Now that Yamandú Orsi, who won Uruguay's presidency takes office, he has an opportunity to make history by focusing on strengthening the country's policies to support people with disabilities and other marginalized populations.
Uruguay’s care policy, inaugurated in 2015, marked a significant step forward for the South American country and the region. It brought visibility to the need for public policies addressing the realities of thousands of people dedicated to the care and support of children, people with disabilities, and older people. Uruguay has been a pioneer in establishing new pathways to recognize the often unrecognized and unpaid work of these caregivers and support people. Uruguayan law states that dependency is "the state in which people find themselves when they require the assistance of one or more other people to carry out basic activities and meet the needs of daily life" (Article 3, D). The underlying idea of the concept of "dependency" is that some people with disabilities cannot carry out their daily activities on their own and, therefore, are not autonomous, which is a misconception. Consequently, the term can stigmatize people with disabilities and older persons by portraying them as a burden to society and their families.
However, as highlighted in a Human Rights Watch report published in September, this policy has fallen short of its promise. For example, thousands, like Adriana Paciel, who is 57 and has a physical disability, are excluded from the personal assistant program due to age. Despite needing support for daily activities, she’s ineligible since the program only serves those under age 29 and 80 and over.
In part, the flaws in the support programs are due to a failure to address the intersectional dimensions of all the social agents involved in care and support relationships. Beyond recognizing the unpaid and unacknowledged work of caregivers, primarily women, these policies also need to ensure the social participation and empowerment of the people they aim to serve, especially those with disabilities.
Organizations of people with disabilities have not had a significant role in designing and carrying out the care system, inaugurated in 2015. Consequently, the narrative underpinning the care system and public policy in Uruguay continues to perpetuate stereotypes that depict people with disabilities as dependent, fragile, and in need of care.
Our research underscores the need for Uruguayan authorities to move away from a dependency narrative and build the system on the principles outlined in international human rights law—focusing on support and recognizing the autonomy and legal capacity of people with disabilities. Achieving this requires opening new pathways for the participation of disability organizations in designing public policy and strengthening the care system, which has been significantly contracting since 2020.
To begin with, the government should review the age- and income-based restrictions on these support programs , which risk arbitrary results, and work to expand them to the maximum of its available resources, toward making the programs universal. Many people with disabilities who require assistance are deemed ineligible for programs, particularly for personal assistants, solely because of their age.
The redesign of Uruguay’s support and care system to broaden its coverage should also include significant reforms to diversify the types of support provided to different populations. This would ensure that all disabilities, including intellectual and sensory disabilities (such as blindness and deafness can benefit from the system. We found that the personal assistants program focuses on individuals with physical disabilities, excluding those who require other types of support, such as communication assistance or help understanding social interactions.
Uruguay should also reconsider its policy of institutionalizing people who lack family or social support. With an expanded range of community-based services, these people could be fully included in society, as is their right.
Effective participation by organizations of people with disabilities could address the current lack of monitoring in the system, which hampers the ability to provide timely and adequate solutions for deficient or inappropriate services. It would also enable the exploration of support models that extend beyond personal assistants.
Uruguay's Congress should thoroughly review the system and promote other policies that have proven effective in other countries. For instance, a review could explore centers for independent living, which have been developed in the United States and Japan, as well as in some Latin American countries like Costa Rica. Providing funding to organizations of people with disabilities to manage centers for independent living could serve as an incentive to address the employment and economic development needs of people e with disabilities, while also leveraging the organizations’ expertise in understanding the types of support required.
President-elect Orsi could show regional leadership by revitalizing a public policy that has served as a model for Latin America and the international community. Uruguay has achieved a great deal, but it can achieve much more.