Making Care the State's Job
From Uruguay, Chile, and Bogotá

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"Making care the state's job" doesn't take a single shape. Some countries build a national system by law; some cities weave a web of care hubs through their streets. Here are three frontrunners — Uruguay, Chile, and Colombia's capital, Bogotá — looked at down to their design and their problems.

Uruguay: the region's first integrated care system

Uruguay lit the fuse. A 2015 law (No. 19,353) created the region's first integrated care system (SNIC). It covers children 0–12, people with disabilities, older people over 64 who need assistance, and those who care for them. Nurseries, day centers for older people — and, notably, a "personal assistants" (asistentes personales) program that gives people with severe dependency the individual assistance to keep living their own lives. That's the design closest to the "support for autonomy" idea above. Care workers' conditions and training are written into the law, with the state, local governments, the private sector, and the community sharing roles. Evaluations, though, have flagged gaps in eligibility lines, funding, and rural coverage.

Chile: care as the fourth pillar

In 2025 Chile passed the "Chile Cuida" law, creating a national system of supports and care (SNAC) — scaling up a "local care and support network" first piloted in municipalities. It spells out the three rights (to receive, to give, and self-care) and places care as the "fourth pillar" of social protection, led by the Ministry of Social Development and Family. Historic — but, as people there keep saying, the law is done; the real wall is implementation and funding.

Bogotá: care blocks woven through the city

Colombia's capital took the angle of the city, not the nation. Its "Manzanas del Cuidado" (care blocks) gather care services within an area about 800 meters across, on the logic of the "15-minute city." At the root of the design is the time-use survey — measuring how much time unpaid care takes from women, and pulling facilities within walking distance to give that time back. Three strands: rest, retraining, and income support for carers; childcare and education for children; and cultural work to break the norm that "care is women's work." By the city's count there were 27 blocks by 2025, with "care buses" for areas without a fixed hub; between 2021 and June 2025 the system delivered over 6.7 million services to more than 911,000 women and their families. Researchers now treat it as a new field: care as urban policy.

What the three designs light up

Uruguay through "a national system," Chile through "a declaration of rights," Bogotá through "city infrastructure." Different routes, the same attempt — to lift unpaid care out of the family's (the woman's) private burden into public work shared by society.

They share homework, too. First, funding and sustainability. Second, the pay and conditions of care workers themselves — lean on them cheaply and you've just shifted the burden onto another vulnerable group. Third, the point from before: whether, for a person with a disability, it becomes "being looked after" or self-directed support for autonomy. As Mexico's proposal was criticized for being weak on disability and elderly rights, a bad design can let autonomy slide backward under the banner of care.

Still, for people with disabilities and older people, whether care moves from "something the family sorts out" to "something society supports" shapes quality of life at the root. Latin America's experiment — successes and failures alike — is a leading case worth watching for any country facing the same question, Japan included.

A national system, a declaration of rights, city infrastructure — different forms, one question: how to share care across society while protecting the autonomy of the cared-for.

This article is the author’s commentary and opinion based on public information. Please confirm the latest details, figures, and procedures with governments and primary sources. Quotation is kept minimal and sources are cited.