States should establish a competent monitoring mechanism such as an ombudsperson 1 A December 2019 UN General Assembly Resolution on the Promotion and Protection of the Rights of Children recognises that a child should grow up in a family environment to have a full and harmonious development of her or his personality and potential urges member states to take actions to progressively replace institutionalisation with quality alternative care and redirect resources to family and community-based services and calls for “every effort, where the immediate family is unable to care for a child with disabilities, to provide quality alternative care within the wider family, and, failing that, within the community in a family setting, bearing in mind the best interests of the child and taking into account the child's views and preferences”. Momentum for a shift from institutional to family-based care is growing internationally-our recommendations provide a template for further action and criteria against which progress can be assessed.īetween 5 million and 6 million children (aged 0–18 years) worldwide are estimated to live in institutions rather than in family-based care settings, although this estimate is based on scarce data and might be an underestimate. These recommendations prioritise the role of families in the lives of children to prevent child separation and to strengthen families, to protect children without parental care by providing high-quality family-based alternatives, and to strengthen systems for the protection and care of separated children. 14 key recommendations are addressed to multinational agencies, national governments, local authorities, and institutions. Family-based care refers to caregiving by extended family or foster, kafalah (the practice of guardianship of orphaned children in Islam), or adoptive family, preferably in close physical proximity to the biological family to facilitate the continued contact of children with important individuals in their life when this is in their best interest. In this part of the Commission, international experts in reforming care for children identified evidence-based policy recommendations to promote family-based alternatives to institutionalisation. Worldwide, millions of children live in institutions, which runs counter to both the UN-recognised right of children to be raised in a family environment, and the findings of our accompanying systematic review of the physical, neurobiological, psychological, and mental health costs of institutionalisation and the benefits of deinstitutionalisation of child welfare systems.
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