評価調査結果要約表（英文）1. Outline of the ProjectCountry: Myanmar
Issue/Sector: Assistance for persons
disabilities
Office in Charge: Human Development
Department, Higher Education and Social
Security Group, Social Security Division
Period (R/D): 31st March 2008
23rd July 2008 – 22nd July 2013

withProject Title: Project on Strengthening ofRehabilitation
Cooperation scheme: Technical Cooperation
ProjectTotal cost (at the time of evaluation):
310 million yen
Partner Country’s Implementing Organization:
Ministry of HealthSupporting Organizations in Japan: National
Rehabilitation Center for Persons with Disabilities,
Japanese Physical Therapy Association andJapanese Association of Occupational Therapists

1-1 Background of the Project
In Myanmar, the number of persons with disabilities (PWD) is estimated to be 1.2 million which isequivalent to 2.3% of the national population (2010). The Myanmar Government has provided special
education, social services like vocational training and employment for PWDs via efforts of the Ministryof Social Welfare, Relief and Resettlement (MSWRR). Also the Ministry of Health (MOH) has
provided medical and health services of prevention and rehabilitation. However, the services being
provided were insufficient in quantity and quality. There was an urgent need for increasing
opportunities of basic medical rehabilitation services for persons with disabilities and upgrading
techniques of the service providers. In such circumstances, the Myanmar Government requested
technical cooperation to the Japanese Government. JICA and MOH have implemented the entitled
Project since July 2008 mainly at the National Rehabilitation Hospital (NRH) which is the only national
hospital specialized in rehabilitation.
The Terminal Evaluation was conducted for the purpose of evaluating the achievement of theProject.
1-2 Project Overview(1) Overall GoalQuality of rehabilitation services in Myanmar is improved<Indicator>
1.
2.

Satisfaction of patients to rehabilitation services at Mandalay General Hospital (MGH), (Nay Pyi
Taw General Hospital) NGH, and Yangon General Hospital (YGH) is increased
Number of patients treated for the rehabilitation service at MGH, NGH, and YGH is increased(2) Project Purpose
The system for providing quality rehabilitation services in NRH is strengthened.
<Indicators>
1. Satisfaction of patients to rehabilitation services at NRH exceeds 4 in five-grade evaluation.
2. Health and mental condition of discharged patients are improved.

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3.

Hospitalization period at NRH is shortened.

(3) Outputs<Output 1>
Training systems of NRH for rehabilitation services are improved.
<Indicators for Output 1>
1.1 Training materials for the Training of Trainers (TOT) are developed based of the training needs.
1.2 Techniques and knowledge on rehabilitation service of participants of TOT are improved.
1.3 Physiotherapists trained in TOT are able to train other staff.
1.4 Capacity of NRH staff to plan and conduct training is strengthened.
<Output 2>
The systems to improve the quality of rehabilitation services in NRH are upgraded.
<Indicators for Output 2>
2.1 Monitoring and evaluation system for rehabilitation service is developed in NRH.
2.2 Monitoring and evaluation are regularly conducted and activities to improve services are plannedand carried out based on the result.
2.3 Rehabilitation service in NRH is delivered by team approach among each specialty.
2.4 Recording of rehabilitation service is shared among all the departments of NRH.
2.5 Risk management system is developed and maintained in NRH.
2.6 Printed-materials or audio-visual materials are developed based on the needs.
2.7 Physical accessibility of NRH is improved.
<Output 3>
The collaboration between NRH and rehabilitation related institutions including institutions from theMSWRR is enhanced.
<Indicators for Output 3>
3.1 Number of patients being referred to NRH from other hospitals and NGOs is increased.
3.2 Number of the referral programs in the Medical Social Work (MSW) section is increased.
3.3 Number of patients being referred to other sectors from NRH is increased.
(4) Inputs
Japanese Side:Expert dispatch:

4 long-term experts and 12 short-term experts (physical therapy (PT),
Rehabilitation Medicine, occupational therapy (OT), Rehabilitation Nursing,speech therapy (ST))
Training in Japan and China: 33 trainees
Provision of equipment and machinery: USD 413,889
Local cost: JPY41,203 thousand
Myanmar Side:
Assignment of counterpart personnel
Project office space (including telephone bills and electricity expenses)
Project cost: USD 2,210x

2. Evaluation TeamMembers

PeriodLeader
Rehabilitation Medicine

Dr. KUNO Kenji (Senior Advisor on Social Security, JICA)Dr. ETO Fumio (President, National Rehabilitation Center for
Persons with Disabilities)
Cooperation Planning
Mr. KUWABARA Tomohiro (Social Security Division,Human Development Department, JICA)
Evaluation Analysis
Ms. NOGUCHI Junko (Senior Researcher, Foundation for
Advanced Studies on International Development)
thrd
14 February 2013 – 23 February Type of Evaluation: Terminal Evaluation
2013

3.

Results of Evaluation

3-1

Project Performance(1) Achievement of Outputs<Output 1>
As materials for TOT, manuals were elaborated on spinal cord injury (SCI), cerebral palsy (CP)and stroke; all the necessary materials were developed. All of them were revised based on the feedback
from the first TOT courses. As of February 2013, five TOT courses were conducted. In total, 40 trainees
participated in TOT on SCI, 48 trainees participated in TOT on CP, and 25 trainees participated in TOT
on stroke. In the second TOT on SCI and CP, all trainers were from the Myanmar side who had been
trained in the first TOT. In the evaluation by the participants of the second TOT, the trainers received
high evaluation regarding their class preparation and management. Thus, it can be said that theMyanmar personnel trained in TOT have gained sufficient knowledge and skills as trainers and areready for the future training courses. TOT has been managed by the Human Resource Development(HRD) Team established within NRH. NHR has been upgrading its management skills throughhands-on experience.
<Output 2>
As tools of monitoring and evaluation of rehabilitation services, various forms have been
introduced, and regular monitoring and evaluation has been conducted. Also, NRH has made various
efforts in the team approach including: Recording system; Risk management system; and Case
conference.
Several educational materials for the patients were elaborated and distributed to related hospitals
and institutions. The usage of these materials was evaluated high. The physical accessibility has been
improved at NRH. The most highly evaluated equipment is handrail.
<Output 3>
The number of the patients referred to NRH in 2012 increased compared to 2009. Currently 27
referral programs are available from the MSW Section of NRH. From March to December 2012, a totalof 557 patients were referred to various programs with difference sources. However, there are a few
patients who need but not are given a wheelchair due to lack of financial sources.
(2) Project Purpose
Patients’ satisfaction survey has been conducted for four times regarding the treatment by NRH
staff, equipment and referral service. The patients’ satisfaction increased and remains high. Also in thexi

assessment of the inpatients on discharge, most patients answered that they have “no health problem”,
and that they feel mentally “very good” or “good”. The average days of hospitalization decreased fromthe year 2008 to 2011, but increased in 2012.
(3) Overall Goal
The baseline data will be collected as one of the Project activities in the remaining period of theProject. For the future evaluation, the survey format has been agreed on SCI and stroke patients’satisfaction, as some hospitals do not treat CP patients.
At YGH, the participants of TOT and the Study Visit to Japan have shared acquired knowledge
and skills with their colleagues and improved their services. For example of the Project impacts, they
got ideas from the Japanese rehabilitation services and made several assistive devices and training tools
with materials available in Myanmar.
3-2 Summary or Evaluation Results(1) Relevance
The Project relevance is evaluated high from the following reasons.
 The objectives of the Project are in accordance with the Myanmar’s health sector policy “NationalHealth Plan (2006-2011),” which is still effective at the moment.
 The National Disability Survey (2010) indicated that Myanmar has a disability prevalence of 2.32
percent, translating to approximately 1.2 million persons living with disability. Several universities
provide opportunities to train rehabilitation professionals; however it is still insufficient to cover all
the needs in the country When the Project started, one of the priority areas of Japanese Assistance for Myanmar was“emergent and humanitarian assistance, which included support for socially vulnerable people”. The
current assistance policies include “assistance for improvement of people’s livelihoods”..
(2) Effectiveness
The Project effectiveness is evaluated high from the following reasons.
 The Project Purpose has been achieved. In other words, NRH provides rehabilitation services which
satisfy the patients, and they are discharged with good physical and mental conditions.
 The Project Outputs have been produced as planned and these have contributed to the achievementof the Project Purpose. First, every TOT courses were conducted satisfactorily and NRH staff now
can treat the patients with more upgraded knowledge, skills and confidence. Second, NRH hasreinforced various rehabilitation services through the patient report system, case conferences,barrier-free facilities, risk management system. Third, the extended and enriched referral system hasconnected the discharged patients and various programs such as vocational training, provision ofwheel chairs, etc.
 There was no influence of the external factors to the achievement of the Project Purpose.
(3) Efficiency
Considering the following, overall, efficiency of the Project is evaluated as high.
The Project Outputs have been produced mostly as expected. First, NRH has upgraded its functions
as the HRD center in the county. NRH has developed training curriculum and materials on CP, SCI
and stroke, and trainers have been trained. It also produced various pamphlets on rehabilitation
services. Second, NRH strengthened its functions also as the rehabilitation hospital. Third, thexii

referral programs have been extended.
 Both Myanmar and Japanese government allocated resources mostly as planned, except a few
delays in the early period, namely the postponed dispatch of the short-term JICA experts due to thedelayed issue of the visa. However, since the Project members changed by the Japanese side, theinputs and activities have been speeded up to make up for the delay by much improved
communication and project management.
 There was no influence of the external factors to the achievement of the Outputs.
(4) Impact
Several positive impacts have been observed at NRH and YGH. More positive impacts can beexpected in the near future. No negative impact has been reported.
 The Specialized Training Courses have not started yet, so it is too early to expect the Overall Goalat the moment. If the courses are conducted as planned, there will be upgraded services and patients’satisfaction at the hospitals whose staff participates in the courses.
 Besides, the following positive impacts have come out. First, at NRH and YGH, the participants ofTOT and the Study Visit got ideas from the Japanese rehabilitation services and made several
assistive devices and training tools on their own. Second, expectations have been raised for HRD in
the areas of OT and ST, although currently PT covers needs of OT and ST in the rehabilitation
services.
(5) Sustainability
It is assumed that NRH would maintain and upgrade rehabilitation services by itself after theProject. And, if the training courses are conducted with the developed resources at NRH in the near
future, sustainability of the Project effect will be assured.
 Staff of NRH has acquired sufficient knowledge and skills for rehabilitation services. And, NRH is
now equipped with many of the latest rehabilitation facilities and resources such as the training andreference materials. Thus, sustainability will be assured in technical aspects. However, there is one
concern, which is cost for repair of the procured equipment.
 As organizational factors, NRH has upgraded various systems. The Medical Superintendent andstaff share the purpose and understand its role in each system. It can be considered that thesesystems have become ingrained at NRH. It needs to be considered how to maintain these systems
without extra burden after the Project.
 As for the continuity of the future training courses for HRD in the country, HRD members has
started planning of the “Specialized Training for PT” on SCI in September 2013. The curriculum
and materials are ready, as those of the second TOT on SIC can be utilized. Trainers have also beentrained.
 For the necessary budget of the Specialized Training which will be held 6 times in total from 2013
to 2018, DOH confirmed the continuous support and necessary financing in the meeting held inSeptember 2012. And, YGH has offered to provide part of accommodation for the participants.
3-3 Factors that Promoted Realization of Effects(1) Factors Concerning the PlanningNot in particular.

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(2) Factors Concerning the Implementation Process HRD members, as well as JICA experts, have devoted huge time and efforts for various activities
which include curriculum and material development of TOT courses, lectures, elaboration ofevaluation forms for rehabilitation services, meetings, etc. Their dedication has enabled timely andeffective implementation of the Project.
 The Project has placed much importance in the team approach in project management, especially inthe composition of HRD Team and selection of the participants of the study visit to Japan. For
example, the participation as a team of doctor, nurse and PT promoted understanding from multiple
perspectives and helped the learning to be applied as a team when they came back to the hospitals.
 There was communication difficulty at the beginning of the Project, but this was resolved in thelatter half. Both HRD members and JICA experts have worked at NRH. They communicate witheach other whenever necessary, and have held regular monthly HRD meetings for projectmanagement. Communication within the Project has been smooth and productive. So as thecommunication with the Project and JICA, monitoring reports have been submitted with sufficient
information on project management from the Project to JICA.
 Feedback functions effectively in the Project. For example, when the training is finished, the Project
conducts an evaluation to review that training and prepare for a better next training. Thus, activities
are implemented in the Plan-Do-Check-Action cycle.
 The Project has recorded the Project implementation process and results. Besides, the Projectmonitors its progress by collecting data and related information based on the indicators set in thePDM. These records help the Project members understand the progress precisely.
3-4 Factors that Impeded Realization of Effects(1) Factors Concerning the Planning At the first half of the Project, there was not a clear definition and understanding on “collaborationfor referral” and “improvement of rehabilitation services in other hospitals.”(2) Factors concerning the Project Implementation
 Dispatch of two JICA short-term experts was delayed or canceled because the timing of visa
approval was not corresponded appropriately. As a result, part of TOT curriculum had to bemodified and a training course was postponed. This was solved in the latter half of the period.
3-5Conclusion
As described above, the Project has high relevance, effectiveness and efficiency, and more positive
impacts and the effects sustainability can be expected in the near future. Thus, the Project shall becompleted as scheduled in July 2013. Thus, the Project has been successful. Based on this success, therehabilitation sector in Myanmar has now risen to the next level where it addresses the challenge ofwidening the geographical areas of service provision and expanding the range of rehabilitation services
including the field of OT and ST.
3-6 Recommendations and Lessons Learned(1) Recommendations<To DOH>
 To prioritize HRD in the sector of medical rehabilitation in the National Health Plan.
 To widen further the range of services in the field of OT and ST, besides the existing rehabilitation

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services.
 To conduct at least one Specialized Training course per year. If conditions permit, it is recommended
to increase the courses per year.
 To allocate budget and administrative staff at NRH and other relevant hospital for effective
management of the Specialized Training.
 To encourage the hospital of the trainer to send him/her to the Specialized Training course.
 To give relevant acknowledgement to the trainers of the Specialized Training for their motivation.
 To conduct patients’ satisfaction surveys to monitor the impacts of the Specialized Training courses.
 To include new topics as well as OT and ST, when the training curriculum is revised in the future.
 To spread the outcome of the Project all over the country.
 To keep a budget for maintenance of the equipment procured to NRH<To NRH>
 To consider how each of the systems upgraded by the Project should be operated after the Project.
 To make a concrete action plan for the activities to be implemented after the Project in order tosustain upgraded services of NRH.
 To share and disseminate the experience from the Project with other hospitals through various
opportunities.
<To HRD with Myanmar Consultants>
 To elaborate an action plan for the Specialized Training before the Project is completed.
 To establish a preparatory committee for the Specialized Training (management unit for theSpecialized Training courses).
 To manage the Specialized Training in close cooperation with the Department, NRH, YGH, NGH,MGH, NOGH, UMT, etc.
 To conduct evaluation at the end of each Specialized Training course for improvement of the nextcourse.
<To Other Stakeholders> (It is recommended to YGH) To continue its dedicated support for the Specialized Training.
 (It is recommended to NGH, MGH, NOGH, UMT, etc.) To get actively involved in management ofthe Specialized Training, as they have been so in the Project.
<To JICA> To consider necessary inputs to support the Myanmar side in order to enhance the outcome of theProject, if appropriate.
 To keep paying attention to the development of the rehabilitation sector and to consider further
collaboration, if appropriate.
(2) Lessons Learned
 In this Project, aside from the official counterpart members indicated in R/D, task teams and groups
have been organized by function with principal participation of NRH where most project activities
are implemented. By organizing teams this way, the team approach of NRH has been strengthened.
However, these ad-hoc teams should be absorbed in the existing system in a sustainable way. Before
the Project is completed.
 The Project has started discussion and planning for the Specialized Training for PT which will start
after the Project is completed. To ensure sustainability of the Project outcome and achieve theOverall Goal, planning should be strategic, by incorporating activities in the Project which may becontinued even after the Project. Also, external factors which may influence the Overall Goal shouldxv

be internalized as much as possible.
 In this Project, “Hospitalization period at NRH is shortened” is set as third indicator of the ProjectPurpose. Through the evaluation, it was judged that utilizing the indicator for the evaluation of theProject Pupose is difficult since variables which affect quiality of rehabilitation service are present
in other than hospitalization period. The above mentioned disucssion should be considered in futurecooperation.

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