Health sector has increasingly played a critical role in global trends of development assistance toward focusing human-centered development and poverty reduction, sharing common goals such as `Millennium Development Goals', and expanding sector-wide approaches and donor harmonization. Japan has contributed to the developing world as the top or leading donor over a decade, and has extensively committed itself to health-sector assistance. In particular, Japan has announced commitments to fighting some of the global health issues through the Global Issues Initiative on Population and AIDS, the Global Parasite Control for the 21st Century known as Hashimoto Initiative, and the Okinawa Infectious Diseases Initiative. However, to increase efficiency and effectiveness, and world's proper appreciation of Japan's development assistance for health, some challenges should be tackled, including priority settings in issues and approaches, more strategic collaboration/coordination with overseas and Japanese development partners, and human resources development and retention in Japan.

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 The opportunity for the community health nursing profession to engage in international cooperative activities is increasing in recent years. Many challenges are anticipated for developing the cooperative activities, since the basic situations in each country regarding the environment, the cultural background or the health system are quite different. However analysis of the challenges is not enough, we must also understand limitations based on individual personal experiences. The purpose of this report is to describe the challenges that interrupt the development of cooperative activities.
 The target group was sixteen public health nurses who were sent to developing countries as JOCV (Japan Overseas Cooperative Volunteers) from June1997 to March 1999. The research was conducted for two years. Data were collected from each participant using five semi-structured questionnaires and analyzed using qualitative methods for the following areas: (1) challenges, (2) changes in viewpoints about the language learning, and (3) changes in participants' health conditions.
 Fifteen participants returned the questionnaires. Results showed wide variation in the challenges described, and the challenges changed during the period of assignment. During the beginning period, there were many descriptions about difficulties based on daily life and cultural adaptation. Afterward, challenges based on the cooperative activities became the core of issues to resolve. Some challenges involved a lack of information for planning the cooperative activities, lack of funds, a too-short time frame, local staff's resistance to the out-reach activities. Also some issues were very difficult solely on the basis of the personal effort required
 When we carry out cooperative activities in developing countries, there will inevitably be various challenges. However, there are two types of challenges, challenges able to be resolved by personal effort and challenges in need of system responsiveness. To develop effective cooperative activities in a limited period, it is necessary to understand the possible challenges that will happen and take measures to prevent avoidable situations.

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 Between June 1998 and January 2000, "The Master Plan Study on Strengthening Primary Health Care Services (JICA PHC Study)" was executed in the Republic of Malawi. The purpose of the study was to formulate a central region master plan and a national master plan to improve the primary health care (PHC) system, and to transfer essential research, analytical skills, and methodologies to Malawian counterparts. The health investigations covered the referral system, human resources, health finance, policy and management, the health management information system, community participation, logistics systems and health facilities and supplies. As a result of the study, childhood malnutrition, maternal health, and the inappropriate role of informal drug-sellers, in the PHC system were found to be key health issues, and on the basis of these problems the national master plan was formulated with six prioritized proposed projects. In this report, the following challenges to the execution of effective and efficient study were discussed and recommended through the review of health development studies conducted in five developing countries including Malawi; 1) the study purpose and the concept of a master plan should be clarified, 2) the study outcome should be evaluated and utilized effectively, 3) terms of reference for the study should be reviewed and improved, 4) a better relationship with counterparts and donors should be developed, and 5) a capacity of participants in the study such as consultants should be built up.

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