Summary of the Evaluation Study
1. Outline of the ProjectCountry: Republic of the Philippines

Project title: Project for Cordillera-wide Strengthening of
the Local Health System for Effective and Efficient
Delivery of Maternal and Child Health Services

Sector: Health

Cooperation scheme: Technical Cooperation Project

Division in charge:
JICA Philippines OfficeTotal cost:566 million yen

Period of Cooperation:
February, 2012 – February, 2017 (5 years)

Partner country’s Implementing Organization:
Department of Health (DOH), Department of Health
Cordillera Regional Office (DOH-CAR)
Supporting Organization in Japan: System Science
Consultants Inc.

1-1 Background of the Project
The Maternal Mortality Rate (MMR) in the Philippines in 2006 was 162 per 100,000 live births. Although
this figure was slightly lower than the 172 recorded by the Demographic and Health Survey (DHS) in
1998, there was a prevailing view that achievement of the relevant Millennium Development Goals(MDG) by 2015 (i.e. 62 per 100,000 live births) would be difficult unless the rate of decrease wasconsiderably accelerated. Meanwhile, both the mortality rate of children under five years of age and the
Infant Mortality Rate (IMR) showed a declining trend in a period of 15 years from 55 per 1,000 live
births (1998 – 1992) to 34 (2003 – 2007) for the former and from 34 per 1,000 live births to 25 for thelatter (DHS: 2008). The Department of Health (DOH) believed that the MDG of reducing the mortality
rate of children under five years of age to 21 per 1,000 live births by 2015 would be achieved by reducing
the infant mortality rate. To ensure the successful reduction of these mortality rates, the DOH announced
the Maternal, Neonatal and Child Health and Nutrition (MNCHN) (AO 0029 Series of 2008), an
ambitious mother and child health policy focusing on the qualitative improvement of parturient care,
illustrating its emphasis on the mother and child health program as a highest priority issue.
In the Cordillera Administrative Region (CAR) located in the northern part of Luzon Island of thePhilippines, ethnic groups with different languages and cultures account for 70% of the local inhabitants.
As many of these people live in the Cordillera mountain range, they are geographically isolated, resulting
in poor access to health services. The ratio of poor people is higher than the national average and Abraand Apayao Provinces are counted among the 10 poorest provinces in the Philippines. Against thisbackground, the DOH has designated the region a “Geographically Isolated and Disadvantaged Area
(GIDA)”, making it a priority area for the implementation of the MNCHN. Health service providers in
CAR faced a number of problems, including (i) insufficient training of health personnel in addition to ashortage of the absolute number of such personnel, (ii) lack of the minimum equipment required toprovide adequate health services at many health care facilities, (iii) shortage of medicines, (iv) lack ofeffective as well as efficient functioning of the referral system and (v) lack of a sufficient health budget
required to provide adequate health services. At the same time, there were problems regarding local
inhabitants receiving health services, including (i) an unwillingness to access suitable medical care forcultural reasons, (ii) financial inability to pay the facility usage fee and cost of medicines and (iii) lackof appropriate knowledge of available health services. These problems on both the providing andxii

receiving sides of health services made the effective implementation of the health program difficult.
Under these circumstances, JICA implemented two technical cooperation projects in CAR: “the Projectof Strengthening of Local Health System in the Province of Benguet” (2006 – 2011) and “Mother andChild Health Project” (2006 – 2010 in Biliran and Ifugao Provinces). The present Project aims at
developing a framework capable of providing efficient and effective mother and child health services bymeans of strengthening local health services in the Cordillera Region in line with the current national
health policy, making the best use of the outcomes of and lessons learned from the two preceding
technical cooperation projects.
1-2

Project Overview(1) Overall Goal
Health status of people in the region is improved, particularly of women and children.
(2) Project Purpose
Local health system in the region is strengthened to deliver effective and efficient Maternaland Child Health (MCH) services.
(3) Outputs
1) Health governance and financing are strengthened through functional Inter-Local HealthZones (ILHZs) in the target sites.
2) Service delivery framework for MCH is strengthened in the target sites.
3) Hospitals, Rural Health Units (RHUs), and Barangay Health Stations (BHSs) become Basic
Emergency Obstetric and Newborn Care (BEmONC) capable and RHUs and BHSs become
Maternity Care Package (MCP) accredited by Philippine Health Insurance Corporation(PhilHealth) in the target sites.
4) Lessons learned and good practices of the project are disseminated nationwide as well as
region-wide.
(4) Input (at the time of Terminal Evaluation)＜Japanese side＞
Experts:
Total: 127.66MM (actual results for 1st – 4th year and plan for 5th year)
Local cost:
Approximately 153 million yen (actual results for 1st – 4th year andplanthfor 5 year)
Counterpart training: 16 persons (1 more person planned for 2016)
Procured equipment: Approximately 3.2 million yen＜Philippines side＞
Assignment of C/P: Approximately 89 persons
Facilities necessary for the Project: office space, utilities, meeting space, etc.
Activity cost for the Project: 859.95 million PhP (actual results of 1st – 4th year)xiii

2. Evaluation Team
Members of
Evaluation
Team:＜Japanese side＞
Team Leader

Name

Title and Affiliation

Tomoya Yoshida

Technical Advisor (Maternal andChild Health)Shogo Kanamori

Director, Health Team 3,
Health Group 2,
Human Development
Department, JICA
Health Adviser to DOH

Cooperation Planning

MisakiKawaguchi

Representative
JICA Philippines Office

Akiko Ito

Deputy Director
Health Team 3, Health Group2,
Human Development
Department, JICA

Hajime Sonoda

Senior Consultant
Global Group 21, Japan

Cooperation Planning

Evaluation Analysis＜Philippines side＞

Maylene M.
BeltranDirector IV, Bureau ofInternational Health
Cooperation, Department of
HealthJocelyn T.
SositoSenior Health Program
Officer, Bureau ofInternational Health
Cooperation Department of
HealthGrace R.
Buquiran
Period of
September 19 – October 6, 2016
Evaluation:
3. Results of Evaluation

Chief Health Program Officer,
Project Monitoring Division
Bureau of International Health
Cooperation, DOH
Type of Evaluation: Terminal
Evaluation

3-1 Achievement(1) Achievement of Outputs
On the whole, output 2 was thought to be achieved as with the achievement of all indicators of output
2. Output 1 and 3 were largely thought to be achieved as allmost all the indicators have been achievedin both outputs.
Output 1: Health governance and financing are strengthened through functional Inter Local
Health Zones (ILHZs) in the target sites. (Target sites: Dolasan and VPP ILHZs in
Abra, ILHZs in Apayao)-

Training was conducted in 2 Zones in Abra and 4 Zones in Apayao. In total 6 ILHZs were
formulated. All the ILHZs prepared and implemented ILHZ annual plan, and establishedxivCommon Health Trust Fund (CHTF) by March 2015. 3 ILHZ has utilized the CHTF and other 3
ILHZ is accumulating fund for future utilization.
-

The proportion of health budget in each provincial budget in 2015 increased from 7.7 % (as of2012) to 27.2 % in Abra, while that in Apayao was 14.8%, unchanged from the inception of the
project. However, the health budget in Apayao has increased by 20 % between 2012 and 2015.
Therefore, compared with the health budget 2012 in both provinces, the both budget 2015 have
been
increased
respectively(Abra:
81,419,587→1,056,159,889PHP,
Apayao:79,601,633→221,855,676PHP).

-

The proportion of provincial health budget in 2015 increased to 27.2% in Abra, but remained
almost same at 14.8% in Apayao. While, the amounts in Apayao increased by 20% from 2012 to2015. The median of proportion among the 13 cities / municipalities in 2015 was 7.9%, which isslightly less than 8.6% in 2012. However, including the reimbursement gained by themunicipalities, it is inferred that the median of proportion would be higher.

-

All the 26 municipalities in the target area enacted promotion of Facility Based Delivery (FBD)
by December 2013. In total 25 municipalities (out of total 26 municipalities) in the target area
have enacted support of Community Health Team (CHT) activities-

During the period between 2011 – 2015, number of PhilHealth members in the target sites
increased by three times, and the amount of reimbursement increased by 22 times.

Output 2: Service delivery framework for MCH is strengthened in the target sites. (Target sites:
Dolasan and VPP ILHZ in Abra, Apayao, Benguet)-

A MNCHN manual which incorporate local traditions related to delivery was prepared. Training
on the manual was conducted to the medical personnel in the target sites in cascade.

-

Referral is practiced based on the referral guidelines for MNCHN prepared in each ILHZ.
Maternal / Neonatal Death Review (MNDR) has been held with more than 10 cases since 2013by all the 6 provinces in CAR and Baguio City. MNDR at regional level in CAR is also held
repeatedly-

Manual and tools for Supportive Supervision and Monitoring for BEmONC capable facility(hereinafter referred to as “BEmONC Monitoring”) were prepared. After the training on them,each province formulated BEmONC Monitoring Team and started BEmONC Monitoring since
2015.

-

Flipcharts and banners for CHT were developed and distributed together with family healthdiaries during the CHT meetings. Family health diaries were reproduced and orientations were
given to CHT for their utilization.

-

356 Barangays out of the total 360 Barangays in the target sites integrated the MNCHN
emergency and preparedness plan into the Barangay Disaster Risk Reduction and Management
Plan.

Output 3: Hospitals, Rural Health Units (RHUs) and Barangay Health Stations (BHSs) become
BEmONC certified by DOH and RHUs and BHSs become MCP accredited by
PhilHealth in the target sites.
-

By March 2014, all the 129 health professionals available for training were trained on BEmONC,
and 182 health professionals were trained on harmonized BEmONC.

-

As of January 2016, total 108 facilities (15 hospitals, 19 RHUs and 74 BHSs) in the target arexv

capable to provide BEmONC. As of December 2015, total 97 facilities (15 hospitals, 19 RHUs
and 63 BHSs in the target area were entitled MCP accreditation by PhilHealth.
Output 4: Lessons learned and good practices of the project are disseminated nationwide as
well as region-wide.
-

By March 2016, the project issued one (1) fact sheet, eight (8) newsletters, and six (6) press
releases. There have been 67 newspaper articles issued, 25 TV / radio broadcasts on the project.
A Good Practice Booklet was issued.

-

In 2013 “Project Expansion Plan” was prepared by DOH-CAR, and being implemented.
Taking opportunities when stakeholders from in and out of the region get together, 24
presentations have been given on the experience and good practice of the Project. National forum
was conducted in the 3rd year with 277 participants.

(2) Achievement of the Project Purpose
Project Purpose: Local health system in the region is strengthened to deliver effective andefficient MCH services.
Indicators

for

the

targetsites(6Baseline

Targetmunicipalities in Abra, Apayao and Benguet)

2012

2013

2014

2015

2017

FBD Rate

79%

86%

89%

93%

85%

Pre-Natal Care Completion Ratio

63%

75%

81%

84%

80%

Post-partum Care Completion Ratio

90%

96%

97%

98%

90%

Indicators for entire CAR

Baseline

Target

2011

2012

2013

2014

2015

2017

Number of active ILHZ

7

11

12

14

17

increase

Number of Province/City conducting MNDR

0

0

7

7

7

7

Number of BEmONC capable health facilities

0

0

32

166

188

177*

12

23

53

88

144

131*

Numberofaccreditation

RHU

/

BHS

with

MCP

Notes: Figures with underline are those figures equal or more than the target level.
Target figures with (*) are elevated targets through the revision of PDM in June 2015.
The post-partum care completion ratio rose to 90 % in the first year of the project, from 70 % before theinception of this Project, which has already been exceeded the national target at 80 %. Therefore, thetarget was set at 90 % to maintain the outcome of the Project.
3-2 Summary of Evaluation results by Five Evaluation Criteria(1) RelevanceThe framework and purposes of the Project is consistent with the Philippines national policy on health(Kalusugan Pangkalahatan) and its MNCHN policy to facilitate facility-based deliveries. These policies
have been maintained till the time of terminal evaluation. While, the Project is also relevant to thepriority areas of the Philippine Health Agenda (2016 – 2022) adopted by the Duterte administration.
As DOH defines CAR as a GIDA, it was appropriate that the Project targeted CAR. The selection of the
Project’s target provinces in CAR is also deemed relevant because Apayao and Abra are among thepoorest provinces with most needs of assistance, and JICA had another project in CAR whichxviexperiences could be well utilized.
In addition, Japanese Government’s assistance to the Project can be justified as its scope and objectives
are in line with Japanese Government’s Assistance Strategy in the Philippines in 2012 and Japan’s
Strategy on Global Health Diplomacy as well as the framework of “JICA’s Operation in Health Sector –Present and Future –”.
(2) EffectivenessAs shown in “3-1 (2) Achievement of the Project Purpose”, pre-defined targets for the Project Purpose,including those targets revised up in 2015, have been already achieved by the end of 2015, two-year
ahead of the original target year. Therefore, effectiveness of the Project is high. There are following
reasons for the high effectiveness of the Project.
- Project activities covering various aspects of MNCHN services, namely institutional, technical,
infrastructural and financial aspects were planned as a package in a comprehensive and integrated
manner, and implemented steadily as planned through concerted efforts by the JICA Experts andcounterpart personnel.
- Commitment of provincial and municipal local governments to MCH has been attained throughrepeated advocacy to the governments and Local Chief Executives (LCEs). As a result, Local
Government Units (LGUs) in the target sites have been taking such important actions for MNCHN
services; prohibiting home based delivery, improvement of infrastructure for RHUs and BHSs,
providing additional cash incentive for CHT members as well as pregnant women, sponsoring theinsurance premiums for PhilHealth, etc.
- Utilization of MCP of PhilHealth has been enhanced to secure quality MNCHN services and create
additional motivation of LGUs and medical personnel at municipal and barangay levels by availingthe reimbursement.
- BEmONC Monitoring and MNDR were introduced to assure the quality of MNCHN services(3) Efficiency
The Outputs of the Project have been fully or mostly achieved. Inputs from both Japanese and Philippine
sides have been adequate, and the activities have been conducted as planned. There have been no
problems in communication within the Project, and mechanism for monitoring and decision making
through Joint Coordination Committee (JCC) and Regional United Project Management Committee(RUPMC) and other meetings was adequate. Following factors are identified which affected theimplementation of project activities and production of the Outputs.
- In order to uphold commitment of LCEs, the Projectcontinuously advocated the issue especial when
new LCEs became in position.
- PDM has been revised twice in order to accommodate newly recognized needs and deal with limited
availability of information; uplift some targets based on the results of early project years. Various
minor adjustments have been made in the approach of the Project to cope with the changes in relevant
policies and regulations. Thus, the Project has been managed with flexibility and readiness to adjust
itself to the changes of its context.
- Three Filipino field consultants employed by the Project have technical background in Medicine or
public health and experiences in governmental health services in CAR and other regions in
Philippines. Especially in Apayao and Abra provinces which are far from the project office in Baguio,continuous presence of such field consultants has been very helpful for the efficient implementationxvii

of the Project.
(4) Impact
Among the indicators for the overall goal, FDB Rate and MMR in CAR have been improving since 2010,
while no such improvement is confirmed for IMR although the IMR has been below the MDGs target of
19 (per 1,000 live births) since the inception of the Project. all the three (3) indicators have been attaining
the MDG targets or the Project’s target set for overall goal. As far as these indicators are concerned, theOverall Goal had been achieved.
2010

2011

2012

2013

2014

2015

TargetFBD Rate

68%

73%

78%

83%

90%

92%

85%

MMR

65

62

71

66

50

45

52

IMR

9

11

10

10

8

11

19

Note: Figures with underline are those figures equal or more than the target level.
While the improvement of FDB Rate can be regarded as direct impact of the Project, impact on MMR
and IMR would be indirect. Project’s contribution to MMR and IMR needs further examinations.
Followings are pointed out as other impacts of the Project.
- In order to assess FBD Rate and Pre-Natal / Post-Partum Care completion rates more accurately, theProject developed RB-TCL (Residence Based TCL) by re-compiling the occurrence based TCL which
is a part of regular (Field Health Service Information System) FHSIS practice. It was proved that
residence based obstetric indicators compiled for each municipality and barangay population are very
useful for LGUs in conducting monitoring and evidence based planning, as they are more accurate.
Considering its usefulness, DOH-CAR decided to take the same approach in compiling indicators on
immunization. In addition, DOH-Region I has requested to the Project to extend technical assistancefor introducing Residence Based-TCL in the Region.
- The Project will have some positive impacts which are not limited to MCH but an improvement of
medical and health services related to patient referral and transport in emergencies , for example, theeffective referral system and improved infrastructure, equipment and enhanced capacity at RHU /BHS.
(5) Sustainability
In view of the followings, sustainability of the Project is considered to be fairly high; DOH-CAR andhealth workers at provincial and municipal governments in the target sites have acquired sufficienttechnical capacity to continue the activities initiated by the Project; it is expected that its approaches andbasic institutional framework will be maintained in general; DOH-CAR and all the LCEs interviewed
by the evaluation team expressed their firm commitment to the continuation of the project activities.
However, there are following issues which may affect the sustainability of the Project’s effects andrequire attention;- Lowering of priority by the changes of LCEs after elections; While the Project has been promoting
enactment of ordinances and resolutions in order to minimize negative influence of the changes ofLCEs, it would be necessary for DOH-CAR to continue advocacy so that all the LGUs have relevant

xviii

ordinances and resolutions.
- Changes of trained local health workers; DOH-CAR would need to continue training in cooperation
with Baguio General Hospital.
- Gradual implementation of the Project Expansion Plan; There was a delay in procurement ofequipment by DOH and restriction on training due to limited availability of trainer and some trainees.
Steady implementation of the Project Expansion Plan would be necessary.
- Changes in PhilHealth policies; There is a risk that PhilHealth might modify insurance fee andpremium of the MCH care package, in future when sufficient funds are no longer available for
PhilHealth.
3-3 Promoting Factors of Project(1) Planning aspect- Interventions on MNCHN service were planned as a package in a comprehensive and integrated
manner. These interventions, which are in line with the Philippine’s policy on MNCHN, pulled out
active efforts of the Philippine side and would lead to sustainability after the completion of the
Project.
(2) Implementation aspect- Implementation had flexibility allowing modifications of PDM in response to the necessity related
to indicator and changes in relevant policies.
- Three filed consultants with sufficient technical background and experiences were assigned in eachprovince.
3-4 Hindering Factor of the Project(1) Planning aspect- No major problem was identified.
(2) Implementation aspect- No major problem was identified.
3-5 Conclusion
The Project is high relevant to the Philippines’ policies on universal health care, MNCHN service
delivery, and the development needs of CAR. Its efficient implementation led to full achievement of theindicators of Project Purpose by the end of 2015, two-year ahead of the original target year. Fruitfulresults of the Project are attributed to the fact that the interventions were planned in a comprehensive
and integrated manner as a package, and were steadily implemented through the concerted efforts of thecounterpart personnel and the JICA Expert team. Considering the completion of technical capacity
building for the counterpart personnel and the commitment of local authorities regarding thecontinuation of activities, sustainability of the Project is fairly high. Part of the indicators defined for
the Overall Goal has shown improving trend, while the Project’s contribution to these indicators needs
further examination. In view of the above, the Project is expected to be completed highly satisfactory.
3-6 Recommendations
1. ILHZ as a functional platform for strengthening SDNs
【DOH】The Project’s successful experiences in establishing functional ILHZs shall be referred toby the ongoing initiative of DOH in strengthening Service Delivery Networks (SDNs). Essential

xix

components to make ILHZs functioning, as identified through the project’s experiences, include
establishment of governing framework supported by MOA among participating LCEs, profiling offacilities within ILHZs, development of referral rules and protocols, and regular meetings at ILHZs
to discuss key operational issues such as maternal referrals. These components could also be
considered as key elements to strengthen SDNs.
2. Institutionalizing supportive supervision for sustainable quality assurance of BEmONC capablefacilities【DOH】To ensure the service quality of BEmONC capable facilities in the project target areas,
regular conduct of the supportive supervision has been institutionalized by means of executive orders
or Resolutions at the provincial level. In addition, DOH-CAR is in the process of making asatisfactory performance demonstrated by BEmONC-trained staff during the supportive supervision
as a pre-requisite for Licence To Operate (LTO). It is suggested that the concerned offices of DOH
explore the possibility to institutionalize the BEmONC supportive supervision requirement at thenational policy level as well as to encourage provincial governments to legislate the support toconducting supervision of BEmONC capable facilities.
【 DOH-CAR 】 In order to keep providing quality BEmONC services, DOH-CAR should
continuously provide complete BEmONC training for newly positioned health workers and refresher
training for existing health workers. Moreover, DOH-CAR should ensure continuous practicing of
BEmONC supportive supervision by provincial governments in order to identify any gaps in healthservice delivery to be filled.
3. Institutionalizing regional MNDR for improving the management at the hospital level【DOH】Based on the successful introduction of the MNDR mechanism to the Project’s target
provinces, DOH-CAR initiated regular sessions of MNDRs at the regional level. With theparticipation of specialist doctors at Baguio General Hospital, the regional MNDRs aimed to review
death cases that required technical knowledge above provincial review teams’ capacity and to provide
mutual learning opportunities within the region. Taking lessons learned from CAR Region, theconcerned offices of DOH may also look into the possibility for countrywide application of theregional MNDRs.
4. Application of residence-based definitions of key maternal and infant care indicators【DOH】The Project demonstrated the usefulness of the residence-based definitions of the key
maternal and infant care indicators, such as FBD Rate, Pre-Natal / Post-Partum Care Completion
Rate and Fully Immunized Children Rate, particularly in effective performance monitoring down tothe barangay level and evidence-based decision making at each LGU level. DOH is advised to explore
the possibility of endorsing the residence-based definitions of the indicators to enable LGUs toeffectively mobilize resources toward achievement of Universal Health Care. Revisiting FHSIS’s
definitions and the existing pre-natal TCL could be one way, whereas, introducing a residence-based
TCL at birthing homes to facilitate data aggregation may be another option. Suitable modalities tomeet local needs shall be identified among concerned offices of DOH.
【The Project】While the Project has successfully introduced the residence-based definitions of the
key maternal and infant care indicators to the project target sites, data aggregation and analysis arestill performed under the guidance of the Japanese experts. It is therefore recommended that, by thexxend of the project period, the Project conduct activities to institutionalize the data management
process involving data collection, aggregation, analyses and presentation by producing amanual/guiding note, and to capacitate DOH-CAR to provide guidance to LGUs in data analysis andtheir utilization for better decision making. The Project is also expected to extend its assistance inbuilding capacity of DOH Region I in adopting the residence-based definitions in response to its
official request. In addition, “Delivery Tracking Chart” used as a companion tool of the residencebased TCL in the target sites of the Project may also be disseminated to other provinces/regions.
5. Promotion of local legislation and its enforcement【The Project / DOH-CAR / DOH】Considering that the major challenge for sustainability is possible
shift of priorities by LCEs and decline of funding for MNCHN services, the Project and DOH-CAR
need to promote relevant local legislation by Ordinance and Resolutions. To secure enforcement ofsuch legislation, DOH-CAR also need to make persistent efforts to convince the LCEs. Municipal
governments are also advised to facilitate legislation of corresponding municipal ordinances /resolutions at barangay level. Meanwhile, it is also important that local health workers fully
understand the importance of the activities initiated by the Project and are able to convince their LCE
by demonstrating the results. In addition, DOH may consider to incorporate the status of theavailability of concerned local ordinance and resolutions as part of the LGU scorecard indicators.
6. Disseminating the good practices in entire CAR【DOH-CAR】 The Project Expansion Plan prepared by the Project is being implemented since2014 through 2016. DOH-CAR would need to provide sufficient resources to disseminate theProject’s good practices to the entire CAR through its steady implementation and on occasions of
Kapihans (press conference) and regional forums.
3-7 Lessons learned
1. Usefulness of Residence Based Definitions of Maternal and Child Health Indicators
The target client list introduced in this Project to identify all pregnant women in the target area, hasbeen created by BHW and CHT members, who are working closely with the community. The list was
excellentin that even if all the services were provided in different places, it can be grasped basedon the place of residence and can be followed to provide the services. Moreover, the performance of
health services in each area can be accurately monitored in actual number rather than estimates, andalso it can accurately monitor the efforts of health service providers, which has contributed toincreasing the motivation of the health service providers. It has the potential to be widely utilized indeveloping countries where the resident registration system has not been established.
2.

Necessity for an Integrated Approach in Remote Areas
The Project planned to improve access to MCH services in geographically isolated areas ofmountainous area, and was achieved the target goal. However, not only the need in health sector but
for a comprehensive approach to MCH services has emerged. The municipality in the target area of
the Project said that improvement of road network was needed to further reduce maternal andneonatal deaths. Improving MCH services should consider not only health interventions but
comprehensive efforts across sectors, such as development of roads to access to the health services.

xxi

3.

Deployment of Field Consultants by Target Area
Under the Project, field consultants were deployed in each of the three target provinces. Each field
consultant had experience of working as a doctor or nurse in the public health sector in CAR and wasable to play a part in the technology transfer to the counterparts in each province under the guidanceand supervision of the Japanese experts stationed in Baguio. This type of personnel deployment isbelieved to be more advantageous than the repetition of short visits by a Japanese expert to eachprovince because of the facts that (i) a close alignment and strong relationship of trust was fully
established between the counterparts and the Japanese side and (ii) the field consultants were always
ready to provide a quick response when required while maintaining good communication with theJapanese experts. For a technical cooperation project which simultaneously target multiple areas,
JICA should consider the continued deployment of field consultants with adequate qualifications andexperience.

xxii