The hidden epidemic of carers in the developing world.

Unpaid carers are often overlooked by policy- makers and the development community. The World Health organisation (WHO) estimates over a billion people, about 15% of the world's population have some form of disability. With rates of disability set to increase due to population ageing and chronic health conditions, a silent epidemic is growing.

Disability is extremely diverse. While some health conditions associated with disability result in poor health and extensive health care needs, others do not. However for those who do need care, adequate rehabilitation services including daycare centres for children and adults are severely lacking in the developing world. In 2002, the WHO estimated in developing countries the need for carers would need to increase by 400% to meet demand. Affordability of health services and transportation are two main reasons why people with disabilities do not receive needed health care in low income countries. 30- 32% of non-disabled people are unable to afford health care compared to 51-53% of people with disabilities.

The lack of appropriate services for people with disabilities is a significant barrier to health care. For example, research by Carers Worldwide in Uttar Pradesh and Tamil Nadu states of India found that after the cost, the lack of services in the area was the second most significant barrier to using health facilities. Due to a lack of services many family members are torn between leaving their family member at home without any assistance. Leaving a person with disabilities alone can often be highly distressing and dangerous. The other alternative is to leave them to the care of a younger member of the household, quite often a girl, meaning she will miss out on an education.

Women and girls are often in unpaid work which will involve back breaking work including lifting, feeding and maintaining personal hygiene of their loved ones. Often in a home which is not accessible for people with disabilities. The impact of this unpaid work, particularly families who live in poverty, is huge. The responsibility of a carer infringes women's ability from going to school or joining the labour market quelling their chance of economic improvement.

This constant affliction can adversely affect a woman's health, and because of the informal nature of care work, it is not recognised by the state, which means women are often not be eligible for social benefits, such as pensions. Women's mental health is also affected many caregivers feel they are voiceless, marginalised and excluded.

The international development virtually ignores caregivers throughout the developing world. A UN report commented that in the Beijing declaration in 1995 (a global commitment to achieve equality, development and peace for women) that the disparity between women and men in paid and unpaid work needed to be tackled had not been matched with action. The report says "across the world,millions of women still find that poverty is their reward for a lifetime spent caring, and unpaid care provision by women and girls is still treated as an infinite cost-free resource that fills the gaps when public services are not available or accessible.

Caregivers worldwide are one of the only international NGO's providing support to caregivers in developing countries. Although their efforts are admirable more needs to be done by governments on how to value and redistribute unpaid care work. Future development goals should also take into account unpaid care in its targets and indicators.

The UN report recommend that governments should also conduct regular surveys on the time given over to care work with a view to recognising, reducing and redistributing it. They should also design policies that take into account unpaid care, which could include the provision of affordable childcare, improved local healthcare provision to shift the responsibility for attending to a relative's medical needs from a woman to the public sector.

For this change to happen it is essential that the profile of disability in developing world and the health of caregivers is recognised by the public, NGOs and governments. Without changing perceptions of disabilities and the government acknowledging the woefully neglected caregivers worldwide carers will continue to be unacknowledged.