Alternative Care
for Children in Uganda
A government and civil society partnership
to support the Alternative Care Framework

The Problem

There are millions of children in Uganda in desperate need of assistance to prevent separation from their families. There are also over 50,000 children already in alternative care, separated from their families.

The Ministry of Gender, Labour and Social Development (MoGLSD), supported by UNICEF, set up an Alternative Care Task Force in 2011 to investigate the state of childcare in Uganda and to develop a national Alternative Care Framework. Here are some of the findings.

The key issues and observations

  • Children recruited into institutions (commonly referred to as orphanages) in line with a 'vision' rather than the needs of the community
  • Very little will to resettle children when an organisation has a child sponsorship or international adoption are involved
  • Most children in the institutions assessed do have families and sometimes visited them
  • International adoption reduces efforts to find Ugandan solutions
  • Some institutions admitted donors not willing to fund resettlement activities
  • Record keeping, policies, procedures very limited
  • Many children available for International Adoption are from the Makindye area
  • 'Pastors' often ill-equipped and unskilled to deliver quality child care services
  • Standards vary greatly - saw magnificent facilities but also appalling conditions
  • Social work not taken seriously in most institutions
  • Some institutions cannot differentiate between boarding schools / orphanages
  • Limited awareness of the legal requirements, Children's Act or home regulations
  • Limited 'formal' engagement between district officials and institutions
  • Many parents abdicate parental responsibility to institutions thus removing the opportunity for their children to grow up in a family and community environment

There is mushrooming number of Baby and Children's Homes (current estimates 500+), which are removing children out of families and communities and placing them into institutional care facilities.

Key problems with institutional care

The effect of institutional care on children and society at large can be significant. Analytical epidemiological study designs (i.e., including a control/comparison group) show that young children placed in institutional care are at risk of harm in terms of attachment disorder and developmental delays in social, behavioural, and cognitive domains. Delays in physical growth, neural atrophy, and abnormal brain development have also been found.

The findings suggest that the lack of a one-to-one relationship with a primary caregiver is a major cause of harm to children in residential care. Evidence indicates that infants who are placed in institutional care will suffer harm to their development if they are not moved to family-based care by the age of six months.

Some effects on children brought up in institutional care include:

  • Attachment disorders and the inability to develop healthy relationships
  • Physical and psychological development delays
  • Low IQ's and educational delays
  • Post-traumatic stress resulting in high levels of depression
  • Poor 'cause-and-effect' resulting in bad decision and a lack of conscience
  • Poor self-regulations and high over-stimulation
  • Early sexualisation resulting in distorted and unhealthy and/or damaging sexual relationships and behaviours
  • Poor transitions and failure to cope effectively with change
  • Disconnection from Ugandan communities and culture making it increasingly difficult for post institutionalised children to live within a Ugandan community setting

In Wakiso it has been reported that three child care institutions are opening every month. In Jinja, where there are already over forty child care institutions, the district staff report that they are inundated with information about new homes which have previously not been known to them. Without immediate and decisive action Uganda could have more child care institutions per capita than any other African country.

Some statistics from the study

  • 80% of Homes are without a Child Protection Policy
  • 78% of Homes do not have MGLSD Approved Home Status
  • 62% of Homes are without any social work capacity
  • 52% of children are without a current Care Order
  • 52% of Homes are without any resettlement or alternative care programmes
  • 48% of Homes have poor or very poor child care standards
  • 40% of Homes do not have a current CBO or NGO certificate
  • 40% of Homes have an international adoption programme
  • 30% of Homes have major concerns (need extra investigations)
  • 25% of Homes resettle with birth parents or extended family
  • 22% of Homes have only an international adoption programme
  • 12% of Homes are recommended for immediate closure
  • 10% of Homes have (or are implementing) a foster care programme
  • 7% of Homes have an active Ugandan adoption programme
  • 7% of Homes have a Ugandan adoption and foster care programme but no international adoption programme

International Adoption

The 400% increase in international adoptions from Uganda from 2010 to 2011 outlines the growing demand for Ugandan children.

During the baseline study a number of child care institutions were identified which exist solely for the purposes of making children available for international adoption. In many cases these child care institutions were funded solely by international adoption agencies and evidence was found that children in those institutions had been procured from communities in order to be matched to the demographics demanded by foreign families.

In June 2012 the Netherlands informed the Ugandan government of their intentions to stop all adoptions from Uganda due to the level of corruption and bad practises involved in the international adoption process. This decision was made following a year-long process involving a number of delegations coming to Uganda to investigate the situation on the ground and meet with government officials.

The Alternative Care Framework includes an option for international adoption, but only after every effort has been made to reunite children with their parents or kin, or failing that, having tried domestic adoption.


There are funds coming into Uganda from civil society to respond to the crisis in childcare and there are many people willing to help. What stands across the road to progress is the fact that so many people are following different agendas and providing different and conflicting solutions.

One person's solution can create another person's problem. When we all support the same solution, we will make a real and lasting difference to the lives of the millions of children suffering and at risk.