Policy Pathways towards a National Care Strategy
Care is essential to every economy and society, yet it remains fragmented across policies, institutions and budgets. From childcare and eldercare to healthcare, domestic work and unpaid household labour, care supports families, communities and economies but is often undervalued and unevenly distributed.
The global care crisis has made these gaps increasingly visible. The COVID-19 pandemic exposed weaknesses in care infrastructure and placed additional pressures on households, caregivers and care workers. At the same time, ageing populations, persistent gender inequalities and rising care needs are increasing the demand for care services.
A National Care Strategy (NCS) can provide a framework for responding to these challenges. Rather than treating care as a collection of separate policy issues, an NCS can bring together social protection, labour, infrastructure, economic and social policies under a common framework.
This policy brief sets out the case for a National Care Strategy and draws on the International Labour Organization’s 5Rs framework: recognising, reducing, redistributing, representing and rewarding care work. It also examines experiences from countries including Brazil and Kenya to identify practical pathways for building stronger care systems.
Why do we need a National Care Strategy?
Care policy is often spread across different government departments and policy areas, with no single framework connecting them. Childcare, eldercare, social protection, labour rights, healthcare, infrastructure and other aspects of care may therefore be addressed separately.
This fragmentation makes it difficult to develop a coherent picture of care needs, allocate resources effectively or hold institutions accountable for delivering care-related commitments.
A National Care Strategy can provide the institutional architecture needed to bring these efforts together. It can establish mechanisms for governance, financing, data collection and accountability while embedding care within national economic and social planning.
A comprehensive strategy can also support broader development objectives, including gender equality, job creation, human development and social cohesion.
The 5Rs of care
The International Labour Organization’s 5Rs framework provides a useful foundation for developing a National Care Strategy.
The framework calls for governments and other actors to:
- Recognise unpaid care work and its contribution to households, communities and economies;
- Reduce the amount of unpaid care work through infrastructure, services and other forms of support;
- Redistribute care more fairly between households, the state, the market and communities;
- Represent care workers and strengthen their voice and access to labour protections; and
- Reward paid care work through decent wages, working conditions and recognition of the skills involved.
Together, these principles shift care away from being treated as an individual or private responsibility and towards understanding it as a collective social and economic concern.
Recognising care work
Making care visible is a necessary first step towards developing effective policy.
Unpaid care work includes activities such as childcare, eldercare, household work, collecting water and firewood and other forms of household and community support. Much of this work is not captured in conventional measures of economic activity, despite the time and resources it requires.
Time-use surveys can help governments understand how people spend their time and how unpaid care is distributed across households and between women and men. When combined with labour force, income, expenditure and household surveys, this data can provide a fuller picture of the care economy.
Kenya provides an example of how this evidence can inform policy. Findings from its time-use survey contributed to a care needs assessment that informed the development of its national care policy.
More frequent and lower-cost “light diaries” can also supplement comprehensive time-use surveys by providing more regular information on how people spend their time.
Reducing the burden of unpaid care
Care responsibilities are shaped by the infrastructure and services available to households.
Where households lack reliable access to water, electricity, transport, healthcare, education and childcare, more time is required to meet basic needs. This work disproportionately affects women, girls and rural communities.
Infrastructure investment can therefore reduce the amount of unpaid care work required within households. Evidence cited in the brief includes examples from Rwanda where access to water tanks, early childhood development centres and energy-efficient cooking stoves reduced the time households spent on unpaid care.
Reducing unpaid care is not simply about making household life easier. It can free up time for education, paid employment, rest and participation in community life.
Infrastructure investment should therefore form a central component of a National Care Strategy, alongside investment in care services themselves.
Redistributing care
Care is a social necessity, but much of the responsibility for providing it remains concentrated within households.
A National Care Strategy can help redistribute this responsibility between households, the state, the market and communities. This means moving away from an approach in which families are expected to absorb growing care needs without sufficient public support.
Brazil’s national care policy provides an example of a more integrated approach. It recognises the roles of the state, businesses and the market, communities and organised civil society in providing and supporting care.
A National Care Strategy can similarly establish care as a shared responsibility across government and society, ensuring that different institutions contribute to meeting care needs rather than leaving households to carry the burden alone.
Representing care workers
Care workers are central to the care economy, but many work in conditions characterised by informality, casualisation, low pay and limited labour protections.
Domestic workers are particularly vulnerable. The growth of informal and platform-based work also creates new challenges for ensuring that care workers can access labour rights and representation.
Kenya’s National Care Policy demonstrates one pathway for addressing these gaps. It identifies weaknesses in labour protections for domestic workers and proposes measures including the formal registration of workers, the creation of a database and initiatives to increase access to social security benefits.
Brazil has similarly recognised both people receiving care and those providing care, including paid and unpaid care workers, as important audiences for its national care policy.
Representation is therefore an essential part of building a care system that protects not only those who receive care but also the people who provide it.
Rewarding care work
Paid care work is often undervalued and poorly remunerated despite requiring significant skills and responsibility.
Care work is frequently treated as “women’s work”, contributing to assumptions that it requires little skill and should be poorly paid. Domestic workers and other care workers can consequently experience low wages, insecure employment and limited access to social protection.
A National Care Strategy can help address these inequalities by institutionalising support for paid care workers and establishing decent working conditions across the sector.
Recognising and rewarding care work is also important for building a sustainable care workforce. As demand for care grows, decent jobs and working conditions will be necessary to attract and retain workers in the sector.
The challenge of fragmented policy
One of the biggest obstacles to effective care policy is the absence of a coherent institutional framework.
In countries including South Africa, Mexico and Canada, care remains spread across different sectors and policy frameworks. This can weaken the integration of care into national budgets, development plans and broader economic strategies.
Fragmentation also makes it harder to assess the total cost of care, determine where investment is needed and establish clear accountability for implementation.
Without an overarching strategy, individual departments can develop policies without fully considering how their decisions affect the care economy or the people who provide and receive care.
A National Care Strategy can provide a framework for overcoming this fragmentation and creating greater coherence across government.
Learning from Brazil and Kenya
Brazil and Kenya demonstrate different pathways towards building more integrated care systems.
Brazil’s national care policy uses an intersectoral approach, bringing together almost 20 ministries through an interministerial task team. Its structure includes dedicated groups focused on financing, legislative processes, coordination and the participation of care workers, including domestic workers.
Kenya’s National Care Policy demonstrates the importance of evidence, infrastructure and worker protections. Its time-use data contributed to assessing care needs, while the policy also identifies gaps in labour protections for domestic workers and measures to improve their registration and access to social security.
These experiences show that a National Care Strategy does not need to start from scratch. Existing policies, institutions and data systems can provide the foundations for a more coherent approach.
Care investment can create jobs
Care is not only a social policy issue. Investment in the care economy can also support employment and economic growth.
Expanding healthcare, education, childcare, eldercare and other care services creates jobs while addressing unmet care needs. The brief cites estimates that investment in the care economy could generate 203 million jobs across G20 countries by 2035.
Research cited in the brief also indicates that care investment could contribute to employment growth of 5.5% in Europe and 7.5% in Africa, while helping to narrow gender gaps in employment.
This creates an opportunity to pursue several policy objectives simultaneously: improving access to care, reducing unpaid care burdens, creating decent employment and supporting gender equality.
Building the foundations of a National Care Strategy
A National Care Strategy should provide a coherent framework for action across government and society.
The brief identifies several key building blocks:
- a clear legal and institutional foundation for care;
- inter-ministerial governance and coordination;
- investment in care infrastructure and services;
- development of a skilled and protected care workforce;
- regular collection of data on paid and unpaid care;
- clear monitoring and accountability frameworks; and
- dedicated and sustainable financing for care.
Existing data systems can also provide a starting point. For example, light time-use diaries incorporated into labour force and household surveys can provide more regular information while governments develop the capacity for comprehensive time-use surveys.
A pathway towards a National Care Strategy
A National Care Strategy provides an opportunity to bring together policies that already exist while identifying gaps that remain.
Rather than creating another isolated policy intervention, an NCS can connect labour-market policy, social protection, infrastructure, macroeconomic policy and migration policy through a shared understanding of care.
It can make care visible in national planning and budgets, establish mechanisms for monitoring progress and ensure that the needs of both care recipients and care workers are considered.
The brief calls for governments, particularly across the G20, to use existing policies and institutions as the foundation for a comprehensive strategy that recognises care as essential to national development.
Making care a public good
Care is not a marginal issue affecting only particular groups. Everyone receives care at different points in their lives, while millions of people provide care as paid or unpaid workers.
A National Care Strategy can help move care from the margins of policymaking to the centre of economic and social planning. By recognising, reducing, redistributing, representing and rewarding care work, governments can address gender inequalities, improve working conditions, strengthen care services and support more inclusive economies.
Building a care economy is therefore not only about responding to a crisis. It is an opportunity to create jobs, strengthen public services, support human development and build societies in which care is recognised as a shared responsibility.