Summary
1. Outline of the ProjectCountry: People's Republic of China
Project Title: Health-Care in Poor Remote Area
Issue/Sector: Medical care
Cooperation Scheme: Domestic Training Program
Division in Charge: Human Development Department, JICA
Total investment: 4,410,300 yuan
Cost per trainee: 17,700 yuan
Percentage of Japanese contribution: 68%
Period of Cooperation:(R/D): May 2000–December 2004
(Extension): N/A(Continuation after F/U): N/A
Partner Country’s Implementing Organization: JICA Medical Care and Nursing
Training Center, China-Japan Friendship Hospital
Supporting Organization in Japan: Related Cooperation: None in particular
1-1 Background of the Project
The pace of development in western China has been slow in comparison withthat in coastal areas, and its level of medical technology is lower than that in regions
whose economies have seen greater development. With the implementation of Chinese
government's policy aimed at developing the western regions, the improvement of thelevel of medical technology in remote impoverished regions in the west has become oneof the key issues of Chinese government policy. The China-Japan Friendship Hospital isa general hospital that was established in 1980s by way of Japanese aid. Many years oftechnical cooperation has made it one of the best general hospitals in China. The
hospital was designated as a Grade III-A hospital in 1993 and as a National HealthHospital in 2001, and boasts an outstanding reputation in Beijing and nationwide.
On April 28, 2000, China and Japan inaugurated “The Domestic Training
Program for Health-Care in Poor Remote Area,” aimed at improving health careconditions for people in impoverished areas, improving the quality of medical care andnursing offered at local hospitals and the level of medical care as a whole, promoting
linkage with the implementation of hygiene and health care system for entire

populations, and also disseminating among medical personnel in the impoverishedwestern regions the technology and knowledge that has been accumulated throughtechnical cooperation with Japan up to the present.
1-2 Project Overview
During the project implementation period (from 2000 to 2004), JICA Medical Care andNursing Training Center of China-Japan Friendship Hospital held training classes overa period of five terms. The contents thereof cover various areas of the medical field,
including clinical, nursing, medical technology, and test fields. Through various forms of
training such as lectures, observation, practical training, and visits, 250 rank-and-file
medical personnel were able to benefit from new knowledge and technology as well as
experience accumulated by the China-Japan Friendship Hospital with a view toimproving the level of the medical technology in some impoverished provinces ofwestern and central China such as Qinghai, Gansu, Ningxia, and Xinjiang.
(1) Overall Goals
To improve on-site medical conditions, to narrow regional gaps, and to raise the level of
medical services nationwide(2) Project Purpose
To foster high-quality sanitary technicians in central and western China(3) Project Outputs
1) To ascertain new technology and developmental trends in specialized fields and to
broaden the outlook thereof2) To raise the level of technical knowledge(4) Project Inputs
Japanese side:
Purchase of facilities:

76,500 yuan

Training costs:

3,753,000 yuan

Total:

3,829,500 yuan

Chinese Side:
Manpower:

Total 261 persons

Costs:

580,800 yuan

2. Evaluation Team Overview
Leader: Li Wei, Vice General Manager, Beijing Manyo Consultants Co., Ltd.
Evaluation Period: From November 1, 2004 to January 7, 2005

Type of Evaluation: Terminal evaluation
3. Overview of Evaluation Results
3-1 Summary of Evaluation Results
1) Relevance
China’s impoverished regions are spread mainly throughout the west of thecountry and in areas where ethnic minorities reside, and disease is one of the principal
causes of poverty. In the midst of the implementation of the project, the Central
Committee of the Communist Party of China and the State Council (government)
announced the “Decision of the Central Committee of CPC and the State Council on
Further Strengthening the Public Health Work in Rural Areas,” hammered out thedetails of “the assistance to the poor through public health work” campaign andincorporated it into a nationwide plan on the assistance to the poor. From theviewpoints of Chinese government's development policy and concrete needs, this projectis very important and also concurs with the Japanese government’s assistance policy.
This project establishes as its beneficiaries the medical personnel in theprovincial hospitals in the poor districts in the west, which fits the current Chinese
medical and health care system, and as such the selection of the beneficiaries isappropriate. As an organization, the China-Japan Friendship Hospital has strong
training capacity capable of implementing this project. In addition, the hospital itself isthe product of a Japanese government assistance project and is conducive to the
diffusion of Japanese technology and the expansion of Japanese influence. Therefore,
appropriate choices have been made in regards to the project-implementing
organization and technology diffusion model.
Based on the analysis of the current situation, this project is quite relevant.
2) EffectivenessThe levels of specialist qualification of 250 trainees have been improved
through the training in general. This training proved not only to be useful in improving
the expertise of the trainees but also brought about new perceptions on new technology
and trends in the development of expertise, resulting in the positive effects of widening
participants’ outlooks and thinking.
The questionnaire results show that both the implementing organization andbeneficiaries have appreciated the results of the training. In the examination upon thecompletion of the project, all the trainees were judged as having succeeded. With theself-evaluation of the trainees, more than 98% answered that their level of expertise
had improved. Also, 100% of the lecturers judged that the trainees' levels of theoreticalknowledge in their areas of expertise had improved on a whole, and 94.4% of themjudged that the trainees' levels of ability in practical contexts had improved. According
to the feedback from the trainees, the degree of satisfaction of the hospitals that had
dispatched the trainees reached 95.5%. The project therefore can be seen as producing
satisfactory results.
Following the training, all the trainees found front-line positions (with somepromoted to managerial positions), and are using the knowledge and technology theygained through the training in their actual work. 54% of the trainees have been
acknowledged as well-qualified personnel by the organization for which they work, andare producing a positive stimulatory effect in improving on-site medical conditions andmedical technology as a whole.
The result of the research shows that the project has already produced results,
and that its purpose of fostering qualified medical and health care personnel for thelowest level hospitals in the west has almost been achieved.
3) Efficiency
For the project, there was a sufficient input of human resources, both in termsof quantity and quality, and high-level lessons were ensured. All the equipment andsupplies used by trainees in practical training and experiments represents facilities
within the actual possession of the China-Japan Friendship Hospital and allpurchased equipment and supplies constitute educational materials purchased for the
purpose of ensuring high quality of lessons by experts. The extent and timing of the
input of such expenses was executed as planned and strictly controlled so as toremain within the scope of the plan.
Training and activities pertaining to each area were implemented as scheduled,
all the human resources, goods, and funds were secured prior to the commencement oftraining, and educational activities were successfully implemented at the appropriate
time.
The management and conduct of the project managers were appropriate.
Serious consideration, however, in regards to the collection, organization, and summaryof project-related data was somewhat lacking, and further improvement on the
management level is expected.

(4) Impact
All the trainees have stated that “the learning was a fruitful experience andwhat was learned can be applied to day-to-day work,” and are providing services to the
local patients by using the knowledge and technology they have gained through thetraining. 98.7% of them have been trying to transmit and spread the knowledge andtechnology with which they have been imparted in various forms, and the effects of thisspread of technology have begun to come to light.
95% of the trainees have participated in technology improvement, revision ofrules and systems, and/or review of operation procedures at the hospitals where theywork, and are contributing to the improvement of the medical service system of their
hospitals. Some of them have been selected as key technical experts or managers andare, albeit on a local level, playing useful roles in quality improvement of regional
medical care.
The number of trainees was limited and it is therefore difficult to directly
observe “the improvement in the level of medical technology in remote impoverishedareas.” They are, however, playing a role to some extent in the overall target of“improving on-site medical conditions” and “the narrowing of regional gaps.”(5) Sustainability
Although expenses will remain a problem for the training program following
the completion of the support project, the government is expected to maintain its policy
over a long period of time into the future wherein medical and health care in
impoverished areas is supported. The China-Japan Friendship Hospital that
implemented the training has a long-term and stable organizational structure, and assuch it can secure the necessary input of human resources and goods for training.
3-2 Factors Promoted the Project(1) Planning-

As a part of the government's policy of “providing assistance to the poor throughpublic health projects,” financial aid to provincial hospitals in poor areas has beenenhanced.

-

The government's strategy to develop the western region has been implemented.

-

The needs for provincial hospitals to improve their level of local medical careservices had been urgent.

(2) Implementation Process-

China-Japan Friendship Hospital has good lecturers, and its affiliated JICA Medical
Care and Nursing Training Center is highly competent in implementing training.

-

The reputation of the China-Japan Friendship Hospital proved to be useful ininviting people to the lessons given by experts of national repute.

-

The trainees' eagerness to learn was strong.

-

The curriculum setting was basically practical in its orientation.

-

The outbreak of SARS made the curriculum substantial and graphically illustrated
its practicality.

3-3 Factors Contributed in the Production of Effect
1) Planning-

The aim as of the launching of the plan came to be somewhat weakened, as target
areas were shifted from former liberated districts, minorities regions, remote areas,
and impoverished regions to western China in its entirety, and the attendees fromprovincial hospitals in minorities regions and impoverished areas decreased
somewhat.

-

Due to the limit on the number of the trainees, it was difficult to satisfy practicalneeds.

-

Medical conditions in impoverished regions are inferior and trainees have little
occasion to make contact with advanced facilities, and as such they had difficulty
absorbing new technology.

2) Implementation Process-

The trainees constituted people recommended by each province’s Department of
Health, and extensiveness of beneficiary hospitals was restricted.

-

There was a disparity in trainees’ levels of expertise.

-

There was an outbreak of SARS during the implementation period of the project,
and training fell behind as a result.

3-4 Conclusions
Through examination of the results of the following five evaluation items, theevaluation team judged that the project had been implemented effectively and thetargets had been achieved.
-

In light of the Chinese government's development and practical need-focused policy,
the established project is quite necessary and conforms with the assistance policy of

the Japanese government. By way of an analysis of the beneficiary selection, project
format, and implementation ability of the implementing organization, the project is
indeed shown to be relevant.
-

Both the lecturers and the trainees have recognized the results of the training. All
the trainees were successful in their examinations upon the completion of the
training, and the planned goal of fostering high-quality sanitary technicians forcentral and western China has been achieved. All the trainees consider that “thelearning was a fruitful experience and what was learned is applicable to their work,”
and all of them have assumed front-line roles upon completing their training andare providing services to patients in local areas by using the knowledge andtechnology they gained.

-

Project costs were strictly controlled, and both investment and the effects thereof
concur with the plan.

-

Almost all the trainees have been transmitting the knowledge and technology
learned in various capacities at the hospitals where they are working, and theeffects of this diffusion of technology have begun to come to light. This is resulting in
the improvement of services at local hospitals, albeit at the local level.

-

In regards to training activities following the completion of the support project,should funds be secured, the implementing organization of the training has theability to continue said training.

3-5 Recommendations(1) To the implementing organization
In order to achieve the overall goals of the project, the implementing
organization is to compile records of the trainees as early as possible. It is recommended
follow-ups be conducted so as to monitor the circumstances of said individuals and topromote exchanges and cooperation among trainees, between the trainees and experts,
and between trainees and the China-Japan Friendship Hospital.
It is recommended that the project be summarized in an assiduous fashion,that methods for establishing curriculum for specific trainees with various
circumstances be examined, that the yardsticks for curriculum innovation andpracticality be understood, and that ex-post evaluation on the effect of the training be
conducted.
(2) To JICA
In order to satisfy the needs (or to ease the lack) of medical organizations in
impoverished areas for the necessary quantity and quality of medical personnel, it isrecommended that the project's role be fulfilled and that the China-Japan Friendship
Hospital’s support on further human resource development for western China bemaintained.
In order to maintain contact with the trainees, the building of a personnel
database (network) and the expansion of the effect of the project are also recommended.
3-6 Lessons Learned(1) Setting of the project
The success of this project shows that many results can be achieved by way oflimited effort provided that new support projects are implemented with the use of theresult of the past assistance. This experience can be of help in making future projectplans.
(2) Management of the project
Both the lectures by experts and visits to famous medical organizations weresuccessful components of this project, and have had positive effects in expanding the
project's influence and promoting regional exchanges, and as such they are worthy ofpromoting in a broad fashion.
Furthermore, managerial capacity should be considered carefully upon the
choice of project implementing organization, in addition to its project implementation
ability. It is necessary to prioritize surveys of needs prior to the implementation oftraining, the collection and organization of data during the implementation, and ex-post
follow-up surveys following implementation.
3-7 Follow-ups
None in particular