Ex-post Evaluation

1. Outline of the Project

Country:

The Kingdom of Thailand

Project title:

The Family Planning and Maternal and Child Health Project

Issue/Sector:

Population/Family Planning

Cooperation Scheme:

Project-type Technical Cooperation

Division in Charge:

First Medical Cooperation Division, Medical Cooperation Department

Total Cost:

2.85 Million Yen

Period of Cooperation

June 1991 – May 1996

Partner Country’s Implementing Organization:

Family Health Division, Department of Health, Ministry of Public Health

Supporting Organization in Japan:

National Institute of Public Health, The former Ministry of Health and Welfare (The current Ministry of Health, Labor and Welfare)
International Medical Center of Japan,
University of Tokyo

Related Cooperation:

Project-type Technical Cooperation; “The Family Planning Project (Central-west of Thailand)”
“The Public Health Project”

1-1 Background of the Project

The Government of Thailand had conducted the national family planning policy since 1970. As a result, the growth of the population decreased from 3.0 percent in 1970 to 1.5 percent in 1985. The 6th National Economic and Social Development Plan put the high priority on family planning and its goal was set to decrease the growth rate to 1.3% by 1991. Japan had conducted the Project-type Technical Cooperation for family planning in central-west of Thailand from 1974 to 1989.

However, the areas that had not received the benefit from this project were still large, and the wide gap of the health status among the regions was recognized; especially, in the northeast region the status of maternal and child health was relatively low compared to the national level, and both birth rate and infant mortality were higher than those in other regions.

Considering this background, the Government of Thailand requested the Government of Japan to provide cooperation in family planning and maternal and child health (FP/MCH) in the north east regions of Thailand.

1-2 Project Overview

To expand services for improving the status of maternal and child health in the northeast region through strengthening of information, education and communication (IEC) activities and improvement in abilities of medical experts and the personnel engaged in FP/MCH service.

(1) Overall Goal
To improve health status of communities in the northeastern part of Thailand

(2) Project Purpose
To promote and strengthen FP/MCH activities

(3) Outputs
1) To establish the basic FP/MCH activities at community level and to strengthen the IEC activities at community level.
2) To promote the skills of middle manpower and nurses in terms of FP/MCH.
3) To establish the health information system.
4) To promote the research on the FP/MCH.

(4) Inputs

2. Evaluation Team

Members of Evaluation Team

Local Consultant: IC Net (Thailand) Co., Ltd.

Period of Evaluation

17 February 2002–19 March 2002

Type of Evaluation:

Ex-Post Evaluation by Overseas Offices

3. Results of Evaluation

3-1 Summary of Evaluation Results

(1) Relevance
In the 8th National Economic and Social Development Plan, effective between 1997 and 2000, the Government of Thailand put the high priority on FP/MCH, especially on qualitative improvement and diffusion of services by using technologies, on strengthening of services by non-medical staff, and on political assurance and quality control by the standards for certifying good hospitals. The result of the implementation of this Project was consistent with these priorities.

(2) Effectiveness
The terminal evaluation in 1996 agreed that the purpose of the Project, “to promote and strengthen FP/MCH activities” had been achieved very effectively. Also at the point of the evaluation this time, the processing of the Project aimed at local need assessment, equipment/technology inputs, and information management was effective, and many of the inputs are still being used today or have contributed to achieving the long-term goals of government to improve services at the peripheral levels.

(3) Efficiency
Since the joint evaluation carried out in 1996 did not state the efficiency of the Project, it is difficult to assess it at this moment of ex-post evaluation. However, based on the interview results in four provinces conducted for this ex-post evaluation, it could be predicted that the inputs of human resources such as dispatching the long and short term experts, and medical and other equipment for the Project were made without delay. All inputs provided through the Project had been utilized within the scope of the Project activities and had greatly contributed to achieving the Project goal.

(4) Impact
The result of the evaluation survey this time showed that MCH index was improved as follows:
1) Status of health was improved, considering that the Contraceptive Prevalence Rate (CPR) and Maternal Mortality Rate (MMR) in northeast Thailand nearly reached the national goal level, and that both of them continuously uphold the level.
2) MCH in northeast Thailand has been improved both qualitatively and quantitatively, and is enough to keep the current level. Data shows an apparent increase in Infant Mortality Rate (IMR), yet the increase in IMR is a result of the improvement and increase in accuracy in the recording and reporting system.
3) The rate of the Newborn Birth Weight under 2,500 grams has not achieved the national goal except in Khonkaen, which may mean that the quality of the MCH care has not reached the completely satisfactory level as expected at the national level. This may require taking effective measures to lower this rate in the near future.
Overall, it may not be able to clearly identify the direct or sole contribution of the Project to these indicators. However, it is possible to relate the inputs and the results of the Project as one of the contributors to the improvement or stable condition of these health indicators. It is noted that most of the health personnel agreed that the biggest contributor to improved health status was the financial and political support from the central level. They also admitted that except for some problems, the Project had positive synergetic effects with regard to government support and contributed to enhancing the health status in northeast Thailand.

(5) Sustainability
Overall, it is assessed that the effects on the health brought about by the Project have been sustainable in terms of organization, finance, human resources and equipment, since the Project was designed within the existing structure and the structure has remained much the same as of the point of the time of the Project. The biggest factor contributing to success in the sustainability of the project results was the continual support from Thai government to the health sector. In addition, it is confirmed that most equipment provided by the Project is still in use. The reasons for this result are appropriate need assessment, the well-established maintenance system, and so forth. However, the evaluation team did not find clear evidence of the sustainability of IEC activities or its materials.

3-2 Factors that promoted realization of effects

(1) Factors concerning Planning
1) The Project was in support of a program prioritized by the government for several years.
2) Effective assessment of needs at the problem area level is aimed at improving service quality and contributing towards positive impact to the final population groups.

(2) Factors concerning the Implementation Process
1) Selection of appropriate interventions both in terms of equipment and personnel development responding to the need assessment.
2) Teamwork and dedication of health personnel of the hospitals and health centers; good spirit of cooperation between the JICA experts and the Thai counterparts.
3) Integration of equipment and training activities into the regular programs of the Ministry of Public Health, leading to long-term impacts on the interventions.

3-3 Factors that impeded realization of effects

(1) Factors concerning Planning
N/A

(2) Factors concerning the Implementation Process
To some extent, but not significantly affecting the Project results, the lack of adequate training on equipment use and maintenance has led to some items not being fully utilized.

3-4 Conclusion

This project achieved the goals as were expected from the government of Thailand, participants from the northeast Thailand and their organizations. The Evaluation Team is of the conclusion that the FP/MCH Project was successful in achieving its goals, contributing towards the health improvement of mothers and women. Furthermore, the Ministry of Public Health has been successful in sustaining the long-term utilization of the inputs, therefore leading to extended benefits beyond the Project period.

3-5 Recommendations

(1) Decentralizing problem identification and solution finding to the provincial, district and sub-district are the key factors leading to effective responses and commitment of personnel at these levels.

(2) Decentralizing services to the peripheral level is a good goal but must be supported by sufficient staffs that are adequately trained.

(3) More careful planning and implementation must be made of equipment setup, initial training and follow-up services. The supplier or maintenance service agency should be well marked/the label on the equipment itself.

(4) Periodic follow-up assessments should be conducted comparing health problems/issues with organization/personnel capacity and new technology, aiming at decentralized services.

3-6 Lessons Learned

(1) Sustained government policy is significant to long-term impact of the Project interventions as well as replicability and expansion. Future project formulation and development should include a detailed review and analysis of government policies and trends in prioritizing budgetary allocations, manpower and technology development.

Information systems are valuable to the effective management and monitoring of health systems. Clearer and standardized systems should be used that can provide useful information to the immediate users as well as to other users for monitoring and technical support.

3-7 Follow-up Situation

N/A