Social Due Diligence Report
September 2019
People’s Republic of China: Hebei Elderly Care Development Project
Prepared by the Hebei Provincial Government for the Asian Development Bank.
CURRENCY EQUIVALENTS (as of 30 September 2019)
Currency unit – Chinese Yuan (CNY) CNY1.00 = $0.14 $1.00 = CNY7.12
ABBREVIATIONS ADB – Asian Development Bank ECS – elderly care system EC – elderly care HCBC – home- and community-based care IA – implementing agency ICT – information and communication technology PMO – project management office PRC – People's Republic of China PPTA – project preparatory technical assistance PSA – poverty and social analysis
WEIGHTS AND MEASURES square meter – m2
NOTE In this report, "$" refers to US dollars.
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LOAN 3536-PRC: Hebei Elderly Care Development Project
Social Due Diligence on Subproject Changes
Date:
September 2019
LOAN 3536-PRC: Hebei Elderly Care Development Project (HECP) Social Due Diligence Report
1. Introduction
1.1. Project Summary
1. This 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.
1.2. Purpose of this report
2. As the locations of home- and community-based care (HCBC) centers of four subprojects have been changed. The total amount of involved HCBC centers are 25 that is Xinji Subproject involves 8 centers, Li County has 10 centers, Julu County has 4 centers, and She County has 3 centers. Among them, 23 centers involve change of locations.
3. As required by ADB SPS 2009 of this project, the new locations of project components are needed to carry out social due diligence and review social impacts, to confirm (i) all key potential social impacts and risks are identified; (ii) that effective measures to avoid, minimize, mitigate, or compensate for the adverse impacts are incorporated into the safeguard plans; (iii) that implementing agencies understand ADB’s safeguard policy principles and requirements and has the necessary commitment and capacity to manage environmental impacts and/or risks adequately.
1.3. General changes
4. Xinji Subproject owner has been changed to Xinji Construction Investment Co. Ltd. not the Hebei Dayu Clothing Co., Ltd., and the original eight HCBC centers was planned to establish by renovating existing buildings in three local urban communities and five existing garment manufacturing sites as describe by IEE. Thus, the locations of 8 HCBC centers have to be changed completely, and the renovation construction areas are reduced compared to original planning, from 3,750 m2 to 3,544 m2. However, the number of beds after the change remains the same as before. Each care center provides 10–20 beds and there are 130 beds in total.
5. Li County has 10 HCBC centers and 9 out 10 centers are changed to new locations. The changes increase construction areas from 7,283.55 m2 to 7,532.3 m2 and remain the same number of beds 400 in total and 10 fixed beds and 30 movable beds for each care center.
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6. Julu County has changed locations of 4 HCBC centers. All of four new locations are within scopes of rural clinics and care centers. The total amount of beds will increase from 110 to 129. The construction activities are mainly to procure and install elevators and purchase equipment and materials for elderly care.
7. She County has changed location of 2 HCBC centers and remains 1 HCBC center’s location. These changes reduce construction areas from 3,100 m2 to 2995.51 m2, and remain the same number of beds as 80 for 3 HCBC centers.
2. Xinji Subproject Due Diligence
2.1. General situation
8. The construction content of this subproject project has two parts: new construction and rehabilitation. The total construction area is 38,133 square meters, and 568 beds can be provided. Among them, the newly elderly care institution and medical rehabilitation center mainly include 2 elderly nursing buildings (one of which is a dependent care area and a geriatric medical rehabilitation center, the other one is a semi-dependent area), and one multi- functional building (including restaurants and activity rooms, etc.), with a building area of 30,233 square meters, can provide 438 beds. The rehabilitation part is divided into 8 townships and community service centers. The total construction area is 7,900 m2, and the renovation and upgrading construction area is 3,750 m2 provided 130 beds. The total investment of the project is CNY234.3051 million.
2.2. Comparison of construction location and scale
9. According to the preliminary design documents and on-site visits, the construction sites of eight HCBC centers before and after the change were identified. The following figure briefly identifies the location and name of the changed location. The construction scale of the changed locations was slightly reduced from the original 3,750 m2 to 3,544 m2. The number of beds after the change remains the same that each day care center provides 10–20 beds for a total of 130 beds.
Area Area New location (m2) GPS coordinates Beds Original (m2) Beds E115.215979, Fanghua Chemical Road Hospital 457.45 10 120 10 N37.905823 Community E115.21015, Aolin Shengyuan Likang Hospital 518.07 10 130 10 N37.93198 Community Dongming Property E115.230140, Qinghewan 463.27 10 150 10 Building N37.941325 Community Hemujing Township Health E115.334671, 238.72 20 Qianying Township 1200 20 Center N37.921388 Zhangguzhuang Town E115.287307, 465.98 20 Wangkou Town 2000 20 Health Center N 38.054347 E 115.381696 Jiucheng Health Center 503.45 20 Jiucheng Town 1000 20 N 37.998955 Nanzhiqiu Town Health 526.51 E 115.239074, 20 Nanzhiqiu Town 2000 20
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Area Area New location (m2) GPS coordinates Beds Original (m2) Beds Center N 37.756793 Xinjiantou Town Health E115.253145, 370.79 20 Xinleitou Town 1300 20 Center N 37.982893 Total 3544 130 7900 130
2.3. Profile of elderly service in Xinji City
10. Xinji has total population of 635,000 by 2018, and over 60s accounting for 18% of total population. Among the population over 60s, nearly 70% of them are living in rural areas. Since the implementation of poverty alleviation in Xinji City, there are still 4,776 people in poor condition by 2018, which greatly reduce the poverty percentage comparing with poor population in 2015. However, the poor population in rural area is still higher than urban population, especially for the elderly people.
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11. Rural area still takes the larger part of elderly population than that of urban area, thus, the elderly care service in rural area is vital to project outcomes. Currently the city has a total of 20 EC institutions, including 12 public nursing homes held by the civil affairs department, and 8 private ones. The total number of the beds are 2,037.
12. However, there are no community- and home-based EC services in Xinji City. There are no pertinent facilities. Although some EC institutions have the brand of Community and Home EC Service Center, they actually did not provide EC services to the elderly in the communities.
2.4. Impacts of Location Changes
13. In this subproject, there are eight HCBC centers around Xinji City, 5 in rural area and 3 in urban area. Although the locations of these HCBC centers have been changed, they are still within the scope of Xinji City and remaining the same ratio 5 in rural area and 3 in urban area. Therefore, the conclusions and results of affordability analysis and demand analysis in the poverty and social analysis (PSA) prepared during project preparatory technical assistance (PPTA) stage are still valid and can draw the same conclusions, particularly the PRC has achieved great efforts on poverty alleviation and elderly care service since 2016.
3. Li County Subproject Due Diligence
3.1. General situation
14. The Baoding County Elderly Care Development Project consists of a comprehensive elderly care service center and 10 HCBC centers. The total construction area is 38,565.76 m2, of which the above-ground construction area is 36,534.62 m2 and the underground construction area is 2,031.14 m2. A total of 825 beds are provided, of which 425 are provided for the Comprehensive Elderly Care Service Center, and 300 movable beds (for temporary rest during the daytime) and 100 fixed beds are provided for HCBC centers. Each HCBC center has call system, lounge, dining room, reading room, cultural and sports room, clinic, rehabilitation room, and elderly school.
3.2. Comparison of construction location and scale
15. According to the preliminary design documents and on-site visits, the construction sites of HCBC centers before and after the change were identified. Among the 10 locations, except Zhonghua Village (the HCBC center on the north side of Wenliu) does not change, the other 9 centers have changed locations. The following figure briefly identifies the locations and name of the original and new sites. The red markers are new construction sites and the green ones are original construction sites.
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16. The construction area after changed locations is slightly higher than that before the change. The subproject plans to increase the construction area of each day care center to 753.23 m2, and the total area will increase from 7,283.55 m2 to 7,532.3 m2. The number of beds after the change remains the same as before. Each HCBC center provides 10 fixed beds and 30 movable beds for a total of 400 beds. The following table is a comparison of the original and new construction sites.
GPS Original GPS New location Area (m2) coordinates location Area (m2) coordinates Beigaohuang 753.23 115.596680, Dongnan 428.29 115.577481 Village 38.443978 Street 38.486979 Zhonghua 753.23 115.609540, Zhonghua 937.95 115.609540, Village 38.498537 Village 38.498537 Junyu Hefu 753.23 115.593681, Junpeng 863.41 115.59366, 38.492917 Garden 38.490833 Chugang 753.23 115.680125, Junpeng 839.52 115.585387, Village 38.433727 Shang Pin 38.509663 Liushi Village 753.23 115.747753, Liushi Town 893.93 115.722160, 38.549218 38.544949 Dongwufu 753.23 115.725067 Beiguodan 839.52 115.699996,
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GPS Original GPS New location Area (m2) coordinates location Area (m2) coordinates Village 38.500362 Town 38.633098 Beizong 753.23 115.645515, Xinxiang 863.41 115.634535, Village 38.585055 Village 38.509007 Sangyuan 753.23 115.600945 Nanzhuang 760.74 115.648651, North Village 38.626789 Town 38.422840 Linbao Village 753.23 115.525956, Baoxu Town 428.29 115.726247, 38.569991 38.494339 Yangdong 753.23 115.630546, Xinxing Town 428.29 115.646820, Village 38.620819 38.553738
3.3. Profile of elderly service in Li County
17. Li County has total population around 530,000 by 2018, and over 60s accounting for 17% of total population. Since the implementation of poverty alleviation in Li County, there are still 1529 households 3441 people in poor condition by 2018, which greatly reduce the poverty percentage comparing with poor population in 2015 (4519 people). However, the poor population in rural area is still higher than urban population, especially for the elderly people, because most young people are migrant workers working in other cities.
18. Rural area still takes the larger part of elderly population than that of urban area, thus, the elderly care service in rural area is key to project outcomes. Currently Li County has no community and home-based EC services, and no pertinent facilities, but only one public EC institution in Li County, i.e., the county Glorious Institution which has 200 beds and are serving for 110 elderly people.
3.4. Impacts of Location Changes
19. In this subproject, there were ten HCBC centers around Li County, 7 in rural area and 3 in urban area. After the change of locations of these HCBC centers, they are still within the scope of Li County and remain the same number of centers, but add one more to rural area and 2 in urban area. Therefore, the conclusions and results of affordability analysis and demand analysis in PSA prepared during project PPTA stage are still valid and can draw the same conclusions, particularly the PRC has achieved great efforts on poverty alleviation and elderly care service since 2016.
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4. Julu County Subproject Due Diligence
4.1. General situation
20. The Baoding County Healthcare and Elderly Care Integrated Service Center consists of a comprehensive elderly care service center and 4 HCBC centers. Four existing HCBS centers will be renovated, with a total area of 3,384 m2 and 110 beds, and a new elderly care center with a total construction floor area of 20,945 m2 (with land area 18,424 m2) will be constructed with a capacity of 403 beds. This subproject will be piloting health and elderly care integration.
4.2. Comparison of construction location and scale
21. According to the preliminary design documents and on-site visits, the construction sites of HCBC centers before and after the change were identified. Among the 4 locations, except Xiaoluzhai Township does not change, the other 3 centers have changed locations. The following figure briefly identifies the locations and names of the original and new sites. The red markers are new construction sites and the green ones are original construction sites.
22. The construction area after changed locations is slightly higher than that before the change. The subproject plans to increase the construction area of each day care center to
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753.23 m2, and the total area will reduce from 3,309 m2 to 3,180 m2. The number of beds after the change will increase from 110 to 129 beds, which Xiaolvzhai will provide 39 beds, Guanzhai Center provides 30 beds, Wanghuzhai provides 20 beds, and Dicun provides 40 beds. The following table is a comparison of the original and new construction sites.
New location Area (m2) GPS Original Area (m2) GPS coordinates location coordinates Xiaolvzhai 900 114.956244, Xiaolvzhai 900 114.956244, Clinic Center 37.252121 Clinic Center 37.252121 Guanzhai Clinic 580 115.018460, Hezhai Central 478 114.971120, Center 37.345780 Old People’s 37.297879 Home Wanghuzhai 850 114.959317, Yantong Town 978 115.137450, Clinic Center 37.203669 Elderly Center 37.298780 Dicun Township 850 115.094077, Sujiaying Civil 953 115.124729, Clinic Center 37.161894 Service Center 37.343773
4.3. Profile of elderly service in Julu County
23. Julu County has total population around 420,000 by 2018, and over 60s accounting for 13% of total population. Since the Julu County was designated as National Poverty County, it has made great efforts on implementation of poverty alleviation. In May 2019, Julu County has been removed out from the list of national poverty county. There are still 8215 people in poor condition by 2018, which greatly reduce the poverty percentage comparing with poor population in 2015. However, the poor population in rural area is still higher than urban population, especially for the elderly people, because most young people are migrant workers working in other cities.
24. Regarding the elderly service in Julu County, Julu County has made great contributions to integration of elderly care and health care since 2012. Since 2014, Julu County of Hebei Province has integrated resources for both elderly care and medical care, promoted cooperation between elderly care institutions and medical institutions, and continuously enhanced the capacity of elderly medical services to meet the multi-level old-age needs of the elderly. At present, three county-level hospitals in Julu County, eight township hospitals and 18 village-level nursing homes have realized medical integration.
4.4. Impacts of Location Changes
25. In this subproject, there were four HCBC centers around Julu County, all of them are in rural areas of four townships. After the change of locations of these HCBC centers, they are still within the scope of Julu County and remaining the same number of centers, but relocate one to the north side and one the south side of Julu County, which enhance the coverage area of HCBC centers. Therefore, the conclusions and results of affordability analysis and demand analysis in PSA prepared during project PPTA stage are still valid and can draw the same conclusions, particularly Julu County has achieved great efforts on poverty alleviation and integration of elderly care service since 2012.
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5. She County Subproject Due Diligence
5.1. General situation
26. There are 3 HCBC centers in She County, and they are designed with renovation area 3,100 m2 and 80 beds. 2 of three 3 HCBC centers have to changed due to project implementation delay.
5.2. Comparison of construction location and scale
27. According to the preliminary design documents and on-site visits, the construction sites of HCBC centers before and after the change were identified. Among the 3 locations, except Runqinyuan Kangyang HCBC Center does not change, the other 2 centers have changed locations. The following figure briefly identifies the locations and names of the original and new sites. The red markers are new construction sites and the green ones are original construction sites.
28. HCBC Center of Xinkangyang Community and HCBC Center of Longguan Tianxia Community have signed a lease agreement. The Runqinyuan Kangyang HCBC Center is under construction.
GPS Original GPS New location Area (m2) coordinates location Area (m2) coordinates Longguan 225.4 113.681237, Lanbaowan 113.675073, Tianxia 36.569302 Community 36.570694 Community Xinkangyang 270.11 113.652620, Junziju 113.687704,
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GPS Original GPS New location Area (m2) coordinates location Area (m2) coordinates Community 36.574875 Community 36.581461 Runqinyuan 2500 113.650335, Runqinyuan 115.137450, Kangyang 36.573138 Kangyang 37.298780
5.3. Profile of elderly service in She County
29. She County has total population around 430,000 by 2018, and over 60s accounting for 13% of total population. Since the implementation of poverty alleviation in She County, there are still 8,481 people in poor condition by 2018. However, the poor population in rural area is still higher than urban population as the main terrain of She County is mountainous area of Taihang Mountain, especially for the elderly people, because most young people are migrant workers working in Handan City and other cities.
30. Rural area still takes the larger part of elderly population than that of urban area, thus, the elderly care service in rural area is key to project outcomes. Currently She County has eight EC institutions. Four are transforming from public to private and there are no elderly residents. The other 4 EC institutions have a total of 528 beds with 182 elderly occupants. The overall average occupancy rate is 34.5%. There is one Community and Home EC Service Center in the county, which actually did not provide EC services to the elderly in the communities.
5.4. Impacts of Location Changes
31. In this subproject, there were 3 HCBC centers around She County, all of them in urban area. After the change of locations of these HCBC centers, they are still within the scope of Li County and remaining the same number, and the new location are still close the residential community that elder people are easily access to these HCBC centers. Therefore, the conclusions and results of affordability analysis and demand analysis in PSA prepared during project PPTA stage are still valid and can draw the same conclusions, particularly the PRC has achieved great efforts on poverty alleviation and elderly care service since 2016.
6. Conclusions and Recommendations
32. Although locations of some HCBC centers have been changed, they are still within the original project scope, the number of beds and construction area of these centers are not substantially changed. It can be concluded that the outcomes and outputs in social and gender aspects will not be affected by these changes. The conclusions of demand analysis and affordability analysis of PSA prepared during PPTA stage are still valid and can be used for further project implementation. The social and gender action plan is still valid and does not need further revision.
33. According to the new locations of HCBC centers and project progress, the social and gender action plan has been updated to reflect new responsible institutions and timeframe, and the original actions and indicators are still valid to implement because there is no substantial change on project outputs and scope.
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Social and Gender Action Plan
Outputs Action Indicators and targets Responsible Timeframe Budget Institutions Output 1: Community and home care services improved Improve selected 1. Ensure affordability of community EC 1. Number and percentage of the IAs, PMO, 2017– Project community services for vulnerable elderly, vulnerable elderly enjoying the consultants, design 2019 budget, centers and rural including women EC services, (age and sex- institute, civil affair communal homes 2. Conduct stakeholders’ consultations disaggregated). At least 40% department, Julu on the design of the community and are female. Health home care services, and ensure 2. Minutes of consultation; Commission, design of services are gender number of suggestions communities sensitive incorporated into the design; 3. Establish gender sensitive community number of gender-sensitive feedback mechanism on quality and design features accessibility of EC services 3. Feedback records 4. Establish/use gender sensitive self- 4. Number of self-support groups; support groups of elders and their number of groups’ participants families who can help others at the (age and sex-disaggregated) community level 5. At least one self-support group established in each county/city/district, funded at 1,2000 Yuan per year for three years Develop 1. Training and consultations for the 1. Number and percentage of IAs, PMO, civil 2017– Project information elders on how to use ICT terminal training participants (age and affair department, 2022 budget technology facilities sex-disaggregated) communities, Julu networks Health Commission, ICT operator
Develop services Develop a HCBC working group 1. 50% of group members are IAs, PMO, civil 2019– and creating links female affair department, 2020 and support 2. Time and frequency of working health department networks group meetings; Minutes of the meetings
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Outputs Action Indicators and targets Responsible Timeframe Budget Institutions Output 2: Institutional elderly care service capacity increased and quality improved
Provide expanded 1. Staff orientation and in-service training 1. About 80% of staff, including IAs, PMO, 2017– Project institutional care on diversity and inclusion caregivers, received training on consultants, civil 2022 budget facilities and 2. Organize caregivers supporting diversity and inclusion affair department, services for program, including counseling 2. Number and percentage of Julu Health elderly at various services participants of which 70% are Commission stages of need women.
For Outputs 1-2: Generating Job Opportunities
Develop HCBS 1. Generate 690 skilled and 176 1. 20% of which are first made IAs, PMO, 2017– Project centers, EC unskilled jobs at the construction stage available to the poor and 15 % consultants, design 2022 construction centers and a with no age discrimination to women (Baseline for female institute, and training center in construction workers is 5%) contractors operation Yanshan 2. Generate 1,211 skilled and 153 2. 30% of which are first made funds University unskilled jobs at the operation stage available to the low-income with no age discrimination person and 50 % to women (Baseline for female staff is 30 %) 3. 35 % of managerial positions will be given to women
Output 3: Elderly Care planning, development of human resources and industry capacity improved Develop training 1. Raise the awareness of residential, 1. Gender and age-sensitive Yanshan 1. 2017– Project programs and community and home based ECSs’ training courses and materials University, training 2022 budget training materials providers and local officials on social Number, percentage and type program developer, inclusion issues through providing of trainees (Sex-disaggregated) social consultant, 2. 2017– gender and age-sensitive training. EC consultants, 2020 2. Number and percentage of PMO, Civil Affairs 2. Yanshan University to develop a newly recruited staff (sex and Dept. Human gender and age-sensitive staff age disaggregated) Resource and recruitment and development plan Social Security Dept. Output 4: Capacity of the EC Sector Organizations Improved (Pilot) Develop local EC Consultation with stakeholders on socially 1. Draft socially inclusive EC IAs, PMO, Project Development inclusive local EC development planning document consultants, local 2019– budget
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Outputs Action Indicators and targets Responsible Timeframe Budget Institutions Planning Li 2. Number, percentage and types government, civil 2021 County of stakeholders participated in affairs department the planning process (sex- disaggregated) Develop the Develop a gender and age-sensitive EC A gender and age-sensitive EC care elderly long-term care assessment guideline assessment guideline care assessment system (Shuangluan District) Develop quality Develop quality monitoring indicators for Monitoring indicators established management gender sensitive and social inclusiveness (sex and age-disaggregated) system for EC institutions (She County)
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