Implementation of

Deinstitutionalization in Ghana
Kwabena Frimpong-Manso
Kfrimpong-manso@ug.edu.gh
 Introduction
 Children have the right to grow up in a family environment, but for
many children this has not been possible (Martin & Zulaika, 2016).
 Family-based placements for children in alternative care (Petersen,
2019) is preferred to residential care.
 Yet, there are increasing number of children in institutions.
 Many LMICs are reforming their alternative care systems to
deinstitutionalize children and secure their right to a family (Aziz, 2021;
Bajpai, 2016; Forber-Pratt et al., 2020).
 Ghana established Care Reform Initiative (CRI) in 2007
 De-emphasize over-reliance on institutional care
 Regulate establishment and management of RHCs
 Promote alternate family-based care and prevent family separation
 Background in Ghana

 Significant steps taken to strengthen legal and policy

frameworks.
 Limited success in reducing "over-reliance" on RHCs
 From 2007 to 2017 – 12% reduction in RHCs
 Deinstitutionalization and closure of RHCs identified as
a key strategies
 Five-Year Roadmap for Closure of RHCs (2017-
2021)
 Baseline 2017: 130 RHCs, Target 2021: 67 RHCs
 Period until 2019 marked by increase in new RHCs
 DI Guidelines introduced in 2020
 Period from 2020 marked by downward trend
 Actual 2021: 129 RHCs
 Net reduction = 1 RHCs
 Scope of Study
 Aim of study: To examine the current state of DI in Ghana, with a focus on factors
that facilitate and inhibit DI implementation.
 Study settings: Eastern and Greater Accra regions (26 MMDAs including 7 ISS
MMDAs)
 Period of data collection: October 2021 and February 2022
 Qualitative In-depth Interviews: 31
 10 DSWCD staff from 10 MMDAs, 1 DSW-HQ interview, 10 staff from NGOs, 10 RHC
managers and social workers from RHCs.
 Analysis: Thematic
 Study Limitations
 Limited involvement of NGOs
 Hesitance among certain participants to express themselves freely
 Potential Facilitators of DI

Promoting suitable alternative Strengthening families

care options “They [NGO] are able to help the
“The best is kinship care…if that parents with some capital to do some
doesn’t work then we move to business and from there they can take
foster care.” (SW 5) care of their own children.” (NGO 5).

Sensitization and advocacy

“And also, once in a while, the district or
region has to organize something to
educate the communities on special needs
kids and how to handle them.”
 Potential Facilitators of DI
Gradual process
“Deinstitutionalization should be carefully
made and not in a rush that we are copying
other developed countries, we should know
our country and understand the children and
family” (RHC 7).
Capacity building
“There should be capacity
building of the workers there at
the institutions and also do away
with old ways of doing things in
the institutions”. (SW 5)

Interagency collaboration (INGOs local NGOs,

police, media, RHCs)
“… So to collaborate well with key stakeholders,
education, DOVVSU, and the NCCE for all of
them to understand the importance of
deinstitutionalization so that they would all help”
(NGO2)
 Challenges to DI
Finding alternatives to RHCs
“looking for foster parents, adoptive
parents and then family care is
difficult to because nobody is ready to
take a disabled child”
Inadequate Logistics & Human Resources
“Transportation of the children to look for
their families is another problem”
We need a lot of human resources because it
is a heavy workload…not just human
resources but quality, dedicated people who
are ready for the job
Resistance from RHCs
“One challenge is the resistance the
officers face from the managers of
institutions because they feel their
homes are going to be empty so they
refuse to help the process”
Trickle down of DI trainings
“We sit in Accra formulate beautiful policies,
but the implementation becomes a problem.
You have somebody who lives on the island
and has never come to the mainland, these are
the people that the government needs to
collaborate with the other agencies to take the
message to the vulnerable communities.”
 Reflections for the next 5-year Roadmap
Challenges to DI
Lack of suitable alternatives
during emergencies.
Are RHCs really temporary
in practice?
Limited capacity to address
drivers of separation
Unpreparedness of families
due to finances, parental
separation, etc.

RHCs is not an Do we need to ISS as an

optimal family re-adjust our opportunity to
environment pace and strengthen
focus?
 The way forward
 Stakeholders should re-look at process for determining more realistic DI
targets in the next Roadmap.
 Case workers need to actively explore the possibility of kinship care as
temporary or even permanent alternative care option. Support from
government and NGOs is required to succeed.
 Managers of RHCs should be sensitized on the negative impact of
institutionalization on children.
 Sensitization should encourage RHCs to engage in the DI process and
transition to alternate community-based services.
 Develop more accessible multimedia materials on DI Guidelines targeting
various stakeholders (RHCs, NGOs, etc.)
 The way forward
 Existing social protection programmes should be strengthened to address
drivers of family separation and new ones developed “reintegration
packages” to children and their families following a needs assessment.
 DSWCD should continue encouraging some RHCs to become small and
‘family-like’ as a stop gap through transition to alternative family-based
care models (e.g., foster care).
 More DSWO staff should be employed and DSWCD should be provided
with adequate financial resources and logistics.
 DSWCD should enhance the activities of the Social Service sub-committee
in each MMDA to facilitate collaboration between the DSWCD and
relevant agencies (school, police, health, and RHCs).