The TA will assist the Yichang Municipal Government (YMG) in preparing an elderly services strategic development plan for Yichang.the TA will (i) identify national and international best practices on elderly care and analyze their applicability to Yichang Municipality; (ii) provide capacity development support to key stakeholders in Yichang to increase their understanding of elderly needs assessment and services planning,;and (iii) implement a participatory planning process to develop a strategic elderly care services development plan covering institutional, community, and home-based services (including opportunities to initiate public private partnerships); and (iv) disseminate findings.
|Project Name||Strategic Elderly Care Services Development in Yichang|
|Country||China, People's Republic of
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Governance and capacity development
Private sector development
|Sector / Subsector||
Health - Health care finance - Health insurance and subsidized health programs
Water and other urban infrastructure and services - Urban policy, institutional and capacity development
|Gender Equity and Mainstreaming||Effective gender mainstreaming|
|Description||The TA will assist the Yichang Municipal Government (YMG) in preparing an elderly services strategic development plan for Yichang.the TA will (i) identify national and international best practices on elderly care and analyze their applicability to Yichang Municipality; (ii) provide capacity development support to key stakeholders in Yichang to increase their understanding of elderly needs assessment and services planning,;and (iii) implement a participatory planning process to develop a strategic elderly care services development plan covering institutional, community, and home-based services (including opportunities to initiate public private partnerships); and (iv) disseminate findings.|
|Project Rationale and Linkage to Country/Regional Strategy||
The main demographic challenges facing the PRC in this century are the dramatic aging of its population and the scale of internal migration, which is largely driven by urbanization. The proportion of people above the age of 60 across the PRC is expected to grow from roughly 12% in 2010 to 34% by 2050. The PRC's population is aging rapidly at a time when the per capita income remains modest; social security systems cover a broad portion of the population, but are still insufficient to meet the financial needs of retired senior citizens, as illustrated by the Yichang experience. The high cost of care for the elderly will require long-term care financial coverage mechanisms to avoid major inequities in the way people experience their life as seniors. Furthermore, the current acute shortage of caregivers and nurses specialized in elderly care, most of whom are women, is exacerbated by low compensation levels and working conditions that make these professions unattractive.
The PRC has been addressing the consequences of its aging population since the late 1970s, with successive policies to finance old age care, stimulate private sector participation, define the responsibilities of families, and organize community-wide responses to support the elderly. The PRC's Twelfth Five-Year Plan, 2010 2015 further recognized these challenges. It called for establishing an old age care system (with targets for home-based care, community care, and institutional care) expanding grassroots aging associations; encouraging volunteerism among senior citizens; and improving health management services.
The 2012 revision of the Elderly Law includes requirements for local governments to develop community services for senior citizens. The recent opinions of the State Council (September 2013) to accelerate the development of the elderly care service industry recognizes the progress made and the significant challenges that remain. The challenges include insufficient elderly care services and products, an underdeveloped market, and imbalanced regional rural urban development. The opinions of the State Council include a comprehensive list of policy directions; set development goals; describe organization and management arrangements; and assign responsibilities to combine public, private, and civil society efforts.
In the PRC, children traditionally took primary responsibility for caring for their parents' medical and nonmedical needs (e.g., daily activities and emotional and financial requirements). However, the ability of children to meet this traditional responsibility is increasingly challenged by several factors, including small family size (resulting in part from the one child policy), high labor force mobility, the high labor participation rate of women, increasing financial burdens on the families of children with the duty to care, and the eroding importance of filial piety. Support provided by the government for the poor elderly includes (i) payment of social pensions for poor rural and urban citizens; (ii) provision of residential or community-based care services for selected elderly living on social assistance; and (iii) support to the most destitute, including childless old people and elderly whose children also live in poverty.
Currently, only childless elderly people living on social assistance such as the _Three Nos_ in the cities and _Five Guarantees_ households in the countryside are provided residential or community-based care services by the government. Other elderly welfare assistance recipients are generally ineligible for care subsidies by the government. There is a need for the government to expand subsidies for these elderly people, including to low-income households that are slightly above the poverty threshold (the marginal poor).
Yichang Municipality submitted a project proposal to ADB through the Ministry of Finance to provide TA to strengthen local policies and strategies, and to update
|Impact||The elderly care system is more inclusive and affordable in Yichang.|
|Description of Outcome||A balanced elderly services strategic development plan (covering infrastructure, community, and home-based care) for Yichang|
|Progress Toward Outcome||New strategies and approaches to elderly care were discussed with YMG and private and civil society stakeholders. A clear path to the drafting of the strategic development plan for elderly care in Yichang wasagreed on. Concepts like aging in place, healthy aging, and aging mainstreaming were adopted as the guiding principles for the plan. Strategies on private sector engagement, ensuring affordabliity, improving the quality of long-term care, quality and safety monitoring, IT platforms for home-based care and community care, sustainable financing, and human resources development for elderly care were thoroughly discussed and agreed on. The TA has provided intensive advisory support to develop the plan in cooperation with YMG and other stakeholders. Extensive baseline information was collected through surveys and qualitative data collection. The final draft strategic plan was discussed during a workshop in May 2016.|
|Description of Project Outputs||
1. Study report on national and international experience on elderly care services
2. Capacity development to plan elderly care services for concerned officials of Yichang Municipal Government
3. Elderly service facilities construction plan of Yichang reviewed and updated into a strategic development plan
4. Dissemination of findings
|Status of Implementation Progress (Outputs, Activities, and Issues)||
The study report on international and national experience is developed and was discussed extensively with YMG. The final study report was submitted in August 2016.
The TA provided training to YMG officials, bureaus, and agencies involved in elderly care. The overseas study tour to Japan and the Republic of Korea took place in November-December 2015 and a study tour to the US and Canada was held in June and July 2016.
The elderly care service facilities construction plan was reviewed and findings discussed with YMG. The final workshop in May 2016 presented the TA main findings and key elements of the long-term care strategic plan. The final version of the strategic plan was submitted to ADB in August 2016.
YMG has held several dissemination events. ADB presented the findings of the Strategic Plan at the 6th US-China Health Summit in the session on Healthy Cities in Xi'an, PRC on 3 September 2016.
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design||A reconnaissance mission took place in Yichang City, Hubei Province from 24 February -3 March 2014 to formulate the proposed policy and advisory technical assistance. A Memorandum of Understanding was signed with YMG on 3 March 2014. The mission held meetings with YMG; Yichang Finance Bureau; the bureaus of Civil Affairs, Development and Reform Commission, Human Resources and Social Security; the Poverty Bureau, Public Health Bureau; the Council on Aging, School of Nursing of the Three Gorges College of Profession and Technology; and private sector representatives. The mission visited Yichang's social welfare institution, several private not-for-profit elderly care apartments, community elderly care services, and several hospitals in Yichang providing geriatric health care, and conducted two focus group discussions with a group of elderly citizens and social welfare officers involved in elderly care.|
|During Project Implementation||Regular meetings and seminars were held involving concerned Yichang government bureaus and agencies, relevant educational institutions, and private sector representatives. Dissemination of TA achievements were ensured through two workshops during the preparation of the Yichang elderly care services strategic development plan, the preparation of a knowledge product on elderly care systems development in PRC, and a final conference on TA findings with local, provincial, national, and international experts. A survey of the needs of the elderly and the availability of adequate elderly care services in Yichang municipality and series of focus group discussions with elderly and other stakeholders were undertaken during project implementation.|
|Consulting Services||In dialogue with YMG/YFB, ADB has engaged two national and an international consultant, reporting to YFB and ADB, and as requested, to YMG. ADB also recruited a national consultant on a lump-sum basis to implement a survey on the needs and services for elderly people. The consultants were hired on an individual basis in accordance with ADB''s Guidelines on the Use of Consultants (2013, as amended from time to time). The two national consultants include specialists with expertise in (i) elderly care, social and community approaches, health, training, and survey methodology; and (ii) elderly care, private sector development, including not-for-profit approaches, finance, and planning. The senior international consultant is an aging specialist with multi-country expertise in elderly care services planning. Consultants' reports will be prepared in Chinese and English.|
|Responsible ADB Officer||Walker, Wendy M.|
|Responsible ADB Department||East Asia Department|
|Responsible ADB Division||Urban and Social Sectors Division, EARD|
Yichang Municipal Government
No. 102 Yanjiang Blvd.
Yichang City, Hubei PRC
Post Code : 443000
|Concept Clearance||14 May 2014|
|Fact Finding||24 Feb 2014 to 05 Mar 2014|
|Approval||27 Jun 2014|
|Last Review Mission||-|
|Last PDS Update||30 Mar 2017|
|Approval||Signing Date||Effectivity Date||Closing|
|27 Jun 2014||21 Jul 2014||21 Jul 2014||23 Jul 2015||31 Dec 2016||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|750,000.00||0.00||100,000.00||0.00||0.00||0.00||850,000.00||27 Jun 2014||683,904.54|
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|Title||Document Type||Document Date|
|Strategic Elderly Care Services Development in Yichang||Technical Assistance Reports||Jun 2014|
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