Ex-post Evaluation

1 Background of the Project

The high Under-five mortality rate caused by infectious diseases was a great cause for concern for the Malawi Government. Because of the critical problem, the Malawi Government submitted a proposal to the World Bank to establish a National Reference Laboratory whose mandate was to provide laboratory back up to health institutions in Malawi. With funding from the World Bank, MOH constructed laboratory buildings at CHSU. Initial equipment was procured and laboratory functions started (NHP 1999-2004). Due to low level of diagnostic technology at CHSU, Malawi Government decided to expand and improve upon the work done with support from the World Bank. The Malawi Government then made another request to the Government of Japan for technical cooperation. The Government of Japan decided to implement the project.
The JICA-CHSU project was implemented from 1994 to 1999 and extended to August 2000 (JICA-CHSU Report, 2000). The main goal of the project was to "reduce the morbidity and mortality of children less than five years of age in the model area". The project purpose was to strengthen the function of CHSU in infectious diseases control as the national institute of health.

2 Project Overview

(1)Overall Goal:

The mortality in the model area (especially the mortality of children under 5 years old) is reduced.

(2)Project Purpose

The function of CHSU as the national institute of health with the main emphasis on infectious diseases control is strengthened.

(3)Outputs

a) The technical level of CHSU in the examination and detection of micro-organisms is improved.

b) An epidemiological surveillance network in the model area is established.

c) A referral function between CHSU and the hospital in the model area is established.

(4) Inputs

Japanese side:

Malawi side:

3-1 Summary of Evaluation Results

(1)Impact

The overall goal of the project of reducing under-five mortality was, however, thought to be too broad and not directly linked to the project purpose. Information regarding the current mortality rate would not be available until after National Demographic Health Survey to be carried out later in 2004. The Demographic Health Survey 2000 indicated that the Under Five mortality rate was at 189/1000, higher than the 167/1000 quoted for 1993 (in the Project Design Matrix). Positive impacts include the ability of staffs at CHSU and the project area to provide information on outbreaks in time using the Integrated Diseases Surveillance and Response project implemented by Ministry of Health with funding from World Health Organization. The negative impacts include inability for MOH to provide sufficient funding for continuation of all project activities, which started almost 1 year after handover. Activities that haven been affected include inability to procure reagents, lack of maintenance and rehabilitation of infrastructure and equipment.

(2) Sustainability

The technical skills transfer was successful under the project. There has been a high attrition of members of staff in some departments where there is only one counterpart instead of the numbers trained as counterparts. Few specimens are sent to CHSU from district hospitals resulting into some laboratory technicians to not utilize their skills fully. Funding from MOH through Other Recurrent Transactions (ORT) to support laboratory and other activities has not been guaranteed. Procurement of reagents and spare parts has been delayed for certain departments, which do not have the support of development partners. This has affected the performance of those departments.

3-2 Factors promoting sustainability and impact

(1)Factors concerning to Planning

Planning activities for CHSU Project was the responsibility of project management team at CHSU with little involvement of Ministry of Health during the project period. Because of funding implications to CHSU, sections at MOH involved with CHSU activities need to work together to prepare plans for activities of CHSU. The current situation is not conducive to the preparation of plans that would promote sustainability of CHSU and improve the impact.

(2)Factors concerning to the Implementation Process

Implementation of activities of CHSU project went on well during the project period. Funding was always
available from project funds. The situation changed after hand over as funding for implementation from MOH has not been available all the time.

3-3 Factors inhibiting sustainability and impact

(1)Factors concerning to Planning

The planning of activities is carried out with support from two departments of Preventive Health Services and Health Technical Support Services. There is lack of coordination between the two departments supporting CHSU and this has affected the preparation of plans.

(2)Factors concerning to the Implementation Process

Insufficient funding to CHSU by MOH has affected implementation of public health laboratories activities. The laboratory staffs that have left CHSU have an effect on the quality of laboratory work as few staffs still at working have too much work.

3-4 Conclusion

CHSU project was relevant and provided MOH and Malawi as a whole with an institution for all reference laboratory activities. But because of low funding, the sustainability of activities at CHSU is questionable. Coupled with this is the problem of retention of staffs who were counterparts to the experts during the CHSU project who have left CHSU. Most staffs have left and have not been replaced.

3-5 Recommendations

Based on the ex-post evaluation, the following recommendations are being made:

(1) Each project is expected to improve the efficiency of inputs into the project and to secure sustainability of the project after handover. For greater efficiency of resources and secured sustainability, it is required that formulation of future programmes should be based on preparation of the logical framework at the planning stage involving all stakeholders.

(2) Different donor organizations are implementing laboratory related projects with Malawi Government at CHSU and district hospitals. Arrangements for cooperation and coordination should be made as soon as other projects are being planned so that the projects complement each other.

(3) While there were some contributions from the Malawi Government in provision of working area and human resources, there have been problems for continued funding after handover. For future projects it is recommended that during the project planning stage, agreements should be made on funding for the continuation of the project.

(4) Maintenance and repair of laboratory equipment has been a problem for CHSU. There is, therefore, need to include in future projects a component for training of electro-medical engineers in maintenance and repair of specific laboratory equipment procured under the project.

3-6 Lessons Learned

The project was implemented successfully prior to the hand over of the project. Due to little involvement of MOH headquarters during the implementation it appears that MOH was not fully prepared to take over the support of the project. Because of lack of preparation of MOH for take over of project activities, maintenance and repair of some of the equipment has not been done. For the project's sustainability, the planning stage should have included the role of MOH after the project period. Besides, MOH does not have a policy document for guiding activities at CHSU. This has s created problems on how to deal with issues and problems that need some solutions at the higher level.

3-7 Follow-Up

JICA has currently no specific assistance plan for CHSU. JICA however would make the best of the outputs and lessons learned through the Project by sharing this Evaluation with CDC, DFID and other partners who are involved in health projects.