Models of care

A wide range of options exists for care of orphans. The most common types of orphan care include:

1. A statutory residential care facility, serving primarily HIV infected children.
2. A statutory adoption and foster care program, where a welfare society owns homes and appoints community mothers to care for a group of children (preferably no more than six).This is also called "Foster cluster care".
3. An unregistered residential care setting, which houses HIV+ and destitute mothers with their children and offers continued care for the children when the mothers are ill or die.
4. Home-based care and support, where caregivers are identified and children are legally placed in foster care, and assistance is given through foster care grants.
5. Community-based support structures, where grandparents or other close relatives care for their orphaned grandchildren, with no government support.
6. Informal fostering or non-statutory foster care, where women in the community volunteer to care for orphans in a group home setting, with no government support

A 2001 study comparing the cost-effectiveness of these six models of orphan care in South Africa (See Desmond and Gow: The Cost-Effectiveness of Six Models of Care for Orphan and Vulnerable Children in South Africa) came to the following conclusions:

• The most cost-effective models of care are those based in the community, but often the quality of care was compromised due to the lack of adequate external support in the form of government grants to the caretakers.
• Community-based orphan care should ideally have a supervision component provided by an NGO or another more formal entity, to ensure that the caregiver receives some support and that children are protected against abuse and exploitation.
• Even when government grants exist, it is often too difficult for caretakers to access the support. This was especially true in rural areas. Therefore, government grant programs for foster families need to be relatively simple to access, while trying to minimize cases of fraud.
• Although it very high cost, statutory residential care for HIV infected orphans is necessary as a last resort, given the difficulty of placing these children in other care settings where they would be unlikely to have access to the medical attention they require.

A 2004 World Bank study concluded that each arrangement has its pros and cons, but "whenever possible, orphaned siblings should remain together and with their kin and in their community of origin. When relatives are not available, placement in families willing to adopt or foster a child is the most appropriate solution. Institutions should always be considered a last resort, and small-scale foster homes should be favored over residential placements such as orphanages."