Solutions

CREATING CARING COMMUNITIES: LESSONS FROM GENEVA AND BOGOTA

The well-being of individuals and societies, especially children, persons with disabilities, and older adults, depends on caregivers and the care services provided. When care is recognized, redistributed, and remunerated, it brings significant benefits: it increases employment, improves caregivers’ participation in the labor market, boosts family incomes, generates returns by expanding consumption and savings capacity, increases tax revenue, and enhances social security systems.

In this context, many local governments have begun to implement Local Care Systems, prioritizing not only the population receiving such care but also those providing it. Thus, we are witnessing the transformation from mere service provision to “caring cities”. As a positive example, local governments are leading in the creation of caring communities, from the local to the national level. Such is the case of Mexico City, Santiago de Chile or Bogotá, where cities served as a guide for the national models and regulation.

Care policies and programs have grown exponentially in recent years, especially following the COVID-19, during which the importance of care work became more visible. In Latin America, the Montevideo Strategy (2016), the Santiago Commitment (2020), and the Buenos Aires Commitment (2022) are examples of care policies led by local governments that also involve various actors in their operationalization and financing.

Caring communities represent a clear step towards achieving the SDGs, particularly SDG No. 5.4: Recognize and value unpaid care and domestic work through the provision of public services, infrastructure, and social protection policies, and promote shared responsibility within the household and family, as appropriate in each country.

If you missed the webinar, it is available here in English, French, and Spanish.

The webinar held on May 28th, within the framework of the “Local Solutions” series of local action for the SDGs, highlighted the best practices and lessons learned from two cities that have implemented Care Systems and Policies: Bogotá and Geneva. We learned how, with the aim of putting caregivers at the center, each city has created programs that correspond to its own particular reality and, by constantly evaluating and listening to the population, they are building successful policies in the field.

CITIES AND THEIR PROJECTS

GENEVA, IN SWITZERLAND

One person out of 4 in Switzerland takes on caregiving roles, corresponding to about 1.9 million caregivers. It is striking that 10% of adolescents between the ages of 10 and 15 are caregivers, with the risk of dropping out of school. Under this reality, in the last 10 years Geneva has implemented a policy for the provision of care, which has evolved as follows:

  • In 2013 the Geneva constitution included the provision of services and aid for caregivers.
  • Between 2017 and 2020 the first concrete project on caregiving was initiated.
  • In 2020, in response to the effects of Covid, the Canton Delegation for Caregivers was created.
  • In 2021, the home support program for caregivers was launched; legislation on the subject was passed and a commission of experts was created to follow up on specific actions for caregivers, which were implemented between 2021 and 2023.

The Caregiver Agency was included in the social services department and brings together all the services related to caregiving. It aims to address and respond to the growing needs of caregivers, articulating with other institutions, empowering existing programs, and providing individual or collective support to caregivers, taking into account the diversity of this population, as well as their realities, to respond to them in a differentiated manner.

The agency works in hand with organizations and associations as well as strategic partnerships. The Agency also encourages caregivers to participate in policy creation.

Types of support provided by the Agency to the caregivers:

  1. Information: regarding their rights.
  2. Trainings: dedicated to creating awareness in voluntary workers and caregivers, regarding the existing programs
  3. Support: individual and collective support to prevent the problems that may appear; counseling.
  4. Networking
  5. Respite care system: to prevent burnout

A cantonal care roadmap being finalized, to be implemented from 2024 to 2028, based on 3 pillars:

(i) governance which includes interinstitutional articulation; (ii) a cantonal statute which is a system in which each canton takes care of the caregivers, facilitates their access to services and improves them according to specific needs, it also includes hospitalization services to better support caregivers when they need it; (iii) information and communication targeted at different types of populations such as employers, professionals and larger audiences.

BOGOTÁ, IN COLOMBIA

Bogotá has become one of the leading cities in Latin America to establish a Care System for caregivers. This innovative model aims to contribute to gender equality and equal opportunities through a set of services, policies, technical and institutional actions that seek to recognize, redistribute, and reduce care work.

This program focuses on women, who traditionally bear a disproportionate share of the care burden due to gender inequalities and stereotypes. Globally, women spend between 2 and 10 times more time than men on unpaid care tasks (OECD, 2022), and more than 2 million people work 8 hours a day in unpaid care roles. In Latin America, women bear 70% of the total burden of these tasks.

In Bogotá more than 90% of caregiving tasks are performed by women, limiting the use of their time and imposing emotional and physical burdens. Aiming at bringing solutions to this reality, since 2020, 23 “Care Blocks” (Manzanas del Cuidado) have been implemented and from 2021 the “Care Buses” were developed to assist caregivers.

THE HOME ASSISTANCE PROGRAM

The problem it seeks to solve: Women’s “time poverty”. In Bogota 30% of the female population are full-time unpaid caregivers: 90% of them are low-income; 33% lack time for personal care;70% have not studied beyond high school.

In addition, the district identified that 14% of full-time caregivers are unable to leave their homes due to the conditions of the people they care for. Therefore, an additional effort was made to reach out to caregivers through a “door-to-door care” program.

The solution: in 2023 the Home Assistance Program was implemented, through the Global Mayors Challenge and executed by UNDP. This program seeks to relieve caregivers from the overload of care work, while a professional at home provides care services and promotes autonomy to people with disabilities, their caregivers receive different services or carry out activities for respite, personal development, self-care or implement productive initiatives that had been postponed.

The program is implemented in 19 localities of the District of Bogotá and benefits approximately 410 households.

ServiceResultsAchievements
1.Home Assistance Service (relays)102 caregivers and 109 people with disabilities participated in more than 75% of the sessions. 5,164 hours freed up– 48% of the people with disabilities improved in the performance variables. – The level of dependency of these people decreased in all categories. – Level of satisfaction: 9.8/10  
2. Legal orientation service96 households assisted 196 legal assistance sessions  – Access to medical appointments, supplies, medicines, therapies and procedures, which were limited or restricted before joining the Program, was achieved. – Satisfaction level: 9.2/10
3. Knowledge certification service85 caregivers certified  – Ease of enrollment process – The methodology had a differential and inclusive approach. – Attrition rate was below 10%. – Satisfaction level: 9.6/10
4. Cultural transformation72 participating householdsChanges in caregivers and family relationships were evidenced.  – Satisfaction level: 9.4/10

Impact of the program on the lives of caregivers

  1. Increased recognition: 81% of caregivers feel that there was increased recognition of their caregiving duties by the person with a disability. 72% Caregivers consider that the program contributed “a lot” to the improvement of their self-care. Certifications and graduations contribute to improved recognition in the short term.
  • Greater redistribution: 48% of people with disabilities increased their levels of independence and autonomy.                 
  • Reduction of overload: 50% of caregivers reduced the degree of unpaid work overload.

Challenges: One of the biggest challenges is to implement specialized actions, due to the particular needs of each family, which implies a previous characterization to understand and effectively develop the activities that each one really needs, this requires an intersectoral articulation exercise. Other challenges and solutions include:

ChallengeSolution
Addressing a dispersed population in 19 localitiesImplement in a staggered manner
Population and territories with different characteristicsA reading of realities, so that services arrive in a timely and targeted way
Reach caregivers who are unable to access the blocks and buses of careDefinition of entry criteria and prioritization
Provide simultaneous services in homesServices and actors were organized so as not to saturate households
To have permanent informationA monitoring and follow-up system was developed

Building partnerships: in order to strengthen the Program and its effects, efforts have been focused on (i) generating inter-institutional articulation in the roundtables created for this purpose by the System of Care; (ii) dissemination of the Program through virtual tools and in different communication media; (iii) promoting the participation of academia and the private sector; and (iv) receiving the support of international cooperation agencies such as UNDP and the Global Mayors Challenge.

SDGs addressed: Goal 1 – End poverty in all its forms everywhere; Goal 5 – Achieve gender equality and empower all women and girls; Goal 10 – Reduce inequality within and among countries.

CONCLUSION

In order to implement programs, policies and systems of care, it is necessary to carry out an adequate characterization of the population: Both in the case of Bogota and Geneva, the cities carried out characterization processes that included population surveys and the use of available demographic information.

In the case of Bogota, the System of Care has focused on women, who are the main caregivers. Geneva, on the other hand, has included the elderly, young people and caregivers in general, taking into account that 56% of caregivers are women, that more men are caregivers, and that there are more care services including the offer of the private sector.

  • Importance of coordination and taking into account pre-existing programs in the public, social and private sectors: regarding caring communities, it is increasingly common to find a wide range of services offered by different sectors. However, these services are offered without the organizations or institutions being aware of what the others are doing. The experiences of Geneva and Bogotá highlighted the importance of working in a system logic, building upon what already exists and solving the challenges of coordination with good information systems, spaces for articulation, monitoring and follow-up.
  • The key is to provide services at the most local and territorial level possible: both the care blocks in Bogotá and the Cantons in Geneva are a bid to bring care services and attention to caregivers down to the micro level, facilitating the identification of concrete needs and the provision of quality services, close to homes and reaching caregivers directly.
  • Ensure that the care issue is included in the public agenda, in legislation and in spaces for citizen participation: in order to avoid that progress in the matter is affected or suffers setbacks due to changes in agendas or political will.
  • Making caregivers visible in the caregiving communities: taking into account that most social and care policies have focused on those who need care, these new programs put the caregiving community at the center of the policies, which has allowed their visibility and recognition. 

The time has come for local governments to turn “care” into an opportunity, creating systems that place care at the center, aiming to provide inclusive care and services for those who need them most. These models are becoming a priority for cities seeking to address inequalities, improve people’s lives and create caring communities.