Children have a right to access quality healthcare in their own communities. Yet, all too often across the world, lack of access to, or inability to pay for, quality healthcare is a key driver of institutionalisation

This results in children being torn from their families and placed in institutions to meet their basic needs, such as life-saving drugs or therapies or access to supportive aids, and services for children living with disabilities. 

Families that have a child living with long-term medical needs such as HIV, or a disability, often face significant challenges accessing adequate treatment and support. As a result, the children can be placed in supposedly ‘specialised institutions’, reinforcing the common misconception and discrimination that they cannot be supported to live in their community. 

Discriminatory attitudes towards certain communities can increase the likelihood of institutionalisation. In some contexts, disability is seen as a ‘medical problem’, requiring a medicalised solution in an institutional setting, rather than providing specialised support through the frame of care in family settings. Consequently, this places many children with disabilities at risk of being separated from their families. 

Another important factor to consider is that poor health of parents or caregivers can lead to a child being institutionalised. Recent research indicates that 1 in every 2 covid deaths is a caregiver. The scale of the impact of ‘long covid’ on the health of parents and caregivers  and the vulnerability of families remains to be seen.

Orphanages lead to poor health outcomes

Over 80 years of research demonstrates the detrimental effects of institutionalisation on the health of children. This is due to many interrelated factors, including the lack of individualised, stable care, neglect, violence, and over-medication.

Institutions can lead to: 

  • Impaired or delayed cognitive development 
  • Impaired or delayed physical growth
  • Impaired or delayed psycho-social development
  • Impaired or delayed brain development. For babies and very young children, the impact on brain development is particularly acute
  • Higher mortality rates and an increased risk of infectious disease or chronic illness caused by lack of healthcare, poor hygiene, malnutrition and overcrowded conditions
  • Increased risk of mental health problems, psychiatric symptoms, emotional, attachment and behavioural problems
  • Detrimental effects of overmedicalisation, which is commonly used within institutions.

Major longitudinal studies show that the experience of living in institutions can cast a long shadow on a child’s development, increasing the risks of adversities through to adulthood.  This can result in a need for lifelong physical and mental health services. 

The role of health services in the care reform process

The care reform process plays a critical role in identifying where universal and targeted health services are needed to support communities and prevent the separation of children from their families.  While health resources remain locked up in institutions, they will continue to draw vulnerable families towards them

By providing adequate health services for all communities, children will no longer be forced to enter orphanages just to receive medical care. This will have long term positive effects on their health – and will contribute to the delivery of SDG3: Ensuring healthy lives and promote well-being for all at all ages.

Vasilica's story

Vasilica was only four months old and his sister, Ecaterina, was just one when they were taken away from their mother and sent to live in an orphanage. The local authorities thought the children’s mother, Ana would not be able to care for her daughter, Ecaterina and her son, Vasilica as Vasilica was born prematurely and has cerebral palsy.

Read their story