Investments in care services are core to a human-centred recovery says Valeria Esquivel.

The Covid pandemic is a health, social and economic global catastrophe, still unravelling in many parts of the world. It has also been an eye-opener: it has revealed how mobile we were and how rapidly virtual communications could keep us connected. It has also unveiled how unequal our world is, and how those inequalities are further exacerbated by Covid depending on the access to health, social protection, technology, jobs, vaccines.

Covid has also brought home something those of us who provide care have always known: without care, the world comes to a halt. Health systems were ill-prepared to cope with any crisis of Covid proportions – that forced governments to take draconian measures to stop the spread of the disease. School closures left families with children juggling with care during their usual working hours and pushed many young people out of education altogether.

The unpaid care work that takes place in households and families to support everyday life is a vital part of the economic system.

What was hidden behind the scenes became evident: the unpaid care work that takes place in households and families to support everyday life is a vital part of the economic system. And when everything else fails, it takes up the slack.

Before Covid, three quarters of all that unpaid care work was primarily carried out by women. As care service closures, and the need to care for those who become sick, created an unprecedented demand for care within the home, those same women took up the added burden sometimes beyond the point of exhaustion.

As a result, many women had to cut out paid working hours or leave employment altogether. The catastrophic losses in women’s employment brought about by the pandemic – a so-called demand-side phenomenon –  combined with the new care demands (a “supply-side phenomenon”) resulted in an inordinate increase of women’s withdrawal from the labour market, for young women in particular.

The International Labour Organisation’s (ILO’s)  global call to action for a human-centred recovery from the Covid crisis that is inclusive, sustainable and resilient was adopted by governments, workers and employers in June 2021. It recognises that: “women have suffered disproportionate job and income losses, including because of their overrepresentation in the hardest-hit sectors, and many continue to work on the front line, sustaining care systems, economies and societies, while often also doing the majority of unpaid care work, which underscores the need for a gender-responsive recovery.” The ILO calls for, amongst other measures, “appropriate public and private investment in sectors (…) with strong potential to expand decent work opportunities, such as the care economy”.

The case for investments in care

Investments in care services – in health and social work, and in education – have the potential to become a central pillar of a gender-responsive and job-rich recovery strategy, as they create decent jobs, particularly for women. In 2018, estimates showed that investments in care services could create up to 269m new jobs by 2030, comprising a 120m increase in sectoral employment from 2015 plus 149m additional jobs that could be generated indirectly in other sectors. In total, there could be 475m jobs in care services by 2030, of which 264m would be taken up by women.

There is a case for investments in care services on the basis of equality, efficiency and resilience.

First, care investments enhance the wellbeing of those who need regular care, particularly children and the elderly. They create job opportunities for women. By redistributing some of the unpaid care work, they also make it possible for women to join the workforce again – a double win. In doing so, investments in care counterbalance inequalities in gender, income and care accessibility that have been reinforced by the Covid crisis.

Second, investments in care are efficient – they enhance productivity (see box Caring productively). The problem is their full contributions to productivity are not captured in measures of sectoral gross domestic product simply because they produce public goods – they keep us all healthy and cared for, and they increase future workforce productivity – but they are not fully paid for that. It is like clean air, we only notice when we don’t have it. Covid has laid bare what happens when we don’t have enough health care workers, beds, ventilators, protective gear and so on. And we are not yet certain we will have what it is required in the future.

Caring productively
The standard definition of labour productivity, – output per worker – does not fully apply to care sectors because at some point, increasing persons cared for per care worker jeopardises care quality.

Nurse under-staffing or too-high pupil-to-teacher ratios are cases in point. Also, as care provision has public-good characteristics, output calculations underestimate the true value of health and education outputs, lowering output per worker calculations. And lastly, most care services are not sold in the market. Without a price, output valuation is not possible so input methods are used to calculate value added. That arises from adding up the value of all factor inputs necessary for producing care services – what is called the “input equal output convention”. Labour inputs will be valued at their cost (wages), under the assumption that pay correctly reflects workers’ productivity. However, existing care pay penalties in care sectors mean that low pay will be directly reflected in lower sectoral value-added. In other words, care sectors do not pay low wages because they have low productivity. They appear to have low productivity because they pay low wages.

The third point is about resilience. Even in health terms, Covid hit vulnerable populations hardest, exacerbating inequalities in their access to health. The sheer differences in national vaccination rollouts illustrates this point. Investment in health, leading to universal health coverage, would  prepare us for future pandemics, instead of leaving us reacting to events as they occur. The costs in lives, jobs and incomes could be a lot less next time around if investments in care take place.

 Investments in care workers – in their wages and decent working conditions– are a prerequisite of good-quality care provision.


Investments in care are high on the agenda in Latin America where Uruguay and Costa Rica have implemented national care systems, and others, including Mexico and Argentina are in the process of implementing such systems (see box The Latin way). The US National Strategy on Gender Equity and Equality proposes that “to build back better” they will  “invest in care infrastructure and care workers to help rebuild the economy and lower costs for working families.” Investments in care workers – in their wages and decent working conditions– are a prerequisite of good-quality care provision.

The Latin way
Uruguay was the first country in Latin America to institutionalise a National Care System of integrated care policies. The system was created by law in November 2015, it is universal in its ambition and it aims to overcome fragmentation in care service provision. It also entails the institutionalisation of inter-sectoral coordination mechanisms. It is human rights-based, solidaristic in its financing and universal in its coverage and in the terms of its minimum quality standards.

It became “the fourth pillar of Uruguay’s social protection”. One of the salient features of the Uruguayan National Care System is its identification of care receivers and care givers – unpaid and paid as right holders. Unfortunately, social and academic organisations, some of them part of the Junta de Cuidados (the advisory body for the system), have recently denounced the “dismantling” of the system.

Mexico is working towards establishing a National Care System. Last year, the lower chamber of the country’s Parliament gave constitutional level to the right to care and to receive care and mandated the creation of the National Care System. The changes are awaiting ratification by the Senate.

The National Care System aims to coordinate care policies, programmes and services “based on personal, family, community and private sector co-responsibility”, as explained by the director of Mexico’s National Women’s Institute, Nadine Gasman. Underscoring the importance of the commitment to care policies, the government of Mexico launched the Global Alliance for Care at a high-level panel on care at the Generation Equality Forum in Paris in July 2021. It called for urgent action by governments, civil society, the private sector and international organisations to promote investments in care.

To consolidate progress, investment in care needs to be costed and budgeted as part of Covid recovery packages to realise their multiple benefits – to employment generation, gender equality, resilience and wellbeing.  Financing these investments is a matter of priority, through domestic taxation, easing debt burdens and channelling to them external sources of funding, like special drawing rights.

The views expressed in this article are those of the author and do not necessarily reflect those of the ILO or its constituents.

Valeria Esquivel

Valeria is Employment Policies and Gender Specialist at the International Labour Office, based in Geneva. She is a feminist economist, having published extensively on labour, macroeconomic and social policies. She has …

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