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NO CHILD LEFT BEHIND: 
FAMILIES NOT INSTITUTIONS 
NO 
– EU EXTERNAL ACTION 
CHAMPIONING 
CHILD 
CHILDREN’S RIGHTS
15 JUNE 2018
LEFT   
Bringing together the voices of young 
people, leading experts and international 
BEHIND
decision and policy-makers, together, we 
will examine the role of the EU and the 
international community in ensuring all 
children across the world can realise their 
right to live safely within families.
Learn more about Lumos at:  
wearelumos.org 

Learn more about The European 
Commission at: ec.europa.eu

Please get in touch with:
xxxxx.xxxxxx@xxxxxxxxxx.xxx for more 
information. 
Protecting Children. Providing Solutions.
Protecting Children. Providing Solutions.



FOREWORDS
Foreword by Ruth, self-advocate from Kenya
Foreword by Neven Mimica, European 
Life begins when a child BELONGS
Commissioner for International Cooperation   
As the former UN Secretary General, Kofi Annan put it: “A society that cuts itself off from the 
and Development
youth severs its lifeline; it is condemned to bleed to death”. 
I believe that all children should have the right to grow and reach their full potential in a safe 
Voices of young people must be taken on board in decision-making processes, policy and 
environment, within families and communities. Sadly, this is not the case for eight million 
legislative formulation and programming. We are the best communicators of our own needs. 
girls and boys around the world who are placed in institutions and orphanages. 
Nothing should be done or decided for us without us.
Most of these children are in fact not orphans, but there are many reasons why they end 
In Kenya, institutional care is heavily relied upon for the care and protection of orphaned and 
up in closed institutions. This can be due to poverty and disability; humanitarian crises, 
vulnerable children. The global shift towards family-based care and strengthening families 
migration or trafficking; or a lack of quality alternative care options and affordable treatment. 
brings great hope for thousands of children in the care system. 
The list is long.
It is important to understand the harms of institutional care through the lens of young adults 
Institutionalisation affects children’s brain development at early ages. Institutions are too 
like us who spent years in institutions.
often characterised by a lack of privacy, invisibility and exclusion, violence and degrading 
I had the worst experience growing up in one; from living on a carrot a day, to no meals at 
treatment. And even when the basic intentions are good, institutionalisation can increase 
all. We suffered from hunger, yet donations were being received. That’s exploitation! It is a 
the risk of harmful practices, behaviours and outcomes, especially in situations of fragility, 
place where children remain at risk of abuse, neglect and developmental damage, among 
poverty and forced displacement. We cannot let this continue.
others. No-one ever asked me what I wanted when in care. My dreams and hopes never really 
The European Commission is committed to supporting children’s rights, protection and 
mattered. 
welfare, inside and outside the EU. This is not only enshrined in the EU’s legal framework, 
The one-size-fits-all approach translated to lost identity and we lacked a sense of belonging. 
it is also part of our collective responsibility and conscience. Our 2017 Guidelines for the 
The longer we stayed in the institution, the more we lost ourselves. We left care physically 
Promotion and Protection of the Rights of the Child recognise institutionalisation as one of 
strong but internally broken. Yes, I acquired an education, but what use is it when I have to 
the risks facing vulnerable children. They highlight the importance of appropriate alternative 
spend my adulthood trying to find myself? 
care, which allows children to participate in family and community life, in their best interest. 
Children thrive best in families and the European Union has a great role to play in ensuring 
I am personally determined to ensure that these commitments are fully reflected in our 
that those behind us are not deprived of this right. Funding orphanages is not the right way 
external action and cooperation with international partners, aligning our practices across 
because no matter how well run an institution is, it can never replace a family. 
policies inside and outside the EU. This is a long journey, but we are decisively on our way. 
No child left behind means every child living in a safe environment with an equal choice and 
Together, we can raise children who do not have to spend a lifetime forgetting their 
chance in life.
childhood. 
1
2


THE CASE FOR CHANGE
The scale and drivers of institutionalisation globally 
Globally, an estimated eight million children live in institutions, often called ‘orphanages’.5 However, 
the majority of these children are not orphans. Around 80% have at least one living parent and, with a 
little additional support, most children could live with their birth or extended families.6 
Children are placed in institutions because of poverty, war, natural disaster, disability and social 
exclusion.7 There is a glaring and unjust relationship between disability and institutionalisation. 
Not only are children and young people with disabilities overrepresented in institutional systems, 
Foreword by Georgette Mulheir, CEO Lumos
placement inside institutions can create otherwise preventable disabilities. Children with disabilities 
are often placed in institutions because their parents cannot afford or access rehabilitation or inclusive 
In the decade after the fall of Ceausescu, the European Union’s PHARE programme channelled over 
education.8 The lack of services and support in the community often means parents are forced to place 
€75 million into Romania’s state-run orphanages.1 The EU and other major donors, understandably 
their child in an institution.9 
thought improving the system of institutional care was the only answer to the humanitarian crisis 
There is a strong gender influence in the harm caused by institutionalisation. Girls in institutions 
in Romania’s care system.
are at a much higher risk of being trafficked for the purposes of sexual exploitation than their peers 
As Romania progressed towards EU accession, new research demonstrated the extent of 
raised in families.10 Furthermore, research suggests that young women with disabilities in institutions 
devastating damage to child health and development caused by institutionalisation.2 It became 
have been routinely sterilised without their consent to control their fertility.11 Many children placed 
clear that only investment in families, not institutions, would enable vulnerable children 
in institutions are from single parent households,12 predominantly single mothers, who are more 
to flourish. The EU insisted Romania transform its childcare system as a prerequisite for EU 
likely to live in poverty.13 Discrimination against single mothers also leads to their children being 
membership, a condition subsequently extended to Bulgaria.
disproportionately represented in institutions.14 
These first instances of EU financial and policy power influencing nations to undertake 
Many institutions put the economic interests of adults ahead of the best interests of the child. In some 
‘deinstitutionalisation’ programmes paved the way for a ground-breaking shift in policy and 
cases, children are actively ‘recruited’ into orphanages, often using false promises of education and 
funding regulations that is transforming systems of care across the EU and beyond.3 
food.15 These ‘orphanages’ are profit-making ventures and exist to attract the lucrative international 
flows of volunteers, donations and other funding. This form of exploitation is increasingly being 
Whilst the EU is now convinced of the harm of institutional care, in many countries extreme 
recognised as a form of child trafficking, namely ‘orphanage trafficking’.16
poverty, discrimination and orphanage-trafficking4 fuel family separation and a proliferation of 
harmful institutions. Many international decision-makers and donors continue to fund orphanage 
Despite the evidence, there is a lack of understanding of the harm of institutions. Many people think 
systems, with the best of intentions, but with harmful consequences for children.
that institutions are a social good, or that better alternatives do not exist, so they continue to invest 
in and donate to these institutions. There is also resistance to change – institutions may be the 
There is an opportunity, indeed a responsibility, to learn from the transformation of care systems in 
biggest employer in a town, or an easy way to make profit. Changing these established systems and 
different countries and contexts and influence other global leaders and donors. Lumos is therefore 
long-standing beliefs on care is complex. It takes a concerted effort and a great deal of expertise for 
delighted to co-host today’s conference with the European Commission to explore how the EU can 
stakeholders to see that alternatives to institutions are viable, and build child protection systems and 
take a lead role in the global movement to transform systems of childcare and protection.
universal access to education, healthcare and other services.
Together we can demonstrate it is both necessary and possible to move away from systems 
that cause serious harm, towards societies that empower all children to be raised in families and 
included in communities, to make choices and take the lead in transforming the world around 
them.
5. The number of residential institutions and the number of children living in them is unknown. Estimates range from more than 2.7 million (‘tip of the iceberg’) in Petrowski, N., Cappa, C. & Gross, P. (2017). Estimating the number of children in formal alternative care: Challenges and Results. 
Child Abuse and Neglect, 40, 388-398. https://doi.org/10.1016/j.chiabu.2016.11.026 [accessed 27 April 2018]. to 8 million (Cited in: Pinheiro, P. (2006). World Report on Violence against Children, UNICEF, New York). These figures are often reported as underestimates, due to lack of data from many 
countries and the large proportion of unregistered institutions.
6. Csáky, C. (2009). Keeping Children Out of Harmful Institutions: Why We Should be Investing in Family-Based Care. London, UK: Save the Children, p7. 
7. Csáky, C. (2009). Op. cit.; Chaitkin, S. et al. (2017) Towards the right care for children - Orientations for reforming alternative care systems Africa, Asia, Latin America. Luxembourg: Publications Office of the European Union.; EveryChild and Better Care Network (2012). Enabling reform. Why 
supporting children with disabilities must be at the heart of successful child care reform. New York: Better Care Network.; UNICEF. (2010). At Home Or in a Home: Formal Care and Adoption of Children in Eastern Europe and Central Asia.; Carter, R. (2005). Family matters: a study of institutional 
childcare in Central and Eastern Europe and the former Soviet Union. London, EveryChild.; Tinova, M, Browne, K.D. and Pritchard, C. as cited in Browne, K. (2009). The Risk of Harm to Young Children in Institutional Care, Save the Children, London.
8. Better Care Network and Every Child (2012). Enabling Reform: Why Supporting Children with Disabilities Must Be at the Heart of Successful Child Care Reform http://bettercarenetwork.org/sites/default/files/Enabling%20Reform%20-%20 Why%20Supporting%20Children%20with%20Disabili-
ties%20Must%20Be%20at%20the%20Heart%20of%20Successful%20Child%20Care%2 0Reform_0.pdf [accessed 3 July 2017].
9. Chiwaula, L. et al. (2014). Drumming together for change: A child’s right to quality care in Sub-Saharan Africa. The Centre for Excellence for looked after children in Scotland (CELCIS).; Csáky, C. (2009). Op. cit.
10. International Organisation for Migration (2007) Protecting Vulnerable Children in Moldova; & Hodnocení systému péče o ohrožené děti. Ministerstvo Vnitra České republiky, 2007
11.  HRW (2011) Sterilization of Women and Girls with Disabilities: A Briefing Paper, https://www.hrw.org/news/2011/11/10/sterilization-women-and-girls-disabilities [accessed 24 May 2018]
1. European Commission. (1999). More EU aid for Romanian orphans. Available at: http://europa.eu/rapid/press-release_IP-99-444_en.htm [Accessed 26 Apr. 2018].
12. Carter, R. (2005), Family matters: a study of institutional childcare in Central and Eastern Europe and the former Soviet Union. London: EveryChild. http://www.bettercarenetwork.org/sites/default/files/Family%20Matters%20-%20A%20Study%20of%20Institutional%20Childcare%20in%20
2. Marshall, P.J., Fox, N.A., & the BEIP Core Group. (2004). A comparison of the electroencephalogram between institutionalized and community children in Romania. Journal of Cognitive Neuroscience 16(8), 1327-1338.
Central%20and%20Eastern%20Europe%20and%20the%20former%20Soviet%20Union.pdf [accessed 18 Apr 2018].
3. Ex-ante conditionality 9: 9.1, REGULATION (EU) No 1303/2013 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, 17 December 2013, Official Journal of the European Union L 347/449, p. 129.
13.  Global issues Joseph Chamie, October 15, 2016 ‘320 Million Children in Single-Parent Families’ http://www.globalissues.org/news/2016/10/15/22568 [accessed 25 May 2018].
4. A growing body of evidence demonstrates that many orphanages are established simply to make money from children. See for example:
14. Csáky, C. (2009). Op. cit.
- Mulheir, G. & Cavanagh, M. et al. (2016). Orphanage Entrepreneurs: The Trafficking of Haiti’s Invisible Children. https://wearelumos.org/sites/default/files/Haiti%20Trafficking%20Report_ENG_web_20EP16.pdf
15. Doore, K.E.V. (2016). Paper orphans: Exploring child trafficking for the purposes of orphanages. The International Journal of Children’s Rights. Volume 24, Issue 2
- Van Doore, K.E. (2016). ‘Paper Orphans: Exploring Child - Trafficking for the Purpose of Orphanages’ in The International Journal of Children’s Rights, Volume 24, Issue 2. http://booksandjournals.brillonline.com/content/journals/10.1163/15718182-02402006 
16.  Joint Standing Committee on Foreign Affairs, Defence and Trade (2017). Hidden in Plain Sight An inquiry into establishing a Modern Slavery Act in Australia. Parliament of the Commonwealth of Australia.
3
4


DRIVERS OF INSTITUTIONALISATION
Children in institutions often come from marginalised or stigmatised 
Gender
communities, making them more vulnerable and less able to access available 
Moldova: Single mothers face a 
support services. The common drivers of institutionalisation include:
multitude of challenges, including 
Poverty
discrimination and an increased 
Armenia: Residential 
likelihood to live in poverty – this 
institutions are a 
increases the risk they have to 
common response 
Poverty
place their child in an institution.22 
when families face 
Girls in institutions are at a high 
Armenia: Residential institutions are a common response when families face 
risk of sexual eDiscrimina
xploitation23  tion on the gr
and in 
ounds of ethnicit
challeng
y
ing life 
challenging life circumstances. As a result, many of the children living in residential 
circumstances. As a 
Moldova they are ten times more 
institutions in the country have been placed there due to poverty.17
Slovakia: 82.5% of children in state care are R
r oma, who ac
esult, man
coun
y of the  t for just 9% of the 
likely to be vic country’s popula
tims of traffick
tion.
ing 
21 
children living in 
than those who grew up in 
residential institutions 
families.24
in the country have 
Discrimination on the 
Trafficking
been placed there due 
grounds of ethnicity
to poverty.25
Nepal: In 2017, the US Department of State recognised, for the first time
Slovakia: 
, that childr
82.5% of childrenen
   
Migration and refugees 
were being trafficked into orphanages. The report stated that: 
in sta “t“Under false pr
e care are R
omises
oma, who   
of education and work opportunities, Nepali parents give their childr
account f
en to brokers
or just 9% of the  
Greece: At the end of 2017, there were an estimated 3,350 unaccompanied children in 
who instead take them to frequently unregistered children
c ’s homes in ur
ountry’
ban l2ca
s population.20  tions, 
Greece, and up to 2,290 were on a waiting list for placement in a shelter. Of those, 54 
where they are forced to pretend to be orphans to garner donations from tourists and 
were detained in police stations and pre-removal centres on the mainland, while 438 
volunteers; some of the children are also forced to beg on the street.”
were in closed facilities on islands. Unaccompanied children are detained because of 
pre-removal or asylum detention provisions or for “protective custody”.22 
Trafficking
Disability
Nepal: In 2017, the US 
Lebanon: There are 3,806 children aged 5–14 with disabilities in government-funded 
Gender
Department of State recognised, 
institutions, with others spread among public and private schools. A lack of inclusive 
for the first time, that children 
Moldova: Single mothers face a multitude of challenges, including discrimination 
education in mainstream schools has led to a high rate of institutionalisa
Migra
tion of
tion and r  
were being trafficked into 
efugees 
and an increased likelihood to live in poverty – this increases the risk they have to 
Dchildren with disabilities
isaster
.18 
orphanages. The report 
Greece: At the end of 2017, 
place their child in an institution.23 Girls in institutions are at a high risk of sexual 
stated that: “Under false 
Haiti: There are an estimated 
there were an estimated 3,350 
exploitation24 and in Moldova they are ten times more likely to be victims of trafficking 
750 orphanages in Haiti – 
Disability
promises of education and 
unaccompanied children in 
than those who grew up in families.25 
work opportunities, Nepali 
many proliferated after the 
Greece, and up to 2,290 were 
Lebanon: There are 3,806 
Disast
2010 ear er
parents give their children to 
thquake, but 80% 
on a waiting list for placement 
children aged 5–14 with 
brokers who instead take them 
of the children living there 
Haiti: There are an estimated 750 orphanages in Haiti – many prolif
in a shelter era
. O ted aft
f those er the
, 54 w  ere 
disabilities in government-
to frequently unregistered 
are not orphans. Only 15% of 
2010 earthquake, but 80% of the children living there are not orphans. Only 15% of the
detained in police stations 
 
funded institutions, with 
children’s homes in urban 
the orphanages are officially 
orphana17es are officially registered.19 The rest operate outside the la
and pre-r
w and man
emoval centr y ar
es 

others spread among public 
locations, where they are forced 
registered.17 The rest operate 
trafficking children to draw in lucrative donations – at least $100m a year
on the mainland .20
, while 438 
and private schools. A lack 
to pretend to be orphans to 
outside the law and many are 
were in closed facilities on 
of inclusive education in 
garner donations from tourists 
trafficking children to draw in 
islands. Unaccompanied 
mainstream schools has led to a 
and volunteers; some of the 
lucrative donations – at least 
children are detained because 
high rate of institutionalisation 
children are also forced to beg 
$100m a year.18
of pre-removal or asylum 
of children with disabilities.25
on the street.”
detention provisions or for 
“protective custody”.21
17. IBESR. (June 2013). Annuaire des Maisons d’Enfants en Haïti. 2013.
18.  Lumos (2017) Funding Haitian Orphanages at the Cost of Children’s Rights https://lumos.contentfiles.net/media/documents/document/2018/01/Funding_Haiti_Orphanages_Report.pdf [accessed 21 May 2018].
22. Pinheiro, P. (2006). World Report on Violence Against Children. United Nations Secretary General’s Study on Violence Against Children. UNICEF, New York.
20. European Roma Rights Centre. Romani children in Europe – the facts. http://www.errc.org/uploads/upload_en/file/factsheet-on-romani-children-in-europe-english.pdf [accessed 21 May 2018].
23. International Organisation for Migration (2007) Op. cit. 
21. EKKA, Situation Update: Unaccompanied Children in Greece, 31 December 2017, available at: http://bit.ly/2E531rQ; Human Rights Watch, ‘Asylum-Seeking Kids Locked Up in Greece’, 23 January 2018, available at: http://bit.ly/2n6FKOC. Cited in: Asylum Information Database (2018) Country 
24. Human Rights Watch (2018). I Would Like to Go to School: Barriers to Education for Children with Disabilities in Lebanon https://www.hrw.org/sites/default/files/report_pdf/lebanon0318_web.pdf [accessed 21 May 2018].
Report: Greece http://www.asylumineurope.org/reports/country/greece [accessed 24 May 2018].
25. Human Rights Watch (2017). “When Will I Get to Go Home?” Abuses and Discrimination against Children in Institutions and Lack of Access to Quality Inclusive Education in Armenia. https://www.hrw.org/sites/default/files/report_pdf/armenia0217_web_1_1.pdf [accesssed 22 May 2018].
5
6




THE HARM CAUSED BY INSTITUTIONS
Over 80 years of research from around the world has demonstrated that living in institutions can 
Young adults leaving institutions are especially vulnerable to these risks because they have had 
cause significant harm to children. They are deprived of loving parental care and can suffer lifelong 
fewer opportunities to develop the social skills and networks they need to live successfully and 
physical and psychological harm as a consequence.26 Babies in particular fail to develop as they 
independently in the community.35 These poor outcomes for children result in high potential social 
should without one-to-one parental interaction, and research has demonstrated the severe impact 
and economic costs to society.36
of institutionalisation on early brain development.27 Studies have shown that children who remain in 
Moreover, children in institutions in many countries experience various forms of neglect, abuse and 
institutions after the age of six months often face severe developmental delays.28 
maltreatment.37 The prevalence of physical and sexual abuse in residential care is also higher than in 
These images from the Bucharest Early Intervention Project show the low electrical activity in an 
other forms of care, even in countries where residential care is better resourced with smaller numbers 
institutionalised child’s brain. Orange and red indicate high activity.29
of children per facility.38 39 
Irrespective of the intentions with which an institution is established, how it is managed, or its 
material conditions, it can never replace the love, support and stability that children need to 
form secure attachments.

The image on the 
right shows an 
institutionalised child’s 
brain, the image on the 
left shows the brain of 
a child who has been 
cared for by a family. 
“Institutions do not provide 
the support you would get 
in a family. It is important 
Institutions can also severely limit the life chances of the children who grow up in them.
that everyone understands 
30 A 
number of studies have shown that care leavers are more likely to be involved in criminal activity, that 
this is not a good way to 
institutions are ineffective in preventing criminality,31 and that young people leaving institutions are 
care for children.” 
at increased risk of prostitution and suicide.32 The risks of becoming homeless are approximately 50 
times higher for those who have lived in institutions, compared with those who were placed in foster 
Pavel, Lumos Self-Advocate
care33. Children placed in foster care are also more likely to attain higher levels of education and family 
stability, are less prone to substance abuse and are less likely to be arrested or convicted.34 
26. Berens, A. E. & Nelson, C. A. (2015). The science of early adversity: is there a role for large institutions in the care of vulnerable children? The Lancet.
27. Nelson, C. & Koga, S. (2004). Effects of Institutionalisation on Brain and Behavioural Development in Young Children: Findings from the Bucharest Early Intervention Project. Paper presented at the International Conference on ‘Mapping the Number and Characteristics of Children Under Three in 
Institutions across Europe at Risk of Harm.’ EU Daphne Programme 2002-2003 and WHO Regional Office for Europe, Copenhagen.
28.  Berens, A.E. & Nelson, C.A. (2015). Op. cit. 
29.  Vanderwert R,. Marshall P., Nelson C., Zeanah C., Fox N., Timing of intervention affects brain electrical activity in children exposed to severe psychosocial neglect. PLoS One 2010, 5, e11415, 2010.
30.  Csaky, C. (2014). Op. cit.
31. Greenwood, P.W. & Rand, S.T. (1993). Evaluation of the paint creek youth center: a residential program for serious delinquents. Criminology, 31.2: 263-279. Slot, N.W., Jagers, H.D., et al. (1992). Cross-cultural replication and evaluation of the Teaching Family Model of community-based 
residential treatment. Behavioral Residential Treatment, 7.5: 341-354.
Sunseri, P.A. (2004). Family functioning and residential treatment outcomes. Residential Treatment for Children & Youth, 22.1: 33-53. Lindquist, M.J., & Santavirta, T. (2012). Does Placing Children in Out-of-Home Care Increase their Adult Criminality? Swedish Institute for Social Research. Stockholm, 
Sweden. 
32.  Cusick, L., Martin, A. & May, T. (2003). Vulnerability and Involvement in Drug Use and Sex Work. Home Office, 2003.
Coy, M. (2008). Young women, local authority care and selling sex: findings from research. British Journal of Social Work, 38.7: 1408-1424. Pashkina, N. (2001). Sotsial’noe obespechenie, 11:42-45. Cited in: Holm-Hansen J, Kristofersen LB, Myrvold, T.M. eds. Orphans in Russia. Oslo, Norwegian 
Institute for Urban and Regional Research (NIBR-rapport 2003:1).
Cusick, L. (2002). Youth prostitution: A literature review. Child Abuse Review, 11.4: 230-251.
33. Research looking at the histories of clients of a centre for homeless people in Prague, run by the NGO Naděje, revealed that 286 out of the organisation’s 3,000 homeless clients (9%) during the period 1993-2004 had lived in children’s institutions, while only 6 of them grew up in foster care 
(Lumos’ analysis of data was based on information from Univerzita Karlova. Centrum pro sociální a ekonomické strategie [Charles University. Centre for Social and Economic Strategies] (2010). Klienti organizace Naděje 1993-2004 [Clients of the Organisation Naděje 1993-2004]. Ver. 1.0. Praha: 
Český Sociálněvědní Datový Archiv, [citováno 21.7.2016]. DOI 10.14473/CSDA00036). Similar numbers of children were growing up in foster care and in children’s institutions at that time. On average, 5,774 children lived in foster care between 1989 and 2003, and 4,435 children lived in chil-
35. Delap, E. (2011). Scaling Down: Reducing, Reshaping and Improving Residential Care Around the World. Positive Care Choices. London: EveryChild. As cited in: Csaky, C. (2014). Op.cit
dren’s institutions between 1997 and 2003. Calculations are based on data from Education System Statistical Yearbook (2016). www.uiv.cz [accessed 16 June 2016]; and MPSV [MOLSA] (2005). Co Nejvíce Opuštěných a Ohrožených Dětí by Mělo Vyrůstat v Rodinách [When Possible, Vulnerable 
36. Congressional Coalition on Adoption Institute [CCAI] (2011). The Way Forward Project Report, p29. http://www.law.harvard.edu/faculty/bartholet/The%20Way%20Forward%20Project%20Report.pdf [accessed 8 March 2016].
Children Should Grow up in Families]. http://www.mpsv.cz/files/clanky/104/180205.pdf [accessed 16 June 2016]. The findings suggest that the risk of becoming homeless is approximately 50 times higher for those who have lived in institutions, compared with those who were placed in foster 
37. European Coalition for Community Living (2010). Wasted Time, Wasted Money, Wasted Lives ... A Wasted Opportunity? – A Focus Report on How the Current Use of Structural Funds Perpetuates the Social Exclusion of Disabled People in Central and Eastern Europe by Failing to Support the 
care. This finding is unsurprising, given that foster families can offer ongoing individualised support for children that can help prepare them for leaving care, while those living in institutions do not benefit from this kind of one-to-one support. See also Prudký, L.A. & Šmídová, M. (2010). Kudy 
Transition from Institutional Care to Community-Based Services, p75. https://www.opensocietyfoundations.org/sites/default/files/wasted-opportunity-20100325.pdf [accessed 2 May 2018]. 
Ke Dnu: Analýza Charakteristik Klientů Naděje, o.s., Středisko Praha, Bolzanova [How to Get to the Bottom: the Characteristics of Clients of Naděje’s Centra Prague Bolzanova]. Vyd. 1. Praha: Socioklub, dotisk, 135 s. Sešity pro sociální politiku.
38. Behal, N., Cusworth, L., Wade, J. et al. (2014). Keeping Children Safe: Allegations Concerning the Abuse or Neglect of Children in Care. http://www.york.ac.uk/inst/spru/research/pdf/Abuseincare.pdf [accessed 2 May 2018].
34. Every Child (2011). Fostering Better Care. http://www.everychild.org.uk/sites/default/files/docs/FosteringBetterCare.pdf [accessed 16 June 2016].
39. Euser, S., Alink, L.R., Tharner, A., et al. (2014). The prevalence of child sexual abuse in out-of-home care: a comparison between abuse in residential and in foster care. Child Maltreatment.
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8


A CHILD’S RIGHT TO A FAMILY
The Inter-American Convention on the Elimination of all forms of Discrimination Against Persons 
with Disabilities
 describes the need to adopt legislative, social, educational, labour-related or 
The international legal framework clearly outlines the case against institutions 
other measures to eliminate discrimination against persons with disabilities and promote their full 
and the need to support children to be in a family and included in the 
integration into society.
community.
The Arab Charter on Human Rights asserts that the state and society shall ensure the protection 
The UN Convention on the Rights of the Child (UNCRC) outlines a range of children’s rights that, 
of the family and provide adolescents and young people the best opportunities for physical and 
taken together, state that most children should live with and be cared for by their birth families.40 It 
mental development. It also requires states to guarantee the dignity, enhance self-reliance and 
is the primary responsibility of parents to raise their children and it is the responsibility of the state 
facilitate the active participation of persons with disabilities in society.
to support parents to fulfil that responsibility.41 Placing children in residential institutions so they can 
access healthcare or education denies them their right to live with their family and to be included 
and participate in community life. Article 2 emphasises the rights of all children, irrespective of 
background or disability, to access all their rights. 
The UN Convention on the Rights of Persons with Disabilities (UNCRPD) reaffirms children’s rights 
to live with their families and be included in the community, to be included in education that meets 
their needs without segregation from their peers, and to participate in decisions that affect them.42
The UN Guidelines for the Alternative Care of Children affirm that states must ensure families 
have access to services which support them in their caregiving role43 and institutions are not a 
suitable option. If institutions still exist, “alternatives should be developed in the context of an overall 
“Every child needs to get love 
deinstitutionalisation strategy with precise goals and objectives, which will allow for their progressive 
from parents, it’s like a suit of 
elimination.”44 
armour that helps to protect 
The EU 2017 Guidelines for the Promotion and Protection of the Rights of the Child outline the 
them through life’s struggles. 
EU’s strategy to strengthen efforts to ensure that every child, especially those most marginalised, is 
I think it is very important 
reached by EU policies and actions.45
to invest in families. To help 
Article 3 of the European Convention on Human Rights (ECHR) protects all citizens from torture 
children stay in their families 
or inhuman and degrading treatment. This is relevant for practices identified in some institutions, 
such as physical restraint or humiliating punishments.46 Article 8 protects all citizens from unlawful 
or find them a new family and 
interference in their private and family life. This includes the rights of children and families to not be 
help them to stay together. 
separated unless it is both necessary and proportionate.47 Additionally, Article 5(1) states that no 
It’s like investing in the 
one shall be deprived of their liberty, except the listed cases in the article and in accordance with a 
procedure prescribed by law – the cases do not include any of the main drivers of institutionalisation, 
blacksmith who forges the 
such as poverty or lack of services. 
suit of armour the child needs, 
Article 19 of the African Charter on the Rights and Welfare of the Child (ACRWC) states that 
which is love.”
children should, whenever possible, have the right to live with their parents, and that no child should 
Martina, Lumos Self-Advocate
be separated from his or her parents against his or her will, except when authorities believe it is in the 
child’s best interest. Article 25 affirms that children who are separated from their parents should get 
special protection and should be provided with alternative family care, and that states should also 
take all possible steps to trace and re-unite children with parents. Furthermore, Article 13 states that 
all children with disabilities have the right to special protection to ensure their dignity and promote 
their self-reliance and active participation in the community.
40. See articles 9 and 7.
41. Article 18.
42. See in particular articles 2; 7; 19; 23; 24. 
43. UN CRC (1989) Article 18; UN Guidelines for the Alternative Care of Children (2009) Article 3.
44. 2009, UN Guidelines for the Alternative Care of Children, A/RES/64/142, paragraph 23. http://www.unicef.org/protection/alternative_care_Guidelines-English.pdf [accessed 24 May 2018].
45. 2017 EU Guidelines for the Promotion and Protection of the Rights of the Child (2017). https://eeas.europa.eu/sites/eeas/files/eu_guidelines_rights_of_child_0.pdf [accessed 24 May 2018].
46. Pinheiro, P.S. (2006). World report on violence against children. Geneva: United Nations; DRI (2015) Op. cit.; Mental Disability Rights International, Human Rights and Mental Health: Mexico. Washington, DC, MRDI, 2000.; Mental Disability Rights Initiative, The Hidden and Forgotten: segregation 
and neglect of children and adults with disabilities in Serbia, Belgrade, 2013.; Mental Disability Rights International, Hidden Suffering: Romania’s Segregation and Abuse of Infants and Children with Disabilities, 2006. Woodin, S. (2017). The charm toolkit piloted. Findings from monitoring: Bulgaria, 
Czech Republic, Hungary & United Kingdom. European Commission. http://mdac.org/sites/mdac.info/files/final_report_en.pdf [accessed 24 April 2018].
47. Wallova and Walla v. The Czech Republic [2006] ECHR 23848/04.
9
10


THE FINANCIAL CASE FOR CHANGE
THE ALTERNATIVE
Governments in many countries believe that providing care and protection to children through 
Principles
institutions is the most cost-effective option. However, research has shown that on average, 
institutional care is eight times more expensive than providing social services to parents and children; 
Investment must be directed towards strengthening families and communities. A holistic childcare and 
it is up to five times more expensive than foster care; and twice as expensive as community residential 
protection system, social support for vulnerable families and inclusive universal services are needed to 
homes or small group homes.48 
tackle the drivers that place families at risk of separation.
In the Kagera region of Tanzania, the World Bank reported that the cost of a child living in an 
Political commitment, technical expertise, resource and the involvement of young people, 
institution was nearly six times higher than supporting a child to live in a foster family.49 A case study 
communities and civil society must be in place to break the cycle of disadvantage and invest in 
in Eritrea showed that the annual cost per child in residential care was $1,900 USD, while the cost for 
children so they can reach their potential. 
family integration was below $100 USD.50
Deinstitutionalisation involves the transformation of services to ensure that children are able to live 
It is important that financial arguments do not override the necessity to support the needs, and realise 
with their families, or in family-based or family-like services in the community. It typically involves: 
the rights, of the child. Reforming systems of protecting and caring for children must never be viewed 
•  Providing community services that prevent family separation, and give vulnerable children 
as a cost-cutting or money saving exercise. The reform process is an opportunity to analyse the needs 
the opportunity to remain with their birth parents, or with other family. Such services might 
of children and direct resources to create a system that meets them. 
include access to healthcare, inclusive education, or targeted services to help at-risk families who 
might need additional support in times of need.
•  Ensuring that appropriate alternatives are available when it is not possible for children to 
remain with their families. Following a thorough assessment of a child’s needs, there may be 
occasions when it is not in the best interests of the child to remain in his or her family. In these 
instances, it is vital that alternative forms of care, such as kinship care or foster care, are in place 
to ensure children continue to benefit from the love and support of a family and remain in their 
community. 
“When you live in a house 
•  Dismantling the institutional system. This is a complex and sensitive process that involves 
moving children from institutions to families or family-based care, and eventually closing down 
with 100 children you 
institutions. Throughout this process it is vital to ensure that each child has a placement that best 
are nobody, you exist in 
meets his or her needs. 
documents, there is no 
•  Redirecting resources. Institutions are expensive. The money and other resources currently 
future for you, no freedom 
invested in institutions should be redirected towards community-based health, education and 
to express your abilities, 
social services that keep families together. In this way, the alternatives to institutionalisation 
become sustainable for the long term, providing assistance to many more children than the 
you are not prepared for the 
institution could.
outside world, and you go 
Fundamentally, it is about inclusion – making sure the right support services are in place to 
down the wrong path. So 
enable all children to live with families, in the community. 
you are useless for others, 
Reform is complex and requires a well-planned approach. Deinstitutionalisation does not mean 
for yourself, and I realised 
closing institutions overnight. Children can only leave institutions once the relevant support and 
you are expensive for 
alternatives are in place. The creation of new services is a critical component of the process. 
society.”
Mihaela, Lumos Self-Advocate
48. Browne, K. (2009). Op. Cit. Carter, R. (2005). Family matters: a study of institutional childcare in Central and Eastern Europe and the former Soviet Union. London, EveryChild.; Csáky, C. (2009). Op. cit.
49. Better Care Network Secretariat. (2009). Global facts about orphanages, Better Care Network. http://handstohearts.org/wp-content/uploads/2011/04/Global-Fact-Sheet-on-Orphanages_BetterCareNetwork.pdf. 
50. Prywes, M., Coury, D. Fesseha, G., Hounsounou, G. and Kielland, A. (2004). Cost of projects for orphans and other vulnerable children: case studies in Eritrea and Benin. Social Protection Discussion Paper Series. Available online: http://www-wds.worldbank.org/servlet/ WDSContentServer/
WDSP/IB/2004/10/12/000012009_20041012101822
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12






EXAMPLES OF REFORM
The reforms have strengthened the capacity of government bodies and professionals working 
with children and families, and family support services and social protection schemes are in place 
Examples of reform from around the world: ensuring high-quality support for 
to address the drivers of family separation. A robust legal and policy framework that includes 
children, families and communities.
prevention of separation and provision of targeted support to families and increased availability of 
alternative care services such as foster care, have led to a reduction in the number of children living in 
institutions.59
Long-term integrated support for families and National Action Plan for Orphans and 
Vulnerable Children (OVC) in Zimbabwe

Protecting children who have been exploited or victims of violence in Senegal  
Zimbabwe has been seriously affected by the AIDS and HIV crisis. In 2011, there were 72 registered 
and Mali
child institutions in Zimbabwe – and according to UNICEF, between 1994 and 2004, 24 new private 
institutions were built and the number of children in residential care doubled.51 
A project in Senegal and Mali aims to protect 1,500 children who have either been exploited or have 
been victims of violence.60 Some of these children have fled Koranic daara schools or the conflict in the 
To tackle this issue, the EU is providing long-term support to the Government’s National OVC Action 
north of Mali. They are often traumatised, isolated and vulnerable. The aim of the project is to tackle 
Plan to enable children to remain with their families.52  This programme aims to develop a sustainable 
child exploitation in the region and build long-term stability. 
child-sensitive National Social Protection Framework for Zimbabwe, strengthening and reforming 
existing national social protection strategies.53
The project, managed by the European Union Delegation in Senegal, aims to reintegrate children 
with their families if possible, or find other ways to protect them. The project supports the return of 
In this context, evaluations have recognised the importance of complementary actions, including 
children to formal education and provides economic support for tutors and training in child rights. 
cash transfers, strengthened child and family care, and effective government social services.54 The 
The project develops community knowledge and raises awareness on protection and participation to 
multi-donor, multi-sector model enables cooperation between government, donors and a variety of 
prevent further exploitation and provide protection for children. 
implementers, and has resulted in coordinated and transparent funding. 
The range of approaches aim to support children to find homes within families and prevent future 
By March 2010, the programme had:
exploitation, trafficking and forced labour. 
•  provided school-related assistance to 249,314 children
•  reunited 5,413 children with their families.55
 
Tackling orphanage trafficking and voluntourism in Australia
Reforming the care system for vulnerable children in Rwanda 
The number of people volunteering in orphanages, and the amount of donations given internationally, 
has become so great that it has created a demand for more orphanages. ‘Orphanage trafficking’ is the 
Rwanda has made great strides in reforming its system of care for vulnerable children. Donors, 
active recruitment of children from vulnerable families into residential institutions for the purpose of 
including the EU, USAID, Displaced Children and Orphans Fund (DCOF) and Global Fund, have 
exploitation.61 
supported care reform, early childhood education, prevention and economic strengthening.56
In 2017, the Australian government’s parliamentary inquiry into establishing a Modern Slavery Act set 
Prior to 1994 there were 37 residential facilities housing 4,800 children, but by 1995 – in the wake 
a global precedent by recommending that ‘orphanage trafficking’ should be included in the definition 
of the 1994 genocide – the number of facilities rose to 77, housing 12,704 children. Work on family 
of modern slavery. 
tracing and reunification, alongside an expansion of foster care for children who could not be 
reunified, meant that by April 2000, the 37 remaining centres housed fewer than 5,000 children.57 
In its final report, the Committee listed 11 recommendations on measures to fight orphanage 
trafficking.62 Under the acknowledgement that orphanage tourism contributes to the demand for 
There were several significant developments between 2010 and 2012, including the passing of a 
children to be trafficked into orphanages, the government launched a ‘Smart Volunteering’ campaign 
landmark law on the Rights and Protection of the Child; the establishment of the National Commission 
which explicitly discourages any short-term, unskilled volunteering in orphanages.63 With mounting 
for Children (NCC); and successful pilot deinstitutionalisation projects. These initiatives demonstrated 
pressure, several travel agencies have since publicly withdrawn from offering orphanage trips. 
that – with a concrete strategy, well-trained social workers and available alternative care options such 
as formal foster care – deinstitutionalisation was possible in Rwanda.58 
51. Muguwe, Emely & Taruvinga, F.C. & Manyumwa, Ennie & Shoko, Nothabo. (2011). Re-integration of institutionalised children into society: A case study of Zimbabwe. Journal of Sustainable Development in Africa. 13. 142-149.
52. EUTM RCA, EU support to orphaned and vulnerable children in Swaziland, (14 March 2017). https://eeas.europa.eu/csdp-missions-operations/eutm-rca/22764/eu-support-orphaned-and-vulnerable-children-swaziland_en and Europe Aid, The EU allocates 6 million Euros to support the 
National Action Plan (NAP) for Orphans and Other Vulnerable Children (OVC) of Zimbabwe (23 March 2010). https://ec.europa.eu/europeaid/sites/devco/files/aap-financing-zimbabwe-spe1-pr-20110329_en.pdf
53. See for example UNICEF (2010), 2010 Zimbabwe: Evaluation of Programme of Support for National Action Plan for Orphans and Vulnerable Children Impact/ Outcome Assessment. https://www.unicef.org/evaldatabase/index_60354.html; KFW (2015), Ex post evaluation – Zimbabwe
https://ec.europa.eu/europeaid/sites/devco/files/aap-financing-zimbabwe-spe1-af-20100320_en.pdf
https://www.kfw-entwicklungsbank.de/PDF/Evaluierung/Ergebnisse-und-Publikationen/PDF-Dokumente-R-Z_EN/Simbabwe_OVC_2015_E.pdf; The Special Support Measure: Programme of Support to the National Action Plan for Orphans and other vulnerable children – Phase 2. CRIS ZW/
EDF/022-675 at https://ec.europa.eu/europeaid/.../aap-financing-zimbabwe-spe1-af-20100320_en.pdf
54.  Jimat Development Consultants (19 May 2010), Final report : Programme of Support for the National Action Plan for Orphans and Other Vulnerable Children : Outcome Assessment. https://www.unicef.org/evaluation/files/Zimbabwe_2010-002_PoS_Outcome_Assessment_Final_19_
59.  Ibid.
May_10.pdf
60. Exploited Children in Senegal and Mali to help Prevent Future Crises in the Region’. This project runs from 01/03/2015 - 28/02/2018 with EU funds of €750,000 and is managed by the European Union Delegation in Senegal.
55. UNICEF (May 2010), Child-Sensitive Social Protection in Zimbabwe. https://www.unicef.org/zimbabwe/ZIM_resources_childsensitivesocprotection.pdf 
61. Kathryn E. van Doore, ‘Paper Orphans: Exploring Child Trafficking for the Purpose of Orphanages’ (2016). 24(2). International Journal of Children’s Rights. 378.
56. Better Care Network & UNICEF. (2015). Country Care Profile: Rwanda. https://bettercarenetwork.org/sites/default/files/Country%20Care%20Profile%20-%20Rwanda_0.pdf [accessed 23 May 2018].
62. Parliament of Australia. Inquiry into Establishing a Modern Slavery Act. 8. Orphanage trafficking. https://www.aph.gov.au/Parliamentary_Business/Committees/Joint/Foreign_Affairs_Defence_and_Trade/ModernSlavery/Final_report/section?id=committees%2freportjnt%2f024102%2f25036 
57.  Ibid.
[accessed 24 May 2015]. 
58.  Better Care Network & UNICEF. (2015). An Analysis of Child-Care Reform in Three African Countries: Summary of Key Findings. https://bettercarenetwork.org/sites/default/files/An%20Analysis%20of%20Child-Care%20Reforms%20in%20Three%20African%20Countries%20-%20Summary%20
63. Australian Government, Department of Foreign Affairs and Trade. http://dfat.gov.au/people-to-people/volunteers/Pages/smart-volunteering.aspx 
of%20Key%20Findings_0.pdf
13
14







Returning children to families in Moldova 
Reuniting children with their families in Haiti 
I know what it means to be a child deprived of identity and family care, because I lived through this 
Picked up by a policeman, wandering alone and separated from their family after the earthquake 
experience. I had a difficult period in my life: my father died when I was six months old, and when I was six 
in 2010, Mirlande and her brother were taken to the only place he believed would look after them 
years old my mother became a victim of a serious car accident, after which she needed medical treatment 
– an orphanage. Instead, the siblings were starved, abused and used to garner donations from well-
for a long time. Left without supervision, I was taken into an institution, and nobody asked for my opinion 
meaning tourists and volunteers.
nor for my mother’s.
They took all the stuff and sold it. The white people would bring us sandals, and she [the Director] would 
It was very hard in the institution, we lived under strict rules. Nobody was interested in our opinions. They 
not give them to us – all the kids would walk around barefoot. If something valuable was sent to a kid by 
put the same clothes on us, cut our hair, and there was never any hope of getting out of there. We were 
their sponsor, she would take it and use it for herself.” In the six years that passed, Mirlande began to lose 
punished just because we wanted to go home, and sometimes we didn’t even have the right to tears. The 
hope of ever returning home to her mother.
things that happened there remained within those walls, and will be in my memory for the rest of my life.
However, in 2016, when a team of government child protection workers, supported by Lumos, arrived 
After seven years spent in the institution, at the age of 14, my life changed – Lumos helped me to find a 
to begin the process of closing the orphanage and returning the children to family care. A family tracer 
wonderful family. Only then did I understand what it means to have a family, brothers, sisters, and what’s 
worked with Mirlande and her brother, and they told him every single detail they could remember 
most important – love, which I was deprived of in my childhood.
about their family. Armed with all they told him, he travelled first to their home village, where he 
I can’t change my past anymore, I can only build my present and future, based on my decisions. Similarly, 
learned that their mother was now living in the Haitian capital of Port-au-Prince. When he eventually 
we can’t change the past of millions of children left without parental care, but together we can build a 
found her, Mirlande’s mother was elated. “Even though my mom was searching for us, she did not know if 
better future for them by respecting their rights and offering support in a safe environment. These children 
we were still alive.”
exist and they need us. They still have a chance, since we are here today, and today is the first day towards 
Several visits and support sessions later, the family were officially reunited. Mirlande is now happy and 
improving the lives of children.”  
safe, and the family continues to receive support to ensure that they stay together. “What hurt me the 
- Olga
most was the fact that I was not living with my parents. Your parents’ love is stronger than anyone else’s.”
•  Of the approximately 30,000 children in orphanages in Haiti, the 
88%
685%
Government of Haiti estimates that 80% have one or two living 
parents who could care for them at home or in another family 

There has been an 88% 
685% increase of children 
setting, if properly supported.66 Since Lumos began working in 
Haiti, the team has worked closely with IBESR – the government 
reduction in children in 
with special-educational 
department responsible for children – and supported the closure of 
institutions, from 11,544 in 
needs in mainstream 
eight institutions.67 More than 75% of the children have been able to 
2007 to 1,429 in 2017.64
schooling, from 1,253 at the 
go home to their families with support.
beginning of the inclusive 
•  Terre des Hommes and IBESR run a foster care programme in Les 
education programme in 
Cayes, Haiti, which is funded by the European Union, UNICEF and the 
Embassy of France.68 The programme includes a formal certification 
2010 to 9,840 in 2017.65
process and in 2016 there were 20 families listed in the accredited 
 
foster family protection programme, with eight more families 
awaiting certification.69 
66. Committee on the Rights of the Child. (24 February 2016). Concluding observations on the combined second and third periodic report of Haiti. CRC/C/HTI/CO/2-3. https://documents-dds-ny.un.org/doc/UNDOC/GEN/G16/035/15/PDF/G1603515.pdf?OpenElement [accessed 2 March 2017].
67. Lumos. (2018). [Numbers of institutions closed in Haiti]. Unpublished data: on file with Lumos.
64. Data sourced from the Ministry of Education, Culture and Research and the Ministry of Health, Labour and Social Protection. Government of the Republic of Moldova. (2018). [Number of children in institutions]. On file with Lumos. 
68. UNICEF (2016). Foster families in Haiti: One girl’s story https://www.unicef.org/protection/haiti_93429.html [accessed 25 May 2018].
65. Data sourced from the National Bureau of Statistics. Government of the Republic of Moldova. (2018). [Number of children with special educational needs in mainstream schooling]. On file with Lumos.
69. UNICEF, Timounyo! Don Dario and Fatya, beneficiaries of the protection program- Foster families at les Cayes (20 July 2016). http://timounyo.com/don-dario-and-fatya-beneficiaries-of-the-protection-program-foster-families-at-cayes/?lang=en [accessed 25 May 2018].
15
16




Transforming care systems in Bulgaria
Diverting money from institutions towards community-based services in Europe
Ivan spent several years in the Rudnik institution in Bulgaria. Cold, dark, with a large number of 
The European Union is playing a pivotal role in supporting deinstitutionalisation across Europe. In 
children with disabilities crammed into uncomfortably close conditions, with no toys or personal 
2013, the ex-ante conditionality 9.1 was introduced in the Regulations governing the use of the 
belongings, Rudnik did not come close to home for Ivan. “It was an awful place to live,” he says. “The 
European Structural and Investment Funds (ESIF). The ex-ante conditionality states that Member States 
food and the conditions were terrible. Nothing was good about that place.” 
must have and implement a “national strategic policy framework for poverty reduction, aiming at 
active inclusion” that “includes measures for the shift from institutional to community-based care.”75 
“No children’s drawings on the walls, just children isolated in this closed building… we couldn’t believe the 
This means that Member States can no longer spend ESIF on building new institutions and have to 
conditions inside,” remembers Ilia Iliev, Head of the Bulgarian Social Services Department, of his first 
prioritise community-based services. 
visit to Rudnik. Thankfully, political commitment and the support of international organisations have 
brought incredible change to Bulgaria. 
The guidelines accompanying the ESIF explicitly state that “building or renovating long-stay residential 
With the support of the European Commission and civil society, the Bulgarian government embarked 
institutions is excluded, regardless of their size” and emphasise that any new measures should allow 
on an ambitious programme to transform the system of caring for vulnerable children. In 2009, the 
for the possibility of inclusion in the community and high-quality care.76 This landmark decision has 
Bulgarian government developed its Vision for Deinstitutionalisation of Children in Bulgaria. In recent 
resulted in hundreds of millions of Euros being directed towards reforming systems, shifting away 
years, large-scale homes for children with disabilities have been replaced by family support services, 
from institutions to community-based care, making a positive impact on some of Europe’s most 
foster care and small group homes, which prioritise keeping children at home where possible.
socially excluded citizen’s.77
For Ivan, who now lives in a small group home that supports his independence and aims to provide a 
family environment, this is welcome news. “I left Rudnik with one backpack that contained my entire life. 
No child should ever have to live in an institution. When I graduate from school, I would like to get a house, 
where me and my brother Ilko would live.”

•  87% reduction in children in institutions (from 6,730 in 2009 to 906 in 2017).70 
•  Number of children moved from harmful institutions to families, family-style settings, or 
“I left Rudnik with one 
independent living: 5,824 (2009–2017).71
backpack that contained my 
87% reduction 
Number of children 
Number of children 
Number of 
•  Number of children prevented from entering institutions: 18,766 children (2009–2017).72 
entire life. No child should 
in children in 
moved from harmful 
prevented from 
institutions closed: 
•  Number of institutions closed: 94 (2010–2017).
ever have to live in an 
73
institutions (from 
institutions to 
entering institutions: 
94 (2010–2017).73
6,730 in 2009 to 906 
families,  
18,766 children 
institution. When I graduate 
•  The Bulgarian government has demonstrated that when a system shifts away from a reliance 
on institutions
in 2017).71
, towards communit
family-st y-based ser
yle settings,  vices, many mor
(2009–2017).72e children and families can be 
from school, I would like to 
supported – with better outcomes – using a similar budget
or independent 

get a house, where me and 
living: 5,824 (2009–
•  In 2010, the highest proportion of state expenditure on vulnerable children went towards 
my brother Ilko would live.”
2017).
institutions. 15,278 children were supported with a budget of €52 million.
Ivan, Lumos Self-Advocate
•  By 2017, the emphasis had shifted towards providing community-based support, and the number 
of children living in institutions had reduced. 27,550 children are being supported with a budget of 
The Bulgarian government has demonstrated that when a system shifts away from a reliance on 
€55 million.74 
institutions, towards community-based services, many more children and families can be supported – 
with better outcomes – using a similar budget. 
•  In 2010, the highest proportion of state expenditure on vulnerable children went towards 
institutions. 15,278 children were supported with a budget of €52 million.
•  By 2017, the emphasis had shifted towards providing community-based support, and the number 
of children living in institutions had reduced. 27,550 children are being supported with a budget of 
€55 million.74
70. Data sourced from the Agency for Social Assistance and the Ministry of Health. Government of the Republic of Bulgaria. (2018). [Number of children in institutions]. On file with Lumos.
71. Data sourced from the Agency for Social Assistance. Government of the Republic of Bulgaria. (2018). [Number of children reunited with their families]. On file with Lumos.
75. Annex XI, Part 1: Thematic ex ante conditionalities, Regulation (EU) No 1303/2013
72. Data sourced from the Agency for Social Assistance. Government of the Republic of Bulgaria. (2018). [Number of children prevented from entering institutions]. On file with Lumos.
76. Draft Thematic guidance Fiche for Desk Officers Transition from Institutional to Community-Based Care (Deinstitutionalisation-DI) Version 2 – 27/01/2014 available: http://ec.europa.eu/regional_policy/sources/docgener/informat/2014/guidance_deinstitutionalistion.pdf 
73. Data sourced from the State Agency for Child Protection. Government of the Republic of Bulgaria. (2018). [Number of institutions closed]. On file with Lumos.
77. Crowther, N., Quinn, G. & Hillen-Moore, A. (2017). Opening up communities, closing down institutions: Harnessing the European Structural and Investment Funds. Community Living for Europe: Structural Funds Watch. https://eustructuralfundswatchdotcom.files.wordpress.com/2017/11/cle-
74. Bisser Spirov. (13 February 2018). “Money Matters”: An analysis of the financing of the deinstitutionalization process in Bulgaria. Presentation at Economic case for investing in prevention and early intervention conference. Brussels.
sfw_opening-up-communities-november-2017_final.pdf [accessed 24 May 2018].
17
18

•  Ensure long-term investment and planning that leads to sustainable transformation
THE WAY  FORWARD
Transforming the system of care in a country takes longer than typical five-year political terms. 
Formal political dialogue and coordinated, complementary support from a range of donors is vital 
to ensure consistency in the implementation of reform. 
It is possible to end the harmful practice of institutionalisation. Every 
government, business, civil society organisation and individual has a part to play 
•  Strengthen capacity to undertake reform. Once political will, funding, vision and plans are in 
place, one of the biggest obstacles to implementation is the understanding that reform will involve 
in achieving better outcomes for vulnerable children and their families. 
significant change across the system. The capacity of staff across all levels of the system will need 
to be built to ensure they are equipped with the right skills and support to deliver.
Invest in children and families 
•  Create open and clear communications throughout the reform process. Good communications 
can minimise resistance and, in the long run, save money. A communications strategy must have 
•  Invest in children and prioritise funding that drives the transition from institutions to family 
clear messaging aimed at changing the attitudes and behaviours of communities, institution 
and community-based services. Funding should be directed towards services that support 
directors and personnel, politicians, funders and individuals. 
children to live in families and their communities. These include: family support, early childhood 
development, inclusive education, health and social services, high-quality alternative care and 
strengthening child protection systems. 
Leave no child behind
•  Build systems that keep families together. Creating a better life for children out of institutions 
•  A child is a child. Regardless of their background, faith or migration status, all children are entitled 
doesn’t just mean providing them with ‘care’ in the community. The full range of services a child 
to the same set of rights; those which we hold universal, even in uncertain and unpredictable 
and their family need must be planned – across government ministries, donors and communities 
times. The evidence and the rights framework is clear – children need families to thrive.
– to ensure that children are included, safe and secure, can actively participate, and have access to 
•  Prioritise the most vulnerable children. Often, babies and children with disabilities are those 
more targeted support when they need it. 
who suffer greatest harm from institutionalisation. Their needs must be identified and prioritised 
at the beginning of the reform process. 
Launch high-quality, inclusive and sustainable care system reform
•  Put children and young people at the centre of all reform plans
. Life begins when a child 
Participation, commitment and transparency
belongs. Children’s views must be included when designing, monitoring and implementing 
•  Everyone has a role. A vast range of organisations and people fund, volunteer in, visit and support 
projects that concern them. 
institutions, including multilaterals, governments, businesses, philanthropists and individuals. With 
•  Create a vision. Set a shared vision of the goals of reform and ensure that key ministries, civil 
limited resource, stakeholders must work together to ensure that resource, expertise and good 
society, children and other partners – national and international – are committed and aligned. 
intentions are redirected towards new services to support vulnerable children. 
Outlining a common ambition for children, and the goals and timings, will help set the foundations 
•  Seek out and embrace a range of perspectives in the reform process. The knowledge and 
to develop the strategy and detailed plans, and engage parties involved in reform. 
expertise of civil society, young people, communities and others should be built into the design, 
•  Ensure the transition from institutions to family and community-based services is reflected 
implementation and planning of the reform process.
in relevant laws and policies. Develop regulations to ensure that funds are never used to build, 
renovate or support institutions and that staff responsible for administering programmes are 
trained and supported to deliver to these objectives. 
Invest in data
•  Safely dismantle institutional systems and redirect money towards new services. In parallel 
•  Ensure all children are counted. If you do not know how many children there are and why they 
with developing family and community-based services, the institutional system must be scaled 
are in institutions, how can you solve the problem? Ensure that the post-2015 global monitoring 
back, reducing its ‘pull factor’ for children and resources – and freeing up money to develop and 
framework includes all children, by taking measures to improve and expand data collection 
fund new services. 
methodologies so that children living outside families are represented in disaggregated data.
•  Undertake financial analysis. Mapping the system of care in a country and finding out how much 
•  Measure what matters by investing in rigorous monitoring and evaluation of reform processes
money goes into institutions or other forms of care is key to ensuring money can be redirected 
Ensure that practice reflects the plans and policy intentions, that health, development and quality of life 
towards better forms of care. This also alerts authorities to potential fraud, corruption and 
outcomes for children and young people are monitored, and that systems are put in place to assess the 
even ‘orphanage trafficking’. Money is often an obstacle to change but can also provide a huge 
long-term impact. Ensure practice – good and bad – is documented and shared, so that others can learn 
opportunity to facilitate change. These opportunities cannot be harnessed without information.
from, and build on, what has worked and common issues faced in the process. 
•  Fund demonstration programmes to expand the evidence base. The legal framework states 
that institutions should be the last resort, and only on a temporary basis. Yet without investment 
Raise awareness of ‘orphanage trafficking’
in generating high-quality evidence of family-strengthening and alternative care in a range of 
cultures and contexts – especially in emergencies, following natural disasters, or in cases of mass 
•  Tackle ‘orphanage trafficking’. Ensure all governments and donors are aware of this form of trafficking, 
migration – institutions will continue to be the default solution for vulnerable children. They are 
where children are recruited to orphanages purely as a means of raising funds from unsuspecting donors 
likely to compound harm and risk rather than protect children.
and volunteers. Countries should consider prohibiting organisations from facilitating orphanage tourism 
abroad and support strengthening the rule of law in countries where orphanage trafficking is prolific.
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