For many Colombian families, “the care system” has historically been less a visible public system than a network assembled around everyday necessity. A daughter reduces her working hours to support an ageing parent. A grandmother provides childcare while other adults work. A family supports a relative with disability at home. Community organizations fill gaps that formal services do not reach. Health services intervene when clinical needs arise, while social programs, territorial authorities and households address different parts of the person's wider life.
Colombia is now attempting something more ambitious: to make care itself a coherent field of public policy. The emerging Sistema Nacional de Cuidado, or National Care System, is intended to connect responsibilities that have traditionally been distributed unequally across families, women, communities and separate public institutions. Within the Colombia Aging, Long-Term Care & Community Support Knowledge Hub, this development is particularly important because it could reshape how an ageing population accesses assistance while also changing how Colombia recognizes and supports the people who provide care.
The transition is not complete. The Política Nacional de Cuidado, approved through CONPES 4143 in February 2025, establishes a policy horizon to 2034 and 133 actions across national government. During 2026, work has continued on the governance model for the Sistema Nacional de Cuidado, while a bill introduced in the Cámara de Representantes in July 2026 proposes statutory recognition of the right to care and formal creation and organization of the system. That bill is a legislative proposal, not enacted law. The distinction matters. Colombia has a national care policy and active system-building program, but parts of the permanent legal and governance architecture remain under development.
Colombia is redefining what counts as care policy
The significance of the National Care System lies partly in its breadth. It is not designed solely as an older-person service, disability program or mechanism for childcare. The policy starts from a broader proposition: care is essential to sustaining life, and the way a society distributes responsibility for providing it has consequences for rights, gender equality, economic participation and social wellbeing.
CONPES 4143 describes an inequitable social organization of care in which responsibilities have fallen disproportionately on women and families. Its objective is to advance, by 2034, the transformation of that organization so that the rights of people providing care and people requiring care, assistance or support can be realized more effectively. It also recognizes collective and community care and care practices belonging to ethnic peoples and campesino communities.
This makes the policy structurally different from a conventional long-term care reform. Older people are important beneficiaries, but they form part of a wider population requiring care or support. The architecture also includes paid and unpaid caregivers and recognizes care relationships rather than treating only the recipient as the subject of policy.
The policy is organized around four connected objectives:
- strengthening collective, community, campesino and ethnic care practices;
- improving recognition and effective enjoyment of the rights of caregivers;
- changing cultural factors that reproduce unequal responsibility for care; and
- strengthening state capacity to respond to demand for care, assistance and support and enable the National Care System to function effectively.
That final objective is particularly important operationally. Rights and recognition create direction, but a functioning care system also requires institutions, workforce, financing, information, referral routes, territorial capacity and clear responsibility for implementation.
From familism toward co-responsibility
Colombia is not seeking to remove families from care. Nor would such an objective be realistic or necessarily desirable. Families provide relationships, knowledge, emotional support and continuity that formal services cannot simply reproduce.
The policy challenge is different: family involvement should not mean that the state and wider society can assume unlimited unpaid care will always be available.
CONPES 4143 explicitly frames the desired transition as movement away from a patriarchal, familist and unequal organization of care toward greater social, collective and community co-responsibility. In practice, that changes the question from “Which relative will provide the care?” to “What combination of personal, family, community, public and formal support can meet this person's needs while protecting the rights and wellbeing of everyone involved?”
This connects directly with the wider challenge of family care and care burden. A family may want to remain deeply involved while still needing respite, training, income protection, flexible employment, accessible services or practical assistance. Recognizing those needs does not weaken family care. It can make it more sustainable.
For older people, this shift could become increasingly important as household structures and labor-market participation change. Demographic ageing increases the number of people likely to experience functional limitations at the same time as families cannot necessarily supply unlimited additional hours of unpaid support.
The National Care System is broader than a new service program
A common mistake would be to imagine the Sistema Nacional de Cuidado as a new provider network sitting alongside Colombia's health and social programs. Its purpose is more systemic.
Care already exists across numerous institutions and settings. The challenge is to coordinate and strengthen what is dispersed, address gaps and make responsibilities more visible. National ministries and agencies hold different policy levers. Territorial governments operate services and programs. Health institutions address clinical needs. Education, employment, social protection and disability policies influence both people requiring support and caregivers. Community organizations and ethnic and campesino communities have their own care practices.
A national care architecture therefore has to connect systems without pretending they are identical.
This creates an important distinction between system integration and multi-agency working and institutional merger. Colombia does not need every care-related responsibility to sit inside one organization. It needs sufficient coordination that people do not experience every institutional boundary as a gap in support.
The stronger model is one in which responsibilities remain appropriately distributed but the overall care pathway becomes intelligible. That requires clarity about who does what, where referrals go, how unresolved needs are escalated and which institution is responsible when a person's circumstances cross several policy domains.
Scenario: an older couple reveals why care cannot be organized around one individual
Consider a couple living in Bogotá. The husband, aged 81, develops increasing cognitive impairment and requires supervision, help with medication routines and assistance outside the home. His wife, aged 76, provides almost all his daily support. Their adult children live elsewhere and visit when possible.
A service response focused exclusively on the husband might identify his healthcare needs and perhaps connect him with relevant older-person or community services. A care-system response asks an additional question: what is happening to his wife?
She may be physically capable of continuing for now, but she is sleeping poorly, has stopped attending activities outside the home and is increasingly reluctant to leave her husband alone. If her own health deteriorates, two people may require significantly greater support.
The operational value of a care-system approach is therefore relational. Assessment should identify both the person's need for care and the sustainability of the caregiving arrangement. Appropriate responses might involve health services, dementia support, territorial programs, family participation and opportunities for respite or community assistance.
The Positive Risk Enablement Planner can help organizations structure similar discussions about autonomy, safety and proportionate support. It is not a Colombian assessment instrument, but its underlying principle is relevant: care should not default to restriction simply because risk exists, and caregivers should not be expected to absorb every risk privately.
Territorial delivery will determine whether the system becomes tangible
National policy can establish rights, objectives and institutional direction. Care is ultimately experienced locally.
Colombia's departments, districts and municipalities differ greatly in population density, fiscal resources, administrative capability, provider infrastructure, transport and workforce. Bogotá's capacity to coordinate services cannot simply be assumed in a remote municipality in the Amazonía, Orinoquía or Pacific region.
CONPES 4143 recognizes this territorial dimension. Its implementation includes strengthening state capacity and technical assistance for territorial entities developing local systems and programs. This matters because a national care system that exists primarily through central coordination would not address the practical problem facing a person who cannot obtain support where they live.
Territorialization also requires adaptation. An urban model built around co-located services or regular attendance at community facilities may be inappropriate for a dispersed rural population. Home visiting, mobile provision, community networks and different workforce configurations may be necessary.
The objective should therefore be greater consistency of rights and purpose without demanding identical delivery models everywhere.
This creates a governance challenge. Excessive central prescription can suppress locally appropriate responses. Excessive decentralization can leave major inequalities unchallenged. Colombia's emerging system needs enough national visibility to identify unacceptable variation while preserving territorial flexibility to respond to different communities.
Community care is part of the architecture, not an informal afterthought
One of the most distinctive features of the Colombian policy is its explicit recognition of collective and community care. CONPES 4143 also gives particular attention to practices developed within ethnic peoples and campesino communities.
This is more than cultural acknowledgment. It challenges a model in which legitimate care is assumed to exist only when delivered by formal institutions or paid professionals.
Community networks can provide food, accompaniment, practical assistance, social connection, knowledge of local households and early identification of people whose circumstances are deteriorating. In territories with limited formal infrastructure, those functions may be especially important.
But recognition should not become a rationale for transferring public responsibility to communities without resources. Community care has costs: time, coordination, transport, spaces, equipment and sometimes paid facilitation. Volunteers and community leaders can themselves experience exhaustion.
The operational test is therefore whether community capability is being strengthened rather than merely relied upon.
Organizations examining the contribution of local networks can use the Community Impact Report Builder to structure evidence about reach, participation and wider community outcomes. It does not measure compliance with Colombian policy, but it can help make forms of value visible that conventional service counts often overlook.
Care rights require pathways, not only declarations
The language of rights changes the normative foundation of care. CONPES 4143 recognizes the right to care for those who provide it and the right to receive care, assistance or support for those who require it. The legislative proposal introduced in July 2026 would go further by giving statutory form to the right to care and creating and organizing the Sistema Nacional del Cuidado.
As of September 2026, that bill remains a proposal before Congress rather than an enacted national care law. Its existence nevertheless demonstrates the direction of institutional development and the continuing effort to place the care system on a durable legal footing.
The operational challenge is translating rights language into pathways people can actually use.
A person needs to know where to seek help. Frontline professionals need criteria for identifying care and support needs. Territorial institutions need referral arrangements. Responsibilities between health, disability, ageing, social protection and community services need sufficient clarity that people are not repeatedly redirected.
This is particularly important for people whose circumstances do not fit one program neatly. An older person with disability, chronic disease and an exhausted family caregiver may simultaneously interact with several systems. If each institution recognizes only the part of the situation falling within its formal remit, the household remains responsible for integrating the rest.
That is why rights, consent and decision-making have to be connected with operational access. A right that cannot be navigated, exercised or challenged remains weaker in practice than its policy language suggests.
The governance architecture is still being consolidated
System-building requires a mechanism through which different institutions can make collective decisions. During 2026, Colombia continued developing the governance arrangements for the Sistema Nacional de Cuidado.
A draft decree published for consultation proposed a governance model intended to coordinate and manage the system intersectorally. Government reporting described proposed structures including an intersectoral commission, a technical committee, a territorial care forum and an advisory council. At the time of the 2025–2026 accountability reporting, the governance decree was reported as having completed review and signature processes across relevant ministries and administrative departments but still awaiting presidential signature.
This status is important. Proposed governance arrangements should not be described as though every institution is already functioning nationally in its final statutory form.
The policy direction, however, is clear. Care cannot be governed effectively by one sector because the determinants of care sit across government. The national architecture needs a way to align priorities, resolve overlaps, monitor implementation and include territorial and community perspectives.
Good governance also requires decision rights. If a national body identifies persistent territorial gaps, what can it require? If responsibilities overlap between institutions, who resolves them? If caregivers report that a program is inaccessible, where does that intelligence travel? If implementation falls behind the Plan de Acción y Seguimiento, who owns recovery?
These are not bureaucratic details. They determine whether intersectoral governance changes people's experience or simply creates additional meetings.
The Governance Maturity Assessment can help organizations examine analogous questions about accountability, decision rights, escalation and assurance. It is not an assessment of Colombia's National Care System, but the framework illustrates a wider principle: coordination becomes meaningful only when responsibilities and evidence are clear enough to support action.
Scenario: a municipality builds a local care route
A municipality in Boyacá decides to strengthen its local response to households with high care burdens. It already has programs for older people, disability-related services, health-sector relationships and community organizations, but these operate through different entry points.
The municipality does not necessarily need to create an entirely new service organization. It first maps what already exists. Frontline teams identify where people enter the system, which needs each program can address and where households repeatedly encounter gaps.
A common problem emerges: caregivers are visible to services only indirectly. Professionals record the older person's or disabled person's needs but rarely capture whether the family arrangement is sustainable.
The municipality therefore develops a local care route in which caregiver circumstances are considered alongside the needs of the person receiving support. Community organizations can refer households showing signs of strain. Health services know where non-clinical concerns can be directed. Cases involving several institutions have an agreed coordination route rather than being passed informally between individual professionals.
The important evidence is not simply how many referrals are made. Local leaders monitor whether people reach the intended service, whether unmet needs persist, whether caregivers receive support and which recurring gaps require a change in local provision.
This is how national care policy becomes operational: not through reproducing a central organizational chart locally, but through making fragmented responsibilities function more coherently around people's lives.
The workforce question extends from professionals to unpaid caregivers
A National Care System changes the meaning of workforce planning. Colombia needs sufficient formal workforce capacity, but it also needs to understand the relationship between paid and unpaid care.
Professional services may involve nursing, medicine, rehabilitation, psychology, social disciplines, gerontology and other specialist roles. Everyday support can involve care workers, domestic workers, community workers and family caregivers. The boundaries between these roles affect cost, quality, continuity and responsibility.
CONPES 4143 includes actions relating to the rights and conditions of people providing paid and unpaid care. It also addresses labor formalization and inspection in parts of the paid care economy. This is significant because expanding care services without improving employment conditions can reproduce inequality inside the formal system.
A sustainable workforce strategy should therefore examine workforce, care teams and skill mix across the whole care ecosystem.
Different tasks require different competencies. Clinical interventions require appropriately qualified professionals. Personal support requires practical competence, safeguarding awareness and person-centered practice. Community navigation may depend on local knowledge and trusted relationships. Family caregivers may need information, training and respite rather than professionalization.
The objective should not be to turn every act of care into a professional service. It is to ensure that people are not undertaking complex or risky responsibilities without appropriate support merely because formal capacity is unavailable.
Gender equality is an operating principle, not a secondary benefit
Care reform in Colombia is inseparable from gender. The National Care Policy explicitly identifies the unequal distribution of unpaid domestic and care work and seeks to recognize, reward, reduce and redistribute care.
Redistribution is particularly important. Recognition alone can make women's contribution more visible without actually changing who performs the work. Training caregivers can improve competence while inadvertently making the existing arrangement more sustainable without reducing its inequality.
A genuinely transformative system therefore needs to ask whether interventions alter the distribution of time and opportunity.
If a woman receives caregiver training but still provides twelve hours of unpaid support each day, her expertise has increased but her economic participation may remain constrained. If accessible daytime support allows her to return to employment or education, the care intervention has changed both service provision and gender opportunity.
Men's participation in care also matters. Cultural change is explicitly part of the policy because the long-term redistribution of care cannot depend solely on expanding state services. Household and social expectations about who cares need to change as well.
This makes outcomes more complex than service volume. Colombia's care policy ultimately needs evidence about time use, caregiver wellbeing, employment, autonomy and gender differences alongside conventional measures of program participation.
Scenario: supporting a caregiver changes two life trajectories
A woman in Cali provides daily support to her adult brother, who has a significant disability. She coordinates appointments, prepares meals, assists with personal routines and ensures he can participate outside the home. Over time she has withdrawn from paid employment because care arrangements are too unpredictable.
A narrow service model assesses her brother and asks whether his immediate needs are being met. They are, largely because his sister meets them.
A care-system approach recognizes a different reality. The apparent adequacy of his support depends on another person's restricted economic and social life.
The response does not require removing the sister from her brother's care. It might combine formal assistance at predictable times, community participation, accessible transport and better coordination with health and disability services. This gives her reliable periods in which employment or training becomes possible while preserving the relationship both siblings value.
Outcomes should then be measured for both people. Her brother's safety and participation matter, but so do his sister's income, time, wellbeing and ability to pursue her own goals.
This illustrates why Colombia's care reform cannot be evaluated solely through the number of people receiving formal services. Its deeper objective is to change the distribution and conditions of care itself.
Information will determine whether fragmented care becomes a system
A system cannot coordinate needs it cannot see. Colombia therefore faces a major information challenge as the National Care System develops.
Relevant information is already generated across health, disability, ageing, social protection, employment and territorial programs. Household surveys and time-use evidence provide additional insight into unpaid care. Community organizations may know which families are struggling long before formal institutions do.
The problem is not simply the absence of data. It is whether different information can be converted into usable intelligence without undermining privacy, autonomy or trust.
At national level, policymakers need to understand the distribution of care demand, unpaid work, service capacity and territorial inequality. At local level, teams need enough information to coordinate support around individuals and households. These are related but different data requirements.
Interoperability could reduce repeated assessment and improve continuity, but it should not be interpreted as unrestricted information sharing. Colombia's data-protection framework continues to apply, and sensitive information about health, disability, household circumstances and caregiving relationships requires appropriate governance.
The relevant principle from data governance and information accountability is therefore not “collect everything.” It is to define what information is necessary, who can access it, for what purpose and how accuracy and rights are protected.
Organizations considering greater digital coordination can use the Digital Transformation, AI and Cybersecurity Readiness Assessment to test organizational readiness before expanding technology-enabled workflows. The tool does not prescribe Colombian information-governance requirements, but it can help structure questions about infrastructure, governance, capability and cyber risk.
Scenario: rural care requires a different operating model
An older woman lives with her son in a dispersed rural area of Nariño. She has reduced mobility and several chronic conditions. Her son provides most daily assistance while also working intermittently. Reaching services requires significant travel, and connectivity is unreliable.
A care model designed around frequent attendance at urban facilities will not translate directly to her circumstances. Neither will a digital-first model if connectivity, devices or digital confidence are insufficient.
A territorial response might instead combine periodic mobile professional support, primary healthcare, local community networks, caregiver guidance and planned transport for services that genuinely require travel. Digital communication may supplement this arrangement where connectivity permits, but it cannot become the sole gateway.
The governance question is whether the higher logistical cost of supporting dispersed households is visible. If performance is judged mainly by the number of people served per worker or the cost of each contact, rural provision may appear inefficient even when the operating model is appropriate to geography.
National and territorial leaders therefore need measures that distinguish efficiency from accessibility. The same policy objective may require different delivery intensity and cost across Colombia.
This is one reason health inequities and access barriers need to be considered within care-system design rather than treated as a separate equity discussion.
Financing will reveal how far co-responsibility extends
Article 5 in the Colombia series examined the country's long-term care financing architecture in detail. For the National Care System, the central issue is broader: co-responsibility eventually has to be expressed through resources as well as policy language.
CONPES 4143 establishes a ten-year implementation program, with responsible national entities expected to manage and prioritize resources for agreed actions. Existing services also continue to draw on their established financing arrangements. Older-person provision, health services, disability supports, social programs and territorial initiatives are not automatically merged into a single care budget.
This is appropriate during system development, but it creates a coordination requirement. If institutions remain financially responsible only for narrow components of care, households may continue to absorb needs that fall between them.
Future development will therefore need to connect funding and payment models with the outcomes the National Care System is trying to achieve. That does not necessarily require one national care fund. It does require sufficient alignment that one institution is not rewarded for reducing expenditure by transferring costs to another sector or to families.
Financial evidence should also recognize prevention. Respite, rehabilitation, accessible community support or timely home assistance may have value through sustained family care, maintained function or avoided deterioration even when the benefit appears in another budget later.
Quality needs to follow people across the care ecosystem
As care becomes more coordinated, quality assurance also becomes more complex. Colombia already has regulatory and quality requirements within individual sectors and services. A National Care System adds the need to understand quality across pathways.
A person can receive individually competent interventions and still experience a poor overall outcome if those interventions do not connect. A hospital can discharge appropriately, a community program can deliver its specified activity and a family can continue providing care, yet the combined arrangement may remain unstable.
System-level quality therefore needs to consider several dimensions together: accessibility, continuity, safety, autonomy, caregiver sustainability, equity and outcomes.
Not every indicator should be centralized. Frontline services need operational measures relevant to their work. Territorial authorities need visibility across local pathways. National government needs enough comparable information to understand whether policy objectives are progressing and where persistent gaps require intervention.
The Quality Dashboard Builder can help organizations structure a balanced set of quality and outcome measures for similar purposes. It is not an official Colombian monitoring framework, but it demonstrates how activity, quality, risk and outcomes can be considered together rather than relying on service counts alone.
People receiving care and caregivers should also influence quality assessment. Their experience can reveal coordination failures that administrative data do not show: repeating the same story to several institutions, being unable to identify who is responsible, receiving services at unusable times or finding that nominally available support is inaccessible in practice.
Implementation should be judged by whether responsibility genuinely shifts
Colombia's care reform will generate programs, governance structures, training, technical assistance and institutional activity. Those outputs matter, but they are not the ultimate test.
The deeper test is whether the social organization of care actually changes.
Useful system-level evidence will therefore need to examine whether unpaid care becomes less unequal, whether people requiring support gain greater autonomy and access, whether caregivers have improved social and economic opportunities, whether territorial gaps narrow and whether community forms of care are strengthened without being exploited.
This requires combining quantitative and qualitative evidence. Time-use data can show whether gender differences are changing. Service information can show coverage. Workforce data can identify formalization and capacity. Territorial comparisons can expose geographic inequalities. Lived-experience evidence can show whether people experience the system as more coherent.
If policy implementation expands formal activity while the underlying burden on households remains unchanged, the transformation will be incomplete.
Conversely, relatively modest service developments may have substantial effects if they remove critical pressure points in people's lives. Reliable respite for a caregiver, accessible transport for an older person or coordinated assistance after hospital discharge can change the sustainability of an entire household arrangement.
Institutional transition is itself a governance risk
Colombia's system-building is taking place during institutional change. The Ministry of Equality and Equity, which has held important care-system leadership responsibilities, is in liquidation during 2026. Its Direction of Care has nevertheless continued work on the National Care System, including convening the IV Encuentro por el Futuro de los Cuidados in Barranquilla in May 2026 and progressing governance arrangements.
This makes continuity of responsibility particularly important. A national care system is intended to extend well beyond one administration or institutional configuration. Its policy horizon runs to 2034.
Functions therefore need durable institutional ownership even if ministerial structures change. Implementation plans, data, territorial relationships, technical knowledge and accountability mechanisms should be capable of transferring without losing momentum.
The same principle applies internationally. Major cross-government reforms are vulnerable when they depend too heavily on individual leaders, temporary programs or one organizational structure. Institutionalization means embedding responsibilities deeply enough that the reform can survive administrative change.
What other countries can learn from Colombia's approach
Colombia's National Care System is still developing, so it would be premature to present it internationally as a completed model. Its value for comparative learning lies instead in the questions it is attempting to solve.
First, Colombia treats care as wider than a service sector. This makes visible the relationship between formal provision, unpaid work, gender equality, community life and economic participation.
Second, the policy includes both people requiring care and people providing it. That relational approach is particularly relevant to long-term care systems that assess an older or disabled person without adequately understanding the sustainability of the household supporting them.
Third, Colombia explicitly recognizes community, campesino and ethnic care practices. The transferable principle is not that other countries should replicate those structures, which are rooted in Colombia's own social and cultural context. It is that national care policy should understand and respect forms of support that exist outside formal institutions.
Fourth, the Colombian experience shows why territorialization matters. National rights and policy objectives require local infrastructure, workforce and pathways. Uniform policy language does not produce uniform access automatically.
Finally, Colombia illustrates the importance of distinguishing policy direction from implementation maturity. CONPES 4143 provides a substantial national framework and implementation program through 2034, but governance, legislation and territorial capability continue to evolve. International comparison is strongest when it examines that implementation journey rather than treating policy publication as system completion.
The next phase is about making the architecture usable
The strongest opportunity for Colombia now lies in converting a compelling policy concept into an operating system that people can navigate.
That requires more than creating new programs. Existing health, disability, ageing, employment, social protection and community structures need practical interfaces. Territorial authorities need capability and resources. Caregivers need routes to support that recognize their own rights. People requiring assistance need pathways that protect autonomy rather than assuming dependency removes choice.
Governance arrangements must also produce learning. If municipalities repeatedly identify the same unmet need, national policy should be capable of responding. If one territory develops an effective approach, evidence should travel without assuming that the model can simply be copied elsewhere. If implementation creates unintended burdens, people receiving and providing care need credible ways to make those effects visible.
Technology can assist with coordination and evidence, but institutional relationships remain central. Financing can expand services, but workforce and community capacity determine whether resources become usable support. Rights establish the destination, but implementation determines whether people can reach it.
Conclusion
Colombia's National Care System represents a significant attempt to change the way the country understands responsibility for care. Rather than treating care primarily as a private obligation managed inside households, the Política Nacional de Cuidado establishes a direction based on rights, co-responsibility, recognition of caregivers, community participation and stronger state capacity. For an ageing society, that creates the possibility of developing long-term support within a much broader social architecture rather than constructing older-person services in isolation.
The transition remains unfinished. CONPES 4143 provides 133 actions and a policy horizon to 2034, while governance arrangements continue to consolidate and the bill introduced in July 2026 proposing statutory creation and organization of the Sistema Nacional del Cuidado has not yet become law. Territorial capacity, financing, workforce, data and institutional continuity will determine how quickly national ambition becomes practical support.
The most important measure of success will not be whether Colombia can point to a new organizational structure. It will be whether people experience a different distribution of responsibility: an older person able to obtain support without exhausting a spouse, a disabled person able to exercise greater autonomy, a caregiver able to participate in employment and community life, and a rural household able to access assistance without geography becoming an exclusion mechanism.
That is the deeper promise of Colombia's care-system reform. Policy has begun to make previously hidden care visible. The next task is to ensure that visibility produces durable institutions, stronger local pathways and a fairer sharing of the work required to sustain everyday life.