Promoting Gender Justice in Elder Care -
Partners of the project Initiatives to Strengthen Care Policies in Latin America and the Caribbean:
The Brazilian Care Association (Associação Cuidadosa) and the Departments of Social Assistance, and Departments of Health in the cities of Belo Horizonte, Contagem and Salvador, as well as Northumbria University, are working together on the GRADE project (Gender and Redistribution in Ageing and Dependency Environments). This initiative, supported by the IDRC (International Development Research Centre) under the Alliance for Change in the Care Economy program, aims to analyze the gendered impacts of caregiving policies, particularly focusing on Brazil’s Greater Care Program (PMC).
This project has been developed within the framework of the project Initiatives to Strengthen Care Policies in Latin America and the Caribbean, led by the Group for the Analysis of Development (GRADE), in collaboration with the Global Alliance for Care (GAC), the United Nations Research Institute for Social Development (UNRISD), and with funding from the International Development Research Centre (IDRC).
We assessed the potential of an innovative intervention to promote gender justice. Programa Maior Cuidado (PMC) has operated in the city of Belo Horizonte since 2011 and is now being extended to other locations in Brazil, with support from the Ministry of Health and local
governments. PMC supports care-dependent older people living with vulnerable families in poor communities. Health posts and social assistance centres work together to identify eligible families and provide integrated support. Trained paid caregivers provide families 10-20 hours of support a week. Previous research shows PMC benefits older people and reduces unnecessary use of health services. PMC may have significant effects on gender issues, but these have not been systematically assessed.
Most unpaid family carers for older people are female and this activity is becoming a leading cause of gender injustice. We will assess whether PMC reduces the burden experienced by family carers and increases their capacity and confidence to care well. PMC in Belo Horizonte collects operational data on older people’s status and health service use, but does not routinely gather data on family carers or paid carers. Extending PMC to new locations will enable this because we are partnering with local governments to develop enhanced information systems to include carers.
PMC carers represent a new category of professional family care support worker. They are recruited from disadvantaged communities and most, but not all, are female. We will assess whether this new professional category is an extension of the low-status, mainly female paid care work that prevails across LAC, or if it empowers paid carers and (with reference to male carers) challenges gender norms. We assessed this with focus group discussions with paid carers.
Project Goals
- Investigate how the PMC program affects gender equality in caregiving.
- Assess caregiving through the lens of Remuneration, Recognition, Redistribution, and Reduction of unpaid labor.
- Understand the impact of gender norms on caregiving responsibilities.
Programa Maior Cuidado
Since 2011 Programa Maior Cuidado (PMC) has been supporting care-dependent older people living with vulnerable families in poor districts of Belo Horizonte (BH). Health posts and social assistance centres work together to identify eligible families and provide integrated support. Paid caregivers from similar communities are recruited and trained by an NGO, and provide families 10-20 hours of support a week. PMC carers operate as bridges between older people, families and local health and social assistance services. They monitor older people’s condition and report back to monthly case reviews.
Previous research has assessed PMC’s development and operational fidelity, as well as demonstrating its beneficial effects on older people. Quantitative and qualitative analysis demonstrates being in PMC is associated with more effective use of outpatient services and reduced costs for hospital admissions. These findings led the Ministry of Health (MoH) to identify PMC as a programme of national relevance, funding an implementation manual and co-funding (with local governments) new versions of PMC in 3 locations. If positively evaluated, these pilots will feed into a new national policy promoting similar interventions throughout Brazil. Members of the project team are part of Brazil’s Inter-Ministerial Working Group, tasked with developing a comprehensive national care plan.
PMC has important potential effects on gendered aspects of the care economy. The majority of older people enrolled in PMC BH are female. PMC BH does not collect data on the sex of primary family carers, but key informants report they are mainly women (as elsewhere in Brazil and LAC). Studies from Brazil show family carers experience high levels of harmful effects due to this role and receive no support from outside the family. Brazilian public policy on elder care focusses on supporting residential care homes. PMC recognises that the key role played by mainly female unpaid family carers must be supported, valued and acknowledged by state agencies. PMC offers vulnerable families substantial support in performing this role (typically 10 to 20 hours a week). This does not replace family care: the people included in PMC are highly care-dependent, needing round-the-clock support. Instead, PMC seeks to reduce family caregiving to manageable levels, offering family carers respite and an opportunity to meet their own needs. PMC seeks to redistribute care work between unpaid family carers and the state, through paid care support and monthly case reviews. Interviews with PMC BH staff claim it can sometimes redistribute care work within families, fostering collaboration between relatives of both sexes. A qualitative review of PMC BH indicates it enhances family carers’ capacity and confidence to provide good care, as well as training and developing the capacity of the paid PMC carers. PMC remunerates paid carers and appears to offer them a professional status.
Research and Progress
The project is conducting in-depth studies on caregiving gender norms, with initial findings revealing:
✅ Gender biases in paid and unpaid elder care roles.
✅ The role of men in caregiving and potential for greater male involvement.
✅ Socioeconomic challenges faced by caregivers, particularly women.
Research briefs and outputs:
Fieldwork and Collaboration
As part of the project, Cuidadosa researchers visited Colombia to exchange insights on gender and elder care policies.
See Photos from Our Field Visit:
