The Implications of Clientelism for Reintegration and Family Strengthening

Abstract

This study examines the impact of clientelism on reintegration and family-strengthening efforts for children in Cambodian and Myanmar residential care institutions where clientelism is present. It finds that patron–client relationships between directors and families often undermine reintegration by limiting parental agency and co-opting reintegration to serve the interests of directors rather than children. While some directors use their influence as patrons to support reintegration, such instances are rare. More commonly, clientelist dynamics obstruct reunification and restrict access to family-strengthening services. The findings call for adaptations to case management and family assessments to address these dynamics, and for expanded family-strengthening services that consider families’ long-term aspirations otherwise facilitated through clientelism. These interim measures must be paired with broader social welfare reforms and equitable access to public services to reduce families’ reliance on clientelism. A blended approach that simultaneously engages and curtails clientelism may offer a pragmatic pathway towards strengthening rights-based care and protection systems for vulnerable children.

Introduction

Across much of Asia, governments and civil society actors are working collaboratively to reform child protection and care systems, aligning them with international child rights standards and global evidence on best practices in child development and alternative care (Chaitkin et al., 2017; Flagothier, 2016; Forber-Pratt et al., 2020). A central objective of these reforms is to reduce overreliance on residential care by building systems that strengthen the capacity of families and communities to care for and protect their children, while ensuring access to quality, family-based alternative care when needed (Better Care Network and the Global Social Service Workforce Alliance, 2015). This shift aims to prevent the trauma of unnecessary family separation (Trivedi, 2019) and mitigate the well-documented harms associated with institutionalisation (Van IJzendoorn et al., 2020).

For children already separated and in residential care institutions (RCIs), care reform strategies often prioritise reintegration services aimed at reunifying children with their families, where it is in their best interests. A critical component of successful reintegration is the provision of family-strengthening services to address the underlying causes of separation and build families’ capacity to provide nurturing care. Across Asia, family-strengthening approaches typically incorporate social protection and cash transfers (Rossi & Villanueva, 2023), positive parenting programmes (Shenderovich et al., 2021), economic strengthening, access to counselling, mental health services, education and social work support (Daly et al., 2015).

While these services are essential in addressing the predominant factors contributing to a child’s placement in residential care, emerging research from Cambodia and Myanmar has identified clientelism as an additional driver of child institutionalisation (Nhep, 2024b, 2025). However, existing literature has yet to consider the effectiveness of standard reintegration and family-strengthening approaches in cases where clientelism has played a role in a child’s institutionalisation. This article seeks to address this gap by analysing the implications of clientelist relationships between directors of RCIs and children and their families for reintegration and family-strengthening efforts. It begins with a brief overview of the existing literature on clientelism in RCIs, followed by the findings from the analysis of qualitative interviews with senior social workers from Cambodia and Myanmar who have experience providing reintegration services to children institutionalised within clientelist frameworks. The article concludes with a discussion of the practical implications and recommendations for reintegration and family-strengthening efforts in contexts where clientelism is embedded within RCIs.

Clientelism in Residential Care Facilities: Overview

Clientelism refers to a system of asymmetrical, dyadic relationships between patrons and clients that facilitate unequal yet reciprocal and mutually beneficial exchanges (Scott, 1972). These relationships are informal but governed by deeply ingrained norms and obligations that are culturally reinforced (Eisenstadt & Roniger, 1980; Scott, 1972). Clientelism is pervasive across many parts of Asia (Aspinall, 2015; Khan & Jomo, 2000). Where present, clientelist networks often infiltrate social policy (Yuda, 2021), establish particularistic mechanisms for accessing services and distributing benefits, undermining democratic systems, governance and the rule of law (Hicken, 2011).

Child institutionalisation is known to be caused by a complex interplay of factors affecting families, including material poverty, social marginalisation, discrimination and a lack of community services (Van IJzendoorn et al., 2020). The widespread availability of institutions promising to address these issues, in the absence of community-based alternatives, has been recognised as a ‘pull factor’ that incentivises child and family separation (Cheney, 2018). More recently, clientelism in RCIs in Cambodia and Myanmar has been identified as an additional and previously unrecognised pull factor that interacts with family vulnerability, contributing to child institutionalisation (Nhep, 2024b, 2025). In communities where material poverty and social exclusion are pervasive, clientelism has emerged as a decisive factor in determining why some children are institutionalised while others are not. Clientelist networks provide specific families experiencing vulnerability with access to RCIs, bypassing formal channels. Clientelism further incentivises child institutionalisation by offering not only immediate support through RCI but also the potential of long-term diffuse support and opportunities for the whole family in exchange for the child’s institutionalisation and conformity with clientelist norms (Nhep, 2024b, 2025).

Research in Cambodia and Myanmar found that clientelism was most prevalent in unregistered or unregulated RCIs where founders or directors utilised it to circumvent the enforcement of laws and regulations (Nhep, 2024b, 2025). This enabled these RCIs to operate without government oversight and institutionalise children in violation of established gatekeeping policies (Nhep, 2024b, 2025). Furthermore, the conflict between clientelist norms and child rights norms contributed to significant child rights violations in RCIs where clientelism was present (Nhep, 2024c). In the most egregious cases, clientelism facilitated the recruitment, transfer, harbouring and exploitation of children in RCIs in instances of orphanage trafficking (Nhep, 2024d).

This article is part of a larger study undertaken by the author exploring the nexus between clientelism and child institutionalisation. It examines previously unreported themes related to the impact of clientelism in RCIs on family-strengthening efforts in the context of reintegration.

Method

This qualitative deductive study (Bingham & Wilkowsky, 2023), informed by clientelism theory, aimed to explore the presence of clientelism in Cambodian and Myanmar RCIs and its impact on children’s reintegration. Semi-structured interviews were conducted with 24 senior social workers (14 from Cambodia and 10 from Myanmar) with experience in reintegrating children from RCIs and supporting RCI transitions or closures. Interviews examined participants’ observations of patron–client relationships in RCIs and their effects on admission, reintegration and family-strengthening efforts. A detailed description of the conceptual model and interview process is available in earlier publications (Nhep, 2024a, Nhep, 2024c).

Deductive thematic analysis (Braun & Clarke, 2021) was used, coding data around key clientelism characteristics and child protection procedures. Codes were grouped into themes, focusing on clientelism’s impact on procedural guarantees, including gatekeeping and placement reviews. The study was approved by [Blinded] University’s Human Research Ethics Committee (Blinded 2022/559).

Results

Participants unanimously reported that clientelism in RCIs significantly impacts reintegration, influencing families’ receptivity to reintegration and family-strengthening services. Three distinct themes emerged from the analysis:

1. Clientelism’s impact on parental agency and participation in reintegration.

2. The co-optation of reintegration to serve the directors’ interests.

3. The discrepancy between clientelist promises and expectations and family-strengthening support.

Clientelism’s Impact on Parental Agency and Participation in Reintegration

Participants noted that patron–client relationships between directors of RCIs and the families of children in care encroach on parental rights and agency. This limits families’ ability to take an active role in the reintegration process, irrespective of their level of interest. In cases where children were admitted into unregulated RCIs, parental rights were neither suspended nor terminated, as these admissions lacked involvement from the courts or mandated authorities. However, in fulfilling their obligation to submit to the patron director, parents felt compelled to relinquish their rights and responsibilities over their children, placing them under the director’s full authority. As a result, families felt disempowered to initiate reunification or to accept or participate in reintegration services offered to them without the director’s consent. This dynamic persisted even for families who wanted their children to return home and possessed sufficient means to provide for their care.

Families who place their children in orphanages through patron-client networks and through favours are disempowered to advocate for their children once they are in the orphanage. (C05)

When the relationship between the director and children and families is patron-client, then reintegration becomes almost totally dependent on the cooperation of the director. If the director is not supportive of reintegration, they just have to say one word and it will prevent the parents from being able to cooperate with us. (M01)

The Co-optation of Reintegration to Serve the Directors’ Interests

Participants described how patron–client relationships between directors and families reshaped the motivations behind reintegration. Instead of being driven by the child’s best interests and the family’s readiness, reintegration was contingent on whether it aligned with the director’s goals for operating the RCI. Directors supportive of reintegration used their authority as patrons to positively influence families, encouraging co-operation with social workers during assessments. In contrast, directors focused on retaining children for personal or financial gain often obstructed reintegration, discouraging family co-operation or instructing families to provide false information during assessments.

For some directors, the more children they have in care the more they benefit personally, financially, and therefore they will be resistant to reintegration as it may reduce their benefits. In these cases, they may use their status and influence over the parents to try to prevent reintegration. At that point they are acting to protect their program and the personal benefits they derive from their program. They’re no longer acting to benefit children or with their best interests in mind. (C03)

When there is a clientelist relationship between the family and the director, it has a significant impact on reintegration…. The director might communicate with the family ahead of our family visit and put pressure on the family to take a particular position with us when we conduct an assessment. This is going to impact the level of information we can extract from the family for assessment purposes. (C02)

In many unregulated RCIs in Cambodia and Myanmar, reintegration programmes were neither fully embraced nor rejected. Instead, they were co-opted by clientelism, with directors utilising their status and authority as patrons to exert control over reintegration. Patron directors often utilised reintegration services provided by third-party child protection organisations to facilitate the exit of select children, all the while intending to maintain the operation of their RCI. Children put forward for reintegration by the director typically included those perceived as difficult; those who, due to age or other factors, no longer aligned with the director’s motivations for operating the institution; and those viewed as failing to fulfil their clientelist obligations to the director. In these cases, reintegration was used as a means of severing the patron–client relationship with children and families. However, reintegration was obstructed for children who remained valuable to the director, particularly in the context of child labour schemes and orphanage tourism, or for those perceived to have fulfilled their clientelist obligations by demonstrating gratitude and loyalty.

Where clientelism is involved, directors typically push to reintegrate the children who they consider problems and who aren’t part of clientelist relationships or who aren’t upholding their end of the bargain. They do this to get rid of those children and to create a perception that they are cooperating with reintegration. Then those children have left reintegration stalls. (C01)

The Discrepancy Between Clientelist Promises and Expectations and Family-Strengthening Support

Participants described how the enduring and diffuse nature of reciprocal exchange within patron–client relationships deterred families from pursuing reintegration and accepting family-strengthening services. The exit of children from residential care, particularly before the age of 18, often signals the termination of the patron–client relationship, severing the family’s access to the patron’s resources and networks, as well as the potential for future support and opportunities.

Admission of children under patron-client relationships is tied up in promises made by the directors or recruiters to the family. They’re not going to want the child to return home, or they’ll lose those benefits. (C02)

While reintegration services involved assessments aimed at identifying risks and needs that informed the provision of family-strengthening services, social workers employ a strengths-based approach designed to empower families to achieve independence. This objective conflicts with clientelism, which operates on the principle of long-term reliance and dependence.

Directors highlight to the families that they’ll lose the patron-client relationship and long-term expectations of support that come with it if they agree to accept reintegration and family strengthening services... Directors tell the family that the family strengthening services we are offering as an alternative are only for 2 years and are not long-term. We explain that we only provide short-term support, but we strengthen the community and strengthen the family, so they’re not in a long-term dependent relationship. (C09)

Families used clientelism not only to address immediate needs but also to secure protection against future risks and pursue upward social mobility. Promises from directors, such as opportunities for university education, migration or employment, often surpassed the support offered by family-strengthening services. This perceived disparity led some families to reject reintegration and family-strengthening services in favour of maintaining clientelist ties with the patron-director, contingent on their child’s continued institutionalisation.

When the promises and expectations extend so far into the future and are these huge promises like going overseas to study, the parents are going to be very reluctant to do anything that might compromise the chances of those promises being fulfilled…. The parents are worried if they take their children back, the benefits that were promised won’t eventuate. (C05)

Discussion

Clientelism significantly undermined reintegration and family-strengthening efforts for children admitted to residential care through patron–client relationships between directors and families. These relationships restricted parents’ ability to initiate, accept or engage with reintegration services without the director’s approval. In many cases, reintegration was co-opted to serve the director’s interests, rather than the child’s best interests. While some directors used their influence to encourage family co-operation, these instances were rare. More often, directors obstructed reintegration and limited families’ access to family-strengthening services.

Clientelism, rooted in subservience and dependence, directly contrasts with the empowerment principles of family-strengthening approaches. As Yuda (2021, p. 1372) observed, in contexts where welfare states are weak and social policy relies on clientelist networks, families may view clientelism as a more reliable form of social security, offering material support and prospects for upward social mobility, which family-strengthening services often fail to match. This perception leads some families to reject reintegration in favour of maintaining clientelist ties.

The findings highlight the need to address clientelism within reintegration case management and family-strengthening services due to its potential to undermine these efforts. Training for social workers should include modules on identifying and managing clientelism in RCIs, particularly in child and family assessments, to equip practitioners with the skills needed to navigate its impact on reintegration. Family assessments should not only address material risks and needs but also uncover implicit promises tied to clientelist relationships with RCI directors, especially those linked to ongoing institutionalisation. Family-strengthening services may need to expand to address families’ long-term aspirations, offering a viable alternative to clientelist exchange. Additionally, strategies for engaging supportive RCI directors in case management processes should be considered to facilitate their endorsement and implicit permission for reintegration.

Adaptations to case management and family-strengthening approaches should be seen as interim measures complementing broader reforms in social and child welfare systems, strengthening child rights governance and promoting equitable access to public services (Brinkerhoff & Goldsmith, 2002). Children in residential care may require preferential access to social protection mechanisms, such as cash transfers, scholarships and healthcare, providing a safety net to encourage families to accept reintegration, even when it dissolves clientelist ties with directors (Nhep, 2024b, 2025). Schneider and Zúniga-Hamlin (2005, p. 577) noted that the transition from clientelism to a rights-based system requires a mix of top-down and bottom-up approaches, potentially involving ‘blended patterns of rights and clientelism’, where clientelism is both used and gradually reduced. Such blended approaches must be contemplated and integrated into care reforms across Asia to address clientelism in child protection and care systems, as further explored in other publications (Nhep, 2024c).

Conclusion

This analysis underscores the significant role of clientelism in obstructing reintegration and family-strengthening efforts for children in RCIs where clientelism is present. When admissions are shaped by patron–client relationships, families’ autonomy and engagement with reintegration processes are severely restricted. While some patron-directors may support reunification, the broader pattern of obstruction highlights the need to address clientelism as a structural barrier to reintegration and family strengthening. Integrating an understanding of clientelist dynamics into case management, assessments and social worker training is crucial for an effective response. Family-strengthening services should not only address immediate material needs but link families to alternatives and opportunities that compete with the perceived long-term benefits offered by clientelist ties. These adaptations must be part of broader reforms to strengthen child rights governance and social protection systems, reducing reliance on clientelism through inclusive public services. A blended approach, using clientelist networks in the short term while fostering rights-based alternatives, may offer a pragmatic path in contexts where clientelism remains prevalent.