Every Piece Counts: The Importance of Coordination in Integrated Care Systems

When I was a child, I would go to my grandfather's store where he sold and repaired watches. He would give me a magnifying glass and let me help him. Before my eyes would appear springs and tiny jagged pieces that made up the inside of each clock. What I liked most was to see how they moved in time with each other. Like any curious child, I would ask my grandfather which was the piece without which the clock would not work. He would explain that it didn't matter the size or shape of the pieces, they were all important and had to work together so that the clock could fulfill its function: to measure and tell the exact time.

With that lesson I understood the importance of coordination and how each component, no matter how small, is vital to the functioning of an entire system. Integrated care systems not only improve lives; they build more just, equitable and sustainable societies. For that to happen, like the mechanism of a watch, we need to coordinate and connect all its parts.

What are Integrated Care Systems?

An integrated care system can be defined as the set of regulations, institutions and policies designed both to assist and support people who require it, and to recognize, reduce and redistribute the unpaid care work that continues to be performed mainly by women. Care is a basic need for people's daily lives and, at the same time, it enables social and labor force reproduction.

Integrated care systems have the following three main characteristics:

1. They serve all target populations: children and adolescents; elderly people in a situation of dependency; people with disabilities who require care; and caregivers.
2. They move towards the recognition, reduction and redistribution of unpaid care work: mainly performed by mothers, grandmothers and girls. This means that integrated care systems are fundamental for gender equity, as they free up time for women to finish their studies, get training, enter the labor market and have time for leisure and self-care.
3. They ensure that all care providers -public and private- meet quality standards: this requires determining the characteristics that care providers must meet and the results that the services are expected to have on the people receiving care. A quality assurance system not only defines standards, but also monitors compliance and acts in case of non-compliance.

The five components of Integrated Care Systems according to the United Nations are:

1. Care services: These include the creation and expansion of services to meet the care needs of different populations, whether in institutions such as child care centers or in-home or remote services, such as telecare. These may be day or residential and long-stay services. Also, time-for-care policies are included, such as maternity, paternity and caregiving leave.
2. Regulations: This component covers both the regulation of the functioning and quality of public and private care services, as well as the regulation of the working conditions of care workers.
3. Training of caregivers: Comprehensive care systems seek to train care workers in order to improve their working conditions and guarantee the quality of services. An IDB study concludes that there are approximately 9 million paid caregivers in the region, 95% of whom are women. These are workers, often in precarious conditions, without social protection and with low wages, who, in some cases, suffer physical or verbal violence. This component also includes programs for certifying the labor competencies of caregivers.
4. Information and knowledge management: This includes the collection of statistical data, satellite accounts and time use surveys, which make it possible to measure the gap in time dedicated to unpaid care between men and women. Although significant progress has been made, only 16 countries in the region have developed Time Use Surveys and the data yielded by these statistics do not yet allow for comparisons between countries due to the heterogeneous nature of the data sources.
5. Communication to promote cultural change: It is necessary to promote a cultural change that fosters social co-responsibility for care, where the State, the market, the community and families distribute care responsibilities and where, within families, care is shared equitably between men and women.

Financing and Governance of Integrated Care Systems

One of the main challenges in advancing care policies and systems is their sustainable financing. Implementing systems of care that serve more people and with higher quality requires allocating more resources to these policies. Each country must determine how to move gradually toward building comprehensive systems of care in accordance with its priorities and resources.

In general, the countries of the region finance these policies with general revenues, facing challenges such as budgetary restrictions and possible changes in the public agenda in the face of new governments.

If the resources are properly implemented, the economic and social returns can be significant, including increased well-being of individuals, job creation and facilitating women's participation in the labor force. This not only increases household income, but also activates the economy.

A second challenge of comprehensive care systems is the governance model. This must articulate all the efforts and resources of the institutions that provide care services at the national and subnational levels, including coordination with civil society and the private sector.

The chart below summarizes the components and main characteristics of Integrated Care Systems and, at the same time, is the roadmap that guided the discussions at the Regional Policy Dialogue: "Integrated Care Systems: Boosting Well-being, Equity and the Economy in Latin America and the Caribbean". It took place in Antigua, Guatemala, in July 2024, and was organized by the Gender and Diversity Division and the Social Protection and Health Division of the Inter-American Development Bank.

Among the main conclusions of the Regional Policy Dialogue was that the region is making progress in the consolidation of comprehensive care policies and systems. Although the progress and challenges of each country are different, the important thing is to recognize that, in comprehensive care systems, as in the machinery of a watch, all the pieces are relevant. We need them all to work together to achieve the main objective: to improve people's lives.

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