Challenges to achieve a National Care Policy in Paraguay

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Por Marcela Achinelli.*

Given that the coun­try is in the midst of a change of gov­ern­ment, it is es­sen­tial to take into ac­count some of the chal­lenges that re­main in or­der to achieve a Na­tional Care Pol­icy in Paraguay. In fact, al­ready dur­ing the elec­toral cam­paign, the main can­di­dates for the pres­i­dency echoed care-re­lated is­sues. While San­ti­ago Peña promised “free day care cen­ters”, Efraín Ale­gre claimed “day care cen­ters for all”. It is not by chance that this pro­posal has crossed the dif­fer­ent po­lit­i­cal groups. Within the frame­work of what is called the “care econ­omy”, there is an agenda on so­cial pro­tec­tion in gen­eral and on na­tional care pol­icy in par­tic­u­lar, which must be ur­gently ad­dressed.

The care econ­omy an­a­lyzes both those who de­mand care ser­vices and those who of­fer them, tak­ing into ac­count that the care of de­pen­dents (chil­dren, peo­ple with dis­abil­i­ties and the el­derly) re­quires a so­cial or­ga­ni­za­tion such that the re­spon­si­bil­ity can­not fall ex­clu­sively on fam­i­lies. From this ap­proach, the need for a co-re­spon­si­bil­ity scheme in­volv­ing the State, com­pa­nies, civil so­ci­ety and fam­i­lies is pro­posed.

When speak­ing of co-re­spon­si­bil­ity for care, the aim is to make vis­i­ble the un­fair dis­tri­b­u­tion of re­pro­duc­tive tasks, given that up to now these tasks have fallen on women. Data from the Time Use Sur­vey (2016) show that it is women who spend more time on un­paid work (care and house­work), which rep­re­sented 22.4% of the Paraguayan econ­o­my’s Gross Do­mes­tic Prod­uct that same year. Also, Paraguayan house­holds in ex­tended and sin­gle-par­ent fam­i­lies are mostly headed by women, mak­ing care arrange­ments a fun­da­men­tal de­ci­sion for those who head the house­holds.

The professionalization of care work is one of the first measures to promote the take-off of the National Care Policy. For this, it is important to make it visible that care is directed to our dependent family members and therefore we must value it under a vision of equity and equality, where the responsibility is shared between the State, civil society, companies, and families.

Ini­tially, this prob­lem was ad­dressed by the Coun­cil of Eu­ro­pean Com­mu­ni­ties in 1992. As a re­sult of the de­mo­graphic change tak­ing place in the coun­tries of that re­gion (fewer chil­dren per woman, pop­u­la­tion pyra­mid with many older adults), the im­por­tance of or­ga­niz­ing care was raised. The pro­fes­sion­al­iza­tion of these tasks was seen as the way to achieve their so­cial and then eco­nomic hi­er­ar­chiza­tion, based on de­cent work. This im­plied the pos­si­bil­ity of ac­cess to salaries com­men­su­rate with the ser­vice ren­dered, pen­sion con­tri­bu­tions and health in­sur­ance. An­other ad­vance was the pos­si­bil­ity of adapt­ing fam­ily homes for for­mal ded­i­ca­tion to these ac­tiv­i­ties, with ad­e­quate guar­an­tees and con­di­tions. One ex­am­ple was the Nordic coun­tries that be­gan to train care­givers, who were then given a gov­ern­ment-is­sued care­giver’s li­cense to pro­vide this ser­vice. To these care­givers, gov­ern­ments gave them the pos­si­bil­ity to readapt their homes ac­cord­ing to reg­u­la­tions es­tab­lished for each type of care through soft loans. These steps have been es­sen­tial to gen­er­ate a cul­tural change with re­spect to the val­u­a­tion of the pro­vi­sion of these ser­vices in Eu­ro­pean coun­tries.

In Latin Amer­ica, coun­tries such as Ecuador, Ar­gentina, Chile and Uruguay have im­ple­mented care poli­cies, with the Uruguayan sys­tem be­ing the first to be es­tab­lished as such. This ex­pe­ri­ence helped Paraguay to de­velop its own Na­tional Care Pol­icy, whose law should be dealt with by the gov­ern­ment of San­ti­ago Peña. This pol­icy seeks to es­tab­lish the prin­ci­ple of equal­ity and non-dis­crim­i­na­tion by gen­der in the prac­tice of car­ing for de­pen­dents, im­ple­ment mea­sures to fa­cil­i­tate the rec­on­cil­i­a­tion of paid work and fam­ily, and pro­mote co-re­spon­si­bil­ity for the care of de­pen­dents among the dif­fer­ent strata of so­ci­ety. This pol­icy is also based on the so­ciode­mo­graphic trans­for­ma­tions that bring us face to face with an ac­cel­er­ated ag­ing of the pop­u­la­tion, as well as a chal­leng­ing re­la­tion­ship to ac­com­mo­date be­tween seg­ments of the pop­u­la­tion of work­ing age and those who are still de­pen­dent.

Care poli­cies in­clude a se­ries of mea­sures such as ma­ter­nity, pa­ter­nity and/​or parental leave, care cen­ters at­tached to work, tele­work­ing, flex­i­ble en­try and exit per­mits, home care cen­ters, home and in-home care­givers, homes for the el­derly, adap­ta­tion of space for peo­ple with dis­abil­i­ties, among oth­ers. The doc­u­ment, which refers to the Paraguayan case, pre­sents ad­vances in these terms and raises the pro­fes­sion­al­iza­tion of care-re­lated work as a ma­jor chal­lenge.

In Paraguay there are some ex­pe­ri­ences of pro­fes­sion­al­iza­tion of the care sec­tor, some of them sup­ported by the Min­istry of La­bor, Em­ploy­ment and So­cial Se­cu­rity and the So­cial Se­cu­rity In­sti­tute, such as Corazón de Mamá, Can­guro en Casa, Taita. These pri­vate ini­tia­tives de­velop ser­vices in the care area. Corazón de Mamá, based in Ciu­dad del Este, pro­vides breast­feed­ing con­sult­ing ser­vices, ges­ta­tional pi­lates, phys­io­ther­apy and ki­ne­si­ol­ogy, psy­chol­ogy and psy­chope­d­a­gogy, a school for nan­nies and care­givers, and be­reave­ment groups for par­ents. Can­guro en Casa of­fers, through a plat­form, the ser­vices of spe­cial­ized care­givers in Asun­ción whom the com­pany trains in child­care (babysit­ting). Taita, an ini­tia­tive that is also be­ing de­vel­oped in Asun­ción, is a ser­vice fo­cused on older adults that in­cludes res­i­dence, home phys­io­ther­apy, day care, club for au­tonomous older adults, and home care­givers.

How­ever, these ini­tia­tives are not part of a pub­lic pol­icy but are pri­vate MSME-type en­ter­prises that, al­though they are fo­cused on pro­vid­ing care ser­vices for in­fants and the el­derly, the train­ing com­po­nent is aimed ex­clu­sively at the peo­ple re­cruited for this work.

Much re­mains to be done. The pub­lic of­fer of out-of-home care ser­vices has been lim­ited to ba­sic ed­u­ca­tion and health, fo­cused on early child­hood. Lit­tle or no care ser­vices have been of­fered for in­fants, the el­derly, or peo­ple with dis­abil­i­ties. A com­mu­nity-based so­lu­tion for fam­i­lies is the home care scheme. With this, care would be pro­vided in the same ar­eas where the peo­ple who need it are, as an al­ter­na­tive to con­ven­tional day care cen­ters. The dif­fer­ence is that, for ex­am­ple, a fa­ther or mother who lives in the same neigh­bor­hood as us and has young chil­dren, and is un­able, or un­will­ing to work out­side the home, could be will­ing to care for an ad­di­tional child at home. This would avoid, among other things, mov­ing from one place to an­other with the in­fant which means time and money. But the key point of this ap­proach to care­giv­ing is that it is not done on a fa­vor ba­sis but on a paid ba­sis.

As a first step, the Na­tional Gov­ern­ment could pro­fes­sion­al­ize the care sec­tor and then cre­ate a Na­tional Care Reg­istry that would al­low those who make up the reg­istry to ac­cess soft loans from fi­nan­cial en­ti­ties to ad­just their homes in or­der to pro­vide ser­vices to their com­mu­nity.

In ad­di­tion, a Na­tional Care Reg­istry would en­cour­age those who are usu­ally left out to en­ter the for­mal fi­nan­cial scheme. Over­sight and reg­u­la­tion would be the re­spon­si­bil­ity of pub­lic en­ti­ties such as the Min­istry of La­bor, Em­ploy­ment and So­cial Se­cu­rity, the Min­istry of Chil­dren and Ado­les­cents, the Min­istry of Ur­ban­ism, Hous­ing and Habi­tat, Senadis, among oth­ers, de­pend­ing on the type of care re­quired. The Min­istry of In­for­ma­tion and Com­mu­ni­ca­tion Tech­nolo­gies could also in­ter­vene by cre­at­ing an ap­pli­ca­tion that con­cen­trates the data of care­givers so that they are pub­licly ac­ces­si­ble.

The pro­fes­sion­al­iza­tion of care work is one of the first mea­sures to pro­mote the take-off of the Na­tional Care Pol­icy. For this, it is im­por­tant to make it vis­i­ble that care is di­rected to our de­pen­dent fam­ily mem­bers and there­fore we must value it un­der a vi­sion of eq­uity and equal­ity, where the re­spon­si­bil­ity is shared be­tween the State, civil so­ci­ety, com­pa­nies, and fam­i­lies.

If the new pres­i­dent-elect has real in­ten­tions to im­prove the liv­ing con­di­tions of women and to guar­an­tee the care of chil­dren, he should pri­or­i­tize the im­ple­men­ta­tion of the Na­tional Care Pol­icy.

Cover im­age: Yuki Yshizuka

* Econ­o­mist, Re­searcher in Eco­nom­ics and Gen­der