Main challenges to childcare services:

Access and Equity: Access to childcare services remains unequal, especially for children under three years old. Barriers such as geographical distance, cultural preferences and socioeconomic factors may still limit participation, particularly for marginalized and rural communities. Additionally, these services need to adapt to the increasing inflow of migrant children. Expanding childcare services with quality and sustaining that quality over time requires building workforce capacity and a solid institutional architecture. Childcare services for children under three years of age may be combined or complemented with other strategies to promote ECD outcomes, such as parenting programs.

Quality: The effectiveness of childcare services relies on center-based services’ quality, especially process quality—i.e., the quality of the interactions between caregivers/adults and children. High-quality interactions are engaging, warm, frequent, rich in language and responsive to children’s needs. Other factors—known as structural quality—such as group size, content, materials, workforce characteristics and security, contribute to child well-being and safety, but they are not enough to improve child development. Assuring quality requires that services present certain minimum service characteristics, have pre-established quality standards, and, importantly, put in place mechanisms to monitor the implementation of such standards.

Nutrition: Childcare centers are increasingly contributing to reducing hunger and malnutrition by providing at least one meal as part of their services. In such cases it is critical to ensure that the meals provided meet the unique nutritional needs of the different-aged children in their care, that the food is stored and prepared in a way that prevents food-borne illness, and that clean cooking equipment is used to prevent negative health impacts for the children.

Human resources: Investing in the training, professional development and remuneration of childcare providers to improve their skills helps to provide high-quality care and education to young children. Offering in-service and on-going coaching-based training and professional development programs for the workforce on daily planning, effective high-quality interactions, and strategies to support children’s learning is an important step to better process quality.

Institutional governance and coordination: The cross-sector nature of childcare services – they include health, nutrition, sanitation, education, violence prevention and social protection - requires a solid institutional structure to bring together and coordinate actions from different sectors and levels of government. The transition from early childhood care to school-age care requires coordination to ensure both continuity in care services and consistency in pedagogical approaches and standards. Data systems that enable relevant parties to exchange information in a timely manner are crucial for this coordination.

Prior conditions for long-term care:  

A prior condition for the implementation of long-term care systems is the training of human resources. Care workers are the backbone of quality in long-term care services. Care is provided by multidisciplinary teams that include, among others, caregivers, nurse assistants, nurses, occupational therapists, nutritionists, speech therapists and care managers. Training includes technical skills (e.g., how to support changes in posture), relational skills (e.g., how to deal with depression or how to communicate with people with dementia) and self-care skills. Training that aims to increase long-term care quality requires transitioning from a model based on services to a person-based care model.  

A second prior condition is the definition and supervision of quality standards. The quality of care is a priority in care policies. Governments have the responsibility to regulate and supervise quality to protect the quality of life of fragile and vulnerable people who need support (OECD, 2013). However, there is no single definition of quality. In general, quality is associated with safety, efficacy, and patient-centered services. Recently, more modern definitions are being introduced, that emphasize people's experience, quality of life, and maintenance of identity and autonomy. There are different instruments and tools for the promotion and evaluation of quality: regulation, incentives and finally the collection and publication of information (Malley et al. 2015).  

The final prior condition is the definition of a sustainable financing scheme. Long-term care systems are typically funded through social security (as in the Netherland, France or Korea) or general taxation (as in Sweden), or a mix of the two. Private insurance typically covers less than 2% of the costs, except in few countries, and is never the main source of funding. The same holds for co-payments, which are a way to increase sustainability and equity of the system. An important lesson learned from the European experience is that it is key to set the level of benefits taking into account the aging trend of the population. This means that, when the population is aging rapidly, countries must forecast expenditure in the coming decades, and choose the level of coverage and the type of services that will be affordable, let’s say, in 20 or 30 years.

In terms of complementary interventions, it is necessary to ensure coordination between long-term care and healthcare services. This ensures: (i) a slower progression of frailty (and loss of functional abilities); (ii) a more efficient use of healthcare services, and reduces the length and cost of hospitalizations.

Prior conditions for social care services for PwD are broadly consistent with those listed above for long-term care.

Complementary interventions for social services for PwD: Personal assistance and center-based services for PwD form part of a broader network of inclusion policies beyond care policies that work together to promote the autonomy of people with disabilities, and in doing so, can also have important effects on the distribution of caregiving within families. In other words, to achieve maximum impact on both caregivers and PwD, a caregiving system with a disability focus should emphasize the transversality of accessibility and inclusion in the inventory of programs and services provided by government, NGOs, and the private sector. Higher levels of inclusion of PwD with high support needs in schools, training programs, and the workforce results in less need for unpaid care at home and increases in autonomy and independence for PwD.