Ex-post Evaluation

1. Outline of the Project

Country:

Nepal

Project title:

Medical Education Project

Issue/Sector:

Health and medicine

Cooperation Scheme:

Project-type Technical Cooperation

Division in Charge:

Medical Cooperation Department

Total Cost:

Period of Cooperation

June 1989 - June 1994
June 1994 - June 1996 (Follow-up)

Partner Country’s Implementing Organization:

Tribhuvan University Teaching Hospital and Institute of Medicine (IOM•TUTH)

Supporting Organization in Japan:

Related Cooperation:

Project-type Technical Cooperation; “Tribhuvan University Medical Education Project”
Grant Aid; “Project for the Expansion of Tribhuvan Univ., Institute of Medicine and the Teaching Hospital”

1-1 Background of the Project

Since June 1989, the government of Japan started a project-type technical cooperation entitled “Medical Education Project” at the Institute of Medicine (IOM) and Tribhuvan University Teaching Hospital (TUTH), which was the only medical institution in Nepal, by the request of the government of Nepal. This Project took after the “Tribhuvan University Medical Education Project” which was implemented starting in June 1980. The end goal of this series of cooperation for IOM/TUTH was to widely disseminate its medical services throughout Nepal and to support the people of the entire country in leading healthy and enriched lives, by strengthening and developing the role of IOM/TUTH as the core institution for medical education and healthcare.

1-2 Project Overview

The Project was carried out for five years from June 1989, aiming for IOM graduates to obtain international recognition through the strengthening of basic medical science education at IOM, and to enhance clinical function through strengthening collaboration between each clinical laboratory at TUTH and IOM. After the completion of the Project, a follow-up project was implemented to enhance the capacity of TUTH in the field of post-graduate training, as well as to promote cooperation among departments.

(1) Overall Goal
To develop national self-reliance in the training of healthcare professionals of all categories.

(2) Project Purpose
To establish a core for medical education in Nepal by enhancing the function of TUTH and IOM.

(3) Outputs
1) To strengthen the technical level of clinical activities, laboratory tests, and examinations.
2) To enhance the capacity of post-graduate education.
3) To strengthen the medical research department.
4) To improve hospital management, including proper care and maintenance of medical equipment and instruments.

(4) Inputs

2. Evaluation Team

Members of Evaluation Team

Simon Gautam, Development Management Institute

Period of Evaluation

November 10, 2002 - January 18, 2003

Type of Evaluation:

Ex-Post Evaluation by Overseas Office

3. Results of Evaluation

3-1 Summary of Evaluation Results

(1) Impact
The table below shows a breakdown of medical and healthcare specialists who have graduated from IOM/TUTH as of 2002. IOM/TUTH has contributed greatly to training healthcare and medical specialists within Nepal. The level of recognition toward IOM/TUTH is improving, as seen by its bachelor’s degrees being recognized by the Indian government and recently it accepts foreign exchange students from India, Sri Lanka, Bangladesh and other neighboring countries.

(Source: IOM/TUTH)

(2) Sustainability
Its functions as a hospital are being maintained and developed. After the Project was completed, the number of annual outpatients has hovered at around 190-240 thousand, while the average number of days patients spent hospitalized has been 7-8 and the bed occupancy rate has been maintained at over 80%. The number of operations performed increased annually, with 7,858 cases in 2001. The number of tests such as laboratory tests and radiation exams increased dramatically in recent years, with more than 480,000 cases per year.

There is also progress in human resource development within the healthcare field. After the Project was completed, 11 courses were added, the departments were augmented, and the number of entering students also increased. The number of students entering the MD (medical doctor) and bachelor’s degree programs increased from 116 in 1996 to 187 in 2002. At present, post-graduate training has expanded to 19 fields. There were no other medical educational institutions in Nepal before now, and IOM/TUTH had been educating and training medical technicians for all fields. However, private universities have been established and increasing recently, and their graduate training programs now focus on more specialized and advanced fields.

Almost all the staff members who received technical training from Japanese experts during the Project period have remained at their positions, and the technology is well incorporated. Maintenance level of medical equipment is also good, budget allocations to IOM/TUTH are increasing every year, and the budget for repairs is also increasing. However, measures to deal with decrepit equipment will have to be devised, since the current budget is not sufficient for renewing expensive equipment to the latest version.

While 174 faculty members work at IOM/TUTH, there are only 87 staff members in the administration division and 31 in the management division, which indicates a higher ratio of non-medical personnel. Teaching staff should be increased while cutting back on management in order to expand the capacity of medical education, but TUTH has no authority over personnel assignments.

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