Using Data to Advance Reform of the Child Care System: Lessons Learned in Uganda By Ismael Ddumba-Nyanzi and Lisa Parker, Data for Impact (D4I) Photo by Robin Yamaguchi. Every child has the right to grow up in a supportive family environment. However, in Uganda, millions of children have been separated or are at risk of being separated from their families. An estimated 50,000 children live in residential care (also referred to as orphanages or children’s homes), although more than two-thirds of the children in residential care have at least one living parent.[1] One of the main reasons they are placed in institutional care is poverty and conditions attributable to poverty. The detrimental effects of institutional care on a child’s well-being are widely documented. Children who grow up in these institutions have worse development outcomes―for example, are more likely to suffer from poor health, developmental delay, and emotional attachment disorders―than children in family-based care. Children in institutional care also face a significantly increased risk of sexual and physical abuse, a lack of stimulation, and harsh discipline. Notwithstanding, the number of children’s homes in Uganda has grown steadily over the last decade; from an estimated 35 in the mid-1990s to more than 500. Over the last decade, in line with the 2009 United Nations Guidelines for the Alternative Care of Children, the Ugandan Ministry of Gender, Labour, and Social Development (MGLSD) has made efforts to reform the care system to ensure appropriate care for children without adequate parental care. A National Framework for Alternative Care (NFAC) was developed in 2012 to provide overarching guidance on processes, structures, and services for children at risk of separation or in need of alternative care. Identifying gaps and prioritizing needs in care reform In 2017, the United States Agency for International Development’s (USAID) Displaced Children and Orphans Fund (DCOF) supported the MGLSD to implement a structured assessment with MEASURE Evaluation of the national care system in line with the United Nations Alternative Care Guidelines. The assessment identified gaps and helped the MGLSD prioritize continuing needs in care reform.[2] Simply put, Uganda lacked a functioning monitoring and evaluation (M&E) system to collect routine data on alternative care. Consequently, there were no quality, reliable administrative data that could inform decision making either at the national or district level. In addition, there was little demand for data, especially from the national level, which dampened interest at lower levels for collecting and reporting data. Enhancing the generation and use of data Today, in the context of ongoing reforms, there is an identified need for a strong M&E system that provides timely, reliable, and accurate data and information on children in alternative care. With support from USAID, the Data for Impact (D4I) project is working with the MGLSD to strengthen the collection, management, analysis, and use of routine data to improve the provision of appropriate alternative care services for children without parental care in Uganda. Our ultimate aim is to ensure that children grow up in safe, nurturing, and stable family environments. D4I activities in Uganda focus on rolling out the guidelines for routine monitoring of formal care in nine priority districts. This involves training and mentorship to district probational and social welfare officers (PSWOs) and children’s home wardens and social workers on the use of the different data management tools. D4I also works to promote a culture of data use at district and national levels through the institutionalization of data review processes and tools. Since 2020, we have been organizing meetings every six months to review data with all the stakeholders at national and pilot district levels (decision makers, data users, and data producers). The meetings serve as a forum to review available data, assess the quality of those data, and interpret findings to identify priority areas for action. At the district level, the meetings include representatives from children’s homes and district local government staff such as PSWOs. At the national level, the meetings involve PSWOs and community development officers from selected pilot districts and technical staff from the MGLSD’s Department of Youth and Children Affairs (DYCA), the Policy and Planning Unit, and the Information Technology Unit. D4I provides guidance on meeting structure, indicators, pre-meeting preparation, meeting facilitation, and follow-up on recommendations for action after the meeting. What difference did these data reviews make? In one data review meeting, for example, after viewing data visualizations, participants noted that a large proportion of children were without valid care plans, particularly those in unapproved children’s homes, and proposed increasing capacity-building efforts for social workers on case planning. At the national level in another data review meeting, participants reviewed the age profile of children in residential care and saw that children under three were still being placed in residential instead of family-based care—contrary to existing national and international guidance. In yet another review, it became apparent that a large proportion of young adults ages 18 and older were still living in residential care, raising concerns about how children in care are prepared for and supported to leave care. Each data review meeting resulted in a prioritized action plan outlining specific data-informed actions to address problem areas, roles and responsibilities, timelines, and processes for tracking progress on action plans after the meeting. How can quality data make a difference to improve outcomes for children without parental care? What have we learned? People can collect the data, but they do not make meaningful use of it until there is the realization at the national and district levels of the value data can add. Without pressure from the top, sometimes reporting units are reluctant to collect and make sense of these data. Fortunately, as the processes and systems of M&E and data use were institutionalized, we observed a general improvement in data literacy and a growing appreciation of the value of data at the national and district level―an appreciation that data could play a role in decisions on care reform and the potential for this work to be expanded beyond the pilot districts targeted by D4I. Data is central to the reform process These interventions also had an important practical outcome. With the increased collection and reporting of data in combination with the data review meetings and the frequent engagement with stakeholders at multiple levels, the government has recently allocated new financial resources for child care reform, including funds for the MGLSD to provide oversight and monitoring of alternative care provision. For example, since the start of FY 2020/21, UGX 14 million (USD$3,200) has been released to National Alternative Care Implementation Unit (NACIU) on a quarterly basis to support assessment and inspection of children’s homes across the country. This investment will provide an opportunity for the MGLSD to have some sustainable funding from the government for the next couple of years. Ismael Ddumba-Nyanzi is a child protection monitoring, evaluation, and research specialist, with a particular interest in alternative care for children, family reintegration, and prevention of family-child separation. He is a Resident Advisor for Palladium on the USAID-funded D4I project, based in Kampala, Uganda. His most recent work includes facilitating the participatory care reform assessment process and supporting Uganda’s Ministry of Gender, Labour and Social Development to strengthen the collection, management, and use of routine data to improve the provision of alternative care services in Uganda. Dr. Lisa Parker has 15 years of experience strengthening data and systems for planning, monitoring, evaluating, and assuring the quality of programs for women, infants, children and youth, and ensuring that national and sub-national health management information systems are using validated data. In her current role as Director, Measurement and Learning, for Data, Informatics and Analytical Solutions at Palladium, she serves as Project Director for the PEPFAR-funded ACHIEVE project and oversees Data Strengthening activities under this mechanism and serves as activity lead for D4I’s Strengthening Collection, Management and Use of Quality Routine Data for Alternative Care in Uganda. [1]https://bettercarenetwork.org/sites/default/files/Child%20Care%20Institutions%20in%20Selected%20Districts%20in%20Uganda%20and%20the%20Situation%20of%20Children%20in%20Care.pdf [2] https://www.measureevaluation.org/resources/publications/tr-18-250
