OVC Support Toolkit  >  Living environments  >  Alternatives to community care in extended families 

Residential Care

This section looks at issues relating to residential or institutional care of children. Other sections look, in general, at other alternatives to extended family care and in detail at placing children with other families.

Key points about residential care for children are:

• Residential care is an ineffective way of providing care for children and young people. It is poor at meeting their psychosocial needs and prepares them poorly for adult life. It is also extremely expensive and could never provide care for more than a very small proportion of orphans and other vulnerable children.
• Residential care has harmful effects on societies. It promotes stigma and discrimination, consumes resources and undermines community-based care responses.
• Based on this evidence, many countries have agreed that no new child care institutions should be built. However, there continues to be widespread public and political support for these institutions.
• Child care institutions will continue to exist and operate for the foreseeable future. They should be run to agreed standards to improve services provided for children in their care.
• A few organisations are moving away from providing institutional care to supporting community-based methods of care. These efforts need to be encouraged and replicated.

The Problems with Residential Care

A great deal of evidence has been collected from around the world which shows that residential/institutional care is an extremely poor way of providing care for children and young people. Problems of residential care include:

• It prepares children and young people poorly for adult lives as it places little evidence on teaching them skills they need.
• Children and young people who grow up in institutions often fail to develop their own cultural identity. They may feel alienated from their community. They often lack networks of friends and relatives and may lack the social skills needed to develop these. Adults who grew up in institutions form an 'underclass' in some societies.
• Children and young people from institutions often lack interpersonal skills. Some may develop anti-social forms of behaviour.
• Institutions are very poor at providing for children's psychosocial needs.
• Children and young people in institutions are more vulnerable to physical and sexual abuse.
• nstitutions may promote stigma and discrimination. Children and young people in such institutions may be seen as 'different' from other children and young people and stigmatised as a result. Levels of physical care above and beyond those in the local community may also promote stigma.
• The cost of providing care in institutions is extremely high. The costs of building and establishing institutions can be enormous. Save the Children estimate that the cost of providing care for a child in an institution can be twelve times the cost of caring for that child in the community. Institutions have been described as a 'magnet' for resources. They attract them which means that fewer resources are available for other forms of care.
• Institutions undermine community care for orphans and other vulnerable children by consuming resources that might be available for support to community care. In addition, institutions attract children and young people to them for financial reasons. The higher physical standards of care may be attractive to poor communities. Financial resources available through the institution to support a child may relieve the financial burden on the family/community. Consequently, many children may end up in institutions when they could be well-cared for in communities. For example, Save the Children report that 85% of children in institutions in Uganda had traceable relatives.
• Institutions only provide care for a very small proportion of orphans and other vulnerable children. HIV/AIDS is increasing the number of orphans and other vulnerable children. Institutions will never have the capacity to provide care for these children and young people.
• Many institutions lack staff who are skilled in providing child care.
• Children and young people rarely have the opportunity to participate in decisions that affect them in residential care.
• Much residential care fails to meet the requirements of the Convention on the Rights of the Child.

Why are there so many Institutions?

Save the Children estimate that 8 million children live in institutions worldwide and that the number is growing. Yet, there is a great deal of evidence that institutions are not a good way of providing care for children. In developed countries, many have closed and children are largely cared for in other ways. However, in many developing countries institutions are thriving and developing. New institutions are being built. For example, Save the Children report that the number of orphanages in Liberia grew from 4 in 1989 to 117 by 2001. Reasons for this include:

• The widespread belief that institutions are the best or only way to care for children. Examples of this include India, China, Eastern Europe and countries of the former Soviet Union where this view is widely held.
• The desire in certain societies to control children and to prevent them from being a nuisance. Many institutions set up for 'street children' are based largely on this desire rather than the best interests of children.
• Moral and religious values. Many institutions are run by religious organisations who seek to promote particular values and beliefs. These beliefs may include the view that certain environments are not suitable for raising children. An example of this is an institution aimed only at children of women who sell sex in India.
• Political and public support for child care institutions. Many institutions in developing countries are supported by local political figures. This is because they are seen as a worthy cause by the general public. In addition, the general public in developed countries have similar views. This means that child care institutions in developing countries are able to raise funds relatively easily.
• Institutions may represent an 'easy' option for social workers. Administrative, legal and financial issues may make it easier for a social worker to place a vulnerable child in an institution rather than trying to support them in their extended family or community.
• Cultural barriers to adoption and fostering. In many societies, there are cultural beliefs which make it difficult for a family to adopt or foster a child who is not related to them.

The Way Forward

Residential care is an inappropriate way of providing care for children and young people. However, some people argue that this should be available as a last resort for children where no other form of care is available, particularly on a short-term basis. The problem with this argument is that it allows institutions to remain. They will continue to be magnets, attracting both children and resources.

The following principles are proposed:

1. No new child care institutions should be built. Current institutions should not expand their residential facilities.

2. Institutional facilities should be adapted to provide services other than residential care. These might include day care facilities and educational services.

3. Guidelines and rules for residential care should be adopted by organisations and countries. These should always have the best interests of the child at their centre. Institutions should develop links with their local communities. They should encourage children and young people to develop links with their communities and extended families. Care should be provided at a level appropriate to the surrounding community. It should seek to provide as close to a family structure as possible. Children and young people should be allowed to participate in all decisions which affect them.

4. Organisations with experience of providing institutional care should move towards community-based models of care. Resistance from staff, donors and children will need to be overcome. Practical steps include visits to birth places, family tracing and payment for foster care. Experience from Ethiopia shows that it may be best to try to reunite children under 15 with their extended families while trying to assist those over 15 to prepare for independent living.

• Send to a friend
• Printer-friendly
• Introductions to themes (pdf)