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Caring for orphans and vulnerable children in a context of poverty andcultural Transition: A case study of a group foster homes program inBurkina FasoDia Sanoua; Huguette Turgeon-O'Briena; Sayouba Ouedraogob; Thérèse Desrosiersa
a Department of Food and Nutrition Sciences, Laval University, Quebec, QC, Canada b Module ofSocial Sciences, University of Quebec in Outaouais, Gatineau, QC, Canada
To cite this Article Sanou, Dia , Turgeon-O'Brien, Huguette , Ouedraogo, Sayouba and Desrosiers, Thérèse(2008) 'Caringfor orphans and vulnerable children in a context of poverty and cultural Transition: A case study of a group fosterhomes program in Burkina Faso', Journal of Children and Poverty, 14: 2, 139 — 155To link to this Article: DOI: 10.1080/10796120802335862URL: http://dx.doi.org/10.1080/10796120802335862
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Caring for orphans and vulnerable children in a context of poverty and culturalTransition: A case study of a group foster homes program in Burkina Faso
Dia Sanoua, Huguette Turgeon-O’Briena, Sayouba Ouedraogob, andTherese Desrosiersa*
aDepartment of Food and Nutrition Sciences, Laval University, Quebec, QC, Canada; bModule ofSocial Sciences, University of Quebec in Outaouais, Gatineau, QC, Canada
This paper analyses the functional dynamic of a group foster homes-based program inBurkina Faso and its potential to meet the developmental needs of children. Data werecollected through field observations, interviews, and questionnaires. Findings suggestthat this community-based program combines institutional care and extended familynetworks. Orphaned, abandoned, and vulnerable children were brought together infoster homes, each headed by a non-relative woman and supported by the programoperator. The program guaranteed the basic needs of children as specified by theConvention on the Rights of the Child. The nutritional status that is indicative of theoverall well-being in emergency seems to be better than the average children of BurkinaFaso, suggesting that basic vital needs of children were met. Familial ties are alsodeveloped between each family member. Children have the opportunity to interact withcommunity, therefore preparing them for social life. Despite some limitations, mainlydue to the lack of psychological support, the program achieves its objectives of caring forchildren and provides a familial environment for orphans. Therefore, many organiza-tions caring for orphans in Africa through institutional settings might learn from thisexperience in terms of management style, parenting, and connections with relatives andcommunity.
Introduction
The first of The Lancet’s series on child development in developing countries estimated
that more than 200 million children under five years fail to reach their developmental
potential, therefore causing a high risk of intergenerational vulnerability (Grantham-
McGregor et al. 2007). Orphaned and abandoned children especially are at increased risk
of poor health, material vulnerability, and psychological distress (UNICEF 2003). So far,
orphans have been cared for by community through extended family and other social
networks (Oleke, Blystad, and Rekdal 2005; Dabire 2001; Gueye et al. 1993). Some
organizations also have tried to implement institutional care that aims to provide a home
for orphans in need of care and to serve as an alternative to parents. However, researches
concur that institutional care does not meet the psycho-emotional needs of children
(Audemard, Vignikin, and Desgrees du Lou 2006; Makame, Ani, and Grantham-
McGregor 2002). In this sense, the orphan care systems seem to be at a crossroads in
sub-Saharan Africa, and experts and international organizations have sounded the alarm
that appropriate interventions to manage this problem are needed (UNAIDS 2001; Foster
*Corresponding author. Email: [email protected]
Journal of Children and Poverty
Vol. 14, No. 2, September 2008, 139�155
ISSN 1079-6126 print/ISSN 1469-9389 online
# 2008 Taylor & Francis
DOI: 10.1080/10796120802335862
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2000). They have called for the community-based organizations such as religious-based or
village-based committees to take a leading role in the process (Foster 2000).In the context of Burkina Faso, the congregation of Sœurs de l’Immaculee Conception
(SIC), a Christian organization, has implemented an alternative program referred to as
group foster homes or village homes, which tries to combine the traditional orphan care
system and an institutional approach. This article (1) describes the functional dynamic of
the program, (2) examines living conditions and nutritional status of children, and (3)
assesses whether the program meets the developmental needs of vulnerable children, using
the framework of Bronfenbrenner’s bioecological systems theory for child development.
These objectives will be addressed after a discussion of theoretical aspects of institutional
care issues in Africa and Bronfenbrenner’s theory of child development.
Statement of the problem
Contextualization of the institutional care in Africa
The orphanhood issue in Africa predates the AIDS epidemic, but the traditional systems
took care of orphans through complex mechanisms including child fosterage, exchanges of
children between families, remarriage customs like levirate and sororate, and so forth.
(Audemard, Vignikin, and Desgrees du Lou 2006; Verhoef 2005). During the last decades,
the number of orphans has increased due to HIV/AIDS while high rates of adult mortality,
economic crisis, cultural transition, and other social challenges have negatively affected
family solidarity (Abebe and Aase 2007; Oleke, Blystad, and Rekdal 2005; Foster, Drew,
and Makufa 1995). Many caregivers are either too old or too young to adequately care for
orphaned children, and many orphans leave their foster families to become street children.
Strategic thinkers are sending alarming messages that the traditional system is collapsing
and will no longer be able to care for all the children (Foster 2000).
Institutional care is an alternative to provide care for orphans when kinship care is
unavailable. But several studies suggest that early institutionalization increases the risk for
psychosocial and developmental problems, including attachment disorders and deficits in
cognitive functioning (Sigal et al. 2003; Makame, Ani, and Grantham-McGregor 2002;
Castle et al. 1999). Such adverse outcomes, together with scandals concerning the coercion
of biological parents and child abuse, motivated industrialized countries to close down
orphanages after World War II (McKenzie 1999; Wiener 1998) while in Africa,
institutional care is still common. Nowadays, there are two trends of thought about
institutional care.
The first trend argues that institutional care should never be considered because other
care options are available. This position is rooted in the evidence of the developmental
problems mentioned above and the psychoanalytic theories that emphasize the importance
of early mother�infant bonds for child development (Wiener 1998). Another drawback of
orphanages is the higher cost of care compared to child fosterage (Bhargava and Bigombe
2003; McKenzie 1999). Therefore, experts and international agencies have called for the
abandonment of institutional care in favor of investing in the traditional systems (Chirwa
2002). They claim that communities are developing adaptive mechanisms that can continue
to care for most orphans. So, one can use community-based organizations (CBOs) to
strengthen existing networks and empower community efforts by providing financial
assistance (Evans 2005; UNAIDS 2001). Some authors advocate for recruitment of
community volunteers who will identify, support, and supervise vulnerable families who
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are caring for orphans as observed in Uganda (Lee et al. 2002; Drew, Makufa, and Foster
1998).
On the contrary, the second trend of thought is more pessimistic and calls for
immediate actions to address the increasing burden of orphanhood. Although they do
agree with the primacy of child fosterage, partisans of this position believe that the
extended family has failed (Zimmerman 2005; McKenzie 1999). The following facts seem
to corroborate this situation: many orphans in foster families are suffering from
discrimination, deprivation, exclusion, hard treatment, and illnesses as compared to
biological children (Oni 1995; Castle 1995; Bledsoe, Ewbank, and Isiugo-Abanihe 1988);
community restructuring and coping mechanisms are in progress and will take years to
achieve, while orphans are hungry, dying, or becoming street children (Zimmerman 2005).
In addition, caution must be observed in generalizing findings because the situation may
vary between countries. For example, Zimmerman (2005) observed that orphanage care is
a better way to meet the maximum number of needs for a large group of Malawian orphans
in the most efficient manner. McKenzie (1997) found that some orphanage alumni
experienced positive outcomes on socioeconomic status compared to the general
population, suggesting that institutionalization is not always negative. Wolff and Fesseha
(1999) have shown that an institutional setting that encourages close personal ties with
caregivers reduced the more serious psychological disorders of Eritrean war orphans.Some authors identified limitations of the studies: there are insufficient follow-up data
comparing developmental indices of African institutionalized orphans with family fostered
or adopted children (Zimmerman 2005); most of the existing data are not adjusted for the
child’s age at time of placement and his experiences prior to institutionalization, which
may influence the child’s behavioral adaptabilities (McCall 1999). Zimmerman (2005)
insists on the necessity of saving many highly vulnerable children and advocates for
realistic, practical and immediately feasible solutions, which include orphanages that may
play an important role in alleviating most of the problems African orphans and
communities are facing.
From these dichotomous positions, it appears that when a loving foster family is
available, no one would ever propose the institutionalization of children. Unfortunately,
the availability and effectiveness of foster care, the circumstances for placement, the care
conditions in the institution, and the general socio-cultural context may vary greatly across
and within a country. Therefore, we believe that generalizing institutional care as always
negative is to be avoided at all cost as it is exaggerated. Findings from Eritrea (Wolff and
Fasseha 1998), Malawi (Zimmerman 2005), and the United States (McKenzie 1997) have
demonstrated that institutional care might have beneficial effects, while orphans fostered
with relatives often become second-rank children, often are not attending school, and may
have difficulties receiving health care (Christiansen 2003). In addition, the African context
is characterized by high rates of adult mortality (due to AIDS and other causes), poverty,
famine, cultural transitions, and other challenges. These changing patterns affect
community structures and responsibilities that are evolving over time and may impede
the effectiveness of strengthening and empowering relatives and community members
(Abebe and Aase 2007; Oleke, Blystad, and Rekdal 2005; Madhavan 2004; Nyambedha,
Wandibba, and Aagaard-Hansen 2003). Finally, modern theories consider that child
development goes beyond the mother�child bonds and takes place through processes of
interactions between an active child and its environment (Thomas and Michel 1998).
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Bronfenbrenner’s bioecological systems theory
Bronfenbrenner’s bioecological systems theory, also referred to as the Process�Person�Context�Time (PPCT) model, provides a useful theoretical framework for nursing,
pediatric, and educative techniques, and social work (Thomas and Michel 1998) to
analyze child development. This theory assumes that child development is a dynamic and
reciprocal process of interactions between individuals and a series of environmental
factors, both concrete and abstract. Indeed,
the interaction between factors in the child’s maturing biology, his/her immediate family/community environment, and the societal landscape fuels and steers his development. Changesor conflicts in any one layer will ripple throughout other layers. To study a child’s developmentthen, we must look not only at the child and his/her immediate environment, but also at theinteraction of the larger environment as well. (Parquette and Ryan 2001, 1)
Bronfenbrenner’s framework includes four ecological levels, with bi-directional and
reciprocal influences within and between the systems:
. microsystem: interpersonal interactions between the child and his immediate
environments (family, school, peer group, childcare environments, etc.).. mesosystem: the interrelationships between two or more settings of the child’s
immediate environments (home, day-care center, schools).
. exosystem: external environmental settings that only indirectly affect development
(parent’s workplace, school boards, social service agencies, etc.).
. macrosystem: the larger social and cultural context (culture, subculture, economy,
war, technological changes or other broader social context, etc.).
Methods
Study location
The survey took place in the village of Guilongou (Province of Oubritenga), approximately
40 km north of Ouagadougou, the capital of Burkina Faso. Burkina Faso is a landlocked
country in western Africa with a population estimated at 13.7 million in 2006 (Institut
National de la Statistique et de la Demographie 2007). Due to its limited natural resources,
the country is one of the poorest in the world. In 2007, the human development index was
0.370, and 46.4% of individuals lived with less than the national poverty threshold,
estimated at $150 per year (PNUD 2007). This poverty results in difficult access to basic
social services, unemployment, illiteracy, malnutrition, and high mortality rates (Institut
National de la Statistique et de la Demographie 2005).
Demographic data collection
Data were gathered using a variety of methods in order to collect both quantitative and
qualitative information from program operators and caregivers. These methods included
individual interviews, field observations, and a structured questionnaire. The first part of
the questionnaire was administered to the supervisor and intended to capture information
on the program history, background, and functioning. In the second part, the following
demographic data regarding children were requested from caregivers: age, sex, village and
province of origin, date of admission, reason of placement, relation to caregiver, living
status of parents, and school attendance. Age, education level, marital status, and parity of
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caregivers also were recorded. Family living conditions (meals, access to health care, nature
of lodging, interactions and ties between family members) were assessed by field
observations and interviews.
An orphan was defined as a child less than 17 years old who had lost her/his father,
mother, or both parents andwas categorized either as a paternal, maternal, or double orphan.
An AIDS orphan was defined as a child who had lost one or both parents because of AIDS.
Assessment of nutritional status
Nutritional status is recognized as an inexpensive and valuable indicator of health status
and can reflect overall social well-being of individuals and populations in emergency
(World Health Organization (WHO 1995a; Pelletier 1994). We assessed the nutritional
status of children using simple anthropometric parameters such as age, weight, and height/
length. Weight and height were measured by means of standard techniques for children
wearing no shoes and light clothes. Measurements were used to calculate three z-scores
including weight-for-height/length (WHZ), height/length-for-age (HAZ), and weight-for-
age (WAZ) using the growth standards (WHO 1995b). The z-score is a measure of the
width of distribution of an index (e.g., weight) around the mean and indicates how many
standard deviations (SD) it is distant from the median of the reference population. By
convention, children with a z-score of less than 2 SD below the median of the reference
population are malnourished (WHO 1995b). Stunting (HAZ) measures how tall or short
the child is in relation to age. It reflects long-term food shortages and is indicative of the
child’s overall well-being.
Results
Rationale and objectives of the program
According to the managerial staff, the group foster homes program is a humanitarian
initiative that aims to (1) care for orphaned and vulnerable children by ensuring their
material needs (clothes, foods, health care), (2) offer rehabilitation and a familial
environment for orphaned and abandoned children, and (3) provide the orphans and
abandoned children with a moral, intellectual, and spiritual education.
Before the establishment of the group foster homes, orphaned and vulnerable children
in need of care were initially fostered to surrounding families that received financial
support from the congregation. But difficulties appeared quickly. First, the number of
children increased. Second, in the context of extreme long-term poverty, the financial
support from the congregation was used by foster families for purposes other than the
children’s needs. Third, many foster children suffered from harsh treatment, their rights
were violated in various ways, and they had to face stigmatization and discrimination.
Finally, the cost of care increased without improvement in the well-being of the children.
As the number of children in need of care was growing, it was decided in 2002 to
reunite children placed in surrounding families within group foster homes. Female
caregivers were hired from the community and allocated an individual house and resources
on the congregation property. Together with non-relative children in need of care, and
coming from different villages, they formed family units.The flow chart of the overall process of the program is presented in Figure 1. Children
are referred to the SIC congregation by the regional office of social welfare, the police, a
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relative of the child, a relative of the congregation’s nuns, or any person in the community.
After a preliminary investigation, the manager decides whether or not the child will be
accepted in a foster home. At registration, available demographic information of the
children is checked and registered. Afterwards, the child is placed with a caregiver and
integrated into the family where he/she will stay until the child leaves the home.
Characteristics of children and their families
Characteristics of children are presented in Table 1. From its opening in October 2002 to
March 2006, 131 children were admitted to the orphanage. There were 47 non-orphans and
72 orphans. The status of some children (N�12) was considered unknown, because at
Congrégation des Sœurs de l’Immaculée Conception de
Ouagadougou
Orphans- maternal - paternal- both parents
Other vulnerable children- abandoned- disabled parents- socio-culturally unwanted
Regional office of Ministry of Social Welfare and
National Solidarity
InvestigationsVillage homes
- birth certificate- health booklet- material needs - nutritional and health care - advices and education - familial environment: parenting,
interaction with peers, socialization
Adoption- national- international
Fostering- extended family
members - academic purpose
Family reunification
Police
ChurchSchool
Traditional events
Community
Figure 1. Flow chart of the overall process of the program.
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least one of their parents was not identified, and it was not known whether the parent was
alive or dead. The AIDS orphans were estimated to represent 16.7% of the orphans. The
mean age, at entry into the orphanage, was 27.4 months, and most (85%) were admitted
before their fourth birthday. Twelve children had at least one unidentified parent, and the
ethnicity was declared undetermined for seven of them, because in Burkina Faso, most of
the ethnic groups function on the basis of patriarchy. Thus, when the father of a child is
unknown, it is assumed that his ethnicity is unknown.
An orphan was placed in the orphanage when he/she had lost (1) both his/her parents
at an early age, (2) his/her mother at an early age and there were no relatives to offer care,
or (3) the one living parent was sick or was unable to care for the child due to extreme
poverty. Parental disability such as physical disability (3.1%), elderly father (�65 years,
1.5%), and extreme poverty (10.7%) also led to orphanage placement. Parental illnesses
included mental disability (12.2%), epilepsy (1.5%), and dementia (0.8%). Of the culturally
unwanted children, four were from adulterous relationships, two from incestuous
relationships and two were twins. The fathers were absent for a long period due to
cultural constraints, and the mothers were unable to care for the children.The main characteristics of the group foster families are summarized in Table 2. The
mean family size was 7.3 persons. The caregiver to child ratio was about 1:6, and an
average of 3.7 children per family were less than five years old. Each family was headed by
a woman because, in Burkina Faso, women have the responsibility to care for children and
Table 1. Profile of children admitted to village homes (N�131).
Characteristic No. of children %
Gender
Male 66 50.4
Female 65 49.6
Age
BFive years 84 64.1
]Five years 41 31.3
Unknown birthday 6 4.6
Ethnicity
Mossi 108 82.4
Others 11 8.4
Unknown (at least one parent unknown) 12 9.2
Parent vital status
Non-orphans 47 35.9
Orphans 72 54.9
Maternal orphans 41 31.3
Paternal orphans 16 12.2
Double orphans 15 11.4
Unknown (at least one parent unknown) 12 9.2
Reason of placement
Orphanhood alone 57 43.5
Caregiver child 20 15.3
Parent disability 20 15.3
Parent illness 19 14.5
Cultural constraints 10 7.6
Abandoned child (unknown parents) 5 3.8
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restore normal life. All caregivers were able to read and write French or Moore, a local
language.
Material living conditions
Families had access to proper hygiene facilities and to safe drinking water, which were
provided by two well holes. Each child had a health record booklet and was able to easily
access health care when sick. Basic needs such as food, clothing, and health care costs were
provided by external NGOs and individual sponsoring. During the rainy season, they grew
cereals (maize and sorghum), peanuts, and legumes. There were plans to build shops and a
rural restaurant and to develop market gardening and pig breeding in order to provide
additional income. Another planned project is the construction of preschool and primary
schools. The congregation of SIC provides additional support and was involved in all
decisions affecting the children.
Although children older than 10 years of age helped their caregivers in activities such as
washing, keeping young children, and cleaning their young brothers or sisters, they did not
participate in heavy workloads such as cooking, carrying water or wood on their head, and
so forth, as is currently the practice in rural Burkina Faso. Also, there seems to be no
preference given between caregivers’ children and the other children for involvement in
different activities. Interestingly, boys sometimes participated in duties that are generally
specific to girls in this area. We did not observe or hear of cases of outside work for extra
income.
Nutritional status
The overall nutritional status was determined to be poor, because the mean z-scores were
negative, and the prevalence of wasting (WHZB�2), stunting (HAZB�2), and
underweight (WAZB�2) were 19, 32, and 26%, respectively (Table 3). The higher
Table 2. Characteristic of families of the group foster homes (N�15).
Characteristic No. of children (%) Mean (min, max)
Caregivers
Marital status of caregivers
Widowed 10 (66.7)
Divorced 2 (13.3)
Unmarried 2 (13.3)
Cultural constraint 1 (6.7)
Caregivers education (number)
BPrimary 3 (20)
Primary 4 (26.7)
Secondary school 5 (33.3)
Adult literacy 3 (20)
Family composition
Number of children per family 6.9 (4, 9)
Number of children under five years 3.7 (2, 5)
Village of origin 5.6 (3, 8)
Province of origin 3.8 (2, 6)
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prevalence of wasting (35.7%) was observed for children aged 0�11 months, whereas
children aged 12�23 months were rather stunted (42.9%) and underweight (42.9%).
Social organization and educational development
This program tried to keep the children’s living conditions as close as possible to a family-
type arrangement. The duties of caregivers included all aspects related to child care that a
normal mother would provide such as daily housekeeping, nutritional and health care,
advice, psycho-emotional care, and other types of nurturance. Children and caregivers ate
together from a communal dish placed in the center. Children had a sense of ownership and
developed a bond with their caregiver and sibling relationships that seemed positive
and secure. Indeed, most of the children considered their caregivers as their real mothers
and were close to the women. Also, children of the same caregiver treated one another as
brothers and sisters. When a child was afflicted, he was more easily consoled by a family
member than by anyone else. Familial solidarity also appeared when there was a quarrel
between children of different families. Children of the same family tended to take the side of
their brothers and sisters. In these group foster homes, we did not see any apparent
stigmatization or exclusion.Regarding school attendance, 37 (28%) children admitted to the orphanage ranged in
age from 6 to 13 years old, and 94.6% (N�35) of them attended school. Girls and boys
had the same opportunity to access education. For young children (2�5 years), a preschool
opportunity was offered. The tutor of preschool activities was often a staff member, one of
the caregivers with a relatively high education level (at least secondary III), or a volunteer
from a local NGO. Preschool activities, aimed at increasing the physical, social, and
educational behaviors of children, were offered to children aged 2�6 years. Children had
ample time for leisure activities, and they took pleasure in interacting and playing together.
In Burkina Faso, there are three major religious groups: Muslim (52%), Christian
(18%), and traditional religions (26%) (MAECR 2008). Many people are Christian or
Muslim but hold beliefs that sometimes are close to the traditional religion (animism).
There was neither religious, nor ethnic or geographical discrimination for admission in
foster homes. After admission, each child conserved his identity when it was known (name,
Table 3. Nutritional status of the children (N�69).
Indicators Mean (SD) % (CI95%)
Age (months) 52.40 (3.53)
Weight-for-height z-score (WHZ) �0.90 (1.29)
B�3 7.2 (0.4, 14.1)
B�2 18.8 (8.9, 28.8)
Height-for-age z-score (HAZ) �1.58 (1.17)
B�3 10.1 (2.3, 18.0)
B�2 31.9 (20.2, 42.6)
Weight-for-age z-score (WAZ) �1.55 (1.03)
B�3 10.1 (2.3, 18.0)
B�3 26.1 (15.0, 37.2)
WAZ is a measure of the child’s weight in relation to age. HAZ is a measure of how tall or short the child is inrelation to age. WHZ is a measure of how thin or fat a child is compared to height.
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ethnicity). However, all the children were provided with Christian moral and spiritual
education. After they leave the foster home, they will be free to choose their own religion.
Connection with relatives and community
During their stay in the village homes, children whose biological parents or relatives were
identified kept in close contact with them. The biological parent or a relative must visit
regularly the child in the foster home. Also, children aged two years or older were eligible
for a one-month holiday per year to stay with relatives. The aim of this process was togradually prepare children to integrate into a community later, upon leaving the foster
home. Also, children interacted with other children at school, at church, and at catechism
classes.
Discussion
The environment in which children grow up is an important predictor of their adult
outcome and their ability to have a productive life. Because orphaned and abandonedchildren are at an increased risk of material vulnerability and psychological distress,
institutional care can play an important role in alleviating some of the problems related to
orphanhood.
In the present study, the AIDS orphans represented 16.7% of the orphans. This ratio is
comparable to the results of the Demographic and Health Survey (Institut National de la
Statistique et de la Demographie 2004) and confirms that the AIDS epidemic has
contributed to the orphanhood crisis in Burkina Faso. Overall, 36% of children were non-
orphans, and only 11% were double orphans. This observation suggests that orphan statusitself is not the only factor that leads to institutional placement. Admission to group foster
homes was associated with parent disabilities (poverty and illnesses), child abandonment,
and pressure of customs. The high proportion of non-orphans and single parentless
children also indicate that failure of the extended family to care for orphans in Burkina
Faso is probably not due to the increase in the number of orphans only, but also to social
changes, including modification of family structure, decline of solidarity, and changes in
traditional practices.
Eleven percent of children (culturally unwanted) were placed in village homes becauseof unknown parents or cultural constraints. Among the Mossi, the most important ethnic
group in Burkina Faso, unwanted pregnancy (resulting from an unmarried woman in an
incestuous or adulterous relationship) tarnishes and dishonors the family. However, such
pregnancies are common, due to ignorance and lack of contraceptive use. In some cases,
the child is killed, and this practice is glorified by traditional rules and customs in order to
preserve social values. Sometimes the pregnant woman is banished by her family, or the
family is stigmatized, particularly in a rural area. Indeed, according to a Mossi custom
leader, ‘in traditional community where marriage is an arrangement between severalfamilies, divorce does not exist. Therefore, children from two-timing must be eliminated in
order to ensure the pureness of lineage because each child pertains to one clan’ (Sore 2007,
12�13). According to the author, other reasons can lead to infanticide such as breech birth,
a child who is born albino, the birth of twins, children from incest, children from
unmarried girls, children who do not cry at birth, and other situations that may seem
‘abnormal’ from a traditional perspective (Sore 2007). In such situations, child
institutionalization aims to avoid stigmatization of the mother or the death of the child.
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Families had access to adequate services. According to the Institut National de la
Statistique et de la Demographie (2004), many households in Burkina Faso (69%) had no
toilets in their houses. The living standards of these children seem to be higher than the
average children of Burkina Faso. As a result, the nutritional and health status in terms of
stunting (31% versus 39%) were better compared to the average of the country’s children
reported by a demographic and health survey (Institut National de la Statistique et de la
Demographie 2004). However, despite this relatively positive status, malnutrition is a
public health problem. Indeed, in the reference population, 2.5% of the children should be
below two standard deviations of the z-score, and when this proportion reaches 15%,
nutritional status is considered critical (WHO 1995b). The second of The Lancet’s series on
child development has shown that nutrient deficiencies (stunting, iodine and iron
deficiencies) and inadequate emotional stimulation are the key factors that contribute to
adverse developmental outcomes (Walker et al. 2007). Therefore, integrating an appro-
priate nutrition program can improve the well-being of the children.
The main criticism of orphanages is their inability to meet children’s psychological and
long-term needs (Makame, Ani, and Grantham-McGregor 2002; Drew, Makufa, and
Foster 1998). Because our study was not designed for this, we were unable to measure the
impacts of the program on psychosocial and developmental outcomes of children
compared to other care options. However, it is important to mention that most of the
institutions evaluated in studies critical of orphanages were not based on the familial
environment characterized by close relationships between members. The case study in
Eritrea, for example, suggested that the psychosocial disorders in care institutions
depended on the management style and the children’s relationships with the staff (Wolff
and Fasseha 1999), and that western-styled institutions were less effective in comparison to
the village’s homes.
It is also important to keep in mind that the main concern in caring for vulnerable
children is the overall developmental outcomes. In addition to the risk factors mentioned
above (inadequate emotional stimulation, stunting, iodine and iron deficiencies), Walker et
al. (2007) also established evidence of risks with social conditions (maternal depression,
exposure to domestic and community violence, lack of support, orphanhood or stigma,
negative life events), environmental factors (lead and arsenic), and some infectious
diseases. Poverty also has been associated with poor cognitive and educational perfor-
mance in children (Grantham-McGregor et al. 2007); hunger and not attending school
were reported by orphans as a source of internalizing problems (Makame, Ani, and
Grantham-McGregor 2002). Therefore, because the program referred to in the current
study adequately ensured material needs and created familial environment, lower
psychosocial problems should be expected compared to routine institutional care.
Material needs, including food, clothes, health care, and school fees are met. Also,
nutritional status that is indicative of overall well-being seems to be better than the average
of children in Burkina Faso. The body supports life, and provides a mobility system and
the means by which the child perceives and interacts with its environment, so that
maintaining the health of the body is lifesaving. Good health requires adequate nutrition
and hygiene, disease prevention or treatment, and leisure activities (Parquette and Ryan
2001). The third of The Lancet’s series found that the most effective strategies that
can prevent or ameliorate the loss of developmental potential for children should aim to
improve the survival, health, nutrition, cognition, and education of children (Engle et al.
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2007). According to Bronfenbrenner’s bioecological systems theory, child development
arises from cumulative and interactive effects of many factors related not only to
psychosocial conditions, but also to economic, biological, and environmental factors
(Thomas and Michel 1998). All factors mentioned by Engle et al. (2007) are related to the
child’s proximal environment and the ‘proximal processes are posited as the primary
engines of development’ (Bronfenbrenner and Morris 1998, 996). Indeed, if the relation-
ships among the subsystems breakdown at this level, the child will not have the tools
necessary to explore other parts of his environment.
In the program, caregivers are hired from the community on the basis of defined skills
so that they can provide daily care to children, as well as emotional support and stable
parenting. They also receive training on child care practices, food preparation, and
hygiene. They are supervised and provided with technical skills (training), as well as
material and psychological support from the congregation’s staff, thus improving their
sensitivity and increasing responsibility. These processes might reduce the incidence of
household poverty and prevent the detrimental factors related to the family such as
maternal depression, maternal exposure to violence, and environmental hazards (heavy
metals and infection). So the familial environment created for children is adequate for a
harmonious development, because many of the personal characteristics of the child such as
language, behavior, and beliefs are all developed through the input and behavior-related
feedback within the family (Bronfenbrenner and Morris 1998).
Children in this program benefit from preschool or school opportunity. School
provides the opportunity for academic learning and sport activities, as well as for
extracurricular unstructured relationships with other children. The extracurricular
activities are beneficial for children to learn about social games, rules, and functioning,
and offer an opportunity for them to practice their social skills (Parrila et al. 2002). School
also can create confident relationships between schoolchild and teacher, a relationship that
might nurture families.
Interaction between the community, the SIC, and the church influences the family
functioning through societal values, rules, and legislation within the mesosystem and the
exosystem, thereby indirectly affecting the child. Some subsystems might also affect the
child’s psychological well-being. Indeed, findings suggested that spiritual and religious
commitment may enhance mental health and protect against behavioral disorders (Sigal et
al. 2003). Similarly, participating in community activities and attending school might
reduce the child’s isolation and adverse behavioral outcomes. Also, the continuities and
changes occurring in the child’s environment over time, for example, the influences of
media (television) and the visits of foreign persons (sponsors, NGO staff), influence
families and children.
In summary, the village home-based program has an impact on most of the subsystems
within the microsystem, which is the primary determinant of child development. Each of
the four systems of the model is also considered by the program, with an emphasis on their
interrelatedness. Therefore, when analyzed within the framework of Bronfenbrenner’s
model, this program could be a relevant alternative in a context where foster care is
overwhelmed. However, some potential deficiencies have been identified that may hamper
the program’s effectiveness. The first insufficiency is the lack of a validated evaluation tool
to assess whether the child is really in need of placement and to assess his specific needs at
entrance. The second limitation is the lack of qualified staff such as social workers and
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psychosocial counselors. The presence of such staff could help with assessing and
monitoring the psychological behaviors of children after admission and with intervening,
if necessary. The third challenge of the program is how best to promote the reintegration of
the children into the community.
The study itself is limited, because the findings cannot be generalized. The sufficient
resources allocated to the families by the congregation limit the extension of this approach
in conditions of restricted resources. Another limitation of the study is the lack of
information on the reinsertion outcomes due to the newness of the program. The study is
also limited by the absence of children’s voices on parenting quality and the perceptions of
their futures. It is essential to understand how children experience their orphan status
outside the village homes (school, church, and community), how the other community
members perceive them, and how efficient the reinsertion process is. Because the study
design did not enable us to assess the psychological outcomes of this program, further
research, including longitudinal studies, is needed to assess the cognitive development,
school performances, and psychosocial behaviors of these children.
Policy implications
Despite its potential deficiencies, the group foster homes-based program has certain
policy implications. In terms of the United Nations Convention on the Rights of the
Child and on the perspectives of the Engle et al. (2007) framework and Bronfenbrenner’s
bioecological systems theory for child development, the program has the potential to
fulfill the developmental needs of vulnerable children in low-resource conditions. The
international community advocates for the abandonment of orphanages, in favor of
supporting community-based interventions. Indubitably, the family kinships approach
remains the best option to care for vulnerable children and has to be promoted and
empowered. However, the question must be posed as to how to adequately achieve this
goal in a continuously changing society. All the changes due to social transition and
economic crisis are probably not completely reversible. We agree with Zimmermann
(2005) that supporting the capability of communities, households, and their coping
mechanisms will take more time to achieve while many orphans are waiting for urgent
solutions.We should also mention the fact that the situation is not consistent across cases, and it
has been reported that even fostered children may continue to experience psychosocial
problems (Sengendo and Nambi 1997). Therefore, one has to keep in mind that inadequate
material and physiological needs (food, health, housing, etc.) can be life threatening and
are more pressing than psychological needs (Foster 2000). We also agree with Zimmerman
(2005) and Gibbons (2005) that in situations where foster care is not always realistic, due to
some traditional beliefs and other circumstances, institutional care is a chance for the
survival of many orphans who may otherwise die. It is certainly not the best solution, but
we cannot deny the great contribution of such care for the survival of thousands of
orphans across Africa. Institutional care is not a new phenomenon in Africa, and we
believe that it is likely to continue to exist for a long time. Depending on the magnitude of
the problem, institutional care should continue to be part of the solution for some children.
Therefore, it is important, while looking for solutions to assist and strengthen community
efforts to care for orphans, to think of how best institutions should be organized in order to
reduce psychological problems.
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Our findings suggest that it is possible to establish small group foster families that
combine institutional and family networks. Such settings can create a familial environment
and stable relationships between children and caregivers and between children and their
peers, thus enhancing interactions within the community and preparing children for social
life in the community. In Burkina Faso, the number of orphanages is increasing.
Throughout sub-Saharan Africa, many humanitarian NGOs such as SOS-Kinderdorf
International, Orphan Aid Africa, Orphanages for Africa, and Kids Home International
are caring for many children through institutions (orphanages, children’s village, villagehomes). They might learn from this rural program of a Christian community-based
organization, particularly in terms of the household settings, management style, parenting,
and connections with relatives and community.
Follow-up investigations on the psychosocial outcomes of the variety of institutional
settings are needed, because most studies published are cross-sectional and have examined
orphanages of the traditional type. Indeed, the structure and the management style of
orphanages are evolving in order to accommodate the social context of the community.
Such innovative approaches in institutional care may induce different psychosocialoutcomes compared to traditional orphanages (Wolff and Fasseha 1998). The duration
and the conditions of institutionalization, the quality of parenting, the post-institution
environment, and the child’s individual experiences also may influence the psychosocial
adaptation.
Acknowledgements
The study was funded by the Canadian International Development Agency, through the ‘ProgrammeCanadien des Bourses de la Francophonie,’ the International Office of Laval University, and theNational Public Health Laboratory of Burkina Faso. We are grateful to the children and theircaregivers, who enthusiastically participated in the study, and also to the staff of the congregation ofSoeurs de l’Immaculee Conception de Ouagadougou, who authorized the study.
Notes on contributors
Dia Sanou, MSc, is a food scientist at National Public Health Laboratory, Ministry of Health(Burkina Faso). He is currently a PhD candidate in nutrition at Laval University where he hasworked on a dietary intervention to improve iron status of preschool orphans and vulnerable childrenin Burkina Faso. Mr Sanou’s current and future research interests also include aboriginal childnutrition, ecological approaches and community-based participatory strategies to understanding andimproving the nutrition and health status of children.
Huguette Turgeon-O’Brien, DtP, PhD, is professor of human nutrition and Director of the master’sand doctoral studies program at Laval University. Her primary research interest is in the area of ironstatus of different subgroups of the population. She is presently involved in researches in Morocco,Benin, Burkina Faso, and Northern Canada, mainly on the effects of bioavailable dietary iron on ironstatus and parasitic infections.
Sayouba Ouedraogo, PhD, is a postdoctoral fellow at the University of Quebec in Outaouais,Quebec. He is a research associate at the School of Social Service, Laval University, where he ismember of the Center of Research on Social Innovations (CRISES). His research and teaching areasinclude community and rural organizations, social movements (protest movements), poverty,methods in social sciences and qualitative research.
Therese Desrosiers, DtP, PhD, is Professor of Human Nutrition and Director of a distance learningprogram in Food and Nutrition at Laval University, Quebec. She has a special interest in developing
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applied research aiming to improve the nutritional status of vulnerable children in developingcountries and has published in the areas of anemia, mineral bioavailability and complementary foods.She plans and supervises multicultural and interdisciplinary professional field training in BurkinaFaso. Dr Desrosiers has a lot of experience with international adoption of children from variouscountries.
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