Without delay, the cost of unpaid care provision is no more than 26 percent of the cost of alternatives. Finally, what worked and did not work in relation to the study is used to inform recommendations for improved future research on unpaid care work in South Africa.
OUTLINE OF TOPIC AREA
Although the subsistence production of goods was recognized as an 'economic' activity, the provision of household and personal services by household members for consumption within the household – such as cooking, cleaning and childcare – was left outside the production boundary. The failure to count household and personal services by household members for household consumption seems all the more problematic in light of the increased time women have to spend on this work, with reduced social spending and the privatization of former social and health services of the state (Chen et al., 2005), which is the case in many countries.
RESEARCH PROBLEM
This meant that many of the costs of providing services had to be picked up by women with their own time, energy and resources (Ogden et al., 2004). The purpose of this research is to reveal the implications of choosing HCBC as opposed to other policy choices and to find, using a gender lens, a credible way to assess the social and economic consequences of this care policy for households, families and women's centre.
STRUCTURE OF THESIS
They also reflect on the process of valuing unpaid care work and the different methodologies used in the study. This chapter focuses on the unpaid care work that women do at home.
WOMEN’S PAID AND UNPAID WORK IN AN ERA OF RETRENCHMENT
Women's role in unpaid care work tends to lead them into similar occupations and sectors of the paid economy, particularly the clothing and textile industry, teaching, childcare, health care and domestic services (Chen et al., 2005). The increasing participation of women in the labor market means that many women face the double burden of market and non-market production (Chen et al., 2005).
THE CONTINUUM OF PAID AND UNPAID HEALTH/CARE WORK
According to Chen et al. 2005), through the lens of the continuum of care provision, the links between formal and informal work, and between paid and unpaid work, and the changing spatial boundaries of care – between the health facility and the home – become more apparent. In South Africa, typically tertiary and secondary health care is paid, while for primary health care there is a cadre of paid workers, often with some help from unpaid workers.
DEFINING CARE WORK AND THE CARE ECONOMY
Third, the notion of complexity refers to the extent to which particular skill is required in providing care. Rather, the love and duty involved in caring are powerful components of care work (Lewis, 2001).
CRITIQUE OF COMMUNITY CARE
Parker (1981) argues that the availability of a community care system and the position of women have been taken for granted. That is, the assumption is that community care is “appropriate for all categories of addiction.
HOUSEHOLD STRUCTURE AND UNEMPLOYMENT IN SOUTH AFRICA
In 2001, eight in ten households were occupied by family groups, indicating that the majority in South Africa live with relatives, while less than one in four households were occupied by non-family members or a single person (Amoateng et al., 2007 , p. .47). The (in)employment regime in South Africa is also quite different from that in many other countries.
PROVISION OF HEALTH AND WELFARE SERVICES IN SOUTH AFRICA
The Department of Health says most conditions affecting adults with HIV infection can be effectively managed at home. There is no policy document similar to that of the Department of Health on the website of the Department of Social Development, so it appears that this department does not have a separate policy for HCBC.
COSTS OF UNPAID CARE PROVISION
The value of caregivers' unpaid labor is often a major component of the total cost of care. To understand more about the costs faced by family carers, this thesis assesses the costs of providing unpaid care undertaken for sick people within the home.
MEASURING UNPAID CARE WORK TIME
- The System of National Accounts
- Methods for measuring time-use
- Accounting for simultaneous activities
- Collecting time-use data
- The South African Time Use Survey and the care economy
Unpaid care work provides something without which the rest of the economy and society would not exist (Budlender et al., 2001). In this thesis, aspects of all three main time use methods are used.
VALUING UNPAID CARE WORK TIME
Approaches to valuing unpaid care work
The opportunity cost method: The normal wages or income from paid work that the person would do if he were employed is taken as the value of the opportunity cost. Furthermore, in an economy with full employment for a working older adult, there is a clear trade-off between wage employment and providing unpaid care work, and here it is appropriate to cost the value of unpaid care work in terms of the wages foregone.
Valuations of unpaid care work in South Africa
For example, unpaid care work is equal to between 19 and 53 percent of the value of paid work, depending on the valuation approach used. It is clear that the value of individual care and unpaid care work is relatively high when considered as a percentage of these other incomes and services.
THE 2004 KWAZULU-NATAL INCOME DYNAMICS STUDY
Ninety percent of the interviews for the 2004 KIDS were conducted between March and July 2004, and data collection officially ended in January 2005. In 2004, as in 1998, the households of the core members of the original household group were identified and interviewed.
THE 2004 KIDS QUALITATIVE STUDY
- Selection of study sites and households
- Field researchers
- Fieldwork
- The issue of dying
Field researchers are trained in the use of structured guides before beginning fieldwork. Quotations or accounts are from researchers in the field. statement account and are usually made in the third person.
THE ‘CARE’ COMPONENT OF THE 2004 KIDS QUALITATIVE STUDY
- Household selection
- Representivity
- Information collected
- The extended case study method
- Tools used to collect study information
- Field researchers’ perspectives on the collection of time-use information
- The researcher’s role
Not all the information obtained with the care structured guide was used in this thesis. This observational information was also used to verify some of the information obtained from main carers and the sick people.
PROFILE OF UNPAID CARE PROVISION IN AFRICAN HOUSEHOLDS USING THE 2004 KIDS.90
Characteristics of cared-for
The data sets on the sick and dying who received care were combined for the analysis of cared for and carers. With regard to the dependent's relationship with the head of the household, table 5.2 shows that over half of the care recipients are the head's son or daughter or son-in-law.
Characteristics of caregivers
The average age of the caregivers was 46 years, with the male caregivers on average being older than the female caregivers. Regarding the relationship of the caregiver to the household head (see Table 5.8), it is surprising that more than a quarter of the caregivers were wives, husbands or partners of the household head.
PROFILE OF THE 2004 KIDS QUALITATIVE STUDY ‘CARE’ HOUSEHOLDS
Care situations
In the Shibe household, the patient's children are cared for by the mother, who is the main caregiver. The return of a sick person did not result in the care of more than one sick adult in these households.
Gendered care provision
While unpaid labor has been valued in the South African context (Budlender, 2008; Budlender & Brathaug, 2002), the specific activities that make up the unpaid care of sick people at home – part of unpaid care work – have not been counted and assessed . Together, wage costs and financial costs of unpaid care work are referred to as the costs of unpaid care.
LIMITATIONS OF THE SAMPLE
COSTS MEASURED AND ‘VALUING’ APPROACHES ADOPTED
METHODOLOGY FOR COUNTING UNPAID CARE WORK TIME
- Tools used
- Daily unpaid care work time per ill person
- Selection of the illness period
- Care activities included
- Approaches used
- Simultaneous time-use
The time spent bathing a sick person in the Yengwa household was given as "45 to 60 minutes". For example, in the Mbongeni household, a sick person was dressed twice a day and undressed 3.5 times a day.
COUNTED UNPAID CARE WORK TIME
Daily time spent on unpaid care work
Across all households, the average daily time spent by non-households on care was 1.2 hours per sick person. The total time that households and non-household members spent caring for a sick person ranged from 3.0 hours per day to 35.4 hours per day.
Operationalising Parker and Lawton
Preparing food/beverage and helping a person eat/drink consumed an average of a fifth of the time. Together, these three types of activities took up more than two-thirds of the total time spent on unpaid care work.
VALUING UNPAID CARE WORK TIME
The average earnings method
Therefore, it may be better to use the wages of the self-employed rather than wage earners when estimating the average earnings approach. Hourly costs of unpaid care work using the average self-employed wage are much lower.
The opportunity cost method
As table 6.8 shows, a further six of the main carers received an old-age pension. A quarter of the main carers in the KIDS study were employed, while around half (nine in total) were employed when they started their caring duties (two of these were pensioners).
The generalist method
Note: household-type work and nursing-type work hours per household may not equal totals calculated elsewhere due to rounding. The overall value of the work of caregivers within study households using this proportional approach – that is, adding the values of domestic work and nursing-type work per day – is
The specialist method
In addition to the work of nursing professionals, the time spent on cleaning is the highest (15 percent of the total time). Likewise, Table 6.16 shows what the value of these different types of work would be if average earnings rates were assigned to time spent in unpaid care work.
Comparing results from the various methods
This is in contrast to Budlender's prediction that the opportunity cost method provides the widest range of estimates. Budlender's recommendation would also have been true for this study if the code for nurse and midwifery professionals had not been used in the specialist method, since the opportunity cost method using educational information produces the 'next' widest range of.
The method and earnings rates most appropriate for the African poor in KwaZulu-Natal
It is only with respect to some of the approaches that the difference between the two earnings rates is large. For example, for female institutional-based personal care workers (using the opportunity cost method using employment information), the median earnings rate is 134 percent of average earnings.
METHODOLOGY FOR COUNTING FINANCIAL COSTS
Tools used
In accordance with the approach described above, the employment costs of the person caring for the grandchild were not taken into account. Moreover, in the Mngadi household, Gladys, the sick person's cousin, traveled from Johannesburg to Urban 2 to care for her cousin.
Financial costs counted
Costs associated with visiting a sick person in hospital (if the sick person has been admitted to hospital). Costs related to the sick person's care, but picked up by someone living outside the household.
Assumptions/approaches used
Similarly, the sick person in the Shibe household ate breadcrumbs, but the amount of breadcrumbs was not known and it was therefore not possible to estimate this cost. If the cost of an item is missing, and it is not stated elsewhere under study.
COUNTED FINANCIAL COSTS
COSTED UNPAID CARE PROVISION
INTRODUCTION
APPROACH TO ESTIMATING COSTS
Capital and start-up costs
Recurrent costs
PRIVATE SECTOR HOME-BASED CARE
PUBLIC HOSPITAL INPATIENT CARE
NGO/FBO/CBO PROVIDED INPATIENT CARE
NGO/FBO/CBO PROVIDED HOME-BASED CARE
SPENDING ON UNPAID CARE PROVISION
FINDINGS FROM THE 2004 KIDS AND THE 2004 KIDS QUALITATIVE STUDY
THE LITERATURE ON GENDER AND THE ECONOMY OF PAID AND UNPAID WORK
THE UNITED KINGDOM’S TYPOLOGY OF CARE ACTIVITIES AS APPLIED TO KWAZULU-
VALUING UNPAID CARE WORK
METHODOLOGIES USED IN THIS STUDY
IMPLICATIONS OF THIS STUDY FOR IMPROVED FUTURE DATA COLLECTION ON UNPAID
RELEVANT SOCIAL POLICY DEVELOPMENTS
SOCIAL POLICY ROLE OF THE STATE WITH REGARD TO CARE
POLICY OPTIONS FOR SOUTH AFRICA
Improve and expand the service of home- and community-based care
Make payment for caregiving
Introduce the basic income grant
Introduce mass-based employment under the expanded public works programme
CONCLUDING REMARKS
