Asia is undergoing one of the most profound demographic shifts in the world, wherein by 2050, the number of people over the age of 65 is expected to exceed 1 billion. The Midterm Review of Strategy 2020; Social Protection Operation Plan, 2014-2020; and Operational Plan for Health, 2015-2020 of ADB all recognize the challenges this demographic shift poses for growth in the region and the risk of creating new vulnerable populations if these challenges are not addressed. The TA will be a first step in developing a new ADB business line that cuts across sectors and is at the center of development needs in Asia and the Pacific.
|Project Name||Strengthening Developing Member Countries’ Capacity in Elderly Care|
|Project Type / Modality of Assistance||Technical Assistance
|Source of Funding / Amount||
|Strategic Agendas||Inclusive economic growth
|Drivers of Change||Gender Equity and Mainstreaming
Governance and capacity development
Private sector development
|Sector / Subsector||
Health / Health sector development and reform
|Gender Equity and Mainstreaming||Effective gender mainstreaming|
|Project Rationale and Linkage to Country/Regional Strategy||Asia is undergoing one of the most profound demographic shifts in the world, wherein by 2050, the number of people over the age of 65 is expected to exceed 1 billion. The Midterm Review of Strategy 2020; Social Protection Operation Plan, 2014-2020; and Operational Plan for Health, 2015-2020 of ADB all recognize the challenges this demographic shift poses for growth in the region and the risk of creating new vulnerable populations if these challenges are not addressed. The TA will be a first step in developing a new ADB business line that cuts across sectors and is at the center of development needs in Asia and the Pacific.|
|Impact||DMCs commitment to develop elderly care services supported by ADB financing and knowledge work by 2020 intensified (MTR 2020, and Operational Plan for Health for 2015 to 2020). Old-age vulnerabilities in Asia and the Pacific through increasing social protection operations reduced (Social Protection Operational Plan for 2014 to 2020).|
|Description of Outcome||Strategic planning and policy development in elderly care improved.|
|Progress Toward Outcome||
In November 2016, the consulting firm HelpAge International was mobilized to assist ADB in implementing the TA until May 2019. The consulting firm was tasked to: (i) build an in-depth knowledge base for six countries (Thailand, Viet Nam, Indonesia, Mongolia, Tonga, and Sri Lanka) on emerging LTC policies, programs and systems; (ii) identify areas and/or projects for investment; and (iii) build capacity and assist government, private sector, and civil society stakeholders in DMCs across Asia and the Pacific in strategic planning and exchange of experiences. The focus of the assignment is on components one (country diagnostics) and two (capacity building).
A Kick Off workshop was held in Thailand on 12-13 January 2017 attended by the 17 national and international HelpAge consultants and a member of the ADB TA supervising unit to finalize the methodology for preparing the country diagnostic studies. An inception report was submitted and approved in February 2017. National consultation workshops were organized in the six TA countries to present the initial findings of the country diagnostic studies and seek feedback from a wide range of stakeholders consisting of senior officials from concerned national and local government ministries/agencies, associations of the elderly, public and private sector providers, NGOs and CSOs, research institutions and universities. All six country diagnostic studies have been completed with the final draft reports being edited. These reports provide snapshots of the existing situation for long-term care in each country (policies, services, institutional responsibilities and challenges). Furthermore, a capacity building framework was developed based on the initial findings of the draft country diagnostic reports and the feedback received from earlier national consultation workshops. Strategic planning was integrated in the capacity development plan as the first activity with subsequent capacity building activities identified to strengthen the initial strategic plan with deliverables, timelines, and performance indicators. Strategic planning workshops were undertaken in Indonesia, Mongolia, Sri Lanka, and Viet Nam between April-August 2018.
All six country diagnostic studies and final draft reports have been completed. These reports provide snapshots of the existing situation for long-term care in each country (policies, services, institutional responsibilities and challenges). The results of the country diagnostics and feedback from national consultations identified several priority areas for LTC system development, to include: coordination of efforts across sectors under a shared strategic direction which considers the various elements of LTC system, development of human resources to ensure supply of appropriately skilled care providers, development of integrated and accessible services along the continuum of care and coordination mechanisms, and development of financial systems for LTC which ensure that needed care is affordable. Furthermore, a capacity building framework was developed based on the initial findings of the draft country diagnostic reports and the feedback received from earlier national consultation workshops. Strategic planning was integrated in the capacity development plan as the first activity with subsequent capacity building activities identified to strengthen the initial strategic plan with deliverables, timelines, and performance indicators. Strategic planning workshops were undertaken in Indonesia, Mongolia, Sri Lanka, and Viet Nam between April-August 2018. In January 2019, a strategic planning workshop was held in Nuku'alofa in response to an earlier request from the government to build on the initial findings of the country diagnostic study on the current situation of LTC in Tonga. The Technical Working Groups established in these four DMCs continue to work on their respective strategic plans on LTC. In Indonesia, STRANAS and LTC plan will feed into the National Development Plan expected to be approved in 2019. Mongolia's Law on Elderly and the LTC plan when completed this year will feed into the National Plan on Elderly. In Viet Nam, the ongoing strategic planning is informing the political and policy shift towards the bigger program of Adapting to Aging Viet Nam.
|Description of Project Outputs||
1. Knowledge base on elderly care improved
2. Capacity of DMCs to develop policies and plans for elderly care services increased
3. Knowledge sharing and networking systems developed
|Status of Implementation Progress (Outputs, Activities, and Issues)||
1. A major output of the TA is the preparation of country diagnostic studies for the six TA countries, to cover policy and regulatory frameworks, institutional arrangements and capacity, needs of older people and service provider assessments, human resources (constraints and development), existing programs and coverage and financing. All six country diagnostic studies have been completed with national consultation workshops held to seek feedback from a wide range of stakeholders. The country diagnostic studies undertaken revealed the varying country contexts on rate of population aging, geography, economic and social development, political systems and other key factors on how countries should respond to the challenges of an aging population. But, there were common realities shared by the six country diagnostics such as the large deficits in LTC care service provision and especially for affordable care provision. The majority of care provision is supplied informally usually by family members, who rarely receive any support or training. As population demographics change and support needed for complex care needs rise, there is a need to develop systems and services which can help alleviate the widening gap between demand and supply for care.
2. A capacity building framework was prepared based on the findings of the country diagnostic studies and feedback from earlier national consultations with a wide range of stakeholders. Strategic planning was integrated in the capacity development plan as the first activity with subsequent capacity building activities taking place to strengthen the initial strategic plan with deliverables, timelines, and performance indicators. To date, strategic planning workshops on long-term care were held in Jakarta (25-27 April 2018); Colombo (13-14 June 2018), Hanoi (18-19 June 2018), and Ulaanbaatar (30-31 August 2018). In Sri Lanka, Viet Nam, and Mongolia, the workshops were preceded by short site visits to understand more about the country context with regards to existing health and social services for older people requiring long-term care.
The capacity building workshops for DMC officials, private sector and civil society stakeholders are being conducted in a phased manner to enable relevant content development and availability of appropriate resource persons. Areas to be covered include home, community and residential based elderly care services and facilities, human resources, financing and insurance systems, monitoring and evaluation programs, among others. In Indonesia, a Workshop on LTC Service Delivery, Quality Care, and Partnership was held on 15-17 November 2018 in Jakarta. Topics discussed included examples of integrated and comprehensive home and community-based services, management framework for quality care, quality monitoring tools, care management standards. Licensing mechanisms, practice guidelines, among others. Similar workshops were held in Ulaanbaatar, Mongolia on 21-23 November 2018; and in Hanoi, Viet Nam on 10-12 December 2018. The second capacity building workshop focusing on human resources and financing were held in Ulaanbaatar, Mongolia on 13-14 March 2019; in Jakarta, Indonesia on 20-21 March 2019; and in Hanoi, Viet Nam on 27-28 March 2019. Two workshops covering the two topics will be held in Sri Lanka in May 2019.
Other regional training and capacity-building workshops to develop policies and plans for elderly care services were also completed. A regional learning program was held in Tokyo on 5-7 December 2018 in collaboration with ADBI. The event was attended by 48 participants from 9 DMCs and ADB staff from regional departments and sector/thematic groups. Resource experts from Tsao Foundation, Singapore's Center of Excellence on Aging and ADB's Knowledge Partner under RETA 9111, as well as practitioners and experts from Japan's Ministry of Health, Labor and Welfare, National Institute of Public Health, Japan International Cooperation Agency, and other leading organizations on community care centers, residential care centers, community-based integrated system participated and shared their views and experiences. The regional program helped DMCs and ADB staff acquire knowledge and better understanding of the system in Japan in developing policies and investments on long-term care the DMCs and ADB to identify suitable modalities and assistance for capacity building in DMCs, including identifying potential investments for development operations in the emerging area of long-term care. Tsao Foundation, a Singapore-based institution focusing on community-based services for aging population in Singapore, delivered the training workshop on 27 February 2019 2 March 2019 in Singapore. This workshop is one of the major deliverables under the ADB-Tsao KPA signed in December 2017. The participants learned about the design, management, and delivery of home and community-based care in Singapore, including care management process, quality management and human resource development. There were field visits to Tsao Foundation programs and other initiatives in Singapore (i.e., Hua Mei Mobile Clinic, EPICC Senior Care Center, Whampoa Community for Successful Ageing, St. Andrews Community Hospital, Kampung Admiralty Active Ageing Hub, and Kampung Wellness), which highlighted a range of elderly care services and approaches.
3. The TA also provides for the establishment of partnerships with centers of excellence. A Knowledge Partnership Agreement (KPA) with Tsao Foundation was signed on 27 December 2017 to provide additional technical expertise for the TA activities on capacity building, networking, peer review, and knowledge creation. Innovative and focused activities to support the strengthening of DMC's capacity in elderly care will be developed under the KPA. The Tsao Foundation is a Singapore-based institution focusing on community-based services for aging population in Singapore, and research on aging in general. Similar partnership or collaboration with other centers of excellence will be established. Discussions with other centers of excellence are ongoing.
Two regional conferences were held as part of Output 3 activities, namely: (i)_3rd ASEAN-Japan Active Aging Conference_ held on 26 27 June 2017 at ADB Headquarters, Manila in collaboration with the Ministry of Labor and Social Welfare (MLSW) of Japan building on the ministry's cooperation with the Association of Southeast Asian Nation; and (ii) Regional Conference on Aging Asia and the Pacific Developing Long Term Care Systems, held on 28 29 June 2017, also at ADB Headquarters.
The 3rd ASEAN-Japan Active Aging Conference was attended by 51 participants representing officials from ASEAN member countries, , MLSW Japan, and several ADB staff from regional departments. This conference falls within the various cooperation frameworks established to address aging-related policies and actions in the ASEAN, such as the ASEAN+3 Health Ministers' Meeting, ASEAN Plus Three Ministerial Meeting on Social Welfare Development, and ASEAN-Japan High Level Officials Meeting on Caring Societies.
The Regional Conference on Aging Asia and the Pacific Developing Long Term Care Systems discussed the policies and growing challenges in the region, including the physical, social, and psychological aspects of aging and long-term care. It focused on the need to integrate long-term care solutions across multiple sectors. The conference supported sharing of best practices in developing policies, implementing services, and designing investments in elderly care from the experience of Hong Kong, China; Japan; the Republic of Korea; and Singapore, which have been the region's leaders in addressing the demands for elderly care in ways that are adapted to their needs and circumstances. There is a wide geographic spread amongst the participants and resource persons in this room. Over 200 participants came from 20 countries across the entire Asia Pacific region covered by 5 regional departments of ADB from the Central and West Asia region to the Pacific. There were also resource persons from 14 countries including: Australia, Brazil, Indonesia, Japan, Republic of Korea, Mongolia, People's Republic of China, the Philippines, Singapore, Sri Lanka, Switzerland, Thailand, Tonga, and Viet Nam. The conference sessions were designed in collaboration with the sector and thematic groups, ERCD, and the regional sector divisions. The participants to the conference included DMC officials and civil society stakeholders, resource persons of various fields of expertise from academe and research institutions, international organizations, foundations, and development partners from within and outside the region.
The TA under the e-Asia Knowledge Partnership financing supported the Conference on Developing Healthy, Inclusive, and Age-Friendly Cities in the People's Republic of China: From Policy to Practice. The conference, which was a collaboration between ADB (Social Development Thematic Group, SDCC and Urban and Social Sectors Division, EARD) and Tongji University, PRC, was held on 21-22 November 2018 in Shanghai. There were about 64 attendees with the participants coming from Georgia, Sri Lanka, Viet Nam, various PRC provinces, ADB staff, and included experts from Canada, United Kingdom, Hong Kong, PRC, and Singapore. The conference featured a major policy reform area, i.e., Health China 2030, which called on all sectors and government institutions to address the remaining challenges of developing a healthy China. There was a focus on the role for the urban sector in creating healthy environments, ensuring access to services, and addressing the needs of disabled and older populations as they seek to age in place. The conference provided insights on how to move from policy to practice, profiled ADB projects and knowledge networks, and shared international good practice in tools and approaches.
A TA website has been created in time for the two regional conferences in June 2017, and is being revamped and populated with updates on the TA progress, information and links to various publications, knowledge products on good practices, emerging issues, and working solutions in aging and long-term care. The website will showcase knowledge products, good practices, and working solutions in aging and long-term care. It will create a knowledge base in Asia and the Pacific on developing long-term care systems and services, help capacity building of DMC officials, and create a knowledge network to disseminate good practices and expertise. The TA has also published newsletters on various topics and events related to aging and long-term care. It is also planned that the TA will develop an e-network of professionals and specialists in government, private sector, and civil society working in long-term care across Asia and the Pacific.
The TA promotes the visibility of both JFPR and e-Asia and Knowledge Partnership Fund in the various workshops, training, and capacity building activities within and outside ADB. The logos of both financiers were prominently displayed on all workshop materials including backdrop, agenda, signages, and IDs and publicity material. Financial assistance was specifically mentioned in all correspondence leading up to the event, with specific acknowledgment of the financial support at the start of workshops, national consultations, trainings, and conferences.
|Geographical Location||Indonesia - Nation-wide; Mongolia - Nation-wide; Sri Lanka - Nation-wide; Thailand - Nation-wide; Tonga - Nation-wide; Viet Nam - Nation-wide|
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design||A working group with focal points from each ADB regional department, will help ensure good coordination with government and other stakeholders.|
|During Project Implementation||Consultations with DMC officials, private sector, various civil society stakeholders, were conducted in the preparation of the country diagnostic studies, and in the conduct of the capacity building workshops.|
|Consulting Services||HelpAge International has mobilized a team consisting of 12 national consultants, four international consultants, a project officer, and a research assistant. Four other individual consultants (International Long-Term Care Specialist, and national TA Coordination and Knowledge Management (KM) Specialist, Content Analysis and Writing Specialist), and Website Developer and Information System Manager have also been mobilized. The consultants were engaged according to ADB's Guidelines on the Use of Consultants (2013, as amended from time to time). Proceeds of the TA are being disbursed in accordance with the Technical Assistance Disbursement Handbook (2010, as amended from time to time).|
|Responsible ADB Officer||Walker, Wendy M.|
|Responsible ADB Department||Sustainable Development and Climate Change Department|
|Responsible ADB Division||SDTC-SOC|
|Concept Clearance||15 Jul 2015|
|Fact Finding||24 Aug 2015 to 28 Aug 2015|
|Approval||13 May 2016|
|Last Review Mission||-|
|Last PDS Update||27 Mar 2019|
|Approval||Signing Date||Effectivity Date||Closing|
|13 May 2016||-||13 May 2016||31 May 2019||13 May 2021||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|0.00||2,500,000.00||0.00||0.00||0.00||0.00||2,500,000.00||13 May 2016||1,957,624.17|
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|Title||Document Type||Document Date|
|Country Diagnostic Study on Long-Term Care in Thailand||Reports||Dec 2020|
|Country Diagnostic Study on Long-Term Care in Mongolia||Reports||Nov 2020|
|Lessons from Thailand's National Community-Based Long-Term Care Program for Older Persons||Brochures and Flyers||Nov 2020|
|Singapore's Long-Term Care System: Adapting to Population Aging||Brochures and Flyers||Sep 2020|
|Strengthening Elderly Care Capacity in Asia and the Pacific||Papers and Briefs||Sep 2016|
The Access to Information Policy (AIP) establishes the disclosure requirements for documents and information ADB produces or requires to be produced in its operations to facilitate stakeholder participation in ADB's decision-making. For more information, refer to the Safeguard Policy Statement, Operations Manual F1, and Operations Manual L3.
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|Contract Title||Approval Number||Contract Date||Contractor||Contractor Address||Executing Agency||Contract Description||Total Contract Amount (US$)||Contract Amount Financed by ADB (US$)|
|Capacity Development||Technical Assistance 9111||23 Nov 2016||Helpage International (United Kingdom)||207-221 Pentonville Rd London,London N1 Tavis House, 1-6 Tavistock Square WC1H 9 London, United Kingdom||Asian Development Bank||1,022,543.00||—|
None currently available.