Summary
1. Outline of the ProjectCountry: The Republic of Kazakhstan
Project Title: Technical Cooperation for the Improvement of Health Care Services in theSemipalatinsk Region in the Republic of Kazakhstan
Issue/Sector: Healthcare and medical care
Cooperation Scheme: Technical Assistance Project
Division in Charge: Health Administration Team, Group III, Human Development
Department, JICA
Total cost (as of the time of evaluation): 342,194 thousand Japanese yen(Extended period): 189,928 thousand Japanese yen
Period of Cooperation (Duration):(R/D): March 20, 2000 – June 30, 2003
(Extended): July 1, 2003 – June 30, 2005Partner Country’s Implementing Organization: Health Care Department of EastKazakhstan Oblast, Semipalatinsk Consulting and Diagnostic Center, etc.
Supporting Organization in Japan: Oita University of Nursing and Health Sciences,
Radiation Effects Research Foundation (RERF), Hiroshima Atomic Bomb Casualty
Council, Hiroshima University, Nagasaki University
Related Cooperation: Grant Aid Project for the Improvement of Medical Equipment for
the Semipalatinsk Region of Kazakhstan
1-1 Background of the Project
It is said that about 470 nuclear tests were conducted in and around the Semipalatinsk
Region over a 40-year period during the Soviet era. As a result, groundwater and soil
were contaminated and people’s living conditions deteriorated. Members of the United
Nations unanimously passed a resolution on proceeding with assistance to theSemipalatinsk Region in 1997, and Japan proposed convening an international
conference at the United Nations General Assembly in 1998. In specific terms, Japandecided to assist the region in relation to the health sector, and investigated the current
situations regarding health administration organizations and medical facilities throughthe dispatching of short-term experts and the implementation of a project formulation
study. Japan also hosted the International Conference on the Semipalatinsk Region inTokyo and presented Japan’s position regarding its policy for future assistance throughtechnical cooperation and grant aid.

In this context, following the two preliminary surveys, JICA publicized the minutes ofMarch 2000 meeting on the subject of “Technical Cooperation for the Improvement ofHealth Care Services in the Semipalatinsk Region in the Republic of Kazakhstan,” athree-year project starting in July 2000, and implemented technical cooperation
focusing on the establishment of systems for primary screening, detailed healthexamination and diagnoses for residents of the heavily-polluted region near
Semipalatinsk City, assistance with the collection and analysis of post-diagnosis data,
the development of human resources through accepting trainees and the provision ofmachinery and equipment.
As a result of the evaluation study implemented for the period from January 24 toFebruary 8 2003, it was decided by the relevant parties that the period of the project
should be extended in order to establish the diagnosis system initiated through thisproject and to achieve the project purpose, and therefore the project period wasextended for a two-year period from July 1, 2003 to June 30, 2005.
1-2 Project Overview(1) Overall Goal
To improve the health care services in Semipalatinsk City and the neighboring regions.
(2) Project Purpose
To improve the systems for primary screenings, detailed health examination anddiagnoses in the heavily polluted area near Semipalatinsk City.
(3) Project Outputs
1) Understanding of the health consequences of radiation on the part of the government
and the public to be promoted.
2) Primary screening is to be implemented in an effective and systematic fashion
through the use of existing health care facilities and mobile examination vehicles.
3) Detailed health examinations of persons selected for examination are to be
implemented in an effective and systematic fashion.
4) Diagnoses are to be reached so as to confirm what diseases are to be targeted by theproject.
5) Data on screening, detailed health examinations and the diagnoses are to beaccumulated.
6) The local government is to utilize the accumulated data so as to formulate
countermeasures.
(4) Project Inputs (as of this terminal evaluation)
Japanese Side:Short-term experts

76 persons (114.75M/M in total, among whom 43were dispatched for an extended period of 66.54M/M)
No. of trainees received in Japan 16 persons (13 persons in the field of healthadministration, one person in the field of databases and two persons in the field ofcytology)
Kazakhstani Side:
Equipment supply (extended period):

35,392 thousand Japanese yen

Local cost (extended period):

10,954 thousand Japanese yen

Assignment of personnel:

1,004 persons in total

Buildings and facilities:

Semipalatinsk Consulting and Diagnostic Center

provided space for the JICA Project Office.
2. Evaluation Team Overview
Members of the evaluation team(Area in charge: name, title)(1) Team leader:
Akira Hashizume
Executive Technical Advisor, Human Development Department, JICA
(2) Technical Evaluation 1:
Tomoko Kusama
President, Oita University of Nursing and Health Sciences(3) Technical Evaluation 2:
Chikako Ito
Director, Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty
Council(4) Project Evaluation:
Tatsuya Ashida
Health Administration Team, Group III, Human Development Department, JICA
(5) Analysis and Evaluation:
Keiko Kita
Global Link Management(6) Interpreter
Jun Katori
Japan International Cooperation CenterEvaluation Period
From May 14, 2005 to June 8, 2005

Evaluation type: Terminal evaluation
3. Overview of Evaluation Results
3-1 Achievements(1) Achievement of the Project Purpose
The project purpose, namely making improvements to primary screening
systems, detailed health examinations and diagnoses in the heavily polluted area near
Semipalatinsk City, has for the most part been achieved. All the frameworks have been
established; 15,751 people have been screened, 829 people have received detailed
examinations, and 71 patients suffering from types of cancer targeted under the project
are registered in the “Oracle” database. Introduction of the “Papanicolaou” method has
improved the accuracy of diagnoses, allowing early detection of cancers. 36 medical
personnel have already adopted the “Papanicolaou” method. The route for transfer fromprimary screening to diagnosis has already been decided/implemented for each targeted
disease.
(2) Outputs Achievement
Activities were smoothly implemented during the extended period of theproject, and all outputs apart from Output 6 have essentially been achieved. For issues
to be addressed in the future, the need to improve the follow-up system for people whohave received screening has been pointed out. It is probable that Output 6, “utilization
by local governments of the accumulated data on the formulation of measures,” will be
implemented once the input of all data is completed and the data has been processed.
(3) Implementation Process
The arrival of medical equipment provided under the Grant Aid Project has
significantly delayed the commencement of screening. However, technical transfers in
the fields of cytology and pathology, for which grand aid was not required, resulted insuccess immediately upon the introduction and diffusion of the “Papanicolaou” methodin Kazakhstan.
The project was smoothly implemented during the extended period of theproject, and ownership was successfully transferred to the Kazakhstani side.
3-2 Summary of Evaluation Results

(1) Relevance
It is considered that the relevance of this project is high. Support based on
experience gained through the provision of medical care to atomic bomb victims in
Hiroshima and Nagasaki met the needs of residents in the heavily polluted area near
Semipalatinsk City. The project was also coherent to the Kazakhstan’s “NationalDevelopment Plan for the Year 2010,” which sets out the social policy andenvironmental protection as strategic issues.
(2) Effectiveness
It is considered that the effectiveness of the project is high. Virtually all
activities under Outputs 1-5 have been completed. Upon the completion of all of theproject’s activities, the output will have been achieved, as will the project purpose
accordingly. On the other hand, none of the two activities planned under Output 6 hadbeen initiated as of yet. However, it is probable that these activities will begin once
input of the examination data program has been completed and statistics drawn
therefrom. The previous final evaluation pointed out the necessity for the establishmentof a comprehensive examination system by way of integrating all outputs in asystematic fashion. It is considered that this suggestion had been implemented.
(3) Efficiency
Overall, it is considered that the project has been implemented in an efficientmanner. The dispatching of experts for technical transfers was mostly appropriate interms of timing, duration and numbers of personnel, with the exception of database
preparation. Although technical transfers in relation to database preparation shouldhave been finished at the initial stage of the project, the adequate provision of
dispatched experts and Japan-based training during the extended period contributed tothe overcoming of this delay.
As for the provision of equipment, although there was a delay in the
introduction of the Grant Aid Project at the initial stage of the project due to factors on
the Kazakhstani side, no serious problems occurred over the extended period, and mostof the equipment provided has been utilized adequately.
(4) Impact
Several positive impacts were confirmed through the implementation of theproject. Screening using mobile vehicles has provided opportunities for free-of-charge
medical checkups to residents in remote areas. As the screening was conducted by ateam of medical personnel from different hospitals, it also contributed to theestablishment and reinforcement of inter-hospital partnerships. Provision of the mostadvanced medical equipment has helped improve the treatment/curing capabilities andthe practicing speed of medical doctors, which has contributed to the shortening ofhospitalization periods for patients. An unexpected result was an increase in thenumber of cases of early diagnosis of tuberculosis.
(5) Sustainability
It is considered that the organizational and technical basis necessary for thefuture independent maintenance and development of the results achieved under theproject by the project counterparts in the future. Also, at the JCC meeting, the Directorof the Health Care Department of East Kazakhstan Oblast promised continuous
political and financial support into the future upon the completion of the project.
3-3 Factors Contributing in the Production of Effects(1) Planning
The project has been able to generate highly sustainable results during thelimited project period through linkage between the Grant Aid Project and the Technical
Assistance Project.
(2) Implementation Process
In order to cope with the late arrival of medical equipment provided under theGrant Aid Project, the schedule had been adjusted so as to give priority to thedispatching of experts in the fields of cytology and pathology, for which grant aid was
not required. Also, primary responsibility for project coordination and supervision wasshifted from the city to the oblast, while the Director of the Health Care Department ofEast Kazakhstan, who continuously provided support and backup to the project,remained in office throughout the duration of the project. In addition to theparticipation of the KazNII (the Kazakhstan Research Institute of Radiation Medicineand Ecology), the continued growth of the Kazakhstani economy since thecommencement of the project also contributed to the success of the project.
3-4 Problems and Factors that Raised Problems(1) Planning
Nothing specific(2) Implementation Process
The late arrival of medical equipment provided under the Grant Aid Project
due to a delay in the signing of the Exchange of Note and the ratification thereof by theParliament of Kazakhstan had a significant effect on the implementation process of theproject thereafter. Although two out of three administrative C/Ps who participated intraining in Japan during the three-year period prior to the extension of the project left
their positions, virtually all of those who participated in the training in Japan held
during the extension period continue to be engaged in the project.
3-5 Conclusion
With the exception of Output 6, “the utilization by local governments of theaccumulated data on the formulation of measures,” all outputs were achieved
successfully, and it is probable that the project purpose will be achieved in the nearfuture. If Output 6 is also achieved with the further efforts of the Kazakhstani side in
the future, it is certain that the project purpose will be achieved.
As for the five evaluation criteria, the relevancy of the project is high, and theefficient and effective implementation of the project has resulted in significant positiveimpacts. It is probable that the results achieved through the project will be maintainedand developed into the future.
3-6 Recommendations (Specific Measures, Recommendations and Advice in Relation tothis Project)(1) Cooperation among medical personnel, programmers and other parties involved
should be maintained in order to efficiently and effectively utilize the database
constructed through this project. Also, the Kazakhstani side should continuously
consider the property and accessibility thereof.
(2) A system for follow-up examinations for those who received primary screening
should be established through the utilization of the database.
(3) An exclusive team charged with implementing screening practices should beorganized.
(4) The Kazakhstani side should consider issues pertaining to further expansion of theknowledge and skills transferred through this project to other regions.

3-7 Lessons Learned(1) The successful outcome of this project were attributed to: (i) project implementationin terms of the manner in which the linkages between Grant Aid and TechnicalCooperation Projects was implemented simultaneously; (ii) favorable collaboration
among the five implementing institutes (four counterpart hospitals and KazNII)
established with the support of the Health Care Department of the East Kazakhstan
Oblast; (iii) cooperation among the members of the screening team consisting of medical
doctors, nurses and engineers.
(2)The Kazakhstani side effectively utilized the Japanese experts by way of such means
as holding seminars pertaining to the transfer of the “Papanicolaou” method, which wasintroduced to Kazakhstan for the first time, not only in Semipalatinsk but also inregions such as Astana and Almaty.
(3) Despite the fact that no long-term Japanese experts were dispatched, cooperative
relations were maintained between counterparts and the short-term Japanese experts
who were repeatedly dispatched.
(4) The project coordinators on the Kazakhstani side were assigned for the entire
five–year period during which the project was implemented, which permitted themonitoring of the implementation of the project.