1. Background of Project

In Zambia, infectious diseases are the principal causeof ill health. Specifically, 20 percent of the adultpopulation is infected with the AIDS virus, and theincidence of tuberculosis has increased rapidly since themid-1980s. Against this background, Japan implementedProject-type Technical Cooperation titled "University ofZambia, School of Medicine Project" from February 1980to February 1989. This project provided technicalcooperation to the University Teaching Hospital inZambia (UTH) mainly in the fields of neonatal care andpediatric surgery. Following this project, another Project-type Technical Cooperation, "Infectious Diseases Project"was implemented in the field of medical technology forviral diseases from April 1989 to March 1994.

Based on the outcome of these previous cooperationactivities, the Government of Zambia requested Japan toprovide technical cooperation with the aim of strengtheningthe functions of the UTH Virology Laboratory, which hadbeen set up through the Infectious Diseases Project, sothat the Laboratory would be capable of laboratorydiagnosis not only on viral diseases but also bacterialinfections.

2. Project Overview(1) Period of Cooperation

1 April 1995-31 March 2000

(2) Type of CooperationProject-type Technical Cooperation

(3) Partner Country's Implementing OrganizationUniversity Teaching Hospital in Zambia (UTH)

(4) Narrative Summary1) Overall Goal

To control infectious diseases in Zambia throughdevelopment of human resources.

2) Project PurposeTo strengthen the functions of the VirologyLaboratory at UTH as a public health laboratory

for improved diagnosis of infectious diseases.3) Outputs

a) The quality of laboratory diagnosis on infectiousdiseases at UTH is improved.

b) Etiological and epidemiological studies oninfectious diseases are conducted at the hospitaland in communities.

c) The surveillance system for infectious diseases isstrengthened.

d) Essential laboratory techniques for infectiousdiseases are improved at the district level.

e) Data obtained from the project are effectivelyutilized.

4) InputsJapanese Side

Long-term experts 8Short-term experts 14Trainees received 10Equipment approx. 212 million yenLocal cost approx. 118 million yen

Zambian SideCounterparts 17Land, facilities, equipmentLocal cost approx. 1 million yen

3. Members of Evaluation Team

Team Leader:Youichi MINAMISHIMA, Vice President, MiyazakiMedical University

Epidemiology and Human Resource Development:Hiroshi SUZUKI, School of Medicine, NiigataUniversity

Bacteriology and Immunology:Kazuo SUGAMURA, School of Medicine, TohokuUniversity

Virology:Kiyoto NAKAMURA, School of Medicine, YamagataUniversity

Project Management:Ikuo TAKIZAWA, Second Medical Cooperation

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Zambia

LusakaAngola

Namibia

Botswana ZimbabweMozanbique

The Democratic Republic of Congo

Tanzania

Malawi

Zambia

LusakaProject Site

Infectious DiseasesControl Project

Division, Medical Cooperation Department, JICA

4. Period of Evaluation

20 July 1999-5 August 1999

5. Results of Evaluation(1) Efficiency

Since most of the inputs including major equipmentwere implemented effectively and produced a number ofoutputs, they were judged to be mostly efficient.However, due to the characteristic of research-orientedprojects where core activities bring about a number ofsmaller research themes, project activities tended todiffuse over time as the project progressed, which madethe implementation of specific research programs andoutput-oriented project management difficult. Also, theconsiderable delay in the dispatch of one long-term expertand the consequent delay in activities of the tuberculosisdivision might have restricted achievement of theanticipated outputs.

(2) EffectivenessMost of the planned transfer of microbiological

techniques (viruses and acid-fast bacteria) were completed.Also, through five technical workshops for districthospital staff, the project trained a total of 226 doctors andtechnologists on surveillance and laboratory diagnosis ofHIV and polio. From these achievements, it wasconsidered that UTH established its technical andorganizational base for carrying out surveillance ofinfectious diseases as well as providing technical supportfor other laboratories in the country; thus, the purpose ofthe project was mostly achieved.

(3) ImpactThe UTH Virology Laboratory gained increasing

gained an international reputation because of its improvedlaboratory techniques and research capacity. TheLaboratory was designated as a national referencelaboratory for the polio eradication program under theAfrica Regional Polio Laboratory Network, and was alsorecognized as a national institute for influenza by WHO in1997. As a result, researchers in Zambia were highlymotivated to work in the Laboratory, which may have along-term impact on retaining highly skilled humanresources within the country. Moreover, data collected bythe etiological and epidemiological studies supported bythe project provided valuable base-line information for thehealth reform proceeding in Zambia. In this way, theproject also contributed to the better control of infectiousdiseases.

(4) RelevanceControl of infectious diseases has continued to be an

urgent and important public health issue in Zambia. Therecently defined essential package of health-care servicesalso included control of infectious diseases as one of its

major targets. Also, it was significant to developvirological laboratories in Africa, where the basis forvirus control is still fragile, and therefore relevance of theproject was considered to be high.

(5) SustainabilityThe retention rate of trained counterparts in the UTH

Virology Laboratory was high. It was thus consideredpossible that they would continue to supervise and guidethe younger members of the laboratory staff. Regardingfinancial aspects, the activities of UTH related to polio,HIV and influenza were receiving financial support fromdonors including NORAD, WHO and UNICEF. Otheractivities that were currently funded from the projectwould likely be sustainable to some extent considering theefforts of the Laboratory to introduce cost-sharingmechanisms through charging for some of the services itprovides. However, there were some concerns over theavailability of funds for operation and maintenance ofequipment provided, especially for the supply of high-costconsumables necessary for some equipment.

6. Lessons Learned and Recommendations(1) Lessons Learned

When planning a project that includes components ofresearch and development, the planners should prepare, inaddition to PDM and other standard project documents, adetailed implementation plan of individual researchprograms. Once such a project starts, the implementersshould always make sure that the activities are carried outin accordance with the implementation plan.

(2) RecommendationsSince the tuberculosis section had not fully achieved

the intended output due to the delay in the dispatch of onelong-term expert, it was recommended to extend the termof the expert for one year and to provide additionaltechnical cooperation after the termination of the project.Also, in the event Zambia requests another technicalcooperation project to utilize the UTH VirologyLaboratory, it was considered desirable that the Japaneseside respond to the request positively after confirming thepossibility of securing the necessary support mechanism(i.e., human resources to be dispatched as experts and hostorganizations to accept Zambian trainees).

7. Follow-up Situation

Based on the above recommendation, the term of theexpert in the field of tuberculosis was extended one yearand two months.

In addition, with the aim of strengthening the systemof testing for AIDS and tuberculosis (as an AIDS-relatedcomplication) infection, Project-type TechnicalCooperation, "The HIV/AIDS and Tuberculosis ControlProject" is being implemented for a five year durationfrom 30 March 2001.

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1. Background of Project

Despite the Zambian Government's efforts to promotethe construction of wells in villages in the SouthernProvince, many facilities were not in use due to thelowering of the water level of shallow wells andbreakdown of pumping facilities. As a consequence, thewater supply coverage rate was estimated to be as low as18 percent. Community people resorted to using hand-made shallow wells, distant surface water and stagnantwater for their water supply, and drank this water withoutfiltration or boiling. The situation was further aggravatedby low rainfall in 1992, and the shortage of domesticwater and incidence of diseases associated with waterbecame serious.

Under these circumstances, the Government ofZambia formulated a plan for the construction of boreholewater supply facilities and the improvement of waterconditions in the villages in southern provinces, andrequested Grant Aid from Japan. In this project, DfIDoversaw the maintenance activities of wells carried out bycommunity members under the WASHE program1).

2. Project Overview(1) Period of Cooperation

FY1996

(2) Type of Cooperation

Grant Aid

(3) Partner Country's Implementing Organizations

Ministry of Energy and Water Development (MEWD)Department of Water Affairs (DWA)

(4) Narrative Summary

1) Overall GoalThe incidence of disease associated withinadequate water and poor hygiene practices and

burden of water collection on community peopleare reduced.

2) Project PurposeCommunity people in the project sites have accessto safe water for domestic use.

3) Outputsa) 60 borehole facilities with hand pumps are

constructed.b) Resources and equipment necessary for the

maintenance of borehole facilities are provided. c) The organizational capability and activities of

WASHE committees are enhanced in order tostrengthen the maintenance activities of boreholefacilities. (DfID)

4) InputsJapanese Side

Grant Total 702 million yen(E/N amount)

Zambian SideLand

3. Members of Evaluation Team

JICA Zambia Office (Commissioned to ASCO, accompanied by HarumiIDA, Project Formulation Adviser, JICA)

4. Period of Evaluation

7 November 1999-20 November 1999

5. Results of Evaluation(1) Efficiency

The construction of boreholes and the provision ofresources and materials were implemented as scheduled.

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Zambia

Angola

Namibia

BotswanaZimbabwe Mozambique

The Democratic Republic of Congo

Tanzania

Malawi

Southern Province

Lusaka

Zambia

Monze, Sinazongwe, and NamwalaDistricts in the Southern Province

Project Sites

Southern Province WaterSupply Project

(2) Effectiveness

A total of 220 borehole facilities were installed in thevillages and the schools in the city and nine districtsthrough Phase I and II of this project.

Most of the sixty boreholes constructed in phase I andthen studied by the evaluation team were still being usedat the time of evaluation, two years after the delivery tothe Zambian side. However, the establishment of drainagefacilities on the side of community people was behindschedule in some areas.

At the same time, the organization of WASHEcommittees was promoted at the village level (V-WASHE) as reflected by the enhancement oforganizational capability and activities of district-levelWASHE committees (D-WASHE) which DfID tookcharge of. As a result, a V-WASHE committee consistingof community representatives was established in everyvillage where a borehole was installed, and a certain levelof maintenance activities were carried out by communitypeople. Also, sanitary education was implemented in mostvillages. However, measures to protect water supplyfacilities, such as putting a fence around wells, andmaintenance activities were not adequate in those villageswhich were inaccessible by road and difficult to receivethe support of WASHE committees.

(3) Impact

With the exception of a few areas, clean waterbecame available for community people year-round in theareas where boreholes were installed. Also, time spent forcollection of water was reduced; therefore, this projectcontributed to the improvement of the quality of life ofvillagers.

(4) Relevance

The target villages were those areas where theprovision of infrastructure was delayed and publicservices were not accessible. Thus, the villagers in theseareas urgently required water-supply facilities. Inaddition, this project was based on the national waterpolicy of the government of Zambia; therefore, therelevance of this project was considered high.

(5) Sustainability

The borehole maintenance system had someweaknesses particularly in communities that lackedharmony and support from NGOs. Also, small technicalproblems frequently occurred as no regular maintenanceof boreholes was carried out. Although, in principle, waterfees were collected regularly from community people,there was concern that the funds would not be sufficientfor large-scale renovation work. Furthermore, it was

difficult to charge such fees in the areas where many userswere poor.

6. Lessons Learned and Recommendations(1) Lessons Learned

In projects where water supply facilities, such asboreholes, are installed, drainage facilities should beprovided at the same time. In order to keep the water safefor drinking, there should be measures to protect wellsand drainage ditches, such as planting a hedge or buildinga log fence to deny access to animals.

(2) Recommendations

Support to V-WASHE committees should becontinued in order to enable sustainable maintenanceactivities by communities. In particular, a trainingprogram on the methods of maintenance and renovationof wells and the issues of health and hygiene should beprovided to borehole managers, WASHE members andborehole users. In addition, community fund raising formaintenance is necessary, and further support on thesoftware side should also be considered in order make theproject more sustainable at the community level.

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Deep well for manual fire engine (Monze District)

1) The WASHE (Water, Sanitation, Health and Education)program outlines the basic concepts and framework for thesystem of water supply and sanitation activities in local villages.WASHE aims to promote concrete measures and resolve thesalient issues laid out in the National Water Policy in acomprehensive manner. The activities are promoted throughthe WASHE committees established at every administrative andregional level.