The Oscar Study

The OSCAR Study

UNICEF estimates that there are 153 million children in the world who have lost or both parents. While the numbers of orphaned children have been decreasing in most regions of the world, they continue to rise in sub-Saharan Africa, partially due to the HIV/AIDS pandemic. ‘Separated children’ are those whose parents are effectively absent from their lives, in essence rendering them virtual orphans (of note, the definition of ‘separated children’ has evolved since our study started, to reflect the alarming number of children fleeing conflict in Syria and elsewhere, and who are unaccompanied by their parents or guardians).

The Orphaned and Separated Children’s Assessments Related to their (OSCAR’s) Health and Well-Being Study is designed to evaluate different types of care environments for orphaned and separated children and adolescents, and understand how their care environments affect their physical and mental health. In Phase II, we are collecting the costs associated with different care environments, in order to measure their cost-effectiveness.

The study is funded by the United States National Institutes of Child Health and Human Development (NICHD R01HD060478), and started in 2009 and will run until 2020. It consists of nearly 2500 orphaned and separated children and adolescents, aged 18 years or less at enrollment into the study. Roughly half are living in one of 18 Charitable Children’s Institutions (CCI’s) in Uasin Gishu county in western Kenya, such as orphanages and rescue centers, and half are living in extended (usually biological) family environments in one of six Locations in the county (half rural, half peri-urban). The cohort also includes 100 street-connected children and adolescents who continue to be followed today as a preliminary cohort of young people essentially representing a third model of care: self-care.

Why this study is important

Most families in sub-Saharan Africa are already caring for and/or supporting many children – their own, and children of relatives who are not able, for whatever reason. Most are living hand to mouth, day by day. Traditionally, orphaned children are cared for by the extended family. Grandmothers are caring for about half of all orphaned children, and as one grandmother said to us, ‘Love I give her, but food I don’t have. Orphans who stay with grandmothers are given a lot of love, but food is a problem.’

There is widespread evidence of intra-household discrimination against orphaned children – they are less likely to be enrolled in school, less likely to have basic material possessions, and generally have worse health outcomes than children living in the same households who are not orphaned. As a result, many children are living with family who either cannot, or do not want to, care for them.

To fill the gap, alternative care environments have sprung up – orphanages, rescue centers, community-based organizations, and both formal and informal fostering and adoption. In North America and Australia, Residential Schools did an unquantifiable amount of damage to the indigenous children who were forced to live there over many years. In Eastern Europe, state-run orphanages chained toddlers to cribs, essentially starved the children living there of food, love, and stimulation.

There is overwhelming evidence from these historical tragedies, all too reminiscent of Charles Dickens “Oliver Twist”, that institutions are bad for children. Yet, in the context of widespread extreme poverty, the AIDS epidemic which orphaned millions of children, and other trends like rapid urbanization, innovative and cost-effective solutions are needed to help care for the many children in need of love, material support, and protection.

The question we pose through this research is whether institutions are inherently bad for children. Is it possible that there could be contexts and situations in which institutions could be a safety net for vulnerable children? What are the alternatives for children whose families are unwilling or unable to care for them? These are the questions we are seeking answers to.

Our goal is to deliver evidence-based information about optimal and cost-effective environments for orphaned and separated children, in a context of a high HIV burden, and in the face of widespread extreme poverty. Through this we hope to inform policy about how to reduce vulnerability among, and improve support, the many children especially in sub-Saharan Africa, who are in urgent need.