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What is Care Reform?

Martin Punaks colour - croppedMartin Punaks is an international development and child protection consultant, a human rights activist and a husband and dad. Martin lived and worked in South Asia for seven years and while currently based in the UK he is still working internationally. See



Care reform is the process of transitioning from institutional care for children towards family and community-based care. Having worked in care reform for over ten years, one of the most rewarding parts of my job is seeing people rethink their often well-established views on children’s care. So when Tearfund Ireland asked if I would co-facilitate the Beyond Institutional Care: Rethinking How We Care for Vulnerable Children conference on May 14 2021, I didn’t hesitate in accepting.

The vast majority of people who run or support children’s homes do so with the best intentions. I can understand their logic that if children are from poor families, or cannot access education or healthcare, taking them to a place where they can have an apparently better quality of life is a compassionate course of action. I was certainly motivated by compassion when I volunteered in an orphanage for severely disabled children in Peru when I was nineteen. But what I wish I had known back then was the harm my good intentions could actually be causing those children, and the harm that growing up in a children’s home can cause.

The case for children to grow up in families is reinforced by 80 years of research[1] and several international treaties, not least of all the UNCRC and the recent 2019 UN Resolution on the Rights of the Child. The evidence is clear that growing up in institutional care hampers the physical, emotional and intellectual development of children and reduces their life chances.  Yet many people still struggle with this concept, and I can understand why.

A common view I still encounter is that, while families are seen as best, some believe there are extenuating circumstances that justify institutional care to ‘protect’ children. Situations such as conflicts, natural disasters and children at risk of child abuse are often cited to me. This seems a reasonable argument. But there are actually many tools at our disposal to enable family-based care even in these difficult circumstances. For example, children being abused by their parents can live with other family members or in foster care. Similarly my work in Nepal after the 2015 earthquake demonstrated that there were ways we could safely keep traumatised children together with families even in the most devastated areas.

Another misconception people sometimes have is that care reform advocates are asking for all children’s homes to close immediately. This is not the case at all. To force massive closures of children’s homes in a short space of time would be incredibly dangerous. Care reform is a gradual process that involves the building and strengthening of services and systems to support families to care for their children, as much as it is about the reintegration of the children living in children’s homes. Children’s homes’ staff are an integral part of this solution – nobody knows the children as well as they do, and they are often the best people to run the alternative family and community-based services.

These days I am witnessing more and more people accepting the primacy of the family in children’s care. There is greater understanding of practical ways in which support for children’s homes can be redirected towards families, and thus address the reasons why the children were separated in the first place.

All of us are united in wanting the very best for children, and we can only achieve this by talking and working together.


[1] Berens, AE & Nelson CA. 2015. ‘The Science of Early Adversity: Is There A Role for Institutions in the Care of Vulnerable Children?’ in The Lancet, Volume 386, Issue 9991, p.388-398, 25 July 2015; Van IJzendoorn, MH et al. 2020. ‘Institutionalisation and Deinstitutionalisation of Children 1: A Systematic and Integrative Review of Evidence Regarding Effects on Development’ in The Lancet Psychiatry, Vol. 7, No. 8, 23 June 2020.


Cover Photo: Grandmother with her fostered teenagers. Zimbabwe. Credit: Markus Köker, Tearfund Ireland