In the last decade, several countries in Latin America and the Caribbean have been actively working on building and strengthening care systems. This has represented a paradigm shift as it has required a broader perspective, placing the care needs of families at the center and organizing public policy responses around them.

One of the main pillars of a care system is the organization of service provision for different groups of people involved: babies, young children, school-aged children, dependent adults, and caregivers. In several countries, it also includes services to facilitate the autonomy of people with disabilities.

The care system is, by nature, a complex and intersectoral entity with a broad mandate. For example, it ensures the quality of services offered by all providers, both public and private, channels investments towards areas with unmet care needs, promotes policies aimed at balancing the responsibility of care within families and society as a whole, encouraging more men and boys to participate in these tasks, among other things.

As the system also protects the rights of workers in the sector and promotes their formalization and professional development, we must consider that of the 9 million people engaged in paid care work in the region, 95% are women. Therefore, a care system must address their needs.

There are many angles from which to reflect on the role of care systems and the challenges their design and implementation pose for governments in the region. In this blog post, I will focus on ensuring the quality of services, which I consider to be probably one of the most important aspects.

Quality as a Key Element in a Care System

The region has made significant efforts to document the quality level of its care services and to implement strategies to improve it. The quality of childcare services, for example, has been evaluated in several countries using reliable instruments that capture a range of elements associated with the safety and well-being of the children attending them. Consistently, it has been observed that the quality of public childcare services is very low in all the countries where it has been evaluated, both in community and institutional models.

The quality of long-term care services is also a challenge. A recent study concluded that these services were of very low quality in 21 countries in the region. For care services to contribute to child development and the well-being of dependent older adults, they must offer quality that is at least comparable (if not superior) to what the person receiving care would receive in the absence of the service. Studies show that low-quality childcare services can have detrimental effects on the children attending them.

Fortunately, much research and practical experiences show how to improve the quality of care services, even when offered on a large scale through providers with limited resources and capacities. In this article I published in 2017, which remains relevant, I reflect on some key elements that apply to the provision of childcare services. They are summarized in the following list.

Eight Relevant Considerations in the Framework of the Discussion on Care Systems:

1. Expand coverage only if there is a strategy to offer quality services.
2. Focus subsidized services on children from the poorest and most vulnerable families.
3. Offer attractive working conditions to staff.
4. Provide mentoring and training as part of the continuous training strategy, so that staff learn to consistently offer quality interactions to the children in their care.
5. Implement continuous quality improvement strategies that are fed by real-time data and can trigger positive outcomes.
6. Strengthen pre-service training programs for providers.
7. Implement evidence-based curricula.
8. Maintain an emphasis on the quality of processes.

If you are interested in learning more about care systems and the IDB’s work on the topic, you can access the following resources: Interactive Care Menu, Care Systems and IDB Operational Work, Early Childhood Development Hub, Panorama of Aging and Long-Term Care.