Transforming Institutional Care | Better Care Network

The detrimental effects of institutional care on a child’s well-being are widely documented. Community care alternatives such as kinship or foster care, are much more effective in providing care and protection for a child, and are sustainable options until family reunification can take place. Institutional care should only be used as a short-term last resort for children over the age of 3, when all other options have been exhausted.

Countries which have traditionally relied on institutional care are now undergoing major transformations to their child care and social welfare policies, in order to move towards community care options. Such transformations are rooted in the research-based evidence of the impact of institutions on a child’s development, vulnerability to abuse within institutional settings, and the institution's high operational costs. It is therefore of great concern that the use of institutions is increasing in developing countries with high rates of HIV/AIDS. Such projects are typically funded by foreign donors to the detriment of the local population, and pressure should be placed on the host governments to pursue policies of community rather than institutional care.

Institutions should be divided into small group homes in order to provide care which more closely resembles a family structure, with the close supervision of consistent adult caretakers, and with siblings, cousins and friends kept together. Adolescents, who may find integration into a new family difficult, may benefit from small group home care or supported independent living arrangements. Such homes should be fully integrated in the community to which the children belong, with a comparable standard of living. Any group home must adhere to stringent standards of documentation and care and be regularly monitored by protection workers to ensure the children have their safety, health, psychosocial, and educational needs met.

Any child in an institution must have their needs assessed and planned for, to enable them to return to their families as soon as possible. If a child has become separated from her family in an emergency, documentation, tracing and reunification activities should begin urgently. If a child has been removed from parental care for her safety, support services should be provided to the parents in order to facilitate the return of the child. Children must be kept fully informed and involved in any plans for their care, and encouraged to maintain contact with known relatives where possible.

The literature in this section deals with examples of countries which are working to develop their child care policies away from using large scale institutions to alternative community care options such as kinship care, fostering, and small group homes.

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Country Care Review: Albania

Better Care Network , 25 Sep 2019

This country care review includes the Concluding Observations of the Committee on the Rights of the Child and the Committee on the Rights of Persons with Disabilities. The Committees' recommendations on the issue of Family Environment and Alternative Care, and other care relevant issues, are highlighted.

Specific Alternative Childcare Services

Murli Desai, 18 Sep 2019

The aim of this module from the book Rights-based Integrated Child Protection Service Delivery Systems is to learn to place children in specific alternative childcare services.

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A Goal within Reach: Ending the Institutionalization of Children to Ensure No One is Left Behind

Lumos, 16 Sep 2019

This report from Lumos defines the global problem of institutionalization of children - including the factors that drive it and the harmful impacts it has on children's physical and cognitive development - and proposes global solutions in line with the Sustainable Development Goals.

The Impact of the Care Setting on Child Rehabilitation

Better Care Network, 12 Sep 2019

In this video, Sreyna and Chenda, two practitioners from Hagar Cambodia, discuss their learning regarding the impact of the care setting on child rehabilitation.

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Family Tracing for Children Without Adequate Documentation

Better Care Network, 12 Sep 2019

In this video, Dy Noeut and Kim Malin of New Smile Organisation (NSO) discuss their experience of conducting family tracing as a part of reintegration efforts in the context of an unregistered orphanage where children’s files contained missing and inaccurate information.

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Securing Stakeholder Buy-In for Reintegration: Part One

Better Care Network, 12 Sep 2019

In this two-part video series, Nou Dalin, part of the social work team with Cambodia Children's Trust (CCT), discusses her experience of working in partnership with the Department of Social Affairs, Veterans and Youth Rehabilitation (DoSVY) to implement the Ministry of Social Affairs, Veterans and Youth Rehabilitation (MoSVY) Action Plan on Improving Childcare in Battambang Province in Cambodia.

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Deinstitutionalization of OVC In Ghana’s Central Region Factors That Impact Alternative Care In Bawjiase And Surroundings

Beugre, Anita Princia W. - Leiden University, 01 Sep 2019

Set in Central Region Ghana, using Country-Side Children’s Welfare Home (CCWH) as the main case study, this thesis investigates the underlying factors that are preventing families in the Bawjiase and surroundings from opening their homes and hearts to vulnerable children.

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Rethinking institutional care using family-based alternative child care system for orphans and vulnerable children in Nigeria

Chinwe U Nnama-Okechukwu & Uzoma O Okoye - Journal of Social Work in Developing Societies, 16 Aug 2019

This paper is based on field work experience, review of relevant literature and studies on alternative child care system in Nigeria.

Let’s Raise Children in Families Programme Case Study: Michelle

National Commission for Children, UNICEF, USAID, 01 Aug 2019

This case study profiles the reintegration experiences of one child who has participated in the Tubarerere Mu Muryango (Let’s Raise Children in Families - TMM) programme in Rwanda.

Programme Brief: Let’s Raise Children in Families

National Commission for Children, UNICEF, USAID, 01 Aug 2019

This programme brief is part of a package of materials documenting successes and lessons learnt from implementation of the Tubarerere Mu Muryango (TMM) child care reform programme between 2012 and 2018.