HEALTH-LATIN AMERICA:
The Challenge of Paying for Unremunerated Work
Daniela Estrada

SANTIAGO,  (IPS) - María Angélica is a Chilean woman who could not work in her profession as a chef for nearly two years, because she had to look after her mother, who was ill. Including this kind of unpaid women's work in national budgets is one of the big challenges Latin America faces in order to make progress in gender equality.

Experts brought together by the Economic Commission for Latin America and the Caribbean (ECLAC) and the Pan American Health Organisation (PAHO) have been working out methods of doing this at an International Workshop on Household Satellite Accounts: Gender and Health, which ended Tuesday in the Chilean capital.

This is the fourth time that experts from the region on the Systems of National Accounts (SNA) have met to design a way of determining the value of unremunerated work in Satellite Accounts, which would allow the creation of standards applicable in each country.

"The SNA is the statistical system used by every country in the world to calculate the main macroeconomic indicators, such as gross domestic product, per capita income, balance of payments and fiscal deficit, among others," Rubén Suárez of the PAHO told IPS.

María Angélica, 24, remembered how her mother, fighting ovarian cancer, had undergone a number of courses of chemotherapy, which confined her to bed for weeks at a time. This meant that her daughter could not take on a paid job outside the home, which among other things would have helped to pay for the heavy costs of the illness.

The young woman was in charge of dispensing her mother's medications and taking her for medical check-ups, as well as cooking meals for the family and cleaning the house, while her father and brothers worked.

Like María Angélica, many women take daily responsibility for the care of sick relatives with acute or chronic illnesses, and this work is neither valued by society nor paid for by the state.

Regional trends show that health systems encourage patients to convalesce and recover at home, in order to cut down on costs in hospitals.

Chilean President Michelle Bachelet announced on Jun. 2 that a monthly payment of 40 dollars, as well as training courses, would be provided for people who are caring for a bed-ridden relative and who belong to the lowest income families in the country.

The programme, which also provides for home care, will start this month in 10 municipalities. At the end of the year it will be extended to all of the country's primary health care centres, to benefit an estimated 115,000 people.

But in order to widen the coverage of this kind of benefit, the true extent of unpaid women's work in the health sector must be known. One possibility is to include it in the Systems of National Accounts, specifically in the so-called satellite accounts, so that more precise indicators are available for drawing up egalitarian public policies.

"Apart from the SNA, countries also need to develop statistical methods for particular sectors (like tourism, the environment, or health) that can be used to evaluate different types of public policies. These instruments are called satellite accounts," Suárez said.

But to make women's unremunerated healthcare work visible, to recognise and put a proper value on it, also requires carrying out time use surveys, said Ernesto Ottone, the assistant executive secretary of ECLAC and formerly an adviser to ex-president Ricardo Lagos (2000-2006) who stepped down in March.

So far, only nine Latin American countries have measured time use, including Mexico, Nicaragua, Cuba and Bolivia.

According to a report recently published by the Observatory of Gender Equity in Health, led by PAHO -- the regional branch of the World Health Organisation -- women who care for chronically ill patients have workdays that often exceed eight hours.

"Traditional ways of measuring the economy have overlooked many sectors. In order to make progress towards public policies that would eradicate inequality, especially gender inequality, we need instruments to measure those indicators," said Health Minister María Soledad Barría, who acknowledged that the care of the sick has tended to be left up to families.

This has major consequences for women, who are the chief providers of this care. As well as having to give up paid work, their mental health is also affected, she said.

That's why the support plan just launched by the Chilean government "is a good sign, because it is headed in the right direction, although it's not a full solution to the problem," Barría added.

The need to measure contributions for unpaid work from a gender perspective came up at the Fourth World Conference on Women held in Beijing in 1995, which called on national and international institutions to develop methodological proposals and instruments that would shed light on gender inequalities.

"We are talking about highly significant work, which is not only important in economic terms, but also in producing wellbeing and in forming human capital within the home, which often has more impact than what schools can give," the PAHO expert said.

"The countries of the OECD (Organisation for Economic Cooperation and Development, which groups the industrial powers) provide subsidies for families who care for sick people at home," Suárez pointed out.

"The only example of that sort in Latin America is Brazil, which has a programme called 'Going Home' ('Volta a Casa'), that includes a subsidy for families to take care of their senior citizens," he commented.

In his opinion, there are different ways that states could remunerate the unpaid work done by these people, for example by offering them social safety nets, or tax breaks.

Agreeing with this position, Lourdes Ferran, an expert at the Central University of Venezuela, told IPS that a kind of pension for women homemakers on reaching a given age might be considered.

Ferran further said that in any case, "when (national, regional or municipal) budgets are redrawn, unpaid activities in the home that substitute or could substitute for activities of the market, not-for-profit organisations or the government, should be taken into account."

However, she believed that these changes would take place gradually in the countries of the region, since there are so many priorities to consider when calculating budgets.