Summary
1. Outline of the ProjectCountry: People’s Republic of China
Project Title: Project for Human Resources Development of Rehabilitation Professionals
Issue/Sector: Social security - Support for disabled
Cooperation Scheme: Technical Assistance Project
Division in Charge: Social Security Team, Group II, Human Development Department,
JICA
Total cost: 700 million Japanese yen
Period of Cooperation (Duration):(R/D): Five-year period of cooperation (November 1, 2001–October 31, 2006)(Extended):(F/U):(E/N) (Aid)
Partner Country’s Implementing Organization: China Disabled Persons’ Federation;
China Rehabilitation Research Centre
Supporting Organization in Japan: International University of Health and Welfare;
National Rehabilitation Center for the Disabled; Japanese Physical Therapy
Association; Japanese Association of Occupational Therapists
Related Cooperation: Grant Aid “Facility Planning for the Rehabilitation ResearchCenter for Disabled Persons” (1985-1988); Project-type Technical Cooperation “Projecton China Rehabilitation Research Center” 1986-1993
1-1 Background of the Project
The number of occupational hazards and traffic accidents has been rapidly
increasing in China, in line with the country’s rapid economic growth and increase inindustrial facilities and traffic volume, and it is reported that the number of disabled
persons in China now reaches 60 million. With these circumstances in mind, theRegulations on Rehabilitation Management in General Hospitals were enacted by the
Ministry of Health of China, which require that large-sized general hospitals establish
rehabilitation departments and to hire physical therapists and occupational therapists.
However, there is a notable shortage in rehabilitation workers, and there is an urgent
need to foster rehabilitation workers and lecturers in charge of developing humanresources.
The China Rehabilitation Research Centre (CRRC) was inaugurated in the late

1980s under the cooperation of China Welfare Fund for the Handicapped (now the
China Disabled Persons’ Federation) and the Japanese government, as a comprehensive
institute engaged in clinical care, research and education in the field of rehabilitation.
Thus, the basis for implementing the fostering of rehabilitation workers had been
established. Although the CRRC has been actively providing technical training torehabilitation workers throughout China, the education provided has proveninadequate, both in terms of quality and quantity, for the fulfillment of the demand forrehabilitation in China.
Thus, the CRRC and the China Disabled Persons’ Federation (CDPF)
requested that this project be implemented by the Japanese government in 1997, with aview to establishing a new training school for the CRRC. In response to this request, a
five-year technical assistance project was initiated in November 1, 2001.
1-2 Project Overview(1) Overall Goal
To enable physical therapists (PT) and occupational therapists (OT) to render services
throughout China.
(2) Project Purpose
To develop high-quality PTs and OTs who receive four years of education in accordancewith global standards(3) Project Outputs
1) To establish curricula for a four-year educational program for PTs and OTs inaccordance with global standards
2) To develop instructors able to provide rehabilitation treatment
3) To improve the educational skills of instructors
4) To improve the level of educational management
5) To prepare educational materials and equipment
6) To implement the four-year education system(4) Project Inputs (including scheduled inputs yet to be implemented but alreadyscheduled for implementation prior to the end of the project)
Japanese side:
Dispatch of chief advisor: 14 persons in total
Long-term experts

2 personsShort-term experts

23 persons in total

No. of trainees received in Japan 15 persons in total
Equipment supply

approx. 168,409,000 Japanese yenLocal cost

approx. 1,025,000 yuan (approx. 15,181,000 Japanese yen)

Chinese Side:
Assignment of counterparts:

121 instructors, 26 educational management staff

Procurement of land and facility for the project:

1,125

squaremeter(2,532,000yuan) in total, including multimedia classroom, laboratory, practical room, computerclassroom, classroom for language and audio learning, electronic reference room,accommodations for students, office for experts
Personnel cost for management:
Other

1,760,000 yuan

550,000 yuan

6,559,000 yuan in total (approx. 97,071,000 Japanese yen)
2. Evaluation Team Overview
Members of the evaluation team(Area in charge: name, title)
Team leader:Hajime Watanabe
Team Director, Social Security Team, Group II, Human Development Department, JICA
Rehabilitation:
Masami Akai
Vice Director, National Rehabilitation Center for the Disabled
Human resource development:
Motoko Sugihara
Chair, Department of Occupational Therapy, International University of Health andWelfareEvaluation planning:
Mariko Kinoshita
Social Security Team, Group II, Human Development Department, JICA
Evaluation and analysis:
Nobuyuki Kemmotsu
Senior Consultant, Chuo Kaihatsu Corporation
Interpreter:
Locally employed interpreter
Evaluation Period
From May 14, 2006 to May 27, 2006

3. Overview of Evaluation Results
3-1 State of output achievements(1) Output achievements
1) To establish curricula for four-year education program for PTs and OTs in accordancewith global standards
The four-year curricula have already been prepared, based on curricula in othercountries, including Japan, and on internationally recognized standards, and as such it
is considered that Output 1 has been achieved.
2) To develop able instructors in the field of rehabilitation treatment
Although persons with master’s degree and capable of teaching physical therapy andoccupational therapy in universities were very limited in number prior to thecommencement of the project, six persons have been trained in each area of physicaltherapy and occupational therapy covered by this project. This will increase the numberof such persons with advanced education to nine in physical therapy and six in
occupational therapy. Thus, it is considered that Output 2 has been achieved.
3) To improve the educational skills of instructors
Effective use of audio-visual educational materials is becoming common practice.
Clinical training, for which even the concept did not previously exist, is also being
implemented through the obtaining of advice from the Japanese experts. In conclusion,
although it can be said that Output 3 has reached the intended level in terms ofevaluation index, further strengthening is recommended. In particular, clinical training
is a field with a low level of experience in China, and as such in clinical training for thecurrent year’s graduates, which represented the first time such training was
implemented, the team of Japanese experts offered various sorts of instruction, such as
how to divide students in groups and how to visit the training hospitals one by one. It
cannot be expected that the necessary methods and know-how for clinical training could
be established in China through a single trial, and therefore it is considered that
continuous supervision by the experts will be necessary.
4) To improve the educational management level
As the classes are operated based on curricula and syllabi in general, it is consideredthat Output 4 is achieved. However, there are some cases where the classes are notoperated in accordance with the syllabus. In addition, it is considered that improvementof the quality of education through adequate evaluation of teachers is necessary. Thus,
it is considered that cooperation in the future will be necessary in some areas.
5) To prepare educational materials and instruments19 exclusive textbooks on physical and occupational therapy, the first of their kind in
China, have been completed. The necessary equipment and educational instruments
have been sufficiently prepared. Thus, it can be said that Output 5 has been achieved.
However, people who have actually used the textbooks have pointed out duplications
and insufficiencies therein, so revisions are to be implemented at some point in future.
6) To implement the four-year education system
In July of this year, 38 members of the inaugural class will graduate, and their job
placement following graduation will also be determined. The number of applicants forentrance is exceeding the number of places. It is expected that this four-year education
program will be implemented continuously into the future, consistently generating
about 40 graduates a year. Therefore, it can be said that Output 6 has been achieved.
(2) Project Purpose Achievements
The project aims to develop four-year education curricula for PTs and OTs inaccordance with global standards, and employs the number of graduates and the qualityof instructors as evaluation indexes. The project period is five years, and there were no
graduates yet at the time of the evaluation; however, it is expected that 38 members of
the inaugural class will graduate in the summer of 2006. Without any financial
difficulties, it is expected that the four-year education system will be implemented
continuously into the future as well. On the other hand, future cooperation will benecessary for some aspects of the system in terms of the quality of the education.
3-2 Summary of Evaluation Results(1) Relevance
In China, an increase in the occurrence of psychiatric disorders and traffic
accidents is forecasted due to the rapid aging of the population and economic growth.
Under such circumstances, the government’s awareness of support for the disabled isincreasing, and there is a strong demand for rehabilitation professionals. The Chinese
government outlines its basic policy in the strategic target set in 2002 as “enabling all
disabled persons to receive the necessary rehabilitation services by 2015.” On the other
hand, the country faces problems such as a shortage of rehabilitation professionals andinsufficiency in terms of the quality and numbers of instructors in charge of providing
training in the field of rehabilitation-related human resources, and this project aims toprovide support in terms of fostering instructors, as well as deal with other issues.
In Japan, the General Framework for ODA and the Medium-Term Policy on

ODA was reviewed after the launch of the project, and its policy of placing further
emphasis on human security issues was made clear. This project, which aims to develop
human resources for the socially vulnerable, adheres to the idea of human security. Also,in the Economic Cooperation Program for China (October 2001), the Ministry of Foreign
Affairs has established measures aimed at supporting socially vulnerable groups andhuman resource development, emphasizing these as priority areas and issues. This
project is contributing to the promotion of the social rehabilitation of vulnerable groups,
including disabled persons and the elderly, and as such it is considered that it is in linewith the aforementioned trend.
Thus, it can be said that the project relevance has further increased since thetime of the launch of the project, in consideration of the policy of the Chinese
government as well as the new General Framework of ODA and the new Medium-Term
Policy on ODA in Japan, formulated after the commencement of the project.
(2) Effectiveness1) Achievement of project purpose
Considering that it is expected that 38 members of the inaugural will graduate
in the summer of 2006, and that the four-year education system will constantly
generate graduates into the future as well, it is considered that the project’s purpose isachieved. However, opinions have been voiced that the content of the education being
provided and the quality and quantity of the instructors should be further
strengthened.
2) Causal correlation (contribution of outputs in achieving the purpose)
Outputs obtained as a result of the project’s activities (including theestablishment of curricula, the development of educational equipment and materials
and instructor training) have all contributed effectively to the achievement of the
purpose.
Therefore, in general, it is considered that the project has been highly effective(3) Efficiency
All inputs from the Japanese and Chinese sides are being used effectively inthe project activities and are contributing in producing outputs. Outputs are being
achieved as planned for the most part, and the efficiency of the project is being ensured.
As for the amount, quality and timing of inputs, although some problems werepointed out in the Mid-Term Evaluation, such as delay in the delivery of someequipment and frequent changes of chief advisors (once every few months) due torestrictions placed on the dispatch period for Japanese experts. However, remedial
measures such as a comprehensive handover process and repeated dispatches were
implemented, and as such there were no problems for the most part during the latter
half of the project period.
(4) Impact
1) Prospects for achievement of overall goal
Development of facilities and human resources will be essential in order toachieve the overall goal. The CDPF maintains a high level of enthusiasm in regards tothe achievement of the overall goal and it is currently promoting the development offacilities and human resources in rural areas. Although the development of facilities is
not directly related to the project, the upgrading of facilities is being actively
implemented especially within the CDPF group.
On the other hand, a human resources development plan for the future has
been outlined in the “Rehabilitation-related Human Resources Development Plan of the
China Disabled Persons’ Federation 2005-2015.” Following the project results, it isexpected that human resource development will progress further, with graduates being
produced every year, contributing in the achievement of the overall goal. However, it isalso expected that the smooth progress of human resource development and thespecifics of human resource allocation in rural areas will henceforth become issues to beaddressed. In addition, cooperation with rehabilitation facilities under the control of the
Ministry of Health and the Ministry of Civil Affairs is crucial in order to disseminate
rehabilitation in rural areas, and it will become necessary to ensure coordination
between these organizations.
2) Other ripple effects
The Chinese government is moving towards introducing a national certification
system for rehabilitation therapists. More universities and vocational schools arestarting to establish or reinforce courses related to rehabilitation medicine, wherein the
curricula created through the project are being used as reference or educational
material. Consequently, some positive ripple effects stemming from the project havebeen observed. However, the certification system is expected to cover only rehabilitation
therapists, and there are still many uncertainties as to what kind of certification system
will transpire. Therefore, it is still too early to evaluate the degree of the impact. No
negative impacts are anticipated.
(5) Sustainability

1) Political sustainability
The Chinese government is becoming strongly aware of rehabilitation for thedisabled. In order to expand the School of Rehabilitation Medicine affiliated with the
CRRC, the government has secured a site 200m west of the premises. The governmentis also making preparation for the introduction of a national certification system forrehabilitation therapists.
2) Organizational sustainability
The CRRC is an organization directly affiliated with the China Disabled
Persons’ Federation, and already has nearly 20 years of history (since its establishment
in 1988). As the largest modern rehabilitation facility for disabled people in China, it isconsidered that it possesses sufficient capability as a treatment and research institute.
It is also positioned as a center for activities such as comprehensive rehabilitation forthe disabled, research in rehabilitation-related science and technology, training of
rehabilitation-relatedhuman

resources,

and

the

provisionofcomprehensive

rehabilitation services. It serves a central role in the dissemination of rehabilitation
medicine technology throughout China.
However, it only has a short history as a university education institute and it isdesirable that its education management capacity be strengthened. There is also anecessity to constantly improve the syllabus, the training plan and the appointment of
instructors for the time being.
3) Financial sustainability
Rehabilitation-related treatment (clinical practice) is being steadily carried out
by the CRRC, which is producing profits. Comparing the profit with the cost burden of
the project, profit is larger. Therefore, it is considered probable that financial
sustainability will be ensured.
The Chinese side made consistent efforts to secure the necessary budgetary
resources during the project period, and there were no particular problems in terms of
consumable goods for equipment, travel (accommodations) costs for counterparts, etc.
4) Technical sustainability
The counterparts acquired knowledge and technical skills through this project,and sustainability in terms of rehabilitation skills has been ensured. However,individual instructors should continue to make an effort to bolster their own skill levels.
Educational materials, including textbooks, should also be subject to regular reviews for
improvement.
Also, while the CRRC acknowledges the necessity of educational management
as an educational institute, it cannot be said that the center has achieved a thoroughcomprehension of the education system, given that only one class of graduates has been
produced to date.
Resources and equipments are being adequately managed without any
problems in particular.
Considering all of the aforementioned aspects, it is considered that the level ofsustainability is significantly high. However, the Chinese side should continuously
make efforts in relation to strengthening in terms of education management in its
capacity as an education institute.
3-3 Factors Contributing in the Production of Effect(1) At the stage of implementation study prior to the inauguration of the project,recognition of the four-year curriculum for the training of rehabilitation professionals
had yet to be obtained. However, the Ministry of Education sanctioned theestablishment of an educational course in the School of Rehabilitation Medicine, Capital
Medical University. It became possible to recruit students from September 2002 as aresult of the early permission.
(2) Although not an actual element of the project, Japanese students implemented
clinical education within the CRRC. This not only provided an occasion for instructors
from the School of Rehabilitation Medicine to observe actual examples of clinicaleducation, but also had the effect that the students came to be active in holding casereport meetings and implementing degree-based research.
3-4 Problems and Factors that Raised Problems
In the spring of 2003, the project activities were interrupted for two and a halfmonths due to the effects by SARS. The interruption occurred at a critical point wherein
trainees in Japan for the first year were about to return to China and begin fullparticipation in the project activities. It was a setback for the project and there was adelay therein. However, due to efforts made by those involved thereafter, the delay was
overcome, and as a result, the project is progressing as scheduled for the most part.
3-5 Conclusion
This project achieved the concrete output of establishing a four-year education
system for training professionals, and a system capable of training about 40 highly
specialized personnel a year in the future is now more or less established. The mostimportant factors in this success have been an excellent selection of project strategy andadequate input and activities in accordance with the plan. This project established thebasis for a four-year university program for training human resources who are to
assume key roles in realizing the overall goal, namely “enabling PT and OT to renderservices throughout China.” This project is also considered as having yielded goodresults from the perspective of the five criteria of evaluation. However, although afour-year university was founded and the project purpose has been achieved, further
improvement will be necessary in future. In particular, the quantity and quality of
instructors are still insufficient, and educational affairs management must also be
reinforced. By strengthening these aspects and by considering measures to develop andexpand the outputs of the project nationwide, it is expected that further efforts andcontributions will be made in order to achieve the overall goal.
3-6 Recommendations (Specific Measures, Recommendations and Advice on thisProject)
In order to achieve further solid achievement of the project purpose and toachieve the overall goal, the following issues must be addressed.
(1) To obtain certification of international standards for curricula
The School of Rehabilitation Medicine is currently applying to the World
Federation of Occupational Therapists (WFOT) for international standards certification
for its OT curriculum, and the results are expected to come in this July. If it fails to
obtain said certification, study of the reasons for the rejection must be made and thenecessary measures taken.
Although the World Confederation for Physical Therapy (WCPT) does not havea certification system similar to the WFOT, it is desirable for the PT curriculum toobtain some kind of internationally recognized certification.
(2) To coordinate clinical services and education
Instructors of the university should be sufficiently prepared in advance before
giving lectures and practical training instructions in order to ensure adequate
education. However, all the counterparts are currently in charge of both clinical andeducational work, which makes it difficult for them to ensure sufficient preparation
time. There is also benefits in being in charge of clinical and educational works
simultaneously, so this cannot be characterized as an outright defect; however, there isan adequate amount of the necessary coordination. While CRRC has a long history as atreatment institute, it has a rather short history as an educational institute, and its
instructors are not particularly experienced, and as such it is necessary to takemeasures aimed at coordination such as making significant

time allowances for

preparation in advance.
(3) To review educational materials
There are 19 exclusive textbooks that have been prepared and are being usedin this project, and the questionnaire results show that the students are generally
satisfied with them. However, many of the Japanese experts and counterparts havepointed out that “although they are adequate for the most part, there are a few
problems therein, and as such they need to be revised, or additional preparation of
textbooks needs to be made.” Duplications and insufficiencies became apparent throughactual use, and so preparation for revision work must be initiated soon.
(4) To establish clinical training system
Clinical training under the supervision of clinical education instructors has
been incorporated into the third and fourth years of the four-year education curriculumfor PTs and OTs. This is a field wherein China has relatively little experience. During
this project, support and intervention by Japanese experts were required in many areas,
including the organization of classes and the appointment of students groups. In future,
self-reliant operation in this term will be necessary.
(5) To construct an evaluation system to improve the quality of instructors
For the education of rehabilitation professionals, the acquisition of theapplication capability to respond to the various needs of disabled persons is necessary,in addition to systematic knowledge and skill acquisition. Thus, improvement of thecontents of the education and educational method will be continuously necessary for
instructors in such areas. It is recommended that the instructors, upon participating in
the training program in Japan and returning to China, upgrade the contents (skill level)of their education and construct an evaluation system aimed at reinforcing the teachingcapabilities of the instructors.
(6) To ensure sustainability and to take measures for the achievement of the overall goal
In order for the Chinese side to independently progress towards theachievement of the overall goal, it is necessary to further increase the quantity andquality of instructors and to strengthen the management of educational affairs. It isalso necessary to expand the results of the project nationwide.
In order to further ensure sustainability for the project, it is necessary topromptly consider specific measures aimed at establishing education in accordance withthe curriculum as well as further improving the educational skills of the instructors,
and implementing these measures, during the remaining duration of the project. The
Chinese side has requested follow-ups (training of instructors and reinforcement ofeducation management) over a two-year period. In response, the Japanese investigationteam recommended that the CRRC, based on consultations with Japanese experts,
summarize assistance needed from Japan during the period up to July 2007, when thecurrent third grade students graduate, and submit the summary to the JICA China
Office.
3-7 Lessons Learned (Matters Helpful for Discovering/Forming Similar Projects Derived
from this Project and Implementation, Operation and Administration Thereof)(1) Importance of educational affairs management
Under this project, the creation of curriculum, the development of educational
materials and equipments and the training of instructors were all implemented during
a relatively short period, and the newly founded four-year university program is now
getting on track. On the other hand, there are concerns pertaining to weaknesses in
educational affairs management. Upon the formulation of the project plan, the creationof curriculum, the development of educational materials and equipment, and theeducation of instructors were given adequate consideration. However, opinions havebeen voiced on both the Japanese and Chinese sides that prior discussions on
educational affairs management might have been insufficient. It is necessary for
projects aiming to establish a new university or university department to give sufficientconsideration to the educational affairs management system in addition to theeducational system itself.
(2) Clarifying the objective of training in Japan
One-year training stints in Japan were provided for six PTs and six Ots, whowere among the candidates for instructors (counterparts) (in addition to two doctors andone prosthetist) in this project, which constituted an important measure for the trainingof instructors. The objective of this was to train instructors and have them acquire theknowledge and technical skills inherently necessary for instructors. However, because it
was decided at the start of the project that it would be mandatory for instructors infour-year universities in China to have a master’s degree or a higher degree, they wererequired to acquire a master’s degree during the project period. Although it was a toughassignment to acquire master’s degree during the project, in addition to earning 30

credits or more per year, it is expected that all twelve participants (including the two
who are currently enrolled in graduate school) will acquire master’s degrees thanks tothe efforts of those involved.
However, earning credits for gaining master’s degrees and preparing theses
has proven excessively burdensome. Therefore, training in relation to educational work
such as educational affairs management, operation of subjects and students guidancenecessary for four-year university instructors, as well as teaching methods and faculty
development for the improvement of teaching methods, could not be sufficiently carriedout during the period of the training program.
It is important to set clear objectives for the training program in Japan, in
consideration of the length of the training period, and to disseminate these objectives onboth the Japanese and Chinese sides.