SummaryI.

Outline of the ProjectCountry：Cambodia

Project title：Promotion of Medical Equipment
Management System

Issue/Sector：Health Sector

Cooperation scheme：Technical Cooperation

Division in charge：JICA Cambodia OfficeTotal cost：37,000,000yen

Period ofCooperation(R/D): 1/Jan/2006-3/Dec/2008

Partner Country’s Implementing Organization：Ministryof Health(Extension):NA(F/U) :NASupporting Organization in Japan：NA

Related Cooperation
Project：

NA

Background of the Project
The Royal Government of Cambodia (hereinafter referred to as RGC) has set out a strategy called
Health Strategic Plan 2003-07 as national policy in the health sector (HSP, currently it is pursuing HSP22008-2015) and has been pursuing improvement of hospitals including medical equipment (ME) throughconstruction and renovation as well as improvement of education for medical service providers.
Maintenance and management of ME had been recognized as one of the most important concerns by theMinistry of Health (MOH) and development partners. However, the agency in charge, Hospital ServiceDepartment (HSD) of the Ministry had not been able to establish practical measures to manage ME in thewhole country. Provincial public hospitals were facing many challenges such as insufficient number ofME at hand, and a large number of ME not in operation or prone to break down. These challenges are not
only caused by technical capacity of ME technicians or operators but also by the way ME is managed.
There was indeed a great need for establishing sound and comprehensive ME management system andimproving capacity of HSD to give instructions to hospitals to follow the system.
JICA had been implementing Phase II of the Maternal and Child Health Project at National
Maternal and Child Health Centre (NMCHC) since April 2000 for five years, which included activities toupgrade ME maintenance and management capacity of the Engineering Section. As a result, the Section
started to receive requests from other hospitals for ME maintenance and training. Given the fact that thiswas the first successful case, MOH started to examine the way to spread out such system across thecountry.
Based on such background, did MOH request support to the Government of Japan to solve issues
surrounding ME in this country. After a series of discussions and studies, it was decided to launch theProject on Promotion of Medical Equipment Management System (MEDEM Project) from January 2006
for three years, with an aim to introduce basic ME maintenance and management activities in hospitals as
its main goal.
１２ Project Overview（１）Overall Goal
Basic maintenance of medical equipment is conducted at NHs and CPA3 RHs, and the following fourindicators are defined for evaluation.

i（２）Project Purpose
Basic maintenance and management activities for medical equipment are introduced at target NHs andCPA3 RHs, by following the instruction of MOH and by receiving technical guidance of NW（３）Outputs
Output 1: Administrative instruction of HSD of MOH on medical equipment management for target
NHs and CPA3 RHs is strengthened, with technical guidance of NW.
Output 2: Technical skills of medical equipment technicians in target NHs and CPA3 RHs is improved.
Output 3: Management skill of medical equipment managers in target NHs and CPA3 RHs is improved.
（４）Inputs
Japanese side：( Total37,000,000yen )1 Long-term Expert
4 Short-term Experts
4 Trainees received
Equipment 64,688 USD
Local Cost 231,655.98 USD
Cambodian Side：Counterpart Allocation
Offices and Facilities
Local Cost; Expenses for Medical Equipment Managemnet Seminar
Accommodations for Medical Equipment Technician Training(1,300USD/ training )II.

(8,853.15USD),

Evaluation TeamMembers of Evaluation TeamLeader; Mr Hikoyuki UKAI (JICA Cambodia Office, Depuy Resident
Representative)
Medical Equipment Management; Mr Yoichi SUGIURA (GeneralManager,Clinical Engineering Division, Tokyo Women’s Medical University
Yachiyo Medical Centre)
Evaluation Analysis; Mr Naoki TAKE (Consultant/ Economist,Kaihatsu Management Consulting Inc.)
Cooperation Planning; Ms Masayo TERAKADO (JICA CambodiaOffice, Assistant Resident Representative)

Period of Evaluation：19/ Aug/ 2008~ 5/ Sep/ 2008

Type of Evaluation：Final Evaluation

III. Results of Evaluation
１. Project Performance（１）Inputs and Outputs
Output 1: Administrative instruction of HSD of MOH on medical equipment management for target NHs
and CPA3 RHs is strengthened, with technical guidance of NW.
The Project has sought strengthening administrative instruction of HSD on ME management withtechnical guidance of NW/NMCHC to 18 CPA3 RHs and 4 NHs designated as the target hospitals. A lotii

of improvements especially for the capacity to carry out the following activities are identified; inventory
update, monitoring trip and feed back, HSD annual work plan, HSD quarterly report, and implementationof ME training. It is possible to conclude Output 1 has been achieved.
Output 2: Technical skills of medical equipment technicians in target NHs and CPA3 RHs is improved.
The Project is aimed at upgrading the knowledge and skill of ME technicians assigned at the target
hospitals. Judging from the improvements in scores of pre-test and post-test conducted in the training
courses where these technicians are trained in theory and practice with a number of useful manuals
developed by the Project, as well as the improvements in monitoring on the performance of ME
technicians, it is also possible to conclude that Output 2 is achieved.
Output 3: Management skill of medical equipment managers in target NHs and CPA3 RHs is improved.
The Project has sought to upgrade the knowledge and skill of ME management at the target
hospitals, as it has done in the field of ME technician. Judging from the improvements in scores of pretest and post-test conducted in the training courses where these managers are trained with a number of
useful manuals developed by the Project, as well as the improvements in monitoring scores, it is also
possible to conclude that Output 3 is achieved. However, on-site observations on the progress might berequired to capture the real progress of the Output.
（ ２ ） Project Purpose: Basic maintenance and management activities for medical equipment are
introduced at target NHs and CPA3 RHs, by following the instruction of MOH and by receiving technicalguidance of NW.
Based on the designated three indicators, it is possible to say that the Project Purpose has been
generally achieved. As a result of Project activities, all target hospitals could manage to submit the ME
management reports to MOH without delay. Based on the scores of evaluation of the ME reports, alltarget hospitals passed the target. Regarding the preventive maintenance and minor repair activities, there
are great varieties in the performance from hospital to hospital, although the Project indicator has beenachieved. However, most of the hospitals can conduct preventive maintenance as planned.
（３）Implementation Process
The Project made a number of efforts to facilitate the implementation of the Project.
For example, the Project has regularly held the workshops for monitoring the progress of activities
and revised PDM timely, with referring to PDM and PO. Another example is its efforts to have as many
opportunities for discussions among the Project as possible. Taking advantage of the opportunities likethe Mid-term Evaluation and Joint Coordination Committees, the Project actively engaged in discussions
to ensure the sustainability of the activities and organizations required for ME management, andownership of the Cambodian side. The Mid-term Evaluation also enabled the Project to set the concretetargets to some indicators for evaluation.
２. Summary of Evaluation Results（１）Relevance
It is possible to conclude that relevance of the MEDEM Project is high for the following reasons.
First of all, it has strong relevance to the Cambodian Policy, by contributing to the implementationiii

of Health Strategic Plan (HSP) 2003-2007 which puts importance on the improvement of health service.
The Project is also in line with the Japanese assistance strategy to Cambodia.
As for the relevance to the needs of stakeholders of the Project, it is also confirmed high,considering the situation at the target hospitals where the number ME is on increase from 2,340 in 2006
to 2,948 in 2008. While there is a clear need expressed for knowledge and skills for repairing ME athospitals, the Project was not designed to include components to meet such demands. This judgement
can be justified, in light of the feasibility, cost, possibility of utilization of ME agents and the Project
period.
The Evaluation team also recognized the relevance and appropriateness of the skills and knowledgetransferred by the Project.
（２）Effectiveness
Effectiveness of the Project can be confirmed as high.
As described before, the Project Purpose has been generally achieved. Outputs (capacity buildingof three levels at central ministry, technicians at hospital, and its management) are appropriate forachieving the Project Purpose since these three outputs are all indispensable to introduce sound ME
management system and the logic is in line with the principles for capacity development.
While almost all target hospitals conduct periodical check and maintenance, it is also found that
there are differences of the number of preventive maintenance among them. One explanation may be thathospitals with active hospital management activities tend to be also rigorous in preventive maintenance.
Hospital management activities enable MEM-WG to cooperate with other clinical departments smoothly,and facilitate communication with PHD in charge of budget and negotiation with donors, using reliabledata drawn from the MEDEM inventory.
（３）Efficiency
It is possible to affirm that efficiency of the Project is considerably high.
Quantity, quality and timing of the inputs from Japanese side can be evaluated as appropriate.
Performance of Japanese experts is satisfied by Cambodian counterparts.
Cambodian counterpart personnel of HSD, an input from Cambodian side, were frequently
changed, however, it resulted in positive development to improve the management and operation of theProject.
One of the important and significant inputs from Cambodian side is cost-sharing. From 2007, there
was a remarkable increase in their financial contribution to the MEDEM training operation, mainly
through the support to trainees’ accommodation and operational cost (HSSP supported MOH’s budget).
It is also important to note here that the Project design contributed to increase the efficiency byfully utilizing the outcome of the Phase II of the Maternal and Child Health Project at National Maternaland Child Health Centre (NMCHC).
（４）Impact
Although it is too early to conclude the prospect to achieve Overall Goal, it is possible to say that
the Project has some positive impacts and is actively pursuing goals beyond the Project Purpose andmaking a progress toward the achievement of the Goal.
① Division of responsibilities between HSD and NW was made clear, and increased functioning ofiv

HSD (e.g. quarterly reports)② Some hospitals and PHD started to integrate ME management and hospitals and draft AOP basedon accurate data
③ Technical inputs were provided to guidelines of the Ministry of Health, which defies important
standards of services and infrastructure at hospitals and health centres.
④ Technical inputs and expertise were contributed to other JICA projects and the biggest health
SWAp-type project (HSSP).
（５）Sustainability
Sustainability of the Project has significantly improved since the Mid-term Evaluation.
The current national policy provides strong foundation for promotion of ME management.
As for the organizational sustainability, there are positive remarks from the counterparts thatrequired tasks are carried out smoothly thanks to the reform to clarify the responsibilities and Terms ofReferences (TORs) of the NW team after the Mid-term Evaluation. At the same time, we should not
overlook the situation where the workload of HSB has been intensified drastically and there is a danger
that the unit would be overloaded, as a result of their upgraded capacity and performance of HSB andincrease requests from those who started to appreciate and realize the utility of their services. The
management of MOH is well aware of the phenomena and considering the way to encourage the staff.
As for the sustainability of budget, there is a trend that MOH attaches the importance and allocates
relatively higher budget to capital spending, although the MOH budget spent on ME has been on decreasein these few years. There is also a good sign that both central and provincial level, the recognition fordeveloping evidence-based-AOP is ever rising. This is the first important step to obtain national budgets
including HSSP. However, it is necessary to have strong advocacy with related departments to actually
secure the allocation.
Prospects for the sustainability at hospital levels greatly improved. Strong ownership andcommitment to ME management activities are observed in several hospitals. The sense that there is now
support and monitoring from the central level contributes to raise their motivation to the great extent. ME
management activities started to take root at some hospitals, leading to make environment where hospital
together with PHD and development partners as a whole to rigorously engage in ME management.
However, challenges still remain to ensure financial and human resources for ME management activities.
Conclusion
It is concluded that the Project has generally achieved the Project Purpose to introduce basic ME
maintenance and management activities at the target hospitals despite the great varieties in theperformance from hospital to hospital.
One of the biggest attributions is the achievement of the Outputs. At the central level, HSD raised
its capacity to give administrative instructions and the NW team started to play a leading and supportiverole to promote ME management, through activities such as training, monitoring and follow-up visits.
At the hospital level, knowledge and skills of ME managers and technicians were upgraded, andon-site activities mainly through the newly organized MEM-WG are started, including preventive
maintenance and minor repair.
Impacts of the Project are not negligible. It is now possible to assert that the Project is actively
pursuing goals beyond the Project Purpose. There are a number of other examples of the Project’s
３.

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impacts as mentioned above.
Sustainability of the Project was found to be improved significantly since the Mid-term Evaluation.
However, there are several challenges in order to ensure the achievement of the Overall Goal. Firstly,
there should be countermeasures to address ever-increasing workload of HSB as an organizational
challenge. Option might include the delegation of the tasks to NW/NMCHC and in future to hospitallevels. Secondly, ensuring sufficient budget as well as minimum level of human resources for ME
management activities both at the central and provincial levels is an important task of MOH, although
there is a significant improvement in AOP development process and remarkable efforts to increase thestaff recruitment.
To improve conditions of ME (e.g. operable rate) at hospitals is an indicator to achieve the Overall
Goal. How to ensure this achievement through the newly introduced ME management is a challenge. Oneof the important findings of the Project is that sound hospital management is a key to well-functioning
MEM-WG. This enables the output of MEM-WG activities and information to be effectively utilized,
which increases the possibility for ME-related problems to be actually addressed.
４. Recommendations（１）Recommendations to MOH as a Whole- Ensure favorable working environment for ME Technicians (time allocated for ME management andworkshop establishment)- Take more proactive approach to recruitment of ME Technicians- Ensure enough budget through preparation of AOP, enhanced negotiation with relevant authorities
and identifying good practices for user fee utilization- Analyse and disseminate good practices for utilizing user fees for ME management- Share and utilize the information and outputs gained through the Project- Continue efforts to Achieve the Overall Goal
（２）Recommendations to HSD- Integrate ME management with hospital management and QI- Continue efforts to improve human resource management of HSB- Enforce the on-going efforts to support hospitals (e.g. monitoring visits)（３）Recommendations to NMCHC- Make efforts to support and develop the capacity of the hospitals that can play a leading role as a hubof specific areas.
（４）Recommendations to JICA
- Consider measures to address difficulties which MOH is facing, such as ever-increasing workload
compared to the level of salaries.
- Enhance the collaboration with other development partners in the related areas like hospitalmanagement,
５. Lessons Learned- Use of existing resources whose capacities were developed from past cooperation projects is effectivevi

-Systematic approach which developed capacity at both central and hospital level is effective
Follow-up activities after training is more important in human resource development
Mid-term Evaluation and its follow-up activities were positively utilized for opportunity to improve
the Project activities and performances.

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