Building Care Systems: Lessons from Uruguay and Across Latin America
How do cities build care systems when every context is different? Should they start with childcare, long-term care, existing services, new infrastructure, or community networks?
These questions were at the heart of a recent visit to Uruguay organized by the Global Alliance for Care, of which CHANGE is a member. Bringing together national governments, local authorities, international organizations, and practitioners from across Latin America, the exchange explored how different countries are building care systems.
One message stood out throughout the discussions: There is no single blueprint for building a care system.
Successful approaches build on the institutions, infrastructure, and social movements already present in each territory, while placing caregivers at the centre of policy design.
Building locally on national foundations
Before the regional exchange, CHANGE met with the Municipality of Montevideo to learn about the local care system currently under development.
Montevideo offers a particularly interesting case for cities because it is one of the few examples in Latin America where a national care system came first, creating the conditions for local governments to build complementary strategies rather than starting from scratch.
Fiorella Buzeta, Director of the Gender Equality Advisory Office at the Municipality of Montevideo, explained that the city’s approach builds on more than 35 years of territorial work addressing gender-based violence. Through Comuna Mujer, Montevideo has developed a network of local services that provides support to women experiencing all forms of violence while also promoting economic autonomy and participation through territorial referents embedded across the city.
Rather than creating an entirely new institutional structure, Montevideo is asking how this long-standing presence in communities, together with Uruguay’s National Care System, can become the foundation for a local care system centred on caregivers.
This philosophy is reflected in the city’s first interventions. Public laundromats are being introduced in vulnerable neighbourhoods to reduce the time dedicated to unpaid domestic work while redistributing part of this responsibility with the city itself. Workshops and physical activity programmes for caregivers recognise care work, promote wellbeing, and create spaces where caregivers themselves become visible within public policy.
Importantly, these initiatives are being built on evidence rather than assumptions. Working with CAF – Development Bank of Latin America and the Caribbean, Montevideo first developed an inventory of existing infrastructure, public services, and care resources before conducting a qualitative assessment of local care needs. The municipality is now exploring how care can be embedded within future mobility projects—including intermunicipal transport corridors developed alongside the national government—and is developing public campaigns promoting caring masculinities, including public statues depicting men caring for children throughout the city.
Building a national care system: Uruguay’s experience
Montevideo’s strategy is deeply connected to Uruguay’s National Care System, one of the first comprehensive care systems in Latin America and an important reference for governments across the region, including Bogotá during the development of its own Care System.
Uruguay’s model understands care primarily as support for older adults and people with long-term dependency, focusing its interventions on health and education. While its definition of care does not include domestic work, the system has expanded childcare services, strengthened long-term care for older persons and people with disabilities, and increased support for people requiring ongoing assistance in their daily lives.
Importantly, Uruguay has recognised that expanding care services also requires investing in those who provide them. Alongside services for care receivers, the system offers training and certification pathways for caregivers, contributing to the professionalisation of care work and improving service quality.
This governance model has influenced governments beyond Uruguay. During Bogotá’s own process of developing its Care System, the city looked to Uruguay’s institutional arrangements as an important reference, adapting lessons to a city-scale model based on territorial services and cross-sector coordination.
Beyond corporate social responsibility: engaging the private sector in care
One of the most tangible lessons from the visit came not from a conference room, but from a site visit to Centro Siempre Casa Nazaret, a childcare centre operating within Uruguay’s National Care System.
For cities working on care policies, one question often arises: how can the private sector become a genuine co-responsible actor in care? Too often, private sector engagement is limited to donations, sponsorships, or isolated corporate social responsibility initiatives.
Casa Nazaret offers a different model.
The centre was created through negotiations between Uruguay’s construction workers’ union and the national association of construction companies. Rather than framing childcare as an employee benefit, the initiative explicitly recognises it as part of the co-responsibility of care. The childcare centre is funded by the employers’ association and primarily serves the children of construction workers.
Its design reflects the realities of working families. Children can attend flexibly for up to eight hours, before school, after school, or throughout the day depending on caregivers’ work schedules. Alongside childcare, the centre provides specialised services such as speech therapy, demonstrating that expanding access should also mean providing high-quality care.
For cities seeking to engage employers in care, the model offers an important shift in perspective: rather than asking businesses to contribute through philanthropy, it demonstrates how care can become a shared responsibility embedded in labour agreements and supported through partnerships between employers, workers, and government.
Different countries, different starting points
The regional exchange also highlighted that there is no single way to define or build a care system.
While Uruguay initially prioritised people with long-term dependency, other countries have chosen different entry points. Representatives from Chile shared how their country has adopted a broader understanding of unpaid care, while representatives from Colombia described how they have placed community caregivers at the centre of their approach. Experts from Brazil similarly emphasised the importance of existing community care networks.
These experiences demonstrate that care systems can be gradual and contextual. Rather than attempting to solve every dimension of care simultaneously, countries are identifying the populations and challenges that are most urgent in their contexts and expanding from there. Across several countries, women’s movements have played a critical role in keeping care on the political agenda, while in some countries courts have formally recognised the right to care and to be cared for, providing an important legal foundation for public action.
Another recurring idea throughout the exchange was that caregivers should not simply be viewed as beneficiaries of public services, but as active participants in building caring societies. Care systems are strongest when they recognise caregivers as partners in shaping policy, rather than simply recipients of support.
Care systems need care workers
Another strong message throughout the exchange was that expanding care services cannot come at the expense of the women who provide them.
Presentations from the International Labour Organization highlighted persistent gaps in childcare across Latin America, alongside even larger shortages in long-term care services. Participants also stressed the often overlooked realities of paid care workers and community caregivers, whose working conditions remain precarious despite being essential to the functioning of care systems.
The discussions reinforced that care policy is also labour policy. Expanding access to care must go hand in hand with creating decent jobs, recognising the rights of paid care workers, and making visible the contribution of community caregivers. Otherwise, care systems risk relying on the precarious work of women to sustain public services.
From isolated initiatives to integrated systems
A recurring question raised by participating local governments—including Mexico City—was how to move from individual programmes to integrated care systems.
Connecting care with mobility, employment, health, housing, public space, and social protection enables cities to move beyond isolated interventions towards coordinated systems that recognise care as a cross-cutting urban issue.
Some places begin with childcare, others with long-term care, community organisations, gender-based violence services, mobility planning, or existing public infrastructure. The pathways vary because the problems—and the opportunities—vary too. Some governments may prioritise to ageing populations, others to limited childcare coverage or insufficient infrastructure. Some can build on strong community networks or women’s movements, while others leverage existing territorial services or legislative leadership.
What unites these experiences is not a single model, but a shared commitment to recognising caregivers as part of the solution and placing care at the centre of public policy.
For cities beginning this journey, perhaps the most valuable lesson from Uruguay and across Latin America is that care systems are not built by replicating a blueprint. They are built by identifying the strengths already present in a territory, responding to its most pressing care challenges, and gradually connecting these efforts into a coordinated system that places care—and caregivers—at the heart of urban policy.
Looking for practical guidance?
During the exchange, participants shared a resource developed by the Consejo de Nuevo León for local governments interested in designing or strengthening care policies. The kit offers practical tools and recommendations that can support cities at different stages of developing care policies and systems.
about the author:
Eloisa Cardona
Project Manager, CHANGE
Eloisa is a project manager for the City Hub and Network for Gender Equity (CHANGE), and has been since 2024. Previously, she worked at Bogotá’s Secretariat for Women’s Affairs, where she contributed to the city’s Care System and broader equity policies, including efforts to address gender-based violence and expand opportunities for women. Eloisa has also consulted for UN Women Colombia, supporting the use of gender-sensitive budgeting and planning tools for local governments across the country.
Eloisa holds a degree in International Relations and a MSc in Development Management from the London School of Economics.
Tags: Care, Care Blocks
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