_{Assisted care services in China, where older adults receive support through integrated long‑term care services. Credits: WBG}

Synopsis

Ensuring broad access to quality long-term care for aging populations requires governments to coordinate policies across health, social protection, labor markets and workforce development as well as the private sector — no single sector can do it alone. The World Bank Group (WBG) supports governments in building integrated, sustainable care systems by combining investment financing, policy reform, and advisory services tailored to each country's context.

In China, the Guizhou and Anhui projects are building inclusive care systems, and similar reforms are underway in Uzbekistan, North Macedonia, and Colombia, each expanding access to quality care and support for vulnerable groups. These engagements are complemented by International Finance Corporation's (IFC) operations, such as the Silver Bonds mobilizing private financing for senior care infrastructure. Together, they reflect the World Bank Group's integrated approach to building sustainable, multisectoral care systems across diverse country contexts.

Development Challenge

The world is undergoing an unprecedented demographic shift: by 2050, one in six people globally will be over age 65, with the fastest growth in developing countries. By 2040, an estimated 28 percent of the population in China will be over the age of 60. The speed of this transition – led by both increases in life expectancy and declines in fertility – is unprecedented in developing countries. While France took 115 years to double its population aged 65 and over, Vietnam is expected to do so in just 17 years, leaving little time for systems to adapt. As life expectancy rises, healthy life expectancy lags behind, creating a growing need for quality long-term care (LTC).

Traditionally, families, and especially women, provided the majority of care informally, but due to urbanization, migration, and changing gender norms, families are increasingly looking for more formal care arrangements for their older people. As such arrangements remain underdeveloped, gaps in access, quality, workforce capacity, and affordability are becoming very visible. The burden of filling these gaps continues to fall disproportionately on women, whose ability to take advantage of job opportunities more than ever depends on the availability of affordable, quality LTC. Without broad-based LTC systems, these challenges threaten economic growth, fiscal sustainability, gender equality, and the well-being of older adults and their families. However, with strategic planning and investment, this demographic challenge can be transformed into an economic opportunity, driving growth, job creation, and fostering a vibrant 'silver economy.'

WBG Approach

The World Bank's approach to advising client countries developing their LTC systems is grounded in the understanding that the speed of demographic change and the strong pressure on public resources necessitate a two-pronged approach: harnessing the power of the private sector to deliver LTC, while strengthening the capacity of the state to provide stewardship of the LTC quasi-market. The reforms cut across sectors, with each country's engagement shaped by where that country is in its aging trajectory.

In China, where demographic aging is already well advanced, the focus is on building a sustainable, person-centered, three-tier LTC care system at scale, strengthening the care workforce, attracting private investment, scaling up LTC insurance, and reforming regulation and financing so that services can keep pace with demand and are provided with quality, In Uzbekistan, where formal care infrastructure is still nascent, and where the Government is in the process of opening a territorial social services center, the World Bank is helping lay the groundwork: establishing community-based service centers, developing legal frameworks, and creating the conditions for a private care market to grow, while keeping gender equity central to how care is both delivered and staffed. In North Macedonia, the focus is on regulating an emerging care market while investing in social and preschool services to broaden inclusion. And in Colombia, the World Bank is supporting the fiscal and institutional reforms needed to build a system that is equitable, resilient, and financially sustainable over the long term.

Together, these projects reflect a broader conviction: increasing access, improving equity, and ensuring the quality of LTC require integrating policies governing social protection, health, private sector development, labor markets and workforce development, with a strong focus on gender equity and the quality of jobs, into a coherent national strategy — and that is what the World Bank is working to help governments achieve.

Results

• In China, the Anhui Aged Care System Demonstration Project benefited more than 167,500 people, (including more than 73,000 women), from low-income and vulnerable older people who received the basic aged care services mostly through community-based services as well as at home and institutional services at project closure in 2025.
• Guizhou Aged System Development Program assessed the needs of over 940,000 older people and delivered essential aged care services to more than 146,400 people, with the program expected to reach over 285,000 beneficiaries by completion at the end of 2026. The program trained more than 34,600 care workers, including 27,410 graduates, supporting job creation in care services, including hundreds of positions in project-supported facilities.
• The Anhui Aged Care Project improved the quality of services, with the share of providers meeting national service standards increasing from 34 percent to 94 percent at project completion. The program trained 4,473 managers and over 9,400 professionals.
• The INSON Social Protection System for Vulnerable People in Uzbekistan, launched in 2024, is expected to improve access and quality of social services for more than 57,000 beneficiaries, including the older people and people with disabilities, train 3,000 social workers, and create 1,200 new or better jobs in care and social services.
• The Second Social Services Improvement Project in North Macedonia expanded access to licensed social services for over 4,300 vulnerable individuals, including older adults, with a target of 6,000 beneficiaries by 2029, and piloted activation of social assistance beneficiaries into care work, with a focus on quality and inclusivity for older persons.
• In Colombia, the Development Policy Financing (DPF) supported the creation of a National Care System that articulates services, policies, and regulations to meet the demand for care and guarantee the rights of caregivers. To date, ten main territories in the country have established local care systems or integrated government guidelines for the development of care systems into their local development plans, with additional outcomes including support for caregivers of people with disabilities through occupational profiles.
• The World Bank also provided technical assistance to the District of Bogotá for piloting the "Manzanas de Cuidados" ("care blocks") program, supporting caregivers of older people and persons with disabilities.

Contribution to WBG Targets and Jobs

These long-term care operations advance WBG targets, contributing directly to the 'Protection for the Poorest' (500 million people target, with a focus on female beneficiaries) by expanding long-term care, and to 'Healthier Lives' (1.5 billion people goal) by strengthening person-centered health systems and care across the life course They also support the jobs agenda, reflecting the growing role of the care economy as a major global job engine, with estimates of over 300 million decent jobs globally by 2035 created by rising demand for care workers. Moreover, well-organized care policies can boost female labor force participation by freeing up workers from family care, which disproportionately falls on women These projects also promote private sector engagement and emphasize seamless cross-sectoral integration between health and social systems, a crucial element for resilient and equitable LTC systems.

_{Providing home-based social care to an older person in North Macedonia. Credits: WBG}

Lessons Learned

A two‑pronged approach is critical: strengthen government stewardship and regulation of LTC systems, while leveraging private providers to expand service delivery. Early investment in people‑centered system building, workforce training, and quality standards is essential. The demographic data makes it clear that time is short: developing countries are aging at a pace far exceeding that of their high-income peers, with some nations set to double their older population in under two decades. Promoting aging at home, coordinating health and social services, and supporting family caregivers lead to more inclusive and resilient systems. Data-driven approaches and cross-sectoral collaboration are critical for scaling and adapting solutions.

Establishing strong legal frameworks and fostering local partnerships are crucial for effective service delivery. Building a skilled care workforce and engaging private providers in a regulated market are key to scaling up quality services, as is incorporating new technologies into service delivery, such as assistive devices. Community-based services, especially in low-resource contexts, are a good first step toward ensuring equitable access to care.

With demand for long-term care projected to rise by over 200 percent in middle-income countries by 2050, these lessons need to be applied quickly and at scale.

_{Community-based day care center in China providing social engagement and supportive services for older adults under long-term care programs. Credits: WBG}

Next Steps

The World Bank supports countries worldwide in building inclusive, efficient, and sustainable systems for aging populations and help countries develop the building blocks of long-term care—needs assessment, service quality, workforce development, financing, and digital systems. The World Bank’s engagement fosters regulatory reforms, market development, and private sector participation, with increasing attention to helping countries advance the appropriate balance of public and private roles in long-term care systems—ensuring that expanded private investment is accompanied by strong regulation, quality assurance, and equitable access. By sharing global knowledge and piloting scalable models, the World Bank helps governments expand access, improve quality, and ensure the dignity and well-being of older adults across diverse contexts.

Future priorities include supporting care models, including community-based that support aging in place while ensuring financial sustainability, and exploring global solutions such as managed care worker mobility across borders. Continued innovation in financing, workforce development, service delivery and digital platforms will help countries build sustainable long-term care systems, while strengthening regulatory frameworks and system design to support effective public–private collaboration.