Summary of Final Evaluation
1. Outline of the ProjectCountry: Lao People’s Democratic
Republic
Issue/Sector: Health sector
Division in charge：JICA Laos Office
Period of Cooperation August 2006 August 2010

Project title: The technical cooperation on capacity development for
sector-wide coordination in health (CD-SWC)
Cooperation scheme: Technical cooperation
Total cost: 160 Million Japanese Yen
Partner Country’s Implementing agencies: Ministry of Health (MOH)
Supporting Organization in Japan:
National Center for Global Health and Medicine, Japan
Related Cooperation:

1.1 Background of the Project
Prior to CD-SWC, the health sector in Laos had been struggling with numerous stand-alone projects andprograms of various Development Partners (DPs) without a clear, strategic and long-term program framework.
This caused fragmented and overlapping roles and functions of the departments in the MOH and reduced aid
efficiency and effectiveness of DP assisted interventions.
1.2 Project Overview(1) Overall goal: All programs in the health sector are implemented systematically to achieve MDGs withgovernment leadership, single sector policy and harmonization among the MOH and all health related partners.
(2) Project purpose: Organizational capacity of the MOH for the sector wide coordination is enhanced incollaboration with all health related partners.
(3) Outputs:
1) Coordination Mechanism is strengthened.
2) The single health sector policy framework is identified and agreed as the platform for coordination by theMOH and development partners.
3) Program management tool of the single health sector policy framework is developed through Coordination
Mechanism.
4) Coordination practice in the MCH program is facilitated and fed back in Coordination Mechanism.
1.3 Input
Japanese side (as of June 2010):
Experts: 114.8MM
Equipment: 40,425 US dollars
Local cost: 228,608 US dollars
Training: Technical exchange program with Cambodia on sector-wide initiatives (1 week) participated bycoordination unit members and meeting facilitation skill development (1 week) participated by SWC coremembers.
Lao side: Allocation of MOH members as follows:
Sector-Wide Working Group (Policy)

9 members including the Minister, Vice Minister and directors of MOH(SWG-P)

departments

Sector-Wide Working Group (Operation)

10 members including Vice Minister and directors of MOH departments(SWG-O)
Coordination unit (CU)

8 members chaired by Deputy Director of Cabinet, including otherorganizations

Health Planning and Finance Technical

12 members consisting of Director of DPF, Deputy directors and Chiefs ofWorking Group (HP&F-TWG)

other departments

Human Resources for Health Technical

18 members including deputy directors of MOH departments and central

Working Group (HRH-TWG)

hospitals and university and college

Maternal and Child Care/ Expanded

8 members from Departments of Hygiene and Prevention and Health Care,

Program onand other relevant departments

Immunization

TechnicalWorking Group (MCH/EPI-TWG)

Development Partners: Technical assistance and budgetary support for technical working groups and task forces(WHO, UNFPA, WB, etc)ix

2. Evaluation TeamMembers of (1) Mr. Masato TOGAWA (Leader), Chief Representative, JICA Laos OfficeEvaluation (2) Dr. Mitsuhiro USHIO (Advisor on Health Policy), Executive Technical Advisor, JICA HQ(3) Dr. Chiaki MIYOSHI (Advisor on Health System), National Center for Global Health and Medicine, JapanTeam(4) Ms. Yuki YOSHIMURA (Cooperation Planning), Focal Point of Health Section, Representative,JICA LaosOffice(5) Ms. Ayumi MIZUNO (Cooperation Planning), Health Division-3, Health Group-2, Human Development
Department, JICA HQ(6) Mr. Kaneyasu IDA (Evaluation Analysis), Senior Consultant, Inter-works Co., Ltd(7) Dr. Phasouk VONGVICHIT (Laos Evaluator), Department of Planning & Finance, Ministry of Health(8) Dr. Viengmany BOUNKHAM (Laos Evaluator), Department of Planning & Finance, Ministry of Health(9) Dr. Toumlakhone RATTANAVONG (Laos Evaluator), Cabinet, Ministry of Health

Period ofMay 26 - June 19, 2010
Type of Evaluation：Final evaluation
Evaluation
3. Results of Evaluation
3.1 Achievements of the Project
The main achievements of the Project in accordance with the Project Design Matrix are shown in the tablebelow:
Indicator for Project Purpose: SWG (O) can convey coordination of essential interventions (activities and resourceallocation) for maternal, neonatal and child health based on the monitoring outputs with the developed sector
common monitoring framework.
・ SWG (O) has been organized six times. It functions well in terms of sharing views of the MOH and DPs andreviewing progress of coordination efforts. Yet, its function as the consensus and decision making body forconcrete action needs to be strengthened.
・ SWG (O) played a significant role in addressing priority agendas and tasks to TWGs. The cases in point include itsrole to enable MCH/EPI-TWG to be actively engaged in planning and setting a framework for MNCH andcoordinate with PF-TWG to prioritize MCH in the Health Financing Strategy.
Indicator for Output 1: The MOH in the partnership with DPs sets up meeting agenda, organizing meetings andfacilitates coordinating discussions in meetings under coordination mechanism.
SWGs/TWGs have regularly organized meetings and monitor progress according to their Annual Work Plan. Themain achievements of the respective TWGs can be summarized as follows:
HP&F-TWG:
・ Formulation of Health Financing Strategy and Health Information System Strategic Plan
・ Drafting National Health Insurance Decree・ Consolidation of Laos Reproductive Health Survey, Multiple Indicator Cluster Survey and National Health
Survey into Lao Social Indicator Survey
・ Introduction of standard formats for HMIS・ MOH now keeps the data of approximately 85% of the DPs interventions in terms of their inputs and types ofactivities. Prior to the CD-SWC, MOH kept only 30% of such records.
HRH-TWG:
・ Formulation of National Policy on Human Resources
・ Clarification on the roles and responsibilities of six departments of MOH, Provincial Health Department andDistrict Health Office - ongoing・ Reviewing the functions of medical education institutions and medical facilities with stakeholders - ongoing
MCH/EPI-TWG:
・ Formulation of Strategy and Planning Framework for the Integrated Package of Maternal, Neonatal and Child
Health Services 2009-2015
・ Development of Skilled Birth Attendant (SBA) strategic development Plan
・ Actual coordination activities with DPs to integrate with MNCH package on the resource mapping table
Indicator for Output 2: The 7th Five year HSDP is jointly developed with satisfaction of MOH and DPs with thedevelopment process.
・ Through a number of discussions and consultations with departments of MOH, provincial health departments anddistrict health offices and DPs, MOH has drafted the 7th five year HSDP.
・ According to the interviews conducted by the evaluation team to SWGs/TWGs and DPs, the drafting of the 7thplan was highly evaluated as it was based on the review of the 6th plan and relevant information from theprovinces/districts and also it was developed in consultation with DPs although it took nearly one year until actualxdrafting started after SWG (O) announced the drafting of the 7th plan in partnership with DPs.
Indicator for Output 3: SWGs revise the developed sector common monitoring framework with information collectedwith a common format.
・ The SCWMF and its guidance were developed in consultation with DPs. The SCWMF has been used as amonitoring tool and revised and updated since May 2009.
・ The version 2 of SCWMF was used not only as a monitoring tool in the 7th SWG(O) but also as a planning
framework tool in the Retreat workshop for the 7th 5Y HDP formulation.
・ The NGO version of SCWMF was also developed.
Indicators for Output 4: (1) MCH Program development is realized through coordination mechanism. (2)MCH/EPI-TWG regularly reports to SWG(O) and Secretariat monitoring outputs of program strategy
implementation and TWG coordination practice.
・ MOH formed MCH/EPI-TWG and task forces to develop a Strategy and Planning Framework for the Integrated
Package of Maternal Neonatal and Child Health Services 2009-2015 (MNCH package) and it was endorsed by theSteering Committee in March 2009.
・ TWG had monitored and reported progress of preparatory works for MNCH Package to the SWG Secretariat, SWG(O) and (P).
・ A consolidated work plan was developed based on the collected data on existing and planned interventions ofrelevant DPs.
・ TWG has been making efforts to integrated MCH/EPI related activities of DPs into the MNCH package. Several
DPs have already aligned their interventions with the MNCH package.
・ TWG is introducing a concept of Program-based approach and Integration in Provinces and Districts.

3.2 Summary of Evaluation Results(1) RelevanceThe relevance of CD-SWC is judged to be very high. The sixth five-year health sector development plan (2006 2010) indicates the importance of coordinating international assistance to improve aid efficiency. Because MOH
heavily depends on foreign capital for interventions - accounting for 53% of the total expenditure of the MOH in2009, the capacity development of the MOH and creation of functioning coordination mechanism to improve aid
effectiveness are strongly supported by all the stakeholders in MOH as well as DPs. Also, Japan is one of themajor development partners in terms of its volume of aid to Lao PDR and also co-chairs the policy level SWG.
Aid coordination is an important agenda for the Japanese ODA.
(2) Effectiveness
The most important achievement of the CD-SWC is that it helped the MOH create and develop an formal,
functional sector-wide coordination mechanism in accordance with a single policy framework. Necessary
implementation structure and system for SWC has been built and the developed coordination mechanism has
provided a good platform and interface between and among the MOH and DPs for sharing information andconsultation. From the perspective of capacity development of MOH, inter-department cooperation has beensignificantly improved and MOH is now confident in handling day to day coordination activities, yet they are
not confident enough to lead coordination activities and negotiate with DPs. Also, the MOH is still not
experienced enough to systematically run the cycle from planning to monitoring and evaluation of coordination
activities.
(3) Efficiency
CD-SWC made clearly that all activities should be conducted in a participatory, consultative and transparent
manner. This greatly helped the fostering of MOH ownership and involvements of DPs. Particularly, MOH'sdecision to share policy documents with DPs greatly helped set a single policy framework and also encouraged
DPs to align their aid policies with the development plan. Active participation of DPs and their technical andbudgetary support also facilitated progress of TWG activities. Because the CD-SWC has been implemented as acapacity development project with a process-oriented approach, it is not only difficult but also risky to set anelaborate time frame and result-oriented indicators. The CD-SWC revised the PDM to flexibly accommodatechanges in both internal and external environments. Communication gap between MOH staff and DPs somehowxi

made coordination activities difficult due to unstable internet access and limited use of email by MOH staff.
(4) Impact
Some tangible impacts of the CD-SWC on aid effectiveness has been recognized as follows:・ Three separate health surveys have been consolidated into one survey.
・ An increasing number of DPs has adopted and aligned with the developed the MNCH package and SBA
development plan.
・ Coordination of logistic support among DPs (e.g. EPI and family planning for outreach activities)
・ Utilizing resource maps, DPs are able to reduce time and costs for the preparation of their interventions.
A much greater impact is expected when alignments and harmonization are made in the procedures ofmonitoring and planning, budgeting and financial management, reporting and procurement, covering not only
the central level but also the provincial and district levels.
One significant, unanticipated impact is that the coordination mechanism provides good opportunities for DPs topromote and scale up outputs produced by their respective interventions.
(5) Sustainability
At the policy level, aid coordination and harmonization is well accepted by the MOH and VD CAP mandates theSWG to implement the action plan in the health sector. Therefore, the sustainability of the Government would
likely be ensured after the project duration. The organizational sustainability is also positive as the coordination
mechanism has been well entrenched in the MOH and strongly supported by DPs and MOH. Limited personnel
capacity and financial support are identified as risk factors to ensure sustainability because the performance ofTWGs heavily depends on the managerial capacity of the core members in the MOH, and the costs for
coordination activities are currently shouldered by different DPs and it is not yet clear how to cover such
expenses after the project duration.
3.3 Conclusions
The relevance of the CD-SWC is very high because CD-SWC reflects the strong needs for coordination of theMOH and DPs. The CD-SWC has greatly helped the MOH build foundation for conducting coordination
activities and created a platform for information sharing and communication among all stakeholders. Theevaluation team has identified a number of actual evidence and facts to judge that the developed coordination
mechanism is functional although the capacity development of the MOH is still at a rudimental stage to fully
lead and manage coordination activities. Now, the necessary enabling environment for SWC has been built.
SWC should move to a new phase. A much greater impact on aid effectiveness is expected when the developed
coordination mechanism is effectively used to harmonize and align procedures of DP assisted interventions, andalso coordination mechanism is built at provincial and district levels. The institutional sustainability of thedeveloped coordination mechanism is likely ensured because of the consistent policy support and strong
commitments of both the MOH and DPs. Yet, the limited human and financial resources to manage
SWG/Secretariat/TWG activities are the main risk factor for sustainable development of the coordination
mechanism.
3.4 Recommendations
・ MOH should allocate at least one full time assistant coordinator who can act as the manager and focal pointwith DPs.
・ The MOH should review the current structure of the coordination mechanism as well as the roles andfunctions of respective groups in order for each group to perform their roles more effectively andinstitutionalize the coordination unit in the organizational structure of MOH.
・ Because the role of the DPF is vitally important in the Coordination Unit to effectuate the purposes ofcoordination and harmonization, it needs to take the lead role in facilitating coordination activities of TWGs
in the financial and planning aspects.

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・ MOH should consult with NGOs and clarify measures to involve more NGOs and other organizations (e.g.
the private sector and societies) in the coordination mechanism.

・ MOH should devise measures to improve the quality of group meetings. MOH also should consult withrelevant agencies to ensure stable internet accessibility.
3.5 Lessons learned

・ In implementing aid coordination, the key to success is that all activities must be conducted in a collective,transparent, consultative and accountable manner.

・ In the CD-SWC, a number of taskforces were formed to facilitate TWG activities. Yet, some taskforces were
not made functional because the tasks were beyond the available resources and capacity of MOH. It isimportant to assess the implementation capacity and available resources before a task force is formed.
・ In capacity development support, the effectiveness of the PDM may be reduced when it is rigidly usedbecause the project team is pressured or tempted to achieve narrowly defined goals by intensifying technicalassistance. When technical cooperation is intended for capacity development of the recipient organizations,the PDM should be used flexibly and it should be monitored and revised periodically, corresponding to thechanges of the their capacity as well as accommodating changes in the internal and external environments inthe course of the cooperation period.

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