Summary of the Results of the Terminal Evaluation
1.

Outline of the ProjectCountry : Lao People’s Democratic

Project title : Strengthening Integrated Maternal, Neonatal andRepublicChild Health Services in Lao PDR

Issue/Sector : HealthCooperation Scheme : Technical Cooperation

Division in Charge :Total cost

JICA Head OfficeTotal:

Period of Cooperation：

Partner Country’s Implementing Organization：

May 2010 ~ May 2015

Ministry of Health, Provincial/District Health Offices of340 Million Yen

Champasak, Salavan, Sekong and Attapeu Provinces
Supporting Organization in Japan：National Center for
Global Medicine
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Background of the ProjectIn Lao People’s Democratic Republic (Lao PDR), the national health status had been improving

steadily over the past decades. Despite the progress made, Maternal Mortality Ratio (MMR) and Under
Five Mortality Rate (U5MR) still remained the highest among ASEAN countries, where the estimationof MMR to be 220 per 100,000 live births and U5MR to be 71.4 per 1,000 live births (2013).
Improvement of health care services, especially for maternal and child health had been the priority
issue to be addressed by the Lao PDR Government as well as achieving health related MDGs.
In response to the circumstances, the “Strategy and Planning Framework for the Integrated Packageof Maternal, Neonatal and Child Health Services 2009-2015(MNCH Integrated Service Strategy)” wasdeveloped through the maternal, neonatal and child health (MNCH) Technical Working Group toaccelerate reducing maternal, neonatal and child mortality, as well as maternal and child malnutritionin cooperation with various development partners (DPs), such as WHO, UNFPA, UNICEF, The World
Bank, as well as JICA.
In line with this MNCH Integrated Service Strategy, the Project for Strengthening Integrated
Maternal, Neonatal and Child Health Services (hereafter referred to as “the Project”) has been
implemented since May 2010 for the period of five years. The Project aims to improve the coverage ofMNCH services targeting four southern provinces (Champasak, Salavan, Sekong and Attapeu) with theframework described below.
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Project Overview< Overall Goal>
Maternal, neonatal and child mortality is reduced in the four southern provinces, i.e., Champasak,Salavan, Sekong, and Attapeu.
<Project Purpose>
Coverage of the maternal, neonatal and child health (MNCH) services is improved in the four southern
provinces.
<Outputs>viii

Output1: The MNCH Program is appropriately managed by the Provincial and District Health Offices(PHOs and DHOs).
Output2: Capacity to provide integrated MNCH services is improved.
Output3:Utilization of integrated MNCH services is promoted in collaboration with the communityand local organizations
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Inputs (As of December 2014)<Japanese Side>
Long-term experts: 10 (Chief Adviser, Community Health, Nursing and midwifery, MCH
Administration, Coordinator, etc.)
Short-term experts: 5 (Health Education, MNCH Strategy, Architectural Planning, etc.)
Training in Japan: 24Equipment procured: 55,272,100 Yen
Local expenses:75,449,200 Yen<Laos Side>Counterparts: Related departments in Central and Provinces
Office space in each Provincial Health Office
Necessary space and facilities for training, workshops and other activities
Operational expenses such as supply of water, electricity, gas and furniture for the Project office,and other running expenses necessary for the Project operation
2.

Evaluation Team
Members ofEvaluation
Team

1. Ms. Hiroe ONO, Leader, Director, Health Division 4, Health Group 2, HumanDevelopment Department, JICA
2. Dr. Yasuo SUGIURA, Director, Division of Partnership Development, Department
of Global Network and Partnership, Bureau of International Medical Cooperation,
National Center for Global Health and Medicine
3. Ms. Nami KISHIDA, Staff, Health Division 4, Health Group 2, HumanDevelopment Department, JICA
4. Ms. Erika FUKUSHI, MOE Consulting, Inc.
5. Dr. Sengpraseuth VANTHANOUVONG, Chief of MCH sector, Department ofHygiene and Health Prevention, Ministry of Health
6. Mr.Vilasack XAYAPHET, Technical Officer, Asia-Pacific and Africa Division,
Department of International Cooperation, Ministry of Planning and Investment

Period of22 January 2015 ~ 11 February 2015

Terminal Evaluation StudyStudy
3.

Results of Evaluation

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Summary of Project Achievement

Type of Evaluation:(1) Achievement of the Outputs
Project activities have been carried out according to the current PDM (Ver. 1) as well as the AIPs
developed by the respective PHOs/DHOs. Through developing a realistic AIPs by prioritizing theix

activities, the implementation rate of the planned activities is increasing in all of the four provinces.
As a result of better planning, monitoring and trainings provided by the Project, the number ofintegrated service outreach activities and health education events has increased dramatically.
However, some of the activities such as managerial/technical supervisions and the trainings for 1stLevel MNCH Core Services (Module 1,2,3) were not implemented as planned due to unavailabilityof budget or external supports from DPs.
(2) Achievement of the Project Purpose
The achievement of the project purpose was measured by the nine MNCH indicators identified in
the PDM. In summary, the results indicate that coverage of the MNCH services has been gradually
improved in the four provinces between 2010 and 2014, although several indicators remain under
the national targets of 2015, which were set at high level compared with the National average in thelast decade. Further analysis unnecessary, in particular a comparison of the indicators in the fourprovinces with the national average in 2014 as well as trends of the indicators between 2010 and2014 to assess the effectiveness and impact of activities in the four provinces.
(3) Achievement of the Overall Goal
Some more years and efforts seem to be necessary to attain the overall goal, especially U5MR
with the target of 55 per 1,000 live births. Difficulty in obtaining timely the accurate data onnumber of maternal deaths and U5MR especially for the provincial level is a concern to capture
current situation and monitor the progress.
3-2Implementation Process
The four-province meetings were held every 6 months to share their experiences, good practices andchallenges, and they motivated PHOs in implementing the MNCH Integrated Service Strategy.
The Project was formulated in line with the MNCH Integrated Service Strategy, and described inPDM or Log Frame,which clearly link activities, outputs and targets. The AIP which was also
developed based on the MNCH Integrated Service Strategy is useful for monitoring their acitivities.
If the PDM was utilizied more effectively, it could have helped the PHOs/DHOs further strengthen
their managerial capacity by linking day-to-day activities with the project goal, and monitor the current
progress objectively.
Communication for sharing information between the Project in the four provinces and the project
director/the project manager in Vientiane was not always smooth due to physical distance. The resultsof the Project may have had more opportunities to feedback for more effective implementation of theMNCH Integrated Service Strategy. Delayed notification of information from MOH hindered
implementation of MNCH services.
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Evaluation Results(1) Relevance – HighThis Project is relevant in view of consistency with national policies (“The Seventh National
Socio-Economic Development Plan (2011-2015)” and the “Strategy and Planning Framework for theIntegrated Package of Maternal, Neonatal and Child Health Services (2009-2015).”), Japan’sx

cooperation policy (“Japan’s Country Assistance Strategy for Lao PDR (April, 2012)”) and the needs ofthe target groups.
(2) Effectiveness - Moderate
Most of the selected MNCH service coverage indicators for mothers and children have beenimproved during the Project period in the four target provinces though several indicators are yet toreach the national target of 2015. Integration of MNCH and EPI services contributed to theimprovement though further analysis is necessary on the sustainable effect and points to be considered
for the integration.
Development of management capacity made it possible for the PHOs/DHOs to make more realisticplans, raise activity implementation rate, and manage to operate integrated health services. Also, it
assisted to make the supervision more systematic and improve its quality.
The MNCH-TWGs/SWGs have a function of problem solving and coordination for increasing theMNCH service coverage.
There are also various measures experimented by the PHOs/DHOs and the health centers. Some ofthe examples were health staffs together with the village health committees, trying to accumulate
information of pregnant women to deliver MNCH services timely and involvement of husbands andcommunity groups in health education events and outreach activities encouraged women and minority
people to access to health services.
(3) Efficiency - Moderate
Linkage among provinces, districts, health centers and different sections was strengthened throughcollaborative activities such as AIP planning, monitoring/supervision, various meetings, and healtheducation events.
Utilizing AIP made it possible to implement MNCH services efficiently by conducting some different
activities together and avoiding duplication of activities among development partners.
The Project facilitated efficient integration of MNCH and EPI services at outreach and facilities bycombining recording forms, developing manuals and providing trainings.
Knowledge and expertise were shared and utilized among four target provinces and their motivation
was enhanced through joint meetings and exchange visits, etc.
In Sekong and Attapeu, SWGs made it possible to identify important activities of PHOs and increase
allocation for MNCH activities by formulating one AIP for each PHO. Also, essential medicine andequipment for MNCH services have been more properly managed. Furthermore, it has become easier toget support from other sections in implementation of MNCH activities.
Contrarily, the 1st Level MNCH Core Services (module 1-3), which was initially planned to beprovided by another DP, were not conducted. Even with the monitoring of the AIP, effective actions
were not taken on time because of insufficient assessment and communication between central andprovincial levels. This hinders improvement of capacity to provide MNCH services. Also, unstablefinance for the integrated outreach activities affected the smooth implementation of the integrated
MNCH services.
(4) Impact - Moderately High
Some more years and efforts would be necessary to attain the overall goal. Difficulty in obtaining thexiaccurate data on number of maternal deaths and U5MR especially for the provincial level is a concern
to monitor the progress.
Apart from the intended long term objective, the AIP developed and utilized through the persistenteffort of the Project will serve as a reference to the National Annual Operation Plan (AOP), which is
now under preparation. It is a remarkable achievement actualized through the collaboration with otherprojects, especially with “Capacity Development for Sector-wide Coordination in Health Phase 2” ofJICA.
(5) Sustainability - Moderately High<Technical Sustainability>
The AIP was introduced to all of the PHOs/DHOs in the four target provinces at the initial stage ofthe Project (in 2010-2011). Since then, they have developed their AIPs five times. Through thisexperience, they have acquired skills as well as confidence to formulate and monitor their AIPs without
the Project assistance, though some DHOs may still need the support from PHOs.
According to the interviews with the PHOs and selected DHOs, all the PHOs and some of the DHOs
are also quite confident in organizing/supporting/supervising health education events and outreachactivities. The increased numbers of the events and the attendants proves their ability to manage theseactivities. However, managerial supervision from the DHOs to the health centers is not fully
standardized for effective operation.
<Organizational Sustainability>
All of the four PHOs have established either MNCH-TWG or SWG to facilitate coordination among
different sections and development partners. The discussions at the MNCH-TWG/SWG meetings have
gradually enabled them to analyze their problems.
If necessary, the MNCH-TWGs/SWGs involve community groups and leaders to solve them, which
also have strengthened organizational capacity.
However, turnover of some key persons may affect sustainability because some PHOs/DHOs have
limited number of staffs who can continue managing MNCH services.
<Financial Sustainability>
Some of the Project activities such as the MNCH-TWG meetings, AIP planning and health education
events are being operated mainly with the budget from Lao side.
In the process of formulating the AIPs, the PHOs/DHOs evaluate the priority of the activities and its
financial feasibility. Together with more realistic AIPs and negotiation skills for fund mobilization, theywould manage to select activities and continue operating them after the termination of the Project.
However, with the limited budget, there is a concern that some critical activities, such as supervisionand integrated service outreach activities may be postponed or canceled.
3-4Conclusion
The Project aligns with the national objectives and MNCH integrated service strategy. The Project issuccessful in improving the coverage of most of MNCH services, although some of the indicators have
not reached the national target in 2015. The Project has developed a mechanism that the PHOs/DHOs
fulfil their responsibility and manage their task towards the national goal. One of the most remarkablexii

achievements is improvement of management capacity through applying the PDCA cycle. It accelerated
provision of integrated MNCH services and community involvement, which contributed toimprovement of MNCH service coverage.
By further enhancing PHOs’/DHOs’ monitoring/supervision and activities of health centers to reachout to the people, the coverage and quality of health services would effectively increase andMMR/U5MR would decrease in the long run.
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Recommendations<For the Project>
1. Further analysis is recommended to assess the effectiveness and impact of the Integrated MNCH
Services to service coverage as follows; (1) A comparison of the indicators in the four provinces with
the national average in 2014, (2) A comparison of trends of the indicators in the four provinces with
the national average between 2010 and 2014.
2. Sharing the results of analysis and good practices of the Project with MOH, DPs and the four
provinces is recommended for the next MNCH strategy and development projects.
3. Development of simple manuals for management of MNCH activities is recommended.
4. Monthly MNCH reports should be monitored closely by PHOs/DHOs (Ex, using checklists) for
timely submission.
5. Sharing the effective measures adopted for conveying messages to minority people among the four
provinces is recommended.
<For PHO >1. It is recommended to develop AIP in consistency with budget plan and authorized by the directors ofPHOs/DHOs.
2. It is recommended to implement supervision more regularly for capacity building, improvement ofservice and quality of data.
3. It is recommended to collect the number of MNCH services provided at outreach and facilities
separately to measure the contribution of integration.
4. On-the-job training at health facility is important. For example, exchange personnel between
provincial hospitals/district hospitals and health centers for short-term training would be useful. It isalso effective to allocate newly graduated health staffs to health facilities with appropriate
supervisors.
5. It is recommended to properly operate information system on training and human resourcesmanagement.
<For MOH>
1. MNCH indicators should be more clearly defined and shared at all the levels.
2. It is recommended that the MOH collects and analyzes the indicators to review the MNCH Integrated
Service Strategy and to develop the future plan.
3. The MOH is planning to introduce the National Annual Operational Plan (AOP) starting in some pilotprovinces. It is effective to utilize human resources of the four provinces for smooth implementation.
4. It is recommended to provide information on centrally-planned policies and programs well inxiii

advance, for inclusion in the Provincial Plan.
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Lessons Learned

1. Exchange of experiences and results among the four provinces was effective for enhancing
motivation and analytical thinking.
2. Strengthening of management capacity of PHOs/DHOs at the initial stage of the Project accelerated
implementation of integrated MNCH services.
3. Coordination with other sectors is effective for the smooth implementation of the integrated MNCH
services and improvement of capacity to solve problems.
4. The results of monitoring of the AIPs should be shared and discussed at meetings to make a timely
decision on taking countermeasures when necessary to achieve the set goals, and the solutions should
be monitored until problems are solved.
5. As for the future project, alternative approaches should be carefully examined in order to expand theactivities to the districts, health centers and the community, and benefit the local people to the fullest.
These would include the utilization of national staff members as primary implementers or the joint
implementation of the project with the NGOs who have expertise in the locality.

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