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International Health

November 19, 2020

Johns Hopkins Receives Grant to Study Factors Shaping the Effectiveness of National Programs to Care for Orphans and Other Children at Risk

The analysis will complement findings from a recent global study which identified divisive policy disagreements as a major hurdle.


The Johns Hopkins Bloomberg School of Public Health received a grant from the GHR Foundation to study the political, bureaucratic and economic forces shaping the effectiveness of national children’s care systems and identify strategies to augment their effectiveness in three low- and middle-income countries: Cambodia, Uganda and Zambia. The 3-year grant will support an in-depth analysis of the factors affecting children’s care programs—aimed at caring for orphans and children at risk of separation from their families—in each country. Jeremy Shiffman, PhD, a Bloomberg Distinguished Professor of Global Health Policy at the Bloomberg School of Public Health and the Johns Hopkins School of Advanced International Studies, is leading the study.

The analysis will complement a recent study, conducted by Yusra Shawar, PhD, MPH and Shiffman, that identified divisive policy disagreements as a major factor inhibiting effective prioritization of children’s care programs at the global level. Shawar, an assistant scientist in the Department of International Health at the Bloomberg School, is a co-principal investigator. 

“Our global study shed light on how the children’s care policy community understands the problem, the factors that shape their internal tensions, and how this discord has impacted global action for the issue,” Shawar said. “We hope to build on this knowledge and provide insights on the political dynamics that shape children’s care systems at the national-level.”

One major aspect of children’s welfare programs is the care of orphans and children who are either separated or at risk of getting separated from their families. A national program for the care and welfare of such children must work efficiently across sectoral jurisdictions to achieve its objectives. However, evidence indicates that the children’s care systems in low- and middle-income countries are affected by multiple problems going beyond technical concerns or capacity building, such as weak leadership or lack of coordination between multiple sectors and government ministries entrusted with various aspects of child care. Asymmetry between global donor priorities and national government needs, over-dependence on NGO partners for resource mobilization and program implementation, and economic incentives prioritizing operation of residential institutions further exacerbate the existing problems.

The research team will examine and compare the children’s care systems in each country by undertaking investigations to identify the political, bureaucratic, and economic factors shaping the effectiveness of these systems; delineate strategies, based on this analysis, to improve the capacity of these systems to protect children; and develop a generalizable framework for analysis and strategy development applicable to LMICs that face children’s care sector difficulties. The study will result in several products: a narrative synthesis review of the existing systems, a case analysis report for each of the three countries, and a comparative report offering broader insights into factors shaping children’s care systems in LMICs with strategic inputs to improve functioning. The analyses are expected to generate rich evidence that can inform policies for developing effective national care systems for children. 

“Most research on national children’s care systems is technical in orientation,” Shiffman said. “But making these systems work is a political problem as well. For instance, ministries fight for control over the issue. And some countries do not prioritize the issue at all. So how do you get governments to pay attention to the well-being of these millions of neglected children? The uniqueness of our project lies in considering the political dimensions of the issue.”

In addition to Shiffman and Shawar, the research team includes co-investigator Adam Koon, PhD, MPH, a health policy expert and an assistant scientist in the Department of International Health at the Bloomberg School, who will lead the investigations in Uganda. A local researcher in each country will also be joining the team as a co-investigator.