The child care funding crisis: Is there life after subsidies?
- ROBYN WOLFSON VORSTER
- 08 Sep 2017 12:06 (South Africa)
Baby C was born at 29 weeks weighing only 830g after an unsuccessful late-term abortion. For her, surviving the abortion and her prematurity was a battle, and staying alive was a victory. It should have been her last battle, but for many aborted and abandoned babies, making it through the first few months of life is an even bigger struggle.
Although premature babies are kept in hospital until they develop a sucking reflex, they are generally released at 1.6kg. So tiny that they are unable to maintain their blood sugar levels, they are also prone to apnoea because their lungs have not developed properly, cysts on the brain, problems with sight and hearing, anaemia, pneumonia and, especially when aborted, cerebral palsy. To complicate matters further, Baby C was HIV exposed. She is on medicine and will have to be retested periodically. Given the cost and complicated nature of this treatment, her long-term survival depends not just on her own strength, but on the quality of care she receives. Who provides this care to abandoned babies? The answer should be, any baby home. But truthfully, there are few who can. Baby C will probably survive because she is fed every two hours, has round-the-clock kangaroo care, sleeps (when not being carried) on an apnoea monitor and is regularly monitored for pneumonia. Following these nervous first months, she will receive intensive therapeutic interventions and follow-up care. She is one of the fortunate ones, her baby home, Door of Hope, will ensure that she receives all necessary nurturing and care.
Most of Baby C’s treatment will take place at government hospitals, and the therapeutic services are donated by another NGO. However, the cost of keeping her, and the other ten premature babies currently at Door of Hope, alive and thriving should not be underestimated. It is one of the mounting tally of expenses that baby homes face. There are 60 babies in care at Door of Hope. With a calculated cost of R5,000 per child per month, it isn’t surprising that still to be audited financials for 2017, show total expenditure of over R7,147 149. Given South Africa’s economy, the million rand question (literally) is, where does that money come from?
It certainly isn’t coming from subsidies. The non, or late payment of subsidies by the Department of Social Development is notorious and has been well documented (one baby home even reported that it went two years without subsidies because the department was going through changes to personnel, and failed to make the payments. No backdated claims were permitted for this period). But even when subsidies are paid, they are hopelessly inadequate. As a Child and Youth Care Centre (CYCC), Door of Hope receives an agreed lump sum to cover operational costs and the cost of care. The subsidy is paid (when it is) in four tranches, and will amount to slightly over R2-million this year. This will leave the home with a substantial short-fall this financial year of more than R5-million.
For those baby homes registered as Temporary Safe Care Projects, the situation is even gloomier. Many of these organisations should be eligible to register as CYCCs (something the department is making almost impossible). Instead, they are paid a Temporary Safe Care fee of R16 per child per day, or about R500 per month. For one Place of Safety who asked not to be named, this represents a monthly shortfall of R7,000 per child. The fee (which is not a subsidy, so not “guaranteed”), amounts to only about half of a monthly Foster Care Grant, but, unlike the grant, has not increased in the last nine years. The department does not augment the payment for children that are disabled or in need of specialist care. In addition, the department does not pay towards statutory child protection services, like adoption, which some homes provide. These must be covered by the organisation, with the caveat that the amounts they can charge for adoptions are also highly regulated.
Another baby home has similar concerns about funding. The director of the home described the process as follows: “I submit a claim to Children's Court and they decide how many days I can claim, and then it goes in for payment. Six to eight months later, an amount will be deposited to us, but with no reference as to which child. I've called and emailed (the department) to get more specifics but rarely do they reply with an answer.” Such late and erratic payments mean that baby homes are being forced to survive almost completely without government support.
In the absence of subsidies, what alternative funding options are available? The obvious one is the Lotto, or at least it would be if the Lotto funded these initiatives. Although the Lotto website states that R36-billion has been raised through ticket sales, of which R11-billion is available to “good causes”, including charities: “funding the care of the elderly, the disabled and vulnerable children”, there are no up to date stats detailing who is getting what. In 2014, the last year mentioned on the site, R966-million was allocated to an unknown number of beneficiaries. Apparently, funding “vulnerable children” in baby homes is not top of its list though. It makes a Gauteng baby home with a Lotto beneficiary sign up in its foyer notable. But, “beneficiary” may be somewhat of an overstatement. In truth, the organisation received a payment from the Lotto in 2015, an amount which the Lotto terms to be a “small grant” (between R1 and R500,000). The payment covered 10% of the baby home’s annual budget. There has been nothing since.
Equally, international funding has diminished markedly since the global financial crisis in 2008. According to Lisa Vetten, an expert on the funding of the care economy, international donors have shifted their funds to “poorer countries”.
This leaves baby homes with the CSI (Corporate Social Investment) contribution of companies. Where the CSI spend is allocated to vulnerable children, it is a potential solution. But many baby homes express concerns about the way that corporates allocate funds. Businesses are often distrustful of the corporate governance of NGOs, and therefore more willing to donate goods and services rather than cash. While the “nappy and NAN” model of supporting baby homes provides benefit, and frees up funds for other needs, it presupposes that there are funds for other needs. This lack of actual cash funding is one of the reasons that NGOs are often forced to retrench staff, and sometimes lose their premises.
The picture is pretty bleak. But this year, into the fray came the CEO SleepOut™ which named baby homes as the beneficiaries for its 2017 events. As a journalist, I feel almost obligated to include the adjective “controversial” ahead of the SleepOut™ name, and without doubt the brand’s controversy hit its zenith during the 2016 CEO SleepOut™. In 2017, the hangover from the previous year took a while to clear. This year’s media briefing had barely ended before the social media barrage between the SleepOut’s detractors, accusing it of being “poverty porn”, and its supporters, railing against the abuse dished out by “slacktivists”, resumed. Despite the controversy, the funding model applied by the SleepOut™, and specifically, using a business-based approach to raise funds for the most vulnerable, is an interesting one. The organisation has identified key strategies that are essential for integrating the homeless back into society. They are shelter, health care, education, nutrition, and here in South Africa, community. For each CEO SleepOut™ Event, beneficiaries are chosen because they work within one (or more) of these key areas (all five in 2015, education in 2016 and shelter in 2017).
It’s a model that has been financially successful. Over its first two years in operation, the SleepOut™ awarded R35 million to four beneficiaries: Girls and Boys Town, and three educational initiatives. This amounts to 75% of total funds raised. In addition, the brand has spawned a number of satellite events enabling companies, schools and community groups to experience a night outdoors to gain empathy, and collect goods for charity. Interestingly, it is these satellite events, and other activities to benefit secondary beneficiaries like the Salvation Army, Gift of the Givers, and Homeless Talk, that are having the biggest effect. That, and the impact on individual participants, has resulted in Social Return on Investment (SROI) ratios far in excess of the funds raised.
This year, the emphasis is on baby homes providing shelter to our country’s most vulnerable: abandoned babies and those whose mothers are not willing or able to raise them. It is a critical focus, because while homelessness is challenging for adults, even one night outdoors can be fatal for babies. But this year, the funds raised will be far less. It is partly due to the damage done by the ongoing criticism of activists. In addition, the SleepOut™ decided to make the event for female executives only this year. Given the dearth of female CEOs and executives in South Africa, it is not surprising that the numbers dropped dramatically. And even though the importance of an all-female leadership event in a country beset by patriarchy and violence against women should not be underestimated; and the Social ROI will be higher in 2017 than previous years (the satellite SleepOuts™ were particularly successful, as was the awareness created about the beneficiaries, and research about the problem of abandonment), the decline in funds should be somewhat of a pyrrhic victory for detractors.
It may be time to take stock. The concern about “poverty porn” (which, for the uninitiated, is defined as “exploiting the condition of the poor to generate sympathy, for the purpose of fund-raising”), is partly about perceived exploitation, but partly about a lack of focus on the structural challenges that produce poverty in the first place. So perhaps it’s significant that the fireside discussions at this year’s SleepOut™ were focused around these structural challenges. And, based on the input of subject experts on the key issues underpinning abandonment, social injustice and violence against women (an important contributing factor), the Minister of Women in the Presidency, Susan Shabangu, has undertaken to present recommendations re policy change. It remains to be seen if the Minister, who was quick to leverage the event to draw attention to women’s issues and her department, will be as quick to deliver on her promises. If she does, it will mark a huge breakthrough, especially for the projects focusing on violence against women and abandonment. But if she doesn’t, someone else will.
Nonetheless, initiatives like this will always walk a fine line between creating empathy and acting as “poverty porn”. Both the 2015 and 2016 events measured a significant increase in empathy amongst participants (89% in 2015, and a massive 100% increase in awareness about homelessness in 2016). But, for some, the exploitation cost of that increased empathy is too high, and in the absence of constructive guidance from those critics, the SleepOut™ may struggle to navigating such complex challenges successfully. The effect could be crushing. Some will likely consider that good news, but perhaps those cheering its potential demise should also be asking the question, "if not this, then what"? If we fail at philanthropic initiatives too, then who or what will save our flailing NGOs, and specifically, where will funds for these baby homes come from?
Unlike other areas of poverty in South Africa, these vulnerable children can do nothing to raise support without their plight being shared, nor can they call on their communities to fund raise on their behalf. In truth, expecting communities to raise funds to support them (as the government does) is unrealistic on two levels. Firstly, the notion that families who are struggling to feed and clothe their children are likely to pay for a social worker's salary, or fund the care of unrelated children, is aspirational at best, and delusional at worst. Secondly, abandonment, by definition, brings isolation from communities, so there is often a critical lack of backing for these children’s care. The upshot is that many of these baby homes will shut down. It’s an imminent threat. Sadly, despite being a satellite beneficiary of this year's SleepOut™, Lelethu (meaning “Ours”), a baby home in the Eastern Cape (the province with the biggest subsidy crisis and, along with KZN, the highest number of orphans), closed its doors before the first SleepOut™ event even took place.
For me, this is personal. My own five-year-old daughter spent five months in the nursery at Impilo (another satellite beneficiary of this year's SleepOut™). A week ago, I watched her playing with a child who had been abandoned at birth weighing just 810g. He had spent two and a half years at The La Lucia Baby House (also a beneficiary). As I stood next to them, listening to my daughter “reading” books to her small companion, I was struck by the excellence of the care that they had both received, at great expense. Not all children are so fortunate. Justin Foxton, a fellow adoptive dad who runs a baby home, recently produced this list of pathologies that beset children who do not receive this level of care: “Children who are institutionalised may suffer from a wide range of disorders…this includes depression and anxiety, and self-soothing behaviours such as chanting, biting themselves, head banging, rocking, scratching, or cutting themselves. At another level, sub-optimal attachment results in cruel or aggressive behaviour enacted with a cold detachment and a lack of empathy.”
According to Marietjie Strydom, head of the Attachment Foundation, this can lead to lifelong problems with learning, anti-social behaviours and mental health difficulties.
All of which brings us back to Baby C. Door of Hope, the primary beneficiary of this year’s SleepOut™, will continue to provide her with the best care. They will do so using a hotchpotch of subsidies, CSI contributions, donor funding, community support and philanthropic funds, including those from the SleepOut™. But we can no longer complacently believe that excellent organisations like this will continue indefinitely. Unless government changes its approach to subsidies, and the Lotto is used properly, it may be down to business-based initiatives to keep them afloat. As a society, we have a duty to hold those initiatives accountable for their approach and allocation of funds. But, unless we have a better alternative, we dare not close them down, there is way too much at stake. DM