1-1 Background of the Project Pakistan had a severe shortage of medical personnel, as evidenced by the ratio of 2,111 people per doctor (compared to a ratio of 542 people per doctor in Japan). Medical facilities are concentrated in large cities such as those in Punjab province and Sindh province. The doctor shortage is especially acute in Balochistan province, with more than 10,000 people per doctor. Under such conditions, as the only medical college in Balochistan, the responsibilities of Bolan Medical College (BMC) for training personnel and providing medical services to the region’s residents are quite large. In 1990, BMC moved to its current grounds to build a comprehensive medical complex and planned to upgrade its facilities and equipment. However, insufficient financial resources prevented BMC from maintaining enough equipment for medical training, so the government of Pakistan revised the plan for BMC and its adjunct hospital and requested Grant Aid cooperation from the government of Japan. 1-2 Project Overview This project provided Grant Aid aiming at procuring equipment for scholars in the seven medical fields of physiology, biochemistry, anatomy, pharmacology, therapeutics medicine, forensic medicine and community medicine. It also aimed at improving the educational environment of BMC and at fostering well skilled doctors in order to resolve medical problem in Pakistan. (1) Overall Goal
To improve the quality of education offered at BMC and to train skilled doctors. (2) Project Purpose
To provide BMC and the adjunct hospital with equipment and improve their educational environment. (3) Outputs
1) Provision of equipment and teaching aids for practical training in physiology, biochemistry, anatomy, pharmacology, therapeutic medicine, forensic medicine and community medicine.
2) Provision of training in technology necessary to maintain the equipment. (4) Inputs Japanese Side: 488 million yen Pakistan Side: Land and Facilities |
3-1 Summary of Evaluation Results(1) Impact
Almost all the graduates of BMC that were originally from Balochistan province find work at the Department of Health in Balochistan and work as doctors in public medical facilities. BMC students include members of Pakistan’s ethnic minorities, the children of Afghan refugees, and those from administrative regions such as Azad-Kashmir, and from neighboring countries such as Iran, Saudi Arabia, India, Tajikistan, Uzbekistan, Kazakhstan, Azerbaijan, and Turkmenistan. Students from outside the province return to their homes and work as doctors, and therefore the benefits of the project are extended outside the province as well.
Although the existing equipment was well maintained and managed during the planning stages of the project, the quantity and variety were quite limited. Accordingly, only instructors carried out experiments and tests while the students merely observed. This project allowed students to learn how to use inspection equipment for the first time, enabling them to gain a firm grasp of the technology and theory. Students’ results improved overall and there were no longer any students who had to drop out due to poor results. Immediately after graduation, students were able to vaccinate patients and provide medical services, which was a huge contribution to Balochistan given its shortage of doctors. The educational hospital, the Sandeman Hospital and other places employing BMC graduates responded that there were definite improvements in the basic medical knowledge and skills of BMC graduates.
Equipment provided by Grant Aid allowed part of the community medicine department to become autonomous and form the Institute of Public Health Quetta (IPHQ), to be responsible for public health in Balochistan. IPHQ conducts educational activities for residents and provides personnel education.
Balochistan province has a multi-ethnic population and covers a broad area. The donation of micro-buses intensified and expanded the range of the community medicine department’s field training activities, so that over 20 local practical training activities are being implemented. The computers and printing equipment provided through the project allowed the department to prepare pamphlets translated into the local languages (Urdu, Balochi, Pashtu and Arabic). This is expected to be effective in disseminating information.
An autopsy museum was established, housing human skeleton and anatomical models provided through the project. It is the best of its kind in Pakistan. The museum is used not only for the students’ education but also for the instructors’ research projects. As a result, four research reports on experimental medicine, such as plasticized brain specimens and slices, and cartilage regeneration, were published in domestic medical journals, and two research projects were being conducted at the time of this evaluation.
Efforts to alleviate doctor shortages in Balochistan province led to doctors being rushed through their training in medical facilities that did not have adequate equipment. As a result, there are quite a few doctors who do not have the necessary medical technology. However, since BMC has been supplied with new equipment, these doctors can now receive short-term re-education courses. (2) Sustainability
BMC is the only medical training institution in Balochistan province. It maintains an acceptance rate of about 160 students every year. Of these, 110 openings are divided among Balochistan’s administrative regions in proportion to their population. BMC also gives priority to certain groups such as children of Afghan refugees to ensure that students from diverse backgrounds are able to attend the school. Using this system, BMC makes sure that doctors are assigned appropriately throughout the province’s regions, and is considered to be playing an important role in training local medical personnel.
Before the project, BMC had 25 courses and 221 teaching staff members, including professors, associate professors, assistant professors, and doctors. At the time of this evaluation, the number of courses had increased to 31, and there were 400 teaching staff members. An adjunct hospital, which was being built next to the school building before the project, and a comprehensive medical complex integrating medical courses and clinical laboratories have now been completed. Given that the number of entering students has remained roughly the same since the planning stage, the students’ educational environment appeared to have improved at the time of the evaluation.
Many of BMC’s professors received degrees in the United States and Europe and most laboratory technicians had doctoral degrees. The level of knowledge among the BMC staff is very high. In addition, BMC has established several training programs so that teachers—including professors— and laboratory technicians can maintain their specialized technical skills. Most of the lab equipment is being used without any problems. However, although the staff has received training in operating the equipment, some of the highly specialized lab equipment, such as the blood chemistry analyzer and high-performance liquid chromatography (HPLC), are not being used. This is due to insufficient technical skills and knowledge on the part of lab technicians as well as financial reasons.
In 2002, BMC generated 1.7 million rupee in income from tuitions, and its budget allocation from the government totaled 130 million rupees. However, this is sufficient to cover personnel expenses only, and is not enough to pay for operation expenses. The operation and maintenance budget for equipment is only 0.3 million rupees, and it is difficult to secure funds to buy reagents for highly specialized lab equipment. Accordingly, some lab equipment is not operable.
Sandeman Hospital’s Central Electro-medical Workshop (CEW) maintains the equipment procured in the project. CEW was established to repair medical equipment in the province’s hospitals, so they place priority on repairing hospital equipment more than on repairing BMC’s educational equipment. Consequently, for repairing its highly specialized lab equipment, BMC asks the local distributor, but their response is poor since it is hard for BMC to make payments. 3-2 Factors that Promoted the Realization of Effects (1) Factors Concerning the Planning
N/A (2) Factors Concerning to Implementation Process
A variety of training programs were set up within the school that allows teachers—including professors—and lab technicians to brush up on their specialized technical skills in using the main lab equipment, and almost all of the equipment is used without problems. 3-3 Factors that Impeded the Realization of Effects (1) Factors Concerning the Planning
N/A (2) Factors Concerning the Implementation Process
Since BMC does not have its own workshop for medical equipment, if the equipment breaks down it cannot be used in practical training, resulting in the deterioration of it educational function. Since the budget is not enough to cover the cost of reagents for lab equipment, the operation rate tends to be low. 3-4 ConclusionAlmost all the graduates originally from Balochistan province work as doctors in medical institutions within the province, so the project’s contribution to Balochistan’s medical sector is great. The graduates’ knowledge and skills have obviously improved, and the equipment procured in the project has allowed BMC to expand its local medical activities. 3-5 Recommendations(1) Budget for operation and maintenance expenses must be secured. (2) BMC should consider setting up its own workshop for its educational equipment, including the adjunct hospital’s equipment, in order to maintain the BMC’s equipment appropriately. 3-6 Lessons LearnedThe sustainability of projects involving laboratories can greatly depend on the technical skills of laboratory technicians and operation funds, particularly when the project deals with highly specialized lab equipment. Dispatching short-term experts to improve the technical skills of lab technicians and combining it with counterpart training should be considered when planning a project. 3-7 Follow-up SituationN/A |
