The eight Millennium Development Goals (MDGs) have galvanized unprecedented efforts to meet the needs of the worlds poorest. Japan, in line with MDGs, puts priority to the following three health related goals, "reduce child mortality", "improve maternal health", and "combat HIV/AIDS, malaria, and other diseases. So called "vertical approach" is not an answer. Key to success is the establishment of the clear strategy which stress the importance of public health system development. Human resource from donor side, especially the role of health policy advisor to the Government of developing countries, is an essential factor led to success.
As globalization has been accelerated, the partnership is getting important in the international society. JICA projects in Laos on "Public health" and "Pediatric infectious disease prevention" had achieved its goal of regional polio eradication under the strong partnership with Laos government, JICA, WHO and UNICEF. The global commitment at the WHO assembly contributed to the achievement by sharing common goal and partnership, which enabled to draw sufficient financial supports. However, in general, fewer efforts have been done among Japanese researchers/experts to examine the appropriateness of top-down global health policies. JICA should break away form the power of ministries which possess huge vested interests in ODA business so that the agency can find and address problems actively in the project sites. In this way, as one of influential nations in Asia, we can build equal partnerships in the international society, respecting diversity of environment and cultures of developing countries. It is also important to evaluate the funding flows and activities of the international organizations, which have been widely criticized for being lack of transparency.
The JICA KIDSMILE Project was launched in 2002, after the intimate review of many former projects in the Lao P.D.R. The overall objective of this project is to strengthen management systems for child health services. This project follows three main principles: 1) to respect not only vertical relationships but also horizontal networks (among departments, among ministries, and with donors), 2) to support existing Laotian activities, without introduction of new health service packages, 3) to improve the existing health systems which had been already implemented by Laotians before this project. The history of JICA's cooperation with the health sector in Laos demonstrates many past successes, such as the eradication of poliomyelitis in 2000. However, only several years after the end of technical cooperations, these outcomes have almost disappeared, and we are facing similar health problems as before, such as low immunization coverage. Now, we recognize that any health system cannot be sustained without stronger Laotian initiative or ownership. In the KIDSMILE Project, we want the Laotian health workers and administrators to consider what they can do by themselves as the real core implementers of all activities, for the sustainability of their work even after the project is completed.
In Lao PDR, while most of the projects used to be implemented as so-called "vertical programs", the Public-Private Partnership, such as Global Alliance for Vaccine Initiative(GAVI) and Global Fund(GF), has recently been introduced in the health sector. As a condition for their introduction, a coordination mechanism was established. In reality, however, the function of its mechanism is limited within its program only. In the centralized country, like Lao PDR, with limited management ability and nontransparent finance, the implementation of this mechanism is actually far from easy. While Japan has been the top donor country of Lao PDR, the cooperation strategy of Japan, mainly project-scheme, were not always appropriate for the coordination mechanism. In 2002, the Health Sector Master Plan (MP) was developed by the JICA Development Study and the National Growth and Poverty Eradication Strategy (NGPES) was also launched in 2003. In addition to these two policies, Lao PDR also has Health Strategy 2020 and Millennium Development Goals (MDGs). The contents of these policies are apparently very similar, though attempts have never been made to consolidate these overlapping policies and none of them has been implemented yet. In order to solve the above problems, it is essential to establish the coordination within the Ministry of Health as well as among donor agencies. For which, the Donor Coordinating Meeting and the Technical Working Group Meeting started in 2004. Now, the role of Japan is to assist the Lao government to implement the policies/strategies. In the context of Partnership, it is important to clarify the prioritized Japanese aid strategy and to enhance the coordination mechanism, which should be the main role of health policy advisor. For the effective implementation, some activities of the health policy advisor are incorporated into the newly proposed project of the capacity building for the sector wide coordination.
The Government of Tanzania has gropingly urged an enterprise of development partnership between the host government and funding donor agencies by promoting structural reformation and reinforcement of the government administrative functions. While Poverty Reduction Strategy Paper was accepted and implemented since November, 2000, the Government of Tanzania has spearheaded a challenge of uniformity of development modalities through sector reformations, funding integration and good governance by leading other neighboring countries. Hence, issue prioritization, budgetary integration, executive standardization were intensively discussed by the Government of Tanzania and stakeholders throughout an innovative process of development partnership. Simultaneously, Tanzania has released consecutive development plans such as "Tanzania Development Vision 2025", "Tanzania Assistance Strategy", "Poverty Reduction Strategy Paper" accompanied by the financial arrangement of "Public Expenditure Review" and Mid-term Expenditure Framework". These strategic development dispositions created an attractive environment for development partners to promote integrated financial assistant scheme. According to the Health Sector Reform in the Government of Tanzania since 1994, a practical application of development partnership has been initiated and implemented by the induction of "Health Sector Basket Fund", which was introduced by the accord of several donor partners and international agencies. This pooling fund mechanism aims to integrate current scattered budgetary systems and to promote transparency, accountability and ownership of the finance in the Health Sector. Indeed, the sector-specific Basket Fund forwarded the decentralization process of the Health Sector Reform in light of evidence-oriented health interventions at the district and community levels. In this paper, the present condition of the development partnership in the Health Sector of the Government of Tanzania is examined according to the background, adaptation, application, current considerations and future orientation of the development partnership.
In Thailand, the maternal and child health (MCH) handbook has been used for nearly two decades in one of the MCH activities. A cross-sectional study was conducted to assess the utilization of the MCH handbook, and to analyze the relation to mother's MCH promoting belief and action. The data was collected from 224 mothers at one district in Kanchanburi province, Thailand, from January to February in 2005. About the utilization of the MCH handbook by mothers, there was a low rate of reading (14.3% mother had read all of the contents) and self-recording (0.9% mother had recorded every part). Multiple regression coefficients showed utilization of the MCH handbook was related to both mother's MCH promoting belief (p=0.001) and action (p=0.039). This was the strongest predictor variable of mother's MCH promoting belief. Other factors which significantly related to MCH promoting belief were family income, age, and education, and relation to action were marital status, occupation and age. According to the findings of this study, for MCH promotion, mothers' belief and action can be inspired through utilizing the MCH handbook and comprehensive assessment.
The objective of this study is to assess the differences in access to antiretroviral treatment among health insurance recipients, using a patient-based analysis. METHODS: The subjects were 324 outpatients with the human immunodeficiency virus who were treated at a regional hospital for infectious diseases in Khon Kaen Province. We collected data every visit of the patients during the study period between April1 and September 30 in 2002. We defined access to antiretroviral treatment as having a prescription for antiretroviral drugs on at least one visit during the study period. We examined the relationship between access to antiretroviral treatment and age, sex, stage of acquired immune deficiency syndrome (AIDS), and health insurance. We also compared the results of the patient-based analysis and the record-based analysis that was used in our previous study. RESULTS: Multiple logistic regression analysis shows that patients insured by the Civil Servant Medical Benefit Scheme have better access to antiretroviral treatment than the others (vs. Universal Coverage; odds ratio=11.38, 95% confidence interval=4.09, 31.65). We have also shown that patients with AIDS-related complex have better access to antiretroviral treatment compared to asymptomatic AIDS patients (odds ratio=3.38, 95% confidence interval=1.31-8.76). Values of these odds ratios were lower in the record-based analysis than in the patient-based analysis. CONCLUSIONS: Patients insured by the Civil Servant Medical Benefit Scheme had better access to antiretroviral drugs. We reconfirm the differences in access to antiretroviral treatment among health insurance recipients, using the patient-based analysis.
There were 651 deliveries and 4 maternal deaths at Christian Hospital Chandraghona between October 2000 and August 2001. Eleven eclampsia patients were admitted and the mean age was 22.1 years. Ten patients were primipara and 1 patient was multipara. Among those eclampsia cases, 2 maternal deaths were observed and 10 patients delivered babies (8 live babies and 2 stillbirths). Delivery methods were 8 normal deliveries, 1 forceps delivery and 1 cesarean section. Ten patients had never consulted a doctor before eclampsia occurred. Eclampsia occurred at the third trimester of pregnancy in 9 patients and after delivery in 2 patients. Nine patients came to the hospital within 5 hours after the onset of eclampsia. Those who came late to the hospital progressed to be maternal death. To reduce maternal death, it is necessary to promote antenatal checkup and provide education about obstetrical complications at the grassroots level.
Purpose: To investigate characteristics of community-based issues in nutrition and to assess the effectiveness of a training programme developed to address them. Design: The JICA trainee was the chief of the nutrition section of the Nepali Ministry of Health. The project was undertaken after reviewing, in co-operation with JICA, the aims and expected results of the programme. The Nepali trainee alone determined the theme of the programme after considering results of an issue analysis. A programme was then designed to link policy with community realities, incorporating lectures, discussion, and on-site practice. Educational materials employed were those already in use in nutrition programmes both within Japan and in other countries. To create a plan of action, the trainee undertook an analysis of the Nepali communities' institutional and human resources. Evaluation of the training programme took place on two levels. The trainee self-evaluated her own issues analysis, community resource assessments, and action plan. Additionally, comments made by the trainee during the training period were recorded, categorized and evaluated. Results:
1. The trainee's analysis of the action plan:
1-1. Community issues were analyzed with support of the Japanese staff. The theme of the training was "Awareness of community resources is an essential part of any nutritional programme". 1-2. Through the analysis of institutional and human resources, the "Tea Shop" was found to be key to the community's nutritional improvement.
2. Staff analysis of the trainee's comments:
2-1. Five stages in the change of the trainee's attitude were observed. First stage: Shouldn't the responsibility for resolving nutritional issues be with local workers and organizations? Second stage: What are the needs of the local citizens? Third stage: What are the responsibilities of the leaders? Fourth stage: What is needed for me to fulfill my duties? Fifth stage: What is the first thing I should do after returning to my office?
2-2. Support by staff was thought to be effective in making clear the tasks required of the trainee, in providing a framework for understanding the issues from the community viewpoint, identifying methods for establishing links between community and government and making government-produced materials relevant to the community, informing the process of educational materials development, and analyzing community resources.