Unpaid provision, mainly by women, of early childcare and long-term care (LTC) of frail older people within their families is globally a major driver of gender inequality. The time poverty and negative health impacts associated with unpaid care provision undermine women’s opportunities for economic empowerment. Unpaid care arrangements also often imply poor care of dependent children or older adults.  

Expansion of access to organized care has been shown to free women’s time to engage in training and work and to expand their employment and enterprise opportunities. Organized care thus gives women the potential for economic empowerment and can lead to improved quality of care.  Recognition of the likely benefits of expanded organized care systems for individuals, gender equality and sustainable development, encapsulated in SDG target 5.4, is fueling research, debate and action mainly in the global North, Asia and Latin America. Yet, in sub-Saharan Africa(SSA), the evidence base and policy discourse on organized care and the potential for developing a care economy remain patchy. 

The ”Ghana’s Care Economy” project intends to address this gap with an incisive mixed-method study in Ghana to generate comprehensive evidence on the normative underpinnings, lived experiences and costs of unpaid LTC. It will give us knowledge of present and future demands for organized care; and of the feasibility and viability of novel micro-enterprise models for LTC provision and their cost-effectiveness. In so doing, the project aims to build junior researcher capacity at the highest level of quality. 

The study team combines in-depth expertise in economics, social gerontology, gender and public health, which combined with our prior successful collaboration, we are positioned to deliver the above-mentioned outputs efficiently. Potential impacts of the findings are enhanced by the team’s established relationships with key Ghanaian and African policy players and by Ghana’s role model status within SSA. The timing of the project is in line with the SSA government's current focus on how best to achieve the SDGs and optimize labour market engagement of women and youth to reap a demographic dividend.

• Advanced policy and scientific debate on LTC, unpaid care and women’s empowerment in Africa and movement toward evidence-informed policies and strategies on LTC in Ghana and at the Africa-region level
• Development of LTC systems solutions grounded in and appropriate to Ghanaian social and cultural contexts that lead to:
  • Improved labour market and educational opportunities for unpaid family carers
  • Enhanced opportunities for micro-enterprise participation in care provisioning
  • Enhanced overall health and well-being of care-dependent older people and unpaid family carers.
• Strong local capacity for care economy research with a mix of junior and senior researchers and a strong national and international network

The project has two broad aims; A) to contribute new knowledge that clarifies the case for expanded LTC service provision in Ghana, and test potential promising service models as a vehicle for enhancing women’s well-being, education and labour market opportunities and care quality, and expanding inclusive private sector growth; and B) strengthen local capacity for continued LTC economy research.

Specifically, it seeks to achieve these aims through the following objectives:

1. To assess normative attitudes, values and expectations on what constitutes ‘quality’ LTC and acceptable costs to caregivers’ health or opportunities; and what roles families, State and other actors ought to play in LTC provision
2. To examine unpaid LTC arrangements and determine their effects on caregivers’ subjective well-being, mental and physical health, education and labour market opportunities, and the quality of the care provided
3. To determine existing, and forecast future need, demand and financing options for LTC services, and estimate the impact on unpaid carers’ labour market outcomes
4. To assess the landscape of the existing organized LTC provision and develop a typology of organizational, operational, workforce and financing approaches
5. To determine LTC service clients’, care workers’ and providers’ experiences of care quality, work conditions, LTC service business potentials and the impacts of service access on clients’ subjective well-being and opportunities
6. To develop small-/micro-enterprise LTC service prototypes, test their feasibility and viability and estimate their potential for upscaling

Expected outputs

1. Evidence on normative underpinnings, experiences, quality deficits and costs of unpaid LTC provision, and on current as well as future demand for organized care services
2. Evidence-based micro-enterprise service models for the provision of LTC developed
3. Evidence on feasibility, viability and potential cost-effectiveness of the microenterprise models developed
4. Project results ‘translated’ for use by key stakeholders i.e. study communities, policymakers, civil society, and academia – through meetings, scientific publications and relevant knowledge products.
5. PhD degrees relating to the care economy awarded; postdoctoral researchers trained and pursuing an academic career.

Expected outcomes

1. Strong local capacity for care economy research with a mix of junior and senior researchers and a strong national and international network
2. Advanced policy and scientific debate on LTC, unpaid care and women’s empowerment in Africa and movement toward evidence-informed policies and strategies on LTC in Ghana and at the Africa-region level
3. Development of LTC systems solutions that lead to i) Improved labour market participation and educational attainment of unpaid family carers; ii) Enhanced opportunities for micro-enterprise participation in care provisioning; and iii) Enhanced overall health and well-being of care-dependent elderly and unpaid family carers.

Each of the specific research objectives is addressed using a combination of qualitative and quantitative data and methods of analysis. Thus, community-based primary qualitative and quantitative data has been collected in selected districts within three selected regions located in the northern, central and southern parts of Ghana. In each district, data collection comprised:

1. A series of formative, qualitative studies with purposive samples of LTC dependent older adults, and caregivers of unorganized LTC, relevant kin, community-based key informants, and care workers and proprietors of organized LTC.
2. A survey among LTC-dependent older adults and their unpaid primary LTC caregivers was selected through two-stage random sampling based on Ghana Statistical Survey Enumeration Areas and household listings.
3. A qualitative mapping of existing organized LTC services.