49028-002: Hebei Elderly Care Development Project | Asian Development Bank

China, People's Republic of: Hebei Elderly Care Development Project

Sovereign (Public) Project | 49028-002 Status: Active

The Asian Development Bank is working with the People's Republic of China to support the development of elderly care services in Hebei Province. The project is piloting innovative approaches, upgrading and renovation of elderly care facilities, and procuring equipment.

Project Details

Project Officer
Ressano Garcia, Antonio East Asia Department Request for information
  • China, People's Republic of
  • Loan
  • Technical Assistance
  • Health
Project Name Hebei Elderly Care Development Project
Project Number 49028-002
Country China, People's Republic of
Project Status Active
Project Type / Modality of Assistance Loan
Technical Assistance
Source of Funding / Amount
Loan 3536-PRC: Hebei Elderly Care Development Project
Ordinary capital resources US$ 100.00 million
TA 9326-PRC: Establishment of an Integrated Comprehensive Three-tier System for Elderly Care
Technical Assistance Special Fund US$ 670,000.00
Strategic Agendas Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Sector / Subsector

Education / Education sector development - social protection initiatives

Health / Health sector development and reform - Health system development

Gender Equity and Mainstreaming Effective gender mainstreaming

The proposed project will support the development of an integrated three-tier elderly care system (ECS) in Hebei Province through improving the quality and coverage of home, community, and residential elderly care services (ECSS) and facilities. It will be the first project for the Asian Development Bank (ADB) comprehensively addressing ECS and services development by public and private sector.

The project will have demonstration value for other provinces in the People's Republic of China (PRC) and developing countries in Asia and the Pacific facing similar challenges of aging populations. Innovative features include the development of (i) an integrated elderly care service model that links home, community, and residential care and management; (ii) pilot projects to support good practice ECS development in areas such as management, quality assurance, and new services development; (iii) a model of government and private sector collaboration that has only limited risk for government and which may be more flexible and market responsive than use of public- private partnerships; and (iv) a human resources development program at the tertiary and continuing education levels, which anticipates the growth of the sector and demand for new skills.

The impact, which is aligned with the government''s goal, will be an established comprehensive three-tiered ECS (home, community, and residential). The outcome will be improved capacity of the ECS and quality of ECSS in Hebei. The proposed project will include nine subprojects covering urban and rural areas. Indicative project outputs are as follows: Output 1, improved community and home care services, will develop (i) selected community centers, (ii) services and support networks to improve and expand service delivery and quality, (iii) capacity of the implementing agencies to create sustainable home- and community-based care services (HCBC), services that meet the needs of the elderly, and (iv) information and communication technology (ICT) networks that support the elderly and service delivery. Output 2, increased residential elderly care service capacity and improved quality, will (i) provide residential care services for elderly with various types of need (i.e., nursing care, dementia care, rehabilitation); (ii) establish links to existing health care facilities and home and community care to support a continuum of care; and (iii) serve as demonstration models of government and private sector collaboration for other small cities seeking to improve elderly care quality and service delivery. Output 3, improved development of human resources and industry capacity, will help address the human resources shortages and quality by supporting Yanshan University to develop (i) training programs and faculty capacity in emerging service areas, such as caregiving and nursing, rehabilitation, elderly care management, technology to support elderly care, and counseling; (ii) curriculum and training materials in the priority areas with selected academic and training institutions across the province; and (iii) an elderly care training and research center, and student dormitory on the Yanshan University campus. Output 4, improved capacity of elderly care sector organizations, will build the capacity of stakeholders and local civil affairs bureaus (CABs) in planning, elderly care management, assessment, and quality assurance and monitoring. It will also implement innovative pilot projects in priority areas, such as health and elderly care integration, new services development (rehabilitation and dementia care), HCBC, and ICT. Training and advisory support will be provided to facilitate the efficient implementation and operationalization of the ECSS.

Project Rationale and Linkage to Country/Regional Strategy

The most significant demographic challenge facing the PRC is the aging of the population, and the social and economic impacts that will occur because of the rapid pace and scale of the demographic change. The proportion of people above the age of 60 across the PRC is expected to grow from about 12% in 2010 to 34% by 2050. Traditional family support systems are increasingly unable to meet elderly care needs because of the combined impacts of fast urbanization, internal migration of youth away from rural areas, and the one-child policy. The population is aging rapidly while the country''s per capita income is still modest and social security systems are insufficient to meet the needs of senior citizens. The growing demand for quality and affordable ECSS and development of care models for urban and rural areas exceeds supply. These are urgent development issues that must be addressed.

Hebei entered _aging society_ status in 1999 when it passed the 10% threshold of population over the age of 60. This is projected to be 17% in 2016, rising to 31% by 2050. The province has great diversity in the distribution of elderly, their care needs, income levels, and availability of services. Some rural counties have a high density of elderly who are _left behind_ after their children have moved to urban areas. Few elderly remain in other counties, making it difficult to provide decentralized services. Urban areas are aging at different rates, resulting in a variety of demand for services. The government has identified Hebei as a demonstration province for elderly care development because of its experience in developing a rural care model, and since it is representative of the challenges other provinces face with limited government funds available for elderly care and growing elderly populations. A strong desire exists in the province -and nationally- to identify models and implementation partnerships that can deliver quality and affordable ECSS. To achieve this, it is necessary to identify and define the optimum roles for government, private sector, civil society stakeholders, and the public in elderly care.

The PRC''s Twelfth Five-Year Plan, 2011 -2015 supported creating a three-tiered old age care system with home-based care as the base, community care as a support, and residential care as supplement. This is in line with international trends to support _aging in place_ (supporting elderly to live in their communities), de-institutionalization, and active aging. The PRC''s Thirteenth Five-Year Plan, 2016 -2020 seeks to expand coverage, and enhance the quality of services by developing the private sector and civil society organizations capacity to play a greater role in elderly care. The government is seeking models for elderly care that address key challenges: financing gaps, developing the market, and improving the unbalanced rural urban development. In the next 5 years, significant changes are expected to take place: (i) subsidies to the sector will increase and be better targeted, and new programs such as long-term care insurance may play a greater role in promoting access; and (ii) the next generation of elderly (particularly urban) will be better-off and more able to afford care. Stimulating the role of the private sector and civil society is critical for expanding coverage and improving the quality of services. ADB''s recently approved project in Yichang Municipality, Hubei will develop one approach- a model public -private partnerships for ECSS in urban districts. A range of other models that can successfully operate in less-developed areas, build new partnerships for service delivery, and address the multiple care needs of aging populations, also needs to be developed.

Translating national policies into programs in Hebei is challenging. For residential nursing care, only 50% of the projected total need for beds (250,000) in the province is available, and public perceptions and the quality of elderly care facilities are low. Human resources, incentives, and policies to retain and train staff, are insufficient. Planning for the expansion of ECSS is not systematic, and home and community care services are largely underdeveloped. Critical service areas such as dementia care and rehabilitation are very limited, and government financing of elderly care is insufficient. To help address the lack of services, local governments are seeking ways to incentivize new care models and private and civil society organizations (CSOs) involvement, neither of which are yet significant. Poor public perceptions of the quality of services, affordability, and traditional cultural attitudes are key constraints to the uptake and sustainability of services.

To address these problems, the project will develop five anchor elderly care residential facilities (run by the public and private sectors) targeting elderly with long-term care needs. These will serve as care hubs, and develop and operate HCBC services and ICT networks to serve a broad range of elderly. This will support the concept of _aging in place_, a lifestyle that consultations with elderly found that most prefer, and affordable care options. Additional facilities and services, such as rehabilitation centers, will be constructed to help relieve pressure on hospital beds to improve health and elderly care sector integration - an emerging government policy focus. Capacity building for implementing agencies, local CABs, and implementation of pilot projects to address critical aspects of ECS development are integral to the project design. Yanshan University will develop an elderly care training center and short- and long-term new courses in five priority areas: (i) caregiving and nursing, (ii) occupational therapy, (iii) elderly care management, (iv) geriatric psychology, and (v) ICT for elderly care. Together, the subprojects seek to create demonstration facilities and services, expand human resources, and improve industry capacity for the three-tiered ECS in Hebei.

The project supports the PRC''s Thirteenth Five-Year Plan, 2016-2020 and the Hebei Provincial Thirteenth Five-Year Plan, 2016-2020, which seek to develop the ECS, stimulate investment, and define roles and responsibilities for the government and the private and CSOs. The project is aligned with ADB''s country partnership strategy, 2016-2020 pillar on inclusive growth; the Midterm Review of Strategy 2020, which supports social protection and health; and the Operational Plan for Health, 2015-2020, which has elderly care as a focus area.

Impact A comprehensive three-tiered elderly care system (home, community, and residential) established
Project Outcome
Description of Outcome Capacity of the elderly care system and quality of elderly care services in Hebei improved
Progress Toward Outcome
Implementation Progress
Description of Project Outputs

1. Community and home care services improved

2. Residential elderly care service capacity increased and quality improved

3. Development of human resources and industry capacity improved

4. Capacity of elderly care sector organizations improved

Status of Implementation Progress (Outputs, Activities, and Issues) The loan was signed on 17 July 2017 and became effective on 26 October 2017. Recruitment of the loan implementation consultants is ongoing.
Geographical Location Nation-wide
Safeguard Categories
Environment B
Involuntary Resettlement B
Indigenous Peoples C
Summary of Environmental and Social Aspects
Environmental Aspects An initial environmental examination (IEE), including an environmental management plan, was prepared and will be disclosed on the ADB website. The IEE complies with ADB's SPS. The project will help establish safe, operationally and energy-efficient public buildings, which meet the two-star national green building standards. The IEE concludes that the project's anticipated environmental impacts can be mitigated through implementation of the environmental management plan. Some environmental impacts are anticipated, including waste, wastewater, noise, fugitive dust, community and occupational health, and safety. Overall, implementation-related impacts are localized, short-term, and can be effectively mitigated through the application of good construction and housekeeping practices, and implementation of construction phase community and occupational health and safety plans. During operation, no major environmental impacts are anticipated, and minor impacts will be addressed through conventional operation and maintenance practices. Environmental management is supported by loan covenants, capacity development, and institutional-strengthening activities under the project. Environmental complaints or disputes will be handled in accordance with the grievance redress mechanism established for the project.
Involuntary Resettlement Four resettlement plans have been prepared for Xinji City, She County, Shuangluan District, and Li County in accordance with government laws and regulations and ADB's SPS. A total of 168.75 mu of collective land will be affected, most of which is unused land, garden land, and collective construction land not allocated to any households. Of these, 32.37 mu are cultivated land. The impacts on 91 households (310 persons) are marginal as their main source of income is mostly nonagricultural, with agricultural income accounting for only 2% 4% of their total income. Houses to be demolished (1,195 m2) will affect two enterprises and 11 workers. Extensive consultations were carried out during resettlement planning, and key information in the resettlement plans was disclosed in October 2016 by distributing copies of resettlement information booklets to the affected villages and households. The resettlement plans have a provision on leasing land and properties for establishing community elderly care centers. The cost of resettlement is estimated at CNY28.46 million, including contingencies. Due diligence was carried out for the 39.75 mu of project land previously acquired. This concluded that resettlement planning and implementation were carried out satisfactorily, in accordance with state and provincial regulations and policies. The executing agency has the capacity to update, implement, and monitor the resettlement plans. The indigenous peoples impact is categorized C. Ethnic minorities make up 4.55% of the total population in Hebei, of which 71% are Man. Two project sites in Shuangluan District and Chengde City have a larger ethnic minority population, but the social assessment determined that this population is well-integrated socially and economically in the project areas, and it will not be adversely affected by land acquisition and resettlement.
Indigenous Peoples Of the total population in Hebei, the ethnic minority population is 4.55%, of which 71% are Man. Two project sites in Shuangluan District and Chengde City have a larger ethnic minority population, but the social assessment determined that this population is well-integrated socially and economically in the project areas, and it will not be adversely affected by land acquisition and resettlement.
Stakeholder Communication, Participation, and Consultation
During Project Design

Civil society, private sector, and other development partners involved in the EC sector were consulted during PPTA processing and implementation. A set of stakeholder workshops were organized (i) at the beginning of PPTA implementation to gather initial inputs for

the work to be carried out under the PPTA, and (ii) towards the midterm of PPTA implementation to report on the work accomplished and agree on an initial project design and monitoring framework. Surveys were organized as required and agreed with the executing agency. Focus group discussions and key informant interviews were organized including elderly, service providers, civil society organizations, and governmental and private sector stakeholders.

During Project Implementation Stakeholder consultations and surveys will be organized to ensure a participative approach to the monitoring and evaluation of elderly care services provided under the project. A stakeholder consultation and engagement plan (Table 30 of the Project Administration Manual) has been prepared to highlight the most important communications challenges faced by the project
Responsible ADB Officer Ressano Garcia, Antonio
Responsible ADB Department East Asia Department
Responsible ADB Division Urban and Social Sectors Division, EARD
Executing Agencies
Chengde Haoren Elderly Care Service Industry Corporation
[email protected]
Jinyuan Building, Shuangluan District,
Chengde City
Hebei Provincial Government
Hebei Provincial Finance Bureau
48 South Zhonghua St Shijiazhuang 050051
Hebei Province, People's Rep of China
Hebei Runqinyuan Elderly Care Industry Development Corporation
[email protected]
Zhenxing Road, She County
Julu County Hospital
[email protected]
Jiankang East Road, Julu County,
Xingtai Shi
Li County Guangrongyuan
[email protected]
Balizhuang, Liwu Town, Li County
Baoding City
Xinji Juyouleyuan Elderly Care Service Corporation
[email protected]
Yinbin Road, North part of Xinji City
Yanshan University
[email protected]
No. 438 Hebei Street, Qinhuangdao City
Concept Clearance 20 Nov 2015
Fact Finding 10 Oct 2016 to 17 Oct 2016
MRM 12 Dec 2016
Approval 06 Jun 2017
Last Review Mission -
Last PDS Update 16 Mar 2018

Loan 3536-PRC

Approval Signing Date Effectivity Date Closing
Original Revised Actual
06 Jun 2017 17 Jul 2017 26 Oct 2017 31 Dec 2022 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 180.12 Cumulative Contract Awards
ADB 100.00 06 Jun 2017 1.92 0.00 2%
Counterpart 80.12 Cumulative Disbursements
Cofinancing 0.00 06 Jun 2017 0.11 0.00 0%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

TA 9326-PRC

Approval Signing Date Effectivity Date Closing
Original Revised Actual
06 Jun 2017 28 Jun 2017 28 Jun 2017 30 Jun 2020 - -
Financing Plan/TA Utilization Cumulative Disbursements
ADB Cofinancing Counterpart Total Date Amount
Gov Beneficiaries Project Sponsor Others
670,000.00 0.00 0.00 0.00 0.00 0.00 670,000.00 06 Jun 2017 0.00
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - - - - - Satisfactory

Project Data Sheets (PDS) contain summary information on the project or program. Because the PDS is a work in progress, some information may not be included in its initial version but will be added as it becomes available. Information about proposed projects is tentative and indicative.

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Safeguard Documents See also: Safeguards

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Evaluation Documents See also: Independent Evaluation

None currently available.

Related Publications

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Tender Title Type Status Posting Date Deadline
Consulting Services of Project Implementation Support Firm - Consulting Closed 30 Aug 2017 28 Sep 2017

Contracts Awarded

No contracts awarded for this project were found

Procurement Plan