Understanding Deinstitutionalisation in India

Co-Written by  Dr. Kiran Modi, LaxmiMadhwan & Leena Prasad


Decades of research has clearly proved the harms of ‘institutionalised’ care onOHC (Out of Home) children. There are several studies that have showed the systemic inadequacies observed across institutions the world over, thus sparking a global call for care reformation; one towards family strengthening, deinstitutionalisation and finding alternative family and community-based care systems.

Child Care Institutions(CCIs) are broadly defined as residential living arrangements for children without parental care, in which care is provided to more than ten children by a relatively smaller number of paid adult carers[1]. Institutional care is most oftenorganized, routine and puts a system of impersonal structure to cater to thebasic living arrangements for children, with a more professional rather than parental relationship between the carers and the children.In India, CCIs remain the first choice for most children without parental care, or orphans, as defined by the Juvenile Justice (Care and Protection of Children) Act, 2015. This Act, in spirit, follows the principle that family is the best for a child’s growth, but in reality,makes CCIs the first priority, also attributable to the absence of family and community based non-institutional care options in India.

Compelling Evidence for Change

Evidence of harm to children caused by institutional care dates back to the early twentieth century. Dr. Henry Dwight Chapin reported noticeable harms to the health of children residing in medical institutions[2], increasing their risk of mortality. Along the psychosocial spectrum of health, findings from the BucharestEarly Intervention Project[3] revealed that compared to the 100% secure attachment found among children living with their parents, less than 4% of children in institutional care had secure attachment with their caregivers. Decades of research has confirmed that institutional care harms children, with negative impacts lasting through their lifetimes[4]. Children raised in CCIs are at a higher risk of being involved in prostitution and criminal activities, and more likely to commit suicide and remain insecure in their adultlife, compared to children raised in families.[5]Since present Aftercare services are insufficient, most of them are ill-prepared for transition from CCIs to independent living, and thus again fall into the vicious cycle of vulnerability, homelessness, unemployment and poverty.

Systemic inadequacies have also been of great concern, with numerous institutions not adhering to minimum standards of care, and functioning in nearly desolate conditions[6]. Further, a growing number of incidences of abuse are being reported in CCIs[7]. Globally, institutionalisation has been linked with exploitation and trafficking, often falling within the ambit of modern slavery, and many childrenin institutional care are subjected to abuse (physical, sexual and emotional) and neglect[8].

The harmsinflicted by institutional care to the health and development of children are distressing, yet, the negative impacts of institutionalisation percolate deeper. It has been argued that institutional care disrupts healthy familial and social structures, where communities are disintegrated and dependency and reliance on institutions is the result[9]. The cost intensive framework for running CCIs adds another layer to the issue. Institutional care causes a financial toll with expenditure per child in institutional care significantly greater than other forms of alternative care including kinship or foster care[10].

The United Nations Convention on the Rights of the Child (UNCRC)[11] and Sustainable Development Goals (SDGs)[12] affirm that a family environment, one where children experience love, happiness and understanding, is essential for their harmonious development, also propounding the responsibility of each nation to strive to provide children and youth nurturing environments by which they can fully realize their rights and capabilities. The United Nations Guidelines on Alternative Care (UNGAC)[13]also provides the principles of ‘necessity’ and ‘suitability’to ensure suitable placements and better outcomes for children. The causes of separation of children from families are first identified, and as possible, resolved. Should separation still be the best alternative, mechanisms are put in place to ensure the care provided is contextual to the individual needs of the child. The necessity principle thus reduces the perceived need for formal alternative care, discouraging recourse to the same only when absolutely necessary. The suitability principle ensures that should alternative care be required, minimum standards are in place to meet the needs of the child.

The deinstitutionalisation movement, which aligns with the principles of family being the best for every child, has been gaining momentum the world over. Deinstitutionalisation refers to mechanisms that replace institutional care with family strengthening and family-based alternative care services. Deinstitutionalisation advocates the continuum of care, acknowledging the ever-changing needs and contexts of children, and for a system that provides family-based services suited to the needs of each child’s best interest.

Mechanisms for Positive Change            

a) Prevention and Family Strengthening

Preventing dependency on alternative care, due to socioeconomic factors such as discrimination, disease, poverty and deprivation, is one among the first necessary steps towards improved care. Families at risk, with lack of access to basic services, poor parenting skills and intra-familial conflicts, must also be supported to overcome their difficulties, so that children can remain within their families. Children may also be separated from their families during emergencies such as wars and natural disasters, for which,rather than separation and institutionalisation, emergency care and rehabilitation units must be established to restore children to their families and communities.  Gatekeeping mechanisms must be in place to ensure that a child’s separation from the family occurs only when necessary and provided that there are a range of appropriate family and community-based alternatives to meet the child’s needs holistically.

b) Family-Based Care Alternatives

In circumstances, where alternative care is most suitable towards their best interest, children must be supported with individualized, quality care within family-based care settings, such as in kinship care, foster care and small residential homes. Every step of the way, the child’s voice must be heard and participation ensured towards their life decisions. When they turn 18, transitional support to independent living in the form of Aftercare must be carefully planned, such that young adults remain supported until they are able to live independently. Family-based care would thus serve the purpose of improved developmental outcomes for children, while simultaneously using the necessary resources favorably.

Journey to Reformation

Positive reformation, especially in a context like India where an estimated 23.6 million children are in OHC[14], needs supportive forces at the grassroots, local and national levels. The Theory of Change implemented by Hope and Homes for Children[15], an organization devoted to deinstitutionalisation and family-based care, suggests that a common objective towards improving alternative care can be achieved through collaborations betweengovernment functionaries and NGOs. Political will has precedence in bringing about this reformation, which can be facilitated by developing a national deinstitutionalisation action plan, with a long term vision, and creating a national working body to administer and supervise the work, all of which is supported by inputs from children, youth and parents. An analysis of the current scenario of alternative care is an integral next step, through mapping of alternative care services, policies and standards, and family strengthening and prevention services. This is to be followed by a mapping of funding streams and expenditure on institutions and other such services, the costs of transition, and an estimate of sustaining new systems. Subsequent results could inform the development of projects that address gaps and incorporate better care models. Trained and skilled workforce, with solid case management and problem solving skills, would be responsible to implement the projects.

Some nations have achieved remarkable feats in their reformative efforts. Romania, for example, has brought down its reliance on institutional care, witnessing a decrease in the number of children in institutions from 100,000 in 2000 to 7,353 in 2017[16]. The reformation has been possible through measures including developing family-based care alternatives, such as kinship and foster care, uniting the civil society towards the common goal of better care for children, government commitment, and funding. The government aims to close all institutions by the year 2022. Bulgaria is another promising example, reducing dependency on institutional care by 80% from 2009 to 2017[17], and developing a 4-year action plan from 2016-2020 that aims to prevent family separation, promote family-based care, and support successful transition of youth to independent living. Commendable work towards deinstitutionalisation is presently also underway in Sudan and Rwanda, throughadoption of community-based reintegration of children and frameworks for family-based care consistent with cultural traditions of the communities, among other such mechanisms[18].

Challenges to Consider

Deinstitutionalisation and family strengthening mechanisms are child-centered, optimally focusing efforts and resources in scalable, measurable ways. However, its effective implementation requires the consideration of certain challenges. To execute these intensive strategies, specialist skills and adequate resources are necessary during the transition period from institutional to family-based care. The communities involved are mostly deprived and fragile, making the nature of interventions more complex. Substantial investments would be required to overcome the present systemic gaps and develop the appropriate professionals in place of the present workforce, who must also be supported towards suitable alternatives to employment and livelihood. Innovative ways to build capacities in the existing child protection cadre across the country, could help make things robustly functional on the ground level.

The nobility of the deinstitutionalisation and family strengthening movement lies in the purpose of its inception; that every child deserves the loving care of a family. While the hurdles involved in a transition from present institutional care systems can seem daunting, this very virtue could prove the catalyst to unite local, national and international bodies towards a global reformation, in the best interest of each child.  For a country like India, where child rights in general takes a low priority with the Government[19], attaining the goal of deinstitutionalisation through a family strengthening and non-institutional approach to alternative care, has a long way to go. A policy paper is the need of the hour today that must be developed by the Government of India in close participation with the civil society. It is important to put in place a contextualized Indian approach to this issue which can be implemented in a long-term phased and planned manner. Small group homes that provide long-term residential care to orphaned and abandoned children and youth, with a continuum of care approach and mentorship to each child and youth, must also find its place in the care ecosystem, with clear and transparent monitoring mechanisms. Non-institutional care options such as foster care must be promoted and rolled out slowly, to make them popular amongst the masses with incentives and regular, close and long-term monitoring in place. The new movement that has already taken its roots in India needs more thinking at the level of multiple stakeholders so that we can work towards effective prevention of separation of children from their families as well as in safeguarding the best interest of all children who are deprived of parental care in the country.

(PS: This is the first submission in the series of articles we propose to submit on a range of issues around Alternative Care, which include challenges in running small group homes, gaps in the policy on group foster care, ideals of family restoration, and voices of aftercare youth, among other pertinent matters.)





















Dr Kiran Modi, LaxmiMadhwan & Leena Prasad are development professionals with Research and Advocacy domain at the NGO Udayan Care, New Delhi, India.


Join Our News Letter


Support Countercurrents

Countercurrents is answerable only to our readers. Support honest journalism because we have no PLANET B.
Become a Patron at Patreon

Join Our Newsletter


Join our WhatsApp and Telegram Channels

Get CounterCurrents updates on our WhatsApp and Telegram Channels

Related Posts

Join Our Newsletter

Annual Subscription

Join Countercurrents Annual Fund Raising Campaign and help us

Latest News