Formal care in Kazakhstan: the budgetary aspect

1. Formal care in Kazakhstan: the budgetary aspect Elena Andreeva Astana, April 2009

2. Contents: International comparisons: the way forward Demographic analysis Estimates of spending obligations Recommendations and best practices

3. Information Sources: UNICEF Innocenti Research Centre Official sources in Kazakhstan WB data Own estimates of the author

4. Percentage of children in formal care, 2006:

5. Share of children in guardianship/foster families in total number of children in formal care

7. Number of children raised by guardians/foster parents out of every 100 children in the nation (2006)

8. Composition of formal care in Kazakhstan and Russia, 2006 Kazakhstan Russia

9. Findings and recommendations : Ensure presence of all required country indicators in the TransMonee/UNICEF submission form (RK Statistical Agency?) High time to start the deinstitutionalization reform Introduction of guardianship grants can lead to doubling the number of children in guardianship care

10. Динамика вероятности лишиться родительской опеки в Казахстане, количество случаев в года на 100 000 детского населения , 2004-2008

11. Rate of children left without parental care during the year, 2006 (per 100 000 population aged 0-17)

12. Probability of parental care deprivation during the reporting year for all children, newborn babies and children older than 12 months: number of cases per 100 000 children of correponding age, Kazakhstan

13. Demography Sources of data: RK Statistical Agency, 1999-2009; World Bank forecast, 2010-2050

16. Annual number of live births,000, and approx. age composition of population aged 0-17 in the beginning of 2009, Kazakhstan

17. Age composition of children in residential care in Kazakhstan, beginning of 2009 Source: RK Ministry of Education and Science

19. Estimate of number of children deprived of parental care in residential institutions in Kazakhstan in two scenarios

20. Two scenarios:

21. Children Deprived of Parental Care in Kazakhstan: A Flows and Stocks Model Total population aged 0-17 in Kazakhstan 4 617 000 0,00215 9 944 Children deprived of parental care during the year 0,08 0,40 0,52 Residential institutions 16 883 Adoptive care Guardianship/foster care 29 147 Base year - 2006

22. Deinstitualization Reform Family outreach All population aged 0-17 in Kazakhstan 4 617 000 Daycare centers Family crisis hotline Temporary shelters 0,00215 Social advertisement 9 944 Children deprived of parental care during the year Newlyborn abandonment prevention Guardianship allowances 0,08 0,40 0,52 Children in residential care 16 883 Adoptive care Guardians 29 147 Socialization of residential care allumni Provision of support services to guardians/foster parents

23. Unit costs (per child-year) of different forms of care Orphan Homes $5 000 Correctional Institutions $5 000 Family type homes $3 000 Children villages $4 000 Foster Care $1 700 Guardianship, no allowance 0 Guardianship + allowance $400 $1=150 TG

24. What is the unit cost of an alternative service? What is cheaper – keeping a child in a temporary shelter or in a foster family? What is cheaper – provide daycare services for a child or work with blood family? Such questions have no meaning because alternative services are efficient only when provided in a combination.

25. Simple case: foster families Child subsistence grant ~ food +clothing in orphanage Foster parent remuneration ~ wage in social care sector Does that mean that residential care and foster care cost the same? We cannot say until we know the duration and the outcome of each type of care

26. For instance: Length of stay in a foster family = 6 months While the child in in foster care, a a team of specialists works with the blood family = 6 months After 6 months the child returns to blood family OR The child is placed in residential care – how long will he/she stay there? If he or she stays until graduation, he/she will be entitled to a graduation package – what %% of graduates?

27. Unit cost of residential care: 1 man-year in orphanage == $5000 (750 000 TG/150) But how many years do children spend in residential care? And what happens to them after they exit from residential care?

28. Length of stay in residential care depending on age of entry, years On the average the government will spend $55 000 per child who entered residential care as a 6 year old: 11 years until graduation * $ 5000 per year Length of stay is multiplied by $5000 (more for baby homes) Source of data: authors’ estimates based on similar data for other countries and empirical evidence on abandoned babies in Kazakhstan (infant homes’ reports)

29. At what age do children enter into residential care? number of children East Kazakhstan Oblast: age of children deprived of parental care in IQ 2009 (100 children): year of birth

30. How much shall the government spend on children of each age group who entered into residential care in East Kazakhstan Oblast in Q1 2009 from entry until graduation? amount spent on all children in age group, $ age at entry For newlybort infants: 33 babies*2,5 years*$5000 = $412 500

31. Each of the 100 children deprived of parental care in Q1 2009 in East Kazakhstan Oblast shall spend 5.11 years in residential care on the average. Total spending on all these 100 children in the next ten years will reach = 100 children * 5.11 years * $5000 = $ 2 558 000

32. Распределение этих средств ($2558000) по годам:

33. This estimate was for 100 social orphans who were identified as such in East Kazakhstan Oblast in Q1 2009 In 2008 the total number of new entries into the residential care system for children in Kazakhstan was almost 10 000

34. More recommendations : It is necessary to cut down the flow of children into the residential care system Efforts should b focused primarily on prevention of abandonment of newly born babies and work with families with children of pre-school age in order to eliminate abandonment at early school age – this focus will give the biggest budgetary and socio-economic effect Young village girls coming to cities in search of work deserve special attention (my hypothesis) Support of guardianship families and guardianship allowances

35. Probability of parental care deprivation during the reporting year for all children, newborn babies and children older than 12 months: number of cases per 100 000 children of corresponding age, Kazakhstan

36. However: The cost of abandonment prevention services should not be underestimated. Every single service often costs less that residential care, but usually more than one service is needed to prevent abandonment and the number of potential recipients is much greater, than the number of children in residential care. In fact, all families at risk are potential clients (how many such families are there?)

37. Examples: Introduction of guardianship allowances can lead to doubling the number of children under guardianship Daycare centers permit to find new children with special need who live with their blood families whose parents have not attended to their special needs (lack of knowledge, lack of skills, did not see the need) Creation of psychological assistance services in schools leads to growing number of calls/visits on the part of “problem-free” kids and their parents

38. For reference: Based on results of the Tomsk study: 10% of the total number of families in Tomsk belong to the risk group Alternative care services for 1 family costs $200 a year on the average (an estimate) Alternative care services for all families at risk (20 000 , 1 000 000 total population) = $2 000 000 a year Empirical evidence suggests that effectiveness of prevention is close to 100% (evidence from pilot localities)

39. More recommendations (ad hoc sequence): The conditions created for social orphans in residential care should not notable exceed the average quality of life: antagonism towards social orphans barriers to admission into residential care (too expensive) induces families to put their children into orphanages refusal of children to be placed in a family with average income (no instances known, but probability is high)

40. Wages in social care: provision of high quality services requires high quality skills. Recommendation: critically re-assess expenditure norms applied in social protection, other sectors and size of various grants to families: state standards should be uniform in all spheres and be applicable to all categories of citizens in need

41. It is necessary to introduce personalized case management of cases of social orphans and children at risk. The case management procedures should be equally applicable to all children, independent of the type of departmental subordination of the institution that deals with the child in question (infant home, orphanage, temporary retention center…). It is necessary to organize data exchange across ministries/departments (coordinator needed!) Under Medium-term budgeting information requirements grow manifold: demographic forecast (Statistical Agency), integration of data bases of the Ministry of Education and Science, Ministry of Labor and Social Protection, Ministry of Health Care, bureaus of registration of civil status, etc. Some uses of data were demonstrated in the presentation, other uses, such as mapping of social services, can also be useful

42. Example of a Social Service map: location of families with children with special needs in rural area, Tomsk Oblast, Russia. Source of Data: Bureau of Medical and Social Expertise

43. Ration of the number of children with disabilities in total number of children in each age group (Source of data on the number of children with disabilities in each age group: Bureau of Medical and Social Expertise, Tomsk Oblast) % of children with disabilities year of birth

44. Recommendations on the uses of the existing centralized data base of children in need of family placement: It is necessary to develop the methodology of analysis (some ideas were suggested in this presentation!) Unification of databases of the Ministry of Education, Ministry of Labor and Social Protection, Ministry of Home Affairs will permit to evaluate the long-term consequences of the social protection policy (for instance, how many former orphans have applied for unemployment benefits) Open access to selected fields of records in the data base of children in need of family placement can significantly speed up the process of family placement (social advertisement). Experience of Russia – see next slide

45. With regard to existing residential care institutions: Develop specific plans for transforming the existing residential care institutions Some are already performing alternative services, such as adoptive/ guardian family support. Another possibility – training of prospective foster/adoptive families, home studies, post-placement control (outreach, telephone counseling, etc. ) Assignment of new alternative care functions, if accompanied by additional funding, is very likely to turn orphanages into reform supporters. + Premises could be used for delivery of alternative services

46. Estimated aggregate effect of deinstitualization in Tomsk Oblast, Russia

47. Thank you for your attention enik@fpcenter.org