Care Work at the Core: A Starting Point for a More Inclusive Society

Nine out of ten women in Bogota spend an average of 5.5 hours a day on care work for which they are not paid – the equivalent to 13% of the city’s GDP if these hours were paid. A new care system through Bogota’s Ministry of Women allows women who put in long hours of care work to free up some time for self-care and professional growth, and aims to create more equitable communities.

Before the pandemic, 800,000 women in Bogota were dedicated exclusively to care work, looking after family members and the home. But following the closure of nurseries and schools at the peak of the crisis, this number grew to 1.2 million – 30% of the city’s population of women.

Two-thirds of these women did not complete high school, many had left their jobs, and 21% were suffering from both physical and mental health problems.

In the experience of Luisa, a Bogota resident, who spends each day caring for her three young children and a mother with chronic illness: life is full and exhausting. Luisa gave up her part-time job in a grocery store after the birth of their third child in 2019, and the household relies on the wages of her husband, a construction worker whose physically demanding job leaves him tired at the end of the day. Covid and lockdowns added to the family’s financial uncertainty and increased demands on Luisa’s time, compounding her feelings of stress and anxiety.

Because of time-poverty, Luisa and millions of women around the world like her put aside their own needs for those of their loved ones. The relaxation and recreation needed for their physical and mental well-being tend to fall by the wayside. Furthermore, being “stuck at home” means that they lose opportunities to get the training, economic autonomy, and political participation that could help improve their circumstances.

Creating Opportunity for Carers

To address these challenges, in 2020 Bogota’s Ministry of Women launched the SIDICU (District Care System) with support from the Open Society Foundations – which works to build vibrant and inclusive democracies whose governments are accountable to their citizens – and several other players. The system offers services and programs to unpaid caregivers like Luisa, through a growing network of centers (Manzanas del Cuidado), mobile units, and – in time – home visits.

At its core, it recognizes and values care work and those who do it, and aims to provide programs and services that can help balance the provision of care between men and women. Furthermore, it seeks to restore lost opportunities to women caregivers by reducing their hours of unpaid care work, and in this way enable personal development and self-care.

The programs and services offered are designed to help build skills and bring relief, including space where they can rest or read a book, socialize with peers and establish networks, learn digital skills and first aid, train in technical, technological or professional careers, get their laundry done, as well as make use of fitness and wellness services. What is key is that both services and care are provided simultaneously.

As a result of her involvement with programs, Luisa has made new friends and now feels less alone in her struggles. She has also accessed resources at one of the centers and uses the childcare and laundry services while she participates in a training program where she is learning computer skills.

At centers, care providers can step in for carers, taking on their duties for a time, and providing care to those who may need it, such as children and people with disabilities. In the future, home visits will be offered, where carers are given a break to attend a program while their care responsibilities at home are taken care of. Cultural change programs that are connected to care work are also available to the wider community.

Since its launch, the SIDICU has delivered over 135,000 services to care workers, people who require care, and the general public, and continues to fulfill its commitment to recognize, reduce and redistribute unpaid care work in an equitable manner throughout society.

The tenth care center opened in Bogota’s town of Rafael Uribe Uribe in early June 2022 and will benefit 4,921 caregivers and more than 12,600 people who require care or high levels of support through more than 30 services. In this town, 34% of women 15 years of age or older perform domestic work and care at home as their main activity. The center gives them and all the caregivers in this town a space with services designed for them and their families.

An Assessment to Capture Lessons

Dalberg collaborated with the Ministry of Women from the Fall of 2020 to design the operating model for the mobile units and support its implementation, in the process coordinating with the many entities supporting the initiative, including UN Women and UNDP.

A financial assessment of the centers – Manzana del cuidado – then followed, where Dalberg engaged separate departments that provide care, such as the Ministries for Education, Health, and Social Development. Dalberg also developed a monitoring, evaluation, and learning (MEL) framework, and designed data collection tools, later assessing the impact of programs and services within the District Care System.

To determine the relevance, effectiveness, coherence, efficiency, sustainability and impact of programs and services, in the summer of 2021 Dalberg surveyed areas such as how a program improves accessibility to care, whether there is the willingness to pay, and if services align with what people want or need. Consideration was given to whether the services are additive, their impact (mental, health, emotional support), as well as what services were the best, the optimal time to receive them, and what types of support staff are considered the most helpful.

Dalberg learned that when it came to effectiveness, the care system has reduced several important access barriers to services, though some limitations still exist that prevent more people from accessing services. These challenges include transportation – for people who live far from the block or the meeting place of the mobile unit; a lack of access to technology at home, such as devices and the internet; and a lack of computer knowledge. Other barriers included the risks and fears surrounding Covid-19, poor weather conditions, and insecure conditions surrounding the locations of centers and mobile units offering programs and services.

Dalberg interviewed government entities, facilitators, private operators and end-beneficiaries, and drew on the analysis of attendance databases to gain insights on how the care system’s impact could be understood and supported. To strengthen the operational model around these findings, Dalberg offered recommendations about the portfolio of services, the operating model, stakeholder coordination, MEL, and sustainability. Input was also given by the Universidad de los Andes, Bogota, School of Government on the financial sustainability of the system.

Shaping the Future of Care Worker Support

What emerged from Dalberg’s assessment is the need to recognize and understand the diverse needs that women caregivers experience, driven mainly by their location and level of rurality, age, the labor market around them, and who they care for.

A deep understanding of women’s lives and routines could lead to greater value and uptake of services, and provide data to adjust the care system’s schedules and range of services around their needs.

One recommendation to test in the future might be to add activities such as puzzles or lottery games that promote children’s cognitive development and learning around the subject of care while their carers are using services, or expanding the service offer so that boys and girls older than 5 years of age can also attend. On the flip side, considering stopping the care service for infants between 0-2 years of age might make sense given the specific needs of children that age, and instead the care system could facilitate access to nurseries or centers dedicated to the care of those children.

Another key focus of the care system should be the value of a network of peers and local organizations for building community and engagement. Dalberg recommends leveraging more local organizations, actors and leaders, and bringing in the active participation of other district entities to strengthen the system. In this way, rather than acting in isolation, local actors can play a role in increasing demand.
For now, Dalberg also recommends maintaining a virtual option for services to complement the face-to-face offer, and concentrating efforts on continuing to refine and consolidate services offered rather than expanding the portfolio too much. Down the road, caregivers could also be offered employment-oriented or income-generating services.

A program that is poised for growth

This is the first program of its kind to be implemented at this scale in Latin America, and will provide a valuable example to learn from. Its launch during the pandemic was particularly timely and relevant – when the care demand on women had increased so dramatically – but this also made it far more difficult to implement.

Bogota’s current administration, which supported the care system’s development as a flagship project backed by the mayor, will end its term at the end of 2023. Before then, the number of Manzanas del Cuidado centers is expected to double to 20 centers, and house visitation services will be piloted with the support of a grant from the Bloomberg Philanthropies Global Mayors Challenge.

Philanthropic funding has provided an opportunity to experiment and refine the model before turning it over for public funding, and its long-term sustainability will depend on securing this next step. The administration is therefore focusing on embedding the program into Bogota’s Plan de Desrrollo Territorial, and on securing public funding.

Care system actors from around the world will gather in Bogota in June 2022 for a practical session to examine the District Care System, and to share perspectives and solutions to the global care challenge.

As the District Care System goes from strength to strength, there will be further opportunities to explore in the realm of care, including how to support women with earning an income.





Photo credit: Bogota’s Ministry of Women

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