Japan International Cooperation Agency
Share
  • 日本語
  • English
  • Français
  • Espanol
  • Home
  • About JICA
  • News & Features
  • Countries & Regions
  • Our Work
  • Publications
  • Investor Relations

Ex-post Evaluation

Asia

1. Outline of the Project

Country:

Bangladesh

Project title:

A Pilot Project on Prevention and Control of Rheumatic Fever and Rheumatic Heart Diseases

Issue/Sector:

Health and medicine

Cooperatiosn Scheme:

Project-Type Technical Cooperation

Division in Charge:

Medical Cooperation Department

Total Cost:

Period of Cooperation

November 1988 - October 1992
November 1992 - June 1993 (Follow-up)
1996 (Aftercare)

Partner Country’s Implementing Organization:

Ministry of Health and Family Welfare and National Center for Control of Rheumatic Fever & Rheumatic Heart Diseases (NCCRF & HD)

Supporting Organization in Japan:

Related Cooperation:

Project-Type Technical Cooperation “Cardiovascular Diseases Control Project”

1-1 Background of the Project

Between1979-1986, with the request of the government of Bangladesh, Japan implemented a technical cooperation project for the Cardiovascular Diseases Control Project. Through the Project’s activities, the government of Bangladesh recognized the importance of tackling rheumatic fever (RF) and rheumatic heart disease (RHD), which are widespread among children of low-income backgrounds, requesting the government of Japan to provide technical cooperation to develop the capability to control RF and RHD through project cooperation.

1-2 Project Overview

This Project aimed at preventing and reducing RF and RHD cases by introducing methods of prevention and control in NCCRF & HD, as well as proposing effective measures to prevent RF and RHD by applying the results of epidemiological studies conducted by the Project. The Project was implemented between 1988 and 1992. A follow-up was then implemented and experts were further dispatched in order to strengthen the NCCRF & HD’s medical capabilities.

(1) Overall Goal
To contribute to the promotion of public health in Bangladesh by applying the results of this cooperation in a nationwide program of under Ministry of Health and Family Welfare.

(2) Project Purpose
To develop a measure of control over RF and RHD through the cooperation and collaboration of hospitals.

(3) Outputs
1) Introduction of effective and efficient methods of RF and RHD prevention and control.
2) Conducting of epidemiological studies in the fields concerned.
3) Improvement of diagnostic capability.
4) Improvement of examination and testing methods.

(4) Inputs

Japanese side:

Long-Term Experts

6

Equipment

257 Million yen

Short-term Experts

29

Local Cost

 

Trainees Received

10

Bangladesh Side:

Counterparts

20

Land and Facilities

 

Local Cost

1 Million yen

2. Evaluation Team

Members of Evaluation Team

M Shah Alam, Crown Agents

Period of Evaluation

February 14 - March 20, 2003

Type of Evaluation:

Ex-post Evaluation by Overseas Office

3. Results of Evaluation

3-1 Summary of Evaluation Results

(1) Impact
As a nationwide and regional epidemiological study on RF and RHC was not implemented, it was not possible to assess the extent of the Project’s contribution to the control of the diseases. However, it appears that the number of patients in Dhaka is decreasing, and the Center’s recent data shows that the number of new outpatients during March and November—the period during which outbreaks are most frequent—was 110-115 and only 8-9 of these were suffering from RF and RHC. Furthermore, interviews with collaborating hospitals report that the number of patients with RF and RHD is very low. This is probably because the number of patients in the city with RF and RHC has fallen and patients tend to go to the NCCRF & HD Center due to its reputation for RF and RHC treatment.

This study surveyed 50 newly-arrived outpatients. Most respondents said that they came to the center for early-stage treatment since the center would provide tests and treatment for free or at very low cost. Sixty percent of the respondents answered that they visited the center after recommendations from family and friends, while 40% responded that other hospitals had recommended the center. The center is increasingly recognized as a specialized institution for the treatment of RF and RHC, at least in Dhaka city.

The Project initially intended to extend its activities after its experience in the pilot area by introducing epidemiological study and countermeasures. However, nationwide development of the center was not possible, and the spillover effect was limited.

(2) Sustainability
Rheumatic fever and rheumatic heart disease can be prevented, and in this regard, educational activities are of extreme importance. Many educational booklets were prepared and distributed, but these efforts were discontinued after 1998 because a budget for these educational activities could not be secured. Also, the necessary logistics for activities in outlying areas such as the provision of cars could not be arranged. As a result, educational activities are limited to sending staff from the center to rural villages on a volunteer basis and contributing articles to newspapers.

Surveys must be conducted on a nationwide scale to develop a plan that will be effective in preventing RF and RHC. The Project implemented an epidemiological survey in the pilot regions. However, with a lack of budget allocation and the inability to make arrangements for a survey, after the Project’s completion, surveys gradually stopped, and were discontinued in 1999. As a result, understanding of RF and RHC at a nationwide level has not been gained.

The center focuses on improving its role as a medical institution and maintaining sustainability in this field. The number of center outpatients and tests are both increasing, but the number of patients with RF and RHC is decreasing.

Also, short-term training courses for rural health personnel, conducted during the Project period, was continued until 1999 for doctors, nurses and other technical staff and then terminated due to financial difficulty. During the Project period, the center shared diagnostics, epidemiological surveys and prevention activities with 12 medical institutions. This was effective in providing the center with more referrals as well. After the Project was completed however, the official affiliations and cooperative relationships were discontinued.

The center is maintaining its role as a medical institution, but there are concerns as to whether it will have technical sustainability in the future since the center does not provide training and disseminate technology. Furthermore, crucial equipment supplied during the Project (color Doppler ultrasound diagnostic equipment, LA2000 immunochemical measuring devices) is now old and cannot be used when needed. Since equipment donated to the center is not registered with the Ministry of Health, a budget for maintenance is not allocated and the problems will become more severe. Moreover, the maintenance technician trained in Japan has left his position, further impeding proper equipment maintenance. The center lacks the budget to upgrade not only the aforementioned medical devices and equipment, but other ones as well, and there is a strong possibility that old equipment could inhibit the Project’s sustainability.

3-2 Factors that Promoted the Realization of Effects

(1) Factors concerning the Planning
N/A

(2) Factors Concerning the Implementation Process
N/A

3-3 Factors that Impeded the Realization of Effects

(1) Factors Concerning the Planning Process
N/A

(2) Factors Concerning the Implementation Process
The Bangladesh government aims to strengthen the health sector through a “health and population sector program,” but the center is not included in this program and the budget allocation is not sufficient. Moreover, the donated equipment is not registered as Ministry of Health and Family Welfare (MOH) equipment and therefore would not be allocated under the maintenance budget.

3-4 Conclusion

Since the poor are particularly affected by RF and RHC, technical cooperation on prevention and early treatment is particularly beneficial for the poor. During the Project period, clinical, preventative, epidemiological and research activities were conducted. After the Project was completed, the center’s role in diagnosis was maintained, but activities in other sectors were curtailed or discontinued. As a result, the Project’s final goal of curbing RF and RHC in outlying regions—particularly in impoverished regions—was achieved only to a limited extent.

3-5 Recommendations

The center’s role is currently limited to clinical activities, and although it has some distinctive characteristics, it does not stand out much compared to other medical institutions. Accordingly, the organization’s mission and orientation should be reviewed. Preventative activities have had a significant result on EPI in outlying regions, and for the further result, the center should strengthen its affiliations with regional organizations under MOH jurisdiction working with RF and RHC, NGOs, and the Ministry of Education.

3-6 Lessons Learned

When the Project is completed, the implementing organization should submit a concrete maintenance plan, to be examined in detail to determine whether the implementing organization can sustain the activities it conducted during the cooperation period.

The project was supposed to be carried out in cooperation with other medical institutions, but these affiliations came to an end when the project was finished. These affiliations should not be entirely left up to the discretion of the implementing organization. Rather, an official and permanent committee should be set up with the participation of all collaborating hospitals and their own collective sense of partnership should be encouraged. JICA’s sustained involvement and support will be essential to these committees.

3-7 Follow-up Situation

N/A

PAGE TOP

Copyright © Japan International Cooperation Agency