed the unique needs of children who had
An increasing amount of evidence is being experienced violence in care.189 Plan International
generated about what successful combination did the same when training their community
approaches to family strengthening in low-and volunteers and caregivers in providing alternative
middle-income countries can look like.180 Lessons care to children affected by the violence in
include that they must address the culture, Burundi.190 Research from Tanzania noted that
values and norms within which the family and providing a manualized training workshop for
broader community operates, to change attitudes caregivers in institutional care improved the
towards violence, neglect and exploitation, as caregiver-child relationships, decreased physical
well perceptions of the role of residential care.181 maltreatment of children by caregivers, improved
That said, a UNICEF Innocenti Research Brief childrens behaviour, and decreased mental health
discussing whether parenting interventions to problems amongst the children in the institution,191
44 reduce VAC can be transported across countries, facilitating reintegration for both children and
notes that interventions should be selected firstly caregivers to family-based care. The 4Children
because of their evidence base and the extent project in Uganda, together with Clowns without
to which they uphold social learning theory Borders, has developed a parenting curricula
principles, rather than their cultural specificity.182 to deliver to parents of children who are being
Other successful combination approaches identify reintegrated from residential care. The study is
an appropriate entry point to involve both men still in the early stages, but the research has the
and women caregivers to address cultural norms potential to inform reintegration efforts in the
around child rearing and child protection, and future.192
particularly around reintegration of children.183
This is particularly true for parents and other
caregivers who are under particular stress, such
as those affected by HIV, poverty, who are young
and/or single mothers, who are aged, who have
or who take care of a child living with a disability,

and who are socially isolated, to reduce the risk
of children being neglected and abandoned.184
Certain programs are taking these lessons into
consideration and are focusing on scaling-up a
combined household economic strengthening
and parenting approach, such as by the Catholic
Relief Service project 4Children in Nigeria, Uganda
and DRC.185 The evidence and promising practices
generated by these programs will be valuable in
informing future approaches to preventing and
addressing violence against children within family-
based care.186
Family strengthening and parenting initiatives mechanisms, encouraging discussions with
should not be implemented without linkages respect to coordination of delivery and monitoring
to existing family support structures and of family support services. For example, the
services, particularly at the sub-national level. Minimum Standards on Comprehensive Services
The INSPIRE package, developed by the World for Children and Young People in the East
Health Organization together with nine other African Community,193 which supports the
global partners, also identifies the need to link operationalization of the EAC Child Policy, calls
and coordinate support services to ongoing for a multi-sectoral approach to implement five
prevention initiatives, to ensure a comprehensive, strategies. These strategies, packaged as the
quality, and sustainable approach to addressing S.C.A.L.E.,194 have been identified to strengthen
VAC and preventing family separation. There is the availability, accessibility, and sustainability of
increasing recognition and acceptance of the family-support services at the community level
roles and responsibilities by various sectors, to to both prevent and respond to VAC as a means
include social welfare, health, education, justice, of keeping children within stable and supportive
and finance, to contribute to such support families.
4.2 Generating a stronger 45
evidence base on VAC in

alternative care settings
The growing body of evidence on violence against children in the
family setting across Africa and the different forms of violence that
children experience in their families is the result of concerted efforts by
government and civil society to generate reliable and robust data on the
magnitude and scope of this violence. More robust data on the scope,

nature and magnitude of violence against children in alternative care
must be generated, to ensure these children are not left behind in
the development of policy frameworks and child protection systems
strengthening interventions. The fact that many countries in the region do
not have updated and accurate national level data on children in residential
care raises serious concerns about how governments can fulfil their
responsibility towards them.
More research is also needed to identify and understand the different

vulnerabilities girls and boys in alternative care experience across
different age cohorts; both the age and gender of children can affect the
level and type of vulnerability to violence. The ACERWC has called for the
need to disaggregate data on alternative care to inform the development
and monitoring of critical laws, policies and programs. 195 Understanding
better childrens experiences of abuse, neglect and exploitation in
alternative care settings can inform (re)integration efforts to ensure they
are successful, and have positive and long-lasting impacts on childrens
wellbeing.
4.3 Adopting policies that address

the links between violence in
the home, family separation, and
placement of children in alternative
care
The evidence that is available points to a high Regional Economic Communities across Africa
prevalence of violence against boys and girls, such as the East African Community (EAC),200
and particularly amongst younger age groups, Southern African Development Community
including within the home, in alternative care and (SADC),201 and the Economic Community of West
after children leave care. This has mobilized policy African States (ECOWAS)202 have developed
makers, practitioners and service-providers to regional policies, frameworks or action plans on
advocate to governments in the region, including childrens rights, and have included within them,
to the African Union, on the importance of strong to a varying extent, family strengthening and
and harmonised statutory and community based prevention of violence against children initiatives.
child protection systems to ensure families are The regional and sub-regional frameworks are
supported, strengthened and empowered to care clear on the role of stable and healthy families in
for and protect their children. The Inter-Agency protecting children from violence, exploitation
Statement on Strengthening Child Protection and abuse, as well as the need to ensure the
Systems in Sub-Saharan Africa (2013),196 the safety and protection of children in alternative
Parenting in Africa Call to Action on Restoring care. The impetus must now lie on ensuring their
46 Families as the Pillar of Development in Africa domestication and operationalization.
(2014),197 and the African Partnership to End
Violence Against Children198 all further highlight There are few national policies that explicitly
the crucial role of healthy and stable families in link violence in the family, including VAC, to
preventing both violence within the home and the risk of family separation, or that recognize
family separation, and the need to ensure the that strengthening family care and parenting
availability and accessibility of family-support support are also a means to decrease the risk
services to strengthen household resilience. of violence in the household. There are some
notable exceptions, however, such as the Public
The Special Representative of the Secretary- Policy for Child Protection in Morocco203 and the
General (SRSG) on Violence Against Children has 2017/18- 2021/22 Tanzania National Plan of Action
also underlined that multi-sectoral agendas are to End Violence Against Women and Children,204
crucial for promoting coordinated action across which may reflect the increasing awareness of
government departments and between central the linkages between VAC as a push factor out of
and local authorities to prevent and address the home and VAC as a pull factor into alternative
VAC: A clear message through legislation is care. Supporting governments to put in place
crucial for legitimizing action by the authorities such policies, together with the plan of actions
and mobilising social support for changes in and strategies needed to implement them, should
perceptions, attitudes, and behaviour. 199 To be a priority.
support the ACERWC to monitor the process
and progress in implementing interventions to
strengthen families and protect children from
violence, abuse, exploitation, and neglect, the
Inter-Agency Work Group on Strengthening Child
Protection Systems in Africa has developed a
framework for the ACERWC to analyse State
Party reports using a child protection systems
lens. This framework is supporting the ACERWC
to more effectively assess to what extent States
are implementing measures to extend services
to prevent violence, neglect, and exploitation to
prevent unnecessary separation of children from
their families.
4.4 Establishing effective
regulatory systems to oversee
the use of alternative care
While policy efforts should be explicit in the need to prevent family

separation, so too should they be clear in identifying measures that address
violence in alternative care, particularly residential care. As highlighted
earlier, the CRC and the AC Guidelines clearly articulate the responsibility of
the state to ensure children are placed in alternative care only when strictly
necessary, and that the care provided is both appropriate and protective.
In order to fulfil this responsibility, States must establish a functioning
regulatory system to oversee the provision of alternative care.205 The
following components have been identified as central to an effective
regulatory system:
a recognised and systematic gatekeeping procedure to ensure

placement decisions are vetted, authorized, and in the best interest of
the child;
development and implementation of minimum standards of care, to 47

include the registration and licensing of residential care providers,
provisions for preventing, identifying, reporting and addressing VAC
in the facilities, and for residential care centres to have safeguarding
policies to include clear reporting mechanisms and disciplinary
measures;
data for each child in care to maintain a thorough knowledge of the

characteristics of children in care, the reasons they are there, and thus
the situations and conditions that need to be tackled. 206
access to legal remedies and independent and confidential complaints

reporting mechanisms by children in alternative care;

genuine opportunities for children and young people to participate
in decisions affecting them in care, including about their
placement in care, and opportunities to share their experiences and
recommendations to improve the quality of care as well as the broader
regulatory system; and
an independent inspectorate that can monitor and review childrens

protection in care, including publications of monitoring reports for
facilities and ensuring closure of facilitates that do not meet national
minimum standards within a given time frame.
In order to address the systemic challenges relating to the care and

protection of children in alternative care, the regulatory systems should be
clearly linked to broader statutory and community based child protection
systems.207
Several countries in the region have made significant efforts to strengthen

their regulatory systems. Liberia, for example, has developed the Guidelines
for Kinship Care, Foster Care and Supported Independent Living, that aim
to promote harmonized national regulations for child welfare practitioners
to improve the quality of family-based alternative care services.208 Kenya
has designated a government body responsible for coordinating and
overseeing the quality of care in alternative care. Rwanda has made
gatekeeping central to the countrys efforts to reform the care system and
community level gatekeeping committees are linked directly to support
services at that level, including preventive services for vulnerable children
and their families.209 Practical tools on the implementation of guidelines
for improving the quality of childcare provision are also available, including
case studies showing how these standards have been applied in various
contexts in the region.210
Yet the lack of effective mechanisms to monitor whether children in

alternative care are placed there appropriately, are safe and receiving
quality care continues to be problematic across the region. When
institutions are not registered, oversight is simply not possible. The
ACERWC has noted its concern about unregistered residential care
institutions, children in both registered and unregistered residential care
who do not have a court order placing them there, the reported weak
enforcement of minimum norms and standards aimed at the protection
of children from violence, neglect and abuse in residential care, and
the inadequate implementation and monitoring of quality assurance
processes. 211 Policies and procedures must be in place to ensure all
48 providers of alternative care services, including residential care facilities, are
registered by the competent national authorities and authorized to operate.
The establishment of an independent monitoring mechanism is highlighted

in the AC Guidelines as an important state responsibility, with frequent
inspections comprising both scheduled and unannounced visits, involving
discussion with and observation of the staff and the children. 212 Yet
accessing residential care centres, including those that are officially
registered, can be particularly difficult for independent bodies.213 To the
extent that monitoring visits do take place, they focus on the quality of
the physical facilities, rather than interacting with the children.214 The
lack of or inaccessible complaints mechanisms, including guidelines on
childrens participation in developing and monitoring their own care plans
compounds this challenge.215
4.5 Investing in a skilled and
well-resourced social service
workforce
Intrinsically linked to regulatory systems, alternative care within different cadres of the
is the social service workforce. The social workforce such as in Makarere University in
service workforce plays a key protection and Uganda. The Tubararere Mu Muryango program
gatekeeping role to prevent children from in Rwanda, led by the National Commission for
unnecessarily and inappropriately being placed Children, provides the guiding framework for care
in alternative care, as well as to respond to reform in the country and includes pre-service
VAC in those settings. While the AC Guidelines and in-service training for district social workers
mention the key competencies that are needed and psychologists combined with monitoring
by staff at the various levels working in care, and supervision to build capacity. The program
there are few training institutes in Africa that offer has worked closely with social work university
accredited courses for professional or auxiliary programs to recruit staff and develop curricula.216
level workers that address the competencies These provide important examples from the
outlined in the AC Guidelines. However, there region of approaches to strengthen the social
are efforts to promote increased awareness, service workforce as an integral part of care
skills and knowledge related to protection and reforms efforts.
49

Allan Gichigi/ Save the Children
This discussion paper has explored the linkages
between VAC and care by highlighting that the
50
child who experiences violence in the home is likely
to be the same child who is separated from his or
her family, and pushed into alternative care. While
the media, faith based communities and initiatives,
and public perceptions both globally and within
Africa often propagate placement in alternative
care, and specifically residential care, as a means
out of poverty or a protection mechanism from

harmful families, the increasing evidence base shows
that children can and are exposed to violence,
abuse, neglect, and exploitation in kinship, foster,
and residential care in Africa. Exposure to violence,
including neglect, in alternative care settings has
negative and long-lasting impacts, impacting on
child and young peoples ability to navigate healthy,
safe, and productive lives well after they leave care.
5
CONCLUSION
Global, regional, and national instruments greater risk of violence and neglect, resulting in
recognise that the family has primary this violence being ignored and unaddressed. If
responsibility for the care and protection we are to ensure that all children are protected,
of children, but they also underline the and that no child is left behind, we need to
responsibility of the State to enable these strengthen regulatory systems that monitor 51
caregivers to care adequately for their children childrens wellbeing in alternative care, and
and provide alternative care for children when particularly residential care, to prevent and
families are not able or willing to. However, address childrens exposure to violence.
there are few policies that explicitly link Furthermore, minimum quality standards
violence in the household, including VAC, to in all forms of alternative care should be
risk of family separation, or that recognize implemented, to include principles of zero-
that strengthening family care and parenting violence, positive parenting/caregiving, and
support are also a means to decrease the risk primary care attachment,217 in addition to
of violence in the household. Discussions and challenging policies that do not outlaw corporal
actions to link more effectively the VAC and punishment in all care settings.
care reform agendas, particularly in terms of
the legal and policy framework, data collection A coordinated and multi-sectoral approach
and use for decision-making, service delivery should be used to inform both prevention and

and public awareness are necessary to inform a response interventions, and particularly to
coordinated and multi-sectoral approach to the support, strengthen and empower families to
VAC and care agendas. provide protective, stable and appropriate care
for children. Where children do need alternative
The evidence discussed in this paper highlights care, such an approach should ensure the care
that VAC in alternative care can and does they receive is appropriate to their specifics
happen, and that younger children are often needs, and they are able thrive in a protective
at higher risk of abuse. However, there are and nurturing family-based setting. When
considerable gaps in the data available, children grow up in safe and nurturing families,
demonstrating the marginalisation of children children are less likely to be separated and
in alternative care, which places them at placed in alternative care.

When children grow up
in safe and nurturing
families, children
are less likely to be
separated and placed
in alternative care.
UNICEF/RWAA2011-00564/Noorani
Glossary of Terms
Alternative care: A formal or informal arrangement Exploitation is the use of a child for someone
whereby a child is looked after at least overnight elses advantage, gratification or profit often
outside the parental home, either by decision resulting in unjust, cruel and harmful treatment of
of a judicial or administrative authority or duly the child. These activities are to the detriment of
accredited body, or at the initiative of the child, the childs physical or mental health, education,
his/her parent(s) or primary caregivers or moral or social-emotional development.224
spontaneously by a care provider in the absence of
parents.218 Family support services include a range of
measures to ensure the support of children and
Care leavers: Children or young people who are families similar to community based support
or have transitioned from alternative care to but may be provided by external agents such as
independent living or back into family. social workers and providing services such as
counselling, parent education, day-care facilities,
Care reform: The Better Care Network defines care material support, etc.225
reform as the actions by government and other
recognized actors to bring about changes to social Foster care: Formal foster care can be described
welfare institutions mandated with child welfare as arrangements that have been ordered or
and protection, and practices to improve out- authorized by an administrative body or judicial
comes for children who are especially vulnerable authority; it usually involves an assessment of
to risks, such as those living outside of family the family to determine which family is best
care.219 placed to care for the child and the provision of
some kind of continuing support and monitoring.
54 Child defined as boys and girls under the age of 18 Informal foster care is a private arrangement
years.220 made between the two families. The lines
between kinship care and informal foster care
Child abuse is a deliberate act of ill treatment that are frequently difficult to differentiate. For the
can harm or is likely to cause harm to a childs purpose of this paper, informal foster care is
safety, well-being, dignity and development. Abuse recognized as the child being with someone
includes all forms of physical, sexual, psychological outside of the extended family such with a
or emotional ill treatment.221 neighbour, a community member, etc.
Child protection system: A comprehensive Kafala: A form of family based care used in
system of laws, policies, procedures and practices Islamic societies that does not involve a change in
designed to ensure the protection of children and kinship status, but does allow an unrelated child,
to facilitate an effective response to allegations or a child of unknown parentage, to receive care,
of child abuse, neglect, exploitation and violence. legal protection and inheritance. Islam prohibits
The child protection system must have certain core breaking the blood tie between children and their
functions, capacities, and structures to go along birth parents. As a result, change of parental
with processes and service continue that ultimately status, name, inheritance rights, guardianship
define what a specific community does to protect requirements (including for marriage purposes)
its children.222 are not allowed and adoption is rarely accepted
in Islamic societies. Some Islamic countries and
Emotional abuse includes the failure of a countries with large Muslim communities do have
caregiver to provide an appropriate and adoption legislation, but these tend to stipulate
supportive environment, and includes acts that that the blood tie to the birth parents is not
have an adverse effect on the emotional health severed by adoption.226
and development of a child. Such acts include
restricting a childs movements, denigration,
ridicule, threats and intimidation, discrimination,
rejection and other non-physical forms of hostile
treatment.223
Neglect is failure of a parent to provide for the Social Services: provided by public or private
development of the child- where the parent is in a organizations aimed at addressing the needs and
position to do so in one or more of the following problems of the most vulnerable populations,
areas: health, education, emotional development, including those stemming from violence, family
nutrition, shelter and safe living conditions. breakdown, homelessness, substance abuse,
Neglect is thus distinguished from circumstances immigration, disability and old age. These can
of poverty in that neglect can occur only in cases include day and residential care, income support,
where reasonable resources are available to the home visiting, and specialist services such as drug
family or caregiver. In addition, abandonment, and alcohol rehabilitation, etc.233
inadequate supervision, poor hygiene and being
deprived of an education have all been considered Social service workforce: the social service
as evidence of neglect.227 workforce is comprised of many cadres of
trained workers who address economic and
Physical abuse of a child as those acts committed social vulnerabilities across multiple sectors
by a caregiver that cause actual physical harm or including child protection, social protection,
have the potential for harm.228 health, justice, education, gender, community
development, immigration and labour. Where
Prevention interventions: to prevent child there are vulnerabilities, this workforce is
maltreatment, prevention interventions are necessary. They provide tangible assistance
typically classified on three levels: primary such as cash, food, medication, and clothing;
prevention (universal services aimed at the whole in-kind assistance such as medical services,
population); secondary prevention (targeted birth registration, and housing support; social
services for families with risk factors, identified services such as case management, referrals, 55
as being in need of further support); and tertiary counselling, and community empowerment; and
prevention (specialist services offered once child administrative and managerial services such as
maltreatment has been detected, and aimed at supervising, coordinating, advocating, mediating
preventing re-victimization).229 and planning.234
Separated child: A child separated from both Violence against children: the definition in the
parents or from his/her previous legal or World Report on Violence and Health (2002) is
customary primary caregiver, but not necessarily also frequently used in addition to Article 19 of
from other relatives.230 the CRC: the intentional use of physical force or
power, threatened or actual, against a child, by an
Sexual abuse is defined as those acts where a individual or group, that either results in or has a
caregiver uses a child for sexual gratification.231 high likelihood of resulting in actual or potential

harm to the childs health, survival, development
Social protection: A wide range of activities or dignity.235
undertaken by societies to alleviate hardship and
respond to the risks that poor and vulnerable Violence within the household is defined based
people face and to provide minimum standards on the definition of child abuse established by
of well-being. This includes services and financial the WHO Consultation on Abuse and Child Abuse
transfers.232 Prevention, which describes it as ...all forms
of physical and/or emotional ill-treatment,
sexual abuse, neglect or negligent treatment
or commercial or other exploitation, resulting
in actual or potential harm to the childs health,
survival, development or dignity in the context of
a relationship of responsibility, trust or power.236
Endnotes
1
Hillis, S., Mercy, J., Amobi, A., Kress, H. (2016). Report on Violence against Children; Nikeyema,
Global prevalence of past-year violence against T, Ending Violence Against Children in Africa:
children: A systematic review and minimum Challenges and Opportunities. Presentation for
estimates. Pediatrics :137 (3). This study defines Elevate Children Funders Group 2015 Annual
violence to include exposure one or more types General Meeting, Washington DC, 5 November
of victimization (physical, sexual or emotional) 2015; World Health Organization, United Nations.
committed by a range of perpetrators (authority Global Status Report on Violence Prevention 2014.
figures, peers, romantic partners, or strangers) in Geneva, Switzerland: WHO Press; 2014.
various locations (home, school, or community). 11
Sherr, L.; Roberts, K., and Gandhi, N. (2017).
2
Defined according to the study to include Child violence experiences in institutionalized/
spanking, slapping, hitting, or shaking. orphanage care. Psychology, Health & Medicine.
3
Hillis, S., (2016). Op cit. pp.1-24. Retrieved from: http://dx.doi.org/10.1080/
4
See https://www.cdc.gov/violenceprevention/ 13548506.2016.1271951
vacs/ for the methodologies, data, and reports 12
Violence against children also occurs in other
on the Violence Against Children Studies. In settings such as schools, on the way to school
Africa, VACS have been conducted in Tanzania and within the community, however it is beyond
(2009), Kenya (2010), Zimbabwe (2011), Malawi the scope of this discussion paper to cover VAC
(2013), and Nigeria (2014); Africa Child Policy in those specific settings. The Leiden Conference
Forum (2014), African Report on Violence against on the Development and Care of Children without
Children Permanent Parents (2012).The Development and
5
For definition of terms, see the Glossary of Care of Institutionally Reared Children. Child
Terms. Development Perspective, 6 (2), pp. 174180;
56 6
Krug et al (2002); Pinheiro (2006); Landers, Nelson, C. III, et al. (2007). Cognitive Recovery
C. (2013), Preventing and Responding to Violence, in Socially Deprived Children: The Bucharest
Abuse, and Neglect in Early Childhood. A Early Intervention Project. Science 318, p.1937;
Technical Background Document. UNICEF Child Bucharest Early Intervention Project (2009)
Protection Section HQ. Caring for Orphaned, Abandoned and Maltreated
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Woodhead, M. (2006). Changing perspectives Children. Accessed at http://bettercarenetwork.
on early childhood: Theory, research and policy. org/library/particular-threats-to-childrens-care-
International Journal of Equity and Innovation in and-protection/effects-of-institutional-care/
Early Childhood, 4 (2). caring-for-orphaned-abandoned-and-maltreated-
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Anda, R, Butchart, A., Felitti, V., Brown, children-bucharest-early-intervention-project ;
D. (2010). Building a framework for global Nelson, C. Fox, N., Zeanah, C. (2013). Anguish of
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adverse childhood experiences. American Journal 12
Better Care Network and UNICEF (2015). An
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Anda, R., Felitti, V., Nordenburg D., Marchbanks, Summary of Findings.
P. (2000). Adverse childhood experiences and 12
Key informant interview, alternative care
sexually transmitted diseases in men and women: consultant, February 9, 2016.
a retrospective study. Pediatrics:106 (1); Reza, 13
Newton, G. (2017) Thoughts on public
A., Breiding, M., Gulaid, J. et. Al (2009). Sexual policy to expand family-based care and contract
violence and its health consequences for female institutional care. Child Abuse and Neglect. (In
children in Swaziland: a clustery survey study: 373 Press); Better Care Network and UNICEF (2015).
pp.1966-1972. Op cit.
9
Crombach, A., & Bambony, M. (2015). 14
UN General Assembly (2010). Guidelines
Intergenerational violence in Burundi: Experienced for the Alternative Care of Children. Adopted
childhood maltreatment increases the risk of by the General Assembly, 24 February 2010, A/
abusive childrearing and intimate partner violence. RES/64/142 (Section II Article 3).
European Journal of Psychotraumatology, 6. 15
Key informant interview, alternative care
http://dx.doi.org/10.3402/ejpt.v6.26995Curley consultant, February 9, 2016.
10
Africa Child Policy Forum (2014), African 16
Central African Republic, Djibouti,
Democratic Republic of Congo, Somalia, Sao Tome RES/64/142 (Article 92).
and Principe, Swaziland. 30
17
Committee on the Rights of the Child. General for the Alternative Care of Children. Adopted
Comment 13: The right of the child to freedom by the General Assembly, 24 February 2010, A/
from all forms of violence. CRC/C/GC/13, April RES/64/142 (Article 93).
2011. 31
18
Krug EG et al., Eds. (2002). World Report for the Alternative Care of Children. Adopted
on Violence and Health. Geneva, World Health by the General Assembly, 24 February 2010, A/
Organization RES/64/142 (Article 95).
19
WHOs definition of child maltreatment. See 32
http://www.who.int/topics/child_abuse/en/ for the Alternative Care of Children. Adopted
20
World Health Organisation (2016). INSPIRE: by the General Assembly, 24 February 2010, A/
Seven Strategies for Ending Violence Against RES/64/142 (Articles 92 and 93).
Children. 33
21
Stoltenborgh,M., Bakermans-Kranenburg, M., for the Alternative Care of Children. Adopted
and van IJzendoorn, M. (2013). The neglect of child by the General Assembly, 24 February 2010, A/
neglect: a meta-analytic review of the prevalence RES/64/142 (Article 96).
of neglect. Soc Psychiatry Psychiatr Epidemiol. 34
48:345355. Retrieved from DOI 10.1007/s00127- for the Alternative Care of Children. Adopted
012-0549-y by the General Assembly, 24 February 2010, A/
22
Norman, R., Munkhtsetseg, B., De, R., RES/64/142 (Article 98).
Butchart, A., Scott, J., Vos, T. (2012). The long- 35
term health consequences of child physical abuse, for the Alternative Care of Children. Adopted
emotional abuse, and neglect: A systematic by the General Assembly, 24 February 2010, A/
review and meta-analysis. Accessed at: http:// RES/64/142 (Articles 80 to 100).
bettercarenetwork.org/sites/default/files/ 36
A key resource that provides practical
attachments/Long%20term%20health%20 guidance on implementation is Moving Forward:
consequences%20of%20child%20abuse.pdf Implementing the Guidelines for the Alternative
23
National Scientific Council on the Developing Care of Children. It offers clear implementing 57
Child. (2012). The Science of Neglect: The guidance to government and civil society
Persistent Absence of Responsive Care Disrupts and provides several examples of promising
the Developing Brain: Working Paper 12. http:// practice of alternative care programs, including
www.developingchild.harvard.edu for children affected by HIV. Such promising
24
UNICEF (2014) Hidden in Plain Site. Retrieved practices include a foster care program for
from https://www.unicef.org/publications/ children orphaned by AIDS in Zimbabwe and a
index_74865.html child and youth care workers training program
25
Cantwell N, Davidson J, Elsley S, Milligan I & for community- based social welfare workers
Quinn, N. (2012) Moving Forward: Implementing in South Africa. See Cantwell N, Davidson J,
the Guidelines for the Alternative Care Elsley S, Milligan I & Quinn, N. (2012) Moving
of Children. UK: Centre for Excellence for Looked Forward: Implementing the Guidelines for the
After Children in Scotland. pp.22-23. Alternative Care of Children. UK: Centre for

26
UN General Assembly (2010). Guidelines Excellence for Looked After Children in Scotland
for the Alternative Care of Children. Adopted and www.alternativecareguidelines.com for more
by the General Assembly, 24 February 2010, A/ information.
RES/64/142 (Section II Article 5). 37
Both the AU PoA on the Family and the AC
27
UN General Assembly (2010). Guidelines Guidelines recognise families as both nuclear and
for the Alternative Care of Children: resolution / extended, including kinship carers.
adopted by the General Assembly, 24 February 38
African Union. Plan of Action on the Family
2010, A/RES/64/142, (Section II Article 13). in Africa. Addis Ababa, 2004.
28
UN General Assembly (2010). Guidelines 39
African Union. Social Policy Framework for
for the Alternative Care of Children. Adopted Africa. Addis Ababa, 2008.
by the General Assembly, 24 February 2010, A/ 40
African Union. Fourth Session of the AU
RES/64/142 (Article 96). Conference of Ministers of Social Development:
29
UN General Assembly (2010). Guidelines Strengthening the African Family for Inclusive
for the Alternative Care of Children. Adopted Development in Africa. Addis Ababa, 26-30 May,
by the General Assembly, 24 February 2010, A/ 2014.
Annex 2: Footnotes
41
ACERWC. Agenda 2040 for Childrens Rights 55
Inter-Agency Task Group (2016) All Children
in Africa. Addis Ababa, 2016. Count but not All Children are Counted An open
42
Better Care Network and UNICEF (2015). letter to the UN and its Member States. http://
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43
Government of Republic of Kenya (2014), systems/data-and-monitoring-tools/un-urged-
Guidelines for the Alternative Family Care of to-ensure-global-development-indicators-count-
Children in Kenya; Minimum Standards for world%E2%80%99s-most-vulnerable-children
Children Living in Residential Care Centers. 56
Op Cit., African Child Policy Forum (2014).
44
Government of Liberia, Ministry of Health 57
It is recognized that violence against
and Social Welfare (2014) Guidelines for Kinship children takes place in broader contexts as well,
Care, Foster Care and Supported Independent to include schools, the justice system, within
Living in Liberia; Better Care Network, UNICEF, places of worship, and the broader community.
PEPFAR, USAID (2015). Country Care Profile: However, violence against children in the home
Liberia. and alternative care settings is the focus of this
45
Gouvernement du Maroc (2015). Politique discussion paper.
Publique Intgre de Protection de lenfance au 58
See the Glossary of Terms for definitions.
Maroc. 59
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46
Government of Namibia. Minimum Standards and violence: The facts
for Residential Child Care Facilities in Namibia. 60
African Child Policy Forum (2016). Crimes
47
Better Care Network and UNICEF (2015). and extreme violence against children in Africa.
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Committee of Experts on the Rights and Welfare Children, London.
of the Child. 62
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48
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of Action to End Violence Against Women and witchcraft as a harmful practice.
58 Children in Tanzania 2017/2018-2021/22. 63
African Child Policy Forum (2016). Crimes
49
See http://www.alternative-care-uganda.org and extreme violence against children in Africa.
for more information. African Child Policy Forum, Addis Ababa.
50
Government of Zambia. Minimum Standards 64
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51
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52
Pinheiro, Paulo Srgio (2006). World Report Uganda, and Zambia. The African Child Policy
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Secretary-Generals Study on Violence against 67
Hearst. M. (2016). Serving children with
Children, Geneva. disabilities: Executive summary. St. Catherine
53
In 2007, Swaziland conducted the first University and SPOON Foundation. September,
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Januario, K., Hemblin, J., Kline, A., and Roby,
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Nigeria (2014) followed suit in leading studies reintegration of children from catholic-affiliated
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54
SOS Childrens Villages and University of 70
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A family is not strictly limited to the
Annex 2: Footnotes
biological parents of the child. It can also include 83
Crombach, A., & Bambony, M. (2015).
those persons who have parental responsibilities Intergenerational violence in Burundi: Experienced
and rights in respect of the child, or any other childhood maltreatment increases the risk of
person whom who the child has developed a abusive childrearing and intimate partner violence.
significant relationship, based on emotional European Journal of Psychotraumatology, 6.
attachment. http://dx.doi.org/10.3402/ejpt.v6.26995Curley
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VACS in Malawi (2013) and Nigeria (2014). 84
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73
Tanzania (2009), Kenya (2010), Zimbabwe Emmeline, M. (2016). Orphanhood and
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74
0% of boys in Zimbabwe identified parents, study from early AIDS-affected Kagera region,
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Evidence compiled from national mappings 142
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J., Kline, A., and Roby, J. (2016). Factors related Maltreated Children. Retrieved from: http://
to the placement and reintegration of children www.bettercarenetwork.org/BCN/details.
from catholic-affiliated residential care facilities asp?id=12323&themeID=1003&topic ID=1023;
in Zambia. Catholic Relief Services, Baltimore; The Leiden Conference on the Development and
Bunkers, K. M., for Family Health International, Care of Children without Permanent Parents. The
Childrens Investment Fund, & UNICEF (2010). Development and Care of Institutionally Reared
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Annex 2: Footnotes
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Science 318, 1937; Bucharest Early Intervention 153
Project (2009) Caring for Orphaned, Abandoned Advisor, Hopes and Homes. February 9, 2016; key
and Maltreated Children; Nelson, C. Fox, N. & informant interview, former member of the CRC.
Zeanah, C. (2013). Anguish of the Abandoned February 10, 2916.
Child. Scientific American. 154
Quoted in SOS Childrens Villages and
143
Hermenau, K., Kaltenbach, E., Mkinga, G., University of Bedfordshire (2014). From a whisper
Hecker, T. (2015) Improving care quality and to a shout: A call to end violence against children
preventing maltreatment in institutional care in alternative care, p.27.
a feasibility study with caregivers. Frontiers 155
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Homes: The Empirical Base for a Century of 163
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149
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See the Declaration and Recommendations
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150
Brown, K. 2009. The Risk of Harm to Young initiatives/the-first-international-conference-in-
Children in Institutional Care. London: Save the africa-on-family-based-care-for-children
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The conference also prompted the need
151
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Child violence experiences in institutionalized/ increase awareness and share learnings about
orphanage care. Psychology, Health & Medicine. processes to strengthen families to prevent
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13548506.2016.1271951 reintegration of children from alternative forms
152
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prevent protection violations such as child abuse, Womens Refugee Commission and CPC Learning
neglect and exploitative labor. Network; Laumann, L. (2015). Household
167
National Commission for Children. Child Economic Strengthening in Support of Prevention
Care Reform in Rwanda; Better Care Network and of Family-Child Separation and Childrens
UNICEF (2015). Country Care Profile: Rwanda; Reintegration in Family Care. Durham, NC, FHI
Better Care Network and UNICEF (2015). An 360; Daly, M., R. Bray, Z. Bruckauf, J. Byrne, A.
Analysis of Childcare Reform in Three Countries: A Margaria, N. Penik, and M. Samms-Vaughan
Summary of Findings. (2015). Family and Parenting Support: Policy and
168
Pryce, J. et al (2016). Aging Out of Care Provision in a Global Context, Innocenti Insight,
in Ethiopia: Challenges and Implications Facing UNICEF Office of Research, Florence, p.12.
Orphans and Vulnerable Youth. Emerging 178
Cluver L et al. Cash plus care: social
Adulthood pp. 1-12; Frimpong-Manso, K (2015). protection cumulatively mitigates HIV-risk
The social support networks of care leavers from behaviour among adolescents in South Africa.
a childrens village in Ghana: formal and informal AIDS 28 (suppl 3): S389-97, 2014.
supports, pp 1-8, retrieved from: http://journals. 179
Retrak. 2014. Mid term review: Reintegration
sagepub.com/doi/abs/10.1177/2167696815599095 of street children and community based child
169
Stein, M., (2009). Promoting the Resilience protection in SNNPR, Ethiopia.
of Young People Leaving Care: Messages from 180
Bray, R. with A. Dawes (2016). Parenting,
Research, Preparation for Independent Living. Family Care and Adolescence in East and
Briefing Paper Issue 1, SOS Childrens Villages. ; Southern Africa: An evidence-focused literature
Key informant interview, Advocacy Advisor, Hopes review, Innocenti Discussion Paper 2016-02,
and Homes. February 9, 2016. UNICEF Office of Research Innocenti, Florence;
170
Catholic Relief Services (2016). Factors Parenting in Africa Network and Save the Children
Related to the Placement into and Reintegration of (2015). Opportunities for strengthening families
Children from Catholic Affiliated Residential through positive discipline knowledge, attitudes
Care Facilities in Zambia; Uganda Care Leavers and practice study; African Child Policy Forum
(2016). The voice of care leavers in Uganda. and International Child Support (2010). Shaping
171
SOS Childrens Villages, University of the Future: Through the Voices of African Parents
Bedfordshire. (2014); Family Health International, 181
de Haan, M., van Esch (2016). Learning 63
Childrens Investment Fund, & UNICEF (2010). under the tree: An evaluation of the skillful
Improving Care Options for Children Through parenting program in West Kenya. Utrecht
Understanding Institutional Child Care and Factors Universiteit. February 2016.
Driving Institutionalization; Uganda Care Leavers 182
Gardner, F. for UNICEF. (2017). Parenting
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172
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paper: Transitional support: The experiences and 2017-10. Accessed at: http://bettercarenetwork.
challenges facing youth transitioning out of state org/sites/default/files/IRB_2017_10.pdf
care in the Western Cape. 183
Doyle, K, Kato-Wallace, J, Kazimbaya, S
173
Ucembe, S. (2013). Exploring the Nexus & Barker, G (2014). Transforming gender roles
between Social Capital and Individual Biographies in domestic and caregiving work: preliminary
of Care leavers in Nairobi, Kenya: A Life Course findings from engaging fathers in maternal,

Perspective. Received from author. newborn, and child health in Rwanda. Gender &
174
Pryce et. al (2015); Family Health Development, 22:3, 515-531; Promundo and Sonke
International et al (2010). Op Cit. Gender Justice Network, What Fathers Have to
175
Mhongera, P. and Lombard, L. (2016) Who do with it? Engaging Men as Caregiving Partners,
is there for me? Evaluating the social support Men Care: A Global Fatherhood Campaign;
received by adolescent girls transitioning from Van Den Berg, W (June 2015), Violence is less
institutional care in Zimbabwe. Practice: Social likely in homes where fathers share chores
Work in Action. equally. The Conversation. Available at: http://
176
Roelen, K. (2016). Cash for care: Making bettercarenetwork.org/news-updates/news/
social protection work for childrens care and violence-is-less-likely-in-homes-where-fathers-
wellbeing. Institute of Development Studies, share-chores-equally
Sussex University. 184
Richter, Linda M. and Sara Naicker. 2013.
177
Chaffin, J., Kalyanpur, A. & Noman, N. (2014). A Review of Published Literature on Supporting
What do we know about economic strengthening and Strengthening Child- Caregiver Relationships
for family reintegration of separated children? (Parenting). Arlington, VA: USAIDs AIDS Support
Annex 2: Footnotes
and Technical Assistance Resources, AIDSTAR- Report of the Special Representative of the
One, Task Order 1. Secretary-General on Violence Against Children.
185
Programming examples known to author Seventieth Session. A/70/298, August 2015.
and information gathered via discussions with 200
East African Community. EAC Child Policy.
4Children staff. Arusha, 2016
186
USAID. (2015). Inventory of the Evidence 201
SADC. SADC Minimum Package of Services
around Prevention of Separation and for Orphans and Other Vulnerable Children and
Reintegration of Children into Family Care: Youth. Gaborone, 2011
A Focus on Africa and Asia. Coordinating 202
Economic Community of West African
Comprehensive Care for Children. Received from States. ECOWAS Regional Action Plan for the
author. Elimination of Child Labor.
187
Teuscher, B. & Roby, J. (2015). Attachment 203
Gouvernement du Maroc (2015). Politique
and hope of institutionalized and reunified Publique Intgre de Protection de lenfance au
children in Ghana FHSS Mentored Research Maroc.
Conference. Book 268. 204
Government of Tanzania. National Plan
188
Child Protection Society. Reunification and of Action to End Violence Against Women and
community reintegration research. January 2014. Children in Tanzania 2017/2018-2021/22.
189
Terre des Homes (n.d.). Op cit. 205
Cantwell, N.; Davidson, J., Elsley, S.;
190
Plan International (2017) Op cit. Milligan, I.; Quinn, N. (2012). Moving Forward:
191
Hermenau, K., Kaltenbach, E., Mkinga, G., Implementing the Guidelines for the Alternative
Hecker, T. (2015) Improving care quality and Care of Children. UK: Centre for Excellence for
preventing maltreatment in institutional care Looked After Children in Scotland.
a feasibility study with caregivers. Frontiers 206
Ibid. p. 22
in Psychology. Retrievable at https://doi. 207
Walakira, E. (eds.) (2017) Child Abuse and
org/10.3389/fpsyg.2015.00937 Neglect in Uganda. Springer
192
Programming known to author and 208
Government of Liberia, Ministry of Health
information shared via discussions with 4Children and Social Welfare (2014) Guidelines for Kinship
staff. Care, Foster Care and Supported Independent
64 193
These Regional Minimum Standards have Living in Liberia.
been validated by the health, education and 209
Better Care Network and UNICEF (2015)
social welfare technical experts of the 6 Partner Making Decisions for the Better Care of Children:
States of the EAC. They await final approval by The role of gatekeeping in strengthening family-
the Sectoral Council on Youth, Children, Gender, based care and reforming alternative care
and Community Development, which will meet in systems. http://bettercarenetwork.org/library/
August 2017. principles-of-good-care-practices/gatekeeping/
194
S.C.A.L.E. is an acronym that stands making-decisions-for-the-better-care-of-children-
for social service workforce strengthening, the-role-of-gatekeeping-in-strengthening-family
coordination of services, accessibility of 210
Swales, D. (2006). Applying the standards:
appropriate services, long-lasting and sustainable Improving quality childcare provision in East
impact of services, evaluation and learning of and Central Africa. Save the Children: London;
services. Cantwell, N.; Davidson, J., Elsley, S.; Milligan, I.;
195
African Committee of Experts on the Rights Quinn, N. (2012). Moving Forward: Implementing
and Welfare of the Child (2014). the Guidelines for the Alternative Care of
196
Inter-Agency Work Group (2013). Inter- Children. UK: Centre for Excellence for Looked
Agency Statement on Strengthening Child After Children in Scotland.
Protection Systems in Sub-Saharan Africa: A call 211
African Committee of Experts on the Rights
to action to African Union States. and Welfare of the Child (2014).
197
Parenting in Africa. Call to Action on 212
Restoring Families as the Pillar of Development in for the Alternative Care of Children. Adopted
Africa. by the General Assembly, 24 February 2010, A/
198
The African Partnership to End VAC feeds RES/64/142 (Articles 128 and 130).
into the Global Partnership to End VAC. The 213
Key informant interview, Alternative care
structure, approach and scope of work is currently consultant. February 9, 2016.
being defined by an interim secretariat, housed at 214
ACPF in Addis Ababa. Advisor, Hopes and Homes. February 9, 2016.
199
United Nations General Assembly. Annual 215
Ait Mansour, H. (2006) Les enfant en
Annex 2: Footnotes
institutions au Maroc. UNICEF. Publication 226
Tolfree, D (2007) Protection Fact Sheet:
forthcoming. Child protection and care related definitions, Save
216
Better Care Network and Global Social the Children
Service Workforce Alliance. 2014. Working 227
National Scientific Council on the
paper on the role of social service workforce Developing Child. (2012). The Science of Neglect:
development in care reform. Washington, DC: The Persistent Absence of Responsive Care
IntraHealth International. Disrupts the Developing Brain: Working Paper 12.
217
Hermanau, K,: Hecker, T., Ruf, M., Schauer, E., http://www.developingchild.harvard.edu
Elbert, T., Schauer, M. Childhood adversity, mental 228
Krug et al (2002); Pinheiro (2006); Landers,
ill-health and aggressive behavior in an African C. (2013), Preventing and Responding to Violence,
orphanage: changes in response to trauma- Abuse, and Neglect in Early Childhood. A
focused therapy and the implementation of a new Technical Background Document. UNICEF Child
instructional system. Child Adolescent Psychiatry Protection Section HQ
and Mental Health. 2011; 5:29. 229
Op. cit.
218
Better Care Network (2015) Toolkit
for the Alternative Care of Children. Adopted Glossary of Key Terms. Accessed at http://
by the General Assembly, 24 February 2010, A/ bettercarenetwork.org/toolkit/glossary-of-
RES/64/142, Article 28 (b) 231
219
Better Care Network, UNICEF and USAID C. (2013), Preventing and Responding to Violence,
(2015). An Analysis of Childcare Reform in Three Abuse, and Neglect in Early Childhood. A
Countries: A Summary of Findings. Technical Background Document. UNICEF Child
220
United Nations General Assembly (1989). Protection Section HQ
Convention on the Rights of the Child. A/ 232
Better Care Network (2015) Toolkit
RES/44/25 Glossary of Key Terms.
221
Better Care Network (2015) Toolkit 233
Better Care Network, 2015
Glossary of Key Terms. Accessed at http:// 234
Global Social Service Workforce Alliance.
bettercarenetwork.org/toolkit/glossary-of- See: www.socialserviceworkforce.org/workforce.
222
Ibid 235
223
Krug et al (2002); Pinheiro (2006); Landers, C. (2013), Preventing and Responding to Violence, 65
C. (2013), Preventing and Responding to Violence, Abuse, and Neglect in Early Childhood. A
Abuse, and Neglect in Early Childhood. A Technical Background Document. UNICEF Child
Technical Background Document. UNICEF Child Protection Section HQ
Protection Section HQ 236
World Health Organization (1999).
224
Better Care Network (2015) Toolkit Consultation on Child Abuse Prevention. Geneva:
Glossary of Key Terms. World Health Organization.
225
Op. cit.

Annex 2: Footnotes
Annex 1: List of Key Informants
NAME POSITION
TECHNICAL EXPERTS ON VAC AND / OR CARE IN AFRICA
Clare Feinstein Africa representative for the Child Protection Initiative, Save the
Children
Mark Riley Alternative care consultant, Uganda
Geoffrey Oyat Regional Child Protection Specialist, East and Southern Africa,
Save the Children
Stephen Ucembe Regional Advocacy Advisor, Hopes and Homes
Professor Julia-Sloth Nielson Former member of the African Experts Committee on the Rights
and Welfare of the Child; Dean of Law at the University of Western
Cape, South Africa
Jonna Karlsson Violence against children specialist, UNICEF ESARO
Joanna Wakia M&E Specialist, Retrak

66
Wambui Njuguna Regional Advisor, ANPPCAN
Shimelis Tsegaye Head, Child Protection and Development Program, African Child
Policy Forum
Beatrice Ogotu Regional Program Manager, Child Protection, Investing in Children

and their Societies
Malika Ait SiAmeur SOS Childrens Village, Morocco
Mariama Diallo and Shohei Child Protection Specialist and Social Protection Specialist,
Kawabata UNICEF Morocco
Insaf Zitouni Senior Psychologist, Studies and Research Service at the National
Institute of Child Protection, Tunis, Tunisia
GLOBAL TECHNICAL EXPERTS ON VAC AND / OR CARE
Maria Herczog Former member of the Committee on the Rights of the Child
Dr. Victoria Schmidt Know Violence in Childhood

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74
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Violence Against

Children and Care

2017 Better Care Network

This paper was possible thanks to the support of Oak Foundation.

Marta Santos Pais

Despite the significant national data surveys

More robust legal frameworks on child protection

As this report highlights, it is urgent to end

The links between violence and care are

2.1 Understanding violence against children 16

3. VIOLENCE AGAINST CHILDREN IN FAMILY AND

3.1 Violence against children in the home 26

4. CONSIDERATIONS FOR POLICY AND SERVICES 42

ANNEX 1: LIST OF KEY INFORMANTS 66

(51 per cent).3 Over the past several years across

Violence Against Children and Care in Africa | A Discussion Paper

who is exposed to violence at home can be, and

Violence Against Children and Care in Africa | A Discussion Paper

neglect or negligent treatment, maltreatment or

Violence Against Children and Care in Africa | A Discussion Paper

The Optional Protocol to the CRC on the Sale of Children, Child

Violence against children has been defined in the World Health

5 5-10 11-17 18+

Intimate partner violence

Emotional or psychological violence and witnessing violence

Figure 1 Violence against children takes different forms at different ages

Child maltreatment, as included in Figure 1, typically includes physical,

Understanding neglect as a form of violence against children

2.2 The CRC and ACRWC on

Violence Against Children and Care in Africa | A Discussion Paper

2.3 The AC Guidelines on

The Guidelines for the Alternative Care of Children, endorsed by the UN

The AC Guidelines also recognize that children can be exposed to violence

providers, peers or third parties.27 They require a strict prohibition of all

Violence Against Children and Care in Africa | A Discussion Paper

violence within different contexts. The Violence

Violence Against Children and Care in Africa | A Discussion Paper

Some children are more likely to experience violence; children with

Children with disabilities are at increased risk for violence

Violence Against Children and Care in Africa | A Discussion Paper

3.1 Violence against

MALAWI NIGERIA TANZANIA

Violence Against Children and Care in Africa | A Discussion Paper

The African Report on Violence against Children75 looked at social,

Evidence on violence against children in the family

Physical abuse in family settings

28 Neglect in family settings

Understanding how VAC in the family psychologically impacts on boys

Violence Against Children and Care in Africa | A Discussion Paper

3.2 VAC and care in

Violence Against Children and Care in Africa | A Discussion Paper

VAC in kinship care

Violence Against Children and Care in Africa | A Discussion Paper

Research has consistently shown that the majority of children in residential

Reason for placement in RWANDA UGANDA GHANA MALAWI MADAGASCAR

Recruitment by care centre or

Violence, abuse, neglect of

Children lack access to

Reconstituted household (e.g.,

Children are affected by