The COVID-19 pandemic made care work and its value extremely visible. States suddenly had to rely on women to paper over the cracks in economies that had been failing the poor for many years. In their households, women were forced to figure out how to do the work of feeding, cleaning, healing, caring, educating, small-scale farming and much more. And they had to do this despite lockdowns, job losses, their own health problems and modest social grants.
Another way that this work became more visible was through economists’ increasing attempts to calculate its monetary value. Social reproduction is usually not counted in national accounts, because these ‘services’ are not sold on the market. Patriarchal gender structures have led to these forms of labour being historically classified as women’s work. Doing this work quietly, dutifully and for free is part and parcel of what defines “womanhood” in most places.
However, there is nothing natural about treating women as the shock absorbers for the social and ecological crises generated by neoliberalism. It is cruel to ask the hyper-exploited, unpaid working class (that is, women) to do more with less, in order to create the paid working class of the future. Especially as both working classes struggle to survive in economies that normalise precarious work, declining wages, and de-unionisation.
From an economic perspective, women—especially Black women—continue to struggle in South Africa’s post-COVID economy. According to the narrow definition of unemployment, the most recent data shows women have an unemployment rate of 34.6%, compared to 28.8% for men. Amongst Black South Africans, unemployment stands at 35.3%, compared to 8.1% for white South Africans. Even though consumer price inflation (CPI) was 3.5% in January 2026, inflation for food (4.4%) and household and utilities (4.8%) remains above the CPI. Even if inflation is under control “on average”, in practice, the prices of goods and services that people literally need to stay alive has continued to increase.
In the face of this crisis, the Parliamentary Budget Office has indicated that:
Advancing the inclusive growth objectives of the 2024-2029 MTDP necessitates a shift away from fiscal consolidation towards targeted investments in public infrastructure, social services, and industrial initiatives. It also requires prioritising resources towards building the resilience of poor households, townships, and rural economies.
Is this a way out of the crisis in the care economy? Will investing in care jobs improve the material base and political power of women doing care work?
Collectivising care work within patriarchal power dynamics?
In the health sector, the South African government is moving forward with implementing the National Health Insurance (NHI) scheme. One could argue that the NHI offers a positive example of investing in care jobs. It also has the benefit of taking care of work outside of the private household and collectivising it through public sector provision. But in its current version, what are the limitations of how the NHI invests public resources?
First, the frontline care work of health promotion and delivery of primary health care services is done by community health workers (CHWs). Typically, these are women who are poorly paid and don’t have the safety of working from a clinic. The NHI makes no commitment to improving the working conditions of this labour force.
Second, the NHI makes provision for the establishment of technical committees: a Benefits Advisory Committee, a Health Care Benefits Pricing Committee and a Stakeholder Advisory Committee. The legislation emphasises that the first three committees should have relevant “technical expertise” in fields like “rights of patients”, “public health” and “health management”. Though CHWs have deep hands-on experience in all these fields, their practical knowledge and know-how is usually undervalued. It is not classified as “technical” expertise, and so it is unlikely that representatives of this class of care workers would be invited to join these structures.
This is reflective of a broader trend related to care work; the labour involved gets reduced to emotional work guided by a “mother’s touch” or “women’s intuition”. Therefore, this work is usually not seen as embodied knowledge that mainstream scientific experts could learn from to develop evidence-based policy.
Usually, it is technical committees that have the real power in defining the prices, services and minimum standards. But they work at a level of abstraction far removed from patient and frontline worker experiences. This can lead to setting targets that reflect ideals or best practices that are largely disconnected from what can be delivered or measured in the field.
The Stakeholder Advisory Committee includes representatives of “organised labour, civil society organisations, associations of health professionals and providers as well as patient advocacy groups”. However, CHWs and health committees don’t fall easily into any of these categories.
South African legislation allows for the establishment of health committees (sometimes called clinic committees) to ensure community voices contribute to improving governance and service delivery at health facilities. Typically, many community representatives on these committees are women. The committees are statutory bodies but face many challenges, including under-funding, a lack of trust between them and health workers, and being ignored in policy-making processes. Despite their challenges, health committees make valuable contributions to building political power for realising the right to health at the community level. This is especially the case during public health crises like COVID-19, when policy elites realise the important work they do in connecting communities and health systems. But after crises, they are usually again marginalised and ignored by these same elites.
The risk is that more financing gets invested in health care, but the technical and advisory committees that govern how the system works risk reproducing the same old power structures that already exist in society and the health system. As a result, community power and women’s political, practical and intellectual contributions to health get erased in the process. At the same time, their role as a cheap and exploitable labour force that subsidises a failing system gets entrenched.
The crisis in the care sector is about more than economics. It is a structural crisis. Racialised economic exploitation, political and gender oppression can be left intact even when the government spends more money on the care sector and care jobs.
The geopolitics of care
The crisis of care also has an international dimension. The United States’ health funding cuts are likely to result in millions of avoidable deaths in low- and middle-income countries. Fatima Hassan and colleagues have argued that this policy decision could therefore be defined as a public health emergency of international concern (PHEIC). This classification requires the World Health Organisation to “help mobilise collaboration, assistance, and financing across WHO member states” to maintain core health systems capacities. It might also make it easier for governments to issue compulsory licenses for essential medicines, including new long-acting antiretrovirals that could help bring an end to the HIV epidemic.
While this may be a long shot, it helps to shed light on a larger truth. Health and the care economy more broadly are not simply a ‘care’ issue, revolving around who should be helped by the government to improve their quality of life. Health and other so-called ‘care economy issues’ are also geopolitical issues. They are used to decide who to allow to live and who to neglect through decisions that entrench corporatised food systems, reliance on fossil fuels, and public investments in war, conflict and colonial occupations.
International financial institutions like the IMF insist on “restoring fiscal credibility and putting debt on a sustained downward path”, despite the recent health cuts. This prioritises the interests of international capital at the expense of ordinary people’s dignity. It shows that the crisis in the care economy is produced by more powerful states, but also by financial institutions aligned with them. At the national level, the most vulnerable constituencies are targeted. At the global level, the health sovereignty of Global South countries is destabilised, whether through ‘sensible’ policy prescriptions or dismantling development assistance.
Towards feminist economies of life
This can only be countered by building what Donna Andrews has called “feminist economies of life”. We should not frame solutions to the care crisis in terms of technical steps, like making an “investment case” for health or calling for public-private partnerships to serve as a “rescue plan” for our health system. We must be clear about how investments in the care economy affect the structural and political drivers of health equity. Only by addressing inequities in the distribution of money, power and resources, including their gendered and racialised dimensions, can we move towards full recognition of the right to care as a human right and a public good.
Lauren Paremoer is Associate Professor of Political Studies at UCT and a member of the People’s Health Movement.
