Evaluation Summary
1. Outline of the ProjectCountry: People's Republic of China

Project Title: Hospital Infection Control Project inGuangzhou

Issue / Sector: Health – Health System

Cooperation Scheme: Technical Cooperation Project

Division in Charge: JICA China OfficeTotal Cost: 269 million yen

Period ofDecember

15,

2005

Cooperation

December 14, 2008

toPartner Country’s Implementing Organizations:
Guangzhou Municipal Science and Technology Bureau,
The First Affiliated Hospital of Guangzhou Medical
College (FAH-GMC), Guangzhou Institute of Respiratory
Disease (GIRD), Guangzhou Center for Disease Control
and Prevention (GZCDC)
Supporting Organizations in Japan:
Kobe City Medical Center General Hospital, Fukuoka
Children's Hospital and Medical Center for Infectious
Diseases, Fukuoka Institute of Health and Environmental
Sciences, Kobe Institute of Health, Fukuoka City Institutefor Hygiene and the Environment, National Institute of
Infectious Diseases, International Medical Center ofJapan, Sendai Medical Center

1-1 Background of the Project
The Severe Acute Respiratory Syndrome (SARS) broke out in 2002, which infected more than 5,000
people and caused tremendous suffering. It was reported that an insufficient infectious disease
surveillance system in the initial stage of the disease prevalence and secondary infections in hospitals
were the main causes of the infection expansion. In other words, the spread of infectious diseases was
not prevented properly at that time since CDCs in charge of infection surveillance and hospitals did notestablish a proper partnership to detect the trend of the disease prevalence at the local level and to takeprompt preventive measures. Also, coping with serious infectious diseases including SARS is premisedon routine hospital infection management such as the establishment of an infection control team andthorough implementation of standard preventive measures. Each hospital in Guangzhou, however, did
not make these basic measures function practically.
In response to the situations described above, the Chinese Government made a request to the Japanese
Government for technical cooperation aiming at capacity strengthening regarding infectious disease
control in Guangzhou. After a series of preliminary studies, JICA launched the “Hospital Infection
Control Project in Guangzhou”, scheduled for three years from December 2005, with the purposes ofdisseminating the know-how of nosocomial infection management in hospitals and developing CDCs’
capacity regarding infectious disease control including pathogen detection techniques.

㼌㼛1-2 Project Overview(1) Overall Goal
Infection control measures including prevention of serious infectious diseases in Guangzhou arestrengthened.
(2) Project Purposes
1) FAH-GMC & GIRD, as model facilities, disseminate their experiences regarding hospital
infection management (including prevention of serious infectious diseases) to major medical
institutions in Guangzhou.
2) GZCDC plays a sufficient role in providing technical instruction regarding hospital infection
control (including prevention of serious infectious diseases).
(3) Outputs
1) The hospital infection management system of FAH-GMC & GIRD as a general hospital isfunctional.
2) FAH-GMC & GIRD medical staff’s capacity to respond to an onset of serious infectious diseases
is improved.
3) FAH-GMC & GIRD laboratory staff’s examination techniques are improved.
4) Manuals and education tools regarding hospital infection management are prepared.
5) Other medical institutions are able to access information regarding knowledge and experiences on
hospital infection management.
6) GZCDC’s capacity to detect major pathogens is improved.
7) GZCDC’s capacity for surveillance and instruction on hospital infection control to relevant
medical institutions is improved.
8) The partnership regarding hospital infection control (including prevention of serious infectious
diseases) between FAH-GMC & GIRD and GZCDC is strengthened.
(4) Inputs
Japanese side:

dispatch of long-term experts: 2 people in total
dispatch of short-term experts: 35 people in total
trainees received in Japan: 39 people in total
equipment: 6.67 million RMB (103.33 million JPY)
local cost: 1.36 million RMB (21.12 million JPY)

Chinese side:

assignment of counterparts: 25 people
land and facilities provision
local cost: 0.96 million RMB (14.95 million JPY)㼛

2. Evaluation Team
Members of

LeaderMr. Masaya Fujimoto

Deputy Resident

Evaluation

Representative, JICA China

Team

OfficeHospital Infection Control Dr. Tunekazu Haruta

Director, Department ofPediatrics and Infectious
Diseases, Kobe City
Medical Center General
Hospital

Infectious Diseases

Dr. Tomonobu Aoki

Executive Director,
Fukuoka Children's Hospitaland Medical Center for
Infectious Diseases

Public HealthDr. Takesumi Yoshimura Director, Fukuoka Instituteof Health andEnvironmental Sciences

Evaluation Planning

Ms. Michiko Kuwauchi

Assistant Resident
Representative, JICA China
OfficeEvaluation and Analysis

Mr. Akira Ogasawara

Construction ProjectConsultants, Inc.

Evaluation

June 22, 2008 to July 3, 2008

Type of Evaluation:

PeriodTerminal Evaluation

3. Results of Evaluation
3-1 Achievement Level(1) Achievement of the Outputs
1) Output 1: the hospital infection management system of FAH-GMC & GIRD as a general
hospital is functional.
The hospital infection management system has been strengthened by establishing 7 Infection
Control Teams (ICTs) during the project implementation, lead by the Hospital Infection
Management Committee and the Hospital Infection Management Division. The rate of missing
reports on hospital infections has decreased from 9.5% in 2005 to 7.3% in 2006 and to 2.5% in
2007. Therefore it can be said that FAH-GMC & GIRD’s hospital infection management system isabout to function.
2) Output 2: FAH-GMC & GIRD medical staff’s capacity to respond to an onset of serious
infectious diseases is improved.
During the project implementation, several lectures and a total of 4 exercises and/or training onserious infectious diseases were conducted, one of which was the case where FAH-GMC & GIRD
actually received a suspected gas gangrene patient (a victim of the 2008 Sichuan Wenchuan
earthquake) as a practical exercise. Therefore the capacity to respond to an onset of serious
infectious diseases has been improved.

㼛㼌3) Output 3: FAH-GMC & GIRD laboratory staff’s examination techniques are improved.
During the project implementation, FAH-GMC & GIRD newly added 6 pathogens which canbe examined. The detection rate of examination was increased from 30.5% at the mid-term
evaluation up to 33.4% at the terminal evaluation. Although FAH-GMC & GIRD’s examination
techniques have been improved to some extent, the capacity to analyze and disseminate
information on examination results more appropriately is required to be developed in order toutilize the examination data more effectively for hospital infection control.
4) Output 4: manuals and education tools regarding hospital infection management are prepared.
A variety of forms of implementation manuals and educational materials on hospital infection
management have been developed and distributed and a training tool on the Internet has been
established. The ratio of FAH-GMC & GIRD staff who owns these manuals and tools wasincreased up to 75% at the time of the terminal evaluation. Therefore it can be said that the
manuals and tools have been relatively broadly shared by various means.
5) Output 5: other medical institutions are able to access information regarding knowledge andexperiences on hospital infection management.
The Japan-China High Level Seminar on Hospital Infection Control was held twice in January
and December 2008. In addition, lectures at the Guangdong and Guangzhou Medical Associationand short-term training courses receiving 35 trainees from 33 medical institutions in total havebeen conducted and a “Hospital Infection Control Course” for students of the Guangzhou Medical
College was established. The regular dissemination of related information on the Internet(updated every three months) and in medical journals (published every month) has beenpromoted. Therefore it can be said that the opportunities for other medical institutions to gain
access to the knowledge and experiences on FAH-GMC & GIRD’s hospital infection management
have been increased.
6) Output 6: GZCDC’s capacity to detect major pathogens is improved.
GZCDC newly added 19 pathogens which can be examined and 11 methods of pathogen
examination. The rapidity and accuracy of examination have also been improved. Therefore
GZCDC’s capacity regarding pathogen examination has been strengthened. In addition, thecapacity of GZCDC and lower-level CDCs for extraction, preservation and transportation ofpathogens has been improved.
7) Output 7: GZCDC’s capacity for surveillance and instruction on hospital infection control torelevant medical institutions is improved.
The Hospital Infection Control Division was newly established in September 2007 and thesurveillance of the quality of disinfection and infection factors at 95 medical institutions was
conducted. Also, GZCDC staff received training on hospital infection control and therefore
GZCDC’s capacity for instruction on hospital infection control has been developed.
8) Output 8: the partnership regarding hospital infection control (including prevention of serious
infectious diseases) between FAH-GMC & GIRD and GZCDC is strengthened.
This output was newly added based on the recommendation of the mid-term evaluation. Then
FAH-GMC & GIRD and GZCDC agreed to hold periodical meetings and they had their firstmeeting in May, 2008. They keep frequent communication on hospital infection control bytelephone or in writing at the working level. The partnership among FAH-GMC & GIRD and㼛㼌㼌GZCDC has been much more strengthened than before the launch of the project.
(2) Achievement of the Project Purposes
1) Project Purpose 1: FAH-GMC & GIRD, as model facilities, disseminate their experiences
regarding hospital infection management (including prevention of serious infectious diseases) tomajor medical institutions in Guangzhou.
As noted above, the hospital infection management system of FAH-GMC & GIRD is
well-functioned by establishing ICTs. As a result, FAH-GMC & GIRD’s experiences regarding
hospital infection management have been accumulated and a model for hospital infection
management has been developed. Also, FAH-GMC & GIRD have given a variety of guidance andassistance to other medical institutions and were designated as an editing institution of the“Guangzhou City Hospital Infection Management News” published by the Guangzhou Medical
Association. FAH-GMC & GIRD have been highly appreciated as a hospital aiming to become
the model facility for hospital infection management. Therefore it can be said that the Project
Purpose 1 has been almost achieved at the time of the terminal evaluation.
2) Project Purpose 2: GZCDC plays a sufficient role in providing technical instruction regarding
hospital infection control (including prevention of serious infectious diseases).
GZCDC has conducted investigation on intestine and respiratory infectious diseases and thesituation of hospital infection control. GZCDC also wrote the “Hospital Infection Control
Techniques”, which is a textbook for medical institutions. Therefore it can be said that the Project
Purpose 2 has been almost achieved at the time of the terminal evaluation.
3-2 Summary of Evaluation Results(1) Relevance
Amid mounting public concerns about infectious diseases such as SARS and avian flu as well as
the safety and quality of medical services, the Chinese Government continues to strengthen its
prevention against and control of infectious diseases and nosocomial infections by developing various
related policies, and has also expressed its support for hospital infection control responding to the“Global Patient Safety Challenge” initiated by the World Health Organization (WHO). Thus theoverall goal and the project purposes are in line with the policies of the Chinese Government and thebeneficiaries’ needs. On the other hand, being a cross-border issue, the Japanese Government regards
infectious diseases control as one of the important issues in aid policies toward China. Therefore it
can be said that the relevance of the project was high. Besides, the project became more relevant
because its design was revised on the basis of the newly established “Regulation on Hospital Infection
Control“ during the project period, in order to strengthen the technique and capacity which are moreconsistent with the Chinese infection control policy.
(2) EffectivenessConsidering that the experience and model of the hospital infection management at the FAH-GMC& GIRD has been disseminated and the technical instruction on hospital infection control by GZCDC
has been adequately provided as noted above, there is a high possibility to achieve the project
purposes by the end of the project.

㼛㼌㼌㼌Almost all of the project outputs contributed to the achievement of the project purposes as a resultof effectively reducing the problems of FAH-GMC & GIRD and GZCDC. As to the project purposeof FAH-GMC & GIRD, some concrete advices for hospital infection control were suggested as aresult of output 1 (strengthening the hospital infection management system) and FAH-GMC & GIRD
have been highly appreciated as a hospital aiming to become the model facility for hospital infection
management as a result of output 5 (actively disseminating information on hospital infection invarious ways). As to GZCDC, it can be said that the project outputs led to the achievement of the
project purpose because the project outputs were modified during the mid-term evaluation based on
the role of the CDCs determined by the “Regulation on Hospital Infection Control” newly establishedby the Ministry of Health and focused on developing the capacity which GZCDC needs to strengthen
for the hospital infection control. Therefore it can be said that the effectiveness of the project issufficiently high.
(3) Efficiency
There were partial problems during the initial stage of the project. However, overall, almost all of
the project inputs and activities were carried out adequately and efficiently as planned and thus large
outputs were produced. Followed up by the Japanese experts to analyze technical problems and needs
and to give technical guidance, the fruits of the trainings on hospital infection control and pathogen
detection in Japan have been utilized after returning to China. Therefore it can be said that eachactivity has complemented one another and contributed to producing the project’s outputs.
Particularly after the middle stage of the project, the efficiency was highly improved since the projectappropriately optimized the range of the technical transfer in line with the problems and needs of
FAH-GMC & GIRD and GZCDC and concentrated the inputs.
(4) Impact
The possibility of achieving the project’s overall goal is relatively high because the collaborationand partnership of FAH-GMC & GIRD and GZCDC as well as the relationship among hospitals in
Guangzhou have been reinforced and GZCDC’s surveillance capacity has also been strengthened.
There is a positive impact that the project contributed to strengthening the relationship andpartnership between the medical institutions in Japan and China, respectively. Negative impacts
caused by the implementation of the project are not found by the terminal evaluation.
(5) Sustainability
The project has strengthened the needed capacity on the basis of policies developed by the
Chinese Ministry of Health. On the one hand, FAH-GMC & GIRD developed human resources tolead measures against nosocomial infections and made the hospital infection management system
function appropriately. On the other hand, GZCDC established the Hospital Infection Control
Division with distinct duties and responsibilities, which unifies roles to control nosocomial infections.
Financial sustainability of all these institutions is still maintained. Therefore the sustainability of the
project is expected to be high in political, organizational, technical and financial aspects.

㼛㼌㼙3-3 Contributing Factors(1) Project Planning
The involvement by numerous Japanese supporting organizations contributed in broadening anddeepening the project cooperation. As a result, considering a wide range of choices, the project could
explore measures against hospital infections that are more appropriate to the actual situations in
China. Besides, the hospital infection control was effectively improved since the project involved not
only hospitals but also CDCs at the local level and encouraged cooperation between them, though it isaiming at infection control in hospitals. Therefore it can be said that the project design involving
various organizations enhanced the effectiveness.
(2) Implementation Process
The Chinese Government places emphasis on the infectious diseases control. Also, FAH-GMC &GIRD and GZCDC leaders are emphasizing hospital infection control and strengthened their hospital
infection management systems in each organization. These factors promoted achievement of the
project purposes.
Besides, the capacity strengthened by the Project Cycle Management (PCM) Training to takeproblem-solving approaches contributed effectively to improving hospital infection management at
the FAH-GMC & GIRD.
3-4 Obstacles(1) Project Planning
During the initial stage of the project, the technique preferentially needed by GZCDC was obscureand had not been transferred efficiently because the Chinese Government had the hospital infection
control policy under consideration and respective responsibilities and roles of hospitals, CDCs andpublic health administrations were uncertain. However this factor had less impact on the achievementof the project purposes since the project design was revised during the mid-term evaluation after the“Regulation on Hospital Infection Control” was newly enforced.
(2) Implementation Process
Although there are numerous supporting organizations in Japan, JICA China Office took charge ofthe project, which was one of the obstacles to slow down the activities at the beginning of the project.
Thereafter communication was improved, and thus this obstacle had less impact on the achievementof the project purposes in terms of results because JICA improved the internal mechanism forcoordination centering around JICA China Office, with the related divisions such as the JICA
headquarters and domestic centers (JICA Hyogo and JICA Kyushu) and reinforced the long-term
expert team to coordinate carefully views between Japan and China.
Though FAH-GMC & GIRD improved their examination techniques, there still remained problems
that a hospital infection management laboratory did not go into full-scale operation and that thecapacity to analyze and announce laboratory data was not fully developed. The improvement in theseregards will likely contribute to further strengthening the hospital infection management andachieving the project purposes to a higher level.

㼛㼙3-5 Conclusion
As described above, there is a sufficiently high probability of achieving the project purposes. It is
recommended to take appropriate actions as described below in the section “Recommendations” in orderto promote higher achievement of the project purposes or to utilize the project results effectively aftertermination.
As to the project evaluation, the relevance, effectiveness and sustainability were highly evaluated andthere is a possibility of positive impact including the overall goal. Though there were partial problems
during the initial stage of the project, they were improved after the middle stage of the project and thus
the project has been high in efficiency on the whole.
3-6 Recommendations(1) Further Improve the Hospital Infection Management at the FAH-GMC & GIRD
Although FAH-GMC & GIRD’s hospital infection management system was significantly
strengthened, it is recommended as follows in order to make the system more functional: 1) to fully
operate the hospital infection management laboratory as soon as possible; 2) to improve theinformation system regarding nosocomial infections; 3) to provide organizational support to maintainand enhance the hospital infection management system that currently becomes functional so as topromote measures against hospital infections as a team medical care; and 4) to consider improving
conditions so as to carry out the standard preventive measures and the specific preventive measuresfor each infection route.
(2) Improve GZCDC’s Information System for Hospital Infection Control
In order to fulfill GZCDC’s function more effectively to control hospital infections it isrecommended: 1) to maintain and improve examination accuracy for infectious diseases prevention;2) to strengthen the mechanism to routinely collect and share information and data; and 3) tostrengthen the system to analyze these information and data and to support infection prevention.
(3) Cooperation between FAH-GMC & GIRD and GZCDC
Regarding the cooperation between FAH-GMC & GIRD and GZCDC, it is recommended to createa model of the cooperation mechanism and assess its effectiveness for reference to other areas,considering the mechanism that encourages hospitals and CDCs to mutually transmit the related
information and opinions.
(4) Utilize the Experiences of Hospital Infection Control Obtained from the Project
In order to utilize more widely and effectively the experiences of the hospital infection control
obtained from the project it is recommended: 1) to sum up the model of the hospital infection control
introduced by the project and to disseminate it extensively by presentations at various seminars andby submissions of papers; and 2) to assess the effectiveness of the systems and measures for hospital
infection management and control introduced by the project so as to propose them to the Ministry of
Health and the CCDC at the national level as one of the ideal models of hospital infection control.

㼛㼙㼌(5) Strengthen the Relationship between Japan and China
It is desirable to maintain and strengthen the partnership and collaborative relationship fortechnology and information exchange established or strengthened through the project after the projecttermination.
3-7 Lessons Learned(1) Partnership Established by the Cooperation among Various Institutions
To involve numerous institutions and organizations contributed to widening the scope of technicalcooperation of the project and to proposing measures that are more appropriate to the actual situations
in developing countries and their needs. Besides, the cooperation between hospitals and CDCs
generated a synergistic effect, which is expected to make greater achievements in the project.
(2) Establishment of a Coordination Framework among the Related Institutions
On the other hand, involving numerous institutions carries a risk of communication gap in general.
As far as the project is concerned, the long-term expert team carefully coordinated views between
Japanese and Chinese sides. Also, within JICA, the close cooperation centering around JICA China
Office taking charge of the project, with the various related divisions such as the JICA headquarters
and domestic centers (JICA Hyogo and JICA Kyushu) contributed to improving the coordination
mechanisms.
(3) Usefulness of Human Networks
Human networks as well as institutional networks worked highly effectively for the collaborationof various institutions/organizations described above.
(4) Practical Application of Result of Training in JapanThe result of the training in Japan was applied effectively within the project because of thefollowing factors: 1) to develop core personnel playing a leading role; 2) to coordinate sufficiently
and to narrow down the range of issues in advance; 3) to foster the sense and awareness of trainees; 4)
to have methodological training in problem analysis and planning; and 5) to make an action plan toclarify the needed activities after returning to China.
䎃䎃㼛㼙㼌㼌