Summary
I. Outline of the ProjectCountry：Bangladesh
Issue/Sector：HealthDivision in charge：Bangladesh office(R/D):July 2006-June 2010
PeriodofCooperation

Project title：Safe Mother food Promotion Project
Cooperation scheme：Technical Cooperation
Total cost：390,000 (thousand) yen
Partner Country’s Implementing Organization：
Ministry of Health and Family Welfare
Directorate General of Health Service (DGHS)
Directorate General of Family Planning (DGFP)
Public Health and Local Government in Narsingdi
Districts
Supporting Organization in Japan：
Japan Overseas Cooperation Volunteer (JOCV)

Related Cooperation Project：
1 Background of the ProjectGovernment of Bangladesh has put high priority on the reduction of Maternal Mortality Ratio (hereinafterreferred to as “MMR”) and Infant Mortality Rate (hereinafter referred to as “IMR”) in the Health Nutritionand Population Sector Program (herein after referred to as “HNPSP”) and focused on working to improvethe maternal, neonatal and child health status.
Under the framework of the Bangladeshi national programs and strategies, Japan has supported theimprovement of Bangladeshi maternal and child health mainly through providing the Japan’s grant aid andtechnical cooperation projects. In 2000, Japan’s grant aid supported to refurbish the Maternal and Child
Health Training Institute (hereinafter referred to as “MCHTI”) in Dhaka. From September 1999 to August
2004, Japanese technical cooperation project for Human Resource Development in Reproductive Health(hereinafter referred to as “HRDRH”) was implemented in order to strengthen the clinical and training
functions of MCHTI.
In July 2006, the Ministry of Health and Family Welfare (hereinafter referred to as “MOHWF”) with support
from the Japan International Cooperation Agency (hereinafter referred to as “JICA”) launched the Safe
Motherhood Promotion Project (hereinafter referred to as “the Project”) toward the goal of improving healthstatus of women in reproductive age and neonate in Narsingdi during the implementation period of four (4)years and envisaging replicable good practices proven in Narsingdi to other districts.
2 Project Overview(1) Overall Goal
Approaches of Reproductive Health services extracted from the Project are standardized and applied to otherdistricts.
(2) Project Purpose
Health status of women of reproductive age and neonates is improved in the target district.
(3) Outputs
Output 1:
Feedback on lessons learnt from the Project is given to the central level, and necessary actions are put intopractice
Output 2:
Management of Health and Family Planning Offices at district and upazila level is improvedOutput 3:
Safe delivery service system is strengthened
Output 4:
Reproductive Health services are more utilized by target community people in cooperation with the private
sectorJapanese side：( Total(thousand) Yen)
Long-term Expert 3 Equipment 80,000(thousand)Yen
Short-term Expert 5 Local cost 100,000 (thousand) Yen
Trainees received 14
Bangladeshi Side：Counterpart 34 Equipment, Land and Facilities, Local CostII. Evaluation Team
Members of Evaluation Team
LeaderDr. Yojiro Ishii, Deputy Director General, Human Development
Department, JICA
Maternal Child Health (MCH)
Dr. Hidechika Akashi, Senior Technical Officer, International Medical
Center of Japan
Community Health
Ms. Chiyuki Yoshida, Chief Nurse, Wakayama Medical Center, Japanese
Red Cross Society
Study Planning 1
Ms. Kotohi Inoue, Assistant Director, South Asia Division 5, South Asia
Department, JICA
Study Planning 2
Ms. Haruko Kamei, Assistant Director, South Asia Division 5, South Asia
Department, JICA
Cooperation Planning 1
Ms. Saeda Makimoto, Representative, JICA Bangladesh Office
Cooperation Planning 2
Ms. Shizu Watanabe, Associate Expert, Human Development Department,
JICA
Evaluation Analysis
Ms. Akiko Tsuru, Consultant, International Techno Center Co., Ltd.
Period of Evaluation
17/January~9/February/ 2009 Type of Evaluation：Terminal Evaluation
III. Results of Evaluation
Project Purpose:All indicators of project purpose achieved the target.

Indicators
1.Proportion of women with obstetriccomplications using EMOC services
2. Proportion of deliveries assisted by skilled
personnel in model unions
3. Case fatality rate at EMOC facilities in modelunions

Baseline
17.8%(2006)

Endline
55.6% (2009)

Target65%

18%(2008)

25.4% (2009)25%

0.7%(2007)

0.1% (2009)<1%

2. Summary of Evaluation Results(1) Relevance
Project is judged high in relevance for the following reasons;- Maternal Mortality and Neonatal Mortality are significantly high and demanding acute necessity for majorinterventions- Overall Goal and Project Purpose are consistent with MDGs that Bangladesh has committed to achieve.
- Project purpose has conformity with Japan’s ODA policy and JICA’s country specific program
implementation.
- The indicators of Narsingdi District (before the project) shows the dismal state of this district and highnecessity of intervention in the area.
(2) EffectivenessProject is judged high in effectiveness for the following reasons;- Level of the achievement of the project purpose- Approaches of the project such as ①Combination of health facility improvement and community
empowerment ②Partnership with CARE Bangladesh ③Model Union Approach ④Upaliza Project
Implementation Committee /District Project Implementation Committee ⑤Private Community Skilled
Birth Attendant(3) Efficiency
Project is judged high in efficiency for the following reasons;- Activities are conducted as planned and scheduled- Maximum utilization of existing resources and minimum inputs from outside(4) Impact
Though the project achievement is highly recognized, further effort to systematize the methodology of theproject is required to achieve the overall goal.
The Ministry has showed strong interest about the CmSS-SMPP model, recognizing it as an effective tool torevitalize community clinics.
Considerable numbers of community groups are functioning in self-sustainable manner and expanded theirscope other than MNH.
(5) Sustainability
Project is judged moderate in sustainability for the following reasons;- Lack of supportive supervision is one of negative factor of sustainability of quality service.
- Conscious involvement of local government strengthen local ownership, which enhances thesustainability of CmSS.

3. Factors promoting better sustainability and impact(1) Appropriate approaches in the context of Bangladesh(2)JOCV members and competent local project staff(3) Active participation of local governments
4. Factors inhibiting better sustainability and impact(1) Shortage of human resource and frequent transfer of personnel(2) Insufficient budget allocation for each facility for maintenance of equipment and procuring daily items
5. Conclusion
The project purpose is considered to be achieved and improvement in maternal and neonatal health inNarsingdi was accomplished through three effective approaches; 1) dual wheels of EmOC public facility
improvement and sekf-sustainable community through CmSS, 2) involvement of local government toimprove its awareness and motivation, and to take leadership in provision of support for maternal andneonatal health improvement, and 3) strengthening coordination between DGHS and DGFP at each level.
Neonatal care and Post natal care services still remain challenges. Further effort in institutionalization of
the various approaches employed by the project and accelerating the on-going efforts of the health service
improvement would enhance the sustainability of the positive effects the project produced.
6. Recommendations(1) Issues to be considered by the project
1) Available data should be reexamined and further analyzed to clarify strengths and weakness of theapproaches of SMPP reflect positive ones in the next health sector program and related strategies
2) The project should clarify and implement the exit strategy in order to sustain the activities without
further external input.
(2) Issues to be considered by GOB in the long run
1) Service delivery capacity and functions of hospitals need to be strengthened.
2) To ensure optimum use of resources, reallocation of available resources such as human resources andlogistics at the district and division levels should be more rigorously pursued.
3) It is recommended that the Government of Bangladesh to consolidate existing committees into acommon platform to coordinate various health programs.
4) Narsingdi district is expected to be a learning site for other districts on effective implementation of safe
motherhood program.
7. Lessons Learned
1) Appropriate project management structure needs to be carefully considered and designed. In the project,
there was no official forum to have project implementation level discussions at a central level.
2) Projects should be designed at the very beginning to collect necessary scientific evidence to measure theachievement of the Project activities.
3) The approach of dual wheels of EmOC public facility improvement and self-sustainable community
participation through CmSS-SMPP was effective. As for the implementation process, supply sidestrengthening should be done prior to demand creation.