Quem vai cuidar? Formação de agenda e tomada de decisão na construção do Sistema Integrado de Cuidados do Uruguai.

Abstract

The goal of this thesis is to clearly lay out the agenda building and public policy formulation processes. In that sense I investigated the Uruguayan long term care policy for people in a state of dependence when it comes to perform everyday life activities. That choice was made because Uruguay was the first latin american country to pass a bill of that nature from a contemporary perspective, which assumes that population aging is a new social risk to be incorporated into welfare systems. The investigation allowed for the empirical application of a modified Multiple Streams Framework (MSF), which proved to be a satisfactory approach to explaining public policy change in Uruguay. By applying the process tracing method to the case study, I was able to test and confirm the presence of causal mechanisms of MSF. I reached the conclusion that, diversely from what happened in policy reforms in developed countries, the feminist movement was the main pressure group pushing for the inclusion of a right to long term care in the social welfare network, as well as the design of a provision system based in the co-responsibility of family, state, civil society and the private sector. The long term care deficit, coming from sociodemographic changes that widened the inequity between genders; the presentation of a proposal to create a care system for children from 0-3 years old, disabled people and the elderly, with a gender perspective; the rise and maintenance of a center-left party (Frente Amplio) in power, holding a parliamentary majority; and the action of Red Género y Familia as a feminist entrepreneur civil organization allowed for the rise of this matter to the political agenda and the subsequent passing of Law n. 19.353/2015, which instates the Nacional Integrated Care System.