The economic and social consequences of family based care
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The Economic and Social Consequences of Family-Based Care. Chris Desmond FXB Center for Health and Human Rights Harvard University. Context and consequences. T he vast majority of children in Africa, orphans included, live with family

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The economic and social consequences of family based care

The Economic and Social Consequences of Family-Based Care

Chris Desmond

FXB Center for Health and Human Rights Harvard University


Context and consequences
Context and consequences

  • The vast majority of children in Africa, orphans included, live with family

  • Many families are, however, facing difficult times and this has consequences for children (not just orphans)

    • Health (mental and physical), education, security, opportunities for the future

    • Not just limited categories of families (child-headed households, skip-generation etc)

  • There are also consequences for others

    • Family, economic and social costs

  • When children fall out of the family system the impacts may be even greater


Are the consequences inevitable or costs of inaction
Are the consequences inevitable or costs of inaction?

  • Some are inevitable, but many can be avoided

  • Children can survive a great deal when appropriately cared for

  • Steps can be taken to:

    • Strengthen families (directly and indirectly)

    • Reintegrate children into the family system

    • Provide replacement care when other options have failed (never orphanages)

  • Resources are limited, and how they are allocated needs to be given careful thought


Efficient vs cheap
Efficient vs. Cheap

  • Important to distinguish between efficient and cheap interventions

  • Need to dispel the idea that children in poor countries are cheap to care for

    • Difference between marginal and total cost.

  • All depends on what you consider to be care

  • What is needed is ways to identify efficient interventions


Identifying efficient responses

Identifying efficient responses

Production line or cake baking?



Identifying efficient responses1
Identifying efficient responses

  • Need to consider the integrated nature of care

    • One reason why orphanages are not only bad, but inefficient

    • One reason to be cautiousof CEA results

  • Need to consider sets of actions to avoid inappropriate conclusions

  • Need to consider the trade-offs between efficiency and equity

  • Need to have open discussions: You should only accept the results of economic analysis to the extent to which you agree with the values on which it is based


What to consider
What to consider?

  • What constitutes adequate care?

  • Is the intervention addressing the integrated nature of care?

  • Does the intervention’s design inappropriately consider the environment fixed?

  • What are the equity / efficiency trade-offs?