Deinstitutionalisation and the Best Interest of the Child: The Case of Rwanda and Lessons for South Asia
What Is ‘Deinstitutionalisation’?
In simple terms, DI is a move away from institutional care to more suitable forms of care for children, whether in family of origin or in alternative care. Much more complex in practice, what it entails is encapsulated in the Necessity and Suitability principles of the UN Guidelines.
Although it is the latter that often steals the limelight in DI processes, preventing the need for alternative care—institutional care in particular—is as critical to render the DI process complete.
The ‘Necessity Principle’, within the context of DI, denotes measures taken to prevent children from losing parental care and falling into the care of institutions, which is often the inevitable in countries where institutions may be the only form of alternative care available.
The ‘Suitability Principle’ entails finding the care option that is the ‘most appropriate to each child’s specific needs, circumstances and best interests’ (Cantwell et al., 2012, p. 14), once the decision is made by authorised authorities that the child requires formal alternative care. The range of alternative care options recognised by the UN Guidelines comprises of both ‘family-based’ care (e.g. formal kinship care and foster care) and ‘family-like’ care (e.g. small group homes and children’s villages). It is important to note here that the Guidelines, while prioritising ‘family and community-based solutions’ (UN Guidelines 2009, para 53), recognised appropriate residential forms of family-like care that conform to specified conditions and where the setting is the most ‘appropriate, necessary and constructive’ response for the circumstances and needs of the individual child concerned and in his/her best interests (UN Guidelines, 2009, paras 21, 123, 126).
The conceptual confusion between ‘institutional’ care and ‘residential’ care, compounded by the absence of a universal definition (even in the UN Guidelines) of an ‘institution’ has contributed substantially to this situation. However, it is ‘large residential facilities’ or ‘institutions’, and not residential facilities as a whole, that are to be targeted through a DI strategy (UN Guidelines, 2009, para 23). In fact, what needs to be addressed are the ‘cultures’ that are institutional or the institutional ‘practices’ that are described by Cantwell et al. (2012) as ‘the regimes and day-to-day organization that take little account of individuality, or psychological and emotional needs, and tend to isolate children from the outside world’ (p. 34). As research further illustrates, in institutions,[g]roup sizes and the number of children per caregiver are large, there are many and changing caregivers from day to day and across time, groups are heterogeneous in age and disability status, and children are periodically transitioned to new groups of peers and caregivers. In nearly all cases, caregivers do not provide warm, sensitive, and responsive interactions with children…. (McCall et al., p. 88, in Davidson et al., 2016, p. 2).
Further, quality of care is not assured by default in family-based care (as evidenced in the Rwanda case below), which is not a ‘perfect’ solution devoid of gaps and challenges as Davidson et al. (2016) highlight, taking foster care as an illustration. They question: Children may be cared for in one family, but to whom do they look for their identity and in which long-term family will they live their adult life? Resolving those questions, and the quest for ‘permanence’ or even stability for children, is an issue that manifests itself in many ways when fostering becomes the dominant form of placement. (p. 8).
This clearly demonstrates that for a DI strategy to be meaningful and effective, it is imperative to have a range of ‘quality’ alternative care options for children without parental care, whether it be family-based or family-like, and for all these options to be given due consideration according to the needs of the child or children concerned.
‘Gatekeeping’ is also a process that plays a vital role in DI, and the function of gatekeeping is applicable to both Necessity and Suitability principles. While a mechanism should be there to ensure that alternative care is absolutely needed, such a mechanism is also needed to ensure that a suitable care option that meets the care requirements of each child is found, institutionalisation is prevented and that suitability is reviewed periodically.
DI is expected to be a ‘gradual, informed, comprehensive and culture-sensitive process’ than a rapid process of reintegration, as the UN Guidelines clearly point out:
While recognizing that residential care facilities and family-based care complement each other in meeting the needs of children, where large residential care facilities (institutions) remain, alternatives should be developed in the context of an overall deinstitutionalization strategy, with precise goals and objectives, which will allow for their progressive elimination. (UN Guidelines 2009, para 23)
Further, the entire system is required to be deinstitutionalised, and therefore it is not a simplistic process of closing down all institutions. The ground has to be prepared, and systems need to be equipped with a range of care options, social services, gatekeeping and monitoring mechanisms, social service workforces, financial investments and the shift in vision required for transitioning from institutional to family-based/like care, to mention a few key requirements.
As reiterated, the best interest of the child should be a fundamental consideration in a DI strategy as well as its implementation.