Project-Financed PHN Research

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stroke and heart disease (Finland), and<sup>an industri-</sup> alized country which has succeeded in<sup>reduciz.g</sup> stroke and heart disease (the United States).

Another successful health research effort established with the additional project<sup>funds is</sup> being carried out in Beijing in cooperation with Oxford University. The study Is<sup>tracing the</sup> effects of different regimes of treating stroke<sup>on</sup> mortality and recovery time.

Yet another study made possible with the additional project funds is the world's<sup>largest study</sup> linking health practices and cause of death.<sup>More</sup> than 500,000 people have been identified and<sup>will</sup> be. monitored over a twenty-year period.<sup>Of key</sup> interest will be the information the study yields about the link between smoking and mortality, since nearly all the existk g studies of smoking<sup>and</sup> mortality have been carried out in industrialized countries and may have limited applicability<sup>in a</sup> developing country.

Finally, the project has financed part of an ongoing study of adult-onset diabetes with cooperation from researchers in the United Kingdom, Finland, France, Italy, and the United States.

Other Chinese projects have also resulted in successfil project-financed research. The<sup>Rural</sup> Health and Preventive Medicine Project<sup>(Second</sup> China Health Project) approved in fiscal year<sup>1986</sup> financed research into alternative insurance schemes which has influenced Chinese rural<sup>health</sup> policy. The Integrated Regional Health<sup>Develop-</sup> ment Project approved in fiscal year 1989<sup>has</sup> funded research to determine if school-based programs influence smoking behavior among<sup>par-</sup> ents. Cartoon books about the health risks<sup>associ-</sup> ated with smoking were the basis for an<sup>experi-</sup> mental curriculum. The result of the program<sup>was</sup> an immediate sharp drop in smoking among<sup>the</sup> parents of the children taking part in the program.

Project-financed research will continue<sup>to</sup> influence Chinese health policy. For example,<sup>a</sup> fiscal year 1992 Bank loan focuses on schistosomiasis and tuberculosis control. The TB<sup>treatment</sup> regime to be extended on a wide scale<sup>is one</sup> developed with project-financed research<sup>from the</sup> fiscal year 1984 Rural Health and Medical<sup>Educa-</sup> tion Project.

# _India-Tami Nadu_

The Tamil Nadu Integrated Nutrition Project in India was an innovative and hi'ghly successful project. It showed that large-scale, communitylevel interventions in the social sectors<sup>can work.</sup> (rhe credit became effective in August 1980<sup>and</sup> closed at the end of March 1989. This<sup>section</sup> draws heavily on the Project Completion<sup>Report</sup> for the project.) The project as designed included provision for a baseline survey and formal mid-term<sup>and</sup> final evaluations. Partly because the mid-term evaluation findings were not ready until 1986,<sup>they</sup> were not acted upon by project management<sup>until</sup> work began on the design of the Second Tamil Nadu Nutrition Project approved in fiscal<sup>year</sup> 1990. However, the results of both the mid-term and final evaluations did have a significant impact on the design of the second project.

The Project Management Unit (PMU) had<sup>at</sup> its disposal funds to commission small, stand-alone research projects and some 40 to 60 such<sup>studies</sup> were authorized. Most were judged by Bank<sup>staff</sup> to be of poor quality and had only a limited<sup>impact</sup> on the redesign of the project. In retrospect,<sup>the</sup> fact that the PMU had great freedom in<sup>commis-</sup> sioning research and so could act rapidly and<sup>with</sup> great flexibigity also contributed to poor<sup>research</sup> design and limited usefulness. It indicates<sup>that a</sup> more formal research committee with qualified members which could review proposals for<sup>rele-</sup> vance and methodological soundness would<sup>have</sup> been a better mechanism. The fact that the<sup>stand-</sup> alone research component was not a very significant part of the total project may have meant<sup>that</sup> Bank staff could not devote sufficient supervision