China, People's Republic of: Demonstration of Guangxi Elderly Care and Health Care Integration and Public-Private Partnership Project

Sovereign Project | 50391-001

The proposed project aims to support Guangxi Zhuang Autonomous Region (GZAR) to promote, coordinate, and deliver integrated elderly care and health care services to provide continued care for those in need. It will serve as a demonstration for the People's Republic of China (PRC) of an integrated elderly care and health care system and will be the first project in GZAR to introduce internationally accepted public-private partnership (PPP) principles and standards in the elderly care sector.

Project Details

  • Project Officer
    Nigam, Jayati
    East Asia Department
    Request for information
  • Country
    China, People's Republic of
  • Sector
    • Health
Project Name Demonstration of Guangxi Elderly Care and Health Care Integration and Public-Private Partnership Project
Project Number 50391-001
Country China, People's Republic of
Project Status Active
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan 3819-PRC: Demonstration of Guangxi Elderly Care and Healthcare Integration and Public-Private Partnership Project
Ordinary capital resources US$ 100.00 million
Strategic Agendas Environmentally sustainable growth
Inclusive economic growth
Drivers of Change Gender Equity and Mainstreaming
Governance and capacity development
Knowledge solutions
Private sector development
Sector / Subsector

Health / Health sector development and reform - Health system development

Gender Equity and Mainstreaming Effective gender mainstreaming
Description The proposed project aims to support Guangxi Zhuang Autonomous Region (GZAR) to promote, coordinate, and deliver integrated elderly care and health care services to provide continued care for those in need. It will serve as a demonstration for the People's Republic of China (PRC) of an integrated elderly care and health care system and will be the first project in GZAR to introduce internationally accepted public-private partnership (PPP) principles and standards in the elderly care sector.
Project Rationale and Linkage to Country/Regional Strategy

The PRC is facing a serious change in its demographic structure. In 2017, 158 million people -11.4% of the population- were aged 65 years and above. The aging rate is expected to reach 14% in 2025 and 21% in 2035. The aging population increases incidence of age-related diseases. Elderly people typically have chronic diseases and experience multiple morbidities. The primary cause of their care dependence is the loss of physical function resulting from chronic diseases and age-associated impairments. Further, many elderly people have complex cases of multiple chronic diseases and physical and/or cognitive disabilities which require a continuity of services for both elderly care and health care. Coordination of care between health sector and elderly care sector is necessary to provide seamless care services for elderly people in need and to reduce avoidable hospitalization.

In an aging society, elderly people tend to be readmitted to hospital because of lack of appropriate elderly care institutions that allow them to transition back to their homes. However, it would be difficult for families to provide adequate care for elderly people who are discharged from hospitals and still require medical and elderly care services. Inadequate care at home can cause further health problems, which may require readmission to hospital. Frequent transitions between hospitals and homes or long stays in hospitals further reduce the functional abilities of the elderly.

In the PRC, more than 100 million elderly people had at least one chronic disease in 2013. The burden of chronic disease is expected to increase by 40% by 2030 from the status of 2013. The number of elderly people with multiple chronic conditions is also increasing significantly in the PRC. Those elderly people would require post-acute care and rehabilitation to restore or stabilize their functionality after discharge from hospital as well as elderly care (long-term care) to maintain their daily living. A coordination system, linking the acute phase care, post-acute phase care, rehabilitation, and elderly care in an effective and efficient way, is at the core of integrated health and elderly care. Such a system needs to ensure smooth linkage of care services across the elderly care and health care sectors.

To create a coordination system, a functional hospital discharge management system needs to be established. The discharge management system will (i) clarify care needs after hospitalization, including needs for medical care, medication, rehabilitation, and elderly care; and (ii) identify where and how an elderly person can access his or her needed care. Such individualized care plans should be prepared based on discussions with the elderly people, their families, medical experts, therapists, social workers, and elderly care experts. Further, it is necessary to strengthen the elderly care service capacity to meet a range of care needs. The integration of health and elderly care will provide seamless care services across the two sectors based on needs, and avoid using medical resources for the elderly care service provision.

Enhanced private sector involvement is vital to fill the gap in supplying coordinated elderly care and health care services. Quantity of private providers varies greatly across localities, and no scheme has been established to ensure their quality. Considering substantial increase in care needs due to rapid aging of the population, it would be unrealistic for the public sector to be the main provider of care services. Meanwhile, the public sector needs to take responsibility for establishing standardized care needs assessment and service quality monitoring systems. The private sector could bring its knowledge and experience to better design facilities, engage skilled staff, and provide efficient services under the guidelines and regulations set by the public sector. Such alignment of responsibilities is not yet clearly established in the PRC elderly care sector.

The Government of the PRC has recognized the importance of integrated elderly care and health care services to respond to its rapidly aging population, and issued a related policy in 2015. In line with the central policy, the Government of GZAR (GGZAR) in 2016 issued policies on the implementation of elderly care and health care integration, and for enhancing the involvement of the private sector in care service provision for elderly people. While the GGZAR issued those policies, it has limited experience and capacity in promoting the integration of elderly care and health care, and private sector involvement in the coordinated care service provision.

In order to build the institutional capacity and system, the municipalities of Nanning and Hezhou were selected as pilot cities for elderly care and health care integration in 2017. In the same year, people aged 65 years and above were 0.8 million and 0.2 million in Nanning and Hezhou municipalities which account for 11.4% and 10.1 % of the population, respectively. More than 85% of those elderly people have at least one chronic disease and about 60% have multimorbidity. The integration of elderly care and health care is necessary to provide needed care services for those elderly people. However, most elderly patients directly return home after discharge from tertiary level hospitals. A functional coordination system is not established between hospitals and elderly care facilities in those municipalities. The inter-sectoral coordination among bureaus, such as the civil affairs bureaus and the health commission, needs to be established.

Impact Integrated elderly care and health care services in Guangxi Zhuang Autonomous Region established
Project Outcome
Description of Outcome Utilization of coordinated health care and elderly care services in Guangxi Zhuang Autonomous Region increased
Progress Toward Outcome The loan and project agreements were signed on 22 November 2019. The project became effective on 4 March 2020. The project management and capacity development consulting services package was awarded on 6 April 2021. Submission 2 for the technical capacity in elderly care sector consulting service package was approved on 19 July 2021. Out of the five elderly care facilities to be construction, the building design plan for the three facilities have been approved by ADB, of which preliminary design for two have been approved.
Implementation Progress
Description of Project Outputs

Coordinated care services and facilities improved

Public -private partnership project for integrated elderly care and health care services provision developed

Management and policy development capacities in promoting integrated elderly care and health care services developed

Status of Implementation Progress (Outputs, Activities, and Issues)

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion.

To be assessed at completion. Launch of tender documents for the PPP subproject is due by Dec 2021. Awarding of contract to the PPP concessionaire will be by 2022.

Building design plans for three facilities that incorporate elderly care design have been approved by ADB. Those designs have been incorporated in the preliminary and detailed designs.

Geographical Location Guangxi
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 (EMP), was prepared for five elderly care facilities and a medical facility, and was disclosed on the ADB website in June 2019. The IEE concluded that the anticipated environmental impacts can be mitigated through effective EMP implementation. During construction, impacts anticipated including noise, air pollutants, demolition waste, and risk to community and occupational health and safety are localized and short-term and can be effectively mitigated by implementing good construction practices. Contractors will address management of wastewater and drainage, medical waste, and their linkage with associated facilities, as required in the IEE and EMP. The EMP lists mitigation procedures that must be strictly followed in compliance with PRC regulations and ADB guidelines. The executing agency has confirmed its commitment and capacity to implement the EMP. Further capacity building is proposed in the EMP. It will assign a safeguards officer within the GPMO to supervise effective implementation of the EMP. The procedures, reporting timelines, and roles and responsibilities of relevant agencies are described in the EMP. Environmental complaints will be handled in accordance with the grievance redress mechanism established for the project by the GPMO.
Involuntary Resettlement The project requires 11.38 hectares (ha) of land, comprising 4.94 ha of rural collective lands and 6.44 ha of state-owned lands. Rural collective lands will be acquired for the second elderly care facility under the Hezhou People's Hospital subproject and will affect 56 households with 296 persons in Xiadao village, of which 26 households with 152 persons will be significantly impacted because of house demolition. The income losses for households with land impacts has been assessed to be insignificant, with less than 1% of their household incomes affected. A draft resettlement plan was prepared following the laws and regulations of the PRC, GZAR, and Hezhou Municipality; and ADB's Safeguard Policy Statement (2009). HMG will be responsible for paying compensation and assisting affected persons before land acquisition and relocation. The other five facilities will be located on stateowned lands, and the resettlement due diligence confirmed that there is no past nor present concerns related to involuntary resettlement. During project implementation, the GPMO and resettlement management staff of implementing agencies and PIEs will be trained in involuntary resettlement procedures. A grievance redress mechanism has been established, and an external agency will be engaged for semiannual resettlement monitoring and evaluation.
Indigenous Peoples In subproject areas of Nanning Municipality, ethnic minorities account for 50% of the total population. In the subproject area in Pinggui District, Hezhou Municipality, they account for 2% of the total population. The Zhuang is the dominant ethnic minority in Nanning while the Yao is the dominant ethnic minority in Hezhou. Ethnic minorities live in harmony with others and anticipate no obstruction or discrimination in accessing improved elderly care and health care services under the project. The subprojects will not adversely affect their community identities, beliefs, religions, or customs. Therefore, an ethnic minority development plan to ensure that they receive improved elderly care services and health services is not required.
Stakeholder Communication, Participation, and Consultation
During Project Design From December 2018 to February 2019, 2,000 persons were interviewed, 8 consultations with government agencies and 5 focus group discussions were held, and 12 key informant interviews were conducted. The civil affairs bureau, poverty alleviation office, health commission, human resource and social security bureau, and Xiadao village committee took part in the consultations.
During Project Implementation During project implementation, consultations will be conducted to (i) increase elderly people's awareness of coordinated elderly care and health care services, (ii) strengthen the understanding of necessary cross-sector coordination among relevant bureaus, and (iii) improve the accessibility of elderly who need coordinated elderly care and health care services.
Business Opportunities
Consulting Services

All consulting services will be undertaken in accordance with ADB's Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time). Details are below:

Quality-cost based selection (implementation support) - 142.5 person-months

Quality-cost based selection (construction supervision) - 320.0 person-months

Quality-cost based selection (technical capacity) - 120.0 person-months

Consultants' qualification selection (external monitoring) - 28.0 person-months

Individual consultant selection (technical capacity) - 20.0 person-months

Procurement

All procurement of goods and work will be undertaken in accordance with ADB's Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time). Details are below:

Open competitive bidding with national advertisement - 18 contracts

Open competitive bidding with international advertisement - 1 contract

Responsible ADB Officer Nigam, Jayati
Responsible ADB Department East Asia Department
Responsible ADB Division Urban and Social Sectors Division, EARD
Executing Agencies
Government of Guangxi Zhuang Autonomous Region, through Guangxi Foreign Loans Project Management Office
[email protected]
18th Floor, Guangxi Development Plaza
East Building, No. 111-1 Minzu_Avenue
Nanning, Guangxi
Timetable
Concept Clearance 06 Dec 2018
Fact Finding 09 Apr 2019 to 16 Apr 2019
MRM 27 Jun 2019
Approval 24 Sep 2019
Last Review Mission -
Last PDS Update 27 Sep 2021

Loan 3819-PRC

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
24 Sep 2019 22 Nov 2019 04 Mar 2020 30 Apr 2026 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 193.52 Cumulative Contract Awards
ADB 100.00 15 Oct 2021 1.27 0.00 1%
Counterpart 93.52 Cumulative Disbursements
Cofinancing 0.00 15 Oct 2021 0.31 0.00 0%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating Unsatisfactory Unsatisfactory Satisfactory Unsatisfactory - -

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.

The Access to Information Policy (AIP) recognizes that transparency and accountability are essential to development effectiveness. It establishes the disclosure requirements for documents and information ADB produces or requires to be produced.

The Accountability Mechanism provides a forum where people adversely affected by ADB-assisted projects can voice and seek solutions to their problems and report alleged noncompliance of ADB's operational policies and procedures.

In preparing any country program or strategy, financing any project, or by making any designation of, or reference to, a particular territory or geographic area in this document, the Asian Development Bank does not intend to make any judgments as to the legal or other status of any territory or area.


Safeguard Documents See also: Safeguards
Safeguard documents provided at the time of project/facility approval may also be found in the list of linked documents provided with the Report and Recommendation of the President.


Evaluation Documents See also: Independent Evaluation

None currently available.


Related Publications

None currently available.


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.

Requests for information may also be directed to the InfoUnit.

Tenders

Tender Title Type Status Posting Date Deadline
External Environment Monitor Specialist Individual - Consulting Closed 20 May 2021 02 Jun 2021
External Resettlement and Social Monitor Specialist Individual - Consulting Closed 20 May 2021 02 Jun 2021
Technical Capacity Development in Elderly Care Sector Firm - Consulting Closed 08 Sep 2020 11 Nov 2020
Project Management and Capacity Development Firm - Consulting Closed 23 Apr 2020 27 May 2020

Contracts Awarded

Contract Title Approval Number Contract Date Contractor | Address Executing Agency Total Contract Amount (US$) Contract Amount Financed by ADB (US$)
PROJECT MANAGEMENT AND CAPACITY DEVELOPMENT Loan 3819 08 Apr 2021 BEIJING HELISON INFORMATION CONSULTING CO. LTD | ROOM 320 NO 12 ANHUILI 2ND COMMUNITY CHAOYANG DISTRICT, BEIJING, CHINA, PEOPLE'S REP.OF Govt of GZAR, thru Guangxi Foreign Lns_Prj Mgt Off 1,094,009.00 1,094,009.00