Evaluation Summary
1. Outline of the ProjectCountry: the Lao People’s
Democratic Republic
Issue/Sector: Healthcare andmedical treatment

Project Title: The Project for Development Innovative ResearchTechnique in Genetic Epidemiology of Malaria and Other Parasitic
Diseases in Lao PDR for Containment of Their Expanding Endemicity
Cooperation Scheme: Technical Cooperation Project (Science andTechnology Research Partnership for Sustainable Development:
SATREPS)
Total Cost： 0.4 billion JPY

Division in charge: Health Team4, Health Group 2, Human
Development Department(R/D):
Partner Country’s Implementing Organization: the Ministry of Health
Period of
1/May/2014 – (MOH), the Center of Malariology, Parasitology and Entomology
Cooperation
30/Apr/2019 (CMPE), Institut Pasteur du Laos (IPL) (the leading organization of theLaotian side), the Lao Tropical and Public Health Institute (Lao TPHI) andthe National Center for Laboratory and Epidemiology (NCLE)
Supporting Organization in Japan: the National Center for Global Healthand Medicine (NCGM) (the leading organization of the Japanese side), theUniversity of Tokyo (UT), University of the Ryukyus (UR), Juntendo
University and Tokyo Medical and Dental University (TMDU).
Other Related Projects: Japan Agency for Medical Research andDevelopment (AMED)
1-1 Background of the Project
Parasitic diseases such as malaria and other trematode infections (Schistosomiasis mekongi, Opisthorchiasis
viverrini, etc.) put a severe burden on the socioeconomics in the Lao People’s Democratic Republic(hereinafter referred to as “the Lao PDR”. The Government of the Lao PDR has been putting efforts toimprove the situation by taking various measures such as the distribution of the Long-Lasting InsecticideTreated Nets as well as the provision of anthelminthic agents with the support of development partners.
However, it is considered to be an urgent need to strengthen the countermeasures based on the scientificevidences to meet the international demands, not just for the Lao PDR, for effective infectious disease control
measures as well as preventing the emergence of drug resistance, which are regarded as global issues.
Accordingly, Japan International Cooperation Agency (JICA), based on the request of the Government of the
Lao PDR, commenced a 5-year technical cooperation entitled “the Project for Development Innovative
Research Technique in Genetic Epidemiology of Malaria and Other Parasitic Diseases in Lao PDR for
Containment of Their Expanding Endemicity” (hereinafter referred to as “the Project” form May 2014 with
the Lao counterpart organizations of the CMPE and IPL of the MOH, under the scheme of SATREPS.
1-2 Project Overview（1） Project Purpose
Research results based on the methods for the genetic epidemiology diagnosis of malaria, Schistosomiasis
mekongi and Opisthorchiasis viverrini are utilized in government services such as in diseases control.
（2） Outputs
1) More convenient and accurate methods (PCR method, LAMP method, etc.) for the diagnosis of malaria,
Schistosomiasis mekongi and Opisthorchiasis viverrini are developed and utilized.
2) Temporal and spatial epidemiological situations of pathogens and vectors of malaria, Schistosomiasisxivmekongi and Opisthorchiasis viverrini is monitored.
3) Mechanism of emergence and expansion of the drug resistant malaria is analyzed.
4) Based on the surveillance system using the developed diagnostic methods on malaria, Schistosomiasis
mekongi and Opisthorchiasis viverrini, education for people is strengthened and endemicity is monitored
together with the local government.
5) Capacity of researchers and administrative officers for the control of malaria and other parasitic diseases
is strengthened.
（3） Inputs
The Japanese side:–
Dispatch of JICA experts: a total of 4 Experts (1 for parasitology research and a total of 3 Project
Coordinators), a total of 101 M/M (Man/Month) / Short-term Experts: a total of 73 Experts, 15
M/M;–
Counterpart Researchers’ visit to Japan: A total of 9 counterpart personnel for sharing the research
progress and outcomes, discussion on the research plan of operation and so on. (a total of 61 days);–
Training in Japan: A total of 5 counterpart personnel for the training of malaria diagnosis, drug
susceptibility test, genetic analysis, malaria epidemiological study, etc.;–
Provision of Equipment: DNA Sequencer, electrophoresis imaging system, multi-gas incubator,
spectrophotometer, deep freezers, automatic electrophoresis apparatus, realtime-PCR system, etc.;and–Overseas Activities Costs: procurement of reagents and consumables, travel costs, costs fortraining, etc.
The Lao PDR side:–
Allocation of Counterpart Personnel: A total of 20 counterparts such as Project Director, ProjectManager, researchers;–
Facilities, Equipment and Materials: Laboratory and office spaces in IPL area, existing research
instruments, equipment and/or devices in the IPL and provincial CMPEs and available data,
information and/or specimens related to the Project.
–
Local Costs: Utilities for the project office and costs other than that covered by JICA for equipment
maintenance management etc.
2. Terminal Evaluation Team
Members

Period of
Evaluation

Dr. Kaname
KANAI
Ms. Yukari
MAEDA
Dr. Yoichi
INOUE
Mr. Katsumi
ISHII

LeaderCooperation
Planning
Evaluation Analysis
Planning and
Evaluation

2/Oct/2018 – 20/Oct/2018

Executive Technical Advisor to the Director
General, Human Development Department, JICA
Staff, Health Team 4, Health Group 2, Human
Development Department, JICA
Senior Consultant, Consulting Division, Japan
Development Service Co., Ltd.
Deputy Manager, Division of International
Collaboration, Department of International
Affairs, AMED
(Observing member)Study Type: Terminal Evaluation

3. Summary of Evaluation Results
3-1 Achievements（1） Output 1
Concerning the LAMP-based DNA detection method for the diagnosis of malaria (LoopampTM MALARIA

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Pan/Pf Detection Kit), the Project observed some problems in its operation in local clinical settings forproper laboratory diagnosis as well as the necessity of product improvement in all three (3) Station of
Malariology, Parasitology and Entomology (SMPEs) under the Provincial Health Offices (PHOs), where
kit was introduced by the Project. In addition, it is a common recognition among stakeholders that it isdifficult to disseminate the LoopampTM shown in the Outcome 1 within the framework of the Project, since
the Project is required to obtain the prequalification of the LoopampTM by WHO in advance of Lao MOH’s
authorization for the product as an official method. Given these circumstances, the Project is planning to
introduce another five LAMP detectors to district health facilities in the areas of high malaria endemicity,and continue accumulating clinical cases as well as the efforts for improving the aforementioned challenges
even following the completion of the Project.
Meanwhile, as was shown in the achievements of OVIs above, it seemed unnecessary to provide diagnostic
services of both Schistosomiasis mekongi and Opisthorchiasis viverrini at local medical facilities in theendemic areas, in consideration of the characteristics of those diseases was well as the initiatives taken by
the Lao government. Further, the Project, in accordance with the request from the MOH, has been providing
testing services using PCR, LAMP and/or ELISA techniques for prevalence surveys performed in endemicareas. For these reasons, it is considered that there is little significance in aiming for “dissemination”(application in the Lao PDR as a laboratory testing service) as stipulated in the Output 1. Having said that,since the MOH expects the IPL to function as a reference laboratory for the diagnoses of Schistosomiasis
mekongi and Opisthorchiasis viverrini, the IPL is necessitated to establish those DNA diagnostic
techniques. Therefore, although it is different from the original assumptions, it can be understood that the
Project has achieved the development and dissemination of diagnostic methods for both diseases in aalternatively in accordance with the needs of the Lao PDR.
Summing up, it was confirmed that the Project established DNA detection methods for the three target
diseases, and applied them to the project research subsequently. At the same time, the application of thosemethods to each disease control measure have practically contributed to the Lao PDR in the form suitable
for the operation required for each of them. For these reasons, it is deemed that the Output 1 is generallyachieved as of the time of the Terminal Evaluation in a manner different from the original plan.
（2） Output 2
The Project has clearly shown that the ratio of Falciparum malaria cases among reported cases of malaria
in the Lao PDR is declining every year, while the ratio of Vivax malaria cases is increasing. Moreover, theactive surveillance of community residents in endemic areas performed by the Project has shown that there
are more asymptomatic carriers of Plasmodium vivax than expected. The Project also revealed thatasymptomatic malaria infection without typical symptoms of malaria infection such as high fever existed
to a certain extent. As the number of malaria patients continues to decline in recent years owing to theefforts of the Lao government and its partner organizations, the demonstration of the existence ofasymptomatic carriers as reservoir by the time of the Terminal Evaluation has been an importantachievement of the Project in consideration of future elimination of malaria. In relation to this, the Project
has brought out the prevalence of G6PD deficiency through the genetic epidemiological analyses by testing
its enzyme activity of community resident, since G6PD deficiency has the potential to trigger a severe
adverse reaction (acute hemolytic anemia) when administering Primaquine in order to eradicate malaria
from the hepatocytes. This is an important point in safely implementing radical eradication treatment forindividuals with hypnozoites in hepatocytes; thus, it is deemed that the Project provided important
evidences for considering mass drug administration of primaquine for extermination of Plasmodium vivax.
As another achievement under the Output 2, the Project identified the first case of human infection with P.
knowlesi in the Lao PDR. P. knowlesi is genetically similar to P. vivax, and it is known that not only the
results of rapid diagnostic tests but also PCR may be mistakenly diagnosed as Vivax malaria. It is known
that human infections with P. knowlesi can be severe in some cases, and many deaths have been reported

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in Malaysia. Therefore, this research result of the Project warns that even if the diagnosis was Vivax malaria
in a rapid diagnostic test, it is necessary to carry out the treatment with appropriate antimalarial drugs
without fail.
In this way, concerning malaria, important epidemiological data has been gathered in the Project as of the
Terminal Evaluation and those findings of advanced analyses using population-genetic techniques havealso been published as scientific articles in international journals. Simultaneously, the Project has been
providing the stakeholders of malaria control such as the MOH and WHO with those findings as convincing
evidences for making policies, countermeasures and so on in the Lao PDR. Concerning Schistosomiasis
mekongi and Opisthorchiasis viverrini, it became a common understanding that the said two diseases are
not applicable to the analyses based on population genetics; therefore, it is deemed from general assessmentthat the degree of achievement of the Output 2 has largely been appropriate as of the time of the Terminal
Evaluation.
（3） Output 3
Since chloroquine resistant Falciparum malaria was dominant in the Mekong region, the use of chloroquine
is prohibited for its treatment in the Lao PDR. However, on conducting analysis of chloroquine resistantgene of pfcrt in the Project, it was confirmed that chloroquine-sensitive (wild type) Plasmodium falciparumis increasing. It is guessed that the decline in chloroquine selection pressure is one of the factors behind
the increase in wild-type Plasmodium falciparum, however, there are still not enough samples to draw any
definite conclusions. Meanwhile, the Project carried out massive survey for the analyses of the mutationon the K13 gene that is considered to be related to the resistance against artemisinin. The analysis results
revealed that artemisinin-resistant protozoa from Cambodia spread gradually from southern to northernparts of the Lao PDR as humans moved, reaching the northernmost Ponsari Province by the end of 2017.
These results suggest a risk that artemisinin-resistant malaria may spread from Poncealy Province of the
Lao PDR to Yunnan Province of China. From these research findings and outcomes, it is demonstrated that
it if of greater importance to implement active surveillance on multidrug resistant genes in the Lao PDR.
As aforementioned, the Project has gained important research findings and outcomes on the mechanismsof the emergence and dissemination of the drug resistance malaria as of the time of the Terminal Evaluation.
Those findings and outcomes were published in international journals as academic articles, one of which
was published in a world-class prestigious journal. Those have also been supplied to relevant organizations
as important evidences for advancing countermeasures against malaria in the Lao PDR, in the region andeven globally. For these reasons, the achievement level of the Output 3 is deemed to be significantly highat the time of the Terminal Evaluation.
（4） Output 4
Concerning malaria, the surveys and analyses on the endemicity, distribution and diffusion of the drugresistant malaria have been carried out under the Output 1, 2 and 3. Regarding Schistosomiasis mekongi,
the Project established the DNA detection method with high sensitivity and specificity in the IPL, andapplied it to research on infection rates not only in humans but also vector snails and animals. The Project
conducted a combined analysis of these infection rate results and geographic data from satellites provided
through the Japan Aerospace Exploration Agency collaboration to create a risk map and to analyze risk
factors for infection. Similarly, concerning Opisthorchiasis viverrini, and the Project developed the DNA
detection method with high sensitivity and specificity, and used for the project research. It is worth notingthat through the development of the DNA detection method for Opisthorchiasis viverrini, the Project
revealed that the microscopic examination actually overestimated the prevalence of the disease by misdistinguishing trematodes, which are morphologically similar to O. viverrini as O. viverrini to a certain
extent. The research findings and outcomes obtained through these activities have been provided asconvincing evidences not only to the MOH but also to the WHO and other organizations engaged in malaria

xviicontrol in the Lao PDR and the region, and are used directly and indirectly for policymaking, surveillance
and implementation of countermeasures.
It was not possible to construct a means for the prevention of infection of the inhabitants based on scientificevidence such as “Position Deviance” within the project period; nonetheless, the Project established DNA
detection methods with high sensitivity and specificity in the IPL, which greatly contributed to functioning
the Laos-Japan parasitology laboratory as a reference laboratory for those target diseases. Besides, thesharing of research findings and outcomes of the Project with stakeholders is deemed to directly contributeto the monitoring of the diseases in the Lao PDR. For these reasons, the Output 4 is considered to be largely
achieved at the time of the Terminal Evaluation.
（5） Output 5
The Project has been advancing its activities with the emphasis on nurturing Laotian young researchers
throughout the project period. As a result, the Laotian researchers became capable of planning fieldsurveys, collecting samples and perform DNA analyses using advanced research instruments bythemselves. Further, under the guidance of the JICA experts (researchers), they have been actively
preparing abstracts and conference presentation slides in English and practicing presentations; as a result,some Laotian members made presentation of the project research orally in English at the National HealthResearch Forum. Meanwhile, the Project has offered basic and refresher training opportunities on malaria
and parasitic disease control to a total of 156 health personnel engaged in parasitic disease control on the
ground in districts and provinces. Not only has this made a contribution to measures for the prevention andcontrol of target diseases, but it has also helped build a nationwide network, as a byproduct of training, forperiodically collecting samples. In addition, the JICA expert (NCGM researchers) stationing in the IPL has
been participating as an advisor in meetings on various infectious disease countermeasures held by the
MOH, WHO and other partners, and continued to share technical advice and research findings andoutcomes generously at meetings. In addition, the Project has provided direct support to the MOH by
preparing implementation protocols for prevalence surveys and other activities, which may havecontributed significantly to the capacity building of administrative officers and personnel in the national
research institutes engaged in infection control in the Lao PDR.
As has been described, the Project has been offering various opportunities for capacity building for various
human resources engaged in infectious disease countermeasure and research in the Lao PDR, and is
expected to continue after the project period ends. Accordingly, the degree of achievement concerning the
Output 5 is thought to generally be appropriate as of the time of the Terminal Evaluation.
（6） Project Purpose
As has been indicated so far, the Project has succeeded in acquiring important findings and researchoutcomes concerning endemicity of malaria (including asymptomatic carriers) and the mechanism that cancontribute to drug resistance in the Lao PDR as of the time of the Terminal Evaluation, and these findings
have even been published as scientific papers. Moreover, the simple and highly sensitive LAMP-based
DNA detection methods were introduced to major research institutes in Vientiane (the CMPE and the IPL)as well as the SMPE of the PHOs covering the north, center and south of the country, and training of healthpersonnel who are engaged in parasitic disease control at such facilities is being advanced. Moreover, as
was indicated in the achievement of Outputs, the JICA long-term experts (NCGM researchers) stationed
in the IPL have shared the research findings and outcomes and offered technical advice when participatingin national conferences on malaria control.
Meanwhile, concerning Schistosomiasis mekongi and Opisthorchiasis viverrini, development work on the
LAMP-based DNA detection method had been completed from the technical point of view. All WHO
member countries are required to strengthen the “preparedness” against infectious diseases, in accordancewith the International Health Regulations (IHR), by preparing options for testing and diagnostic methods.

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Accordingly, the Project established DNA detection methods that have high sensitivity and specificity withrespect to such parasitic diseases, and significantly contributed to the IPL to function as the referencelaboratory for the said diseases in the Lao PDR. Furthermore, the research findings and outcomes gainedusing those detection methods have been used as the evidences for the betterment of the infection control
in the Lao PDR.
As has been described above, the Project has created a variety of research findings and outcomes that willcontribute to the countermeasure of parasitic diseases in the Lao PDR. The IPL Laos-Japan Parasitology
Laboratory, which is the main body of the project implementation, has already been built into the system
of infectious disease control in the Lao PDR as a supplying body of scientific evidences and as animplementation organization of direct countermeasures, making it an indispensable existence. In view of
the above points, the achievement of the Project Purpose at the time of the Terminal Evaluation is highly
satisfactory.
3-2 Summary of Evaluation Results（1） RelevanceThe relevance of the Project has been highly maintained hitherto.
The significance of taking measure for the control not only for malaria but also other parasitic diseases
including Schistosomiasis mekongi and Opisthorchiasis viverrini, the target diseases of the Project, isclearly mentioned in the “Eighth 5-year Health Sector Development Plan 2016-2020”. The Plan stipulates
the specific areas to be addressed as follows: capacity enhancement of both national and local laboratories(including human resource development and quality control) in accordance with the requirements of the
IHR and other international standards; the reinforcement of infectious disease surveillance system; thecontrol of drug resistance; and the strengthening of health education. Meanwhile, the Lao MOH, with thesupport of WHO, the Project (i.e., JICA experts and the IPL) and other stakeholders, issued the “National
Strategic Plan for Malaria Control and Elimination 2016-2020” in January 2016. In the Strategic Plan, it
is clearly mentioned that the CMPE of the MOH should introduce molecular diagnostic techniques to theprovincial-level laboratories with the support of partner organizations as well as the IPL should takeinitiative to plan and implement the research on the drug-resistant malaria. These can be the results of the
project’s efforts to demonstrate the necessity of addressing asymptomatic malaria cases and of researching
the drug resistance; simultaneously, resulted in further enhancement of the relevance of the Project.
Meanwhile, the Government of Japan has been promoting aid activities for infectious disease control, andthe “Global Health Policy 2011-2015” clearly come out with the promotion of the Neglected Tropical
Diseases control, preparedness for emerging and reemerging infectious diseases and international
collaboration for it. Furthermore, in its “Basic Design for Peace and Health (Global Health Cooperation)”and “Basic Policy on Strengthening Countermeasures for Infectious Diseases that Pose a Threat to Global
Society”, both publicly announced in September 2015, the Government of Japan states to build a healthsecurity that is resilient to external factors such as public health emergencies and disasters and to strengthen
Japan’s contribution and roles for the countries and regions facing the pandemic outbreaks of public healthconcerns. The Japan’s Aid Policy for the Lao PDR, issued in April 2012, stipulated the “Improvement ofhealth and Medical Services” as one of four priority areas for assistances. Furthermore, following the
adoption of “Global Action Plan on Antimicrobial Resistance (AMR)” at the WHO General Assembly heldin May 2015, Japan has strengthened its effort to promote international cooperation for the control of AMR.
For these reasons, the Project, aiming to contribute the improvement of health and medical services as wellas the control of drug-resistant malaria in the Lao PDR through the collaborative research and technicalcooperation, is deemed to be highly consistent with the Japan’s Aid Policies.
（2） EffectivenessThe effectiveness of the Project is high in general.

xixAs was described in the Achievement of the Project Purpose, the Project obtained important researchfindings and outcomes of especially in malaria research with regard to the prevalence of the plasmodia(including asymptomatic carries) as well as the mechanism responsible for the emergence and expansionof drug resistance gene mutation. These research results have been published in a number of international
journals as academic papers, and also, many presentations have been made by project members at domestic
and international conferences (9 original articles published in international journals (Annex 7), 39 oralpresentations at international conferences, 7 poster presentations and 18 oral presentations at conferencesin Japan, as of October 2018). Besides, the JICA long-term expert (NCGM researcher) became a memberof national level meetings and conferences for the control of infectious diseases in the Lao PDR andprovided technical guidance on the basis of research findings and outcomes as well as his expertise andexperiences as a scientist. As aforementioned, the Project has generated a number of research findings andoutcomes that will contribute not only to the malaria control in the Lao PDR but also to the Greater Mekong
Sub-region and even the global malaria countermeasures, and are practically used as evidences for theformulation of policies and action plans for malaria countermeasures. The IPL has also been contributing
directly to the implementation of malaria countermeasures in the Lao PDR and the region. Therefore, theachievement level of the Project in malaria is very high in terms of both collaborative research and technicalcooperation.
Meanwhile, concerning Schistosomiasis mekongi and Opisthorchiasis viverrini, the Project has almost
completed development work on the LAMP-based DNA detection methods for each parasitic disease, andthey are used as sensitive, specific and reliable DNA diagnostics in the prevalence surveys conducted by
the MOH and WHO. The MOH also calls for the IPL to function as a reference laboratory in these diseases
from the perspective of IHR compliance. In addition, as with the malaria control countermeasures
mentioned above, the JICA long-term expert (NCGM researcher) is assigned as a temporary member ofthe Advisory Committee on Parasitosis hosted by the MOH and WHO, and the Project has been continuing
to share research findings and outcomes and providing technical advice throughout the project period.
Thus, concerning Schistosomiasis mekongi and Opisthorchiasis viverrini, the Project has also contributed
to the infectious disease countermeasures the Lao PDR in a different way than originally assumed. Thus,
concerning Schistosomiasis mekongi and Opisthorchiasis viverrini, the Project has also contributed to theinfectious disease countermeasures the Lao PDR in a different way than originally assumed.
As aforementioned, on top of the research findings and outcomes gained from the project collaborative
research, the Project has been putting efforts to capacity development not only of Lao young researchers
but also health administrative officers and medical professionals on the ground through joint research workand trainings provided by the Project. For these reasons, it is deemed that the Project Purpose has generally
been accomplished at the time of the Terminal Evaluation.
（3） Efficiency
The efficiency of the Project is high in general.
Meanwhile, as was described in the “Verification of Implementation Process” section, the IPL Parasitology
Laboratory is operated as the Lao-Japan Joint Laboratory, headed by the Chief Advisor of the Project(NCGM department director) and the JICA long-term expert is assigned as the Laboratory Manager toorganize research activities as well as other managerial work in the Lao PDR. The IPL hold a weekly
meeting with the participation of all laboratory heads chaired by the Director of the IPL to share theprogress and achievements as well as to discuss managerial issues. At the initiative of the JICA long-term
expert (NCGM researcher) stationed in the IPL, the liaison and coordination of the research collaboration
amongst the Japanese research institutes such as the UT, the UR，the TMDU and the Juntendo University.
Meanwhile, the project coordinator has changed approximately one year before the end of the project
period; nonetheless, the coordination work was properly taken over to the successor. Thus, the liaison andcoordination amongst the whole players have adequately been continued throughout the project t period.

xxMeanwhile, it usually took longer-than-expected time (approx. 2 to 4 months) to go through procedures
for acquisition of tax exemption certificates for research instruments, reagents, etc. from the Lao authority
concerned in accordance with the R/D. The Mid-term Review mission had observed that similar problems
had happened in other IPL laboratories. In particular, the reagents with short expiration dates can be usedin the experiment for a shorter period of time. Following the time of the Mid-term Review, the IPL has
appealed to the relevant ministries and agencies for problem solving, but it has not been resolved even at
the time of the Terminal Evaluation. In addition, the Project implemented researches following theacquisition of ethical clearance by the relevant authorities concerned both in Japan and the Lao PDR.
Accordingly, the Project submitted research proposals to the National Ethics Committee for HealthResearch properly; however, it took, in many time, more-than-expected time for the Project to receive theresults of the review by the Committee. Although these issues did not have a significant negative impact
on achieving the Outputs and the Project Purpose, it negatively affected the smooth progress of the Project.
（4） Impact
The following positive impacts are confirmed and/or expected by the implementation of the Project.
The IPL Parasitology Laboratory has been operated as the Lao-Japan Joint Laboratory, and the researchersof the NCGM is proactive in doing operational management of the Laboratory. The JICA experts have beenworking on the project research activities in consideration of nurturing Lao researchers, and it is deemedthat the capacity of those researchers has significantly been enhanced in comparison with that in the
beginning of the Project. Moreover, the Laotian young researchers in the IPL sometimes accompanied the
JICA long-term expert (NCGM researcher) to attend the various meeting opportunities at the national level,
and experienced and learned the theory and practice of the infectious disease control as well as the practicalapplication of research outcomes to the society. Having said that, it is recognized that they are still young
researcher and less experienced to run and to maintain or even enhance the research capacity of the IPLParasitology Laboratory by themselves; from the project-designing stage, it had not been anticipated tohand over the project research to the Laotian staff in the IPL Lao-Japan Parasitology Laboratory. Further,as has been mentioned, the IPL Lao-Japan laboratory is already regarded as a part of the implementation
system of the infectious control in the Lao PDR, and the NCGM is decided to sustain the collaborative
research in the IPL even following the termination of the Project; therefore, it is highly expected that the
research activities will further be enhanced and expanded hereafter on the project’s research outcomes andhuman resource development as a strong steppingstone.
On top of that, several positive impacts of the Project have been observed or expected as follows: 1) Efforts
for the acquisition of the prequalification for the LAMP-based DNA detection method for the diagnosis ofmalaria through the collaboration between the NCGM and the Eiken Chemical Co., Ltd.; 2) Cooperative
research with the neopharma Japan Co., Ltd. for research on antimalarial Activity of a substance; 3)
Collaboration with the MOH and the Ministry of Agriculture and Forestry through the prevalence surveys
on Schistosomiasis mekongi and the development to the "One-Health" approach; 4) Collaboration with the
MOH and the Ministry of Agriculture and Forestry through the prevalence surveys on Schistosomiasis
mekongi and the development to the "One-Health" approach; 5) Promotion of Inter-laboratory
collaboration for cross-cutting research in the IPL; and 6) Nurturing Japanese young researchers(Postgraduate students).
（5） Sustainability
A self-sustainability as well as a self-deployment of the benefits provided by the Project can be expected
to some extent.
From the political and institutional aspects, the significance of the control of malaria and other parasitic
diseases will be maintained even after the termination of the project period since the significance is clearlystated in the “Eighth 5-Year Health Sector Development Plan 2016-2020”. Especially for malaria, thexxiMOH, jointly with the Development partner organizations, has strengthened efforts to achieve theelimination of Falciparum malaria by 2015 followed by the elimination of all types of malaria by 2030.
Therefore, it is anticipated that the importance of research outcomes, which will be presented to the MOH
and other stakeholders, will be maintained even after the end of the project period since the outcomes are
expected to be used as solid basis for making decisions, policies and countermeasures by the said agencies.
The Japanese research organizations are anticipated to continue the joint research at the IPL even following
May 2019 when the cooperation period is over. Effective infectious disease countermeasures have been
implemented through various collaborations between research institutes and the governmentalorganizations. However, it is desirable that the MOH and other related organizations will provide more
support to the implementation of joint research and the utilization of research findings and outcomes forpolicymaking, implementing countermeasures, etc. in the Lao PDR, even after the completion of the
project period.
Concerning the financial sustainability, the NCGM has decided to continue the joint research at the IPL
even after the end of the project period, by utilizing financial support from Japanese private companies aswell as by acquiring the competitive research funds in Japan. The IPL also has commenced two projects
financially-supported by the US Foundation, and some of these budgets have become available in all IPL
laboratories since July 2018. Specifically, $1,000 per month are provided for each IPL laboratory for thepurchase of experimental consumables and is expected to continue for two years. Accordingly, the budget
for maintaining collaborative research at the IPL is considered to be secured for the time being after the
project period ended.
As for the technical aspect, the NCGM has decided to continue collaborative research at IPL after thecompletion of the Project. The research and testing technologies provided through the Project will continue
to remain in the IPL, and research results and technical advice will also be shared with relevantorganizations engaged in infectious diseases control in the Lao PDR in a sustainable manner. On the other
hand, the Laotian researchers have enhanced their capacity in comparison with that at the beginning of the
Project, however, the efforts for capacity development should be continued with a long-term point of view.
3-3 Factors that promoted the attainment of the Project（1） Concerning the project design
None in particular.
（2） Concerning the implementation process of the ProjectAt the time of the interviewing opportunities, the CMPE of the MOH as well as WHO showed theirrecognition that the Project (i.e., JICA experts and the IPL researchers) is an important partner who can toprovide scientific evidences such as research findings and outcomes for helping them to develop policies
and/or countermeasures. Based on such recognition, the JICA long-term expert, as a representative of the
IPL Parasitology Laboratory has been assigned as a member of the said meetings and provided technicalguidance based on the project research findings and his expertise and experiences.
On the basis of the establishment of such relationship of mutual trust and collaboration amongst the
stakeholders through the implementation of the Project, the Project has been providing the scientificevidences for policymaking, cooperating by providing testing services, receiving the funding support frompartner organizations, implying the ideal collaboration has been continued from the technical and financial
standpoint. Simultaneously with the implementation of project research activities, the Project has been
putting efforts to apply the research findings and outcomes to the policy making, countermeasure, etc. aswell as to establish the relationship of mutual trust and cooperation with relevant organizations. As aconsequence, the Project has made a great contribution to the infectious disease control in the Lao PDR;
at the same time, the effectiveness of the Project was enhanced significantly.

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3-4 Factors that impeded the attainment of the Project（1） Concerning the project design
None in particular.
（2） Concerning the implementation process of the Project
There were several cases that it took a couple of months to obtain certifications of tax exemption on thebasis of the R/D for the research instruments as well as reagents, which were brought from Japan. Somereagents with relatively short valid period had been shortened the days for expiration date since it had been
kept in the customs for a certain period of time. The IPL has been calling for the improvement of this issue
to the relevant governmental agencies such as the Ministry of Health and the Ministry of Financethroughout the project period; nevertheless, nothing has resolved as of the time of the Terminal Evaluation.
Though it had not caused critical influence on the project activities, it is deemed to hinder the smooth
implementation of project activities to some extent. Thus, this is regarded as a hindering factor against theefficiency of the Project.
3-5 Conclusions
The Terminal Evaluation Mission confirmed that "Relevance" of the Project has highly been maintained, andthat "Effectiveness", "Efficiency", and "Sustainability" were also generally high. The Project has also createda number of positive “Impact” as of the time of the Terminal Evaluation; thus, it is expected to contributesignificantly to the countermeasure of malaria and parasitic diseases in Lao PDR in future.
In particular, the Project has established the cooperative relationships with relevant ministries, national
agencies and other partner organizations by providing scientific evidences and technical advices as well as
by assisting the national surveys, which are beneficially utilized for the infectious disease countermeasuresin the Lao PDR. Under such liaison and cooperation, the Project also proceeded various project activities todate. As the result, various scientific research results have been created, and it has directly contributed to theinfectious disease countermeasure in the Lao PDR.
With regard to malaria, as a result of the establishment of cooperative relationship with local healthprofessionals through the provision of technical training to them, the Project obtained sufficient number ofclinical samples from malaria suspected patients and analyzed them proactively; consequently, the Project
revealed that the present state of asymptomatic malaria carriers, which is recently regarded to be importantfor strengthening the initiatives for malaria elimination. In addition, the important research findings andoutcomes on the emergence and diffusion of the drug-resistant malaria are gained, which had impacted to thecommencement of novel international research collaboration (supervision) for preventing from crossing
border.
On the other hand, concerning Schistosomiasis mekongi and Opisthorchiasis viverrini research, the Project
had developed DNA detection methods based on the novel gene amplification technology, and the developing
work for the methods has largely been completed from a technical standpoint within the cooperative period.
These DNA detection methods are established as diagnostic methods in the IPL, enabling the IPL to function
as a reference laboratory for these diseases, and are also used for the national prevalence surveys conductedby the MOH.
These research findings and outcomes are disseminated to the world through the publications of research
articles in international journals, and many presentations has also been made at academic conferences. Thus,
the achievement of the Project from an academic standpoint is very large. Besides, by taking the opportunities
of field sampling activities, the Project has been providing health education regarding the prevention of
infectious diseases geared to community residents jointly with the health professionals, resulted in the steadycontribution to the community health. The Project has also consistently addressed the fostering of Laotian
young researchers through its research activities, and the staff of the IPL Lao-Japan Parasitology Laboratory
has reached the level where they can make oral presentations in English at domestic and internationalxxiii

conferences at the time of the Terminal Evaluation. Though further self-study and continuation of guidancefrom Japanese researchers are also required to stand alone as researchers, it is deemed that the Project has
made a significant achievement from the viewpoint of JICA's technical cooperation.
Even after the completion of the Project, Japanese research institutes are supposed to continue international
joint research at the IPL by utilizing research funding from companies and scientific research grants in Japan.
The Japanese research institutes will move on to the preparations for the acquisition of WHO pre-certification
for the LAMP-based malaria DNA diagnostic kit, detailed research on asymptomatic malaria carriers, andfurther, novel research on the substance with antimalarial activity. Those international collaborative
researches are also anticipated to continuously contribute not only to scientific research outcomes but also to
the countermeasure of infectious diseases in the Lao PDR hereafter.
3-6 Recommendations（1） To the Project1) Promotion of the "One-Health" approach
The Project had gained an experience of inter-sector collaboration with the Ministry of Agriculture andForestry, such as the implementation of the joint survey. From the aspect of the significance of thecollaboration with other organizations, it is anticipated that this kind of cross-sectoral activities such as
the regular cross-sectoral meeting become widely be done, in order to promote the "One-Health"approach.
2) The effort to explanation of the practical operational procedures at the time of introduction of LAMP
detectors
The Project is planning to introduce another five LAMP detectors to district health facilities in the areasof high malaria endemicity, and continue accumulating clinical cases even following the completion of
the Project. At the time of introduction, it is necessary that the Project should put efforts to publicize theperformance and utilization of the kit to the local stakeholders; at the same time, to introduce thepractical operational procedures of the testing services, such as algorithms for selecting eligible patientsfor genetic diagnosis by LAMP method and specimen transfer method, etc.
Meanwhile, the Project experienced that LAMP reagents under storage could easily deteriorate withmoisture, enough to affect the measurement results as false positive, in usual environment oflaboratories in the Lao PDR, and the problem can happen in hot and humid malaria-endemic areas suchas Southeast Asia and Africa where the LAMP-based malaria DNA detection methods were expected to
be used. Though the current reagent packaging would not cause any problem of the testing results in theusage of mass survey of asymptomatic malaria carriers, it is recommended for the Project, jointly with
the Eiken Chemical Co., Ltd., to resolve the problem by improving the “Product”, such as individual
packaging of reagents, in consideration the usage in practical clinical settings.
（2） To the MOH
1) Improvement of internal quality control system in local clinical laboratories
Capacity of local laboratory staff has significantly been enhanced through the implementation of the
Project, it is confirmed that a problem concerning the quality control toward laboratory testing resultsfrom the LAMP-based DNA detection method for diagnosing malaria, introduced by the support of the
Project. In particular, the Project, with the support of the Eiken Chemical Co., Ltd., developed andintroduced the Standard Operating Procedure (SOP) for the said testing by providing the staff with its
training; nevertheless, it is found that there is no monitoring mechanism for the compliance of the SOP.
This is regarded not only the issue of the Project but also a challenge of the clinical laboratories in wholecountry; therefore, it is recommended that the NCLE, in charge of laboratory quality control andassurance, will take action for the construction and even improvement of the Internal Quality Control(IQC) mechanism immediately.

xxiv2) Coordination with related development partners for effective trainings
Regarding the training on communicable diseases for the lab staffs and officers in rural area which wasprovided by the Project, the Department of Communicable Disease Control and other relevant
departments within MOH should continue to work closely and coordinate with WHO and other partners
which are conducting various trainings, in order to make them more effective without duplication.
3) Improvement of the situation regarding the certification of tax exemption for reagents, research
instruments and equipment.
When reagents, research instruments and equipment were brought from Japan to the Lao PDR, it took
longer time than expected to go through procedures for acquisition of tax exemption certificates forthem from the Lao authority concerned in accordance with the R/D. Especially, some reagents withrelatively short valid period had been shortened the days for expiration date since it had been kept in
the customs for a certain period of time.
Having said that, it is acknowledged that this issue cannot be solved by the MOH alone but is regarded
as a complex issue involving the Ministry of Finance, the Ministry of Planning and Investment, andother relevant agencies. Not only all laboratories in the IPL but also any research institutes engaged in
the infectious disease control in the Lao PDR are being affected by the issue. In other words, the relevant
ministries and agencies should acknowledge the negative impact of the issue on infectious disease
countermeasures in the Lao PDR, and are expected to make further efforts to resolve the issue, at theinitiative of the MOH, by convening inter-ministerial consultations and so on.
4) Smooth implementation of ethical review for the research proposal
The Project implemented researches following the acquisition of ethical clearance by the relevant
authorities concerned both in Japan and the Lao PDR. Accordingly, the Project submitted research
proposals to the National Ethics Committee for Health Research properly; however, it took, in many
time, more-than-expected time for the Project to receive the results of the review by the Committee.
The Project sometimes have to put a special consideration for the timing of survey especially for malaria
and Schistosomiasis mekongi, thus, the Committee is recommended to improve this situation for smooth
implementation of ethical reviewing.
5) Further cooperation to promote international joint research work in IPL with Japanese research institutes
The Japanese research organizations such as NCGM are anticipated to continue the joint research at the
IPL even following May 2019 when the cooperation period is over. MOH should provide more support
to the implementation of joint research and the utilization of research findings and outcomes forpolicymaking, implementing countermeasures, etc. in the Lao PDR, because of the importance of IPL
as the national referral laboratory for the investigation of parasitic diseases and for provision ofevidences for policy making and as a cooperation agency for national surveys. It is expected that the
MOH will involve Lao and Japanese researchers to participate in conferences on countermeasures for
infectious diseases and promote the utilization of research findings more actively.
（3） To the Lao young researchers
1) Further Self-Help Endeavor to enhance International Competitiveness
It is important for the Lao young researchers to come in touch with the advanced scientific research bythemselves, in order to acquire international competitiveness. To achieve it, the Lao young researchers
are advised to continue self-help efforts even following the termination of the Project further, such as
reading more English papers, holding journal club, capturing novel scientific information, obtaining
Ph.D. degree in the future, and increasing other options for capacity enhancement.
3-7 Lessons Learnt（1） Significance of proactive information sharing with stakeholders in light of the practical application of theresearch findings and outcomes to society

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This project, with the full-understanding of the scheme objectives of the SATREPS, has been providing
scientific evidences on malaria, Schistosomiasis mekongi and Opisthorchiasis viverrini to relevantorganizations such as the MOH and WHO in a timely and effective fashion. The JICA long-term expert(NCGM researcher), stationed in the Lao PDR, has been participating countermeasure meetings at various
levels in Lao PDR, and not only sharing information but also providing advices from a professional
perspective and coordinating collaborative countermeasure activities, contributing greatly to the control of
infectious diseases in Lao PDR and even the Greater Mekong Sub-region, thereby maximizing therelevance, effectiveness and impact of the Project.
Many research institutions such as universities do not disclose research findings and outcomes until it ispublished in academic journals or other publications in order to maintain the confidentiality of theirresearch results. Having said that, the principle of SATREPS is the practical application of researchoutcomes to society; therefore, projects are required to promote the information sharing and collaboration
with future users (e.g. governmental authorities) of the research outcomes even within the project period
as well as to provide necessary assistances in a timely manner, in order to fulfill the said principle.
（2） Allocation of resident researcher(s)In the Project, one researcher from a Japanese implementing organization was stationed in the Lao PDR,
and not only the implementation of international joint research but also managerial affairs with relatedorganizations were conducted exclusively. The establishment of such an implementation system enabled
the smooth construction of a research system and the development of human resources as a technology
cooperation project, and also led to technical assistance to the Lao government and internationalorganizations in a timely manner. Since the social application of research findings and outcomes has
strongly been taken into account in SATREPS, it is recommended for SATREPS projects to allocate
researcher(s) stationed in the host country as much as possible to enhance the effectiveness of international
joint research, and to promote information sharing and collaboration with not only the host country but
also international organizations in the region, while giving due consideration to the confidentiality of
research results.
3-8 State of the follow-up

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