USAID Health Reform Support Project ПІДBEHIND МАСКОЮ THE MASK ТУРБОТИ OF CARE ЗВІТA REPORT ЗА BASED РЕЗУЛЬТАТАМИ ON THE RESULTS OF АНАЛІЗУ THE SITUATION СИТУАЦІЇ ANALYSIS OFВ БУДИНКАХ BABY HOMES IN ДИТИНИUKRAINE USAID Health Reform Support Project BEHIND THE MASK OF CARE A REPORT BASED ON THE RESULTS OF THE SITUATION ANALYSIS OF BABY HOMES IN UKRAINE 2020 This report is made possible by the support of the American and British People through the United States Agency for International Development (USAID) and through the UK Good Governance Fund/UK Government (UK aid). The contents of this report are the sole responsibility of Deloitte Consulting, LLP and do not necessarily reflect the views of USAID, the United States Government, UK aid, or the UK Government’s official policies. This document was prepared under Contract Number 72012118C00001. 2 A REPORT BASED ON THE RESULTS OF THE SITUATION ANALYSIS OF BABY HOMES IN UKRAINE Authors 3 AUTHORS IMPLEMENTERS OF THE PILOT ASSESSMENT OF BABY HOMES AND DEVELOPMENT OF Yulia Sereda, PhD in Sociology, Public Health Expert, Pilot Consultant RECOMMENDATIONS FOR REFORM Halyna Postoliuk, Regional Director, Eastern Marie Hickmann, Child Protection Expert, Europe and Central Asia, Hope and Homes for international consultant of the USAID Health Children, International Charitable Organisation, Reform Support PhD in Education, expert on the development of social services and alternative family-based care, Vladyslava Bronova, Senior Legal Advisor Pilot Consultant of the USAID Health Reform Support Nadiia Tatarchuk, Executive Director, Hope Mykola Lytvynenko, Legal Specialist and Homes for Children Ukraine, Charitable of the USAID Health Reform Support Organisation, Pilot Manager Yaroslav Liubchenko, Legal Expert of the USAID Olena Riga, MD, PhD, Doctor of Science, Health Reform Support Professor, Department of Paediatrics-1 and Neonatology, Kharkiv National Medical University, Olha Zhmurko, Executive Director, VoxPopuli international trainer in paediatric palliative care Agency Research Company (EPEC-P), Pilot Consultant Andrii Kashyn, Research Director, VoxPopuli Tetiana Kurilina, MD, PhD, Doctor of Science, Agency Research Company Professor, Department of Paediatrics-2, Shupyk Oleksandra Yatsura, Board Chair of the National Medical Academy of Postgraduate Ukrainian Centre for Social Forecasting, NGO Education, trainer in Paediatric Nutritional Support of the European Society for Paediatric Lilia Tarasiuk, Head of Field Research of the Gastroenterology, Hepatitis and Nutrition Ukrainian Centre for Social Forecasting, NGO (ESPGHAN), Pilot Consultant Tetiana Kamak, Civil Monitoring Officer of the Svitlana Hlushchyk, independent expert in National Preventive Mechanism, co-founder and determining the service needs of the population, Board member of the Ukraine without Torture, Pilot Consultant NGO Evhenia Kazybrid, Social Educator of the Dnipro Centre of Social and Psychological Support Natalia Seriohina, PhD in Public Administration, MANAGERS AND COORDINATORS Associate Professor of the Dnipro Institute of OF THE PILOT ASSESSMENT OF BABY Public Administration of the National Academy HOMES AND DEVELOPMENT OF of Public Administration under the President RECOMMENDATIONS FOR REFORM of Ukraine Natalia Tokarieva, Assistant of the Department Nadiia Tatarchuk, Executive Director, Hope of Paediatrics-1 and Medical Genetics, Dnipro and Homes for Children Ukraine, Charitable Medical Academy of the Ministry of Healthcare Organisation, Pilot Manager of Ukraine Viktoria Antonenko Oleksandra Liedienova, Pilot Coordinator, Hope , Chief Accountant of the and Homes for Children Ukraine, Charitable Dnipropetrovsk Region Centre of Social Services Organisation for Families, Children, and Youth Natalia Davydenko, Child Welfare Advisor, USAID Health Reform Support 4 A REPORT BASED ON THE RESULTS OF THE SITUATION ANALYSIS OF BABY HOMES IN UKRAINE Dina Pushkina, Social Work Specialist Bohdan Rudenko, Deputy Director of the of the Kryvyi Rih City Centre of Social Services Kherson Region Centre of Social Services for Families, Children, and Youth for Families, Children, and Youth Iryna Holoborodko, Practical Psychologist Yulia Nhuen, Social Work Specialist of the of the Kryvyi Rih City Centre of Social Services CrimeaSOS, NGO for Families, Children, and Youth Iryna Taran, Deputy Chief Physician Svitlana Samsonenko, Assistant to the of the O.S. Luchanskyi Kherson City Clinical Department of Paediatrics of the Dnipro Medical Hospital Academy of the Ministry of Healthcare of Ukraine Iryna Andreieva, Economist, Project Manager of Ihor Seriohin, Board Chair of the Search for the 21st Century Association, NGO Missing People, Charitable Foundation, Kryvyi Rih Daria Doshchuk, Regional Projects Coordinator, Hope and Homes for Children Ukraine, Charitable Organisation Maksym Nudha, Director, Maximum, International Charitable Foundation Svitlana Shverdiuk, Paediatrician of the follow-up care office of the clinical-diagnostic department for children of the Prof. M.F. Rudniev SSCMCMC Serhii Seriohin, PhD in Public Administration, Associate Professor of the Department of State, Local and Corporate Finance, University of Customs and Finance, Dnipro Svitlana Shustikova, MA in Public Administration, Deputy Head of the Service on Children’s Affairs of the Poltava Region State Administration (2003–2014) Olha Kraplyna, Practical Psychologist, private practice Larysa Khabirova, Psychologist of the Poltava Region Centre of Social Services for Families, Children, and Youth Inna Nesina, PhD in Medicine, Associate Professor of the Department of Paediatrics-2 of the Ukrainian Medical Academy of Dentistry Olena Riasna, leading Economist of the Health Department of the Executive Committee of the Kremenchuk City Council, Poltava Region Acknowledgements 5 ACKNOWLEDGEMENTS The authors of the study express their sincere gratitude to: The Presidential Commissioner for Children’s Rights for the initiative of assessing baby homes The Ministry of Healthcare of Ukraine and the Ministry of Social Policy of Ukraine for support in the implementation of the project in the regions Management and employees of the Departments of Health and Services on Children’s Affairs of region state administrations in Dnipropetrovsk, Poltava and Kherson regions - for organising requests to health and social care facilities about assessment, collection, clarification, and systematisation of responses Management and employees of the baby homes: Dnipro Specialised Baby Home, Kamianske Specialised Baby Home, Kryvyi Rih Specialised Baby Home, Kremenchuk Specialised Baby Home, and Kherson Region Baby Home - for assistance in conducting the assessment in baby homes and organising family visits Heads of healthcare and social facilities - for information on medical rehabilitation services, palliative care and social services provided in their facilities Participants of in-depth interviews and focus group discussions - for expressed opinions, assessments, and wishes on the status and development of medical rehabilitation, palliative care and social services for children and families in Dnipropetrovsk, Poltava, and Kherson regions. 6 A REPORT BASED ON THE RESULTS OF THE SITUATION ANALYSIS OF BABY HOMES IN UKRAINE TABLE OF CONTENTS ABBREVIATIONS 12 FOREWORD 13 SUMMARY 14 METHODOLOGY 17 FINDINGS 20 General information about children 21 Health and development of children 35 Parents of children, family and environmental factors 51 The capacity of baby homes to be transformed into medical rehabilitation and palliative care centres for children 69 General information about baby homes 70 The way the facilities are organised 72 Services provided in baby homes 73 Equipment and supplies 76 Human resources 78 Financing 86 THE RESULTS OF THE NEEDS ASSESSMENT OF CHILDREN AND FAMILIES FOR MEDICAL REHABILITATION AND PALLIATIVE CARE SERVICES 89 THE RESULTS OF THE NEEDS ASSESSMENT OF CHILDREN AGED 0-6 YEARS AND THEIR FAMILIES FOR SOCIAL SERVICES 107 CONCLUSIONS 117 RECOMMENDATIONS 127 List of Tables 7 LIST OF TABLES 25 Table 1. Status of children in the baby homes of Dnipropetrovsk, Poltava and Kherson regions at the time of the assessment, persons 30 Table 2. Reasons for placement of children into the baby homes of Dnipropetrovsk, Poltava and Kherson regions, % 46 Table 3. Percentage of children in the baby homes of Dnipropetrovsk, Poltava and Kherson regions in need of, and eligible to, paediatric palliative care 49 Table 4. Needs of baby homes children for rehabilitation services 52 Table 5. Characteristics of the sample of assessed families of children from the Dnipropetrovsk, Poltava and Kherson regions’ baby homes 58 Table 6. Types of social benefits received during the last 6 months by the assessed families of children from the Dnipropetrovsk, Poltava and Kherson regions’ baby homes, families 66 Table 7. Biological family reunification opportunities, according to the results of the expert assessment of the families of children from the Dnipropetrovsk, Poltava and Kherson regions’ baby homes, families 68 Table 8. Responses to the question: «Which of the following services would be most useful to your family in the future to provide the child with proper care?», according to the results of the assessment of families of children from the Dnipropetrovsk, Poltava and Kherson regions’ baby homes, families 70 Table 9. Characteristics of baby homes premises in Dnipropetrovsk, Poltava and Kherson regions 74 Table 10. Average monthly usage of rehabilitation and palliative care services by children in the baby