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Ex-post Evaluation

Asia

1. Outline of the Project

Country:

People’s Republic of China

Project title:

The Project for Improvement of Medical Equipment for Maternal and Child Health Care Services in Nanjing

Issue/Sector:

Population/Family Planning

Cooperation Scheme:

Grant Aid

Division in Charge:

Southeast Asia Division, First Regional Department

Total Cost:

Maximum for E/N donation; 1,728 Million Yen

Period of Cooperation

1997

Partner Country’s Implementing Organization:

Jiangsu Maternal and Child Health Center,
Department of Public Health, Jiangsu Province

Supporting Organization in Japan:

None

Related Cooperation:

None

1-1 Background of the Project

In 1995, the rebuilding effort was started at the Jiangsu Province Maternal and Child Health Center (the Center), which plays the central role in maternal and child health in Jiangsu Province, China. However, due to the financial difficulties of the Jiangsu Province government, a request for Grant Aid was made to the Japanese government. In response, the Japanese government conducted a basic design survey in August 1995. Based on the results of the survey, Japanese government implemented Grant Aid covering a wide Project area: The project not only provided equipment for the Center, the tertiary medical institution, but also to the maternal and child health centers and institutions in all of the cities and in 15 prefectures of Jiangsu Province in order to establish a referral system for maternal and child health in the entire province. The Project was completed in April 1998.

1-2 Project Overview

The Project aimed to contribute to the establishment of a maternal and child health service system through Grant Aid for medical equipment for maternal and child health at the Center as well as at maternal and child health centers and institutions in all of the cities and 15 prefectures of Jiangsu Province.

(1) Overall Goals
1) Maternal and child health service network functions in the entire Jiangsu Province.
2) State of maternal and child health in the province improves.

(2) Project Purpose
Contribute to establish the network of Jiangsu Province maternal and child health services with the Center at the top

(3) Outputs
1) Appropriate Diagnostic and medical services are provided at the Center.
2) Maternal and child health and medical staff are trained at the Center.
3) The maternal and child health services at the targeted maternal and child health centers at the city and prefectural level are improved
4) Referrals among health centers selected as pilot sites function appropriately.
5) Referrals to general hospitals function appropriately.

(4) Inputs
Total of Japanese side: 1,728 Million Yen

Total of Jiangsu side: 1,926 Million Yen

2. Evaluation Team

Members of Evaluation Team

Chihiro Oishi, JICA China Office
Kazuhiro Yoshida, JICA Head Office
Tsuyoshi Ito, IC Net Corporation
Liu Ran, JICA China Office
Li Wei, Beijing Manyo Consultants Co. Ltd.

Period of Evaluation

24 February 2002 – 9 March 2002

Type of Evaluation:

Ex-post Evaluation by Overseas Office

3. Results of Evaluation

3-1 Summary of Evaluation Results

(1) Impact
The impacts listed below are observed, although the impact with regard to the overall goal cannot be determined since it was not possible to obtain data from the health centers not targeted in the Project for comparison with data of the targeted centers.
1) In the target area of the Project, there was improvement in the referral system from the prefectural level centers to the city level centers. As the Center was just officially opened in December 2001, however, no data was available on the condition of the referral system from the city level centers to the Center. Furthermore, the data from prefectural level centers in non-target areas of the project were unavailable. Due to the lack of necessary data for comparison, it is necessary to assess the referral system for the entire province in the future.
2) Some maternal and child health centers at the prefecture level provide traveling clinics to the local areas using the supplied car. Therefore, it is confirmed that access to the maternal and child health services has been improved in some areas.

(2) Sustainability
As reported below, training activities for health staff of the city and prefectural level centers were conducted continuously and frequently. Thus, it can be said that there is sustainability in terms of the Project’s training activities. We could not acquire sufficient data to judge sustainability of the medical care in the Center because its official opening was delayed till December 2001, though it was established in January 1997.
1) The Center currently has 85 employees, which is only 15 percent of the original plan of 560. Additional recruiting activities for approximately 90 employees are being implemented, but the Center will continue to have difficulty in finding personnel due to the shortage of experienced doctors in China. The possibility of hiring retired doctors is being considered by the Center.
2) Although the Center now has a number of patients, due to the delayed official opening, some persons say that the equipment is used primarily for research activities and is not frequently used for medical care. On the other hand, training activities for the health staff of the city and prefectural level centers have continued since Project completion. Hence, training opportunities are available for the maternal and child health care staff at the city and prefectural level.
3) The sustainability in financial aspects is largely dependent on the financial aid from their governments. Maternal and child health has two parts, "health" and "medical care", which are now operated with funds from the governments. But "health care", in which medical fees cannot be earned, is still easily affected by governmental financial support. The Center is greatly dependent on the government because the extent of care conducted by its medical section is limited partly because of the delayed opening. The city level centers have a medical care division that attends to an increasing number of patients since implementation of the Project. Although their income from medical treatment fees can be assumed to have increased accordingly, accurate data to support this was not obtained in the study.
4) There have been no major problems with the equipment provided to the city level centers. The maintenance and management system for the equipment is comparatively good, but the possibility of updating equipment largely depends on the financial condition of each regional government.

3-2 Factors that promoted realization of effects

(1) Factors concerning Planning
N/A.

(2) Factors concerning the Implementation Process
1) The Center’s fulfilling of its functions as the top referral promoted the realization of the Project outcome at the city and prefectural level. Despite the delay of staff assignment at the Center according to the original plan, the Center held e training activities for the staff of the city and prefectural level centers, and also responded to consultation requests from prefectural level centers regarding equipment management.
2) Services at the city and prefectural level centers have improved due to the provision of equipment and technical guidance from the Center. This improvement was supported by the fact that the city and prefectural level centers were reasonably well organized at the beginning of the Project.

3-3 Factors that impeded realization of effects

(1) Factors concerning Planning
N/A.

(2) Factors concerning the Implementation Process
The outset of functions of the Center’s medical care section as a tertiary medical institution should be confirmed in the future due to the delay in the Center’s official opening and staff assignment. The delayed staff assignment is partly because the Center's personnel expenses, which are borne by the provincial government. As the personnel expenses increase in line with the number of patients, the Center is unable to afford more doctors.

3-4 Conclusion

The Project represents a prototype as a contribution toward establishing a network of maternal and child health services. Although the function of the Center as the top referral of the network has not been fully established, the Center functions properly as a training facility for maternal and child health-care workers in the province. However, the Center's function as a tertiary medical institution should be confirmed later since there was insufficient information at this point of the study due to the delayed opening of its medical section and delayed staff assignment. The supply of equipment to the city and prefectural level centers led to an increase in the number of patients. Furthermore, health activities at the prefectural level and technical improvements at the city level had positive effects on maternal and child health in the region.

3-5 Recommendations

(1) It is certainly necessary to make clear the division of roles in the field of maternal and child health between general hospitals in the province and the Center. It is also crucial to make efforts to increase the number of patients and experienced doctors. Examples of the efforts include: 1) Effective public relations activities to raise the reputation of the Center, 2) marketing to conclude contracts with private companies that assign the Center as their designated hospital, and 3) part-time employment contracts with doctors of other hospitals.

(2) From the study, it was confirmed that referrals of the prefectural level centers have two parallel routes; one is to city maternal and health institutes and the other is to general hospitals (the study did not cover referral from city level centers to province level centers.) The role and demarcation between the Center and the general hospital may be clarified by examining the function of the overall maternal and child health system, and by giving region-by-region consideration to the current situation of centers, geographic conditions and transportation infrastructure in the region, as needed.

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