Summary the Results of the Terminal Evaluation
1. Outline of the ProjectCountry: Myanmar
Project Title: Strengthening of Basic Health Staff
Issue/Sector:
Cooperation scheme:
Health care- Health care system
Technical Cooperation Project
Office in Charge: Health Division 3, Health Group
Total cost: 276 million yen
2, Human Development Department
Partner Country’s Implementing Organization:
Ministry of Health
Period04 May 2009 to 03 May 2014
Supporting Organizations in Japan:
National Center for Global Health and Medicine
1-1 Background of the Project
The Republic of the Union of Myanmar (Myanmar) is facing great challenges of reducing highmorbidity of infectious diseases and high maternal, infant and child mortality. For improving healthservice coverage and health outcomes, it is essential to ensure sufficient number of health workers
capable of performing to meet the needs of population. However, in Myanmar, severe shortage ofhealth workers has been a major challenge. Especially Basic Health Staff (BHS), who work in thevanguard of delivering basic health services to the community, are not only scarce but also theircapacity and performance is still limited.
Following a series of discussions between Japan International Cooperation Agency (JICA) and theMinistry of Health in Myanmar in 2007 and 2008, the “Project for Strengthening Capacity of Training
Teams for Basic Health Staff” (the Project) was formulated and launched in May 2009. The Project
aims to improve capacity of training teams at all levels (Central, State/Regional and Township level)
for the quality in-service trainings for BHS.
Approaching to an end of the Project in May 2014, the Terminal Evaluation Team (the Team) was
organized in accordance with JICA evaluation guidelines. The Team aims to review the progress
and achievement of the Project as well as to shape clear understanding of the course of the Project for
the remaining project period.
1-2 Project Overview（1） Overall Goal
The quality and coordinated in-service trainings are provided according to the needs of different
levels.
＜Indicators＞
1. 75% of T/S TT receive training for training management from S/R TT and CTT（2） Project Purpose
The capacity of training teams at different levels in the in-service trainings for the BHS isstrengthened＜Indicators＞
1. CTT creates training guidelines and revise as necessary
2. "8 S/R TTs report to CTT and feedback to T/S TTs on Supportive Supervision and Training
Information System"
3. T/S TTs under 8 S/R TTs conduct CME in line with Handbook for Training Teams as training
guideline.

ix

（3） Outputs＜Output 1＞
CTT is functioning＜Indicators for Output 1＞
1. CTT is established
2. CTT meeting is to be held quarterly
3. Information on programme based trainings is shared in CTT
4. CTT introduces Good practices regarding training management toward TTs at all levels＜Output 2＞
Training Information System (= Reporting System of Training) is established.
＜Indicators for Output 2＞
1. S/R TTs report on training data to CTT quarterly
2. At least 90% of T/S TTs in Mon State report training data monthly
3. At least 50% of T/S TTs under the 8 S/R TTs report training data monthly
4. At least 50% of pilot T/S TTs under the 9 S/R TTs report training data monthly＜Output 3＞
Training Management & Teaching methodology are strengthened.
＜Indicators for Output 3＞
1. The 8 S/R TTs have a respective training team meeting quarterly.
2. T/S TTs in Mon State have training team meeting monthly.
3. Pilot T/S TTs under the 8 S/R TTs have training team meeting monthly.
4. At least 90% of T/S TTs in Mon State conduct trainings in line with the curriculum sheet.
5. At least 75% of pilot T/S TTs under the 8 S/R TTs conduct trainings in line with the curriculum
sheet.
6. Training Management is introduced into all the T/S TTs under the 8 S/R.
7. Training Management introduced into the 9 S/R TTs.
＜Output 4＞
Supportive Supervision for training team is strengthened.
＜Indicators for Output 4＞
1. CTT conducts Supportive Supervision to the 8 S/R TTs at least once a year.
2. No. of Supportive Supervision conducted by the 8 S/R TTs to T/S TTs（4） Inputs (Up to the point of the terminal evaluation)
Japanese side
Long-term experts 5 (Chief Advisor, Coordinator)
Short-term experts 22 (Training Information Management, Monitoring and Evaluation, Training
and Management Skill）
Training in Japan 16 counter parts
Provision of equipment and machinery
176,851.23 US$
Local cost552,263.22US$
Myanmar side
Assignment of counterpart personnelx2. Evaluation Team
Members
Team Leader
Advisor / Human
Resources for
HealthMr. Yojiro ISHII Senior Advisor (Health), JICA
Dr. Chiaki
Director, 2nd Expert Service Division,
MIYOSHI
Bureau of International Cooperation,
National Center for Global Health andMedicine
Cooperation &Ms. Yumiko
Associate Expert, Health Division III, Human
Planning
YAMASHITA
Development Department, JICA
Evaluation &Mr. Shigeru
Consultant, System Science Consultants, Inc
Analysis
KOBAYASHI
Period
8th January 2014 toType of Evaluation: Terminal Evaluation
25th January 2014
3. Results of Evaluation
3-1 Project Performance（1） Achievement of Outputs＜Output 1＞
Members as well as duties and responsibilities of CTT were defined and approved by the Official
Letter No., Ahkhaka/Training/2010 (759). In addition, CTT meeting has been held almost on aquarterly basis and information on programme based trainings was shared at a series of the CTT
meetings. Therefore, it was judged that CTT is functioned.
According to the HANDBOOK, CTT has a duty to guide and instruct the Township TTs to prepare
the plan of action (POA) for CME. However, at the later period of the Project, the State/Regional TTs
were taking of the duty since the capacity of State/Regional TTs has been strengthened enough toperform to their duties through the training and experiences of the project activities.
The duties and responsibilities of CTT have changed through the course of the Project, which are now
more on provision of instructions in the training management rather than monitoring of the individual
CME at township level.
＜Output 2＞
All 8 S/R TTs submitted the training data to CTT quarterly although some S/R TTs could not submit
the data on time.
T/S TTs in Mon State showed 100% of the monthly TIS reporting rates from the T/Ss during January
to September 2013. T/Ss under the 8 S/Rs and the pilot T/Ss under the 9 S/Rs also showed more than
50% of the monthly TIS reporting rates too.
Therefore, it was judged that TIS is established.
＜Output 3＞
7 S/Rs out of the 8 have the training team meeting quarterly or monthly. The remaining 1 TT also
held the meeting semi-annually.
All 10 T/S TTs in Mon State all pilot T/S TTs under 8 S/Rs held training team meeting monthly, andthese T/S TTs are conducting the trainings in line with the curriculum sheet.
All 17 S/Rs, all T/S TTs in the 8 S/Rs except 3, and 9 pilot T/S TTs received the introductory training
on the HANDBOOK for introducing the Training Management.
Therefore, it was judged that the Training Management & Teaching methodology are strengthened.

xi

＜Output 4＞
Indicators for Output 4 were achieved at S/Rs level but not at the Central level.
Due to limitation of human resources, no CTT member attended 5 supervisions out of 6 during the 5thround of Supportive Supervision although CTT assigned team members to the series of Supportive
Supervision from 1st to 4th round.
In contrast, the number of the Supportive Supervision S/R TTs conducted to T/S TTs under the
Project. It was also reported that the integrated Supportive Supervision was conducted by 5 S/R TTs
out of 8.
Thus, it was judged that the Supportive Supervision for training team is strengthened.
（2） Project Purpose
Indicators for the Project Purpose are set up for each TT7s level, and all indicators are achieved.
CTT developed the HANDBOOK and introduced it to all S/R TTs. CTT revised the HANDBOOK in
October 2011.
All 8 S/R TTs report TIS data to CTT quarterly. The Project also confirmed through the monitoring ofSupportive Supervision conducted by S/R TTs that all 8 S/R TTs provide the feedback to their T/S
TTs.
In T/S level, about 90% of T/S TTs under 8 S/R TTs conducted CME, and these T/S TTs submitted
TIS report to S/R TTs using forms offered by the HANDBOOK. And the pilot T/S TTs conducted
CME in line with the HANDBOOK.
（3） Overall Goal
The Overall Goal is likely to be achieved.
There were 212 T/S TTs out of 330 (about 65%) already received training for training management asof January 2014. DOH intends to conduct the introductory training on the HANDBOOK continuously
to all remaining townships under the 9 S/Rs. It is expected that the coverage area for training
management will be reached more than 75% in the near future.
3-2 Summary or Evaluation Results（1） Relevance
Relevance of the Project is high from the following viewpoints.
The government of Myanmar set priorities on strengthening capacity of BHS in the National
Health Plan (2011-2016). 6 program areas out of 11 in the Plan include training activities for BHS.
Moreover, there are some set targets stated therein for capacity building of BHS in “Health
Workforce Strategic Plan 2012-2017” too.
According to the Ministry of Foreign Affairs, “Support for livelihood improvement for nations” is
one of the economic cooperation strategies for Myanmar.
Prime Minister Shinzo Abe stressed out the importance of Universal Health Coverage andwillingness to support the development of health sector in developing countries.
According to the position paper of JICA named “JICA’s Operation in Health Sector”, JICA set its
priority on “strengthening capacity of public administration for health” and “addressing humanresource for health”.
（2） Effectiveness
Effectiveness of the Project is high from the following viewpoints.

xii

The Project Purpose is almost achieved as of January 2014 when the Terminal Evaluation was
conducted. The Team observed that the four Outputs have effectively contributed to theachievement of the Project Purpose.
The approach for strengthening the BHS by introducing the systematic training management of
CME worked well.
CTT compiled the essence of training management into the HANDBOOK, which reflects thein-service training system in Myanmar. In the course of development of the HANDBOOK,
training management capacity of CTT was also strengthened.
Learning through the theory and practice with effective use of the HANDBOOK improved
capacity on training management of State/Regional TTs and Township TTs. CME is now
conducted systematically by the Township TTs under 8 States/ Regions.
Supportive Supervision on training management was exercised by State/Regional TTs during the
project period. Although CTT and State/Regional TTs have financial concerns to continue
Supportive Supervision, both parties already started to integrate the Supportive Supervision into
the supervision activities of other programs.
BHS reported the improvement of CME such as:
CME has been implemented more systematically. Audio system and Power Point are used forpresentation. Handout also prepared too.
Topics of CME were used to be selected randomly. However, CME has been implemented inline with the annual plan. Seasonal topics were selected and duplication was avoided.
CME has become bidirectional training.
On the other hand, there are still some gaps between the contents of the HANDBOOK and thefield realities, particularly of the duties and responsibilities of CTT and State and Regional TTs
since the situation has been changed from October 2011 when the Project revised the
HANDBOOK.
（3） Efficiency
Efficiency of the Project is evaluated as relatively high from the following viewpoints.
While the number of the target Township TTs increased from 17 to 177, the Project managed to
conduct all necessary trainings for these targeted Township TTs in time.
Although CTT could not conduct annual Supportive Supervision as planned, CTT collectednecessary information by integration of Supportive Supervision for Training Management into thesupervision activities of other programs.
The HANDBOOK and recording forms developed and distributed by the Project are practical forState/Regional TTs and Township TTs for smooth preparation and implementation of CME. In
addition, intensive works in the initial stage of the Project such as the HANDBOOK preparation,and series of trainings for the Pilot TTs enabled the Project to expand the number of target TTs.
（4） Impacts
Impact is evaluated as high from the following viewpoints.
It is expected that indicator of the Overall Goal “75% of total Township TTs receive training on
training management from State and Regional TT and CTT” will become realized in the near
future since DOH already started to conduct introductory training on the HANDBOOK forremaining Townships in the 9 State/Region.

xiii

Coding system of TIS of the Project was adapted to the coding system for the National HMIS
operated under Department of Health Planning (DHP).
Training tools developed by the Project are utilized by CTT when the CTT members conduct
trainings organized by DOH or other donor agencies.
（5） Sustainability
Sustainability is evaluated as moderate because there are still some issues remain in institutional andfinancial aspects as follows.
Strengthening of BHS is one of the priorities of MOH. In addition, the training for BHS is one of
the key elements in the “Health Workforce Strategic Plan 2012-2017” published in November
2013.
Revision of duties and responsibilities of each TT is necessary at least for continuing the activities
for training management based on the HANDBOOK.
State/Regional TTs and Township TTs already existed before the Project started as the permanent
team. There is no significant institutional problem observed for State/Regional TT and TownshipTT to continue the activities after termination of the Project.
On the other hand, CTT has to revise their duties and responsibilities upon the current situation interms of management body of TIS and Supportive Supervision. According to the DOH, Public
Health Division will take the role of the overall supervisor of the activities for training
management based on the HANDBOOK.
CME and relevant training activities, TIS, and Supportive Supervision are the activities of which
Myanmar side requires financial input for continuing the activities for training management basedon the HANDBOOK. Regular operational costs for TIS and CME have been borne by Myanmarside since the beginning of the Project, so it appears to have no financial concern to continue the
TIS and CME by Myanmar side.
Supportive Supervision is the activity of which Japanese side financially supported during the
Project. There are financial concerns for continuing the Supportive Supervision. It is expected that
CTT and State/Regional TTs would devise integrated Supportive Supervision to manage thefinancial issues for continuing Supportive Supervision for training management.
Considering some possibilities of revision of the HANDBOOK and the needs of the refresher
training in the future, it has to be bear in mind to ensure necessary budget to be able to conduct
such activities by the MOH.
CTT, all State/Regional TTs, Township TTs under the 8 S/Rs and the pilot Township TTs in the 9
S/Rs acquired necessary technique for continuing the activities for training management based on
the HANDBOOK.
The guideline (the HANDBOOK), recording and reporting forms, and other training materials fortraining of trainers were already developed by the Project. CTT has enough capability for
conducting internal trainings by themselves.
3-3 Promoting Factors
According to the HANDBOOK, CTT was expected as a main implementation body of the Project.
However, capacity of State/Regional TTs was significantly improved after expansion of number oftarget Township TTs in 2012. Accordingly, some of its duties and responsibilities such as guidance
and instruction for Township TTs to prepare Plan of Action for CME, Analysis of Township TIS

xivreports were taken on by State/Regional TTs. This significant improvement of State/Regional TTs’
capacity accelerated the project activities smoothly.
The Project employed two National Consultants who retired MOH for supporting JICA experts.
National Consultants took a role to bridge the communication gap between JICA experts and CTT
members since they have personal relationship in DOH and State/Regional Departments of Health.
In addition to the technical support of National Consultants, their administrative coordination also
accelerated the smooth implementation of the project activities.
3-4 Hindering Factors
Project office of JICA experts locates in Yangon, and CTT members, core of the Project work at
DOH in Nay Pyi Taw. This physical distance caused communication gap between JICA experts
and CTT members. Since CTT is core of the Project and all activities in the field are required
instruction from CTT to State and Regional TTs and Township TTs, JICA experts devoted
considerable efforts to communicate with CTT for smooth implementation of the project activities.
Some JICA experts were dispatched behind the schedule due to delays of visa approval. Although
activities were completed on time due to intensive work of JICA experts and National Consultants,
it required close coordination with State/ Regional TTs and Township TTs.
3-5 Conclusion
The Project shows high relevance, effectiveness, and relatively high efficiency. Positive impacts of
the Project were also observed. Although there need some efforts for improving institutional andfinancial sustainability, no serious obstacles were observed for ensuring sustainability. Thus, theTeam concludes that the Project is on the right track to fully accomplish by May 2014 as planned.
The Team expects to the authority of Myanmar to exert its leadership to further strengthening thecapacity of BHS in Myanmar.
3-6 Recommendations and Lessons Learned（1） Recommendations【To the Ministry of Health】
Strengthening Central Management Function：Revising management duties and responsibilities of
CTT to function intensively to oversee, make central decisions, and provide policy guidance anddirection in regards to training management、and securing administrative coordination body at thecentral level, which coordinates and supports CTT to perform its function by the official
notification of the Ministry
To update the HANDBOOK when necessary to reflect any changes and ensure its content to stayin accordance with the scope of training management in Myanmar.
To enhance capacity of State/Regional TTs to be able to fulfill its duties in training management,
which are to collect training information from townships to grasp the overall picture, analyze andmake practical use of training information for effective trainings for BHS, and regularly exercise
Supportive Supervision for townships.
To support township TTs to continue to improve quality of CME through devising and adopting
good practices in training management like training follow-ups
To make better use of training information for provision of adequate in-service trainings for BHS
to address their needs.

xv

【To JICA】
In Myanmar, strengthening of health systems and human resources for health still remains
important. In view of the future JICA’s cooperation for health sector in Myanmar, it is suggested
for JICA to make the best use of the training management system developed in the Project with awider scope of its target for generating greater output of new cooperation.
（2） Lessons Learned
Selection of a horizontal management approach：The horizontal training management approachtaken by the Project has been well adopted by the Townships and the States/Regions of the Project
area because of its usefulness for the coordination of the trainings and the selection of the training
subjects reflecting the needs of BHS. It was a good learning that a horizontal management
approach can contribute.
Narrowing and focusing the Project activities：At the time of the revision of the Project area to be
expanded, the project activities were also revised to squeeze and focused. As the result of therevision, the Project could have achieved the drastic increase of the number of the target Townshiptraining teams. It was learned that a flexible amendment of the scope of the Project narrowing andfocusing certain activities would be required when a drastic quantitative or areal increase isrequired.
Merit of expanding strategy：The Project chose expanding strategy to scale up the number of target
Township horizontally rather than refining the developed model deeply at the selected model area.
As the results, various kinds of Good Practices regarding training management were reported fromthe State/Regional TTs and Township TTs in the expanded area. Training management system was
improved through the information sharing of those Good Practices among all levels of TTs.
Selection of existing activities/mechanisms for assuring the sustainability：The existing CME at the
Township Health Center was selected as one of the Project target subjects. CME is run by the
Township Health Department without much financial input such as transportation cost and daily
allowance since the CME trainings are held on the pay days when the participants (BHS) visit the
Township Health Center by their own expenses for receiving salary. This approach contributed to
improve the financial and institutional sustainability of the CME activities.

xvi