The ‘deinstitutionalisation’ (DI) movement, also known as ‘care reforms’, is spreading rapidly across the globe, gaining momentum with the growing understanding among both practitioners and policy makers of the harmful effects of institutionalisation on the development and well-being of children as well as the strengthening of the child rights discourse. This has led to a growing international trend towards the development of, and a strong belief in, family-based care options for children deprived of parental care, away from large-scale institutions. This trend is reflected in and supported by international frameworks guiding the care of children, including the United Nations Convention on the Rights of the Child and in particular the United National Guidelines for the Alternative Care of Children, which was hailed in 2009. These instruments recognise that a caring and protective family is central to a child’s development, that governments should fulfil children’s right to quality care in families of origin and in alternative care and that institutionalisation of a child should be discouraged. DI processes are, however, not simple and straightforward as there are many challenges and complexities in their cross-cultural implementation. Even though unequivocally agreed by all stakeholders that the ‘best interest of the child’ should be at the heart of such care reform processes, its actual practice can often contradict such understandings as it gets submerged in numerous other considerations, constraints and challenges. This article analyses some of the dominant DI trends prevailing at present, in particular the primacy of family-based care and the misconceptions associated with the suitability of residential care, illustrated by the experience of SOS Children’s Villages in the DI process and its outcomes in Rwanda. The analysis is premised on the framework of the UN guidelines for the alternative care of children and strives to understand whether DI as it is practised in Rwanda is aligned with the principles of ‘necessity’, ‘suitability’ and the ‘best interest of the child’ as stipulated in the Guidelines. The attempt is to draw lessons for South Asia from the success as well as the challenges faced in Rwanda, as many governments in South Asia progressively join the DI movement. It is critical for all child-focused international non-governmental organization/ non-governmental organizations (INGOs/NGOs) in Asia to understand the UNGL, learn from different experiences about the challenges of DI and prepare to engage with policy makers. One of the most important lessons from the Rwanda experience is that the ‘quality’ of care should take precedence over the ‘form’ of care, and that quality is not always guaranteed in family-based care. The shift in the positionality of the government of Rwanda and their willingness to rethink their approach to DI particularly in terms of recognising quality residential care is commendable. This needs to be taken as a precedence by other governments across the world including in South Asia—especially by those who are truly interested in ensuring the best interest of children who have lost the care of their parents.