March 2021
Spotlight on Care Reform in Kenya
“Being at home is the best for me because I learn some house chores from my grandmother and feel happy while playing with my siblings as opposed to being in the CCI [Charitable Children's Institution]”. 

- Girl recently reunified from a Charitable Children’s Home in Kisumu.
Introduction

This month’s issue of the Better Care Network newsletter is published in partnership with the Government of Kenya, the National Council for Children’s Services (NCCS), the Ministry of Labour and Social Protection, the Department of Children’s Services, and UNICEF Kenya, with support from Changing the Way We Care. It is presented in a more narrative format - featuring the voices of several key stakeholders, including those with lived experience of residential care - in order to tell the story of care reform efforts in Kenya. The issue highlights newly launched tools, guidance, and other documents developed by government and non-government actors and provides a platform for some of these key agencies and other individuals to reflect on aspects of care reform in Kenya and further unpack these critical resources. They call attention to particular areas of importance, including: the role of collaboration, government leadership, coordination during the COVID-19 pandemic, engaging care leavers in care reform, key learning from the rapid analysis of children returned home in Murang'a County during the pandemic, and awareness-raising efforts to promote family-based care. We hope that this special issue helps paint the picture of care reform in Kenya as these efforts are taking place - the achievements and the challenges - from the perspective of those who are creating change for children and families throughout the country.

Working Together to Reform Care in Kenya
by the Kenya National Council for Children’s Services, the Department of Children’s Services, UNICEF Kenya, and Changing the Way We Care
Together, the Government of Kenya, National Council for Children’s Services (NCCS), the Ministry of Labour and Social Protection, Department of Children’s Services (DCS), UNICEF Kenya, Changing the Way We CareSM, and many other partners collaborate on coordinated care reform in Kenya. This newsletter issue shares the story of change in Kenya with a focus on the role of coordination and collaboration to achieve this.

Ensuring children’s rights cannot be fully accomplished by one ministry, one organization, or even one sector working in isolation from others. Increasingly, we see the complexity of vulnerabilities for children and families and recognize that addressing multiple risks and building protective factors is best done within coordinated and integrated approaches. Policies, services and other interventions functioning in isolation, siloed by provider, geography, resource availability, etc. result in gaps. Coordination and collaboration involve governments, organizations and individuals working together to address problems and deliver outcomes that are not easily achieved by working alone. The benefits include the ability to contribute to cross-sector objectives and targets; resource efficiencies; increased visibility of the issue; more opportunities to address underlying vulnerabilities and focus on prevention responses; the ability to tackle complexity; and faster response to issues/crises.
Kenya is on a path of care reform,[1] moving forward to a system focused on strengthening families, decreasing reliance on residential care, and expanding services to prevent child and family separation. This is an enormous task requiring resources, time, planning and leadership, partnerships and collaboration, and, perhaps most critically, coordination between actors big and small, including: all levels of government, partners like UNICEF, international organizations and initiatives and local civil society organizations, as well as children, families and care leavers who bring a critical view from their lived experiences. As one representative of the Kenya Society of Care Leavers involved in Kenya’s coordination platform notes, “meaningful child and youth participation in care reform is listening to their views and use that voice to improve their lives.” The system of protecting and caring for children involves all and requires working together, sharing information, and recognizing and leveraging the unique contributions of the many. Summed up in an oft-heard Kiswahili phrase, “Pamoja Twaweza!” (together we can)!

[1] Care reform: refers to the changes to the systems and mechanisms that promote and strengthen the capacity of families and communities to care for their children, address the care and protection needs of vulnerable or at-risk children to prevent separation from their families, decrease reliance on residential care and promote the reintegration of children and ensure appropriate family-based alternative care options are available. 
Timeline of Care Reform
Government Leadership in Care Reform
by the Kenya National Council for Children’s Services
Leadership for care reform in Kenya comes from the National Council for Children’s Services (NCCS) and the Department of Children’s Services (DCS). While the protection of children is the broad mandate of the NCCS, the DCS works in tandem, fulfilling unique functions within the system. The establishment of both was articulated in the 2001 Children’s Act,[1] which mandates them to oversee children’s protection and care in the country. NCCS is responsible for care-related standards and guidance, and providing supervision, oversight, planning, financing and coordination of child protection activities, including care. NCCS approves the registration of charitable children’s institutions and other programs. The DCS is mandated with the implementation, including safeguarding and establishment, promotion, coordination and supervision of services, including the promotion of family-based care for children outside of parental care or at risk of separation.
 
NCCS also facilitates coordination on care reform in Kenya, which has led to several key achievements, including the drafting of the National Care Reform Strategy, which is in the final stages of validation as of February 2021. The National Care Reform Strategy will guide the system transition from residential to family- and community-based care for children. The collaborative approach is advancing the Government of Kenya’s care agenda through enhanced information sharing, feedback mechanisms and opportunities to adapt, and improved documentation and data-informed decision making. Furthermore, the coordination role taken on by NCCS has enhanced its ability to advocate for a unified agenda with various high-level government entities to change approaches to the care of children and to allocate needed resources, engage in global discourse and add Kenya’s evidence to the growing global evidence on the impacts of institutionalization on children as well as best practices.

[1] Government of Kenya (2001). Children’s Act.
However, while the legal and policy framework in Kenya has advanced, gaps and contradictions that hinder comprehensive care reform exist. A new Children’s Bill which hopes to address these issues has been approved this February by Cabinet and sent to parliament.  

Other key achievements of government-led coordination include:

  • Data collection and analysis on child protection and care through the National Child Protection Management Information System;
  • Harmonized social service workforce training;
  • Formation and Training of Alternative Care Committees, with gatekeeping, awareness-raising and community engagement responsibilities;
  • Awareness, training and action planning on alternative family care of children;
  • Government-led care reform pilots in five out of 47 counties
  • Awareness and training for charitable children’s institutions and statutory children’s institutions on case management for reintegration, family care, after care and service transition.

Government leadership in coordinated care reform efforts has also resulted in the development of several key materials, including the resources below.

This 2019-2020 assessment was completed by the National Care Reform Core Team as a participatory self-assessment of the formal alternative care system for children living outside of family care and with a goal of assessing strengths and gaps in that system, building consensus on sector priorities and actions to advance care reform, and setting a baseline to track the progress of change.

In 2019, a residential childcare institution situational analysis was conducted in five counties in Kenya in response to the lack of data on children living in residential care. It was performed in the wake of important commitments made by the Kenyan government to reform the care system by moving away from residential care institutions toward a wider implementation of family-based care solutions. The purpose of this situational analysis is to provide a snapshot of charitable children’s institutions (CCIs), other private childcare institutions and statutory children’s institutions (SCIs), and of the children living in them. The aim is to create a clearer understanding of the current situation of children in residential care in Kenya and to identify strengths and potential challenges which may impact care reform work.
Case Management Package
The package for case management was collaboratively developed by a working group of national government, civil society, and UN agencies in 2019, and includes a caseworker guidebook, caseworker toolkit, and training package. The package developed out of the need for comprehensive, standardized and harmonized case management approaches to promote family care for children in Kenya. It is a guidance tool for policy makers, program designers and practitioners for safe and sustainable reintegration of children.

This guide provides an overview of the principles and practices of case management for reunification and placement of children outside of parental care (e.g., children from Charitable Children’s Institutions (CCIs) and Statutory Children’s Institutions (SCIs) , and street-connected children) into family- and community-based care. It details standard operating procedures (SOPs) and provides associated relevant job aids. 

This toolkit contains caseworker forms for: conducting child and family assessments, consent and assent from caregivers and children, case planning, placement of children and young adults, monitoring, case reviews, case closures, referrals, caregiver and child feedback, and more. 

This Facilitator’s Guide is for use by the varied facilitators of the 'Promoting Family- or Community-Based Care Using a Case Management Approach Workshop,' including national and county trainer of trainers from Kenya's Department of Children's Services, and trained staff from other care reform partners.
Coordination and Children's Care
by the Kenya Department of Children’s Services
Care reform is an evolving process in Kenya and many changes have come to the care system over the past decade. Various State agencies have different mandates, roles and responsibilities within the child protection and care systems and within the care reform agenda. In 2017, the government made a concerted effort to bring together like-minded organizations with the aim of taking the care reform agenda to the next level. These organizations included NCCS, DCS, UNICEF, and leading civil society actors engaged in different elements of care reform.  A concept note was developed for what has become the National Care Reform Core Team. Led by NCCS, this coordination mechanism, helped all actors to come together around the idea that for
care reform to gain full momentum and be sustained, it required not only government leadership, but the active participation of, and close coordination with, non-governmental organizations.

Limited financial and human resources make collaboration even more important. Coordination helps build synergy in resource mobilization and use, minimizing the risks of services concentrated on one geographical area, focus on one component of care, or duplication. Through coordination, care reform advocates are also able to build shared evidence that can be used for advocacy and to speak with the “one voice” needed to raise awareness and counter resistance to change.

For example, collaboration between UNICEF Kenya and the Government of Kenya has resulted in the development of a training package for all professionals working in child protection, including Children Officers, civil society organization workers, and community para-professionals, in an effort to strengthen the social welfare workforce for child protection. The training package focuses on family strengthening and family-based alternative care and is informed by the Guidelines for the Alternative Family Care of Children in Kenya. The training package and other resources developed through coordination and collaboration include:

Kenya's Department of Children’s Services (DCS), and its care reform partners within government and civil society, developed this Facilitator’s Training Manual on implementing the Guidelines for the Alternative Family Care of Children with the intent to streamline and standardize alternative family care services in Kenya through standardized training. This comprehensive training package includes the training facilitator’s manual, PowerPoint presentations, handouts, case studies, and video clips. 

This handbook, developed by the Department of Children's Services, is a key tool for supporting care reform in Kenya, promoting family-based alternative care for children, and moving away from institutional care. This book is particularly written for formal and informal government practitioners as well as Chiefs, Nyumba Kumi and Village elders, Area Advisory Councils, community-based organizations (CBOs), faith-based organizations (FBOs), and non-governmental organizations (NGOs) working in communities.
A Joint Response to COVID-19
by UNICEF Kenya
Kenya’s collaboration and coordination have been put to the test and proven especially useful during the COVID-19 pandemic. Kenya confirmed its first COVID-19 case on 13th March 2020. Immediately after, NCCS established a sub-committee of the National Care Reform Core Team to identify and address child protection and care issues related to the situation, including the potential impact on children in care or at risk of separation from family, as well as the potential impediments to care reform progress. Coordination and collaboration between state and non-state actors has been crucial to the efficient and rapid mobilization of resources, logistical and technical support. Further coordination meant a rapid collaborative response to children released from institutions in response to COVID-19 risks, as well as those remaining in institutions.

Collection of related COVID-19 data was anchored in the response coordination team at the ministerial level, which aided a rapid tracing and generated evidence for a cooperative, standardized and resourced response. The fact that key actors were already networked through coordination mechanisms such as the National Care Reform Core Team and sub-national
county working groups meant that responses did not wait for such mechanisms to be set up. Because collaborative relationships had previously been built, the work easily shifted to virtual meetings and virtual trainings related to the impact of COVID-19 on child protection were conducted. WhatsApp Webinars aimed at building the capacity of key actors engaged in child protection and care were also provided to DCS Children’s Officers and providers of residential care. And by the end of March 2020, a number of resources, guidance and tools had been developed and shared in an effort to ensure that government and partners utilize similar approaches and tools. These include:

The first product from the COVID-19 sub-committee was this set of focused key messages on how to prevent the spread of COVID, truths versus falsehoods, treatment of those infected with the COVID-19 virus and information about key services and hotlines to report abuse or get up to date health information.
Rapid Analysis of Children Returned Home during the COVID-19 Pandemic
Notes from the field: The experience from Murang’a County
by Members of Stahili Foundation: Phyllis Macharia, Social Worker and Peter Mburu, Counsellor
A rapid assessment conducted by DCS with the support of Stahili Foundation revealed that 15 institutions released 197 children out of a total of 580 children (273 girls, 307 boys) living in CCIs across Murang’a county at the onset of the COVID-19 pandemic, in response to a directive from the Principal Secretary. A total of 383 children remained in care. Half (98) of the 197 children released were rapidly reunified with one or both parents, while the remaining children were placed in kinship care, which is the predominant form of family-based alternative care for children across Murang’a.
 
The assessment of children and families in Murang’a County demonstrates a promising picture of strength and optimism for care reform, whereby children have families and all biological parents and kinship carers have been able to care for additional children in the household. However, families assessed cited that they lacked the ability to provide for education and struggled to meet other basic needs, which are considerable and span across
multiple domains. This highlights the need to improve access to services for children in families, especially education (being one of the main drivers of children being placed in CCIs in Murang’a), and the need to address poverty which led to separation in the first place. As of October 2020, CCIs in the county reported to DCS that 39 out of 197 children who had been rapidly released returned to the CCI, despite only one CCI providing education directly and most children coming from within the same sub-county as the CCI. 
 
The assessment also revealed other challenges which hold important lessons for care reform in the county and Kenya as a whole. Children and families have struggled to cope psychologically and emotionally, and some children have returned to CCIs as a result. Children and families were not adequately prepared for new family routines and patterns of interaction and new or adjusted relationships, roles and responsibilities. It is much more difficult to address the challenges of reunification once it has taken place and relationships have become strained or have broken down. The lessons drawn from the experience underscore the importance of careful preparation of children and families through a case management approach. This includes bonding visits which give families the time to work out their relationships, roles and responsibilities, take into account the views of children and young persons, and are anchored in the provision of positive parenting as well as psychosocial and other support to help meet basic needs.  
Rapid analysis of children returned home

The same COVID-19 sub-committee mobilized to conduct, a rapid analysis of the number of children returned home and the number remaining in residential care facilities as a result of the Presidential Directive on Containment of the Corona Virus.[1] The findings were presented in the global webinar on the Protection of Children During the COVID-19 Pandemic: Children and Alternative Care and used to inform Kenya’s responses.

[1] Ministry of Labour and Social Protection. State Department for Social Protection. Office of the Principle Secretary. MEAC L&SP/5/1. Presidential Directive on Containment of the Coronavirus. March 31, 2020
Engaging Care Leavers in Care Reform
by Francisca Akinyi, Nurse and Careleaver

Francisca Akinyi is a registered nurse working as part of an elite team of health care providers responding to and caring for those ill with COVID-19. Besides being a dedicated professional, she is also a mother and a person who grew up in residential care. Francisca feels passionately about the importance of family-based care for children—all children, and has raised her voice to advocate for the unique role and perspective that those with lived experience must contribute to care reform.
As someone with lived experience of growing up in residential care, I would call upon government and other care reform actors to continue to engage careleavers in meaningful ways, guided by mutual respect. Our views, voices, dimensions, experiences, challenges, and failures are a wealth of information that can influence policies, guidelines, strategies, program design, and implementation among others. Our voices have and will continue to contribute an important perspective to policy and programming. We know firsthand what the lack of family-based care means to a child and our voices and our experiences matter and contribute to change. However, there should not be an assumption that our lived experience alone is enough. Concerted efforts should be made to build the capacity of careleavers so that we acquire the necessary skills to participate meaningfully in influencing change. And the welfare of young people and adults who left care need to be prioritized through government policy direction and targeted services. 
by Teresia Wairimu, Social Worker and Care Leaver

Teresia Wairimu is a social worker and a care leaver who is actively engaged in care reform. Teresia shared her experience working in care reform and the unique perspective that someone with lived experience can bring to the effort. 
My experience as a care leaver -- and the challenges I faced while in the orphanage and when reunified with family -- ignited a passion inside me to change the way we care for children. Families play a key role in every aspect of growth and development. My dream for all children to grow up in a loving and caring family and to have roots and foundation in community and society led me to obtain a diploma in community development and social work. Since graduating, I have used my knowledge, enhanced by my lived experience, to help reunify children with families and provide critical support to care leavers. Over the last two years, I worked as a social worker in a CCI and advocated for important changes within the institution which had served as a long-term form of care for 30 children. Patience, persistence, and careful planning led the management staff of the CCI to agree to important changes as well as the redirection of our resources.

During the pandemic, I was trained in case management for reintegration which served to enhance how I went about my work with children and families. Working closely with children and biological families and kin, I supported the reunification of all of the children in the CCI. Reflecting on good practice and my own experience, I made sure that children and young persons were provided with information about the process and prepared for what life is like at home. However, the experience taught me that no matter how good the process is, care leavers and their families continue to need support so that they can better cope. Since 2018, I have also provided peer support to fellow careleavers and as a social worker am working to better strengthen support services and networks for them alongside the Department of Children’s Services and CCIs. I am also a member of the Child Advisory Team and Youth Advisory Team for the General Day of Discussion on Children’s Rights and Alternative Care, organised by the Committee on the Rights of the Child. In this role, I am proud to represent Kenya and engage in important dialogue on the current situation regarding alternative care to find appropriate ways to respond to family and child separation and advocate for systemic changes for children globally.
Kenya has benefitted from the voices and experience of people like Francisca, including members of careleaver networks such as KESCA who have been on the forefront supporting careleaver engagement for close to a decade. Several important documents and videos, developed by or with KESCA, highlight the experience, the challenges and the possibilities of those who have lived experience and are committed to creating change so that other children and young people don’t have to live out. View some of these resources below.

Written by a group of over twenty-five members of the Kenya Society of Care Leavers (KESCA) in collaboration with Changing the Way We Care, this guide targets policymakers, practitioners, representatives of mass media, and faith-based organizations. It promotes the active involvement of care leavers in change in a manner that is empowering; is sensitive to their stories and experiences; promotes dignity; respects rights; and creates room for their voices to advocate for positive change. Care leavers want to have a seat at the table, but they also want to be engaged in a manner that respects their voices, provides a safe environment, and ensures that their stories remain true to their own lived experiences. It is in the spirit of this end goal that the guidance was written.
This video, which is part of the Kenya Practitioner Learning Video Series, features Ruth Wacuka and Samora Korea, two key leaders of the Kenya Society of Care Leavers, discussing the importance of care leaver networks in enabling care leavers to have a collective voice and to build a peer-to-peer supportive platform that aids in the transition of young people into independent living. They furthermore unpack what is required to ensure that engagement of care leavers in the care reform agenda at the national, regional and global level is meaningful and equitable. They challenge the perceived role of care leavers as ‘story tellers’ and call for wider recognition of lived experience as expertise, which, if recognised, would lead to greater intentionality in involving care leavers in agenda setting within the care sector.

In this video on the Do’s and Don’ts of Care Leaver Engagement, Ruth Wacuka discusses what makes engagement meaningful for Care Leavers and what makes it tokenistic, and in the worst cases, exploitative. Ruth makes a number of concrete suggestions throughout the video of practices organizations should encourage and those they should avoid. This covers a range of aspects of engagement including agenda setting, agreements, use of images and identity. 
Awareness Raising and Promoting Family-Based Care
by Stephen Ucembe, Hope and Homes for Children and Peter Kamau, Child in Family Focus, both members of the Association for Alternative Family Care of Children
The government of Kenya instituted a moratorium on registration of new institutions in 2017 to mitigate the proliferation of institutions and concerning incidents of malpractice within the childcare sector. Moreover, it was a period of growing awareness around the negative effects of institutionalization and the importance of family-based care. An almost unanimous feeling to change the way we care for children brought together a group of civil society organizations with a mission to promote family and community-based
care for all children in Kenya through the implementation of the Guidelines for the Alternative Family Care of Children in Kenya and other relevant legislation and policies. The Association for Alternative Family Care of Children has seen its membership grow over the past several years to 30 organizations.

Guided by a desire to implement the Guidelines for the Alternative Family Care of Children in Kenya, Association members have been at the centre of the care reform process including reviewing the draft National Care Reform Strategy. Members have worked closely with the government in developing Standard Operating Procedures on the alternative care of children. In collaboration with the government, the Association has recently developed important awareness raising resources, including the FAQs below, available for free on its website. The Association continues to nurture a platform for its diverse members to learn and exchange experiences and knowledge on various forms of alternative care, including the important aspects of family strengthening and prevention of separation. Last but not least, the Association has been a voice calling for accountability when there are child rights violations within the sector. 

This booklet, along with the accompanying animations, emphasizes the importance of family based care for the care of orphaned and vulnerable children (OVC) in Kenya, provides answers to regularly asked questions, and lists current government efforts to support OVC, including the policy and legal frameworks and existing forms of family and community-based care. It was developed by the Association for Alternative Family Care of Children, in collaboration with the National Council for Children Services and Department of Children’s Services. View the accompanying video in English and Swahili.
Additional Resources from Kenya

The vision of the National Prevention and Response Plan from the Government of Kenya is to foster a society where all children live free of all forms of violence. Its goal is for all children in Kenya to be protected from physical, sexual and emotional violence, and for those children who experience violence to have access to care, support and services. It aims to reduce the prevalence of childhood violence – that is, a child experiencing at least one form of physical, emotional and sexual violence – by 40 per cent by 2024.

This document lays out the concluding observations and recommendations developed and adopted by the African Committee of Experts on the Rights and Welfare of the Child (ACERWC/the Committee), which considered the second periodic report of the Republic of Kenya during its 35th Ordinary Session. This includes a set of recommendations for children in alternative care and prevention of family separation, among other topics.

Against the backdrop of a global and national movement towards de-institutionalization of child care and child protection, this paper from the journal of Social Sciences teases out the range of factors reinforcing Kenya’s over-reliance on live-in institutions as a child care and child protection model. Numerous factors—structural, political, economic, socio-cultural, and legal—contribute to the complexity of the issue. The article highlights this complexity, bringing together different angles, while pointing out the interests of the different stakeholders in reinforcing institutional care. The authors, Njeri Chege and Stephen Ucembe, argue that the sustainability, efficiency and effectiveness of the intended change from institutional care to alternative family-based care requires that a root-cause approach be adopted in addressing the underlying child care and child protection issues.

Related Topics: Residential Care
The purpose of this study from the International Journal of Education and Research was to determine the financial challenges faced by caregivers of orphans in Kitui Central Subcounty, Kitui County, Kenya.


This paper from the Journal of the British Academy provides insights into the feasibility and lessons learned from rural Kenya in providing Care for Child Development (CCD) training - a community-based initiative to support caregivers to develop stronger relationships with young children and support nurturing care - and supporting its implementation alongside the Baby Friendly Community Initiative (BFCI).


This study from the International Journal for Equity in Health sought to identify and understand how street-connected children and youth (SCY)’s social and health inequities in Kenya are produced, maintained, and shaped by structural and social determinants of health using the WHO conceptual framework on social determinants of health (SDH) and the Convention on the Rights of the Child (CRC) General Comment no. 17.
GENERAL INFORMATION

Newsletter participants, currently 4,441 in total, work on issues related to the care and support of vulnerable children across Europe, Africa, the Middle East, Asia and the Americas. The purpose of the newsletter is to enable members to exchange information on matters of mutual concern. If you would like to share a document, raise a specific issue, request a newsletter subscription, or reach out in any other way to the Network, please send the information to us at [email protected] or visit our website at www.bettercarenetwork.org. 

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