At the upcoming International Labour Conference (ILC) there will be a General Discussion on Decent Work and the Care Economy. The outcomes of the General Discussion can be used as a basis for developing future international labour conventions and recommendations that member states can adopt and implement into national labour laws. In 2022 PSI responded to the ILO’s General Survey the outcomes of which resulted in the upcoming General Discussion. 

The Discussion will be based on the following documents: Decent work and the care economy | International Labour Organization (ilo.org), General discussion on decent work and the care economy: Points for discussion | International Labour Organization (ilo.org). This briefing contains PSI’s position on the issues which will be raised in the upcoming General Discussion. 

The ILO recognizes the critical role of care in promoting social development, gender equality, and inclusive growth. The care sector encompasses various forms of unpaid and paid care work, including child care, elderly care, and care for persons with disabilities. Relevant Conventions include the Convention on Domestic Workers (C189), and the Nursing Personnel Convention (C149). 

Despite the ILO's efforts, several challenges persist in promoting decent work in care: 

• Inadequate recognition and valuation of care work: the care sector’s contributions to social development and economic productivity often go unnoticed, resulting in undervaluation and insufficient investment in care services.

• Informal and precarious nature of care work: A significant proportion of care work remains informal, leaving workers without legal protections, social security, and access to essential benefits.

• Gender inequality: Care is heavily gendered, with women disproportionately shouldering care responsibilities. This gender disparity perpetuates discrimination and hampers women's economic empowerment. 

PSI Priorities for the ILC General Discussion

PSI's position

From frontline healthcare work to providing direct care in the home; it is evident that job insecurity, excessive workloads, unsafe conditions, and psychological distress are commonplace for too many care workers. These conditions are endemic across the sector and not confined to any one workplace, role, municipality or even country.     

Globally there is a shortage of care workers to meet growing demand. PSI has highlighted the need for adequate recruitment, training, and retention strategies to address this challenge. Calling on governments and employers to invest in workforce development, provide fair wages and social security, and create supportive working environments to attract and retain skilled professionals. We support formal and informal care workers in their fight for their progressive, worker-led formalisation and for recognition as public service workers.   

Our affiliates have shared their members' experience with the severe staffing shortages, the crisis in recruitment and retention, exploitative and unsafe conditions and low pay which is endemic across private, public and not-for-profit care services.

Key documents

• Decent Work and Quality Long-term Care Systems (Full Report)

• Long-Term Care Reforms Guide for Unions

• The Social Organisation of Care: A Global Snapshot

Recommendations

The ILO report’s recommendations do not go far enough to tackle the severe decent work deficits for care workers and how care is effectively outsourced by wealthy countries experiencing staffing shortages through migrant workers whose rights and benefits are restricted by the state. Therefore, we will be advocating for stronger references to collective bargaining, social dialogue and freedom of association in the outcomes. 

PSI is aligned with other Global Unions in ensuring strong recommendations for decent work for all care workers. 

• PSI will advocate for tripartite commitments on improving wages and conditions, addressing staffing shortages, and non-discrimination in recruitment including fair and ethical recruitment of migrant workers, access to training and promotion opportunities, formalisation, freedom of association and respect for collective bargaining.

• Decent work for all care workers: Ensure decent adequate wages and improvement in working conditions, including equal pay for work of equal value, training opportunities and occupational health and safety for workers in all care sub-sectors: health, care and education, including home care and domestic work for formal and informal workers.

• Strengthening freedom of association and collective bargaining rights of care workers promoting effective participation in social dialogue processes.

• Safe staffing: the ILO to develop a concrete plan of action identifying certain priority measures to be taken in light of the discussion, including addressing the causes and assessing the impacts of the global nursing shortage on the working conditions of nursing personnel and the quality of nursing care provided. The ILO should examine the measures necessary to ensure adequate training quality education, training and lifelong learning for nursing personnel, including training on the use of digital devices and new technology, to facilitate access to quality health services. The ILO has an important role to play in this context; moreover, these efforts should be undertaken in collaboration with the WHO.

• We support recommendations on establishing a specific EPIC pilot programme of equal pay for work of equal value in countries of the Global North and Global South, in the public and private sectors, including migrant care workers.

• We support gender-transformative and rights-based labour migration policies that promote decent work, social protection and non-discriminatory access to public services for all migrant care workers. International recruitment of health and care workers must be in line with the UN Guidance on Bilateral Labour Migration Agreements, ILO Fair Recruitment Guidelines and the WHO Code of Practice on the Ethical Recruitment of Health Personnel. 

• We support recommendations on skills development, professionalisation and formalisation for care workers which is important in tackling the recruitment and retention crisis.

• We support recommendations for ratification and effective implementation of international labour standards implantation of international labour standards relevant to care, including examining their effectiveness and relevance however, we need further examination of their relevance to the situation facing care workers in the current climate, with the view to strengthening these standards.

Financing of Care

PSI’s Position

The state has a responsibility to provide quality and affordable care services and ensure taxpayers’ money is spent on quality public services. However, in many countries, the state has abandoned their role of providing services and instead relies on religious or not-for-profit institutions to step in and provide care. Private care providers ultimately value profit over workers and service users. These providers have become embedded into systems of care in many countries and as investors and hedge funds continue to promote the so-called ‘silver economy’ many more are looking to expand into the sector. 

The evidence is clear that the private provision of care services does not necessarily result in high-quality services. In reality, there have been numerous examples such as ORPEA in France, HC-1 in the UK and Regis Healthcare in Australia- where maximising profits is prioritised over workers who are forced into caring for more patients with less time and resources. PSI works closely with the Centre for International Corporate Tax Accountability and Research (CICTAR) to expose the tax dodging, profit extraction and unethical practices of private actors within the care sector. 

PSI has exposed the risks of privatization and the negative impact of outsourcing of care services on the workforce. It is clear from our affiliates that privatization often leads to cost-cutting measures, job insecurity, and reduced quality of care. PSI advocates for the protection of public services and the rights of workers in the face of privatization and outsourcing. 

Key Documents

• Care Givers and Takers - How finance extracts wealth from the care sector

• Ten Tricks: a short handbook of financial engineering

• The Crisis in Long Term Care - Effects of Private Provision

Recommendations 

PSI welcomes references to care as a public good and the state’s responsibility to ensure good quality care. Still, we are concerned that the full nature of the financialisation of care and its negative impact on workers and service users is not examined. As the ILO report states public investments in care are at the core of sustainable development efforts and to overcome inequity in provision. However, our affiliates would welcome more language on the public provision of care services. References to domestic and international private finance and international development cooperation are concerning given how destructive the expansion of private finance has been for care workers represented by our affiliates. They have been on the frontline of the fight for public care systems and against the financialisation of care and have seen firsthand how their members have been left with worse pay and conditions. 

• We must reclaim the public nature of care services and restore the duty and the primary responsibility of the State to provide public care services and develop care systems that transform gender relations and women's lives. We want to secure wording on the State as the main regulator and the primary provider of care services and references to financing/funding of care by reviewing financing mechanisms, public management and public expenditure in the care economy.

• No reference to Public-private partnerships in the general discussion outcomes.

• ILO to hold a Tripartite meeting on care as a public good, the right to care, the State’s main role in regulating care, public investment for public provision and public management and how funding and provision impact workers and service users.

The Care Economy

PSI’s Position

The current positioning of the care economy is insufficient as the only category of analysis and political intervention to transform women's lives. Moreover, a purely economic analysis has opened the door to market forces and led to the commodification of care as an economic good for profit rather than for the common good, with all the impacts this has on both labour and universal access to care for the community.

Therefore, we propose a characterisation of the care economy as being the same as that of the formal and informal economy.  To limit it exclusively to aspects concerning the modality, sectors, sub-sectors, conditions, skills, professional work requirements, as well as the economic value of the work.  We propose to place the care economy in the exclusive sphere of care work and to separate from it all aspects of the market that have led to the development of other market concepts such as the purple economy or the silver economy.

Key Documents

• The Human Right to Care - PSI - The global union federation of workers in public services.

Recommendations 

From the point of view of the social organisation of care, the care economy should be situated in the working arrangements of care actors, i.e. in decent work for care workers on side and universal access to care for care recipients and their families.

In this sense, it is fundamental to fully recover the four pillars of the ILO's decent work agenda, to start the discussion with it as a baseline:

• Full employment, which includes formalisation and professionalisation.

• Social protection, which includes access to health, safety, and protection against violence and harassment.

• Rights at work, including unionisation, collective bargaining, and working conditions including OSH, such as non-discrimination and equal pay for work of equal value.

• Social dialogue, including women's and migrant and ethnic workers' representation and participation in line with labour force participation rates.

Quality Care Systems

PSI’s Position 

Working with our affiliates PSI campaigns for governments to invest in universal, quality public health and care – including mental health, childcare, early childhood education, elderly care and other social care services - to ensure the creation of millions of jobs with decent work which includes fair wages, and humane working conditions; and to close gender gaps in labour force participation. We promote more sustainable and equitable ways of financing care systems through the reform of global tax and debt architecture and moving away from a reliance on expensive and unequal private provision. We promote the public provision of care and building gender-transformative public care systems with decent work and the recognition of the human right to care at its core. 

PSI emphasizes the importance of maintaining high standards of care in health and care services. Care workers need for proper funding for services, safe staffing levels, workload management, and ongoing professional development opportunities to ensure the provision of quality services. 

Key Documents

• Decent Work and Quality Long-term Care Systems (Full Report)

• Care Manifesto: Rebuilding the social organisation of care

Recommendations

Care just like health is not a commodity and we should promote universal access to care just like the WHO does in promoting universal access to healthcare. The current conceptualisation of care presented in the ILO report fails to recognise the co-dependency between health and care systems. Health problems that could be prevented by investing in a quality care system are instead shifted to the health system once they become acute. Poor access to long-term care services can cause backlogs and increase pressure on already overstretched health services. 

Care leave policies

PSI’s Position

PSI welcomes the fact that the report links care leaves with care services, however, it would have been important to give further development to this element following the conclusions around the General Report "Advancing gender equality at work" of the 2023 ILC, on the responsibilities of employers and governments to provide care services for workers within the workplace or in cooperation with the public care system. 

Key Documents

• ILC 111 Conference paper: Achieving gender equality at work.

• ILC 111 Draft - Adoption of the outcome of the discussion of the General Survey

Recommendations

The ILO report clearly shows that the major development of care leave is based on parental leave (mostly maternal leave but the level of paternity leave is increasing globally). The report fails to acknowledge other types of familial leave which would be beneficial such as those who need to take care-related leave for themselves or other family members (such as older parents). This type of leave remains very limited or non-existent in many countries.  

• We support recommendations on developing comprehensive ratification and implementation of C156, advancing the notion of care leaves.

• The ILO to provide technical support and guidance on the application of C183 to all women workers, including the progressive movement from direct employers’ liability mechanisms towards social security schemes through which maternity benefits are financed, as well as technical support and guidance on the inclusion of care credits in social security.

• Action should be taken to strengthen the capacity of the tripartite constituents to engage in social dialogue and collective bargaining around issues related to balancing work and family/caring responsibilities.

• The ILO should examine existing gaps within the body of international labour standards on the provision of all other care-related leave entitlements, such as leave to care for elderly or disabled family members, with a view to determine whether normative or non-normative action would be necessary to address the gaps

Community Health Workers

PSI’s Position 

PSI is the only Global Union Federation representing CHWs across regions. We are disappointed not to see clear recommendations for CHWs in the report. Our affiliates are fighting for formal recognition of CHWs as workers, not volunteers, decent pay and regular remuneration, and access to social security, including healthcare and pensions, adequate training, equipment, protection against occupational safety and health and infrastructure support. 

Our CHW affiliates encourage Member States to systematically include CHWs in national care policies, strategies, and social dialogue mechanisms, and allocate adequate public funding for CHW programmes as part of investments in care systems. 

Key Documents

• Community Health Workers in South Asia launch a new Charter of Demands

Recommendations

•  Formally recognise CHWs as part of the care workforce within the scope of relevant ILO Conventions, such as the Nursing Personnel Convention, 1977 (No. 149), or through other standard-setting procedures.
  The Committee considers that it may be useful for the Office to undertake studies regarding the situation of these categories of workers that, while they are undoubtedly covered by the fundamental rights and principles at work, may not always be afforded the protections envisaged under Conventions Nos 149 or 189, to determine the measures that might be feasible to afford them access to decent work.

• Reiterate and expand on the CEACR recommendation for the ILO to undertake further work on CHWS:

Nurses

 PSI’s Position 

Nurses are a vital component of the care workforce and our nursing affiliates responded to the ILO’s General Survey in 2021 on Decent Work for care economy workers in a changing economy. The survey reviewed – among other instruments –the Nursing Personnel Convention, 1977 (No.149) and the Nursing Personnel Recommendation, 1977 (No. 157) covering all forms of nursing and care work including formal institutional nursing, aged and disability care, home care and community care services. The General Survey provided an opportunity for affiliates to highlight the barriers nurses and other health workers face in securing decent work and trade union rights and the threats posed by inadequate funding of public health services, privatisation, outsourcing and austerity. 

Key Documents

• Nurses Manifesto - No Going Back!

• PSI Response to ILO General Survey on Decent Work for Care Economy Workers

Recommendations 

For the ILO to secure a tripartite agreement to implement the 2022 outcome of the CAS Discussion on Nursing Personnel which recommends the following: 

• The committee recognised the urgent need to develop and implement, in consultation with nursing personnel and the social partners, comprehensive, long-term and proactive national policies on nursing personnel and nursing services, to promote further improvement of their working conditions. Governments should address, in consultation with the social partners, representatives of nursing personnel and other key stakeholders, workforce planning, qualifications, education and training needed for nursing personnel, both now and, in the future, to ensure that there are the right numbers of nursing personnel in the right places, with the right skills to deliver quality nursing services and ensure the health and well-being of the population.

• The Committee recognized the urgency of addressing the nursing shortages faced by a majority of countries by increasing investment in national health care systems and the nursing workforce and further improving the working conditions of nursing personnel to attract and retain them to the profession. With respect to the impact of migration flows on health systems, members of the Committee from countries of destination recognised the need to take measures to ensure that they reduce overreliance on migrant nursing personnel, while members from countries of origin recognized the need to take measures to improve working conditions for their national nursing personnel to better enable them to attract and retain a qualified nursing workforce.

Background

Public Services International (PSI) is the Global Union Federation at the forefront of the fight for decent work for all care workers and better quality care systems. We represent affiliates globally that organise care workers, campaign for better workplaces and advocate for fundamental reforms to care systems. Our affiliates promote the public provision of care and build gender-transformative public care systems with decent work and the recognition of the human right to care at its core.   

PSI has successfully expanded our work within care to respond to the growing crisis facing workers and service users. As a GUF, PSI is one of the largest representative bodies of care workers. PSI is advocating for a radical new approach to care and highlighting the need to urgently rethink care in our society, to integrate transforming gender roles in the organisation of quality, universal and public care service systems, while also denouncing and opposing the sector's privatisation, commodification and financialisation.  

As care needs continue to grow we must ensure that people have access to affordable publicly provided care services where workers are paid properly and treated with respect.   

The feminisation of care takes place both through unpaid work at the household level, and in paid care work, provided by people hired by other households, or in public or private care services. We must reclaim the public nature of care services and restore the duty and the primary responsibility of the State to provide public care services and develop care systems that transform gender relations and women's lives.

PSI is dedicated to supporting our affiliates to organise and campaign for quality public systems of care that respect workers and service users. Our manifesto for care calls for a global movement to rebuild the social organisation of care based on our five ‘R’ framework.

Fixing the care crisis requires a shift away from notions of a ‘care economy’ towards the social organisation of care.

PSI has produced training materials (advocacy guide and workbook) on rebuilding the social organisation of care for our affiliates.

How PSI defines care 

With our affiliates, we have developed a working definition of care based on the type of work performed by workers our affiliates represent, beyond the artificial formal-informal separations given much of care work exists within the margins. These roles can be delivered formally or through informal forms of work. As a union, we do not distinguish between the worker's employment status, but rather the tasks they perform. 

These are: 

• Childcare

• Elderly and disability care (in both residential and home-based settings)

• Nursing services

• Social services

• Community health services

• Domiciliary care, transport and leisure services