SUMMARY OF TERMINAL EVALUATION
1. Outline of the ProjectCountry: The Islamic Republic of Pakistan

Project title: The EPI/Polio Control Project

Issue/ Sector: Health-Medicine

Cooperation Scheme: Technical Cooperation

Division in charge: Health Division 4, HealthGroup 2, Human Development Department

Total Cost: (As of May 2011) 384 million yen

Period of
Cooperation

Partner Country's Implementing Organization:-Federal EPI of National Institute of Health (NIH)-Quality Control Laboratory (QCL) of NIH-Directorate General Health Service of Government (DGHS)
of Khyber Pakhtunkhwa (KPK)-Executive District Office-Health (EDO-H) in four districts;
Swat, Shangla, Buner and Haripur- EPI cell-Provinces (Punjab, Balochistan, Sindh)

7/September /2006~
6/September /2011

Period of Cooperation: 5 years
Supporting Organization:- National Center for Global Health and Medicine: NCGM
-The Research Foundation for Microbial Diseases of Osaka
University (BIKEN)
1-1 Background of the Project
Pakistan is one of the countries with the highest child mortality rate, such as under 5 mortality rate is
101 per 1,000 live births, infant mortality rate is 80 per 1,000 live births. Immunization coverage is not
optimal with polio being 65%, measles 67% and BCG 80% and many donors such as GAVI, WHO and
UNICEF have supported Expanded Programme on Immunization (EPI) with certain amount of inputs.
Japanese Government had also provided polio vaccine through grant aid scheme since 1996. JICA also had
dispatched long-term and short-term experts, provided equipment and offered the trainings in Japan. Basedon above cooperation and the request from Pakistan government, the EPI/Polio Control Project in Pakistan(hereinafter referred to as ‘the Project’) has been launched in September 2006 to last for five years until
September 2011, in order to increase the number of the children under the age of two who are vaccinatedin the target districts within the province of Khyber Pakhtunkhwa (KPK), namely Swat, Buner, Shangla
and Haripur. The counter- parts of the Project are Ministry of Health (Federal) and KPK Province’s healthoffice. Outputs of this Project are as follows, 1.”EPI services are properly provided in the target districts.”
and 2.”Parents ensure their children to be vaccinated in the target districts.” for districts of Swat, Buner,
Shangla and Haripur, 3.” Quality control capacity of QCL (Quality Control Laboratory)/NIH is enhanced.”for Quality Control Laboratory of National Institute of Health, 4.” Federal and Provincial routine EPI
system is strengthened.” for federal and provincial EPI cells. The chief adviser and project coordinator as
long-term experts and short-term experts of vaccine logistics, QCL capacity strengthening and EPI support
have been dispatched. EPI related equipment is also provided.The Advisory Study Mission was dispatchedin October, 2008 and the Mid-term review was conducted in October, 2009. The Terminal Evaluation Teamwas dispatched in April 2011, to confirm the achievement of the Project, to draw the lessons for the Project’sxiii

activities and related activities, and to collect essential information for the future plan of a project.
1-2 Project Overview(1) Overall Goal
Morbidity due to EPI-targeted vaccine-preventable diseases is reduced in the target districts.
(2) Project Purpose
Children under the age of two are vaccinated in the target districts.
(3) Output
1) EPI services are properly provided in the target districts.
2) Parents ensure their children to be vaccinated in the target districts.
3) Quality control capacity of QCL/NIH is enhanced.
4) Federal and Provincial routine EPI system is strengthened.
(4) Input (at the point of Terminal Evalutaion )Japanese side:
4 personsEquipment Provision

46 items: Cold chain equipment(refrigerators, freezers, temperaturemonitor), QCL equipment etc.
(40,340,908Pak Rs, 40 million JPY)

Short-term Experts(Vaccine Logistics, Vaccine
Quality Control etc.)

9 persons

Costs necessary for the
implementation of the
Project

62.8 million JPY(Local Consultant, Training
Expense)Trainings in Japan(Vaccine Quality Control
etc.)

15 persons

Local Cost (for whole
Project period)

16.2 million Pak Rs
16.2 million JPY

Long-term Experts(Chief Advisor, EPI
Support etc.)

Pakistan’s side:
Counterparts

40 persons

Others: Project Office was provided and the cost of electricity and water supply was paid by Pakistan side.
2. Evaluation Team
Members of
Leader
EvaluationTeam
EPI/Polio
Control

Dr. Mitsuo ISONO

Senior Advisor, Human Development
Department, JICA

Dr. Masahiko HACHIYA

Head, Infectious Disease Control Group
Department of International Medical
Cooperation, Japan
National Center for Global Health andMedicinexivPeriod of
Evaluation

Cooperation
Planning

Mr. Tsunenori AOKI

Deputy Director,
Health Division 4, Health Group 2
Human Development Department, JICA

Evaluation
Analysis

Ms. Yuko AOKIConsultant, Overseas Department,
Kokusai Kogyo Co., Ltd.

17/April/2011- 1/May/2011

Type of Evaluation: Terminal Evaluation

3. Results of Evaluation
3-1 Project Performance- Inputs and Outputs(1) Output 1: EPI services are properly provided in the target districts.
Output 1 is being partially achieved as the indicators for Output 1 shown below have been achievedin Haripur.
Indicator 1 “More than 80% of LHWs, EPI technicians and medical doctors are trained on EPI service
provision” was achieved, as 100% of LHW (731 persons) finished the training course of LHW routine EPI
involvement, 99% of EPI technicians (55 persons) and 100% of MO (Medical Officer) in charge of healthfacility (38 persons) have also completed their training courses in Haripur.
As for Indicator 2 “The number of immunizations administered by LHWs is increased.” the number of
immunization administered by LHW has been increased from 2009 in Haripur. Cases of immunization formeasles were increased from 9 to 722 in 2009 to 2010, 0 to 38 for BCG, 25 to 1698 for polio, 25 to 1698 forpentavalent, and 23 to 2349 for tetanus toxoid.
For Indicator 3 “The number of EPI centers having functional refrigerator is increased”, 27 refrigeratorsfor vaccines are going to be provided to EPI centers in Haripur for storage of vaccines for LHW and EPI
technicians. The number of EPI centers having functional refrigerator will increase from 32 to 59.
As for Indicator 4 “Out Reach Plan is formulated and implemented at First-level Care Facility (FLCF)
level”, according to the situation survey of Haripur, 46% of the EPI technicians had not planned andimplemented the outreach plan before the Project. Since the Project has supported the monthly meeting of
EPI technician, Out Reach Plan is re-formulated and strengthened implementation.
It could not be judged in other three districts (Buner, Shangla and Swat) due to suspension of the Project
activities.
(2) Output 2: Parents ensure their children to be vaccinated in the target districts.
It is difficult to evaluate Output 2 as the Project activities have not been conducted.
Indicators for Output 2, 1.:“The number of religious and community leaders, policy makers, parents,
caretakers of children, maleks, etc. who have participated in social mobilization activities in this project isincreased.” 2: ” The percentage of parents/caretakers of children under one year who recognize that routine
immunization course protects children under one year from 8 dangerous diseases, availing the services tocomplete the course in a timely.” and 3: “The percentage of parents/caretakers of children under one year
who accept that routine immunization is essential in addition to Polio drops during NIDs /SNIDs (Polio
campaign)” have not been achieved as the Project activities have not been conducted due to security reasons
KAP(Knowledge, Attitude and Practice) survey was conducted in Swat, Shangla and Buner in the first halfof the project period. Thereafter, the Project has not conducted the activities at this moment. A seminar forxv

88 members including teachers, community leaders and NGO staff, was held in Haripur in July 2009. Since
then, no activity was conducted until now.
As seen above, it’s difficult to measure the achievement by the indicators as the Project Activities havebeen interrupted in an early stage.
(3) Output 3: Quality control capacity of QCL/NIH is enhanced.
Output 3 is mostly achieved as Indicators shown below have been achieved.
In order to enhance quality control by QCL, the training of ‘Quality Control Testing Method’ and ‘Trend
Analysis’ by short-term experts and the training in Japan of ‘Vaccine Quality Control Technology’ wereconducted.
The indicator 1 “The number of trained QCL staff is increased.” has been achieved, as 7 QCL staff and 2
QA (Quality Assurance) staff participated in the training conducted by short-term experts and among them,
3 staff members participated in the counterpart training in Japan.
Indicator 2 “The knowledge and skill level of QCL staff is increased according to the set criteria, including
GMP.” has also been achieved. According to the Japanese expert, the capacity of trained staff in terms ofknowledge and skill has been improved through the above mentioned trainings.
Indicator 3 “Procured equipment of the QCL is properly utilized and maintained.” has been achieved, as
it was confirmed that almost of all the provided equipment are used and well maintained by the terminal
evaluation team.
(4) Output 4: Federal and Provincial routine EPI system is strengthened.
It is difficult to judge Output 4 at the time of terminal evaluation.
Indicators for Output 4 are 1:” Stock-out days of vaccines and maximum interval of vaccine receipt at
provincial and district vaccine storage is reduced.” 2:” The number of training monitoring and evaluation
is increased.” 3.:“The quality of routine EPI data is improved.” and 4:” The number of monitoring by
provincial EPI Cell and Provincial National Program is increased.”
Since the training course was completed in February, 2011 in all districts of 4 provinces for indicator 1, andthe training of EPI data management has just been completed in March, 2011 for indicator 2, 3 and 4.
To evaluate these training courses, it is necessary to standardize the data format for EPI. However,currently the Project activities are at the stage of integration of the monitoring/evaluation format in KPK
only and have not started in other 3 provinces.
-Project Purpose
The Project purpose was achieved in Haripur as three indicators shown below have been achieved,
but not in Swat, Shangla, and Buner for interruption of the Project Activities.
Indicator 1:” The number of immunized children with measles or pentavalent vaccine under one year-old isincreased.” has been achieved, as the number of immunized children with measles and pentavalent vaccine
under one year-old increased in the last five years in Haripur. The Project contributed to this progress
mainly by introducing LHWs’ involvement in EPI service from 2009. The number of vaccination increasing
started earlier than the Project (from 2008) in Haripur, it can be judged that this improvement was mainly
contributed by the efforts of district government.
Indicator 2: “Reported routine EPI coverage (DPT/Pentavalent) increased” has been achieved for five
years in Haripur. The degree of increase in Haripur appears greater than those of other districts in KPK, but

xviinterpretation of this figure should be made very carefully as the coverage (immunized population/target
population) in Haripur showed over 100% The reason of this can be suspected that the population data forcoverage calculation may be lower than actual number as is based on the census in 1998.
Indicator 3 “Drop-out rate of Pentavalent [(Penta 1-Penta 3)/ Penta 1] is reduced” has been achieved in
Haripur as drop-out rate is tending to decrease from 2008, it dropped from 851 cases into 419 cases from2009 to 2010.
- Prospect of Overall Goal
The achievement of the overall goal cannot be verified at the point of the Terminal Evaluation.
Indicator 1: “Polio free is maintained” was difficult to be judged. Polio cases were reported in Swat andShangla, but not in Haripur and Buner in the last five years. The Project’s contribution to polio control
seems to be limited, and repeated polio immunization campaigns play a major role in controlling polio.
Indicator 2: “The incidence of measles is reduced.” was also difficult to be judged. Measles incidence
was not reduced. The surveillance data shows the incidence peaked in 2007 and incidence in other years
were relatively low. Considering the epidemiology of disease, unstable values may result in reflect naturalfluctuation rather than project effect.
Indicator 3: “The incidence of NT is reduced.” was also difficult to be judged. Neonatal tetanus did notdecrease in incidence. The effect of the Project activities cannot be measured because of the short durationof observation period, difficult clinical diagnosis, and low incidence.
3-2 Summary of Evaluation Results(1) RelevanceThe relevance of the Project is high, considering the importance of EPI/Polio control in global trend andin Pakistan, consistency of the development plan of government of Pakistan and the assistance policy of
government of Japan. Moreover, Japan has the advantage in EPI fieldProtect against infectious diseases is the priority subject in millennium development goal and Pakistan’s
strategy of poverty reduction. In a budget document of Ministry of Health, PC-1(2009-10- 2013-14), EPIroutine activities are included. The Project also follows other health policies and strategies, National HealthStrategy, National EPI Policy and National Emergency Action Plan for Polio eradication (NEAP) 2011.
LHW is obliged to do EPI service under the current EPI policy.
There is consistency with Japanese ODA policy in priority subjects of health and population. EPI service
delivery itself is the basic health service and the Project’s plan of training for LHW and EPI technicians tocontributes to universal access of EPI service to communities.
As JICA has experiences of technical support on EPI field, by dispatching short-term experts in Pakistan
and by EPI projects in China and other countries, those experiences can be utilized in practical support for
EPI service.
(2) Effectiveness
Effectiveness of the Project is can be judged as generally high. Effectiveness of each Output for the
Project purpose “Children under the age of two are vaccinated in the target districts.” is as follows.
Regarding Output 1: “EPI services are properly provided in the target districts.”, effectiveness can beobserved in Haripur. Output 1 is contributing to the Project Purposes, through involvement of LHW andstrengthening of recording and reporting system of EPI, the Project activities turned out the significant

xviiincrease of vaccination especially by LHWs and coverage of immunization.
Output 2:”Parents ensure their children to be vaccinated in the target districts.”, effectiveness cannot be
observed as the Activities were not conducted.
Output 3:”Quality control capacity of QCL/NIH is enhanced.”, effectiveness can be observed indirectly. As
results of comprehensive technical training was conducted to strengthen the skills of QCL staff, provision ofequipment including instruction of its maintenance, and monitoring QCL, quality of the vaccines for EPI has
been secured.
Output 4: “Federal and Provincial routine EPI system is strengthened.”, it’s difficult to judge theeffectiveness as the activities for Output 4 have been in the middle of implementation. At this moment,
there were no effects observed by these activities. However, considering response from trainees andrelevant parties, calculating accurate number of immunization and stable supply of vaccines by EPI data
management can be expected. Thus, effectiveness can be expected if all the activities are completed at thetime of termination of the Project.
(3) Efficiency
Efficiency can be judged as middle level.
As Training courses for LHW for Output 1:“EPI services are properly provided in the target districts”
have not been implemented as planned in three target districts due to security reasons, the efficiency was
rather low. All the equipment provided towards those districts is unable to monitor its use at the time of the
Terminal Evaluation.
The Activities of Output 2:“Parents ensure their children to be vaccinated in the target districts”, such as
promoting the understanding of immunization for religious leaders, have been interrupted due to security
reasons in three target districts. And there were no such activities conducted in Haripur as it was judged low
priority by Japanese experts. The efficiency of the Output 2 should be considered as low in this regard.
Regarding Output 3:“the strengthening of QCL”, the experts and equipment were inputted as scheduled
and related activities were implemented along with the plan. As a result, indicators have been alreadyachieved at the time of terminal evaluation. Thus, the efficiency of the output 3 is high.
Activities for Output 4:“Federal and Provincial routine EPI system is strengthened.” target four provinces.
As Japanese experts and even project local staff are not able to access some area in those provinces due tosecurity reasons, counterparts need to travel to Islamabad. Activities were conducted after getting consensus
among the relevant parties and were conducted smoothly and appropriately. However, not all of planned
activities have been completed at this moment therefore it is too early to judge its efficiency.
(4) Impact
It is difficult to determine the possibility of the achievement of the Overall Goal at this moment.
In terms of positive impact, a mechanism for EPI service delivery including reporting system which wasdeveloped in Haripur has been highly evaluated and the performance of LHW in Haripur is recognized asa good practice by stakeholders. It is expected that the National Programme will contain these systems tointroduce them to other districts.
Judging from interview survey by the terminal evaluation team, it was found that LHW became confident
and well-motivated after the EPI services training. Thus, it is expected that their routine activities will bewell motivated and resulting in providing better health care services to communities.
No negative impact was observed.

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(5) Sustainability
It is judged that the sustainability of the Project is expected in certain level.
Political Sustainability of Project Effects: One of the Project Activities, LHW’s involvement in EPI service
provision was cited in Mid-Term Development Framework 2005-2010 and National EPI Program. The
LHW activities related EPI service delivery will be cited in a new National EPI Policy which is drafted now.
Institutional Sustainability of Project Effects: The Federal and Provincial EPI cells have alreadystrengthened their capacity with adequate number of staff members for EPI service delivery. It is expectedthat these institutions will be able to sustain current capacity after the devolution. Through the various
training courses implemented by the Project, counterparts acquired knowledge and skill. However,those trainings have been conducted only by the Japanese side and the Pakistan side has not been fully
involved. This is due to the lack of adequate human resources in Pakistan side, especially at provincial
levels. Considering this situation, the Project aimed to institutionalize the reporting to obtain technicalsustainability. In future, to obtain the institutional sustainability, a planning and management for proper
human resources allocation will be expected on EPI cells of the federal and provincial levels.
Technical Sustainability of Project Effects: Regarding the output 1:”EPI services are properly provided
in the target districts.” in Haripur, the routine EPI service delivery system through EPI technician and
LHW have been observed well developed. And the KPK Provincial EPI cell has acquired sustainability tomaintain this mechanism technically. For the output 3:”strengthening of QCL”, technical sustainability of
the QCL is high as through the Project, all the staff members have obtained knowledge and skill to deal withthe equipment related to QCL. Regarding the output 4 :”strengthening of routine EPI system in Federal andProvincial EPI cells”, to obtain the technical sustainability, the Project team will still have to be worked onas remaining tasks.
Financial Sustainability of Project Effects: The main implementation body of EPI service provision
will be Provincial Government after the devolution (from federal to province), each Province EPI cell iscurrently reviewing its PC-1 for the next fiscal year (starts from June, 2011). It is expected that proper
service provision would be made as planned though, the Federal and Provincial EPI cells still rely on donors
for operational costs. There were interruptions of trainings or delay of salary payments due to problems
regarding contracts with donors. Thus, the Federal and Provincial EPI cells will have to continue theirefforts to secure the budget.
As for QCL, the financial sustainability is high, as the budget is allocated according to the national
component of PC1.
3-3 Factors promoting better sustainability and impact(1) Factors concerning to Planning
None could be observed.
(2) Factors concerning to the Implementation Process
The Japanese Experts have been attending those regular meetings with counterparts or other organizations
to exude their presence and to share the information about the Project, and to collect the necessary
information on EPI. Some of the meetings were essential for smooth implementation of the Project.
Especially, at the EPI review meeting in September. 2009, the chief adviser share the information on
the concept of vaccine logistics Management and EPI data management, as a result, the concept wasrecognized as a practical mechanism by relevant parties. Soon after that, the component of Vaccine Logistics

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Management was included in PC-1 (Federal) at the time of its revision.
3-4 Factors inhibiting better sustainability and impact(1) Factors concerning to Planning
The Activities of Output 2” Parents ensure their children to be vaccinated in the target districts.”, such as
for religious leaders to promote understandings of EPI towards parents in target districts have not been done.
Which was judged by the Japanese Experts as the priority of these activities was not high in the targeted
district. This might indicate that there was mismatch between the project design and actual situation in
Pakistan. Thus, those activities should have been modified through revision of PDM at the certain point oftime after the midterm review.
(2) Factors concerning to the Implementation Process
While Japanese experts have been communicating with counterparts and other related institutions byattending those conferences above, some concerning factors can be observed as follows.
1)	Non-existence of oversight on the Project: a function to oversee whole activities was not formulated by
the Project even though the counterparts are varied according to the activity of the Project.
2)	Less communication among counterparts: Especially with EPI and National Program of federal andprovince levels, a communication channel was not well organized.
3)	Since the bombing of the madrassa in KPK in October 2006, security problems such as suicidebombing have become widespread and serious. Also, the activities related to health and education has
been restricted due to deterioration of security conditions, and Japanese experts were not able to workin the project sites since May 2007. Furthermore, Japanese experts could not visit even Peshawar andstarted to send national staff of the Project to the project sites for implementing the project activities
and invited the counterparts to Islamabad for meetings. The Project had newly employed medical
doctors as national staff to re-start and promote the activities in three target districts. However, thegrave security condition did not allow them to do so fully. Responding the above situation, in October
2008, Advisory Study Mission was dispatched to Pakistan to review the activities and progress of the
Project. The Advisory Study Mission selected Haripur as new target area among the candidate districts.
The addition of new target district to the Project was approved in second JCC in April 2009. Since
dispatching the Advisory Study Mission, security condition has not improved and the activities inthree target districts have remained suspended. The project activities in Haripur, however, have been
implemented until now. And the training on EPI Data Management has been newly conducted targeting
KPK after the Mid-term review. Furthermore, on July and August 2010, Pakistan suffered extensive
damages from floods. And some of the Training courses of the Project had to be suspended for threemonths, as there was no other choice.
3-5 Conclusion
The Project Purpose has been achieved in Haripur From the view of evaluation of five criteria, relevanceis high, effectiveness is also almost high, and efficiency is moderately high. As for impact, “Prospect for
the achievement of the Overall Goal” cannot be confirmed at the moment. Although EPI service provision
mechanism including reporting system and LHW’s performance in Haripur were not implemented in otherpilot areas including Swat because of security issues, output 1 “EPI services are properly provided in thetarget districts” and output 3 “Quality control capacity of QCL/NIH is enhanced” were partially achievedxxwith clear results in Haripur. As for sustainability of the Project, political aspect of sustainability is assured
though, from institutional aspect, it is needed to proper allocation, plan and management of human resourcesfrom federal to provincial level. Technical aspect of sustainability is almost assured though, continuous
activities until the termination of the Project is required to ensure the Output 4 “Federal and Provincial
routine EPI system is strengthened”. Financial sustainability will be tough issue for Pakistan as it has
chronicle shortage of budget and depending on donors’ support for EPI operational cost, continuous efforts
to obtain the resources is needed.
There were several hindering factors such as change of target areas due to deterioration of security
condition and flood etc…during the implementation process of the Project. The Project team made efforts
to continue the activities they could do in those limited areas. At the moment, the sustainability in termsof technical aspect is not enough, and one of the reasons behid is the length of the project was not enough.
It is necessary that Japanese experts will do their best to assure technical sustainability untill the end of
the project. However, certain results are evaluated from this project, and it is expected to wrap up the
cooporation with the enhancement of technical sustainability within the remaining 6 months. Therefore,
the suspension of the project is not necessary. Meanwhile, Japanese yen loan project “Polio Eradication
Project” has been initiated since August 15, 2011. It should be discussed the possibility of the new technicalcooporation project for the enhancement of EPI to strengthen the emerging yen loan project.
3-6 Recommendations(1) Communication between federal and provincial level has not been enough as the Project activities havebecome diverse after the mid-term review. Thus, it is recommended to enhance communication among all
stakeholders including the Federal and Provincial EPI cells, NIH and other partners to solve the problemsof comprehension of the Project activities by federal EPI cell.
1)	Also, it is recommended to organize a meeting with all stakeholders to share the achievement of the
Project and develop a plan for each output on how to bring the maximum effect of the Project in theremaining period.
2)	Enhancing capacity by conducting training is the major approach of the Project implementation. It is
recommended that the Pakistan side obtain sustainability to conduct these trainings after the end of the
Project. However, as described above, as there are not enough caretakers at provincial levels in thisregard, the Project is recommended to develop training mechanisms with the documented concepts,
so that the Pakistan side can, at least, conduct those trainings by assistant of third parties. Also, it isrecommended to draw lessons learnt from evaluation of the trainings. Also, the federal and provincial
EPI are recommended to enhance intuitional capacity to conduct those trainings.
3)	As for output 1 “EPI services are properly provided in the target districts.” It was recognized thepositive effect of involvement of LHW into EPI program. However, as recommended at the mid-term
review, effects of involvement of LHW have not been analyzed well. Thus, for further progress, theFederal EPI, along with the National Program, is recommended to analyze effects of involvement of
LHW on EPI program, including effects of BCC activities by LHW and impacts, either positive or
negative, by LHW activities for immunization.
4)	As for the activity for output 1 “EPI services are properly provided in the target districts.” which ismaking and implementing of outreach plan by EPI technicians, EPI technicians have been able todevelop outreach plans in Haripur. But, not enough monitoring on implementation of those plans has
been done. It is recommended to develop monitoring and feedback mechanisms of implementation ofxxithose plans.
5)	As for output 4 “Federal and Provincial routine EPI system is strengthened”, for EPI logistics and data
management, the Japanese side is recommended to continue technical assistance so that the Pakistanside can obtain technical sustainability in these fields within the Project period.
6)	At this moment, it is impossible to obtain certain numbers of indicators, especially for output 4“Federal and Provincial routine EPI system is strengthened” of EPI data, vaccine stock and etc... Since
these indicators are very important to judge significance of the Project, the Project is required to collectdata regarding these indicators by the end of the Project period.
7)	As for one of the activities for output 4 “Federal and Provincial routine EPI system is strengthened”,
the Project has finished trainings on EPI data management in only twelve districts in one province atthis moment. Since this training is very meaningful for EPI program and planned to conduct in four
provinces to bring maximum effect of the Project. Thus, the Project is recommended to conduct thesetrainings in remaining provinces as much as possible.
8)	For the activity 4-4 (Conduct analysis and assessment of EPI disease surveillance data at Federal andProvincial EPI Cell) of output 4, the Project is recommended to develop the criteria for validation ofdata quality to assess surveillance data.
3-7 Lessons Learned(1) In the process of on devolution (from federal to province), more decision making authority will bedelegated to provincial level. Under such a circumstance, it is more important to share the contents of the
Project activities among federal level and other donors to ensure maximum effects and development of
Project activities.
(2) It is the same in other projects in Pakistan, the Project tended to be “rendering of service” rather thanenhancing capacity development. It is essential for capacity development that a Project has precise project
design and active approach to Pakistan side before and during Project period.
(3) Regarding the project design, it should be carefully considered that an approach “build implementing
system as a model in a target area and try to expand to country wide“ is very difficult not only to
implement, but to obtain consensus from relevant parties in Pakistan.
(4) As seen in the training course of the Project, there was lack of recipient institutions and human resources
for implementation of training for capacity development. It is important to do deep discussion about it withcounter parts beforehand for better understandings about sustainability of the project and confirmation of
the recipient institution.
(5) Since the project activities tend to be “service rendering” technically and financially, it is recommended
to discus with counter parts beforehand so that counter parts have more ownership and responsibility.
(6) Since the counterparts were assigned according to each activity of the Project, there was no one tooversee and manage those counterparts as a whole. Regarding this matter, a person who is in charge of theentire project activities must be chosen at the beginning of the project design, or meetings such as JCC
should be set to make the counterparts well coordinated.

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(7) When having projects with the possibility of having various restrictions on project activities becauseof the bad security situation, one’s safety must be the first priprity for experts. If possible, local resources
should be utilized, and a structure for the smooth implementation must be prepared.

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