Ex-post Evaluation

• Country : Kingdom of Thailand
• Project title : The project for strengthening of National Institute of Health capabilities for
  research and development on AIDS and emerging infectious diseases
• Issue/Sector : Public Health
• Cooperation scheme : Technical Cooperation
• Division in Charge : 1st Medical Section, Medical Cooperation Division
• Total Cost : 980 million JP yen
• Period of Cooperation :
  (R/D): 24th Dec, 1998, 1st March, 1999 – 28th Feb, 2004
  (Expert) :
  (F/U): 6th May, 2004 – 16th March, 2005
• Partner Country's Implementing Organization: National Institute of Health, Department of Medical Science, Ministry of Public Health
• Supporting Organizations in Japan : National Institute of Infectious Disease, University of Tokyo, Osaka University, etc
• Related Cooperation :
  R/D: 2.45 billion JP yen (1984)
  1.46 billion JP yen(1986)
  131 million JP yen (2001)

1-1 Background of the Project

The National Institute of Health (hereinafter NIH) was officially established in 1986 by the Japanese Grant Scheme, which procured buildings and facilities worth 2.45 billion JP yen (1984) and 1.46 billion JP yen (1986). NIH, belonging to the Department of Medical Sciences (hereinafter DMSc), Ministry of Public Health (hereinafter MoPH), is responsible for research and development (science and technology) to prevent and control diseases. NIH also serves as the national reference laboratory for various etiologic agents.

The Ministry of Public Health, given the serious infectious diseases and HIV/AIDS situation in Thailand, cooperated with JICA under the project of [NIH project](1994~1986) and [Prevention and Control on AIDS](1993~1996). All of the activities were successfully completed as the basis for further steps to be taken and for more collaboration between the Thai and Japanese Governments in AIDS project. The subsequent project proposal from NIH was submitted to JICA focusing on AIDS vaccine development and the increasing importance of other emerging infectious diseases.

In addition, a follow-up project (2004~2005) was additionally implemented after all the mentioned activities were completed.

1-2 Cooperation Overview

(1) Overall Goal

NIH conducts biomedical studies contributing further to the control of infectious disease in Thailand NIH.

(2) Project Purpose

NIH improves its capabilities for research on HIV/AIDS and emerging and re-emerging infectious diseases.

(3) Project Outputs

• Conditions facilitating studies of HIV infection and AIDS are strengthened.
• HIV-1 vaccine evaluation system using animals in the containment laboratory is established.
• Facilities for the national repository system for HIV vaccine trials and the serum bank are established.
• Capabilities of identifying etiologic agents are improved.
• Laboratory network for surveillance is established.

(4) Project Inputs

Members:

• Community Health⁄AIDS (Team Leader)
• Tomohiro Kato
  Kokusai Kogyo (Thailand) Co., Ltd.

• Assistant Researcher
• Thanyatorn Singrueng
  Kokusai Kogyo (Thailand) Co., Ltd.

• Technical Support
• Sucheewan Yoyrurob
  Kokusai Kogyo (Thailand) Co., Ltd

Period of Evaluation:

1st⁄October⁄2006~30th⁄January⁄2007

Type of Evaluation:

Ex-post Evaluation

3-1 Summary of Evaluation Results

(1) Impact

(a) HIV⁄AIDS (Cohort Study)

It could be concluded based on the facts such as the number of registered patients and the publication of the cohort study that the cohort study associated with NIH and Lampang Hospital maintains and improves the quality of its output and performance contributing to the development of HIV⁄AIDS vaccines ever since the termination of the project. In addition,facts and findings which are discussed in Chapter 3.3; "Sustainability" such as availability of manuals, financial support, etc (Annex; Questionnaire, Interview and Field visit survey) could ensure the expansion of this outputs, promising the achievement of the project objective as "NIH improves its capabilities for HIV⁄AIDS" at a higher level in future. Although there is no end to the control of infectious diseases, improvement of NIH research capacities ultimately contributes to a healthy life for the citizens of Thailand and their neighbors.

The installation of GLP (Good Laboratory Practice) has not yet been completed although it was recommended in the terminal evaluation report.

(b) Emerging and Re-emerging Infectious Diseases

As the result of the interview and questionnaire surveys, it was confirmed that many different diagnoses, of which particular knowledge and techniques were principally transferred by the project, of collected samples have become a part of NIH daily works by following routine procedures. This has been realized rather smoothly because of the appropriate input both qualitatively and quantitatively. In fact a lot of samples are delivered from mainly provincial hospitals to NIH for identification of pathogens. No statistical data how many samples are diagnosed is obtained during the study but this fact shows that NIH provides technical services to the local public health units for the control of infectious diseases in Thailand.

Moreover, according to the result of interview survey to Ms. Krongkaew of EID project manager, currently many international organizations have been collaboratively conducting EID surveillance in Thailand by utilizing present resources such as facilities and human resources strengthened in the project. This could have been initiated that the achievement of the project attracted many organizations willingly collaborating with NIH and sentinel laboratories.

(c) Publication

According to the statistical feature of NIH publication, the number of publications from 2000 to 2005 is increasing. Moreover, the number of Thai authors as main authors, after the termination of the project, is bigger than that before the termination. This proves that NIH researchers improved their capacity as researchers satisfactorily to be eligible for their research reports to be published in qualified journals and magazines.

(d) Collaboration with Other Institutes

NIH has currently six MoU with other institutes. Four out of six institutions are Japanese universities, which have been notably involved in the implementation of the project. By analyzing the field of collaboration, these Japanese universities seek for the academic research base in Thailand rather than opportunities for international development cooperation.

In addition to the collaboration works, there were opportunities for C⁄P personnel to receive financial support from external organizations⁄ agencies for their academic or institutional capacity building.

(2) Sustainability

a. Current Situation of Counterpart Personnel

All counterpart personnel have not been transferred to other offices. They are mostly working for the same or similar field of work. This has been enhancing the collaborative research activities currently between Japanese experts and NIH.

b. Organizational and Policy Aspect

There is no particular change to NIH`s position among organizations under MoPH. However, the participation of NIH in South East Asian Nations Infectious Diseases Outbreak Surveillance Network (hereinafter ADSNet) could prove that related positions of NIH as the Thai national reference laboratory is rising. Furthermore, it is expected that the presence of NIH as a referral information resource in the Health Information System would become indispensable.

According to the results of the questionnaire and interview survey, it is understood that the perceptible change or effect due to the decentralization is not still available in NIH, Lampang hospital and sentinel laboratories.

Based on the facts and findings, it could be concluded that sustainability of the project in organizational aspect would be ensured if universal health care policy and decentralization act do not become a big burden.

c. Financial Aspect

According to the tendency of budget transition of both MoPH and DMSc (the increment % of their budgets between 2002 and 2005 is respectively 7.8% and 19.6%), the amount of NIH budget might have also the same or a similar figure. The fact that the outlay of central government for the health sector is increasing may indirectly support the relevance of this hypothesis.

Moreover, the number of collaborating activities has significantly increased since the termination of the project. This could surely strengthen the financial stability of NIH.

3-2 Analysis of Factors of Impact and Sustainability

Considering the nature of NIH as a national reference laboratory, it is the quality of performance on research activities that have potentially affected the achievement of the project's overall goal. In order to fulfill the academic or institutional reputation, there would be the following key factors.

(1) Impact Factors

• Capacity Building of researchers and facilities by the internal training program and the attainment of doctoral degree (Technical Capacity)
• Broad collaboration with other institutes⁄ organization (Technical Capacity and Financial Stability)
• Publication of research results (Direct benefit on the control of infectious diseases and creation of new research project)

(2) Sustainability Factors

• No outflow of C⁄P personnel participated in the project is identical after the termination of the project (Human Resource).
• Knowledge and techniques are still relevant to research activities (Techniques).
• The relative position of NIH in MoPH is kept the same or has enhanced since the termination of the project (Organization).
• The financial condition of NIH is stable or more capable since the termination of the project (Finance)

(3) Other Factor

• Outbreak of infectious diseases in the region (Need for emergency measures on infectious diseases)
• Need of network for the control of infectious diseases (Institutional Framework)
• International cooperation (International Relation)

3-3 Factors hindering⁄ limiting the project achievement

The study team identified no particular problems which may disturb the impact and sustainability of the project.

3-4 Impact Not Anticipated After Project Completion

(1) Establishment of Database

The basic information corresponding to clinical symptoms, diagnosis results, social backgrounds and marital sexual relationship of registered individuals was securely input into NIH host computer. The samples associated with the social backgrounds of specimen donors and more than 48,000 serums could be nothing but a surprising result of activity continuation from the project.

(2) Completion of DNA Sequence Analysis

The collaborative research activity between NIH and Mahidol University of Thailand on DNA sequence analysis has been successfully completed. The serum samples used in this research were provided from the Cohort Study. Mahidol University played the role of a laboratory to perform the sequence of samples, whereas NIH conducted molecular epidemiological analysis of the sequence data, including subtype distribution, new recombinant forms frequency and characteristics of drug resistance mutations (Report of Follow-up, JICA, 2005).

3-5 Follow-up Situation

One Japanese long term expert was dispatched to NIH after the termination of the project.

3-6 Conclusion

Impacts of the project have already been incorporated into the NIH basic function and work since the termination of the project. Moreover, the respectful self efforts of NIH researchers have enhanced NIH diagnostic and analytical capabilities. This will attract more institutes⁄ agencies for collaboration in the fields of HIV⁄AIDS and EID.

Behind this significant achievement, it should be noted that stable financial background, coincidently the recent rapid economic recovery of Thailand, of NIH and other related organizations and the 9th National Health Development Plan (2001-2006) along with the Health Policy in Thailand provided break-though for further development of NIH. Moreover, due to the recent cross-border outbreak of deadly infectious diseases like avian influenza (so called bird flue) reminded the Thai government and people of the importance of infectious disease control and prevention, which is currently controlled by NIH with a satisfactory level (this proves that the achievement of overall goal of the project is attained) and might be projected on the future direction of National Policy on Health.

3-7 Recommendation

In order to achieve the project overall goal with higher level, the following issues are considerably recommended.

(1 )Introduction of Laboratory Standards

As mentioned in the terminal evaluation report, NIH, especially the Animal Center, should install GLP standards in order to ensure the generation of high quality and reliable test data of HIV vaccine candidates for clinical tests.

(2) Utilization of NIH Database

The control of infectious diseases requires quicker response as economic activity of Thailand inflates more around the region and the national policy on health promotes the integrated information system empowered by internet technology. NIH should establish a more enhanced information system which may potentially integrate the national information system and provide useful information to provincial hospital and laboratories in future. This will strongly support the effective control and prevention of cross-border diseases and eventually the achievement of the national health policy.

3-8 Lesson Learned

During the study the following issues were confirmed as for a positive lesson.

• Regular communication between Japanese experts and C⁄P personnel, even after the project, have enhanced the technical capacity of NIH and generated the research opportunities. Therefore, the encouragement of the researcher’s network will benefit the continuous expansion of the project impact and enhance the sustainability of the project achievement, especially like this type of technical cooperation.
• Knowledge and techniques transferred by the project are still relevant and useful in NIH, which has produced enormous result of research activities. From this outcome, the reasonable project inputs designed based on the institutional capacity analysis and the project purpose are considerably important.