Evaluation Summary
1. Outline of the ProjectCountry: The People's Republic Project Title: The Project for Research and Development of Preventionof Bangladesh
and Diagnosis for Neglected Tropical Diseases, especially Kala-Azar
Issue/Sector: Healthcare
medical treatment

and Cooperation Scheme: Technical Cooperation Project (Science andTechnology Research Partnership for Sustainable Development:
SATREPS)

Division in charge: Health Team Total Cost：300 million JPY
4, Health Group 2, Human
Development Department
Period of
Cooperation(R/D):
1/Jun/2011-31/May/2016

Partner Country’s Implementing Organization: International Centre for
Diarrhoeal Disease Research, Bangladesh, and Ministry of Health andFamily Welfare
Supporting Organization in Japan: University of Tokyo and Aichi
Medical University
Other Related Projects: Surya Kanta Kala-Azar Research Center,
Mymensingh Medical College and Mymensingh Medical College
Hospital

1-1 Background of the Project
Leishmaniasis, a vector-bone disease that is transmitted by a hematophagous insect of Phlebotomus(sandflies) is a protozoan zoonosis and regarded as one of neglected tropical diseases (NTD) with a large
distribution in the world as many as 88 countries, 77 of which are developing countries. The prevalence ofVisceral Leishmaniasis (Kala-Azar), the severest type of Leishmaniasis, is highly prevalent especially inpoverty group in the People's Republic of Bangladesh (hereinafter referred to as “Bangladesh”) as well asneighboring countries such as the Republic of India and the Federal Democratic Republic of Nepal, andapproximately 200 million people are endangered for infection in the said 3 countries. In Bangladesh, it isestimated that 65 million people are compromised for Kala-Azar infection and more than 50,000 are newly
infected in each year. Kala-Azar is highly lethal and difficult to achieve a complete cure; nonetheless,measures for Kala-Azar control in terms of diagnosis, treatment and prevention are lagging behind. Under
the circumstances, Bangladesh, in consort with the World Health Organization (WHO), has been putting
efforts into reducing its prevalence from 25 to 1 per 10,000 populations by the year 2015.
”The Project for Research and Development of Prevention and Diagnosis for Neglected Tropical Diseases,
especially Kala-Azar” (hereinafter referred to as “the Project”) is aiming to realize the capacity
enhancement of Bangladeshi research institutes for surveillance of prevalence of Kala-Azar and Post
Kala-Azar Dermal Leishmaniasis (PKDL), development of its rapid diagnostic tools, and research on
vector insect of sandflies through collaborative research activities with Japanese research institution. The
Project is implemented with Bangladeshi counterpart organization such as the International Centre for
Diarrhoeal Disease Research, Bangladesh (hereinafter referred to as “icddr,b”) and the Ministry of Healthand Family Welfare (hereinafter referred to as “MoHFW”) for five years from June 2011 under the schemeof the Science and Technology Research Partnership for Sustainable Development (SATREPS).
1-2 Overview
The Project aims to implement collaborative researches at SKKRC that contribute to the Kala-Azar
Elimination Programme in Bangladesh and to enhance the researching capacity of Bangladeshi research
institutes through the collaborative researches.
(1) Project Purpose
Capacity of icddr,b for surveillance of prevalence of Kala-Azar and PKDL, development of its rapid
diagnostic tools, and research on vector insect of Sand Fly is improved through collaborative research
activities with Japanese research institution.

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(2) Outputs
1) Rapid and reliable diagnostic tools for clinical and sub-clinical Kala-Azar cases and PKDL developedby the Project are introduced as methods for practical use in clinical laboratories in Bangladesh.
2) Mechanisms of Kala-Azar and PKDL are elucidated in Bangladesh, through epidemiological,
immunological, pathological, parasitological and biochemical analysis.
3) Vector control methods including insecticides application are established through identification ofvector insect and its distribution, and reservoir-focused investigations.
4) Implementation of Kala-Azar-related researches are streamlined.
(3) Input (as of the Evaluation)
The Japanese Side
Dispatch of JICA Experts：Long-term Experts: a total of 4 persons (Drug Resistance, Epidemiologicalresearch and Project Coordinator) (115.6 M/M), Short-term Experts：a total of 53 persons） (32.9 M/M)
Provided Equipment ： Automated Clinical Chemistry Analyzer, Automated Hematology Analyzer,
Refrigerated Micro Centrifuge, High-speed Micro Centrifuge, Inverted microscope, Fluorescence
Microscope, 1 vehicle for project activities, etc.
Local Cost：approx. JPY 54,129,000 (≒ USD 449,950)
Bangladesh Researchers visiting Japan for meeting: a total of 11 persons (2.7 M/M)
The Bangladeshi SideCounterparts：12 persons (3 from icddr,b and 9 from SKKRC)
Land and Facilities：Project office in icddr,b and SK Hospital, and research spaces in SKKRC
Local Cost： approx. 1,800,000 BDT (≒ USD 23,500)

2. Terminal Evaluation Team
Members

Dr. Kaname
KANAI

LeaderExecutive Technical Advisor to the Director General, Human
Development Department, JICA

Ms. Yukiyo
KOMINE

Cooperation
Planning

Deputy Director, Office for Science and Technology
Cooperation, Infrastructure and Peacebuilding Department,
JICA

Mr. Tatsuya
ASHIDA

Evaluation
Planning

Assistant Director, Health Team 4, Health Group 2, Human
Development Department, JICA

Dr. Yoichi
INOUE

Evaluation and Senior Consultant, Consulting Division, Japan Development
Analysis
Service Co., Ltd.

Dr. Takeshi
KURATA(Observing
member)Infectious
Diseases
Control
Research

Dr. Haruo
WATANABE(Observing
member)Infectious
Diseases
Control
Research

Ms. Yuko SATO Planning and(Observing
Evaluation
member)Period of 29/Dec/2015 - 18/Jan/2016
Evaluation

Program Supervisor, International Collaborative Research
Program, Department of International Affairs, AMED
Professor, International University if Health and Welfare,
Shioya Hospital
Research Supervisor, International Collaborative Research
Program, Department of International Affairs, AMED

Section Chief, Department of International Affairs, AMED

Study Type: Terminal Evaluationxi

3. Summary of Evaluation Results
3-1 Achievements(1) Output 1
Due to an unexpected external factor, the Project could not realize the introduction of POC testing
through the development of LAMP-based rapid diagnostic test; however, the Project succeeded indeveloping multiplex quantitative realtime PCT method that can diagnose Kala-Azar with highsensitivity and specificity. The realtime-PCR method was introduced to SKKRC; owing to that, morecorrect diagnosis is enabled. The Project also developed a simply handled-test strip that can measure
L-FABL in urine semi-quantitatively. The strip was introduced to SKKRC and used for the monitoring of
disease activity and adverse events cause by chemotherapy. Further, the ELISA method that detect
Leishmania antibody in urine was already commercialized. Since the kit uses urine for testing, a lot ofsamples can be processed at one time non-invasively. Therefore, the kit can be used for mass screening
for identifying high endemic zone of Kala-Azar.
On the other hand, the Japanese research institutes proposed highly sensitive immunochromatographymethod using rKRP42, which was promising to detect early Kala-Azar even at early-phase or subclinicalinfection，and continued developing work for a ELISA-based detection method of antibody against
rKRP42 in urine, and prepared a prototype as of the time of the Terminal Evaluation. The Project is
supposed to evaluate the clinical performance and to determine the cut-off value for diagnosis of the said
method at SKKRC in February 2016 using clinical specimens obtained from the Kala-Azar patients.
For these reasons, it is anticipated that the rapid and reliable diagnostic tools for Kala-Azar cases and
PKDL will be introduced as methods for practical use by the end of the project period; hence, it isdeemed that the Output 1 is achieved in general.
(2) Output 2
Due to the unexpected external factors such as the reconstruction of project implementation system at theinitial phase and political uncertainty and incidents that happened and intermittently continued from thetime around the Mid-term Review, the Project could not recruit sufficient number of family cohorts toanalyze the mechanism of the onset of PKDL, naturally, no significant finding have not been obtained asof the time of the Terminal Evaluation.
Meanwhile, the Project developed a Kala-Azar mass screening system by combining urinalysis for
Kala-Azar antibody with positional information using GIS technology．Using this system, the Project
found that Kala-Azar-prone zones have difference in density even in an endemic area; this finding can bea risk factor for Kala-Azar infection.
Analyses for the risk factors for atypical infection and the onset of PKDL have not been done since theprogress of the whole project activities lagged behind schedule, and remaining future challenges. Thus,though the Project exerted maximum efforts within the limited period activity time, it is deemed theachievement of Output 2 is moderate as of the time of the Terminal Evaluation.
(3) Output 3
Concerning vector research, the Project confirmed the existence of seven (7) species of sandflies in
Bangladesh, one (1) of which is known to transmit the leishmanial protozoa; the Project detected
Leishmania-derived DNA from individuals of the said species, but not for others. Interestingly,
however, the Project obtained some provisional results for indicating the existence of another species
which can transmit the leishmanial protozoa. Meanwhile, the Project could not draw an concreteconclusion with regard the possibility of reservoir animals except for humans; therefore, further researchshould be done to solve this question.
Concerning the vector research, the ecology of sandflies has been poorly understood. The Project wasmoving ahead with the researches with the Ege University, and obtained several novel findings regarding
its ecology such as bimodal activity periods and entry route to rooms (upper wall). With regard to other
ecological characters such as places for oviposition and rest, preference and seasonal change, the Projectis still working on accumulating information and data as of the time of the Terminal Evaluation due to theunexpected delay aforementioned. Meanwhile, the University of Tokyo in consort with the Ege
University confirmed that Olyset® Plus demonstrated strong insecticidal effect to sandflies. On the basisxii

of the result, Sumitomo Chemical Co., Ltd. has provided the Project with 3,340 nets of Olyset® Plus.
The Project has started an operational research to verify the effectiveness of Olyset® Plus for theprevention of Kala-Azar in 2014 and currently is still undergoing in the monitoring activities in Pabna on
a monthly basis.
As described, the Project have not reached at the level of achievement for both vector and reservoir
researches as expected at the time of the Terminal Evaluation doe to the delay of the project activities asaforementioned; however, it is anticipated that the Project is supposed to conclude the results of theexperimental study for the effectiveness of Olyset® Plus for the prevention of Kala-Azar by the end of
the Project period.
(4) Output 4
The the Japanese research institutes and icddr,b were supposed to work hand in hand to the whole processof project research activities from the development of basic techniques and/or technologies,
implementation of experiments and/or studies to the data analyses and its interpretation; nevertheless, it
was inevitable for the Japanese research institutes to take lead role to implement practical research
activates with the direct and/or indirect support of icddr,b and other partner organizations due to thechange in implementation structure of the Bangladesh side. The Project had greatly assisted the MoHFW
to launch SKKRC with icddr,b and other partner organizations such as DNDi, an d subsequently, theProject provided SKKRC to establish the laboratory diagnosis services technically and physically.
Through these great deal of efforts, it is deemed that the environment for the research was successfully
established at SKKRC using its resources; nonetheless, it is also deemed that the implementation systemof the collaborative research between the Japanese research institutes and icddr,b for the Project.
For these reasons, it is deed that the achievement of the Output 4 is moderate as of the time of the
Terminal Evaluation.
(5) Project Purpose
The Project Purpose, according the PDM, is to enhance the capacity of “icddr,b”; however, practicalresearch activities couldn’t be done at and with icddr,b due to unexpected external factors. Under thecircumstances, it can be said that the Project has been doing assistances for enhancing the capacity ofKala-Azar control not at a specific research institute but whole Bangladesh. Meanwhile, the Project was
negatively affected by the unexpected external factors even after the time of of the Mid-term Review
intermittently because of the restriction of project activities especially field activities. Even though suchdifficult situation, the Project exerted maximum efforts for the implementation of project research
activities and generated research outcomes as described in the “Achievement of Outputs” section.
As was described in the Achievement of Output 4, since the Japanese research institutes have been taking
lead role for the practical research activities, the original purpose of the Project that aimed theenhancement of research capacity of the Bangladeshi counterpart hasn’t been achieved. Having said that,
the Project had significantly contributed for the establishment of SKKRC-centered laboratory diagnosis
system for Kala-Azar in Bangladesh as well as the reinforcement of SKKRC as a research center, and thisachievement was beyond our expectations. The Project set a Super Goal as “Government Programme on
Kala-Azar Elimination is strengthened in Bangladesh”. It is considered that the Project advanced toward
the achievement of the Super Goal whereas the original purpose hasn’t been fulfilled. For these reasons,the Project Purpose is expected to be achieved in general by the end of the project period.
3-2 Summary of Evaluation Results(1) RelevanceThe relevance of the Project has been maintained throughout the project period.
The MoHFW has enhanced its efforts in the Kala-Azar Elimination Programme; as a practical initiative,
it took the lead for the establishment of SKKRC at Mymensingh. For this reason, it is considered that the
Project has moved to the forefront of Kala-Azar control in Bangladesh. Especially in recent years, thenumber of newly-infected patients of Kala-Azar is steadily decreasing, and the target prevalence ofKala-Azar in Bangladesh came closer to the national target value of 1/10,000 set in the government-led“Kala-Azar Elimination Programme”. In order to maintain the low number of new infection and even
ideal control of Kala-Azar in near future, the MoHFW decided to extend the programme period for 2

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years until 2017. For these reasons, it is considered that the importance of the Project in the Bangladeshi
policies for the control of Kala-Azar is enhanced further. Meanwhile, Japan’s aid policies put theemphasis of the significance of the preparedness against infectious diseases and international
collaboration for it. For these reasons, the relevance of the Project Purpose has been maintained
throughout the project period.
Concerning the technical transfer of the scientific technologies, due to changes in the project
implementation setup, the novel setup of the Project entails the research institutes on the Japanese side
establishing the basic technologies and preparing the protocol for research and then introducing them to
SKKRC. Since the Project was compelled to change direction of assistance, it is deemed that thetechnical transfer for the enhancement of “research” capacity of the Bangladeshi counterpart
organization. However, the Japanese research institutes continued the research activities in considerationof functional enhancement of laboratory diagnostic services as well as research capacity of SKKRC.
From the standpoint, the Project provided a total of 11 persons engaged in Kala-Azar research, laboratory
diagnosis and/or patient management in SKKRC with short-term training opportunities in Japan forvarious subjects. Moreover, the Japanese research institutes put the maximal efforts to give technicalassistance to the local staff members regarding the management of the laboratory such as procurement ofreagents and consumables as well as the maintenance of laboratory instruments for the maintenance oflaboratory function in both for research and diagnostic services.
(2) EffectivenessThe effectiveness of the Project is considered to be high in general at the time of the Terminal Evaluation.
As was described in “the Achievement of the Project Purpose” section, due to the fact that the Japanese
research institutes have been taking lead role for the practical research activities, the original purpose of
the Project, aiming the enhancement of research capacity of the Bangladeshi counterpart, hasn’t beenachieved as expected. Having said that, the Project had significantly contributed for the establishment of
SKKRC-centered laboratory diagnosis system for Kala-Azar in Bangladesh as well as the reinforcementof SKKRC as a research center, and this achievement was beyond our expectations. The Project set a
Super Goal as “Government Programme on Kala-Azar Elimination is strengthened in Bangladesh”. It isconsidered that the Project advanced toward the achievement of the Super Goal whereas the original
purpose hasn’t been fulfilled. For these reasons, the desired effects expected from the implementation of
the Project, in spite of the different approach, is anticipated to be achieved in general by the end of the
project period.
Meanwhile, the Project was negatively affected by the unexpected external factors even after the time ofof the Mid-term Review intermittently because of the restriction of project activities especially field
activities. Even though such difficult situation, the Project exerted maximum efforts for the
implementation of project research activities and generated research outcomes as described in the“Achievement of Outputs” section. Specifically, the diagnostic methods, developed or modified by the
Project, are used at SKKRC for rapid and accurate diagnosis of Kala-Azar as well as monitoring of theeffect or adverse reactions of chemotherapy. Moreover, the research results with regard to the preventive
effect of Olyset® Plus against Kala-Azar as well as the Kala-Azar mass screening system by combining
urinalysis for Kala-Azar antibody with positional information using GIS technology will be effectively
utilized for the MoHFW and other relevant parties to come up with policies for the control of Kala-Azarin future. The Project is supposed to accelerate the analysis work with the information and data that are
obtained, and is being preparing a total of five (5) drafts of scientific articles or book(s) to publish as of
the time of the Terminal Evaluation.
(3) Efficiency
The efficiency of the Project is moderate as unexpected external factors negatively affected smooth
implementation of research activities.
The Project has proceeded research activities under direct or indirect collaboration with external
institutes such as Mymensingh Medical College and its Hospital, DNDi and the Ege University.
However, unexpected external factors made it necessary to change the project implementation setup, andthe project research activities faced major delays (approx. one and a half years) before the setup wasestablished. After SKKRC was opened, the project research activities were vigorously conducted thanks
to the efforts of related parties. Besides, due to the political unrest from late 2013 to early 2014, JICA

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experts (foreign researchers) were restricted to visit to Bangladesh in timely manner for the planned
activities that are necessary to be done in the specific season. In correct terms, the periods when the
project activities were affected are as follows: whole year in 2013; from January to April 2014; fromJanuary to April 2015; and from September to December 2015. From the viewpoint of the effective
utilization of time resources, these incidents hindered the efficiency of the Project to an extent. In
addition, the Japanese and Bangladeshi sides have not necessarily achieved full recognition of eachother’s research progress. Having said that, the Project is working for finalizing the research outcomes asof the time of the Terminal Evaluation, it is anticipated that the discussions amongst the stakeholders
such as MoHFW, icddr,b, and other partner organizations regarding the practical application of researchoutcomes of the Project to society immediately after the time of the Terminal Evaluation.
Setups of the research instruments had been completed in general by the time of the Mid-term Review.
Especially at SKKRC, not only research instrument but also medical instruments and apparatus such as
ultrasound diagnostic system were introduced for testing, diagnosis and monitoring of Kala-Azar patientsas a part of the project activities. Those instruments and apparatus are effectively used for research
activities and clinical services at SKKRC as of the time of the Terminal Evaluation.
(4) Impact
The following positive impacts are confirmed and/or expected by the implementation of the Project.
Various development partners such as the Project (JICA/AMED), MSF and DNDi has been assisting the
MoHFW to control Kala-Azar under “the Kala-Azar Elimination Programme” through diversified
approaches for the prevention, treatment and research of Kala-Azar. As an integrated result, the numberof Kala-Azar reported cases decreased steadily in recent years, the target value of the Programme(1<10,000 population) is about to be fulfilled. Meanwhile, the total number of Kala-Azar cases in
Bangladesh is decreasing significantly in recent years whereas the number in SKKRC is maintained asmuch as around 400 cases in each year; which is to sat that the portion of Kala-Azar patients treated at
SKKRC is increased in relative terms. Sixty-six percent (66%) of Kala-Azar patients was treated at
SKKRC in 2015 indeed. In addition, with the support of the Project, genetic diagnosis of Kara-Azar
using multiplex quantitative realtime PCR as well as the L-FABP test strip for the monitoring of theeffect and adverse reactions of chemotherapy had been installed and that helped SKKRC to provide
accurate concrete diagnosis as well as patient management. In case of patients are at the primary stage,
concrete diagnoses can be made accurately in general. After the installation in December 2014, SKKRC
is accumulating results and achievement of PCR-based diagnoses; particularly, a total of 250 tests weredone with the said PCR-based method to support the medical professionals to make concrete diagnoses in
SKKRC. For these reasons, SKKRC nowadays plays an important role for the control of Kala-Azar, andis, as a matter of practice, deemed to function as a reference centre for the treatment of Kala-Azar in
Bangladesh.
Meanwhile, the positive impacts derived from the Project are as follows: 1) Accuracy improvement of
concrete diagnosis of Kala-Azar by genetic diagnosis using multiplex quantitative realtime PCR; 2)
Contribution to capacity enhancement of young researchers and health professionals; 3) Establishment of
the Department of Tropical Infectious Diseases in the Mymensingh Medical College; and 4) Findings
regarding the efficacy of pharmaceutical on Kala-Azar treatment in Bangladesh and the influence of thequality of pharmaceuticals on the success of treatment.
(5) Sustainability
A self-sustainability as well as a self-deployment of the benefits provided by the Project can be expected
to some extent as of the time of the Terminal Evaluation.
MoHFW with the support of development partners has been putting great effort to control Kala-Azar
under the “Kala-Azar Elimination Programme” over the years. As a result of the integrated efforts, thenumber of Kala-Azar patients came closer to the target value of the Programme. MoHFW, responding to
the situation, had decided to extend the Programme for 2 years until 2017. For these reason, it isconfirmed that the importance of Kala-Azar control is maintained after the end of the Project, and thesignificance of the achievements and outcomes of the Project will not be detracted.
From the aspect of the financial sustainability, the costs for procuring reagents and consumables used for
diagnostic services and research have been covered by the Project. Therefore, the Project is expected toxv

prepare a list of reagents and consumables with providers, unit costs, etc., followed by the estimation ofannual costs for the maintenance of the services on the basis of relevant records and experiences. The
Bangladeshi stakeholders such as MoHFW, Mymensingh Medical College and its Hospital should
discuss about the segregation of duties at each organization and determine the clear results by the end of
the project period.
From the viewpoint of the technical sustainability, owing to the assistances of the Project, the staff of
SKKRC had received training not only for testing manipulation but also management of laboratory; as aresult, they reached at a sufficient level enough to sustain the operation and management of thelaboratory independently as of the time of the Terminal Evaluation. The manipulation skills andprocedures have been standardized as a form of SOP in various testing methods. Therefore, standardized
testing and diagnostic services are supposed to continue after the end of the project period.
3-3 Factors that promoted the attainment of the Project(1) Concerning the project design
No major promoting factor have been observed as far as the project plan is concerned.
(2) Concerning the implementation process of the Project
The Japanese research institutes have been actively engaged not only in research at SKKRC but also inlaboratory testing, examination and treatment technologies required for diagnosis and treatment of
Kala-Azar, and it has made a major contribution to the establishment of SKKRC as a core agency for
research and treatment of Kala-Azar. Moreover, MoHFW provided funding for the improvement offacilities and assigned personnel for realizing the establishment of SKKRC, which was no more than avision at the start of the Project, and establishing a research base in the Kala-Azar endemic area.
3-4 Factors that impeded the attainment of the Project(1) Concerning the project design
No major obstacles have been observed as far as the project plan is concerned.
(2) Concerning the implementation process of the Project
The said resignation of the Bangladeshi representative (Project Manager) has negatively affected thegeneration of research outcomes as well as project achievements since the research activities areprocrastinated at the initial phase of the Project. In addition, Political uncertainty that has beenintermittently continued from 2013 as well as the said criminal incidents happened in 2015 limited thefield activities of the Project substantially. These issues are recognized as hindering factors against
effectiveness of the Project.
3-5 Conclusions
Based on the series of interviews and discussions with authorities concerned as well as literature reviews,
the result of the Terminal Evaluation showed high relevance, effectiveness and sustainability in general,
whereas effectiveness was deemed to be moderate due to unexpected and inevitable delay of the project
activities. The results also showed positive expectation of the achievement of Super Goal in future,
implying the impact of the Project is deemed to be high.
This report will emphasize on SKKRC’s capacity enhancement for its diagnostic and curative services
enough to bear an important role for the control of Kala-Azar in Bangladesh. In light of the above, theProject is evaluated to be highly satisfactory.
3-6 Recommendations(1) The Team confirmed that the SKKRC was strengthened in its capacity in terms of diagnostic as well as
curative services through the implementation of the Project; therefore, approx. 70% of reported patientswith Kala-Azar was definitively diagnosed determined by the DNA-based testing at SKKRC. As theelimination of Kala-Azar is coming into the range, the Team recommends that the MoHFW should
determine the role of SKKRC in the national surveillance system, i.e., SKKRC functions as Nationalxvi

Reference Laboratory for diagnosis of Kala-Azar.
(2) The stakeholders of the Project such as CDC in MoHFW, MMC and MMCH should discuss under theadvice of JICA Experts the sustainability of SKKRC after the end of Project’s support; in concreteterms, securing the costs for maintenance and utilities as well as maximum utilization of the laboratory
instruments provided by the Project, an internal quality control system such as the mechanism forchecking the compliance of SOPs, etc. human resources nurtured by the Project. The said stakeholders
should determine the role of each party for sustaining the function of SKKRC and report to JICA office
after make consensus within MoHFW no later than the end of the project period.
(3) The JICA experts should summarize the achievements and research outcomes and share widely with thepersonnel in charge of infection control in MoHFW as well as health and medical professionals in
related organization.
3-7 Lessons Learnt(1) The Project was launched in June 2011; unfortunately, the Bangladeshi representative researcher,assigned as the Project Manager of the Project, had resigned his position at icddr,b in February 2012,just 8 months after the commencement of the Project. The implementation system at the Bangladeshi
side was taken over to the new Project Manager; however, the reconstruction of the system was in adifficult condition as a matter of practice since the former Project Manager had led the Project withstrong initiative at the Bangladeshi side from the designing to the implementation stage. In addition,
icddr,b is an independent international research institute that organize research activities in units ofindividual research grant. For these reasons, the collaborative research implementation system, plannedby the former Project Manager, couldn’t be maintained, and unplanned research budget couldn’t beallocated under the new administration of the Bangladesh side. That is to say, icddr,b faced a criticalsituation to allocate necessary human and financial resources as well as research spaces dedicated to theProject. As a result, the collaborative researches couldn’t be done at icddr,b materially.
As a lessons learnt, a change in implementation structure of counterpart organizations can impede project
activities substantially in case that the counterpart research organizations are run with external funding
resources, that is, without independent budget for research activities including staffing researchers.
Though it is impossible for projects to control the turnover of counterpart personnel, relevantorganizations including counterpart organizations of projects should discuss countermeasures for suchstate of affairs at the designing stage of projects.
(2) The Project is a technical cooperation project, implemented under the framework of SATREPS. The
JICA experts well understand such principle, and made efforts not only for seeking research outcomesbut also for yielding a positive impact on the steady achievement of the Super Goal of the Project infuture by introducing and/or applying research outcomes to the clinical practices of Kala-Azar treatment
as well as providing technical training for health personnel in SKKRC.
As a results of those efforts, SKKRC has enhanced its functions for diagnostic and curative services and,as a consequence, is functioning as a referral centre of Kala-Azar treatment in Bangladesh practically.

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