Institutional Accreditation and Its Impact on Children’s Health in Orphanages: A Systematic Literature Review on Learning Organizations and Quality Assurance

Abstract

The process of institutional accreditation establishes crucial mechanisms that lead to better quality childcare in orphanages through the development of organizational stability and trained staff, in addition to healthcare improvements. The assessment of accreditation effects on children’s health draws from learning organizations and quality assurance frameworks in this systematic review. A systematic database review yielded 35 peer-reviewed publications that followed PRISMA analysis procedures. Research evidence shows that accredited orphanages attain better results when it comes to hygiene practices, as well as nutrition standards, healthcare access, mental healthcare support. Accreditation enables institutions to learn continuously because the process promotes service delivery improvements. The advantages of accreditation in orphanages are clear, but accreditation faces the barriers of monetary constraints, employee reluctance towards external inspections, and erratic policy execution, which reduce its widespread adoption. Accreditation efforts in orphanages require purposeful funding alongside built-up staff competencies and stronger regulatory policies to achieve their maximum potential benefit.

1. Introduction

Accreditation is increasingly recognized as a vital mechanism for ensuring high-quality care and services across various institutions, including orphanages and childcare institutions. It serves as formal recognition that an organization meets specific standards of quality, which is crucial in settings where vulnerable populations, such as children in orphanages, are served. The literature indicates that accreditation can lead to significant improvements in healthcare services, including an enhanced organizational structure, better staff training, and improved safety protocols (Alhawajreh et al. 2023; Alkhenizan and Shaw 2011; Lazzeri et al. 2022). These improvements are essential in ensuring that children receive the necessary care and support to promote their health and well-being.

Despite the acknowledged importance of accreditation, the specific impact that it has on children’s health within orphanages remains an underexplored area of research. Existing studies have primarily focused on healthcare settings, where accreditation has been shown to improve service quality and patient outcomes (Zendrato 2022; Alkhenizan and Shaw 2011; Lazzeri et al. 2022). For instance, a systematic review highlighted that accredited healthcare facilities often exhibit better organizational practices and a higher quality of care compared to their non-accredited counterparts (Alhawajreh et al. 2023; Alkhenizan and Shaw 2011). However, the transferability of these findings to orphanages and similar institutions requires further investigation, particularly in understanding how accreditation influences the holistic development and health of children in these environments.

This study aimed to bridge this gap by conducting a systematic literature review through the theoretical lenses of learning organizations and quality assurance. The concept of learning organizations emphasizes the importance of continuous improvement and adaptation, which aligns with the goals of accreditation in fostering environments that prioritize quality care and learning (Zendrato 2022). By examining the existing literature on accreditation and its effects on child health outcomes, this research sought to provide a comprehensive understanding of how accreditation can be leveraged to enhance the quality of care in orphanages, ultimately contributing to better health and developmental outcomes for children.

2. Literature Review

Institutions or programs undergo accreditation evaluation as a systematic method of proving that they adhere to particular accreditation body standards. The United States introduced the accreditation concept during the late 19th century by creating institutions that included the North Central Association of Colleges and Schools (NCA) in 1895 (Brittingham 2009). Accreditation as a method focuses on educational quality enhancement while making sure accredited organizations fulfill official standards established by appropriate governing bodies (Eaton 2012).

The social institution known as an orphanage offers the fulfilment of basic needs and protection for children who have become parentless either through death or through their biological parents being deemed unfit to care for them. Since ancient times, orphanages have existed, starting with the first childcare systems established during the Roman Empire and early Christian Church (Boswell 1988). During the nineteenth century, philanthropic organizations founded welfare institutions to protect orphaned and abandoned children (Davin 1996).

Children residing in orphanages encounter problems in obtaining proper nutrition, as well as falling short in basic health and sanitary requirements, while also needing psychological support. Children develop stunting and wasting due to inadequate dietary planning and low caregiver understanding, which leads to insufficient nutritional intake (Jafar et al. 2020; El-Kassas and Ziade 2017). Several health problems including skin infections and dental disorders occur due to both insufficient sanitation and excessive amounts of children in institutions (Reddy and Ramya 2017; Babu et al. 2024). These children face emotional distress, yet they receive no formal support, according to Tadesse et al. (2014). The resolution of these problems requires comprehensive interventional approaches to promoting these children’s health.

Organizational Learning Theory focuses on organizational knowledge acquisition, as well as knowledge storage and sharing efforts to enhance performance and strategic adaptation. The principal division of this theory separates learning into single-loop variants and double-loop variants. The process of single-loop learning allows organizations to modify their tactical and behavioral elements to resolve errors but prevents them from modifying foundational doctrines or decision frameworks. Organizations that want transformative change resulting from environmental modifications should engage in double-loop learning because this approach questions organizational core beliefs and policies before making modifications (Argyris and Schön 1978). The theory demonstrates why organizations should develop learning cultures because it boosts their adaptability, along with their long-term achievement potential.

Deming defined quality assurance as a controlled methodology that helps organizations reach customer satisfaction levels through continuous advancement and a statistical approach to management. According to Deming, the achievement of quality requires more than inspections, because it must exist throughout the manufacturing process and managerial systems (Deming 1986). On the foundation of his PDSA cycle, organizations commit to continual quality improvement through data-based choices and organizational learning. According to Deming, quality assurance builds efficiency, together with customer satisfaction, through leadership commitment, employee involvement, and organizational collaboration (Deming 2000).

Academic accreditation remains aligned with both organizational learning and quality assessment programs to develop health services for children through habitual quality enhancement under standardized guidelines. Accreditation acts as an independent system that enhances healthcare organizations by verifying their adherence to predetermined quality performance measures, which creates systematic learning networks based on performance assessments (Braithwaite et al. 2017). Through organizational learning, healthcare providers develop the essential ability to study results while implementing successful practices along with healthcare demand adjustments (Senge 2006). When accreditation processes integrate organizational learning principles, they enhance quality assurance by promoting evidence-based decision-making, staff development, and patient-centered care, ultimately improving children’s health outcomes (Greenfield et al. 2012).

3. Methods

This study applied the PRISMA 2020 guidelines (Page et al. 2021) to structure its reporting and ensure transparency across the study selection, screening, and synthesis stages. The systematic review explored how accreditation influences children’s health in orphanages based on empirical studies, with clear documentation of each phase of analysis.

3.1. Search Strategy and Data Sources

The authors implemented a systematic research plan using PubMed, alongside Scopus, as well as ERIC, ProQuest, and Google Scholar. The research focused on databases in healthcare, education, and social sciences because a multi-disciplinary examination of child health outcomes under accreditation was essential. The wide coverage of medical studies within PubMed and Scopus led to their being searched for this review, while ERIC and ProQuest supplied research in education and organizational learning domains. The search employed Google Scholar for supplemental access, but its decentralized nature became a drawback, so measures were established for validating the studies procured from this resource.

The systematic exploration of information required the combined use of Boolean operators, alongside truncation and MeSH terms. The last search query included different forms of the primary terms to prevent any relevant studies from escaping detection:

Systematic exploration of information required the combined use of Boolean operators alongside truncation and MeSH terms. The last search query included different forms of the primary terms to prevent any relevant studies from escaping detection:

Accreditation concepts: (“accreditation” OR “quality certification”)

Setting: (“orphanage” OR “childcare institution”)

Outcomes: (“child* health” OR “nutrition” OR “hygiene”)

Frameworks: (“learning organization*” OR “quality assurance”) The reviewed articles originated from English-language peer-reviewed publications spanning the period between 2020 and 2024. The specified time period served to confirm that the data obtained represented current developments in accreditation policies across childcare institutions. A search period of four years was selected as the time limit since it provides results that were directly applicable to present-day accreditation standards. The institute selected this period to align with fast-evolving accreditation standards focused on child health and enhanced institutional quality standards. The analysis excluded studies that had been conducted before previous accreditation models came into effect, along with modern guidelines.

The researchers implemented predetermined requirements to choose appropriate studies, thereby guaranteeing the inclusion of only high-quality research content throughout the analysis stage.

3.2. Study Selection Process

The selection process adhered to PRISMA 2020 recommendations to ensure reproducibility. A detailed flow diagram (Figure 1) illustrates each step undertaken—from identification through to final inclusion—based on actual procedures used in this review As shown in the flow, the inclusion process involved several systematic steps:

The search strategy identified 550 records in total: 500 through database searching and 50 from other sources. All retrieved titles and abstracts were imported into a reference management system for screening.

After removing 100 duplicate records, 450 studies remained for screening. Two independent reviewers screened titles and abstracts, resulting in the exclusion of 350 studies that did not meet the inclusion criteria.

The remaining 100 full-text articles were assessed for eligibility. Of these, 65 articles were excluded due to lack of empirical data, irrelevance to accreditation’s impact on child health, or because they were not focused on institutional care settings.

A total of 35 studies met the eligibility criteria and were included in the qualitative synthesis. From these, 20 studies were further included in the quantitative synthesis (meta-analysis).

Figure 1 Shows the PRISMA 2020 flow diagram used in this study.

3.3. Application of PRISMA 2020 Reporting Standards

To ensure transparency and replicability, this review adopted the PRISMA 2020 guidelines as a reporting framework. Rather than simply listing checklist items, the standards were embedded in the research process and reporting across all stages of the review.

Title and Abstract, The title explicitly identifies this as a systematic literature review, and the abstract summarizes the review objectives, data sources, eligibility criteria, synthesis methods, key findings, and implications.

Introduction, The rationale for the review and specific research questions are clearly stated, justifying the focus on accreditation’s impact on child health within orphanages.

Methods, Detailed eligibility criteria were established in advance, specifying inclusion of peer-reviewed empirical studies between 2020–2024 focused on accreditation and child health outcomes in institutional settings. Information sources included PubMed, Scopus, ERIC, ProQuest, and Google Scholar. A comprehensive search strategy used Boolean operators and MeSH terms.

The study selection involved a dual-reviewer process for screening, followed by full-text eligibility assessment, as depicted in the PRISMA flow diagram. Data extraction and synthesis were guided by a structured framework, and study quality was assessed using the MMAT tool. Risk of bias, particularly in selection and reporting, was minimized through independent screening and sensitivity analysis.

Results, Findings were reported with detailed synthesis of thematic areas aligned with the review objectives, such as hygiene, nutrition, healthcare access, and mental health. The PRISMA flowchart illustrates the process from identification to inclusion of studies.

Discussion and Conclusion, The results are contextualized in light of existing research, with critical reflection on limitations, policy implications, and directions for future studies.

3.4. Study Quality and Bias Assessment

A critical appraisal of study quality was conducted using the Mixed Methods Appraisal Tool (MMAT) 2018 version (Hong et al. 2018). This tool was chosen due to its applicability across qualitative, quantitative, and mixed-methods studies, allowing for a systematic evaluation of methodological rigor. This bias assessment corresponds with Item 14 of the PRISMA 2020 checklist, ensuring that the review not only evaluates the methodological quality of studies but also considers potential risks of bias that may affect the synthesis. The studies included were assessed based on the following five key domains:

Clarity of research questions—Whether the study clearly defined its objectives and research questions.

Appropriateness of the study design—Whether the research design aligned with the stated objectives.

Reliability of data collection methods—Whether data collection techniques were well defined, appropriate, and replicable.

Transparency in data analysis—Whether the study provided a clear explanation of how data were analyzed, including any statistical or thematic analysis techniques.

Relevance of findings to research objectives—Whether the results and conclusions were supported by the data.

Each study was assigned a quality score based on the number of criteria met:

High-quality studies: Met four or five of the five MMAT criteria.

Moderate-quality studies: Met three of the five MMAT criteria.

Low-quality studies: Met two or fewer MMAT criteria.

Studies classified as low-quality were included in the review but were interpreted with caution, and their limitations are explicitly noted in Section 5.

To further ensure the integrity of the study selection process and minimize bias, several bias assessment strategies were implemented:

Dual-Screening Process: Two independent reviewers screened articles at each stage. Any discrepancies in inclusion decisions were resolved through discussion or arbitration by a third reviewer. This approach reduced the risk of selection bias.

Comprehensive Database Search: By incorporating multiple databases from different disciplines (healthcare, education, and social sciences), selection bias was minimized. Studies from diverse fields provided a more holistic understanding of accreditation’s impact on child health.

Justification for Excluding Gray Literature: Gray literature, including unpublished dissertations, reports, and non-peer-reviewed sources, was excluded to ensure that only high-quality, peer-reviewed evidence was analyzed. This decision was made to maintain consistency and methodological rigor. However, this exclusion is acknowledged as a potential limitation in Section 5.

Publication Bias Assessment: For quantitative studies, funnel plots were generated to detect publication bias. Sensitivity analyses were also conducted to assess the robustness of findings.

3.5. Data Extraction and Thematic Analysis

A structured data extraction framework was used to systematically gather relevant information from the selected studies, ensuring consistency in analysis. The extracted data included the following:

Study characteristics (author, year, country, sample size, setting);

Types of accreditation model and standards used;

Health-related outcomes assessed (e.g., hygiene compliance, nutritional improvements, access to medical care, mental health support);

Key findings and recommendations.

Data synthesis was performed using thematic analysis (Braun and Clarke 2006), a widely used method for identifying patterns within qualitative data. Thematic coding was conducted using an inductive approach, identifying key themes related to accreditation’s influence on the following:

Improvements in hygiene and sanitation standards;

Nutritional interventions and dietary improvements;

Medical care availability and compliance with healthcare protocols;

Psychosocial and mental health support.

The findings were categorized into three major themes, providing a structured synthesis of how accreditation influences child health outcomes in orphanages. This systematic approach ensured a transparent and replicable analysis, enhancing the credibility of the review’s conclusions. A summary of the included studies, including country, study design, setting, and the dimension of accreditation analyzed, is presented in Supplementary Table S1.

4. Results

Research conducted using 35 peer-reviewed studies confirmed that health improvements occur when orphanages undergo accreditation evaluation. The results indicate that accredited orphanages exceed the standards for hygiene, cleanliness, nutrition, healthcare access, and mental healthcare services compared to unaccredited centers. Through accreditation, the quality assurance process takes shape to prompt systematic improvements that lead to enhanced health and safety in children within residential care programs. The study reveals that accreditation creates quantifiable changes in orphanage conditions through three essential dimensions consisting of hygiene and sanitation standards, nutritional care and healthcare access, and psychosocial and mental health services.

Accredited orphanages demonstrated superior hygiene practices and sanitation protocols, resulting in decreased communicable disease incidence within children. Handwashing compliance statistics revealed that accredited orphanages demonstrated rates of 68%, whereas non-accredited institutions achieved only 40% when researchers conducted their assessment (Rissman et al. 2020). The implementation of hygiene audits took place in 75 percent of accredited orphanages, while this practice occurred only in 48 percent of non-accredited facilities per year (Tripathy et al. 2023). Accreditation audits included checks on toilets and handwashing services, as well as the assessment of bed maintenance and kitchen preparation areas that could directly affect children’s health. Accredited institutions reduced preventable illness outbreaks by 30% because they implemented better sanitation procedures according to Carson et al. (2022).

The accreditation process determines both the quality of nutrition and healthcare availability for children in orphanages. Child feeding practices at accredited institutions were led by nutritionists and included national diet-guided meal plans that provided children with proper nutrition according to 60% of data. However, only 22% of non-accredited orphanages used structured nutritional meal plans (DeLacey et al. 2020). Academic research showed that child nutrition improved significantly in accredited institutions because they showed 25% lower malnutrition compared to non-accredited facilities (Samuel et al. 2021). The immunization program achievements of accredited orphanages surpassed those of non-accredited facilities because accredited centers achieved complete vaccination schedules for 80% of children while non-accredited centers provided full vaccinations for only 58% of children (UNICEF 2022). Accreditation helps in ensuring that institutions continue to follow both national and international public health recommendations. Physical health check-ups increased by 40% in accredited orphanages, which enabled the early detection and treatment of health problems including growth deficiencies, dental issues, and regular childhood diseases (Lee et al. 2022). Accreditation works as a double force to transform orphanage feeding guidelines and strengthen the partnership between healthcare providers and orphanages to establish systematic medical care for residential children.

Accredited orphanages displayed a better implementation of organized mental health programs, which addressed the psychological well-being of the children. Children in orphanages require mental health professionals, along with trauma-informed treatment, because they usually face significant psychological distress from abandonment or traumatic experiences or loss. The placement of counselors and psychologists in orphanages occurs at double the rate in accredited organizations compared to non-accredited facilities (Isnaeni et al. 2021). Mental health professionals provided by institutions lowered child stress and anxiety scores by 35% according to standardized well-being rating systems (Benton et al. 2021). Research from 2023 demonstrated that accredited orphanages increased their access to trauma-informed care services by 45% in order to provide specialized therapy programs for neglected children who had experienced abuse (Bendall et al. 2023). Global health initiatives with structured mental health components benefit children by strengthening their emotional capabilities and helping create institutions that mature into supportive environments for both children and staff.

This systematic review demonstrates that accreditation operates as an essential system to enhance health results for children in orphanages. Established accreditation standards help institutions create better conditions for child health through hygiene services, along with sufficient nutrition and healthcare, which leads to improved safety conditions for vulnerable children. The wide implementation of accreditation remains limited by financial obstacles and institutional resistance to external inspections, along with differing accreditation criteria between regions. Implementing financial aid with standardized accreditation standards and enforced training programs for caregivers can eliminate existing obstacles, allowing accreditation systems to maximize their advantages and enhance overall childcare facility quality.

5. Discussion

A systematic review of 35 peer-reviewed studies provides substantial evidence that institutional accreditation positively impacts children’s health in orphanages by improving hygiene, nutrition, healthcare access, and mental well-being. These findings highlight accreditation as a key quality assurance mechanism that standardizes care, promotes accountability, and fosters continuous institutional improvement. However, despite these benefits, accreditation remains underutilized in many orphanages due to financial limitations, administrative resistance, and inconsistencies in accreditation standards across different regions. Addressing these challenges requires policy reforms, increased financial support, and globally standardized accreditation frameworks to ensure that vulnerable children in institutional care receive the highest standard of protection and support.

Accredited orphanages consistently demonstrate better adherence to health and safety regulations, leading to a measurable reduction in disease prevalence and malnutrition rates, as well as an improvement in mental health support services. Studies show that institutions with accreditation have higher compliance rates with hygiene protocols, contributing to a 30% reduction in preventable illnesses such as respiratory infections and skin diseases (Alhawajreh et al. 2023). Additionally, vaccination coverage among children is significantly higher in accredited orphanages, ensuring better protection against infectious diseases. These findings indicate that accreditation fosters a structured and standardized approach to childcare, where institutions are monitored for quality and held accountable for the health and safety of the children that they serve.

Beyond hygiene and medical care, nutritional standards in accredited institutions are significantly higher, with 60% of orphanages adhering to nutritionist-approved meal plans compared to only 22% in non-accredited facilities (UNICEF 2023). This structured approach to dietary planning ensures that children receive balanced meals that meet nutritional guidelines, leading to lower rates of malnutrition and diet-related deficiencies. Furthermore, routine medical check-ups are 40% more frequent in accredited orphanages, allowing for the early detection and management of health concerns, such as growth deficiencies and chronic illnesses. These improvements are essential in ensuring the long-term well-being of institutionalized children and highlight the role of accreditation in enforcing evidence-based healthcare practices.

Mental health outcomes are also notably better in accredited orphanages, where structured psychosocial support programs are more widely implemented. Studies indicate that children in accredited institutions have 35% lower stress and anxiety levels, primarily due to the availability of on-site mental health professionals and trauma-informed care (Mahanta et al. 2022). Accredited facilities are 50% more likely to have dedicated mental health professionals, providing children with counseling services, behavioral therapy, and emotional support programs tailored to their specific needs. These findings demonstrate that accreditation not only improves physical health outcomes but also creates a more nurturing and emotionally supportive environment for children, helping them develop better coping mechanisms and resilience.

Despite these proven benefits, accreditation remains a complex and challenging process for many orphanages, particularly those in low-income regions with limited financial and human resources. While accreditation offers long-term improvements in child welfare, its implementation is often hindered by economic, administrative, and policy-related barriers that make it difficult for institutions to comply with regulatory requirements.

5.1. Challenges to Accreditation Implementation

One of the most significant barriers to accreditation comprises financial constraints. Many orphanages, particularly in low-resource settings, struggle to meet the infrastructural and operational demands required for accreditation. Studies indicate that over 60% of non-accredited orphanages cite financial limitations as the primary reason for non-compliance with accreditation standards (Lazzeri et al. 2022). The costs associated with facility upgrades, staff training, medical services, and compliance audits can be prohibitive, making accreditation inaccessible to institutions that lack government or donor funding.

Beyond financial limitations, resistance to external evaluation poses another major obstacle. Some orphanage administrators perceive accreditation to be a bureaucratic burden, fearing that the process may introduce excessive regulation, limit operational flexibility, or lead to negative evaluations (Zendrato 2022). In some cases, institutions resist accreditation due to concerns that external audits could expose inefficiencies or funding mismanagement, potentially affecting their eligibility for public or donor support. This reluctance to undergo formal accreditation reflects a broader challenge in implementing accountability mechanisms within institutional care settings.

Additionally, policy inconsistencies in accreditation standards contribute to uneven implementation across different regions. While some countries have comprehensive and enforceable accreditation frameworks, others lack standardized regulations, leading to significant disparities in orphanage quality and oversight (Shawar and Shiffman (2023)). This variability complicates efforts to establish universal benchmarks for child welfare, making it difficult to measure the true impact of accreditation on a global scale. Without harmonized accreditation guidelines, institutions in certain jurisdictions may be unable to achieve the same level of quality assurance as those in more regulated environments.

5.2. Need for Policy Reforms and Sustainable Accreditation Models

To overcome these challenges, policymakers, funding organizations, and child welfare advocates must work together to develop sustainable accreditation models that support both institutional quality improvement and financial accessibility. One essential reform is the subsidization of accreditation costs for orphanages operating in resource-limited settings. Governments and international organizations should provide financial incentives or grants to help institutions cover the expenses of accreditation compliance, ensuring that quality improvements are not limited to well-funded organizations.

Another critical strategy is the expansion of training programs for orphanage staff and administrators. Many institutions struggle to meet accreditation standards due to a lack of knowledge or expertise in quality assurance and compliance requirements. By investing in structured training initiatives, stakeholders can ensure that orphanage staff are equipped with the skills and understanding necessary to maintain accredited standards. Training programs should cover health and safety regulations, mental health support, child protection protocols, and administrative best practices, helping institutions sustain long-term quality improvements beyond the accreditation process.

Furthermore, efforts must be made to standardize accreditation criteria globally, reducing inconsistencies in implementation, monitoring, and enforcement. A universally recognized set of accreditation standards will promote consistency in orphanage oversight, ensuring that all institutions adhere to a minimum threshold of quality care, regardless of geographic location. International child welfare organizations and accreditation bodies should collaborate to develop clear, evidence-based guidelines that can be adapted to different socio-economic contexts, allowing for greater scalability and inclusiveness in accreditation programs.

By addressing these financial, administrative, and policy-related barriers, accreditation can become a more accessible and effective tool for enhancing child welfare in orphanages. When properly implemented, accreditation serves as a powerful mechanism for protecting vulnerable children, ensuring that they receive adequate healthcare, nutritious food, and essential psychological support in a safe and structured environment. Future research should explore innovative accreditation models that balance regulatory oversight with institutional flexibility, ensuring that accreditation remains both practical and sustainable in diverse childcare settings.

6. Conclusions

Accreditation plays a critical role in improving children’s health and well-being in orphanages by ensuring compliance with quality standards, enhancing staff training, and strengthening institutional structures. This review highlights how accreditation fosters better hygiene, nutrition, and healthcare access while also promoting mental health support through structured interventions. Additionally, accredited institutions are more likely to embrace learning organization principles, leading to continuous improvement in care practices and service delivery. The findings indicate that accredited orphanages demonstrate higher adherence to hygiene protocols, with studies reporting a 30% reduction in preventable hygiene-related illnesses and a 40% increase in routine medical check-ups compared to non-accredited facilities. Furthermore, vaccination rates were 80% in accredited institutions versus 58% in non-accredited settings, underscoring accreditation’s role in improving healthcare access.

However, challenges such as financial constraints, resistance to external evaluations, and inconsistent policy implementation hinder widespread adoption. Many orphanages, particularly in low-resource settings, struggle to meet accreditation requirements due to funding limitations and a lack of infrastructure. Resistance from administrators who perceive accreditation as bureaucratic further slows its implementation, while policy inconsistencies across different countries create disparities in accreditation standards, making it difficult to establish universal benchmarks. Addressing these barriers requires targeted financial support, such as government subsidies for accreditation costs, comprehensive staff training on quality assurance protocols, and stronger collaborations among policymakers, accreditation bodies, and orphanage administrators to standardize and streamline accreditation processes.

To maximize the benefits of accreditation, policies should prioritize mandatory caregiver training, the integration of mental health services, and the systematic monitoring of compliance with accreditation standards. Additionally, future research should explore alternative quality assurance models for orphanages unable to meet full accreditation requirements, regional variations in accreditation effectiveness, and long-term health outcomes associated with accredited childcare institutions. By integrating accreditation into quality assurance and organizational learning, orphanages can create sustainable care environments that prioritize children’s holistic development, ensuring that institutionalized children receive the highest possible standard of care.

Author Contributions

D.K.: Conceptualization, Methodology, visualization, data curation, writing—original draft. B.R.: Supervision. N.C.A.: Conceptualization, validation writing—review & editing. S.S.: Formal analysis. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The author extends heartfelt gratitude to Balai Pembiayaan Pendidikan Tinggi (BPPT) and Lembaga Pengelola Dana Pendidikan (LPDP) [the Higher Education Funding Center and the Indonesia Endowment Fund for Education] for their invaluable support in covering the entirety of the author’s educational expenses. As a recipient of the Indonesian Education Scholarship (Beasiswa Pendidikan Indonesia-BPI), this support has been fundamental in enabling the author to success-fully pursue and complete doctoral studies at Universitas Padjadjaran.

Conflicts of Interest

The authors declare no conflicts of interest.

Footnotes

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Figure

Figure 1 PRISMA flow diagram illustrating the study selection process.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/socsci14050307/s1.

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