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Caring for the Care Workers: State Must Play a Role

4 Mar 2011

Changes in economic, social and demographic structures have spurred the growth of care employment in recent decades. In both North and South, care workers now comprise a large and growing segment of the labour force. The vulnerability and exploitation of particular categories of care workers (such as migrant domestic workers, nursing aides and providers of elder care) have also increased. These worrying trends can be attributed to cost-cutting measures within the public sector and pervasive labour market informality, along with the continued devaluation of both women’s work and care work.

These findings come from the December 2010 special issue of the International Labour Review, (Vol. 149, No. 4), “Underpaid and Overburdened: A Cross-national Perspective on Care Workers,” co-edited by UNRISD Research Coordinator Shahra Razavi and former UNRISD Research Analyst Silke Staab.

Contributions to the special issue address who these care workers are, whether they are recognized as workers, how their wages compare to those of other workers with similar levels of education and skill, the conditions under which they work, and how their interests could be better secured.

The collection fills an important gap in the current scholarship on care work. By providing new empirical evidence on the working conditions and wages of health, child and elder care workers, especially in selected countries of the global South, it shows how the emergence of new care challenges—such as the intensification of care demands due to HIV/AIDS (South Africa, Tanzania), child nutrition and early education (Argentina, India, Republic of Korea) and population ageing (Republic of Korea)—play out with regard to the working conditions and wages of those who are in charge of children, elders and people living with HIV/AIDS. The analysis is located within the broader context of labour market structures, social policy and public sector reform.

Compared to markets and the non-profit sector, the state plays a qualitatively different role in the provision of care: the state is not only a provider of care services (and hence an important employer of care workers), but also a significant decision maker when it comes to the responsibilities of markets and the non-profit sector. Whether and how the state makes use of its role as a provider, funder and regulator of commodified forms of care is fundamental for the employment conditions of paid care workers.

While the state has historically been a “good” employer, and continues to be so in some countries and for some categories of workers (for example, early education teachers in Argentina), it has become a much less reliable, secure and protected source of care employment in many advanced industrialized and emerging economies.

In many developing countries, the commercialization of public social services was imposed as a cost-cutting measure under structural adjustment, with often deleterious outcomes in terms of employment and service quality as well as access. In Tanzania, for example, the liberalization of private practice alongside the severe deterioration in the funding of the public health sector has led to the stagnation of already low wages for nurses and lower level health personnel, while widening the gap in wages and working conditions between nurses and doctors.

Further, in many countries public social services have come to rely heavily on “voluntary” or “community” work—very often a euphemism for unpaid or underpaid work. This is the case, for example, of Anganwadi workers and helpers who staff the Integrated Child Development Scheme in India. While employed by the state, they are not classified as workers, but as volunteers who receive stipends instead of wages and lack the leave entitlements and social security benefits available to permanent, full-time public employees. Similarly, the employment status of care workers in South Africa’s Expanded Public Works Programme (EPWP) is often “ambiguous and disguised”, as Francie Lund puts it.

Contrary to the view of the state as a good employer, these programmes show a state which deliberately side-steps its own labour regulations by “employing” workers who are not even counted as part of the labour force.

Another cost-cutting measure is the outsourcing of some of the functions hitherto carried out by the state to non-state entities, whether private for-profit or not-for-profit. Indeed, in many developing countries, many social programmes attending to care needs would not function without the participation of community-based and non-profit organizations (NPOs).

Cash-strapped governments seek to partner with NPOs for the provision of care because it saves money: public subsidies frequently make up only a fraction of the cost of care that these organizations provide. More often than not, however, this implies reliance on the unpaid or underpaid work of women who are themselves likely to be among the poor. But there is a limit to how much of the cost the care workers themselves can absorb (through self-exploitation) without negative implications for their own health and well-being, and for the quality of care that is offered. The meaning of “voluntarism” in a context of extensive poverty and structurally high unemployment is also far from clear. While volunteers may join care programmes in the hope of acquiring skills that will channel them into paid employment, there is thin evidence that voluntary work is a stepping stone.

If the evidence shows that the state is abdicating its role as provider, it must not be allowed to renege on its responsibilities as regulator and decision maker. In order to balance the scale, public policy must move from a strategy that relies on market and voluntary provision of care of the most informal and exploitative kind, to one that nurtures professional, decently paid and compassionate forms of care. It must address respect for workers rights, the struggle for equal pay and quality assurance.

The publication is available here.