Summary on the Result of Terminal Evaluation Study
1.Outline of the ProjectCountry： People’s Republic of China (“China” Project title：HIV/AIDS Prevention Project in Gansu
hereafter)
Province
Issue/Sector：Health and medical care

Cooperation scheme：Technical cooperation project

Division in charge：JICA China OfficeTotal cost (as of the evaluation)：470 million yen

Period of Cooperation

15 June 2006 – 14 June Partner Country’s Implementing Bodies：
2009
Ministry of Health, Gansu Provincial Health Department
and Provincial CDC (Center for Disease Control andPrevention), Health Department and CDC of prefecture
and county level at 13 project sites*
Project Sites：Project cities: Lanzhou, Tianshui, Jiuquan,
BaiyinModel sites:
Lanzhou city: Chengguan district and Qilihe district
Tianshui city: Qinzhou district and Qingshui county
Jiuquan city: Suzhou district and Dunhuang city
Baiyin city: Baiyin district and Pingchuan district
Other area assisted by the project: Gangu county,
Tianshui city

1.1.Background of the Project
In China the number of HIV carriers and AIDS patients has increased and the affected area has increased. In
some areas, the HIV infection route has spread from particular groups to the general public and the spread of
HIV/AIDS is becoming worse year by year. The Chinese government has actively taken measures towards
HIV/AIDS prevention such as by formulating preventative policies and strategies, preparing andstrengthening relevant mechanisms, implementing national projects and increasing budgets for HIV/AIDS
prevention. However, the prevention and treatment activities for HIV/AIDS cannot really be said to have been
sufficient, partially due to the social discrimination surrounding HIV/AIDS.
In these circumstances, the Chinese government requested assistance from the Japanese Government tostrengthen HIV/AIDS prevention measures. Initially assistance for comprehensive HIV/AIDS prevention
targeting several provinces and autonomous regions was requested, but finally Gansu Province was chosen as
the target area and a technical assistance project was set up for the duration of three years from June 2006 inorder to strengthen preventative measures against HIV/AIDS in the province. Gansu was the second poorest
province in China and had a highly mobile population, suggesting a high potential risk of HIV/AIDS
spreading in the future although at the time infection levels were rather low. Moreover, measures against
HIV/AIDS had not yet been successfully implemented
1.2.Project Overview(1) Overall Goal
HIV/AIDS prevention measures which were carried out through the project in Gansu Province to bereferred to by other provinces.
(2) Project Purpose
HIV/AIDS prevention measures to be improved in Gansu Province.

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(3) Outputs
1) Health education and preventative intervention activities for target groups at the project sites to bepromoted.
2) Standardized and accessible VCT（Voluntary Counseling and Testing） services at the project sites to beprovided.
3) Capacity and partnership with relevant bodies to implement HIV/AIDS prevention activities at the
project sites to be strengthened.
4) Experience in HIV/AIDS prevention activities to be reflected in the AIDS-prevention related policies ofGansu Province.
(4) Inputs (as of March 2009. Local cost burden by the Chinese side is up to the end of December 2008)
Japanese side:
Dispatch of experts:
Long-term experts: 3 in total, short-term experts: 25 in total
Acceptance of trainees in Japan:
37
Equipment provision:
Local operational cost:
Chinese side:
Allocation of counterparts:
Space and facilities provided:
Local cost burden:
2．Evaluation Team
Members of
Evaluation
Team

Team leader

105,066 thousand JPY (7,054 thousand RMB)
216,150 thousand JPY (14,047 thousand RMB)

116 approx.
project office in Gansu Province CDC, vehicle, office facilities
10,987 thousand RMB
Mitsuhiro Ushio

Executive Technical Advisor to Director General,
Human Development Department, JICA
Evaluation planning Michiko Kuwauchi Assistant Resident Representative, JICA China
OfficeEvaluation analysis Masako Tanaka
TAC International Inc.

Period of2 – 25 March 2009
Type of Evaluation：Terminal evaluation
Evaluation
3．Results of Evaluation
3.1.Achievement Level(1) Project purpose: HIV/AIDS prevention measures to be improved in Gansu Province
The achievement of the project outputs helped to bring about the following effects:
・ Promotion of VCT, enabling HIV carriers at the project sites to be identified
・ The capacity of the Department of Health and CDC in Gansu Province on planning, implementing andmanaging HIV/AIDS prevention measures has been strengthened
・ The possibility of reflecting the experiences and suggestions from the project in the HIV/AIDS
prevention policies of Gansu Province is being considered
Therefore, it is expected that the project purpose will be achieved by the end of the project.
(2) Achievement of the Outputs
Expected outputs have been generated according to the plan as follows (output 4 is anticipated):x1) Output 1: Health education and preventative intervention activities for target groups at the project sites
to be promoted
A wide variety of health education and preventative intervention activities ware carried out targeting
political and community leaders, the general public and high-risk groups as well as priority groups
according to the needs and circumstances of the project sites. Total target numbers (indicator 1) haveincreased (the total number of health education recipients increased from 1,125,154 in the first year
(Jul.2006-Jun.2007) to 7,340,779 in the second year (Jul.2006-Jun.2008) and to 9,433,866 by Decemberof the third year (Jul.2006-Dec.2008); the total number of the preventative intervention activitiy
recipients increased from 8,650 in the first year to 18,467 in the second year and to 34,292 by Decemberof the third year) and it is recognized that the dissemination rate of AIDS-related knowledge (indicator2) has been improved by up to approximately 75 points. These facts show that output 1 has been
generated according to the plan.
2) Output 2: Standardized and accessible VCT（Voluntary Counseling and Testing）services at the projectsites to be provided
By providing VCT services by outreach methods (providing health education/preventativeintervention activities at the site and by mobile VCT vehicles) and strengthening the PR activities of
VCT room services, the number of VCT service recipients (Indicator 1) has increased (the total number
increased from 11,218 in the first year to 31,126 in the second year and to 44,902 by December of thethird year). VCT services as a whole are increasing. These facts show that output 2 has been generated
according to the plan.
3) Output 3: Capacity and partnership with relevant bodies to implement HIV/AIDS prevention activities atthe project sites to be strengthened
The project management capacity of CDCs at the project sites and linkage with relevant bodies were
strengthened. This was achieved through a cycle of theoretical management training using IEC followedby theory-based practicing activities (activity planning – activity implementation – evaluation) andexperience exchanges.
This output can be clearly confirmed by the fact that a variety of activities based on the circumstancesand needs of these areas have been carried out in cooperation with other departments, and several
models have been created from these activities. These facts show that output 3 has been generated
according to the plan.
4) Output 4: Experience in HIV/AIDS prevention activities to be reflected in the AIDS-prevention related
policies of Gansu Province
Regarding the dissemination of the project outputs and strategy on sustainability, issue-based
HIV/AIDS prevention measures are being summarized according to suggestions from the projectexperts. These dissemination efforts according to the suggestions are either planned or have been carriedout, such as introducing the project activities and model cases in the province, management theory
training, and utilizing the project counterparts in preventive intervention activities (indicator 1). The
HIV/AIDS Prevention and Control Activity Guidelines of Gansu Province (provisional title/draft),which incorporate the advice of the project expert, are under consideration and it is also being
investigated whether or not it is necessary for them to be legally enforced by Gansu Provincial Health
Department (Indicator 2).
Through the above-mentioned activities, the project outputs have been planned or carried out tospread out and the project experience is soon to be reflected in the AIDS-prevention related policies ofGansu Province. Output 4 can therefore be said to have been being generated according to the plan.

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3.2.Summary of Evaluation Results(1) Relevance
It is considered that the project has high relevance for the following reasons:・ The overall goal and the project purpose are in accordance with the public health and AIDS prevention
and treatment policies of China as well as the HIV/AIDS prevention and treatment policies of Gansu
Province.
・ The overall goal and the project purpose are in accordance with the Japanese government’s economic
cooperation policies towards China, which focus on infectious disease control.
・ In terms of the project design, the PDM (Project Design Matrix) was changed according to changes in the
HIV/AIDS infection situation in Gansu Province during the mid-term evaluation. Thereafter, the project
has been implemented smoothly according to the revised PDM.
・ The selected project area is considered appropriate as Gansu Province is a poor area and althoughinfection rates are still low, an analysis of the transmission route suggests that we will see HIV/AIDS
spreading from high-risk groups to the general public.
(2) Effectiveness
Although the PDM gradually strayed from the existing situation at the beginning of the project, it wasrevised in response to the changing situation during the mid-term evaluation. Thereafter, as a result ofsmoothly implementing activities based on the revised PDM, the project outputs were achieved. After the
mid-term evaluation, the project focused on modeling many kinds of activities that had previously been
implemented, and several models were accomplished by the time of the terminal evaluation.
It is considered that the project was highly effective for the following reasons:・ It is expected that the project purpose will be accomplished by the end of the project, with the relevant
outputs close to those planned. Gansu province is considered an area with low HIV/AIDS infection rates;
however, the number of HIV carriers has been gradually increasing. It is also predicted that HIV infection
will spread from high-risk groups to the general public as transmission through sexual contact has
increased. Under these circumstances, the project has been strengthening health education andpreventative intervention activities for target groups including the general public, and improving VCTservices, which facilitate the identification of infected individuals. Through these activities, the capacityof planning, implementing and managing of provincial CDC, CDCs at any level at the project sites havebeen strengthened with regard to HIV/AIDS prevention measures (health education and preventive
intervention activities, and supply of VCT services). Therefore, it is considered that each project output
generated a synergetic effect that eventually led to the accomplishment of the project purpose.
・ Several models(*) of HIV/AIDS prevention measures in low prevalence areas have been suggested
through the various activities carried out at each project site, which can be good reference for other low
prevalence areas.
*Community-based HIV/AIDS-related health education in the Qinzhou district of Tianshui city, healthservice activities in the agricultural area of the Qinshui county of Tianshui city, VCT service PR activities
using public buses in Lanzho city, TV programs on AIDS in the Baiyin district of Baiyin city, AIDS healtheducation activities and PR targeting the general public and leaders making use of big events in Jiuquancity and so on.
(3) Efficiency
Comparing the level of output generated and level of input from both the Japanese and Chinese sides aswell as the following facts, it is considered that relevant input was made in terms of efficiency.

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・ The numbers, areas of expertise and technical knowledge of JICA experts and counterparts wereappropriate.
・ Training in Japan helped to renew the concept of health education message in HIV/AIDS prevention
measures, to improve on-site activities and to broaden the views of the people concerned, as well as toenhance the project activities.
・ Appropriate equipment has generally been provided and made use of.
・ Appropriate amount of the project operational management budget has been allocated from both theJapanese and Chinese sides.
On the other hand, elements which had a minor negative impact on efficiency are as follows:・ Dispatches of JICA experts (project coordinator and chief advisor) were delayed, slightly delaying thelaunch of the project. If a long–term chief advisor had been dispatched until the end of the project, theexperience gained through the model activities could be reflected better in the HIV/AIDS prevention
measures of Gansu Province.
・ The biochemical autoanalyzer was not used for outreach test services in the mobile VCT vehicle but
rather installed in the CDC laboratory. The reason for this was that the reagent cost is so high that its rateof loss is too high when recipients of tests are small in number. It was expected that Mobile VCT vehicles
would be introduced in two more cities; however, since they had not been provided by the time of theterminal evaluation, these activities are to be verified by the Chinese side after the termination of the
project.
(4) Impact
It is understood that the overall goal of HIV/AIDS prevention measures that were carried out through the
project in Gansu Province being referred to by other provinces is highly likely to be achieved as informationon the project outputs has been circulated to the Ministry of Health, China CDC and various provinces
throughout the country, and this will continue.
The following positive impacts (ripple effect) have also been confirmed:
・ Through the project activities, the personnel in charge of the project at prefecture and county levels wereable to identify public health needs, and a project on primary health care has been designed (including
PDM).
・ Members of staff that were trained during the project have been responsible for training sessions on
project management, VCT and so on as provincial instructors.
・ CDCs in the project target cities have started the dissemination of the project activities and training at
non-project target sites within cities.
・ Application documents for activities of the global funds project (Round 6) have been prepared using
problem analysis and purpose analysis methods in the project target cities.
・ A health service activity model in agricultural areas of Qinshui county of Tianshui city reminded people
who are involved in public health at several levels in Gansu Province of the importance of, and demandfor, health promotion.
No negative impacts of the project had been found at the time of the terminal evaluation.
(5) Sustainability
It can be judged that the sustainability of the project is high from the political, organizational and financial
point of view:・ Policy: the project policy is in line with the Chinese public health policy and China’s Action Plan
(2006-2010) for Reducing and Preventing the Spread of HIV/AIDS. The HIV/AIDS Prevention andxiii

Control Activity Guidelines of Gansu Province (provisional title/draft), which incorporate the advice ofthe project experts, are under consideration and it is also being investigated whether or not it is necessary
for them to be legally enforced by Gansu Provincial Health Department (Indicator 2).
・ Organization: A department of AIDS and STD (Sexually Transmitted Diseases) was established at CDC
at every level throughout the province and a certain number of staff was allocated. Human resources
development through training sessions in the province carried out by instructors trained during the
project and exchange sessions with the project activity staff is planned.
・ Finance: The number of national and provincial budgets that include HIV/AIDS prevention measures ison the increase. The Gansu Provincial Health Department and provincial CDC have clearly expressed
their intention to disseminate and develop the outputs gained from the project activities in the province.
Despite the limited budget, there are several approaches would support financial sustainability to acertain extent, such as inventive activities by trained staff, cooperation between departments, utilizing
community resources, cooperation with NGOs, utilizing the resources of international NGOs and donors.
3.3.Factors Contributing to Production of EffectIt was confirmed that the following factors helped to accelerate the project.
・ The project management method that was chosen, which used a short cycle (quarter) comprising theapplication, screening, authorization and evaluation of project activities at each project site as well as
sharing experiences throughout the target area.
・ Practice and repetition of activities supported by theoretical training on operational management utilizingIEC.
・ On-site expert guidance・ Introduction of participatory on-site monitoring by staff in charge at the provincial level.
3.4.Problems and Factors that Raised Problems
Although the project management method using a short cycle (quarter) was largely effective as mentioned
above, the following minor issues were raised with regard to management of the project:
・ Short cycle (quarterly) planning and implementation method caused a certain influence that it wasdifficult to grasp the whole activity plan of the project.
・ The short cycle (quarterly) planning and implementation method caused a temporary budget crunch,which was solved with the efforts of the concerned parties.
3.5.Conclusion
The project can end as scheduled since the project has almost accomplished its purpose and has madeconsiderable achievements in each of the 5 evaluation areas. It is also considered that its sustainability is
high.
Large outputs that have never been seen before in any HIV/AIDS prevention measures are:(1) the dissemination of health education and preventive intervention activities accelerated the identificationof infected individuals(2) HIV/AIDS prevention measure activities were carried out through the project, based on the idea that healtheducation is for healthy living, emphasizing the value of life. This resulted in changing the concept of
HIV/AIDS prevention measures from a dreadful disease to a preventable disease and also emphasizedvaluing one’s life at all levels, from the government administration to the community.

xivThe project strategies were not only to simply conduct routine HIV/AIDS prevention activities, but also tocarry out operational management training alongside the prevention activities and to put the theory into
practice in order to develop and strengthen the abilities of the project staff. As a result, multiple different
models were suggested at each project site according to the actual conditions and needs.
It is expected that human resources development at provincial, prefectural and county level will be carriedout and HIV/AIDS prevention measure activities implemented by trained staff will continue in Gansu
Province. Gansu Provincial Health Department and provincial CDC have expressed their intentions tocontinue and to make an effort to disseminate them.
A substantial amount of information has been provided to the Ministry of Health, China CDC and provinces
all over the country. It is expected that these HIV/AIDS prevention measure models and capacity development
methods for practical activities will be extended to other provinces through the continual provision of
information and opportunities for exchange.
3.6.Recommendations(1) The project should continue to document the project outputs so that the information can be shared with theother parties concerned in the province, the Ministry of Health, China CDC and other provinces. The
document should be presented in such a way as to indicate how models were established, how they became
successful and clarify the process of implementation including improvements.
(2) It is important that Gansu Provincial Health Department and provincial CDC should make full use of theexperience of HIV/AIDS prevention measures in a low prevalence area that they gained through the project,and strengthen and promote relevant HIV/AIDS prevention measures.
For that purpose, it is expected that Gansu Provincial Health Department will consider HIV/AIDS
Prevention and Control Activity Guidelines of Gansu Province (provisional title/draft), and initiate andsupport the provincial CDC’s dissemination, development and implementation of the project outputs within
the province.
The provincial CDC has started activities introducing and disseminating the project outputs and further
effort should be made in this respect. The introduction and dissemination of the project outputs should be
carried out in such a way that participants can learn and understand the whole process of achieving theoutputs. This should be done not through one-sided explanations, but rather through exchange sessions orworkshops that involve the project staff.
(3) It is expected that the Ministry of Health and China CDC will continue to provide support by providing
information with materials made by the project for other provinces to refer to and to utilize the project
outputs.
3.7.Lessons learned(1) This project significantly generated outputs in terms of improving the capacity and incentives of thecounterparts as follows. The following method can not be applied to all developing countries; however, it isconsidered an effective method of technical transfer and capacity development.
・ project management training sessions regarding problem analysis, planning, implementation, evaluationand feedback were carried out throughout the project targeting activity operation staff at the projectsites
・ these theories are then put into practice in the actual activities with a quarterly cycle*. (* repetition ofactivities including a quarterly application of an activity plan and budget by staff in charge; examination

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and authorization of the plan by the provincial CDC and Japanese experts based on the previous quarter’s
performance; implementation; and evaluation, reporting and information sharing.)(2) This quarterly project management method clearly shows the outputs and its high flexibility creates
incentives for the counterparts. On the other hand, the rather short cycle management has had a certain
effect on how the project activities as a whole are understood, and may make the project management
difficult.
(3) Japanese experts always reside at the project sites and give technical advice to strengthen not only
technical aspects but also management capacity. This is unique to Japanese on-site technical assistance andis not seen among other donors. The Chinese side highly appreciates this.
(4) A chief advisor and project coordinator familiar with the present situation in China have been dispatched.
Consequently, the activities could be started rapidly and be carried out smoothly from the beginning of theirassignment, which resulted in good outputs over a short period. It is desirable to dispatch experts who arefamiliar with China in order to achieve good outputs over a rather short period - such as the three years of
this project.

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