Summary of Final Evaluation Mission
Ⅰ Summary of Project
Project Name ： The Project for Prevention of Diarrheal

Country：India

Diseases (Phase 2)
Issue/Sector：：Medical Science

Type of Assistance：Technical Cooperation Project

Division in charge：

Total cost：290,000,000Yen

Human Development Department
Duration(R/D) July 2003〜of Project

June 2008

Partner Country’s Implementing Organization：
National Institute of Cholera and Enteric Diseases (NICED)
under the Indian Council of Medical Research (ICMR)
Supporting Organization in Japan ： National Institute of
Infectious Diseases, International Medical Center of Japan,
Osaka University, Okayama University of Science, Sapporo
Medical University

Related Cooperation：1. Background of the Project
The infant mortality rate in India is high (67 per thousand live births, according to the State of theWorld’s Children 2003) and the first cause of infant death in the country is acute diarrheal disordercaused by impure water. The Indian Government had set a goal of reducing the infant mortality rate to45 per thousand live births by 2007 and 28 per thousand by 2012 in its Five-Year National Plan(2002-2007) launched in 2002. Under these circumstances, the government of India requested thegovernment of Japan for the technical cooperation with the aims of establishing countermeasures fordiarrheal diseases including a fostering plan of the human resources necessary for molecularbiology/epidemiology, developing research facilities and promoting collaborative research, making theNational Institute of Cholera and Enteric Diseases (NICED) as the implementing organization.
In response to the above request, JICA’s technical cooperation project for Prevention of DiarrhealDiseases (Phase I) was implemented between February 1998 and January 2003.

After the successful

completion of the Project Phase I, another five-year technical cooperation, the Project for Prevention ofDiarrheal Diseases (Phase II) was launched on 1 July 2003, and will be completed on 30 June 2008.
This time, a final evaluation was carried out from 14 to 28 November 2007 by Japan International
Cooperation Agency to acknowledge and analyze the accomplishments of the Project.
2. Project Overview(1) Super Goal
Mortality rate of diarrheal diseases will be reduced in India.
(2) Overall Goal
Capacities of medical institutions in India to prevent diarrheal diseases will be improved.

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(3) Project Purpose
Strengthen capacities and augment capabilities at NICED and to disseminate the same throughout thecountry for prevention and control of diarrheal diseases.

(4) Outputs
1)

Capacity to identify diarrheal diseases at the molecular level is established.

2)

Strains and diagnostic sera are appropriately managed and archived.

3)

Constant surveillance of pathogens of diarrheal diseases is established.

4)

Technical expertise to identify diarrheal pathogens is transferred to other parts of India andneighboring countries.

5)

Surveillance network of diarrheal diseases is established in India.

6)

Capacity to investigate the efficacy of drugs for diarrheal diseases is improved(4) Inputs (As of January 2006)
Japanese Side：・ Long term Expert*

2・ Provision of Equipment
・ Short term Expert*

60,961,338 JPY

14・ Local cost support including the In-country Training
・ Training for Counterparts in Japan

32,784,127

JPY

18

*The experts provided after November 2004 are categorized into “short-term experts” following thechange of implementation system of JICA.
Indian Side：・ Identification of counterparts personnel

10・ Allocation of budget 502,449,480 JPY
・ Office space for experts
・ Drugs and Other supplies and consumables
Ⅱ Evaluation Mission
MembersofEvaluation
TeamLeader

Dr. Kishio ONOJapanese Project Final Evaluation Team JICA

Basic Medical Sciences
Dr. Hideo HAYASHI

Professor, Chugoku Gakuen University

Evaluation Planning
Mr. Katsujiro HORI

Staff, Infectious Disease Control Team HumanDevelopment Department, JICA

Evaluation Analysis
Ms. Saeko ICHIKAWA Researcher, Social Development Department,
Global Link Management, Inc.
Period of

14th of February 2007〜29th of Type of Mission Final Evaluation Mission

Evaluation

February 2007.

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Ⅲ Results of Evaluation
1. Summary of Evaluation Result(1) Relevance
Based on the assessment of the needs of the health sector in India and in the State of West Bengal,
Indian national policy and the Japanese Official Development Assistance (ODA) policy towards India,
the relevance of the Project is considered to be high.
In India’s National Health Policy of 2002, it was indicated that diarrheal disease such as gastro
enteritis and cholera continues to contribute to a high level of morbidity in the population.
Furthermore it highlights the national need to strengthen its surveillance system, which in turn would
enable timely intervention to contain the spread of infection for these diseases. The Project’s approach
to expand its constant surveillance system and to establish surveillance networks is very much in linewith such national policy directions.
This is also in line with Japanese Government’s 2005 Country Assistance Plan for India, which also
highlights the need to support the prevention of infectious diseases not just through support to thedevelopment of physical infrastructure, but also with an emphasis on human resource development
and institutional strengthening such as referral systems and networks.
(2) EffectivenessThe effectiveness of the Project is relatively high, as the Project Purpose will be achieved to a fairextent by the end of the Project period in June 2008. The Team has acknowledged the achievements ofoutput 1.2.4.6 and its high correlation in achieving the Project purpose. However, it should be notedthat the objectives and concepts of constant surveillance of pathogens (Output 3) and surveillance
network of diarrheal diseases (Output 5) were not clear amongst stakeholders at the time of theProject Planning and during the Mid-Term Evaluation exercise. This resulted in the delay of its
implementation, thus leading to incomplete attainment of outputs.
(3) Efficiency
The Project’s efficiency is high with regards to its inputs and the current achievement levels of
most of the Outputs. All equipments and training programs provided, as well as the dispatch of theshort-term experts have been viewed favorably by the NICED staff. Despite the short length of stayby the experts in NICED, most of the counterparts considered these visits as a good opportunity toexchange information and technology, which enhanced NICED activities.
(4) Impact
The Project’s impact is high with regards to its likelihood to achieve the overall goal in the nearfuture. The Project has contributed greatly towards human resource development throughout India
through in-country training programs, dissemination of information and knowledge in the form of; 1.
publications of reports, 2. confirmation of the diagnostic results of the samples sent to NICED fromother health institutions. These activities contributed greatly to enhance the diagnostic and treatment
capacities of other medical and research institutions. As for the Project’s impact in achieving theSuper Goal to reduce mortality rate of diarrheal diseases in India, the direct impact of basic research
work is hard to be assessed in the short-term. However, on-going NICED activities such as vaccine
trial for cholerae and typhoid and the trial of use of probiotic drink, which is the subliminal effect ofx

the Project implementation, may contribute towards the reduction of mortality due to diarrheal
diseases.
(5) Sustainability
The sustainability of the effects of the Project after its completion is considered high. Institutionallyand financially, ICMR continues to support NICED as a centre of excellence, and this is reflected in
the appropriate amount of budget allocated for the institution. Technical sustainability of the Project isalso high, as NICED continues to retain most of its core research faculty within its organization. The
level of their technical sustainability has been proven already with its capacity to host a series ofin-country and third-country training programs as well as other human resource development
initiatives within the organization.
However the sustainability of the surveillance network needs further consideration for it is still
dependent on acquiring the technical expertise for establishing and sustainable operation of thenetwork.
2. Factors that promoted realization of effects(1) Concerning the Project planThe Project plan was formulated in relevance to the research objective of each scientist. Therefore,
the ownership of the activities can be considered extremely high.
(2) Concerning the Project implementation process
Through consistent cooperation and communication that has taken place over the years between
NICED and the Japanese experts, strong mutual trust has been formulated. It should also be highly
noted that this partnership has led to co-research activities by NICED scientists and Japanese experts
outside the project framework
3. Factors that impeded realization of effects(1) Concerning the Project plan
The Project plan considered minimum input for long term experts. Most of the technical assistancewas conducted by short-term experts with an average stay of 9.6 days per dispatch. Whileeffectiveness was considered by dispatching the same short-term experts over the years, the durationof the stay was not sufficient.
(2) Concerning the Project implementation process
The short duration of the short-term experts was one of the barriers in having concrete common
understanding on the concept of surveillance network amongst the stakeholders. According to theconsensus reached during the final evaluation mission, focus will be put on establishing thefundamental basis of networking during the remaining period of Project implementation.
4. Conclusion
This final evaluation confirmed that the Project has shown good achievement, and will accomplish theProject Purpose to a fair extent by the end of the Project implementation period. Although delay inestablishing surveillance network of diarrheal diseases is observed, the implementation process has beenxi

smooth due to the firm partnership maintained between the Japanese experts and NICED Counterparts,
backed by mutual trust nurtured since the first phase of the Project. NICED has shown remarkableprogress, both in its physical and human resource capacities, to conduct the crucial research activities
for diarrheal disease prevention and control; and now it is in the process to establish a surveillance
network in India for further improvement of prevention and control of diarrheal diseases. Thisestablishment will require technical expertise as well as further commitment from the Indian side.
5. Recommendations(1) Measures recommended to be taken before the end of the Project・It is recommended that NICED may continue to update the training materials for continuous
in-country trainings in the future.
・It is recommended that NICED may start to prepare the management manual for the current
surveillance network between IDH and NICED as a model of surveillance networking in India for
replication to other institutions.
・It is recommended that NICED may start to make a concrete plan (including the budgetary plan andtime framework) of the surveillance networking. In doing so JICA may consider the dispatch of anexpert in the field of surveillance networking.
(2) Measures recommended to be taken after the end of the Project・It is recommended that the role of NICED to provide technical guidance to peripheral research
centers may be systematized and be strengthened for assuring the quality of laboratories acrossnation.
・It is recommended that the role of NICED to conduct in-country and third country training
programs be strengthened for continuous and sustainable human recourses development. In order toaccomplish this, the following measures are recommended.
- ICMR may encourage sufficient budgeting for continuous implementation of the training
programs.
- NICED may consider setting up an administrative division for implementing systematic training
programs and accumulating data of the trainees.
・It is recommended that NICED may establish the surveillance network on diarrheal diseases withthe 25 medical institutions based on the result of the current Project.
6. Lessons Learnt(1) Technology transfer in specific fields of science can be realized through the dispatch of short-term
experts when long-term commitment to the project and partnership with counterpart organization isassured.
(2) It should be noted that in order to sustain the budget and working conditions for the Project,
coordination with not only the Counterpart organization, but also with its policy level advisory bodyis essential. The Project was successful in increasing the counterpart budget steadily throughout theProject implementation period through sufficient coordination between ICMR, NICED and theProject.

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