The changing landscape of public service delivery systems for disabled people in China: a Shanghai case study

Abstract

This article will consider the current development of an emerging contract culture for the delivery of social services and its impact on disabled people in China. The discussion is based on an original qualitative study in Shanghai. The past 30 years have seen dramatic changes in China, which in parts have led to improvements in the lives of disabled people. The China Disabled Persons’ Federation (CDPF) became a key player in delivering these changes with the government. However, the CDPF is being criticized by disabled people for being too bureaucratic and not being effective enough in its delivery of services. One of its responses is to work with newly emerging not-for-profit organizations (NPOs) of and for disabled people. The CDPF has now begun to contract the delivery of some services to such NPOs. It is hoped that this may improve their effectiveness but the development of a contract culture in the delivery of services for disabled people may also be seen to pose a threat.

Keywords:

• Disability
• public service
• not-for-profit organizations
• contracting out
• China

Introduction

Forty years after the foundation of the People’s Republic under Mao Zedong, public services for disabled people in China, like society as a whole, underwent a fundamental shift in the late 1980s under Deng Xiaoping. China moved from a de-centralized system of local provisions of the five guarantees – food, clothing, housing, medical care and burial expenses by the workplace ‘danwei’ – to a semi-governmental system where responsibilities were shared differently between national and local government, the family and the individual, regulated by a new law under which disabled people were represented by the China Disabled Persons’ Federation (CDPF) (Grotz 1992). Another 30 years later we might now be seeing a further fundamental shift under Xi Jinping, with a move towards a ‘contracting out’ system in the provision of social services for disabled people to not-for-profit organizations (NPOs).

There were an estimated 85 million disabled people in China at the end of 2010 (Tong 2017). Based on the World Health Organization estimate of 15% for the percentage of people living with some form of disability, this number could conceivably be significantly higher and the numbers are expected to be growing with an aging population (WHO 2011). The Law for the Protection of Disabled People in China (LPDC) came into force in May 1991 and was revised in 2008. The LPDC broadly addresses the responsibilities of the individual, society and the state with particular sections on rehabilitation, education, employment, culture and sport, and social security, which encompasses medical care and social welfare (Grotz 1992). Further anti-discrimination laws and other legislation affecting disabled people have also been passed since. However, despite reported significant progress and increased wealth in China, the comprehensive and satisfactory provision of services to disabled people has remained an ambition rather than an achievement and some criticisms have been mounting. Furthermore, there seems to be little, if any, involvement of disabled people in the design, delivery and evaluation of the services provided for them outside the officially approved channels.

The public service system for disabled people since the founding of the China Disabled Persons’ Federation

The CDPF was established in 1988 under the leadership of Deng Pufang, the son of the then leader, Deng Xiaoping. It should be noted that following a spinal injury Deng Pufang is a wheelchair user. The CDPF’s role was and remains to represent disabled people, working directly with the government in public policy-making and the delivery of services for disabled people. In this approach the CDPF simultaneously represents the government and also the interests of disabled people to the government. This has been referred to as a ‘half government–half public’ (banguan banmin) approach. This function of the CDPF was enshrined in the LPDC in 1991. The CDPF has divisions reflecting sections of the LPDC, for example on rehabilitation, physical education and rights protection. It also has five affiliated associations, which are set up to specifically represent the interests of people with visual impairments, people with hearing impairments, people with physical impairments, people with learning disabilities and people with mental health conditions.

As there are four levels of local government in China (provincial, prefectural, county and township) involved in providing public services, local branches of the Disabled Persons’ Federations and its affiliated five associations were established to match the structure and levels of government agencies. Locally, affiliated associations are operating under the guidance of the federations and most of their staff are paid directly by the government, with some of them having official government status and roles.

The key successes of the CDPF would appear to be that it managed to maintain a national profile of disability issues and successfully delivered a range of services locally, especially in urban centres, through close collaboration with national and local government. However, its origin and structure might be seen to limit its capacity to represent the interests of service users (Kohrman 2005) and to meet their needs effectively. There is a perception that the CDPF and its local branches represent the interests of government more often than those of disabled people and that the CDPF is not able to provide appropriate services to individuals with special and personal needs. Surveys in two cities showed that about 60% of the sampled disabled people were dissatisfied with the work of the CDPF, suggesting that the CDPF has not performed its functions well (Zhou 2008). Those surveys were undertaken in urban centres where CDPF representation is strongest and it is reasonable to assume that satisfaction rates in rural areas might be even lower, as CDPF provisions seem insufficient in particular for vulnerable children and older people with disabilities in rural China (Shang, Wu, and Wu 2005; Fisher, Shang, and Li 2011).

The rise of not-for-profit organizations and the reform of the public service system for disabled people

China now has a large number of NPOs, working, for example, in community development, environmental protection and social services. There are two types of NPOs operating in China: government-registered NPOs with varying degrees of autonomy from the government, as well as many unregistered NPOs at the grassroots local level (Smith and Zhao 2016). According to official data in 2018 there are about 800,000 government-registered NPOs, many of them government-organized non-governmental organizations. The number of unregistered NPOs is unclear. The number of NPOs related to disability issues allowed to be registered is also unclear.

There are two types of NPOs related to disability. The first type includes education, rehabilitation and employment centres affiliated with and directly sponsored by the CDPF and its local organizations. While independent by name, they act like government agencies. The second type includes NPOs that are either self-founded by disabled people and their families, or founded by social entrepreneurs and social workers. This type includes many disabled people’s self-help organizations (Zhang 2017). Such NPOs are more easily comparable to the civil society organization discussed in the western context.

The Shanghai case study

Shanghai is perceived to lead the nation in the reforms of public services for disabled people. For a case study in Shanghai W, a prefectural level in Shanghai, five officials from the local CDPF branch and the leaders or programme managers from nine NPOs were interviewed between July 2014 and January 2015.

The local CDPF branch and its affiliated service centres have only 22 members of staff to serve approximately 12,000 disabled persons, 3% of the local population in Shanghai W. With that ratio, CDPF staff are unable to meet needs suitably and comprehensively. As a result, disabled people have begun to express their dissatisfaction to the government and the CDPF by writing letters of complaint and engaging in other forms of protest. The local branch of the CDPF is now led by a newly-appointed chief executive and has begun to reform its approach and to outsource services to emerging NPOs.

The first step was to reform the internal governance of its affiliated 12 NPOs in an attempt to improve their service capacity. The local branch of the CDPF then invited five NPOs which were self-founded by social workers to participate in the service delivery. Three of these five organizations were local, one was invited from Pudong, a part of Shanghai, and one invited from Shenzhen, which is in a different province, Guangdong. The latter two are famous for NPO reform and development as well as social work professionalization. Under the new arrangements the number of services programmes more than doubled from 10 in 2010 to 23 in 2015, covering, for example, community integration for people with visual impairments, rehabilitation services for the people with spinal cord injury and employment training for the people with mental health conditions. Available funding was also dramatically increased from 1.14 million RMB in 2010 to 14 million RMB in 2015.

As services have been reorganized, some disabled people have become more actively involved in the design and service delivery process, usually with the help of social workers. For example, one project to cultivate good neighbourhood relationships between disabled people and the rest of the community has established 318 neighbourhood self-help groups since the implementation of the programme in 2010. Each group is composed of disabled people and their non-disabled peers. Groups have at least 10 members with at least one disabled person in the group. These groups are encouraged to elect their own leaders and design activities themselves. They are expected to share learning about rehabilitation, encourage each other and discuss public policies related to them. However, the majority of disabled people will not have a chance to become involved in the design and delivery of the services. This is a situation that even in the leading localities seems unlikely to change in near future.

The challenge for disabled people in the new service delivery system

Disabled people may benefit from increased funding and a new service delivery model; however, the reform process is not without challenges.

Firstly, local NPOs lack other funding sources and have to compete against each other for funds from the government and the CDPF each year. This means the level of services for disabled people are not stable and the process of contracting might be a disincentive for collaboration. If an NPO fails in its bid, the main service provider in the community it previously served will change or services may cease, affecting the day-to-day lives of disabled people and influencing their perception and the reality of the service quality.

Secondly, the branches of the CDPF generally seem to lack contract management skills and are struggling to make decisions about which model of service contracting to choose. So far the competitive bidding model seems preferred in the contracting process but they may need to consider to cooperate with some fixed service providers for longer in certain conditions (DeHoog 1990). The development is still fluid and the CDPF and NPOs are learning how to collaborate with each other and how to supply the service with high quality.

Lastly, there is still very limited space for disabled people and their families to engage in the service delivery process, although some service users are invited by the NPOs to share their service experience in the programme evaluation. Depending on the criteria used, competitive contracting might limit disabled people’s ability to communicate and negotiate with the government and the CDPF. Meaningful involvement takes time and resources, and annual bidding might not allow for that.

Summary and conclusion

Services for disabled people in Shanghai have undergone reform and development for almost 10 years. The local government has already recognized some improvements. They have begun to promote the institutionalization of new service delivery models, involving the contracting of NPOs, and national organizations are now considering roll-out of this approach.

However, it is not clear how substantial the improvements are or what specific mechanisms or processes may have led to any of the improvements. Outsourcing social services sometimes can be highly controversial. Their impact is seen as dependent on how services are commissioned and to what organizations.

More investment and better service user involvement are, of course to be welcomed in principle. However, commissioning organizations in China, even in the leading localities, seem to lack essential skills in this area. The investment in areas where there are few or no skills in commissioning could be counterproductive.

Additional information

Funding

This research was supported by the National Social Science Foundation of China [Grant 17CZZ029].