DESK REVIEWS | 03.03.01. Size and structure of the workforce

DESK REVIEW | 03.03.01. Size and structure of the workforce

The main source of LTC in Brazil is provided for by family/unpaid carers; however, the number of people who began providing care for older adults as ‘formal’ or ‘paid carers’ is increasing rapidly. There is no official statistic on the number of unpaid carers in Brazil. According to the Brazilian Annual Report of Social Information (Relação Anual de Informações Sociais), ‘informal care worker’ was the occupation with the largest growth rate between 2007 and 2017 (growing over 500% – from 5,263 to 34,051 registered informal carer workers) in Brazil (Brazilian Ministry of Economy, 2018). This number reflects a growing interest for the profession by Brazilians (mostly women); however, this may also mean a growing tendency of informal care workers being formally recognized as professionals.

Currently, informal care workers are hired as domestic employees and can be paid for hourly (not registered formally, without any pension or labour rights, and without a minimum payment that is set by the government), or by receiving the minimum wage or more (registered officially, with pension and labour rights as a domestic employee would). For domestic employees, everyone working more than three days a week for a family should be formally hired by law. These individuals are ‘hired’ by the family directly through their personal links, or through care agencies, and they provide from supervision through full time care, which is paid for according to the amount of care needs.


Brazilian Ministry of Economy. (2018). RAIS 2018.

An ILO report states that there are no formal long-term care workers in India. Instead, most care work is performed by informal and/or family carers (Scheil-Adlung & Xenia, 2015).

It has been reported that emphasising family responsibility in long-term care, as is the case in India, creates an unequal gender balance of unpaid family care workers. It disproportionately affects female family members who invest effort and time into unpaid care, and also lose income from employment in the process (International Labour Organization (ILO), 2015). There is no specific data available on formal and informal long-term care work in India.


International Labour Organization. (2015). World Social Protection Report: Building economic recovery, inclusive development and social justice. ILO. Available from:—dgreports/—dcomm/documents/publication/wcms_245201.pdf

Scheil-Adlung, & Xenia. (2015). Long-term care protection for older persons : a review of coverage deficits in 46 countries. ILO Working Papers.


We cannot identify the size and structure of the long-term workforce. No data has been reported on LTC workers (Scheil-Adlung, 2015, p.24).


Scheil-Adlung, X. (2015). Long-term care protection for older persons: A review of coverage deficits in 46 countries. In Extension of Social Security (Issue 50).—ed_protect/—soc_sec/documents/publication/wcms_407620.pdf

Kenya has 20.7 doctors and 159.3 nurses (enrolled and nursing officers) per 100,000 which is below the WHO-recommended average of 21.7 doctors and 228 nurses per 100,000 people (Republic of Kenya, 2014a). Other key cadres of staff in public health facilities include public health officers, pharmacists, laboratory technologists, nutritionists, health records officers, trained health workers, social health workers, and community health extension workers (World Health Organization, 2017b). The majority of the Kenyan health workforce work in the private sector with almost 75% of the medical doctors and 66% of nurses and clinical officers (Kenya HealthCare Federation, 2016). Currently, there are a total of 65 Hospices and palliative care providers across Kenya (Kenya Hospices and Palliative Care Association (KEHPCA), 2019). However, there is no literature on how many health care workers are providing LTC services in Kenya.


Kenya Healthcare Federation and Task Force Health Care. (2016). Kenyan Healthcare Sector: Opportunities for the Dutch Life Sciences & Health Sector. Nairobi, Kenya.

Kenya Hospices and Palliative Care Association (KEHPCA). (2019). Hospices.

Republic of Kenya. (2014a). Kenya Health Policy 2014-2030. Nairobi, Kenya.

World Health Organization. (2017b). Primary Health Care Systems (PRIMASYS): Case Study from Kenya, abridged version. Geneva, Switzerland.

In terms of people working in long-term institutions for older adults (under any modality: home care, old people homes/residences, etc.), the Social Assistance Housing Census CAAS survey identified 14,582 people working in the 1,020 long-term care institutions for older adults. Of these, 86% were employed and 14% worked without payment or as volunteers. The majority were women, representing 78% of the paid workers and 63% of the unpaid workers or volunteers.

The CAAS survey also asked about different characteristics of the employment performed and if the staff was certified in different skills/competencies expected by type of activities performed. Based on these specifications, the CAAS reports that 97% of the personnel working in permanent residences for older adults do not have adequate certification of competencies in the area in which they work. Moreover, there are other individuals (mostly paid informal workers) working in services such as day centres, home care aides, domestic workers that form part of the LTC workforce, but there is no data available on their number, their labour conditions, etc.

The main provision of long-term care (LTC) in South Africa is unpaid family care that ‘almost always’ entails the labour of female relatives (Lloyd-Sherlock, 2019a). Others include the State and dependent older persons themselves. Although there are no data to demonstrate the specific size of each of these, research suggests that there are indications that unpaid carers and older persons themselves are largely responsible for the long-term care of older persons in South Africa (Lloyd-Sherlock, 2019a).


Lloyd-Sherlock, P. (2019a). Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS. Journal of Social Policy, 48(1), 147–167.