1 In Our Lifetime: The Role of Donors in Ending the Institutionalisation of Children Protecting Children. Providing Solutions.
2 2 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Why EU funding Acknowledgements matters This report was written by Ghazal Keshavarzian, Maestral International Senior Associate, Corinna Csaky, Lumos Director of Policy & Research and Georgette Mulheir, Lumos Chief Executive, with significant inputs from Gillian Huebner, Director of Advocacy and Policy at Lumos US. The research was carried out by Ghazal Kesharvarzian and was supported by Irina Papancheva, Jan Klusacek, Jenny Skene, Mara Cavanagh and Silvia Mosneaga from Lumos. We would like to thank the many stakeholders who took time to contribute to this report. Anush Bezhanyan, World Bank Beth Bradford, Maestral International Kelly Bunkers, Maestral International Severine Chevrel, Better Care Network Emily Delap, Family for EveryChild Jessica Evans, Human Rights Watch Philip Goldman, Maestral International Aaron Greenberg, UNICEFz Kendra Gregson, UNICEF Stela Grigoras, Partnership for EveryChild Moldova Peter B. Gross, UNICEF Eleanor Gurney, Elevate Children Funders Group Megan Jones, UNICEF Andrea Khan, Foreign Affairs, Trade and Development Canada Alison Lane, JUCONI Aagje Leven, EuroChild Pat Lim Ah Ken, UNICEF Sian Long, Maestral International Eric Mathews, Disability Rights International Florence Martin, Better Care Network Rosemary McCreery, Maestral International Anna McKeon, Better Volunteering, Better Care Dragana Ciric Milovanovic, MDRI Serbia Mirela Oprea, ChildPact Martin Punaks, Next Generation Nepal Delia Pop, Hope and Homes for Children Mark Riley, Alternative Care Consultant (Uganda) David Tobis, Maestral International John Williamson, Displaced Children and Orphans Fund, USAID The preparation of this report would not have been possible without the support and commitment of these individuals and organisations.
3 Table of Contents Acronyms 4 Executive Summary 5 1. Introduction 8 2. Methodology and limitations The global situation of the institutionalisation of children 12 a. The scale of institutionalisation worldwide b. Why children are placed in institutions c. The harm institutions cause to children and to society d. Why institutions are a poor economic investment 4. Examples of good practice of donor support 16 a. European Union promoting deinstitutionalisation and care reform within Europe b. US Government priority for strengthening children and families worldwide c. The work of the Global Alliance for Children to promote deinstitutionalisation d. Investing in deinstitutionalisation at the national level 5. An overview of donor support for the institutionalisation of children 22 a. The scale of donor investment in institutions b. Why are donors funding institutions? c. Donor support for institutions d. Support for services within institutions and broader development investments e. Supporting deinstitutionalisation and institutionalisation in parallel f. Equity for children with disabilities g. Support during emergencies 6. Conclusions and Recommendations: What needs to change? 30 Bibliography 34 Annex A: Additional Case Studies 36 References 37
4 4 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Acronyms CDC CEE/CIS CHF DCOF DFID DI DOD DRI EC EU ESIF GCCPD HIV/AIDS IPA NCD NGO MoHSW PEPFAR SIDA USAID UN UNCRC UNCRPD UNICEF UNODC US USD VUP Center for Disease Control Central and Eastern Europe and the Commonwealth of Independent States. Cooperative Housing Foundation Displaced Children and Orphans Fund, USAID United Kingdom s Department for International Development Deinstitutionalisation U.S. Department of Defense Disability Rights International European Commission European Union European Structural and Investment Fund Government Commission on Child Protection and Deinstitutionalisation (Georgia) Human immunodeficiency virus infection and acquired immune deficiency syndrome Instrument for Pre-Accession National Council for Disability Non-governmental organisations Ministry of Health and Social Welfare (MoHSW) (Croatia) President s Emergency Plan for AIDS Relief Swedish International Development Agency United States Agency for International Development United Nations UN Convention on the Rights of the Child UN Convention on the Rights of Persons with Disabilities United Nations Children s Fund United Nationals Office of Drugs and Crime United States United States Dollar Vision 2020 Umurenge Programme (VUP) (Rwanda)
5 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 5 Executive Summary Purpose of the report This report summarises available evidence on the scale of the institutionalisation of children globally and the harm this causes to their health, development and future life chances. It emphasises the need for donors to review funding procedures with regard to ending the institutionalisation of children and strengthening families. It presents examples of both good and poor practices to demonstrate what works and what to avoid. It puts forward recommendations that aim to assist donors in planning the use of funds in countries that rely heavily on institutions for vulnerable children. The institutionalisation of children The placement of children in so-called orphanages, residential special schools, large children s homes and other types of institutions seriously harms their health, development and future life chances. A body of research evidence gathered over more than 60 years attests to this fact. This evidence has informed a series of international conventions and instruments that promote family-based care and call for an end to institutionalisation. Despite this, institutions continue to proliferate in some parts of the world. This is partly due to myths and misconceptions, including a belief that children are in institutions because they are orphans, that institutions are a necessary form of care and that they provide an efficient way of delivering services to children. In fact, the evidence shows that most children in institutions have living parents and the primary reasons for admission to institutions across the world are poverty and a lack of access to services in the community. Children with disabilities and those from ethnic minority communities are considerably over-represented in institutions. Outcomes for children in institutions are poor in the extreme, yet paying for a child to live in an institution is significantly more expensive in most cases than supporting them to live at home with their family. The key role of donors in ending institutionalisation Experience of deinstitutionalisation in a number of regions suggests that, with concerted efforts and the right investments, it could be possible to end the institutionalisation of children globally by This will require coordinated action on the part of all stakeholders from children and parents themselves to the international community. Donors have a key role to play at the global level, both in terms of making the right investments and in influencing other stakeholders on the ground, particularly those who are resistant to reform. Initial research has demonstrated that several bilateral and multi-lateral donors have played a key role over the past two decades in transforming systems of health, education and social services that make it possible to reduce reliance on residential institutions. The research for this report found numerous examples of good practice funded by donors, showing a praiseworthy trend towards supporting children in families and communities rather than in institutions. A small selection of specific examples is provided in Section 4. However, these efforts lack consistency at times. The research found examples of the same donor agency simultaneously funding conflicting programmes those aimed at ending institutionalisation and those that reinforce institutions. In other cases, one donor is pioneering the development of community services whilst another is renovating institutions in that same country. Not only does this prolong the period of time that children must spend away from families and in institutions, it also represents an inefficient use of precious financial resources. Moreover where donor intervention is inconsistent, governments and communities in receipt of funds receive mixed messages about appropriate forms of development. In such cases, it is unlikely that governments will be able to develop a coherent approach to reforming their approach to vulnerable children. Investment programmes often leave the most vulnerable children, such as those with disabilities, out of the planning process. They are more likely to remain longer in institutions, in spite of the fact that they are also likely to suffer greater harm as a result of institutionalisation. It is also significant that a number of bilateral donors are funding institutionalisation abroad, in spite of the fact that they moved away from this model in their own countries decades earlier.
6 6 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Donor support for institutions: what to avoid The research highlighted a number of key areas of problematic investment that promoted institutionalisation at the expense of community-based services. The key findings from the examples are summarised here: Direct support to institutions Whilst most organisations have moved away from directly funding orphanages, or institutions, there are still examples of this type of donor funding. Money should instead be given to community support services to keep families together and deinstitutionalisation programmes to reunite them. Institutional reform/parallel funding During reform processes, there is evidence of funding provided to improve institutions, instead of - or as well as - funding deinstitutionalisation. Although sufficient standards must be maintained until all children can be moved, too much funding spent on improvements will hinder or even prevent the deinstitutionalisation process. No improvements should be made that are not strictly necessary for children s safety in the interim period, as they prepare to move. The vast majority of funding should go to setting up services to enable deinstitutionalisation and no children should be left behind. Support for services within institutions In some instances, funding is given to provide services to children living in institutions, such as medical care or psychosocial support. Whilst this may be beneficial, it can have severely negative consequences, such as encouraging parents to give children up to institutions in order to receive this support. Where institution services are necessary and must be funded temporarily, then community services (of the same type) and support for deinstitutionalisation must also be funded. Support during emergencies During natural disasters, conflict and other crises, many children become separated from their parents. Funds are often spent on the simplest service to take care of these children: orphanages. Once admitted, children tend to remain in institutions for long periods and little effort is made to reunite them with family. Instead of residential institutions, donors working in disaster situations should fund emergency foster care and kinship care as well as programmes to locate and reunite families. They should also ensure any temporary centres that are established are included in a medium-term deinstitutionalisation strategy. Lack of equity for children with disabilities There are two parts to this. Firstly, the lack of investment in making mainstream services inclusive of children with complex needs is a key factor driving children into institutions. Secondly, donors frequently fund deinstitutionalisation programmes that do not include children with disabilities or leave services for these children until the end of the reform process. As numbers in institutions decrease, so does the funding; consequently, the services for children with disabilities reduce in quality. If the funds in the system are not ring-fenced, they are used on other local necessities. When the time comes to provide services for children with disabilities, authorities argue that there are insufficient funds in the budget. To avoid these problems, comprehensive plans should be made for funding reform which provide care for all children in the community, including the more intensive services required for children with complex needs. Conclusions There is a need for a consistent approach to deinstitutionalisation on the part of donors. This approach should also be based on evidence of what works best and should also learn from programmes that have resulted in unintended negative outcomes for children. Good intentions can result in poor outcomes. Inconsistent approaches to reforming services for children and families prolong the period of time children must spend in institutions and represent an inefficient use of resources. This sends mixed messages to governments in receipt of funds, making it difficult for them to establish coherent development policies and practices. There is a need to raise awareness among some donors and recipient partners of the myths surrounding the harm caused by institutionalisation. Donors can play a key role in informing others regarding: how to avoid inadvertently funding institutions where to redirect funds: the best practices for supporting children in families. Focusing on shifting funding models will enable changes in practice in relation to the institutionalisation of children. The EU s new regulations on the use of Structural Funds, the US Government s Action Plan on Children in Adversity and the public-private partnership of the Global Alliance for Children all provide excellent examples of major donor efforts to realign resources in the best interests of children, away from institutions and towards community-based services.
7 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 7 Key recommendations to donors include: Review funding procedures and invest more in best practices Develop internal policies and regulations that prohibit the use of funds for renovating and building institutions and instead prioritise the transition from institutional to community-based services. Develop guidance documents for grant managers and governments to ensure deinstitutionalisation programmes include all children and to avoid common pitfalls in the deinstitutionalisation process. Ensure that all development and humanitarian investments are inclusive of children in institutions or those at risk of being institutionalised. Prioritise deinstitutionalisation and the development of community-based services in strategies, funding criteria and plans across all sectors. Scrutinise proposals and review existing agreements to ensure that funds are not contributing to the institutionalisation of children. Raise awareness and disseminate research Work jointly to raise awareness with governments on the harm caused by institutionalisation and the alternatives that exist. Include this as a priority in capacity building for health, education and social service professionals, as well as for politicians. Undertake further research into the use of donor funds on institutionalisation and on the development of community-based services. In particular, estimate the sums expended on both and use the information as an advocacy tool for shifting funding from institutions to community-based investments. Undertake cost-benefit research into the different forms of care institutional and family based in different cultural and economic settings. This research will further assist in identifying what works best in different settings and will provide tools for advocacy and for planning reform. Plan together for the most effective reform Support the development of a joint statement of agreed principles and recommended practices in relation to funding services for vulnerable children and families. This statement should be based on evidence of practices and systems that result in the best outcomes for children and the most efficient use of invested funds. Work together in a number of demonstration sites on the joint planning and implementation of programmes that seek to replace institutions with community-based services. If a group of bilateral and multilateral donors cooperate in this way, it is likely that outcomes will be better and funding will be used more efficiently. Work together to develop guidance for investment in institutions in emergency situations. Where an institution is developed in response to an emergency, or where the emergency is in the institution itself (such as severe abuse or high mortality rates), urgent investments to improve care and save lives should form part of a medium-term plan for deinstitutionalisation.
8 8 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Introduction
9 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 9 Donors play a key role in propagating or eradicating the institutionalisation of children around the world. The issues they choose to fund and the principles and approaches they apply, greatly influence what support is available to children and their families. Whilst all donors have a role to play in this regard, this report focuses on a range of bilateral and multilateral donors* operating around the world. Key Definitions There are many types of facilities that could be defined as children s institutions. These typically include, but are not limited to, orphanages, baby homes, residential schools, residential health facilities, children s homes and homes for persons with disabilities that house both adults and children. Institutions are often designed to deliver a range of services to children including education, health, and/ or alternative care. As such they are found within a variety of sectors, not just in the area of child protection. It is not the type of facility or its size that determines what is an institution, but rather the conditions and culture that preside. In particular, an institution is any residential facility that houses children in which: children are isolated from the broader community and/ or compelled to live together; children (and their families) do not have sufficient control over their lives and over decisions which affect them; the requirements of the organisation itself tend to take precedence over the children s individualised needs. 1 The institutionalisation of children refers to their placement in an institution in order to access any kind of service. As such it is an active consequence of how services are delivered. Any intervention that supports services to be delivered to children through an institution is contributing to their institutionalisation. Deinstitutionalisation refers to a complex set of actions that include at least: Preventing the separation of children from their families, through the development of community-based health, education and social services that are fully accessible to all children and their families Ensuring that every child currently in an institution is supported to move to a placement appropriate for them, where possible their own family or a substitute family in their community Ensuring the transfer of resources from institutions to community-based services, to facilitate the financial sustainability of community-based services Changing attitudes and practices of a broad range of stakeholders politicians, donors, professionals, parents, children and society at large. Many donors recognise the importance of strengthening families and some are actively supporting deinstitutionalisation. For example, strengthening families is a central objective of the US Government s Action Plan on Children in Adversity 2 and the US President s Emergency Plan for AIDS Relief (PEPFAR) Guidance for Orphans and Vulnerable Children Programming. 3 Promoting deinstitutionalisation is part of the regulations governing European Union (EU) Structural and Investment Funds within Europe. It is also a priority of the Global Alliance for Children, a coalition of several major donors including the US Government, The World Bank, the Canadian Government as well as several NGOs and private trusts and foundations. 4 There are also many examples of where donors have proactively promoted inclusive basic services for children and families, supported initiatives that prevent family separation, contributed to the transition from institutional to community-based services for children, invested in processes that enable children affected by institutionalisation to shape the world around them, and worked together with other donors to align their approach at either the national or international level. However, as the evidence in this report demonstrates, many donors continue to fund the institutionalisation of children or are at risk of doing so. Much of this funding is inadvertent, sometimes without the knowledge of the donor itself. For example, donor support for social, educational or health services is often used to fund institutional facilities such as residential schools or homes for children with disabilities; donor support for schools or hospitals has been used to renovate services without making provisions for children with disabilities or other excluded groups, meaning that generations of children may be excluded; and donor investments in infrastructure and maintaining public buildings has been spent renovating institutions. Moreover, the lack of donor investment in structures and services that prevent unnecessary family separation such as social protection, inclusive education and community-based health services perpetuates the institutionalisation of children. It is also the case that different donors, and even different agencies within one donor, take conflicting approaches in different settings leading to confusion and disjointed planning on the part of the recipient country. This report seeks to highlight good and poor practices to donors, so that they can ensure their funding supports children to thrive in a family setting, rather than in institutions. * Bilateral and multilateral aid includes aid given from a donor government to a recipient country and aid given from a donor government to a multilateral organisation, such as the UN, which then administers the money to several recipient countries.
10 10 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Methodology and Limitations
11 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 11 The aim of this report was to provide a snapshot of some of the available data on donor funding of institutions for children. It was never intended as a comprehensive analysis of global funding. Instead the aim was to identify whether there was sufficient evidence to provide a cause for concern for donors, which might justify more in-depth analysis. The report is based on a literature review of the most up-to-date information on donor funding in relation to the institutionalisation of children, 5 and issues related to children outside of family care. This includes: Published and grey literature on institutional care and family-based care; Studies and assessments from United Nations (UN) agencies, non-governmental organisations (NGOs), human rights organisations and research institutes; Strategic documents and policies of key bilateral and multilateral donors (e.g. EU and European Commission (EC), United States Agency for International Development (USAID), Swedish International Development Agency (SIDA), World Bank); Donor websites for information about projects and funding priorities; and Websites of international campaigns, donors and NGOs. NGOs, UN agencies, research institutes and human rights organisations, such as ChildPact, Human Rights Watch, Disability Rights International, Hope and Homes for Children, the Better Care Network, UNICEF, EuroChild, and Family for EveryChild, were consulted to identify examples of donor expenditure from different geographical contexts. Several donors were contacted directly, including Displaced Children and Orphans Fund (DCOF)/USAID, the World Bank, Foreign Affairs, Trade and Development Canada, for further information and clarification of available information. Due to the limited time period and challenges in gathering evidence, the research data upon which this report is based is not fully comprehensive and has some limitations. For example, donors do not monitor their funds in relation to institutionalisation, making it necessary to rely on select examples rather than a full global picture. It was also not possible to conduct interviews with key donors, such as the US Government s PEPFAR, the European Commission or the United Kingdom s Department for International Development (DFID).
12 12 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN The Global Situation of the Institutionalistion of Children
13 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 13 a. The scale of institutionalisation worldwide The exact number of institutions and the number of children living in them are unknown. Estimates indicate that anywhere between 2 and 8 million children are in institutional care, but these estimates are consistently acknowledged to be low and out-dated. 6 The actual figure is likely to be higher, due to the continued proliferation of unregistered institutions and the lack of reliable data. 7 In Ghana, for example, a 2013 government audit found that the number of residential institutions had increased by 169% between , 96% of which were unlicensed and unregulated. 8 Children are living in institutions in every region of the world, including in high, middle and low-income countries. For example, according to the best available evidence: in Indonesia there are up to 500,000 children a ; in Russia up to 600,000 b ; in Japan 35,000 c ; and in Brazil 50,500 ḍ Several reports provide an overview of numbers worldwide e. In many countries institutional care is increasing. 9 The reasons for this are complex and manifold. They stem from a persistent misconception that institutionalisation is a valid means of delivering social, health, educational and other services to children, or at the very least an inadequate but essential response due to a lack of alternatives. It is also linked to the proliferation of unlicensed institutions, some of which operate to serve commercial interests associated with child trafficking and unregulated inter-country adoption. 10 It is also the result of global trends including those associated with conflict, disasters, migration and HIV/AIDS and disease 11 and continued funding for institutionalisation by private, faith-based and public donors. 12 b. Why children are placed in institutions Contrary to popular belief, the vast majority of children in institutions are not orphans. 13 Upwards of 50-90% have a living parent. 14 In Nepal, for example, 62-85% of children in residential care have one or more parents alive. 15 Similar figures are seen in Bolivia (54%), 16 Turkey (60%), 17 Haiti (80%), 18 Ghana (80%), 19 Indonesia (94%), Afghanistan (45-70%), 20 Cambodia (77%), 21 Indonesia (94%), 22 and Russia (95%). 23 Poverty, not orphanhood, is forcing many parents to place their children in institutions in order to access food, shelter, education, health and other basic services. A lack of affordable local schools and health facilities is also leading to parents placing their children into residential schools or health institutions. This is particularly common for children with disabilities or specialist medical requirements, for which local support is not available. Institutions are also used as a child protection response. For example, children who are experiencing abuse or neglect at home; who have become separated from their families during an emergency; who have been abandoned; or whose parents are ill, deceased, incarcerated, have migrated or who have separated or divorced are often placed into institutional care. 24 Discrimination and exclusion on the basis of gender, ethnicity and disability are also driving children into institutions. 25 c. The harm institutions can cause to children and to society There is a strong body of evidence highlighting the benefits of growing up in a family or family-based care as compared to an institution. 26 Living in an institution produces long-term and sometimes permanent effects on children s cognitive, physical, intellectual, and socialemotional development. 27 Research over the last 60 years from across the world has clearly demonstrated the harm caused by institutionalisation. 28 More recent research shows that positive, consistent interaction between a child and parent or other primary caregiver has a significant impact on the early development of the brain. When this is absent, developmental delays, attachment disorder and neural atrophy in the developing brain can occur. 29 The negative effects are more severe the longer that a child remains in an institution, and are most critical in younger children, especially those under three years of age. 30 a Numbers are not known, but estimated between 225,750 and 516,600. Only 5.6% of a sample of 2,248 children had both parents deceased, but an additional 4.8% were unknown. DEPSOS, Save the Children and UNICEF, Someone that Matters : The quality of care in childcare institutions in Indonesia, Save the Children UK: Jakarta, Indonesia, 2007, p19, p83. b Mental Disability Rights International (1999). Children in Russia s Institutions: Human Rights and Opportunities for Reform. c Estimate calculated from data given in: Human Rights Watch, (2014). Without Dreams: Children in Alternative Care in Japan. d RELAF and SOS Children s Villages International, ( 2010). Informe Latinoamericano Situación de la niñez sin cuidado parental o en riesgo de perderlo en América Latina: Contextos, Causas y Respuestas pp [accessed 31 October 2014] See also English summary Relaf.pdf e Lumos (2014). Factsheet: The Global Picture of Children in Institutions. Csaky, C., (2009). Keeping Children out of Harmful Institutions.
14 14 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Children in institutions are also at an increased risk of abuse, exploitation and neglect. 31 In many institutions the standard of care is consistently poor: for example, approximately 85% of residential care homes in Nepal do not meet minimum standards. 32 This is compounded by the chronic lack of regulation and inspection of institutions, most of which are entirely unregulated. For example, in Uganda, more than 95% of 800 residential care facilities are not appropriately licensed by the government and operating in violation of national child protection laws. 33 Violence in institutions is six times higher than violence in family-based care such as foster care; children in group care are almost four times more likely to experience sexual abuse than children in family-based care. 34 Studies have shown that children raised in institutions consistently have poorer outcomes compared to their peers raised in a family setting. 35 Research demonstrates that the transitional period from life in an institution to independent living or adulthood is one of the most vulnerable periods of the child s life and often they are left with no place or no one to turn to once they leave care. 36 After exiting care, young people are often confronted with a number of challenges and hardships such as homelessness, criminal justice and incarceration, mental health, early sexual activity and teenage pregnancy, low educational attainment, unemployment and drug abuse. 37 For example, one study of young adults who were raised in institutions in Russia found they were: 10 times more likely to be involved in prostitution as adults; 40 times more likely to have a criminal record; and 500 times more likely than their peers to commit suicide. 38 Children themselves have consistently highlighted their preference to live in a family setting, rather than an institutional one. 39 One of my dreams for the future has just been realised by being part of this project. I want us to work together to stop bad things in the world trafficking of women and children, abuse in families, homelessness. I want to see day centres for children with disabilities and for children to be taken out of institutions. 41 Child with disability The harm institutionalisation causes children has been recognised in several international and regional human rights instruments including: the UN Convention on the Rights of the Child (UNCRC) (Para. 6) and the Guidelines for the Alternative Care for Children (Para. 3), 42 which were formally welcomed by the UN General Assembly in These and other instruments recognise that children have the best chance of developing to their full potential in a safe and protective family environment. 43 Orphanage care-givers only superficially care for children they feed, dress and wash children. However, there are so many children and caregivers cannot give enough attention and cannot offer support to all of them. 40 Child in foster care in Georgia talking about why foster care is better than institutional care
15 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 15 d. Why institutions are a poor economic investment Several research studies have shown that delivering support to children in an institutional setting is, on average, six to ten times more expensive than supporting children in their own families or in alternative family-based care. 44 Country-level experience has also consistently shown that investing in vulnerable families, inclusive services and family-based alternative care, rather than institutions, is a better use of public money. 45 There are also several long-term benefits to society of investing in children compared with investments made later in the life cycle. 47 Effective support to families and children helps increase the likelihood that children will develop into healthy and productive members of society later on in life. This is vital in order to meet national and international development, humanitarian, and human rights targets. In particular, since many of the children in, or at risk of being in institutions belong to the most marginalised and vulnerable groups in society, addressing their concerns is a priority for the achievement of equity across several development objectives. Investing in institutionalised children, or those at risk of being institutionalised, also reduces the long-term financial burden on state and civil society resources, since fewer children will be dependent on social or economic support in adulthood or engage in crime and other behaviours that have a negative impact on public spending. 48 A better use of public money a Bulgarian example 46 In one region in Bulgaria the cost for complete deinstitutionalisation is estimated at 2,597,745. The ongoing running costs will be 1,653,794 per year, compared to the cost of running the current residential system which is 1,919,875, supporting more than 10 times the number of children. 2,000,000 1,900,000 1,800,000 1,700,000 Running costs 1 year 1,919,875 1,653,794 Number of children supported , ,600, ,500,000 Residential system New system 0 Residential system New system
16 16 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN Examples of Good Practice of Donor Support
17 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 17 These human rights milestones represent a shift in attitude, recently being reflected in European policies and funding. Twenty-five years after the shocking revelations of millions of citizens languishing in institutions, the European Union has now committed to putting fundamental European values of human rights, liberty, solidarity and opportunity at the heart of the regulations for the EU s main tool to promote innovation, skills, employment and social inclusion. 49 Georgette Mulheir, CEO of Lumos, 2014 The last few years have seen a notable shift in some donors understanding of institutionalisation and a greater priority given to supporting children in families and communities. Many of these changes mark an historic achievement in the evolution of rights and development work and set an important precedent for donors and other stakeholders. This section highlights a number of examples in which donors have: - proactively promoted inclusive basic services for vulnerable children and families and other initiatives that prevent unnecessary family separation; - contributed to the transition from institutional to community-based service delivery; and - worked together with other donors to align their approaches in a common vision towards deinstitutionalisation and family strengthening. a. European Union promoting deinstitutionalisation and care reform within Europe Since 2009, many partners, including Lumos, have advocated for changes in legislation to ensure that EU funds support the reform of care systems in European Member States and are not used to maintain outdated and harmful institutional models of care. This has resulted in a major shift in emphasis in how EU Funds are used. In particular, on 20 November 2013, the anniversary of the signing of the UNCRC, the European Parliament confirmed new regulations governing EU Structural and Investment Funds a funding stream that channels many billions of euros across Europe. This new regulation (Ex ante 9.1) obliges countries to use Structural and Investment Funds to dismantle institutions and replace them with community-based services; to adhere to the UN Convention on the Rights of Persons with Disabilities (UNCRPD); and to prevent funds from being used to renovate or build new institutions. 50 There are already several examples of how the new Regulation has been put into action. Partnership agreements between a number of EU Member- States and the EC highlight the transition from institutions to community-based care as a priority. The Partnership agreement of the Republic of Bulgaria, for example, includes a number of commitments to deinstitutionalisation and the development of community-based services. Amongst these are the following: Ensuring that schools are accessible for all children, including through appropriate infrastructure investment to improve the conditions of buildings and ensure equal access (supportive environment for children with special educational needs) ; Ensuring integrated measures for investing in early childhood development - support children and their families from a very early age to prevent risks to their development; access to childcare, nurseries, kindergartens including through improving their infrastructure and facilities; parental support for employment, training and reconciling personal and business life ; Elimination of the institutional model of care and development of integrated inter-sectorial services for social inclusion: deinstitutionalisation of childcare through closing existing specialised institutions and developing preventive and alternative forms of care and services; Improving the access to and the quality of pre-school education, particularly among disadvantaged children introducing a model for early evaluation of the educational needs of the children at pre-school age and for prevention and early intervention concerning their educational difficulties ; Providing accessible and quality services for complete social inclusion and realisation of rights; Providing support for proactive social inclusion of groups with special needs; Providing support services, including integrated cross-sectoral services for children (including integrated services for early childhood development), young people, families with children, the elderly, people with disabilities and other vulnerable groups ;
18 18 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN The challenge now for the EU is both to ensure that the regulation is implemented to the fullest extent in Europe, as well as to apply the spirit of the regulation to all other EU funds invested in Europe and globally. The EU has also used the pre-accession process as a way of promoting deinstitutionalisation. For example, in July 2014, deinstitutionalisation was made a key national priority in Bosnia and Herzegovina and an action plan for 1.5 million of EU funding was committed to over the next three years to this end. 51 There are also significant past examples of the use of pre-accession funding to promote deinstitutionalisation within Europe. For example, as the following case study shows, many have pointed to the role of EU pre-accession political and financial interventions in pushing forward vital reforms to child welfare in Romania. 52 b. US Government priority for strengthening children and families worldwide The US Government has been a pioneer in its commitment to deinstitutionalisation and family strengthening within its global policies and strategies. For example, the US PEPFAR s Guidance for Orphans and Vulnerable Children Programming prioritises preventing and responding to child abuse and family separation by strengthening child protection systems. 60 Of particular note is the US Government Action Plan on Children in Adversity. 61 This is an international whole-of-government plan that applies to all divisions within the US Government and is supported by a process of policy coherence. The goal of the Action Plan is to achieve a world in which all children grow up within protective family care and free from deprivation, exploitation, and danger. As the following text box shows, preventing unnecessary family separation and supporting children to thrive in their own families or in an alternative family-based environment are fundamental to the plan. The US Government Action Plan sets an important precedent for other donors and governments worldwide. The priority now is for the US Government to ensure that this plan is implemented to the fullest extent across all government agencies. One challenge identified so far is the lack of impact monitoring for children living outside of family care. Child welfare reform in Romania Romania s shocking orphanages became the symbol of one of the gravest humanitarian concerns of the early 1990s. International public opinion placed considerable pressure on the Government of Romania to prioritise childcare reform, to close institutions and to create alternative child welfare services. Three decades later, Romania has been heralded as a model in child welfare reform, 53 becoming an aspiration of what is possible when multiple stakeholders from all levels of policy engagement come together. 54 The political will of successive Romanian governments, coupled with coordinated donor support and commitment were the main driving forces. Child welfare reforms were put high on the EU-Romania agenda and were turned into conditionality for EU accession: With this legal basis, both the EU stakeholders and their Romanian counterparts accepted child protection reform as a human rights conditionality to EU membership. 55 The EU s unified institutional position on child protection, targeted investments towards family support and alternative care services, and highly coordinated messaging from the European Parliament and EC were instrumental to the success. 56 Indeed, the period of accession ( ), saw the greatest reduction in the number of children in institutional care and in the number of residential institutions. 57 It is important to note that this period also coincided with major investments from the EC, the European Development Bank, UNICEF, the World Bank, the International Labour Organisation, other bilateral donors (USAID, 58 DFID, Canadian International Development Agency) and foreign international organisations and foundations. 59
19 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN 19 The US Government s Action Plan on Children in Adversity The Action Plan has three principal objectives and three supporting objectives to promote greater U.S. Government coherence and accountability for whole-of-government assistance to vulnerable children: Principal Objectives Objective 1- Build strong beginnings by helping to ensure that children under 5 not only survive, but also thrive, by supporting comprehensive programmes that promote sound development of children through the integration of health, nutrition, and family support. Objective 2 - Put family care first, by U.S. Government assistance supporting and enabling families to care for their children; prevent unnecessary family-child separation; and promote appropriate, protective, and permanent family care. Objective 3 - Protect children by facilitating the efforts of national governments and partners to prevent, respond to, and protect children from violence, exploitation, abuse, and neglect. Supporting Objectives Objective 4 - Strengthen child welfare and protection systems by supporting partners to build and strengthen holistic and integrated models to promote the best interests of the child. Objective 5 - Promote evidence-based policies and programmes by devoting resources to building and maintaining a strong evidence base on which future activities to reach and assist the most vulnerable children can be effectively planned and implemented. This evidence base will assist in the cost-effective utilization of programme funds as well as the monitoring and evaluation of programme effectiveness and long-term impact on children. Objective 6 - Integrate this plan within U.S. Government departments and agencies by institutionalising and integrating the components of this plan in its diplomatic, development, and humanitarian efforts overseas. 62 c. The work of the Global Alliance for Children to promote deinstitutionalisation In response to the global and national conditions of children in extreme adversity, a group of foundations, bilateral, multilateral, NGO and private sector partners founded the Global Alliance for Children. 63 The work of the Alliance represents a response to the Action Plan on Children in Adversity (APCA) mentioned above. Through a donor-advised fund, joint programmes and coordinated funding, the Alliance seeks to achieve the three core objectives of APCA in six countries over the course of five years. In this way, the Alliance seeks to demonstrate that close coordination between governments, donors and experts, joint planning and joint implementation can result in major change for children. It is envisaged that this work can serve as a model for donor collaboration to enable them to be the agents of systemic change. d. Investing in deinstitutionalisation at the national level There are a number of positive examples of donors investing in deinstitutionalisation at the country level. Whilst there is insufficient space in this report to list all instances, below are a few case studies that demonstrate how donor investments have driven major transformations in the way children are cared for in a variety of countries and regions. Some examples of good practice cover dedicated deinstitutionalisation programmes, while others demonstrate how investments in education, health, social protection and other mainstream services can contribute to deinstitutionalisation. Other recent reports record many examples of both around the world. 64
20 20 IN OUR LIFETIME: THE ROLE OF DONORS IN ENDING THE INSTITUTIONALISATION OF CHILDREN My sister and I lived for a couple of years in that institution, where we saw sadness and suffering in each child s eyes. We were not happy about living there either. We got lucky when some extraordinary people helped our grandmother to take us back home into the family. They had great confidence in my grandmother and gave us hope. A year has passed since we came home to our grandmother and started going to the mainstream school, which we like a lot Raluca and her sister Angela were reunited with family in Moldova Deinstitutionalisation and inclusive education jointly planned and implemented in Moldova Moldova has emerged as one of the region s most promising examples of how the use of institutional care can be reduced, leading to thousands of children, such as Raluca and Angela, being reunited with their families. Between 2007 and 2013 the number of children in institutions dropped from 11,500 to 3,909, the under-five mortality rate dropped from 14.0 to 12.1 per 1,000 live births and funding was issued for inclusive education in over 40% of schools. 66 This constitutes a 70% reduction in the number of children in institutions, an increase of children with disabilities educated in inclusive schools from zero to 4,495; 67 and a financial saving derived from reducing numbers in institutions to fund the new community services. This was achieved due to the Government s commitment to child welfare reform, as well as the efforts of local authorities and NGOs on the ground. A combination of programmes with funding from USAID/DCOF, the EU, the World Bank 68 and foundations such as Lumos, Open Society Institute/ Soros Foundation, Medicor Foundation and the World Childhood Foundation, have delivered significant results in deinstitutionalisation through the development of family support services, family substitute services and inclusive education. Two keys to success in Moldova are: A combined approach to deinstitutionalisation and the development of inclusive education. Since many of the children in institutions in Moldova were living in residential special schools, complete deinstitutionalisation would be impossible without the development of inclusive education in mainstream schools for children with disabilities. The Government, with support from NGOs such as Lumos, developed and implemented an inclusive education strategy which has been successfully piloted in a number of regions and is now being rolled out to two thirds of the country. Legislation to ring-fence and transfer resources from institutions to community-based services. As deinstitutionalisation efforts resulted in a reduction of the number of children in institutions, the savings were ring-fenced and transferred to support foster care, inclusive education and other community-based services. Thus the sustainability of inclusive education and foster care was made possible. To date, the reform in Moldova has focused predominantly on school-aged children without disabilities. This is because there were relatively few babies in institutions compared with other countries in the region and because the inclusive education demonstration programmes were needed before all children with disabilities could move from institutions back to the community. This means that the remaining 3,909 children in institutions includes a significant overrepresentation of children with disabilities. The Government has recently undertaken an inter-ministerial planning process and aims to develop the necessary services for younger children and children with disabilities that will end institutionalisation completely in Moldova in the next 5 years. Reducing the use of institutional care in the Republic of Georgia Over the past decade, Georgia has undertaken ambitious childcare reforms. While there are troubling donor practices that have emerged from the care reform (which will be discussed in the next section), Georgia is also an example of how good donor support can reduce institutional care and strengthen the wider deinstitutionalisation and child protection process. 69 In 2005 the Government established a Commission on Child Protection and Deinstitutionalisation to take forward structural reforms, which was a requirement of the EU budget support. 70 This was followed by a significant injection of external funding by the EU, Sida and USAID. 71 These funds strengthened alternative care services and decreased the total number of children in institutional care from 5,000 in 2005 to 1,500 in 2009 through family reunification and foster care services. 72