Bulgaria’s reform journey: replacing orphanages with families

From 35,000 institutionalised children in 1989 to less than a hundred today, Bulgaria has been on a transformative childcare journey. With the support of our donors, our Bulgaria team has been at the heart of the change which has brought thousands of children Back to Family. On this International Day of Families, Galina Bisset celebrates their achievements.

After the fall of communism in 1989, Bulgaria began rebuilding many of its public systems. At the time, more than 35,000 children were living in large institutions – the highest number in Europe relative to the child population. Children could be placed in orphanages simply by a parent signing a form, often because of poverty, disability or lack of support. Institutions were funded according to how many children they housed, creating a system that encouraged separation rather than prevention.

During the 1990s and early 2000s, NGOs began piloting alternatives such as foster care and family support services. A major turning point came in 2000 with the introduction of Bulgaria’s Child Protection Act, which created local Child Protection Departments and introduced the country’s first “gatekeeping” system. Children could no longer be sent directly into institutions without an assessment and attempts to support the family first.

But in practice, institutions still dominated the childcare landscape. Social workers lacked training and there were too few family support services or foster carers available.

Building national reform

As Bulgaria prepared to join the EU, pressure grew to reduce the number of children in institutions. In 2010 the government adopted an ambitious national deinstitutionalisation strategy, aiming to close all 137 remaining institutions over 15 years. Around 7,600 children were still living in them at the time.

The reform was backed by around €100 million in EU and national funding, alongside investment in workforce development and community services.

We were invited to support the closure of baby homes – institutions for children aged 0–3, including babies with disabilities. We focused specifically on this age group because the developmental harm caused by institutionalisation is particularly severe in early childhood, and because there was little local expertise in transitioning babies into family care.

The Teteven Pilot: proving change was possible

Between 2010 and 2012, we led the closure of a baby home in Teteven. At the time, many professionals in Bulgaria believed babies, especially those with disabilities, should remain in institutions.

The pilot showed another way was possible.

We worked closely with Child Protection Departments to prevent family separation and support reunification. This exposed deep-rooted problems in the system. Medical staff often pressured mothers to abandon newborns, particularly if they had disabilities or if the family was poor. Some children were institutionalised for conditions such as eczema or Down Syndrome. Social workers frequently felt unable to challenge medical advice.

We responded by providing practical, long-term support to families so children could stay at home. This became known as the ACTIVE family support model, built around proactive outreach, trust, relationships, and sustained support.

At district level, we also helped establish coordination mechanisms where complex cases could be reviewed jointly by agencies and professionals, giving social workers greater confidence to prevent separation.

To challenge harmful assumptions, we brought in neonatal experts who reassured professionals and parents that most babies with disabilities could grow up safely in families.

Our team also supported some of the country’s first newborn foster care placements, helping shift attitudes about what was possible.

Following the success of the Teteven pilot, we became a key government partner in closing baby homes across Bulgaria.

From institutions to community support

As baby homes closed, we supported the creation of community services in their place, including counselling, day care, emergency support for mothers and babies, and foster care support.

Following the success of the Teteven pilot, we became a key government partner in closing baby homes across Bulgaria.

Progress was not always smooth. Political will changed over time, and some officials resisted reform. While most institutions closed steadily between 2012 and 2020, delays and political instability slowed progress in later years. Bulgaria has had eight elections in the past five years, affecting momentum and accountability.

Today, only two baby homes remain open, housing around 85 children with severe disabilities and complex medical needs. All other institutions for children in Bulgaria were closed by 2020, and our team are working hard to shut the last two.

Thanks to the generous support of our donors, or team in Bulgaria have succeeded in helping thousands of children like Ivanka out of harmful institutions and Back to Family.

What Bulgaria’s reform shows

Bulgaria’s reform demonstrates that large-scale change is possible. More than 760 family and community-based services have been developed, and family care is now the priority approach across the system.

The reform also highlights some important lessons. Systems built around institutions resist change, especially in the final stages. Sustainable reform requires changes across health, social care, education and housing, alongside long-term political commitment and investment in frontline professionals.

Today, only two baby homes remain open, housing around 85 children with severe disabilities and complex medical needs. All other institutions for children in Bulgaria were closed by 2020, and our team are working hard to shut the last two.

Challenges remain, including gaps in support for people with disabilities, workforce shortages and the risk of smaller residential settings becoming substitutes for institutions.

But despite setbacks, the direction of change is clear and irreversible.

Bulgaria has shown that children do not need institutions to survive or thrive. With the right support, children can grow up where they belong: in safe, loving families.