Care work is in crisis because workers are denied their rights

Christy Hoffman is the General Secretary of UNI Global Union, a global trade union federation representing 20 million workers in over 150 countries in the service economy.

This year’s International Labour Conference in Geneva is turning its attention to one of the most urgent and overlooked challenges in the world of work: the persistence of informality – work that is unregulated, unprotected and insecure.

As part of the general discussion on promoting transitions to formal work, governments, employers and unions are confronting the reality that millions of informal workers remain trapped in jobs without adequate pay or access to social protections - despite contributing to vital services.

Few sectors illustrate this crisis more clearly than care.

Around the world, home-based care and community health work are some of the fastest-growing parts of the informal economy - even when publicly funded.

These workers are on the frontlines of health and dignity. They care for the elderly, support people with disabilities, deliver babies, distribute vaccines, and provide critical health information. They are overwhelmingly women.

And in too many countries, they are still considered volunteers - expected to shoulder responsibility without rights, wages or recognition.

UNI Global Union has just released a report that confronts this injustice head-on.

It offers a sweeping indictment of the status quo - and a compelling blueprint for reform.

Based on survey responses from more than 8,700 care workers across eight countries, along with firsthand testimonies from Brazil, Nepal, Pakistan, Colombia and the United States, the message is clear: we cannot fix the global care crisis without fixing care jobs.

Infrastructure works

In Nepal, every single community health worker surveyed said they worked without a salary.

In the Philippines, Barangay Health Workers, the community-based health workers who provide frontline health services at the local level, earn as little as $2 a month. These are the same workers who reduce maternal and child mortality, manage disease outbreaks, and sustain public health in the most underserved communities.

In Colombia, caregivers supporting relatives with disabilities or chronic conditions often receive no pay at all.

“We want the right to a pension, to health care, and to care for ourselves as caregivers - which we do not have,” said María Elisa Alfaro of the Red de Trabajadoras de Cuidados, a national network of paid and unpaid caregivers in Colombia increasing the visibility of care work.

These conditions aren’t just unjust - they’re unsustainable.

At the same time, our report shows what’s possible when workers organise and when governments lead with vision.

In Brazil, community health workers - once excluded from labour protections - are now full-time public employees with pensions, hazard pay, and guaranteed training, thanks to decades of persistent union organising.

In Washington State in the United States, home care workers transformed an informal, fragmented, low-paid workforce into one of the best-supported in the country. Today, they benefit from collective bargaining rights, paid leave, and the highest training standards in the country.

This isn’t charity. It’s infrastructure. And it works.

Governments can make this shift. And they must.

Our report outlines key actions to accelerate formalisation and improve the lives of both workers and those they care for:

Work with unions to transition care workers in existing care systems to fully formalised employment with access to training and professionalisation

Transition workers paid through cash payments to families needing care and support, to formal employment where families maintain the right to choose their caregiver

Recognise unpaid family caregivers as part of the care workforce and ensure that new national care systems have formalisation embedded in them

Invest in training, certification and professional pathways that uphold care quality and worker dignity.

And, most critically, support worker organisation. Every example of real progress - from Sri Lanka to India to Colombia - has been driven by union action.

We are approaching a tipping point. The World Health Organization estimates a shortfall of 11 million health workers by 2030.

We face rising demand for long-term and community-based care as our populations age and inequalities deepen. And yet, too many governments continue to rely on the unpaid or underpaid labour of women to hold their systems together.

At the International Labour Organization this year, informality in care is finally on the agenda. That is progress. But statements and resolutions are not enough. We need enforceable standards, resources, and above all, political courage.

We also need to rewrite the narrative. Care work is not charity. It is not informal. It is work. And workers deserve the same rights and respect as anyone else.

Because here’s the truth: there is no path to universal care coverage, gender equality or economic justice that doesn’t go straight through the front doors of the homes where care work happens every day - largely invisibly and overwhelmingly unpaid.

It’s time to open those doors. And once opened, we must never look away again.