Summary of Evaluation
1. Outline of the Project
Name of Country: Lao People‫ތ‬s Democratic Republic
Name of Project: Capacity Development for Sector-wide Coordination in Health（Phase-2）
Sector: Health

Scheme: Technical Cooperation

Department in-Charge in JICA: Laos Of¿ce
Duration of Project: Five years, from December 2010 to December 2015
Implementing Organization: Ministry of Health（MOH）
Other Related Cooperation Activities: National Center for Global Health and Medicine（NCGM）
1-1ųBackground
The technical cooperation on Capacity Development for Sector-wide Coordination in Health Phase 2(CD-SWC2 or the Project) was launched on 16 December 2010 and will be completed on 15 December
2015. With the remaining cooperation period of approximately four months, JICA conducted theTerminal Evaluation from 2 to 29 August 2015.
1-2ųOutline of the Project(1) Overall Goal
・ The MOH is able to implement strategic plans, and conduct effective coordination and resource
allocation in a sustainable manner to achieve the Millennium Development Goals (MDGs).
(2) Project Purpose
・ Under the 7th five-year health development plan, strategic sub-sector development plans are
implemented with effective alignments and harmonisation.
(3) Outputs
1. Problems identified through the monitoring of the 7th five-year health development plan and its
programmes/sub-programmes are appropriately addressed through meetings of Sector Working
Group Policy Level (SWG (P)) and Sector Working Group Operational Level (SWG (O)) and theSecretariat/Coordination Unit.
2. Maternal, Neonatal and Child Health Technical Working Group (MNCH-TWG) is effective insolving the problems identi¿ed through the implementation and monitoring of the MNCH package
strategy (including Skilled Birth Attendant (SBA) development plan).
3. Human Resources for Health Technical Working Group (HRH-TWG) is effective in solving theproblems identi¿ed through the monitoring of the Health Personnel Development Strategy by 2020.
4. Health Planning and Finance Technical Working Group (HP&F-TWG) is effective in facilitating
joint planning and monitoring ¿ve year health development plan and annual operational plan of theprogrammes/sub-programmes.
(4) Inputs(Japanese side)・ Long-term experts: Chief Advisor, Health System Strengthening, MNCH and Project Coordinator/xi

Institutional Capacity Development
・ Short-term experts: In the areas of Sector Common Workplan and Monitoring Framework(SCWMF), Monitoring Capacity of Five-year Health Sector Development Plan, Evaluation andDevelopment of MNCH Strategy, Geographic Information System (GIS), etc.
・ Provision of Equipment: photocopiers, computers, headsets, printer, etc.
・ Training: Local and international
・ Project operation cost
(Lao side)・ Assignment of counterparts: 32 counterparts including Project Director, Project Managers
・ Of¿ce space and utility costs
・ Meeting rooms for coordination activities
2. Members of Evaluation Study Team

Members

Duration

Team Leader:

Ms. Saeda Makimoto(Senior Representative, JICA Laos Of¿ce)

Health Systems:

Dr. Tomohiko Sugishita(Senior Advisor (Health/Medicine), JICA HQs)

Sector-wide Coordination:

Dr. Chiaki Miyoshi (NCGM)

Cooperation Planning 1:

Mr. Masaki Aoki (Representative, JICA Laos Of¿ce)

Cooperation Planning 2:

Ms. Nami Kishida (Health Division 4, Health Group 2, Human
Development Department, JICA HQs)

Evaluation Analysis:

Mr. Naoki Take(Consultant, Kaihatsu Management Consulting, Inc.)

Cooperation Planning 3:

Mr. Vangxay Phonelameuang(Assistant Programme Of¿cer, JICA Laos Of¿ce)

From 2 to 29 August 2015

TypeEvaluation

3. Outline of Results of Mid-term Review
3-1ųAchievements of Outputs
3-1-1ࠉOutput 1
Indicators

Achievements

1. To what extent the managerial capacityof SWG (P) and (O), the Secretariat isstrengthened

Monitoring 7th Health Sector Development
Plan (HSDP) is a ¿xed agendum. Most ofissues raised at SWG (P) and (O) in 2014
were addressed.

Good

2. To what extent SWG (P) and (O) andthe Secretariat guide and support PHD
and DHO in developing coordination
mechanism

Number of provinces with fully functioned
SWC mechanism: 2 among 18 provinces

Fairxii

Evaluation

3-1-2ࠉOutput 2
Indicators

Achievements

Evaluation

1. Whether MNCH-TWG is able tomonitor progress of MNCH Package
Strategic Plan according to SOP.

MNCH-TWG regularly reviewed MNCH
Strategy.
MNCH-TWG used evaluation of thecurrent MNCH Strategy and developmentof the new strategy.

Excellent

2. To what extent alignments andcoordination are made based on MNCH
Package Strategy at provincial level.

At least 6 out of 18 provinces withfunctioning coordination mechanism:
Attapeu, Sekong, Saravanh, Champasak,
Houaphan and Xiangkhoang

Moderate

3. To what extent alignments andcoordination are made based on MNCH
Package Strategy with DP.

Most of DPs implemented activities in linewith MNCH strategy.

Good

4. Inputs allocated by MOH/DPs toimplement MNCH Package Strategy

Most of DPs provided inputs in line withMNCH strategy.

Good

3-1-3ࠉOutput 3
Indicators

Achievements

1. Whether plans are 1) developed, and2) monitored, and 3) measures are taken
to optimally allocate and retain humanresources.

At least Health Personnel Strategy isdeveloped and shared among stakeholders.
Monitoring is done with use of data.
However, three problems out of 21identi¿ed were solved.

Evaluation
Good3-1-4ࠉOutput 4Indicators

Achievements

1. To what extent HP&F-TWG 1)
updates and 2) monitor the Monitoring
Framework for HSDP as well as upgrade
the Framework so as to measure theprogress of output

The monitoring framework was updatedby HP&F-TWG, incorporated into sectorwide indicator matrix and biannual
progress reports. The monitoring
framework was developed and exercised
to monitor the 7th Five-year HSDP.

Good

2. Whether annual plans based on
available resources are 1) developed and2) monitored and evaluated at central,provincial and district levels.

Annual plans were piloted only at twoprovinces, followed by revision of theplanning template.

Fairxiii

Evaluation

3-2ųEvaluation by Five Criteria(1) Relevance
Relevance of the Project is excellent. It has been ¿rmly aligned with 7th HSDP and Japan‫ތ‬s directionof cooperation to the health sector in Lao PDR. The Project has also properly addressed the needs ofstakeholders in Lao health sector regarding the sector-wide coordination.
(2) Effectiveness
Effectiveness of the Project is moderate. Based on the indicators and performance of sector-wide
coordination, the level of achievement of Project Purpose is moderate. Results of evaluation of Output
1-4 show MNCH and HRH TWG have performed better. Especially MNCH-TWG has performed
coordination with proactive manner.
(3) Ef¿ciency
Efficiency of the Project is moderate. The Project has made achievements with a minimum input.
However, the inputs of the Project were not enough to timely enhance achievements from the otherproject in the same JICA Programme. As for Lao side, counterparts have been assigned from MOH for
project implementation, but their competing tasks and responsibilities prevented it from holding SWG
and TWG regularly(4) Impact
Realisation of positive impact from the Project is expected. Based on the current status of available
indicators of Overall Goal, they are moving forward to the achievements. The Project brought a positive
impact that was not foreseen at the time of the commencement. Ministry of Planning and Investment
appreciates sector-wide coordination in health as one of the best examples and refers the other sectors asreference. In addition, existence of the Project enabled JICA Programme for Improvement of Maternaland Child Health Systems to have synergic impact.
(5) Sustainability
Overall, sustainability of SWC is expected, although it still needs more support to some aspects.
[Policy Aspect] Sector-wide coordination is aligned with the draft 8th HSDP. Round Table Meeting
will be sustained as Ministry of Planning and Investment keeps framework of Vientiane Declaration.
[Institutional Aspect] It is necessary to ¿rmly revise TOR of SWC including strategic direction of theSecretariat, communication among Departments and their role and function.
[Technical Aspect] Many TWGs expressed that they can sustain the meeting itself without anysupport, but that it is necessary to be provided technical inputs in the meeting and to support themeasures and solutions technically.
[Financial Aspect] Since direct cost of TWG is not huge, it is not so dif¿cult for MOH to cover. Statebudget allocation to the health sector is increased year by year, while support from the Global Fund will
be prospective for SWG and TWG.

xiv

3-3ųFacilitating Factors(1) Regarding the plans
・ Existence of Vientiane Declaration enabled Ministry of Health to firmly recognise SWC. Every
ministry has a mandate to organise SWG and periodically report to the Round Table Meeting.
(2) Regarding the implement process
・ The Development Partners following the Paris Declaration and Busan Partnership Agreement topromote aid effectiveness.
・ MOH ensured ownership to the sector-side coordination such as chairpersonship of the meetings.
・ All stakeholders expressed commitment to the sector-wide coordination.
・ Interactive communication among stakeholders, especially between the MOH and Japanese Expert
Team.
・ The process of decentralisation by devolution promotes ownership of coordination and planning/monitoring at provincial level.
・ JICA Program to Maternal and Child Health Systems promotes interactive communication andmutual progress among technical cooperation.
3-4ųImpeding Factors
・ High expectation and different interest to the function of “coordination” promotes sometimes
exaggeration and discourage among stakeholders.
・ The coordination management is immature to promote institutional sustainability and effective
feedback mechanism.
・ The incentive mechanism for participation to coordination meetings is not well supported andof¿cially endorsed.
・ Chairpersons in SWC mechanism could not cope with their competing tasks to hold the meetings
regularly.
・ TOR was not suf¿ciently adjusted to the actual circumstances such as restructuring of the Ministry.
3-5ųConclusion
From evaluation results based on the five criteria, the Evaluation Team observed that the Project
Purpose is promising and sector-wide coordination mechanism has been certainly strengthened withincreasing number of TWGs at central level and its extension to provincial level is being re-explored.
In addition, the Project is developing key tools to meet emerging challenges, such as result basedmanagement, programmatic planning and progress monitoring. Finally “coordination” became an
institutional culture towards ensuring effectiveness and efficiency of organizational management.
Further development of SWC under emerging demands for “coordination” is strongly expected.
It is also recognized that coordination mechanism, especially MNCH-TWG, has been tremendously
developed for their strategic orientation and self-reliance within a short period. This experience can be amodel for autonomous and further development of sector-wide coordination.

xv

As notable advances, with stronger leadership and commitment of the MOH, it is commented that
the MOH and DPs could make initial dialogue for further development of “coordination” in the faceof emerging local and global issues in the remaining period of the Project. For this purpose, JICA andother DPs are expected to contribute intellectual ideas and innovations into this sector-wide coordination
mechanism.
Finally, the Evaluation Team cherishes the leadership by the MOH for high commitment andcontribution to the sector-wide coordination to execute 8th Five-year HSDP and promotes a foundation
for health systems strengthening and overall management towards realisation of Health Sector Reformand Universal Health Coverage.
3-6ųRecommendations(1) To MOH・ Since the Secretariat is a driving force of sector-wide coordination mechanism, it should continue
to be strengthened for further development.
・ MOH might reconsider the meaning and signi¿cance of “coordination” in the wider governmental
and global contexts
・ MOH might consider promoting a function of policy and information management as an essential
coordination function of sector-wide coordination.
・ While the coordination is demanded to respond an emerging agenda articulated by Universal Health
Coverage, health managers and stakeholders are expected to foster managerial competencies.
・ Department of Planning and International Cooperation should continue to develop revised annual
budget plan, monitoring tools and consolidated reporting form for effective resource tracking andresult-based management.
(2) To JICA
・ The newly developed JICA project for improving quality of health services is expected to promote
the sector-wide coordination.
・ While respecting ownership and leadership of the sector-wide coordination by Lao MOH, JICA
might keep catalytic engagement of technical and managerial support for sector-wide coordination
mechanism.
・ The Project might be extended for several months to execute its remaining and newly emerged
activities.
3-7ųLessons Learned
・ The sector-wide coordination as an entry point to improve management capacity of the MOH waseffective to ensure effective and ef¿cient execution of heath service provision.
・ Capacity development was a labour intensive and time-consuming process, but ¿nally it seems that“coordination” became an institutional culture.
・ While the SWC mechanism provides an environment for interactive and proactive communication,xvi

further development such as longer-term strategic planning and budgeting is expected to be enabled
under the single sector policy management led by Lao government.
・ It is important that SWC mechanism should harmonise the efforts between central and provinciallevels for standard implementation.
・ The meaning of “coordination” should be regularly reÀected by a wider systemic point of view andacknowledged by all the concerned parties in a manner of continuous dialogue.

xvii