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

Project Title: Project for Capacity Building of Reproductive
Health and Family Care Service in Central and Western Region

Issue/Sector: Health – Health System

Cooperation Scheme: Technical Cooperation Project

Division in Charge: JICA China Ofﬁce

Total Cost: 269 million yen

Period of Cooperation:
April 1, 2006 to March 31, 2009

Partner Country's Implementing Organizations:
National Population and Family Planning Commission of China
Related Cooperation:
Grant Aid "The Project for Improvement of Equipment for
Reproductive Health/Family Health Training Center"

1-1 Background of the ProjectAs a result of promoting family planning representing one-child policy in China, it led to maintaina low birthrate and to curb accelerated population growth. National Population and Family Planning
Commission of China (NPFPC), which is the highest organ on family planning, gradually changes
the policy from curbing population growth to improvement in the quality of healthy life and works
on comprehensive health promotion service including family planning, maternal and child health,prevention of parasite and nutrition improvement. Recently, it is needed to expand such a healthpromotion service to central and western region in China. where less progress has been made in theeconomic growth, and to deal with new issues such as infectious diseases, ﬂuid population and aging
society. Therefore, it is necessary to develop human resources in central and western region and tostrengthen the existing family health services center which becomes a base for activities.
In response to the situations described above, in 2003, the Chinese Government made a request to
the Government of Japan for technical cooperation aiming at improvement of reproductive health andfamily care services in the central and western 20 provinces, autonomous regions and municipality
through strengthening the training capacity in China Training Center of Reproductive Health and Family
Care (CTC) which was supported by Japanese grant aid. JICA launched the“Project for Capacity
Building of Reproductive Health and Family Care Service in Central and Western Region”, scheduled
for three years from April 2006.
1-2 Project Overview（1）Overall Goal
Situation of the reproductive health and family health are improved in the central and western regionsin China.
（2）Project Purposes
Capacity for provision of the reproductive health and family health service are improved in the centraland western regions in China, through strengthening the training capacity of CTC.
（3）Outputs
1. The training on reproductive health and family health service to meet needs in the target regions isappropriately implemented in CTC.

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2. The implementation system for the service enhancement is strengthened in the service organizationin the model sites.
3. The experiences in the model sites are shared with the target regions through support of CTC.
4. Provincial level staff in the central and western 20 provinces in China is able to lead the service
organizations to spread family health service.
（4）Inputs
Japanese side:
1. Dispatch of long-term experts: 2 people in total
2. Dispatch of short-term experts: 20 people in total
3. Trainees received in Japan: 39 people in total
4. Equipment supply: Approx. 6.28 million RMB (94.2 million JPY)
5. Local Cost
Chinese side:
1. Assignment of counterparts
2. Facilities provision (project ofﬁce for experts in CTC)
3. Local cost
2. Evaluation TeamMembers of Leader/Health System Planning: Dr. HAYASHI Kenji
Vice President, National Institute of Public Health, Japan
Evaluation
Capacity Development: Ms. HORII Satoko
Team
Associate Expert, Reproductive Health Division,
Human Development Department, JICA
Evaluation Planning: Mr. SAKAMOTO Yoshimasa
Representative, China Ofﬁce, JICA
Evaluation and Analysis: Mr. TSURUTA Hirofumi
Chief Consultant, Binko International ltd.
Evaluation
PeriodNovember 15, 2008 to December 5, 2008

Type of Evaluation: Terminal Evaluation

3. Results of Evaluation
3-1 Achievement Level（1）Achievement of the Outputs1）Output 1
It is considered that Output 1 has been sufﬁciently achieved. In CTC, 15 training courses receiving
381 trainees in total have been conducted between the launch of the project and the terminal evaluation.
94% of courses implemented in CTC were based on curricula organized through activities of this project.
In addition, It was conﬁrmed by capacity test after trainings in CTC that all of trainees who participatedin trainings of trainers acquired necessary knowledge.
2）Output 2
It is confirmed that Output 2 has been achieved from both hardware and software aspects. On
hardware aspect, it is conﬁrmed through monitoring that 99% of supplied equipments are utilized. Inviii

addition, construction of facilities and equipment supply were also implemented by resources of Chineseside. On software aspect, service center in the model sites not only formulated their own operation plan
through trainings but also shared experience of training in CTC with 5961 staffs in total, who wereconﬁrmed to fully understand those contents.
3）Output 3
Output 3 is almost achieved and the system to share the experience based on the support of CTC wasdeveloped. The opportunities for 20 provinces to gather for sharing the experience have been properlyoffered. Moreover, the homepage is regularly updated and the newsletter is periodically issued. These
contributed to construction of the system to share the experience of the model sites.
4）Output 4
Although the data of each indicator on PDM is not fully collected, it is considered from theprogress situation that Output 4 has been achieved. Until now, the approach for provincial level staff
to understand the concepts of family health and the services has been taken. Through these activities,promotion of strengthening of the monitor and the assessment capacity was conﬁrmed and plans wereformulated. Furthermore, it worked to construct and promote the implementation system for the family
health service through issuing guideline etc., and organizing the structure to achieve outputs waspromoted.
（2）Achievement of the Project Purposes
It is considered that the Project Purposes has been achieved. At the time of this terminal evaluation,
8 provinces with model sites have determined the spreading sites other than project sites and havestarted introducing family health service there. In addition, 12 provinces without model site have also
determined 11 spreading sites, and 7 sites of them have formulated the plans for introducing the family
health service. These results show exceeding the target value of the project.
3-2 Summary of Evaluation Results（1）Relevance
It can be said that the relevance of the project was high. This project is not only contributing tocorrecting the disparities that is the current biggest challenge in China but also contributing to thedevelopment strategy in China. In addition, it meets with the approach of the government of Japan suchas Economic Cooperation Program for China and Health and Development Initiative.
（2）Effectiveness
It can be said that the effectiveness of the project is high. Through this project, "Strengthening thecapacity of CTC" was promoted and CTC is highly evaluated as a domestic and international trainingbase. Moreover, it was supported on software aspects through such as the training of CTC and on
hardware aspects like the equipment supply. And, it improved "Capacity for service provision in central
and western region" as a result of steady promotion of the family health service in central and westernregion based on the leadership of NPFPC.
（3）EfﬁciencyAfter the mid-term evaluation, the project inputs were carried out according to the plan and it can beix

said that it contributed to producing the project outputs. At the later stages of the project, respective rolesof related officials became clear by the cooperation among the Japanese side experts, NPFPC, CTC,and Chinese side experts etc. and it was improved efﬁciency of the project management and organicinteraction among major components of this project, which are the training in China, the training inJapan and the equipment supply.
（4）Impact
The system for strengthening the capacity of staffs and organization engaged in the family healthservice and for promoting such services system has been established through this project. It is expectedthat the structure established by this project will contribute to the improvement of the health and themedical situation described on the overall goal with enhancement and promotion of family health service
in the future.
（5）Sustainability
Through this project, the concept of family health has been established and the service promoting
system has been developed. Furthermore, CTC has been strengthened the capacity as the base oftraining, information and research, and the capacity of 8 model sites has been steadily strengthened.
As mentioned above, the capacity of individuals, organization, system and society was overall andspontaneously improved, and it established the concept of family health and the base of service
promotion. Such capacity ensures the sustainability of this project for the future.
3-3 Contributing Factors（1）Project Planning・On the NPFPC side, there were the strong will to promote the project, network which have ever been
constructed, spontaneous activities and technological base etc.
・Chinese side experts provided their expertise and technology, and Taicang City family health service
center offered their service model.
・CTC, whose foundation was supported by the Japanese grant aid cooperation, performed the functionof the training base.
（2）Implementation Process
・The concept of "family health" was established as 3 x 3 matrix which consisted on three fields;
maternal and child health, adolescence health and health for the elderly, and three measures; healtheducation, health checks and health counseling. Moreover, the direction of project activities wasdetermined.
・Development of the monitoring system and the management system were selectively carried out.
3-4 Obstacles（1）Project Planning
・"Strengthening the training capacity of CTC" and "Improvement of the capacity for provision andpromotion of services" were included in components of this project and 20 provinces were target
regions. Therefore, project purposes and targets were high.

x（2）Implementation Process
・No experts had been assigned for three months after starting the project.
・Even after experts were assigned, it took a long time to share directions of the implementation
process and recognition of each role among ofﬁcials.
3-5 Conclusion
Through project activities for three years, it was recognized that the training capacity of CTC wasstrengthened and practical capacity of related organizations in central and western regions was improved
due to it, therefore the effectiveness of the project is high. The first contributing factor of this project isthat the concept of family health reﬂecting needs of health issues in China and the basic system for family
health service, 3 x 3 matrix, have been established by NPFPC which played a central role. The second factor
is that the base of implementation system for promotion of family health service in central and westernregions have been developed through utilizing network from central government to grass-root. Finally, it isalso included in factors that effective trainings were implemented through improvement of the capacity of
training management in CTC. As mentioned above, the capacity of system, organization and human resourceon family health was overall improved, therefore it can be said that this project is valuable from aspect ofsustainability.
3-6 Recommendations（1）Improvement of quality of family health service
From now on, it is required that each organization related to training will try to improve capacity ofhuman development for improving respective expertise on providing services and also that the systemdevelopment for its support will be strengthened further.
（2）Strengthening capacity for monitoring
On the process of promoting family health services, activities mentioned below are required; to set
indicators for appropriate evaluation, to strengthen the capacity for monitoring such as data management
and to establish a monitoring system.
（3）Promoting family health services
Provinces with model sites are required to regularly hold workshops with other 12 provinces forpromoting family health services. And also provincial level staffs in each province are required tostrengthen the constant supervision to respective family health service centers for promoting.
（4）Future expansion of adolescence health and health for the elderly
Regarding adolescence health, it is required to expand activities regardless of conventional frame,such as including contents against the comprehensive health problem, collaboration with school healthand so on. Regarding health for the elderly, preparing for aging society with a falling birthrate, it isneeded to focus on prevention of disease and health improvement and to develop the system of healtheducation, health examination and consultation to encourage individual health action.
3-7 Lessons Learned（1）Aspect of capacity developmentxi

Individual capacity, organization capacity and development of social system were improved together
on the process of this project. As a result, it is considered that implementation of family health service intarget regions was accelerated and base for promoting was established. Since China has achieved higheconomic growth and has been required sift in healthcare policy, the future cooperation in healthcareﬁeld are required to include an aspect of capacity development focused on training human resource andstrengthening healthcare system like this project.
（2）Potential of family health
Although approach against individual health problem is generally intervention only for individual
target, family health takes an approach to treat a family sharing life base as one unit. The approach offamily health in units of families, which was considered Chinese culture and established through thisproject, is an innovative idea, so it is expected that this approach will have impact to all of developing
countries.

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