Summary Evaluation
㧝㧚Outline of the ProjectCountry㧦Cambodia

Project title㧦Project for Human Resource Developmentof Co-medicals in the Kingdom of Cambodia

Issue/Sector㧦Human Resource Development

Cooperation Scheme: Technical Cooperation Project

Division in Charge 㧦 Department of Human
Resource Development, Ministry of Health.

Total Cost: 490million US$

Period of
Cooperation

㧔R/D㧕:
15 September, 2003~
14 September , 2008

Partner Organization㧦Technical School for Medical
Care (TSMC), Human Resource Development
Dept.(HRDD), Regional Training Centre(RTC)

㧔Extension㧕㧦Supporting organization in Japan㧦St. Mary’s Hospital㧘
International Medical Center of Japan㧘etc

㧔F/U㧕:

Related Cooperation㧦
(Technical Cooperation) Project on Promotion of
Medical Equipment Management System, Project for
Improving Maternal and Child Health Service in RuralAreas㧔E/N㧕㧔Grant Aid㧕

1-1 Background of the Project
Cambodia has been suffering from severe shortage of human resources after 20 years of internal conflicts
and political turmoil since 1970s. Health services in the country have been hampered its improvement due
to the problem of human resources in terms of quality and quantity, as a consequence, health indicators are
far behind comparing with ones in the neighboring countries.
The project for human resource development of co-medicals was requested by the Royal Government of
Kingdom of Cambodia with the aim of improving the pre-service trainings for co-medicals in Technical
School for Medical Care (TSMC) and the four Regional Training Centers (RTCs). The project was
launched on 15 September, 2003 to implement for five years. The purpose of the Project is “TSMC andfour RTCs are able to provide appropriate education of State Registered Nurses (SRNs), Laboratory
Technologists(RTs), Physiotherapists (PTs) and Radiological Technologists(RTs) based on the national
co-medical education standard”.
1-2 Project Overview
The direct beneficiaries of the Project are the teachers and staff in TSMC and four RTCs. The indirect
beneficiaries of the Project are students in the four courses and also patients who utilize health services in thehealth service institutions.
(1) Overall Goral
Public and private co-medical schools are able to produce graduates who are capable to perform as
qualified co-medicals (SRN, LT, RT, and PT) and the MoH employment status improved.
(2) Project Purpose
TSMC and four RTCs are able to provide appropriate education of SRN, LT, PT and RT based on thenational co-medical standardxi

(3) Outputs
Output 1: “School Approval Criteria (SAC)” and “Guidelines for Accrediting School (GASs)” for SRN,
LT, PT and RT courses are developed and executed.
Output 2: Curricula and syllabi for LT, RT and PT are developed/revised or suggested according to the
SAC and GASs, and approved by the MoH as standards for the country.
Output 3: Educational materials for LT, RT and PT courses are developed/revised/suggested according torevised/developed curricula and syllabi.
Output 4: Scores of post test are higher than scores of pre-test at each training of trainers.
Output 5: The activities of planning committee are monitored with the check list for school management
at the TSMC
Output 6: The Project Activities (Output 1-5) are monitored and received by JCC, PCC and the Project
Implementers(4) Inputs
Japanese Side㧦
Long-term Expert
Short-term Expert
Trainees received
Cambodian Side㧦Counterparts 
Land and Facilities:

6

26 
13

Provision of Equipment    107 million yen
Local Cost   66 million yen
Others      40        Purchasing Equipment   
Office       Local Cost : 1,590 US$ (for X-Ray 4 months training
course) and other maintenance costs for 2
project offices

2㧚Evaluation Team
Members of
Evaluation
Team㧔Japanese side㧕
1. Dr. Hirotsugu Aiga
2. Mr. Keiichi Takemoto
3. Dr. Hidechika Akashi
4. Prof. Yasushi Uchiyama
5. Ms. Nobuko Takaoka
6. Mr. Kimio Abe
7. Ms. Akiko Okitsu
㧔Cambodian side㧕
1. H.E. Prof. Eng Huot
2. Ms. Keat Phoung

Period ofevaluation

Senior Advisor, Human Development Dept., JICA
Director, Health Human Resources Division, Human
Development Dept., JICA
Senior Technical Officer, Expert Service Division, Bureau ofInternational Cooperation, International Medical Centre
Professor, Dept., of Physical Therapy, Faculty of Medicine,
Nagoya University
Director, Division of Nurse Personnel Development,International Cooperation Dept., St. Mary’s Hospital
Staff, Health Human Resource Division, Human
Development Dept., JICA
Chief Researcher, TAC International Inc.
Secretary of State, Ministry of HealthDirector, Human Resource Development Department,
Ministry of Health

26 May, 2008~ 12 June, 2008

Type of Evaluation :Final
Evaluationxii

3㧚Results of Evaluation
3-1 Achievement of the Project3-1-1 Achievement of Outputs
Output1㧦“SAC” and “GASs” for SRN, LT, PT and RT courses are developed and executed.
The indicator for output 1 was “School Approval Criteria” has been approved by the MoH as Anukretand “Guidelines for Accrediting School” was approved by the MoH as Prakas. It was confirmed that
this indicator was fully achieved. The SAC, thereby, was executed by the Government of Cambodia as
Anukret (sub-decree) and the GASs of each co-medical field were executed by the Joint Prakas(Ministerial Ordinance) between the MoH and the Ministry of Education, Youth and Sports (MoEY&S).
Output 2㧦Curricula and syllabi for LT, RT and PT are developed/revised or suggested according to the
SAC and GASs, and approved by the MoH as standards for the country.
The indicator for output 2 was “Curricula and syllabi are developed/revised and approved by the MoH
as standards for the country.” It was confirmed that curricula for LT, PT and RT were developed andapproved by Joint Prakas between the MoH and the MoEY&S as the national standards. However,development of syllabi for the three courses had not been fully completed at the time of evaluation.
As for SRN, development of curricula and syllabi was supported financially by Health Sector Support
Program (HSSP). Japanese side provided reference books for curriculum development and sent HRDD
staff, school directors and teachers to the counterpart training program in Japan and third-country
training programs in Malaysia for the purpose of ensuring opportunities to learn the nursing education
practice in foreign countries. However, this activity was dropped from PDM1.
Output 3㧦Educational materials for LT, RT and PT courses are developed/revised/suggested according torevised/developed curricula and syllabi.
One of the indicators for output 3 was “Curriculum guidelines (teacher’s teaching manuals) for LT,
RT and PT courses are developed”. The results of the interview with the Cambodian counterparts
revealed that development of curriculum guidelines was in progress but had not yet been completed, due
to time constraints and the delay in the approval process of national standard curricula.
ILT course: At the time of evaluation, the Working Groups (WG) was attempting to complete the firstyear curriculum guidelines according to the deadline set by the Project.
PT course: At the time of evaluation, the first year curriculum guidelines were in the process ofdevelopment and its progress was behind that of LT course.
RT course: As for the first- and second-year curriculum guidelines, the work had been almost
completed at the time of the evaluation. As for the third-year curriculum guidelines, the work had notbeen completed for some subjects.
The other indicator of output 3 is “provided books by the Project were fully utilized to making
curriculum guidelines”. Reference books were provided to each course at TSMC and four RTCs
according to the PO. The number of reference books provided was 366 for SRN course, 63 for LT
course, 45 for RT course, 50 for PT course, and 33 for others. It was confirmed that reference books
provided by the Project were fully being utilized for the development of curricula guidelines.

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Some teaching materials on key subjects (e.g. lesson plans, handouts) were produced in Khmer andwere further officially endorsed. Moreover, RT course, in cooperation with other development partners,
produced a textbook for the four-month X-ray training course. A part of the textbook could be used as a
textbook for the RT course.
Output 4: Capacity of SRN, LT, RT and PT teachers are upgraded.
The indicator for output 4 was “Scores of post test are higher than scores of pre-test at each training oftrainers”. It was confirmed that the results of post-tests of trainings indicated higher than that of pre-tests
in all the four courses.
SRN course: Some teachers stated, during the interviews, that the numbers of training programs andtraining areas were not sufficient and that trainings needs should have been examined more carefully.
PT course: The teachers expressed, during the interviews, usefulness of the trainings. However, they
perceived that the numbers of training programs and training areas were not sufficient.
RT course: According to the secondary data, the increase in scores between pre-test sand post-tests
was confirmed in a series of X-ray training courses: i.e. (i) four-month course attended by 100
participants; and (ii) in-country training course attended by 13 participants.
The other indicator is “Teachers who attended the training courses become more confident in theirteaching activities”. The results of self-evaluation tests indicated that the majority of trainees
perceived greater confidence in teaching activities after the participation in training programs.
Output 5: School management of the TSMC is improved.
The indicator for output 5 was “The activities of planning committee are monitored with the check list
for school management at the TSMC”. It was confirmed that the activities of planning committee wereadequately monitored at the TSMC, by using the checklist for school management.
Output 6: The Project Activities (Output 1-5) are monitored and received by JCC, PCC and the Project
implementers.
There were two indicators for output 6. One was “Annual JCC and quarterly PCC meetings
conducted regularly”. The other was “Project progress report is developed and disseminated to JCC and
PCC members for project management”.
It was confirmed that JCC and PCC meetings were called in a regular basis to discuss the projectprogress. The reports of JCC and PCC meetings were prepared and distributed to the participants.
3-1-2 Prospect of Achieving the Project Purpose
It was confirmed that the Project was making a good progress according to the PO towards theachievement of the project purpose. It should be particularly noted that development and approval of the
SAC and GASs was the greatest achievement of the Project for quality control and enhancement ofco-medical pre-service educations. Regarding the indicator “Educations in TSMC and 4 RTCs are
implemented according to educational plan based on developed or revised curricula and syllabi”, theevaluation mission confirmed that education at TSMC and four RTCs were being properly delivered,according to the annual class schedules in line with the new standard curricula.

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The level of achievements of the project purpose, especially whether or not appropriate education isprovided in training schools in the country could not be precisely evaluated as a three-year course had notbeen yet completed at the time of the evaluation. It was, however, confirmed that there were a number ofindications that project purpose had been achieved to certain extent. Although complete implementationof the new standard curricula remained as a challenge, the project purpose could be achieved by enforcing
the standard requirements of the sub-decree of SAC.
It is important to note that the RT course at TSMC was newly established in Cambodia by the Project.
This accomplishment was a crucial achievement and significantly contributed to setting a foundation for
pre-service educations for RT and improvement of RT services in Cambodia.
3-1-3 Prospect of Achieving the Overall Goal
The achievement of the overall goal “Public and private co-medical schools are able to produce
graduates who are capable to perform as qualified co-medicals (SRN, LT, RT, and PT) and the MoH
employment status improved” was measured by using three indicators. Regarding the indicator 1 “Public
and private co-medical schools follow the regulations which established by output 1”, there was a positive
prospect that both public and private co-medical schools would follow the regulation issued as a
sub-decree. However, the enforcement of sub-decree in private sector remain as a challenge for the MoH.
Regarding to the indicator 2 “ Passing rate of the first trial of graduation examination (of SRN) for
public and private co-medical schools are increased”, the average passing rate of the first trial of the Exit
Examinations at five institutions increased from 36% in 2003 to 74% in 2007. LT, RT, and PT courses were
expected to follow the model of the process of the Exit Examinations at SRN course
Regarding to the Indicator 3 “Employment of graduates is increased” could not be precisely measured
due to the time constrains of the mission and difficulty to access the data. Using the data obtained, it was
confirmed that there were an adequate number of vacancy posts at the public institutions available for
TSMC and RTCs new graduates in 2006, 2007 and 2008.
However a challenge remained in the allocation of human resources in rural areas. A great discrepancy
in the deployment of co-medicals between urban and rural areas still existed. The shortage of the secondary
nurses and midwives in rural area remained as serious concerns of the MoH.
3-2 Summary of Evaluation Results(1) RelevanceThe relevance of the Project was graded as high; as it is (i) The Project was in line with the national
policy to strengthen the pre-service education system for co-medicals. Needs for increase in quality ofhuman resources were identified as an issue. The SAC and GASs, to which the Project significantly
contributed, serves as the critical basis for increasing the quality of medical and co-medical education in
the country. (ii) The direction of the Project was consistent with the JICA’s Country Assistance Strategy
for Cambodia, which addressed the importance of strengthening the health sector with emphasis on
improving the quality and quantity of human resource in the country. (iii) The Project was strikingly inline with the current global initiatives to address human resource crisis in the health sector. Cambodia is
one of the typical countries suffering from critical shortage of health workers. The Project is aimed at
proactively addressing the issues and is, thereby, expected to serve as a good practice and exemplary casexv

for other countries in the crisis.
On the other hand, the relevance of planning is a question. The Project was planned to cover from thelevel of policy/regulation development to the level of institutional and capacity development in co-medical
training institutions, different geographical areas of interventions and four courses (SRN, LT, RT, and PT)
for production of qualified human resources for health care systems. Due to this complexity and diversityof the project design, the implementation of activities was not completed as planned, due to limited inputs
and timeframe. It resulted in some delays in achieving the project purpose.
(2) Effectiveness
It was rather premature to evaluate the achievement of the Project before the completion of a three-year
course based on the new standard curricula. Nevertheless, it was confirmed that the project purpose wasbeing achieved to a certain extent by measuring proxy indicators.
One of significant achievements of the Project was to develop the SAC and GASs and get themapproved. On the other hand, enforcement of the new standard curricula remains as a challenge for the
MoH. The relevant stakeholders need to make concerted efforts to fulfill the standard requirements of the
SAC and GASs.
In order to ensure more tangible achievement of the project purpose, the evaluation mission confirmedthat the output or activities to support smooth implementation of SAC and GASs should had been clearlystipulated in PDM2.
(3) Efficiency
Overall, efficiency of the Project was evaluated as high; as it is (i) output 1 was achieved successfully
and output 2 would be achieved by the end of the project implementation period. (ii) It was difficult tomeasure the achievement of output 3 and output 4, due to lack of proper indicators. Although activities
were implemented as planned, limited resources and time constrained the level of achievements of output 3
and output 4. (iii) The output 5 was accelerated by UHS management on TSMC. (iv) Output 6 was
successfully achieved.
Overall, the inputs from Japanese and Cambodian sides were as in a timely manner as planned. The
equipment and training programs provided highly contributed to the improvement of quality of pre-service
educations. Originally planned amounts of inputs , however, were inadequate to fully achieve outputs(4) Impact
Overall, the impact of the Project was expected as high since the overall goal has a fair prospect to beachieved in the near future, if following activities are carried out. The SAC needs to be implemented by
the relevant agencies and set of indicators need to be installed to measure the progress of theimplementation. New standard curricula have been implemented and needs to be reviewed in 2010.
It is a challenge for HRDD to monitor the implementation of SAC in training institutions in the private
sectorSecondly, in the process of developing SAC and GASs in the Project, the MoH in collaboration withUHS extended its efforts to make SAC and GASs also in medical, dental, pharmaceutical and midwiferyxvifields, and GASs in midwifery field. The MoH made tremendous efforts to complete them. These should
be noted as remarkable positive impacts and achievements which subsequently enabled the Government to
set a series of basic regulations and standards for pre-service educations in health sector.
Thirdly, the Project made efforts to involve relevant stakeholders (e.g. the MoEY&S) in the process ofdeveloping the SAC and GASs. This participatory approach encouraged the stakeholders to make theircommitment to implementing the regulations and standard curricula. This should be also accounted as apositive impact of the Project activities.
Fourthly, development of the SAC fostered the recognition on requirements to meet the standards among
medical and co-medical training institutions. It motivated the training institutions to tap available resources
not only from the Government and development partners. Introduction of syllabi led TSMC to replicate it
to other academic areas of UHS. These are accounted as an indirect impact as well.
No specific negative impact of the Project was identified.
(5) Sustainability
Overall, sustainability of the Project was evaluated as high. The followings are positive indications ofsustainability in relation to (i) policy and regulations, (ii) organization and financial capacity, and (iii)
technical capacity.
Policy and Regulations
࡮The SAC was launched as a sub-decree, which ensures the enforcement of the standard regulation of theGovernment. Therefore, the sustainability was judged as high. The MoH was making efforts toincrease the compliance of the output 1. Quality Assurance Program (QAP) was one of such efforts toensure the implementation of SAC by the MoH.
Organization and Financial Capacity
࡮The HRDD is responsible for development of a master plan for training health professionals, monitoring
and coordinating training activities, and liaising with other relevant agencies. Through the project
implementation, the capacity of the HRDD in planning, coordinating and liaising were definitely
strengthened.
࡮The National Health Development Plan 2011-2015, the National Policies and Strategies for Human
Resources for Health 2006-2010, and the HSSP 2 would give a clear direction and means for productionof quality human resources in the country.
࡮The SAC could attract development partners to investing to in the area of human resources development,
since it clearly defines the conditions and criteria for how to improve the capacity and quality of medical
and co-medical training institutions and educations for health professionals.
࡮At the time of the evaluation, HRDD was planning to secure budget for revising curricula in its Annual
Operation Plan (AOP). There was a ministerial ordinance in the GASs which specifies the requirementof allocating 15% of hospital budget to clinical practice.
Technical Capacity
࡮HRDD would ensure continuing education (CE) opportunities among teachers of co-medical trainingxviiinstitutions, by involving them in the existing training-of-trainer courses (e.g. national disease control
programs, MCH program).
࡮The currently working teachers without adequate clinical experiences would be sent to health facilities forclinical practice to fulfill the requirement of three years clinical experiences. It is a mandatory
assignment described in the QAP and SAC for improvement of the quality of teaching skills.
The following are negative indications of sustainability in relation to technical capacity.
࡮Establishment of RT course at TSMC provided the foundation of capacity development in the area of RT.
However, the current number of full-time teachers was minimal, at the time of the evaluation. Therefore,
the sustainability of the course was regarded as a concern. Some measures were taken to ensure job
security for RT new graduates in the Complementary Package of Activities (CPA) guidelines by the
MoH. However, there is no guarantee to ensure the employment of RT new graduates. This situation
jeopardizes the sustainability of the course and the interests of students to be RTs.
3-3 Factors that Promoted Realization of Effects(1) Factors concerning improvement of the quality of students
The Project was involved in the efforts to strengthen the quality and fairness of the undertaking of the
Entrance and Exit Examinations at TSMC and RTCs, though it had not been planned as one of the project
activities. These efforts contributed to improving the quality of students, the moral for examinations andthe implementation of the curricula.
(2) Factors concerning collaborative assistance with a grant aid, and other projects
Renovation and construction of TSMC buildings and equipment provision were undertaken throughgrant aid from the Government of Japan. This contributed greatly to setting a fundamental environment topromote the quality of education at TSMC.
The Project had some collaborative works with other projects in Cambodia being implemented by JICA
and other development partners. E.g. there was collaboration with JICA Medical Equipment Maintenanceand Management Project (MEDEM) in conducting a medical equipments maintenance training course.
The Project adopted some educational materials for LT which were developed by a Japanese Overseas
Cooperation Volunteer (JOCV) in Cambodia. Another promoting factor for the Project was that the RT
expert organized a good professional network in the field of radiological technology in the country, which
was established in his previous assignment to the JICA Maternal and Child Health (MCH) Project. In
addition, GTZ conducted preceptor training programs for hospital staff, where the information andexperiences gained by the Project were shared.
(3) Factors concerning implementation process (Monitoring of the project)
The Project was supposed to conduct a situation analysis to identify existing issues in the field of HRDD
and to develop a detailed plan for the implementation of activities. However, the situation analysis was
not conducted. As a result, the Project could not detail out its activities and identify strategies toeffectively and efficiently implement activities. Two consultation missions were dispatched from Japan inNovember 2004 and May 2005. They contributed to improving managerial capacity of the Project, byrevising and adjusting the scope of the Project.

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(4) Factors concerning strong ownership and commitment of the counterparts
HRDD showed its strong commitment to the Project. Cambodian’s positive and responsive attitude wasmuch appreciated. It significantly contributed to vigorous implementation of the Project. Also, especiallyformulation of SAC and GASs, Cambodian counterparts considered the activities as their duty rather thanproject specific activities, that means that the Project took a right approach for growing commitment andownership among counterparts during the Project period.
(5) Factors concerning transferring the supervisory responsibility for TSMC from the MoH to UHS
After the transfer of supervisory responsibility for TSMC from the MoH to University of Health Science(UHS) came into effect, the new rector of UHS took a strong leadership in improvement of the school
management. This organizational change resulted in creation of the different interests and institutionalsettings between UHS and the MoH/HRDD. It force the Project to make additional efforts and time tocoordinate and harmonize them.
3-4 Factors that Impeded Realization of Effects(6) Factors concerning project design and planning
The Project was planned to cover from the level of policy/regulation development to the level of
institutional and capacity development in co-medical training institutions, different geographical areas ofinterventions and four courses (SRN, LT, RT, and PT) for production of qualified human resources forhealth care systems. Due to this complexity and diversity of the project design, the implementation ofactivities was not completed as planned, due to limited inputs and timeframe. It resulted in some delays inachieving the project purpose.
(7) Factors concerning the improvement of quality of teachers
Limited resources and time constrained the implementation of activities for Output 3 and Output 4.
Despite the efforts made by the Project, attempts to set appropriate indicators to measure quality
improvement failed at the beginning of the Project. This made it difficult for the Project to placesufficient emphasis on the activities to ensure quality of pre-service education. In the area of capacity
development of teachers, their different educational background and learning skills constrained sometimes
the effectiveness of trainings
Some Japanese experts had difficulties in conducting assessments at the initial stage of the Project. It
hampered the consequent short-term experts in undertaking their activities in their assignment period.
Some training was not satisfactory in limited period of time, due to their unfamiliarity to the health status,
social and cultural settings in Cambodia in addition to language barriers.
Transferring the knowledge and skills were not necessarily efficiently conducted since some medical
and technological terms had no standard Khmer translations.
(8) Factors concerning the implementation process
The Project was launched without its PO. During the first two years, the terms used in the PDM0 were
not clearly defined. As a result, the project activities were extended according to the needs. For thisreason, the limited inputs to the Project were diluted to cover the whole activities. The Project could notmonitor activities, due to lack of monitoring tools such as the PO.

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Communication among Japanese experts had been inadequate at the initial stage, though it significantly
improved in the latter part of the Project.
The Project organized a technical advisory committee in Japan which had a mandate to provide theProject with the technical advice and backstopping. The communication mechanism between the advisorycommittee and the Project was not clearly identified at the initial stage of the Project. Thus, the Project
could not fully enjoy their technical supports at the initial stage. Though communication mechanism
improved through involving JICA HQ, the capacity was still not fully utilized.
3-5 Conclusion
Overall, the Project has been successfully implemented. Development and approval of the SAC and
GASs significantly contributed to establishing the regulatory frameworks for pre-service education of healthprofessionals. This definitely serves as one of the essential foundations for ensuring adequate humanresources for health in Cambodia. A number of positive impacts of the Project were identified. For
instance, the MoH spontaneously applied the application of the SAC and GASs to other professional groups(i.e. medical, dental, and pharmaceutical, and midwifery fields). It should be noted that operation of RT
course needs to be carefully monitored, as the first batch of students have not yet graduated from the course.
3-6 Lessons learned
The Project addresses simultaneously two challenging issues on human resources for health in parallel, i.e.
pre-service education delivery and its systems. This wide and ambitious scope of the Project subsequently
led its design to be revised and adjusted twice during the five-year implementation period. Admittedly, thiscreated confusion in the implementation of the Project, to a certain extent. Therefore, it is recommended
that a project selectively address specific issues, by carefully assessing capacity of available inputs from both
Japanese side and recipient country side and by prioritizing necessary interventions.
It is often assumed that those trained as trainers are expected to and actually will further transfer what they
have learned to their colleagues, once they are back at their duty stations. However, it is rather rare that they
practice it, due to financial, temporal, and behavioral barriers. Therefore, it is recommended that follow-up
measures be included as project activities, e.g. budget for training programs at duty stations, coaching andmentoring, and monitoring and supervision.
3-7 General recommendations
3-7-1 Recommendations on Ministry of Health
The MoH/HRDD is advised to make continuous efforts to: (i) disseminate the SAC and GASs to otherstakeholders such as hospitals and development partners; (ii) enforce the SAC and GASs on all the public
and private training institutions; (iii) assist TSMC and RTCs to meet the standard requirements of the SAC
and GASs; and (iv) monitor and supervise them on a regular basis.
The MoH/ HRDD is advised to complete the development and approval process of syllabi and curricula
guidelines for LT, RT, and PT courses. It is suggested that they be carefully developed by taking gradualsteps in view of the progress of each course.
It is recommended that production, recruitment, and deployment of human resources for health beundertaken through close collaboration and coordination between HRDD and PD. This is because humanresources development plan should be underpinned by human resources deployment plan. It will help
ensure access to health professionals and their services regardless of where people live. A particularxxattention should be paid to needs for PD’s policy commitment to taking measures necessary for preventing
health professionals from migrating: (i) from rural to urban areas; and (ii) from public to private sectors.
Note that it is essential to secure, on a sustainable basis, the posts at governmental health facilities for the
new graduates from RT course.
In SRN course, the Exit Examinations have been implemented in closer collaboration between TSMC,
RTCs and the MoH/HRDD. This is an exemplary practice to ensure technical soundness and fairness of
the Exit Examinations. Therefore, it is suggested that the MoH/HRDD be proactively involved inplanning and implementing the Exit Examinations for LT, RT, and PT courses.
Taking into account the difficulties teachers (particularly, part-timer) are currently encountering, it isrecommended that the MoH/HRDD make rigorous efforts to ensure more teacher-friendly working
conditions: i.e. (i) increasing teaching fees; and (ii) enhancing understandings of hospital managers
responsible for releasing their staff to TSMC and RTCs as part-time teachers. This is particularly crucial
among the teachers in RT course, since it is vulnerable to suffering from lack of teachers.
3-7-2 Recommendations on TSMC/UHS and RTCs
It is recommended that TSMC/UHS and RTCs ensure an appropriate educational environment whichmeets the requirement of the SAC and GASs. Therefore, they should plan for and/or secure the operationbudget for each course (e.g. equipments, consumables, other indirect costs) so as to disburse the budget ina timely manner. It should be particularly noted that TSMC/UHS is advised to employ fulltime teacher(s)and prepare the budget plan for RT course, in order for its sustainable operation.
3-7-3 Recommendations on JICA
Since RT course was newly established at TSMC in 2006, the first batch of students will graduate in2009. Therefore, it is desirable that JICA will provide a continuous assistance in operation of RT course
until 2009, if requested.
It is recommended that a post-project evaluation be conducted in order to assess the further development
and impact of the Project.
3-8 Course-specific recommendations
3-8-1 Recommendations on SRN Course
The passing rate of clinical skills part of the Exit Examinations is lower than that of theory part.
Therefore, it is recommended that teaching clinical-skills-related subjects be strengthened and that enoughopportunities of classroom-practice be provided to students, to improve the passing rate of clinical skills
parts.
The subjects in the previous curricula were classified according to type of medical fields. However,the subjects in the new standard curricula (Standard Curricula) are currently classified according to thestages of human life cycle. For more effective implementation of the new standard curricula, it isrecommended that teachers be developed so as to be specialized in newly classified subjects.
The questions of Exit Examinations need to be revised so that they could be in line with the newstandard curricula (Standard Curricula) before the Examination for students studied under the new standard
curricula takes place.
3-8-2 Recommendations on PT Course
It is recommended that a network among PTs be strengthened. It will enable them to ensure continuingxxieducation and view exchange opportunities. The network should attempt to capture all the PTs regardlessof type of duty stations: i.e. (i) health facilities and social welfare facilities; and (ii) public facilities andprivate facilities.

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