Ex-post Evaluation

1.1 Background of the Project

Democratic Socialist Republic of Sri Lanka filled an official request in 1997 to the Government of Japan for achieving optimum standard of factions of the Faculty of Dental Sciences and the Dental Hospital (Teaching) in Peradeniya, which were established under Japanese Grant Aid Project during the period of 1996 – 1998. Under the Grant Aid Project, the Faculty of Dental Sciences was upgraded and the project involved the construction of entirely new physical facilities and the provision of modern equipment for student teaching, patient care and research.

Following the completion of the Grant Aid Project, the need for Project type Technical Cooperation Assistance arose to train staff members, academic and non-academic for proper utilization of the physical facilities made available under the Grant Aid Project.

1.2 Project Overview

The JICA Dental Education Project (1998 – 2003) at the Faculty of Dental Sciences, University of Peradeniya was aimed at the improvement of the health status of Sri Lankan people through the provision of technical training in education, services and research in the field of dental sciences.

(1) Overall Goal

To improve teaching, service and research in the Dental Faculty and Dental Hospital (Teaching) Peradeniya in order to promote oral health status of the people in Sri Lanka.

(2) Project Purpose

To strengthen the function and the capacity of the staff at the Dental Faculty and Dental Hospital (Teaching) Peradeniya.

(3) Outputs

2.1 To improve knowledge and skills of academic, technical and nursing staff.

2.2 To develop the capacity to conduct research and continuing education programs for dental health personal.

2.3 To develop a system to ensure sound maintenance of physical facilities, equipment and instruments of the Dental Faculty and the Dental Hospital.

(4) Inputs (July 2002)

Japanese Organization:

Sri Lankan Organization :

3.1 Summary of Evaluation Results

(1) Impact

a) Achievement of Overall Goal

- Improvements in Undergraduate Teaching

• Dental undergraduate curriculum was revised.
• A semester based modular course system was introduced in basic sciences.
• Integration of basic science subjects took place and Integrated teaching led to development of a holistic approach in the study of health and disease in man.
• New teaching methods were adopted.
• Objective assessment was introduced in the basic sciences.

- Improvements in Patient Care

• Patients admitted increased from 40,000 prior to 1998 to around 100,000 since 2003.
• Patient care maintained at 100,000 for adequate clinical training.
• Quality of service provided, such as provision of special dental appliances, microsurgery, cleft palate / lip correction continued.

- Improvements in Research

• Research communications and publications increased from 38 & 9 in 2002 to 41 & 27 respectively in 2004.
• Participation in workshops and training programs too increased.

b) Other Positive Effects

• Training received in micro-surgery was transferred to general surgeons interested in micro-surgical procedures.
• The level of competency achieved at the finals improved, passes and classes increased from 58.5% and 21.1% in 2002 to 77and 31.1% respectively in 2005.
• Patients were able to receive special dental treatment at a nominal fee.
• Training received in specialized procedures would enable dental surgeons passing out to become more lucrative and employable in the practice sector.
• The image and financial status of academic staff improved very much after clinical training.

c) Negative Effects

• Delays in attending to those seeking dental attention was inevitable due to limitation of resources in the Dental Faculty - Hospital Complex.

(2) Sustainability

a) Educational

- Dean's Office staff under the Dean of the Faculty of Dental Sciences has been trained to monitor the progress in Dental Education via coordinators of programs and the Heads of the Departments. This enabled smooth functioning of the academic programmes conducted by the Faculty of Dental Sciences.

- Trained personnel trained others, helping further upgrading of technical and nursing assistance and continuation of activities.

- Increased allocation as emoluments to academic and non-academic staff continued enabling retention of staff as much as possible.

- Self-funded courses continued to be conducted without burdening the dental faculty.

b) Patient Care

- These services were run with financial inputs in the form of material, equipment and manpower from the Ministry of Health. Critically ill and deformed patients continued to be cared under the guidance of Dental Specialists. Dental appliances were provided to the needy after charging a nominal fee. This practice enabled students, both undergraduate and postgraduate, to become aware and proficient in modern methods of dental treatment, which otherwise wouldn't have been possible.

- Patients were able to get special investigations done after paying a nominal fee approved by the University Council. These investigations are of special nature and are not available in other hospitals.

c) Maintenance of Equipment

- Funds available for their maintenance is meagre and is inadequate for repair work. Some equipment will soon be beyond repair and this means they will need to be replaced. But the cost of replacement will be many times more expensive than having them repaired at the due time. Funding will have to be found if Dental Education is to progress as intended.

- Not all the manuals necessary for their repair are available.

3-2. Factors that have Promoted Project

In order to carry out dental service functions in spite of poor budgetary allocation, the Dental Faculty recommended charging a small fee for the services rendered. This met with strong opposition from the government trade unions. Fortunately, the University Council upheld the recommendation of the Dental Faculty and game covering approval to go ahead with its proposal. This to a certain extent made it possible to sustain the quality of teaching – service functions in the Dental Hospital.

3-3 Factors that have Inhibited Project

Important factors are insufficient funds for maintenance of equipment and lack of trained staff for repair. In addition, untrained nurses in the category of nurses in the Dental Faculty is a stumbling block in quality care of patients seeking treatment. This has made the Faculty more dependent on the Health Ministry.

3-4. Conclusions

There is a significant improvement in dental education in the University of Peradeniya resulting from changes in curricula, instructional methods, introduction of new techniques, improved clinical training and supervision. Government funding available as staff emoluments increased by 70% in the last five years helping to retain most of the staff trained.

3-5. Recommendations

In the short term immediate action should be taken to fund maintenance and repair work.
In the long term, action should be taken to train technicians and dental nurses required to
support special dental procedures and also establish a Board of Management to coordinate the activities of Faculty of Dental Sciences and the Ministry of Health.

3-6. Lessons Learned

At the time agreement was signed between the Governments of Japan and Sri Lanka, a clause should have been added that makes it mandatory for Sri Lankan Government to allocate certain percentage of the value of the equipment donated as annual maintenance expenditure for a period not less than 10 years.