Testimony of Nancy E. Lindborg Assistant Administrator for Democracy, Conflict and Humanitarian Assistance, before the House Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations

Wednesday, July 16, 2014

The Growing Crisis of Africa's Orphans

Chairman Smith, Ranking Member Bass and Members of the Subcommittee, thank you for inviting me to testify on USAID’s response to orphaned and vulnerable children in Africa. Thank you also for your support for USAID’s humanitarian and development programs around the globe.


Africa is a continent on the rise, with growing economies and the youngest population in the world. With fifty percent of the population in Sub-Saharan Africa under the age of 18, there is extraordinary potential for this generation of youth to shape the future of the continent in powerful ways. However, more than 200 million of these children currently live in extreme poverty, over 15 million children have lost one or both parents to AIDS, and millions more are affected by conflict and natural disaster.

I’ve personally seen what happens to children in families facing one catastrophe after another, often unable to buffer the compounding shocks. In March of this year, I visited South Sudan, where violence and insecurity have forced more than one and a half million people from their homes since mid-December. Among those fleeing are thousands of children separated from their families – some sent to safety by parents desperate to save their children. Others became separated from their parents during the recent violence that has ravaged their country.

While the needs and challenges in these settings are often overwhelming, I have seen the enormous difference USAID-supported programs can make in the lives of those affected. Nyawal Ruach, a 29-year old mother from Bor in South Sudan, is one of the people we’ve helped. As she heard the fighting approach, she tied her two boys together to ensure they would not get lost from each other. Despite her efforts, the boys were swept up in the chaos and separated from her as they followed others running to escape the violence. It was at a USAID-supported center established to trace families and rescue lost children where Ms. Ruach found her two sons.

Our efforts, not only in Africa but around the world, are supporting and enabling mothers like Nyawal and many other parents to care for their children. This type of support is aimed at preventing unnecessary family-child separation, promoting appropriate, protective and permanent family care, and ensuring that children not only survive but also thrive. And as we meet the needs of vulnerable children, USAID, as embodied in our new mission statement, focuses also on the underlying drivers that create these crises, partnering to end extreme poverty and promote resilient, democratic societies.

To talk about children in adversity in Africa is to open a very broad conversation that encompasses issues ranging from access to education to lack of economic opportunity. However, for the purposes of this hearing, I would like focus on three main objectives in line with the U.S. Government Action Plan on Children in Adversity to help vulnerable children in Africa and around the world. These three objectives include supporting strong, healthy beginnings; strengthening families and communities so they can protect and promote the well-being and development of children; and the prevention, response, and protection of children from violence, exploitation, abuse, and neglect.

The U.S. Government Action Plan and USAID’s Programmatic Response

For over twenty years, USAID has led efforts to focus on children in adversity through the Agency’s programming worldwide, including our Displaced Children and Orphans Fund. USAID is the lead agency under 2005 Public Law 109-95: The Assistance for Orphans and Other Vulnerable Children in Developing Countries Act, and we house the U.S. Government Special Advisor on Children in Adversity and the Center on Children in Adversity. The Advisor and Center both work to strengthen the efforts of the seven U.S. federal agencies working on the behalf of children and oversee the coordination and implementation of the Action Plan on Children in Adversity.

The Action Plan is a whole-of-government strategy for helping children. Its goal is to ensure that more children grow up within protective family care, free from deprivation, exploitation, and danger. Launched from the White House in December 2012, the Action Plan is grounded in evidence that shows a promising future belongs to those nations that invest wisely in their children, while failure to do so undermines social and economic progress. The Action Plan focuses and coordinates programs throughout the U.S. Government to achieve our three primary objectives: build strong beginnings, put family care first, and protect children.

Across these objectives we face the struggle of determining an accurate accounting for how many children are separated from their families. In response, USAID is developing innovative tools and partnerships that can help us better understand, account for, and track the numbers of children outside of family care, especially in situations of crisis and conflict. Working with Save the Children, for example, we are developing methods to estimate the number of children living outside of family care in disaster settings and testing them on the ground in North Kivu, Democratic Republic of Congo (DRC). Separately, in collaboration with Columbia University, we are working to identify children outside of family care and develop a scorecard that governments and organizations can use to measure their success in reducing the numbers of children outside of families across a broad set of development contexts.

Building Strong Beginnings

Under the first objective, building strong beginnings, we have achieved remarkable results in combating preventable child death and helping all children reach their fifth birthday. And know the challenge is not only to help children survive but also thrive. USAID does this through comprehensive programs that promote sound development of children by integrating health, nutrition, and family support.

Africa has seen significant progress in reducing under-five mortality rates from 180 deaths per 1,000 live births in 1990 to 98 in 2012. As a result of sustained global commitment and growing country ownership, we stand within reach of achieving a goal critical to addressing the crisis of orphans in Africa – a goal once unimaginable: ending preventable child and maternal deaths by 2035. To target the more than 6.6 million children globally under-five who will die this year of largely preventable causes, USAID has narrowed our focus on child and maternal health to the 24 countries - including 17 in Sub-Saharan Africa - that represent more than 70 percent of maternal and child deaths in the developing world.

Evidence has affirmed that the first 1,000 days between a woman’s pregnancy and her child’s second birthday lays the foundation for a person’s lifelong health and future development. To ensure healthier children and more productive communities in the poorest regions of the world, USAID’s Office of Food for Peace is applying the best of nutrition science to better target the special nutritional needs of vulnerable groups, particularly women and children under two. USAID now uses ready-to-use therapeutic and supplementary foods designed to treat and prevent malnutrition, as well as better fortified commodities. USAID has set a goal to meet 10 percent of UNICEF’s global requirement for ready-to-use therapeutic food and 10 percent of the World Food Program’s global requirement for ready-to-use supplementary food to help tackle this burgeoning problem in crisis zones such as South Sudan and Central African Republic.

Additionally, the U.S. Government’s Global Health Initiative, Feed the Future, and the U.S. President’s Emergency Plan for AIDS Relief have comprehensive strategies in health and nutrition to reach chronically underserved children in their early years.

For example, USAID is working with CARE International to implement a multi-faceted program targeting working mothers with young children in rural Kamonyi District, southern Rwanda. The diverse services offered are designed to support families in a variety of ways over the course of several years. The program includes home-based daycare, community-based child development centers for preschoolers, parenting education on child development topics, children’s rights, and income-generating activities. The daycare and preschool centers not only provide meals for the attendees, but also serve as venues for community health workers to conduct monthly check-ups that ensure children who become ill or whose growth falters are quickly identified for treatment.

Strengthening Families and Caregivers

The second objective of the Action Plan is to put family care first. Evidence clearly shows that families – parents, grandparents, relatives, foster families or adoptive families – are the best source of support for children. A National Institutes of Health-funded study of children in institutions in Romania, for example, showed significant deficits in IQ for children in institutions versus those in families. The study also showed that when these children were placed with families at a young age, their IQ nearly rebounded to that of their peers; however, when left in institutions, there was little or no gain.

Yet we know that there are about 56 million children in Africa who have lost one or both parents - of which over 10 million have lost both parents. Our assistance supports and enables families to provide basic care for their children, prevents unnecessary family-child separation, and promotes appropriate, protective and permanent family care. In Africa, the vast majority of children outside of family care do have parents or relatives, and there is a rich tradition of kinship care in Africa. Therefore, getting children into families and strengthening their ability to care and protect is a top priority.

Family unification or reunification and supporting families struggling to provide care for vulnerable children includes strategies such as deinstitutionalizing separated children; increasing family income generation; providing conditional cash transfers; meeting urgent material needs such as food, clothing, and shelter; linking families to appropriate treatment or services; and ensuring parents and caregivers have the knowledge and skills needed to decide what is best for themselves and their families.

In Liberia, for example, approximately 5,000 children live in 114 orphanages, though 88 percent of these children have at least one living parent. Over the past two years, our program partner has placed more than 1,100 children in family care, including more than 500 children previously living in orphanages, and more than 600 who had been living on the street. At the same time, the program supports education and health care, and builds the capacity of local government social services so they can continue this work.

On the other side of the continent in Ethiopia, at least 7,000 children live in orphanages. With support from USAID, the Ethiopian Ministry of Justice conducted a study of more than 100 residential institutions, resulting in the government’s immediate declaration to close 45 substandard institutions. In the last two years, close to 1,000 children have been moved from these inadequate institutions and placed in family care. Also in Ethiopia, the PEPFAR-supported Yekokeb Birhan, the second largest Orphans and Vulnerable Children program in Africa, has supported 76,000 households caring for orphans and vulnerable children through economic strengthening activities. Seventy-five percent of those households now have regular income and improved access to education, health and other critical services. School attendance has increased by 14 percent, with a 71 percent increase in the number of children enrolled in pre-school programs. Full immunization rates jumped from 34 percent at the start of the program to 58 percent - higher than the national average.

We also work to put appropriate family care first through our humanitarian programming. The U.S. Government, through USAID and the U.S. Department of State’s Bureau of Population, Refugees, and Migration, is the single largest contributor to programs focused on addressing the safety and well-being of children in humanitarian situations around the world. In FY2013 alone, USAID allocated more than $17 million in funding to support programs aimed at building knowledge, tools, and capacity to address child protection in 15 conflict and disaster-affected countries - 11 of which are in Africa.

Since the onset of violence in South Sudan on December 15, USAID has helped launch five programs dedicated to identifying and supporting boys and girls who have become separated from their families and reuniting them with surviving caregivers, when possible. Working with UNICEF and other partners, we have identified more than 3,000 unaccompanied, separated, and missing boys and girls–and reunited more than 400 with their families.

In an effort to improve and streamline the reunification process, we have invested in UNICEF’s Rapid Family Tracing and Reunification tool - an open source application for handheld devices that assists child protection workers in the field. With this application, humanitarian workers can use cellphones and other mobile devices to input data and quickly share information with other child protection workers throughout the affected country and across borders. As a result, the length of time children are separated from families and vulnerable to exploitation, violence, and abuse is greatly diminished.

Child Protection

The third objective of the Action Plan on Children in Adversity is to protect children. Global studies show that about 36 percent of girls and 29 percent of boys worldwide have been sexually abused and that over 100 million children are engaged in hazardous work. Violence against children knows no geographic, ethnic, economic or cultural boundaries. It occurs in homes, in schools, on the street, in the workplace and in institutions. No country is immune.

We know that neglect, abuse, and violence have lifelong impacts on children. Those who experience violence at a young age are likely to die at an earlier age, to engage in risky behaviors, be more prone to alcoholism and drug abuse, and spend time incarcerated. With the burgeoning youth populations in Africa, this is a threat to the development gains being made across the continent and the stability and prosperity of the continent. Under the Action Plan’s framework, we are facilitating the efforts of national governments and partners to prevent, respond to, and protect children from violence, exploitation, abuse, and neglect, including trafficking and child labor.

While the overall number of children experiencing violence, abuse, or neglect in Africa is not known, we can extrapolate from startling statistics. In the DRC, 64 percent of women have experienced physical violence since age 15 and 71 percent report some form of sexual, mental, or physical abuse by a spouse or partner. And of the more than 17,000 cases of rape reported in 2009, 58 percent of victims in reported sexual violence cases were under the age of 18. A UNICEF study in Swaziland, found that nearly one in four women experienced physical violence as children, one in three experienced sexual violence, and three in ten were emotionally abused. A similar study in Tanzania found that nearly three in ten women and one in seven men experienced sexual violence as children.

The U.S. Government takes part in Together For Girls, a public-private partnership, dedicated to ending violence against children, with a focus on sexual violence against girls. Using the U.S. Centers for Disease Control and Prevention’s Violence Against Children Survey as an entry point, the partnership provides comprehensive data on the magnitude and consequences of sexual violence against children. The data gathered from the surveys provides the foundation for action, mobilizing countries to lead a response and inform solutions that are evidence-based.

Our programs provide safe spaces for children to heal and learn, giving parents and other caregivers time to address their own needs and those of their families. The programs also include outreach and direct support for parents, equipping them with the knowledge and skills needed to manage stress, support and care for their children and understand the impact of significant child protection risks such as family separation or child labor.

Since 2011, USAID’s child protection work with UNICEF in the DRC has removed over 3,257 children associated with armed groups – including 202 girls – in North Kivu, South Kivu, Orientale, and Katanga provinces. We have provided separated children with temporary care in transit centers or foster families, supported their reintegration into their communities, and helped an additional 5,000 conflict-affected children to enroll in school or obtain vocational skills training. Additionally, we have strengthened the capacity of 15 local organizations assisting children associated with armed groups, and we have created or strengthened over 70 community committees to promote child rights at the grassroots level and prevent child recruitment into armed groups in the DRC.

Also in the DRC, we recently began implementation of a five-year program, the Appropriate Care for Families and Children program (SAFE from Soins Appropriés pour les Familles et les Enfants), that is strengthening services and systems to support family cohesion and respond to the separation of children. SAFE targets vulnerable children including child soldiers, street children, children accused of witchcraft, children involved in the legal system, children with disabilities, child laborers, and HIV/AIDS orphans. SAFE uses a community-based approach to help identify children at risk and reduce stigmatization, discrimination, and rejection through awareness campaigns and other behavior change strategies. Over five years, SAFE will directly benefit 7,000 children and 6,000 adults, and reach 40,000 community members through prevention and awareness-building activities.


Children living under conditions of serious physical deprivation or danger or who experience violence, abuse and neglect face fundamental threats to their survival, well-being, and future. If we do not focus on the child, we lose the person. Investments in a strong start for Africa’s children are critical to laying a foundation for a healthy, productive future for Africa itself.

USAID remains committed to meeting the needs of vulnerable children in Africa while also addressing the root issues that create the conditions for conflict and abuse. Through our work in maternal and child health, nutrition, basic education, human rights, democratic governance, and humanitarian assistance we will continue tackle the underlying issues that lead to children’s vulnerability. We look forward to our ongoing work across the U.S. Government – and with this Subcommittee – to promote healthy, resilient families and communities where children can thrive. Thank you very much.

The Growing Crisis of Africa’s Orphans
Foreign Affairs Committee Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations