China, People's Republic of : Strengthening Public Health Institutions Building Project

Sovereign Project | 54118-001

The project will support the People's Republic of China (PRC) in implementing its Healthy China 2030 to improve the quality and services of the health care system; and its Fourteenth Five-Year Plan, 2021-2025 by implementing health system strengthening. The project is aligned with the Asian Development Bank's (ADB) Strategy 2030, accelerating progress in gender equality, strengthening governance and institutional capacity, and fostering regional cooperation and integration; as well as the country partnership strategy for the PRC, 2021-2025 which aims at strengthening national and regional health security under strategic priority 3. It also supports the United Nations Sustainable Development Goal on promoting healthy lives and well-being.

Project Details

  • Project Officer
    Habib, Najibullah
    Sectors Group
    Request for information
  • Country/Economy
    China, People's Republic of
  • Sector
    • Health
Project Name Strengthening Public Health Institutions Building Project
Project Number 54118-001
Country / Economy China, People's Republic of
Project Status Active
Project Type / Modality of Assistance Loan
Source of Funding / Amount
Loan 4224-PRC: Strengthening Public Health Institutions Building Project
Ordinary capital resources US$ 300.00 million
Operational Priorities OP1: Addressing remaining poverty and reducing inequalities
OP2: Accelerating progress in gender equality
OP3: Tackling climate change, building climate and disaster resilience, and enhancing environmental sustainability
OP6: Strengthening governance and institutional capacity
OP7: Fostering regional cooperation and integration
Sector / Subsector

Health / Disease control of communicable disease - Health system development

Gender Gender equity theme
Description

The project will support the People's Republic of China (PRC) in implementing its Healthy China 2030 to improve the quality and services of the health care system; and its Fourteenth Five-Year Plan, 2021-2025 by implementing health system strengthening. The project is aligned with the Asian Development Bank's (ADB) Strategy 2030, accelerating progress in gender equality, strengthening governance and institutional capacity, and fostering regional cooperation and integration; as well as the country partnership strategy for the PRC, 2021-2025 which aims at strengthening national and regional health security under strategic priority 3. It also supports the United Nations Sustainable Development Goal on promoting healthy lives and well-being.

Close consultation with the World Health Organization (WHO) has informed proposed activities and guided adherence to international best practices and standards to advance core capacities for public health. The project is in harmony with sector support of development partners such as the World Bank and Asian Infrastructure Investment Bank.

Project Rationale and Linkage to Country/Regional Strategy

Strategic context. The proposed project introduces a transformational approach to address gaps by strengthening public health institutional capacity in the PRC. The PRC has experienced rapid economic growth in the past decades enabling more than 850 million people to escape poverty. These achievements allowed investments in the health sector that resulted in near universal health coverage, improved equity and access, reduced child and maternal mortality, lower incidence of infectious disease, and improvement in health outcomes and life expectancy. The government continues to prioritize the health sector. The plan for Healthy China 2030, established in 2016, identifies health as a fundamental prerequisite for social and economic development. It focuses on disease prevention as well as a holistic well-being approach with core indicators including strengthening health security and improving health services. Healthy China 2030, is in line with the health reforms under the PRC's Fourteenth Five-Year Plan, 2021-2025 which prioritizes health system development.

Public health system limitations. While health system development has progressed, the PRC is now faced with increasingly complex health challenges. This includes an overreliance on hospital-centric curative care to the detriment of cost-effective preventive medicine, gaps in the quality of health care particularly in rural areas leading to overburdened urban hospitals, and a rapidly increasing elderly population requiring specialized services. Despite the relatively advanced development of the PRC's health system, the coronavirus disease (COVID-19) pandemic highlights obstacles and development needs in government-led public health systems. The quality of service from health care providers is inadequate, and education and qualification levels among professionals in public health are low. Gaps in legislative frameworks and fragmented public health systems are another challenge. Additionally, weak coordination among health institutions and inefficient referral systems hamper the goals of achieving people-centered, integrated, and cost-effective care to meet the goals of the Healthy China 2030.

Lessons learned. The rapid spread of COVID-19 in the PRC underscored the inability of the hospital system, particularly community and secondary hospitals, to effectively respond to large-scale public health emergencies. Weak coordination between public health agencies, technology and equipment unsuited to rapid detection of infectious diseases, slow response and reporting, insufficient facilities for surge capacity, and limited skills in core public health knowledge highlighted the health system's inability to meet the challenges of future epidemics and hazards in the PRC. In its current state, the public health system's capacity to effectively prevent and contain future public health threats remains uncertain. The post-COVID-19 pandemic recovery period provides a valuable opportunity to strengthen the country's preparedness for emerging infectious diseases (EIDs) and other possible public health threats and apply best practices to better protect against future health hazards. This can be best achieved using a multipronged, all-embracing approach which combines public health institutional capacity building aligned with latest needs, policies, and hardware that are fit-for-purpose and world-class training capacity.

Transformational approaches. Tackling public health hazards using innovative transdisciplinary approaches across different sectors - human health, animal health, agriculture, and environment (known as One Health) - as well as holistic and evidence-based methods to prevent diseases that include mental well-being, wellness, and disease prevention (rather than cure) are a transformational approach that can be used alongside curative, hospital-based medicine to improve health outcomes. Rapid response reporting mechanisms linked to national systems using digital health technologies supported by modern health management policies and frameworks are essential for effective systems. Reducing barriers for women's participation in the public health workforce provides additional benefits. In the context of an upper middle-income developing member country, such as the PRC with a developed health system, a transformational impact requires a strategic and comprehensive approach which reinforces the public health network.

Public health ecosystem. Assessments on the PRC public health systems highlight weak links between responsible agencies, lack of well-trained staff, outdated operational plans and response systems, and poor public health prevention and response. To address these gaps, the project will support the PRC in the development of a complex interconnected network, or ecosystem, through strategic investments in key pillars of public health systems. The project proposes a high impact and transformational approach, comprised of development of public health institutional capacity and policies; upgrading of strategic public health emergency and training facilities with surge capacity; and improvement of talent building and capabilities as well as international exchange. In accordance with the PRC's aim to develop regional centers of public health excellence as demonstration models in economically underdeveloped areas, the project will support Guangxi Zhuang Autonomous Region (GZAR), Guizhou Province, and Shaanxi Province. The proposed project sites were selected on the basis of a wide geographical distribution and commitments to interventions emphasizing public health impact and affordable health care, development of institutional capacity, and international cooperation activities.

Impact

Health and well-being of residents protected, promoted, and restored

Capacity for early warning, risk reduction, and management of health security risks strengthened

Prevention and control of major communicable diseases strengthened

Project Outcome
Description of Outcome

Quality of public health services improved

Progress Toward Outcome The loan was approved on 5 October 2022, signed on 23 December 2022, and became effective on 21 April 2023. An inception mission was held from 15-31 May 2023 to meet, review, discuss, and agree with the three executing agencies, Fangchenggang Municipal People's Government (FMPG); Guiyang Municipal People's Government (GMPG); and Shaanxi Provincial People's Government (SPPG); and four implementing agencies, Fangchenggang City Culture and Tourism Group Co. Ltd. (FCTG); Guiyang Bureau of Health (GBH); Yan'an University Affiliated Hospital (YUAH); and the National Institute of Hospital Administration (NIHA) on the following aspects of the project: (i) implementation arrangements, project implementation units, and confirm designation of responsible officers; (ii) review preparatory work done by the EAs and IAs; (iii) the updated implementation schedule, required procedures, and project reporting based on ADB's reporting procedures and the design and monitoring framework; (iv) update the project implementation details, including procurement plan; (v) contract awards and disbursement targets; (vi) safeguards, social and gender action plan implementation, and the compliance with loan covenants; (vii) time-bound action plans; (viii) confirmation of compliance with loan covenants; (ix) document agreement and action in a signed Memorandum of Understanding (MOU); and (x) high-level national knowledge cooperation on public health institutions building with the Ministry of Finance and the National Development and Reform Commission.
Implementation Progress
Description of Project Outputs

Public health institutional capacity and policies developed

Effective public health ecosystem established

Training excellence and international cooperation capability enhanced

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

Output 1: The first phase of training, public promotion activities, and the first epidemic emergency response simulation exercises are planned in the fourth quarter of 2023. The preparation of the hospital's public health emergency preparedness and response strategy and operation plan is planned for completion in 2024.

Output 2: The first civil works contract for the Women and Children's Branch: main structure of the new outpatient building of Yan'an University Affiliated Hospital was awarded in June 2023. Construction drawing preparation is underway for Fangchenggang; and Guiyang is finalizing the bidding documents for the first civil works package.

Output 3: Fangchenggang has begun conducting trainings. For Yan'an, the implementation plan of the gender action plan will be prepared and completed in the third quarter of 2023; the formulation of the overall plan for training, study tour and public promotion is planned for the third quarter of 2023; and the first phase of training and public promotion activities are planned for the fourth quarter of 2023.

Geographical Location Nation-wide
Safeguard Categories
Environment B
Involuntary Resettlement A
Indigenous Peoples B
Summary of Environmental and Social Aspects
Environmental Aspects
Involuntary Resettlement
Indigenous Peoples
Stakeholder Communication, Participation, and Consultation
During Project Design
During Project Implementation
Business Opportunities
Consulting Services Procurement of consulting services will be conducted following ADB's Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time).
Procurement Procurement of goods, works, and non-consulting services will be conducted following ADB's Procurement Policy (2017, as amended from time to time) and Procurement Regulations for ADB Borrowers (2017, as amended from time to time).
Responsible ADB Officer Habib, Najibullah
Responsible ADB Department Sectors Group
Responsible ADB Division Human and Social Development Sector Office (SG-HSD)
Executing Agencies
Fangchenggang Municipal People's Government
Guiyang Municipal People's Government
Shaanxi Provincial People's Government
Timetable
Concept Clearance 29 Nov 2021
Fact Finding 07 Mar 2022 to 11 Mar 2022
MRM 08 Jun 2022
Approval 05 Oct 2022
Last Review Mission -
Last PDS Update 25 Sep 2023

Loan 4224-PRC

Milestones
Approval Signing Date Effectivity Date Closing
Original Revised Actual
05 Oct 2022 23 Dec 2022 21 Apr 2023 31 Dec 2027 - -
Financing Plan Loan Utilization
Total (Amount in US$ million) Date ADB Others Net Percentage
Project Cost 631.46 Cumulative Contract Awards
ADB 300.00 14 Mar 2024 22.10 0.00 7%
Counterpart 331.46 Cumulative Disbursements
Cofinancing 0.00 14 Mar 2024 0.00 0.00 0%
Status of Covenants
Category Sector Safeguards Social Financial Economic Others
Rating - Satisfactory Satisfactory Satisfactory - 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.

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.

  • 06 Oct 2022 | News Release

    ADB to Help Improve Public Health Services in the PRC

    ADB has approved a $300 million loan to improve the quality of public health services in the Guangxi Zhuang Autonomous Region, Guizhou Province, and Shaanxi Province, in the People’s Republic of China.

Tenders

Tender Title Type Status Posting Date Deadline
Loan 4224-PRC: Strengthening Public Health Institutions Building Project [YA-P1.1-CW03] Invitation for Bids Closed
Start-up Project Management and Coordination Consultant Individual - Consulting Closed
Start-up project management and procurement specialist Individual - Consulting Closed
Loan 4224-PRC: Strengthening Public Health Institutions Building Project [GY-CW1] Invitation for Bids Closed
Loan 4224-PRC: Strengthening Public Health Institutions Building Project (YA-P1.1-CW01) Invitation for Bids Closed
Consulting Services-Project Management Consulting Service Firm - Consulting Closed

Contracts Awarded

Contract Title Approval Number Contract Date Contractor | Address Executing Agency Total Contract Amount (US$) Contract Amount Financed by ADB (US$)
Women and Children's Branch: Logistics Support Building, Mechanical Parking Building, and Outdoor Overall Works (excluding the Intelligent Information System) Loan 4224 27 Mar 2024 Jiangsu Jiangdu Construction Group Co., Ltd. | 200 Wenchang East Road, Jiangdu District, Yangzhou City, Jiangsu Province, People's Republic of China Fangchenggang Municipal People's Government 4,933,720.68 2,547,589.55
FC-CS-01: Project Management consulting services Loan 4224 29 Jan 2024 Hubei Chengkang Future Certified Public Accountants Co., Ltd. | Floor 20, Block B, Wuhan International Building, No. T-1, Dandong Road, Jianghan District, Wuhan, Hubei Province Fanchenggang Municipal People's Government 2,449,291.52 2,440,289.46
YA-P1.1-CW01: Women and Children's Branch: main structure of the new outpatient building (excluding foundation pit and its supporting, precipitation, earthwork excavation section, and the intelligent information system) Loan 4224 16 Jun 2023 Shaanxi Construction Engineering Group Corporation No.6 Construction Engineering Group Co. Ltd. | 199C, Weiyang East Road, Weicheng District, Xianyang City, Shaanxi Province Fanchenggang Municipal People's Government 33,382,474.94 17,063,231.78

Procurement Plan

Title Document Type Document Date
Strengthening Public Health Institutions Building Project: Procurement Plan Procurement Plans Nov 2023