- Latin America and the Caribbean has concrete experiences that are transforming the social organization of care. The challenge is to create the conditions to scale up what has already been shown to work.
- Scaling up care programs requires strengthening five interdependent conditions: governance, financing, human capital, quality, and shared responsibility for care work.
- Expanding coverage is not enough: the challenge is to ensure that care services reach more people while maintaining their quality and sustainability.
Care is fundamental to human development and an indispensable condition for building more productive, equitable, and sustainable societies. In Latin America and the Caribbean, however, there is still a long way to go before quality care services are available at scale to those who need them. According to a study by the Inter-American Development Bank (IDB), the coverage of childcare services, for example, reaches between 30% and 40% in some countries, while long-term care services financed with public resources reach less than 5% of older people with care needs.
Even so, our region already has concrete care experiences that show us how to move forward.
The new IDB publication Paths to Building Care Systems: Nine Case Studies from Latin America and the Caribbean (available in Spanish) analyzes care programs and services led by national governments that deliver services to people and families in their communities. These experiences allow lessons to be drawn about one of the main challenges of the region: how to expand care services without losing quality or sustainability.
In previous blog posts and publications, we have addressed the challenges that countries face in advancing the care agenda. Now, we take this analysis a step further and examine how some of these challenges are being translated into concrete solutions. From nine experiences developed in different territories, we identify lessons that can be useful for countries looking to expand existing services or develop new ones.
These experiences are:
- Brazil: Home Care: Integrated home care service for older people and their unpaid caregivers.
- Chile: Community Care Centers/ Chile Cuida.
- Colombia: Pilot for the strengthening of community care organizations.
- Costa Rica: Day Care Centers for Older Adults.
- Mexico: New model of Education and Child Care Centers/CECI.
- Panama: Comprehensive Early Childhood Care Centers/CAIPI.
- Paraguay: National Program for Comprehensive Early Childhood Care, Seeds of the Future.
- Dominican Republic: Home care model for older persons in a situation of dependency.
- Uruguay: Inter-institutional Centers for Education and Child Care of Trade Unions and Private Companies/SIEMPRE
The cases cover home care services for older people in a situation of dependency, community care centers, early childhood services, models of support for caregivers and coordination mechanisms involving governments, communities, private companies and social organizations.
These experiences differ in their approaches and contexts, but together they demonstrate that the region already has accumulated knowledge on how to organize services, mobilize stakeholders, build capacities, and respond to specific care needs in the local communities.
The publication starts with a central question: what is needed for a care program or service to expand its coverage, maintain its quality and become a sustainable policy?
A key finding is that scaling up a program or service that works in a particular territory requires strengthening five interdependent conditions: governance, financial, human capital, quality, and shared responsibility for care work to support its expansion. The challenge is not simply to replicate a model, but to build the necessary conditions and capacities for it to work in different contexts, maintain its standards, and remain sustainable over time.
Care involves multiple sectors, such as social development, education, health and labor markets, and therefore requires coordination. However, the cases show that coordination alone is not always enough.
Costa Rica, for example, highlights the importance of having a clear leadership in the governance system of care policy, with a mandate and technical capacity that facilitates coordination among different actors. At the territorial level, Brazil and Colombia show that national frameworks (legislation and care policies) need to be translated into local plans, resources and capacities adapted to each context.
Continuity is another challenge. Care systems, policies, and services require long-term horizons that transcend government cycles. Uruguay, Chile, and Panama illustrate how legal frameworks, institutionalization, and consensus contribute to sustaining these processes.
Scaling up also requires addressing how expansion will be financed. A program may begin with temporary or extraordinary funding, but a sustainable policy needs predictable financing mechanisms and clearly defined responsibilities across the different levels of government and among the actors involved.
Offering services to reach more people does not necessarily mean providing better services. Expansion requires adequate infrastructure, trained care workers, and mechanisms to guarantee quality standards.
This is one of the main bottlenecks in our region: the availability of qualified human resources. The nine cases analyzed highlight the need to simultaneously advance in the training of more paid caregivers and in the certification of those who already perform these tasks, along with the creation of better working conditions and measures that protect their well-being.
The experiences of the Dominican Republic and Mexico offer different approaches to professionalization through training and mentoring. Chile and Brazil, in turn, demonstrate the importance of incorporating caregivers’ well-being into care models.
Quality also requires information, monitoring, and evaluation systems. Panama is an example of how the definition of standards, verification mechanisms, and incentives can guide the improvement of services. In Uruguay, the external evaluation of the SIEMPRE Centers generated evidence to inform decisions about expanding the model.
Together, these cases show that scaling up care services requires building the capabilities needed to ensure quality, measure results, and continuously improve services as they expand.
Care systems and policies cannot rely exclusively on families – and, within them, on women – but neither can they be built by the state alone. The cases analyzed propose different ways of coordinating the public and private sectors, communities, social organizations and families in the provision of care.
Colombia demonstrates the potential to strengthen community participation, under clear state stewardship that ensures access and financing. The Dominican Republic and Uruguay illustrate how the private sector can contribute through the contribution of infrastructure, management and installed capacities.
Sharing responsibility for care work between men and women must also be encouraged within households. Paraguay reflects the importance of combining services with actions to support families and with measures that encourage greater participation of male fathers in the care of their children.
This challenge also extends to the paid care workforce. Women represent most people working in the care sector, and the cases analyzed show that progress can be made in strategies that contribute to diversifying this workforce.
Scaling care therefore implies expanding not only services, but also the network of actors involved in their provision, thus redistributing the responsibilities they assume.
Countries in Latin America and the Caribbean do not need to design solutions from scratch. The region already has experiences, institutional innovations, and local lessons that can serve as a starting point.
The challenge is to create the conditions so that these experiences that work can reach more people, maintain their quality, and be sustained over time. Learning from what already exists can help us move from concrete programs to care services with greater scale and sustainability.
Learn about the nine experiences through the stories of the people who lead them (videos available in Spanish):