The knowledge and support technical assistance (TA) will provide research-based solutions in the health sector to support inclusive growth in the People's Republic of China (PRC). It will (i) address institutional challenges, and (ii) promote digital technology and eventually generate regional public goods. The TA will reduce the rural-urban disparity in health service delivery, and support the achievement of Sustainable Development Goal 3 (to ensure healthy lives and promote well-being for all at all ages) and attainment of universal health coverage.
|Project Name||Strengthening the Rural Health System in Guangxi Zhuang Autonomous Region|
|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||Gender Equity and Mainstreaming
Governance and capacity development
|Sector / Subsector||
Health / Health system development
|Gender Equity and Mainstreaming||Effective gender mainstreaming|
|Description||The knowledge and support technical assistance (TA) will provide research-based solutions in the health sector to support inclusive growth in the People's Republic of China (PRC). It will (i) address institutional challenges, and (ii) promote digital technology and eventually generate regional public goods. The TA will reduce the rural-urban disparity in health service delivery, and support the achievement of Sustainable Development Goal 3 (to ensure healthy lives and promote well-being for all at all ages) and attainment of universal health coverage.|
|Project Rationale and Linkage to Country/Regional Strategy||
The Government of the Guangxi Zhuang Autonomous Region (GZAR) is committed to the PRC's national rural revitalization strategy as it aims to reinvigorate rural areas to reduce poverty, promote equity, improve rural development, and support green and inclusive growth. Improving access to health services is critical to achieving this goal, particularly in rural areas.
The PRC's health sector has undergone a series of reforms since 2009. These included shifting resources to primary health care (PHC), which has supported the PRC's high level of health coverage and the New Rural Cooperative Medical Scheme, which has become a nationwide comprehensive insurance scheme providing outpatient benefits that target the rural population. The Healthy China 2030 plan-a national strategy approved by the State Council-further guides all provinces and regions, including GZAR, to prioritize improvement of rural PHC quality, through the use of innovations and health system efficiencies, to reduce the burden on hospitals and secondary health facilities. However, there is still a significant gap across the PRC in terms of health care service quality between urban and rural areas. The quality of clinical processes is often left to the discretion of providers, while the quality of health care services is highly dependent on provider capacity. Providers in urban areas typically have more resources and capacity than those in rural areas. GZAR has a rural population of 3 million people in 54 poor counties, and faces considerable challenges in improving rural health care quality, and in implementing Healthy GZAR 2030.
In addition to gaps in quality between urban and rural health services, GZAR also faces health risks stemming from the significant volume of cross border trade with and migration from Viet Nam. Controlling outbreaks and cross border health threats can be a major challenge; in GZAR, animal trade and human migration have the potential to spread communicable diseases across borders. PHC service providers are the first point of contact for early disease detection, treatment, and surveillance. Ensuring high-quality PHC services, especially in rural border areas, can control potential epidemics and protect the health of the population, including vulnerable groups such as internal and cross border migrants. PHC facilities should be strengthened, particularly in rural underserved areas, by improving the quality and capacity of the facilities, as these are the closest diagnostic facilities on the ground and serve as important surveillance points.
GZAR provides free basic public health services to migrants, focusing mainly on maternal and child health and family planning services. Services include immunization, prenatal and postnatal checkups for pregnant women, prevention and control of communicable diseases, and family planning and health education. While basic health care needs are covered, services related to noncommunicable diseases (NCDs) and other clinical services, occupational health, rehabilitation, and palliative care (i.e., inpatient and outpatient services) are not covered for migrants. Such services should be extended to migrants to reduce inequality and improve the overall health of the migrant population.
In addition, GZAR is facing the PRC's broader national challenge of a rapidly aging elderly population. Longer life expectancies are increasing the susceptibility of the elderly to costly prolonged medical issues, particularly NCDs. NCD cases among Chinese people above the age of 40 are predicted to triple over the next 2 decades, while 35% of the PRC's population will be above 60 years of age by 2050. Increasing health care services for major NCDs (asthma, cancer, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, and stroke) require integration of primary care settings using innovative and cost-effective interventions. ADB has increasingly strengthened its intervention for elderly care in GZAR since 2015. A project approved in September 2019 aims to help GZAR develop a proper integrated health referral system between medical institutions such as hospitals and elderly care institutions, and improve the quality and quantity of elderly care institutions to provide a range of care needs. This effort must be expanded to rural primary health service providers, as they are the first level health care providers in the rural areas.
Although the government has actively promoted the use of digital technology to improve health service delivery and management following the Healthy China 2030 plan, an urban-rural gap remains in terms of the actual use of digital technology in urban and rural health systems. Large hospitals in urban areas are using digital technology to efficiently deliver services and manage overcrowding by queuing patients through online appointment systems, electronic notification of examination results, digital payment systems, and electronic medical records systems. Nevertheless, the use of digital technology in rural health facilities is lagging behind. Online systems to improve family doctor services and remote diagnosis have been designed, but are not fully functional, as rural PHC providers use the system only to settle health insurance claims.
To respond to current gaps in rural health service delivery including the weak adoption of digital technology, rapidly changing needs of the vulnerable rural population, and increasing health risks related to cross border trade and migration; assessments of GZAR's rural health system will be conducted. The TA outputs will help determine interventions that would strengthen GZAR's rural health system.
|Impact||Rural health system in GZAR strengthened|
|Description of Outcome||GZAR''s rural primary health system planning and management improved|
|Progress Toward Outcome|
|Description of Project Outputs||
1. Health services in rural areas assessed
2. Application of digital technology for health care services assessed
3. Knowledge on improved rural PHC expanded
|Status of Implementation Progress (Outputs, Activities, and Issues)|
|Summary of Environmental and Social Aspects|
|Stakeholder Communication, Participation, and Consultation|
|During Project Design|
|During Project Implementation|
|Consulting Services||The TA will engage both national and international consultants. ADB will engage the consultants and carry out procurement following the ADB Procurement Policy (2017, as amended from time to time) and its associated project administration instructions and/or staff instructions.|
|Responsible ADB Officer||Eisuke Tajima|
|Responsible ADB Department||East Asia Department|
|Responsible ADB Division||Urban and Social Sectors Division, EARD|
Guangxi Development and Reform Commission
No. 1 Minle Road, Nanning
Guangxi, PRC (Post code: 530012) Guangxi Zhuang Autonomous Region Health Commission
Minzu Avenue,Nanning,Guangxi Zhuang Autonomous Region Ministry of Health
Project Management, Foreign Loan Office
People's Republic of China
|Concept Clearance||24 Oct 2019|
|Fact Finding||16 Sep 2019 to 20 Sep 2019|
|Approval||03 Dec 2019|
|Last Review Mission||-|
|Last PDS Update||05 Dec 2019|
|Approval||Signing Date||Effectivity Date||Closing|
|03 Dec 2019||28 Dec 2019||28 Dec 2019||30 Jun 2021||-||-|
|Financing Plan/TA Utilization||Cumulative Disbursements|
|400,000.00||0.00||0.00||0.00||0.00||0.00||400,000.00||03 Dec 2019||0.00|
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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|Title||Document Type||Document Date|
|Strengthening the Rural Health System in Guangxi Zhuang Autonomous Region: Technical Assistance Report||Technical Assistance Reports||Dec 2019|
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