Deinstitutionalization- From Orphanages to Family Environments

14 Jun, 2013


by Irma Khabazi, Public Health Program Manager, Open Society Georgia Foundation

“Deinstitutionalization” is a bit of a tongue twister. But it is a necessary word in Georgia and has been for many years now.

It is not only a difficult word to say, it is a difficult thing to do, requiring the cooperation of many people and organizations, from the non-governmental sector to the government. The Open Society Georgia Foundation (OSGF) has worked with many others to educate the public and make this difficult process a reality.

Why has it been so difficult?

Deinstitutionalization is a very complicated process encompassing numerous obstacles including values, caution, fear of novelties, narrow-mindedness, lack of professionalism, attempts to avoid responsibilities, and superficial attitudes towards the problems.

It is much easier for society to ignore problems and pretend nothing is wrong, when hundreds of disabled children or adults are locked up far away, in some kind of space where nobody can see them. (So what, if they are in difficulties or have to live in unbearable conditions and quite often end their lives?)

Those who have  been isolated from society includes newborn babies, grown-ups, children with special needs, people with disabilities, and homeless old people. Looking after these people, working for their integration and bringing them back as dignified members into society, is the essence of this difficult word deinstitutionalization.

It is perhaps easiest to empathize with the children.  A family is the most natural and acceptable environment for them. If a child loses his or her biological family, he or she should live in the environment closest to a family in all possible ways. This sounds like a natural and simple solution, but in reality it is anything but. Many dedicated people and organizations have worked for a long time to follow this path and are still doing so. And there have been victories: Makhinjauri Orphanage was closed down and the number of new-born children at the Tbilisi infant house decreased from 165 to 70. 

This was the result of active cooperation between several partner organizations which aimed at deinstitutionalizing children and developing appropriate services. Our objectives were also to decrease the flow of infants into orphanages and to provide more services in a family environment.

The most challenging part of the process was convincing decision-makers. This was achieved by evidence-based research and specific recommendations to the state, including regulatory amendments and establishing gate-keeping and deinstitutionalization support services.

Advocates worked to improve services: to strengthen the laws, to improve foster care, to re-train staff at preventive day care centers, to evaluate special care and state funding mechanisms and to provide the state with specific recommendations.

Analysis of the legislative amendments revealed obstacles that were hindering the placement of children into foster care services. Advocates made recommendations on simplifying the placement of children into alternative services, with a special focus on those who were temporarily abandoned.

One group of recommendations on amendments regarding child adoption and foster care was prepared for the Department of Social Programs  by the  Ministry of Health, Labor and Social Protection of Georgia. Topics addressed included prevention and deinstitutionalization; increasing services for families with high risk of abandonment; enhancing shelter services for mothers and new-born babies with the emphasis on crisis intervention services;  development of a prevention foundation, of state preventive services and of temporarily substituted care services; prolongation of urgent foster care and funding and equipping shelters to receive new-born babies.

In order to implement the amendments, it was important to address human resources, namely  outlining effective cooperation and trainings in childcare legislative matters for judges and staff of the Social Protection Agency by local and foreign colleagues.

The Foundation’s partner organization “Children of Georgia,” conducted a detailed study and analyzed the flow of babies into the new-born infant houses as well as the legislatives basis connected with this, as well as existing alternative services and their funding.

As a result, specific recommendations were worked out on amendments to the funding rules for foster care and child adoption laws. Additional forms and types of alternative services were identified as necessary for deinstitutionalization of the new-born infant houses. After examining the recommendations, the Ministry of Health, Labor and Social Affairs of Georgia initiated some amendments and decided to improve funding of the alternative family type services.

The Foundation, its partner non-governmental organizations, the “Children of Georgia”, and the state took specific steps towards deinstitutionalizing the new-born infant houses in the State Action Plan of the Children’s Welfare Reform.

I am extremely happy that OSGF makes a real contribution to the process of deinstitutionalization, and supports many individuals and organizations as a direct implementer and initiator of ideas.

However, I also hope that this process will be completed, especially in the context of children. And that soon, every Georgian child, whether typical or with special needs, will have the opportunity to live in a family.