My first job, as a young Residential Social Worker in Sheffield, Northern England, involved supporting very young mothers and babies to stay together. It brought amazing satisfaction to see how it was possible for 14 and 15-year-olds to become good mothers. It was by no means ideal, but once the babies had arrived, it was much better that they could stay with their mums, so long as they could cope.
The harrowing scenes I witnessed two years later in post-Ceaușescu Romania – the appalling harm to children separated from mothers and families and brought up in grim orphanages – will remain with me forever.
These are the deeply human and personal experiences which inspired me on my career path to work to end the institutionalisation of children.
I wonder sometimes, though, what my young self would say if she knew I would spend a great deal of my time, more than 20 years on, thinking and talking about money. I don’t think she would – or, at that stage, could – have understood.
Working in more than 20 nations I have come to realise that money, and financial management, are fundamental to successful reform that moves support to children away from institutions and so-called orphanages, to services supporting families to stay together in the community.
I understand now that the institutionalisation of children is not only extremely harmful to the development and life chances of children, but is also considerably more expensive than community-based services. This is bad economics in the present and the future, particularly in terms of the cost to societies in the longer term.
There is indeed a myth that ending institutionalisation for children in lower-income countries is not possible because these countries cannot afford the change. But evidence shows institutional care is both harmful and expensive wherever it is applied, whereas community-based services provide better outcomes and are more cost effective. Research in Russia shows that institutional care is six times more expensive than providing social services to vulnerable families or voluntary kinship carers. In both Sudan and Cambodia – from my experience and that of dedicated champions working on the ground – family-based care costs 10% of an institutional placement.
It is important to remember, however, that cost-effective does not mean cost saving.
Deinstitutionalisation is significantly cheaper for most children, in most cases, but highly specialised care for a small number of children and young people with complex needs, disabilities and behaviours can be expensive. Overall, DI is no more expensive than an institutionalised system and leads to far better outcomes for children and young people.
If any country proves the argument that reform is affordable, whatever the size of the budget, it is Moldova, by far Europe’s poorest nation. With Lumos’ help, Moldova created financial regulations to ensure that money saved from closing institutions – many of them grim ‘residential special schools’ – was reinvested in support for disabled children in mainstream schools. Over five years more than 4,500 children have moved from institutions to live at home and attend local, mainstream schools, where they are accepted as part of the community and are supported to learn and develop to their full potential.
Countries still running institutionalised care systems fall into two broad categories –the first where the State generally controls funding; the second where orphanages are predominantly privately funded.
The impact on children is similar. The needs of the system – the buildings, staff and continued survival of the status quo – take precedence over the individual needs of children and families. Children from families living in extreme poverty or those with disabilities can get drawn into orphanages as the only possible source of services. Where there is an orphanage built, children will come. The children follow the money; whereas in a deinstitutionalised system the reverse is true.
Georgette Mulheir is the Chief Executive Officer at Lumos Foundation, founded by the famous author J. K. Rowling (“Harry Potter”). For over 20 years she has worked around the world on large-scale programmes to transform the lives of thousands of vulnerable children and their families. She has pioneered a model of deinstitutionalisation now followed in many countries, has advised governments and the European Commission on the reform of services for children and families and is the author of four books related to children’s rights.
This commentary is a shortened version of her blog entry at: http://wearelumos.org/content/why-money-should-follow-child