In China, the issue of ageing is particularly complex as the state’s "One Child
policy, increased life expectancy, the weakened role of family care, rural-urban
migration and limited formal care provision all interact to exacerbate the
problem. Family care, institutional care and community-based care form the
three main care-giving patterns in China. Both family care and institutional
care have confronted a lot of challenges since state-owned enterprises started
transferring welfare responsibilities for their employees to society since the
1980s. The community-based care for the elderly emerged under this context
and the government has continuously highlighted the importance of the
community providing care services for the elderly in China. In line with this
position local governments have, especially since the 1990s, applied the
ideology of welfare socialization to the elderly care service provision system
by introducing multiple service agencies from the market and the third sector.
The actions have been designed to cut cost and improve the efficiency and
quality of community services.
However, the 1990’s application of welfare socialization ideology by
Chinese local governments to provide community care services to elderly
urban residents has not resulted in high service quality. The community service
provision for the elderly is unsatisfactory in several aspects, including the
shortage of funding from the government, the absence of non-government
organizations’ participation, the limited number of service beneficiaries, the
overlap of service, the ignorance of old people’s psychological and emotional
demands, the inefficiency of service information and user fears over
confidentiality.
Consequently, in order to improve service coverage, efficiency and quality,
local governments have started to contract out community-based services to
non-government organizations, particularly social work agencies, in recent
years. Social work agencies delivering contracted community based service are non-governmental service providing organizations registered with civil affairs
departments. They are officially termed professional social work agencies
because they are required to recruit a proportion of employees with a social
worker qualification certificate. The social work agencies are contracted to
provide community services with funds from local governments, thus the
government and social work agencies establish a contract-based relationship in
community service provision.
Community service contracting is divided into two-sub models. The first
one is a non-competitive contracting model (Model 1). Under this model,
though the service purchaser and the service provider have a formal contract
relationship, the contracting process is non-competitive. The second one is a
competitive contracting model (Model 2). Under this model, the service
purchaser and the service provider have a formal contract relationship, and the
contracting is achieved through open and equal bidding.
It is in the context of the emergence of contracting out community service
to social work agencies in urban China that this research is based. In particular,
the research explores the implementation of community service contracting,
analyzes community service provision under the context of contracting,
identifies impacts, challenges and characteristics of community service
contracting, and draws implications for future community service provision for
the elderly in urban China.
This study adopts qualitative research methods in terms of document
analysis and case study to explore the recent developments of community
service contracting in urban China. The document analysis aims to draw a clear
outline of the development of community services for the aged population,
particularly under the context of contracting. In addition, document analysis is
used to facilitate the use of precise and understandable terms in the design of
interview questions, which can improve the validity of the research results.
Moreover, the information derived from documents is also triangulated and
compared with interview data to confirm the congruency between written
artifacts and actual implementation. The case study is conducted in the cities of
Guangzhou and Zhongshan. Both Guangzhou and Zhongshan adopt non-competitive and competitive contracting models in the provision of
community services for the elderly. Two pilot Street Offices adopting different
contracting models are selected for comparison in each case city.
This study finds that after the introduction of community service
contracting government agencies have retreated from directly delivering some
community service programs, and have shouldered more roles in regulation,
funding, coordination, monitoring and inspection. In addition, the emergence
of social work agencies in community service provision system seems to have
yielded a positive effect on integrating community resources, targeting
resident’s service demands and improving community participation through
establishing different volunteer teams or mutual aid networks. Regardless of
whether the non-competitive contracting model or the competitive contracting
model is used, the emergence of community service contracting leads to the
growth of human and financial resources in community service provision and
consequently increases the expansion of community services, which makes
community services more available and accessible to aged residents, enhancing
the level of resident participation, as well as improving elder’s well-being.
On a less positive note, this study also identifies several challenges in the
development of community service for the elderly under the context of
contracting. These challenges include different service ideologies between
government agencies and service providing organizations, the conflict of social
work professionalism and Chinese traditional culture, inappropriate
performance measurement, a scarcity of human and financial resources, lack of
a clear definition of community services and ambiguous functioning of
contracted service providing organizations, fragmented purchasing, unbalanced
development of communities in different areas, distrust in purchaser-user
relationships, and lack of involvement of the private sector in service provision
system.
Consequently, several recommendations for the development of
community service for the elderly are formulated, including giving more
autonomy to social work agencies, strengthening the coordination between
social work organizations and Community Resident’s Committees, enhancing elder’s awareness regarding service programs and service application
procedure, balancing professional judgment and customer’s demands in service
design and creating a social care market.
| Date of Award | 14 Feb 2014 |
|---|
| Original language | English |
|---|
| Awarding Institution | - City University of Hong Kong
|
|---|
| Supervisor | Paul HIGGINS (Supervisor) & Linda WONG (Co-supervisor) |
|---|