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 Name||Hebei Elderly Care Development Project|
|Country||China, People's Republic of
|Project Type / Modality of Assistance||Loan
|Source of Funding / Amount||
|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|
|Description of Outcome||Capacity of the elderly care system and quality of elderly care services in Hebei improved|
|Progress Toward Outcome||The loan was signed on 17 July 2017 and became effective on 26 October 2017. The loan implementation consultants were fielded on 5 June 2018. An inception mission was fielded from 31 July to 3 August 2018. Given the delay in project start-up, the possibility of loan extension will be considered to help provide better implementation planning.A follow-up review mission was conducted in 26 29 November 2018 to review the progress of design preparation and approval, and revise contract award and projection targets. Since the mission, the Hebei PMO has overseen the conduct of environmental management training and work planning, and land acquisition and resettlement as well as preliminary design preparation are at different stages.Review missions in May and July 2019 were fielded to examine implementation problems that the project is encountering and work out measures with the executing agency to resolve them.The procurement plan has been updated to repackage the 49 civil works and goods contracts in the original procurement plan to a reduced total of 27 packages. Preliminary designs for the packages are being updated to comply with new local requirements and are for approval. Land acquisition has been completed for all sites except for Chengde. The first civil works packages for Li County and Yanshan University have been awarded. The first goods package of Yanshan University has been awarded. The first civil works package for Xinji City is being revised to adjust for bid submission and opening procedures because of COVID-related meeting restrictions. The first civil works package of Jvlu has been advertised at the end of Sep 2020. Consultants for the attached capacity development technical assistance were fielded in March 2019 and the inception workshop was held in July 2019. The TA completion date and the consulting firm's contract have been extended given the repercussions of the COVID-19 outbreak. The midterm review mission was fielded in Nov 2020 to accelerate CAD.|
|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)||Output I. Original target of 50 community (correct target) and home care centers were reduced to 47 centers (3 in Xinji county canceled). The construction work has started. It is expected that 19 out of 29 community care centers will be constructed by the end of 2021. Output II. Residential elderly care service capacity increased and quality improved; Ongoing. Output III. Development of human resources and industry capacity improved; Awarded YS C-01 and YS S-01 for the training program development by Yanshan University. Curriculum and training materials development just started. Output IV. Capacity of elderly care sector organizations improved. Drafted elderly care sector plan of Li county for three-tired elderly care system (home, community and residential) and the quality control system for She county elderly care services.|
|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 forthe 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||Lu, Lanlan|
|Responsible ADB Department||East Asia Department|
|Responsible ADB Division||PRC Resident Mission|
Chengde Haoren Elderly Care Service Industry Corporation
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
Zhenxing Road, She County Julu County Hospital
Jiankang East Road, Julu County,
Xingtai Shi Li County Guangrongyuan
Balizhuang, Liwu Town, Li County
Baoding City Xinji Juyouleyuan Elderly Care Service Corporation
Yinbin Road, North part of Xinji City Yanshan University
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||19 Mar 2021|
|Approval||Signing Date||Effectivity Date||Closing|
|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||30.77||0.00||31%|
|Cofinancing||0.00||06 Jun 2017||19.79||0.00||20%|
|Status of Covenants|
|Approval||Signing Date||Effectivity Date||Closing|
|06 Jun 2017||28 Jun 2017||28 Jun 2017||30 Jun 2020||31 Dec 2021||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|670,000.00||0.00||0.00||0.00||0.00||0.00||670,000.00||06 Jun 2017||197,891.00|
|Status of Covenants|
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ADB $100 Million Assistance to Improve Elderly Care Services in Hebei ProvinceADB has approved a loan of $100 million with a complementary technical assistance grant of $670,000 to support development of an elderly care system in Hebei Province, People's Republic of China.
|Tender Title||Type||Status||Posting Date||Deadline|
|49028-002 PRC: Hebei Elderly Care Development Project||Invitation for Bids||Closed||13 Aug 2020||10 Sep 2020|
|Loan 3536 PRC: Hebei Elderly Care Development Project-LX-C0||Invitation for Bids||Closed||10 Sep 2019||09 Oct 2019|
|Loan 3536 PRC: Hebei Elderly Care Development Project (YS-C01)||Invitation for Bids||Closed||28 Aug 2019||22 Oct 2019|
|Establishment of an Integrated Comprehensive Three-tier system for Elderly Care - Consulting Firm||Firm - Consulting||Closed||31 Oct 2018||29 Nov 2018|
|Resettlement Specialist||Individual - Consulting||Closed||11 Sep 2018||25 Sep 2018|
|EC Technical Specialist||Individual - Consulting||Closed||11 Sep 2018||25 Sep 2018|
|Consulting Services of Project Implementation Support||Firm - Consulting||Closed||30 Aug 2017||28 Sep 2017|
|Contract Title||Approval Number||Contract Date||Contractor||Contractor Address||Executing Agency||Contract Description||Total Contract Amount (US$)||Contract Amount Financed by ADB (US$)|
|ELDERLY CARE SERVICE CENTER AND REHABILITATION OF 4 COUNTY COMMUNITY-BASED EC SERVICE CENTERS JL-C01||Loan 3536||04 Mar 2021||SHANXI SIXTH CONSTRUCTION GROUP CO., LTD.||SHANXI DEMONSTRATION ZONE SHANXI PROVINCE CHINA,PEOPLE'SREP.OF||Hebei Provincial Government||CONSTRUCTION||11,940,622.38||8,292,483.34|
|LX-C01: INTEGRATED ELDERLY CARE SERVICE CENTER AND TEN DAYCARE CENTERS||Loan 3536||03 Dec 2019||HEBEI CONSTRUCTION GROUP CO., LTD.||NO. 146, YOUYI NORTH STREET, SHIJIAZHUANG CITY, HEBEI CHINA,PEOPLE'SREP.OF||Hebei Provincial Government||CONSTRUCTION||17,331,951.91||11,925,356.96|
|Capacity Development||Technical Assistance 9326||22 Mar 2019||SIET Company Limited (CHINA,PEOPLE'SREP.OF) in association with Beijing Cuncao Care Management Consulting Co.,Ltd. (CHINA,PEOPLE'SREP.OF)||Unit 103, No. 999 South Suzhouhe Road Sh||Hebei Provincial Government||Consulting Services||516,380.00||—|
|CS01 CONSULTING SERVICES FOR PROJECT IMPLEMENTATION SUPPORT||Loan 3536||17 May 2018||NAREE CONSULTNG LIMITED IN ASSOCIATION WITH||ROOM A3-8, SOHO II, NO.9 GUANGHUA ROAD, CHAOYANG DISTRICT, BEIJING 100020 CHINA,PEOPLE'SREP.OF||Hebei Provincial Government||Consulting Services||1,920,220.00||1,920,220.00|
|Title||Document Type||Document Date|
|Hebei Elderly Care Development Project: Procurement Plan||Procurement Plans||Mar 2021|