Multi-layered Local Governance of the Care Provision System in Lyudao Island, Taiwan

Abstract

This paper examines the process of establishing a care provision system at various spatial scales according to geographical conditions of the islands of Taiwan and region-specific historical background. The paper also explores issues that affect the care provision system based on care-use behaviors. On the remote Taiwanese island of Lyudao, prior to the 1990s, primary health care was provided only by the island’s public health center, and other care needs often relied on the support of care-takers’ families living in the neighborhood. However, following the late 1990s, progress in democratization resulted in the launching of a private clinic and the acceptance of Southeast Asian home-care workers to provide elderly care and daily living support. Thus, the care provision system on the island has been maintained by wide-area and multi-layered governance comprising multiple actors from a local to a global scale. However, the Taiwanese government has been reluctant to introduce remote image diagnosis and an emergency transport system to overcome temporal and geographical constraints. The examination of care-use behaviors revealed that, on the one hand, the families of care-takers or a foreign workforce provide home-care within the island. On the other hand, receiving medical attention off the island entails taking administrative leave from work or family fragmentation. Local care governance comprises actors that alternate or supplement the role of the government and is closely related to the historical background of Lyudao Island in addition to care norms inherent to Taiwan. Simultaneously, it has become obvious that local care governance faces challenges to make legislation to protect the human rights of foreign care workers and to develop a system to provide comprehensive care within local communities.