Brazil-Angola-Japan – Building capacities at the Josina Machel Hospital
Angola – Ministry of Health, Josina Machel Hospital Brazil - Brazilian Cooperation Agency(ABC) Campinas University(UNICAMP), Sao Paulo University Instituto of Heart (INCOR/USP), Santa Cruz Hospital Sofia Feldman Hospital Japan- Japan International Cooperation Agency (JICA)
In this Project, professionals of Josina Machel Hospital (JMH), Lucrecia Paim Maternity Hospital (LPM), 13 primary health care centers, and other hospitals were trained in five areas as follows: hospital administration, equipment maintenance, nursing care, radiology and laboratory. The training course was conducted by Brazilian Experts and Angolan professionals under the coordination of Japan, Brazil and Angola with utilizing the facility of Josina Machel Hospital which was rehabilitated by the Grant Aid Cooperation of Japanese Government.
After 27 years of civil war, the Government of Angola drew out the 'Five Year Health Development Plan' (2000-2004) to improve the facilities of health system which was largely neglected in civil war period. Basing on this plan, Angolan government requested the Grant Aid assistance to the Japanese government for the rehabilitation of the facilities of Josina Machel Hospital, which is reference hospital of national level, and the project was implemented in the period of 2002 to 2005.
After the Grant aid Cooperation, it was needed to train the professionals for improvement of quality of services. Then, Angolan Government requested the technical cooperation project to Japanese Government in 2006. In the process of analysis of proposal, Japan found it better recruiting the Brazilian Experts for this activity because of the language advantage, culture similarity and so on. In the year 2007, a meeting between JICA's President, Ms. Sadako Ogata, and the Brazilian Ministry of Foreign Affairs, Mr. Celso Amorin was held in Brasilia and they confirmed the importance of promotion of JBPP, especially the joint effort to develop international cooperation in beneficiary countries. This meeting opened the possibility to work under the framework of triangular cooperation between Japan, Brazil and Angola. After the meeting, Government of Angola manifested the interest for triangular cooperation project. Then, the project started to implement.
--What was the purpose and overall goal of the SSC activity?
"Josina Machel Hospital becomes a reference in Angola in terms of health care and training for health workers."
a. "Improvement of organization of training in Josina Machel Hospital"
b. "Improvement of quality of services in the target institutions"
--What was the development challenge to which this SSC activity was meant to address?
This Project was formulated as first JBPP's Joint Cooperation Project and the fact itself was the challenge for three countries. The coordination of project also was challenge because of the lack of infrastructure such as water, electricity, telephone and internet. For the Japanese side
--What were/are the expected results of this SSC activity?
The expected results are below;
" Improvement of the hospital administration and the equipment maintenance."
" Improvement of the technical activities in laboratory analysis. "
"Improvement of the technical activities in radiology."
"Improvement of the nursing care."
--Why did the partners engage in the SSC activity?
The Japanese government approved the implementation of the technical cooperation project in April 2007. The support of Brazilian Cooperation Agency was requested by the Japanese government under the framework of the Japan Brazil Partnership Project (JBPP). Then it was signed the Minutes of Meeting to start the joint cooperation project in Angola in September 12, 2007. Then the Training for Capacity Building of Josina Machel Hospital was defined as the first Joint Cooperation Project on the JBPP.
--How did the political context or previous cooperation influence the planning process?
After concluding the grant aid assistance such as infrastructure rehabilitation and donation of equipment, Angolan government was requested a support for training of the human resources since it was needed to brush up their skills to improve the quality of the services in the Josina Machel Hospital. Then we can observe the fact of influence of previous cooperation.
--What kinds of SSC activities or modalities were conducted?
The referred project was implemented as a JBPP's first triangular cooperation project in beneficiary country. The basic implementation style of this cooperation project is to conduct the training course in JM Hospital with participation of Brazilian Expert on Japanese Coordination. For the implementation of the activity, Japan contracted coordinator of the project and procured materials for training activity such as film for X-ray, microscope, etc. The essential running cost for the training activities also was supported by Japan.
In fact, the total of 12 training course was held in 3 years cooperation period, and 714 professionals were trained.
--Please describe the roles, responsibilities, interests and interrelations of the involved stakeholders.
Josina Machel Hospital
The main implementing institute in Angola. It worked as a coordinator of the implementation of training activity with assistance of Japan and Brazil. It achieved the essential role for the participation of other hospitals and primary health care center.
Ministry of Health
Supporting institute in the political level. It contributed the smooth implementation of the project.
Brazilian Cooperation Agency ABC
The coordinating agency for all the activities of Brazil, such as recruiting and dispatching expert and local coordination.
Embassy of Brazil in Angola
It played important role for the coordination in Angola, such as logistic coordination for Brazilian experts and missions. Also it participated important meeting with Angolan side
UNICAMP participated this project for important indication of Brazilian Expert in Laboratory and Radiology.
Sao Paulo University Instituto of Heart (INCOR/USP),
INCOR did not participant this project institutionary. However 2 staff of INCOR participated as Brazilian Expert.
Santa Cruz Hospital
Santa Cruz Hospital participated as supporting institute until the begining of project to 2008. They indicated the Brazilian Expert in Hospital Administration and Equipment Maintenance. In 2009, it happened the change of administration and meantime, 2 experts left the hospital. The hospital has unique history that once it established as hospital for Japanese immigrants and in this moment many staffs are Japanese offspring.
Sofia Feldman Hospital
Sofia Feldman Hospital developed other triangular cooperation activity with JICA. And the year of 2009, they send one expert in nursing care, specially in the maternal health care
JICA South Africa
JICA South Africa is responsible for the Japanese Cooperation in Angola. They identify the needs of Angolan institute and planed for the implementation of this project. In the process of planning, it found the importance of Brazilian participation. And it communicated with JICA headquarter and JICA Brazil for initiating this project. In the implementation period, they coordinated all the activity with Local coordinator for this project and HJM.
JICA Brazil acted important role for the negotiation with ABC and formulation and definition of triangular cooperation. Also it supported all the necessity in the process of implementation of project.
The three department of JICA Headquarter participated the project which is Department of Africa, Department of Latin America and Human Development. Especially the planning moment, Department of Africa and Latin America put effort to initiate the project. Also they put effort for the public relations and this project was taken up the TV program and several newspapers of major mass communication company.
--Did the relation between the providing and receiving countries / governments / organizations change with this experience? Why and how?
Through the success of this first experience of Triangular Cooperation Project in beneficiary country, the needs of Japan Brazil Partnership Program(JBPP) increased dramatically. And also, JBPP started to formulate the challenging big scale project. Besides the fact, this project made it possible to analyze the possibility to develop the following cooperation activity in larger scale in Angolan health sector, such as "Project of Health Sector Human Resource Development in ANGOLA – ProFORSA"
--What were the planned and unplanned achievements of the SSC experience?
The planned achievement is the fact of the improvement of services of professionals in health sector in Angola and the capacity development of JMH as reference institute for training of professionals in health sector. It can be seen the dramatic reduction of mortality rate of JMH, such as more than 1% per year from 2007 to 2009. The unplanned achievement is change of paradigm in Triangular Cooperation. Until this project, the triangular cooperation of Japan and Brazil was small scale and for specific needs. But now JBPP is scoping the development of larger scale project for the positive impact in global level.
--Are these outcomes sustainable? Could they be replicated in similar contexts?
Concerned to the sustainability, according to the final evaluation, it still needs the further cooperation activity in larger scale with participation of Japan and Brazil. Once the project made the certain confidence of Japan and Brazil's Triangular cooperation, if we think about the impact of development, it is still needed the systematic improvement.
--For longer-term projects, could you describe (both positive and negative) impacts?
Impact for the Angolan side
The impact was different in each area, for example Laboratorial analysis can be observed strongly positive and high impact.The second training course contributed to restart the activities in the microbiology field which was stopped during the civil war period. Nursing care can be observed certain positive impact about relationship between professionals and patients in the context of humanized care. And multiplication of new knowledge and technique from the participants to colleagues was happened many case. Other training activity also had small, but positive impact. And the fact of mortality rate reduction, such as more than 1% per year, was obvious impact as well.
Impact for both Brazilian and Japanese side
According to the M/M of September 2007, this project was defined as a test case of triangular cooperation under the framework of JBPP. Thus, this project implemented as first Joint Cooperation Project in beneficiary country under the framework of Japan Brazil Partnership Program (JBPP) and made certain outputs and confidence for JBPP. Beside outputs, this project contributed to the establishment of regulation of JBPP implementation. This fact generates a strongly positive impact and influenced another JBPP and partnership program activity with another country. And also the synergy between Japan, Brazil and Angola are strengthened.
No negative impacts were verified in final evaluation.
--How can this experience help to understand the possible synergies between SSC and aid effectiveness principles?
In the first moment, Japan implemented the Grant aid assistance for rehabilitation of reference hospital in Angola. For utilization of the facility and equipment, it was still needed the improvement of quality of service of professionals in health sector in Angola. Then, through the long time history of partnership between Japan and Brazil, the project got best expert for the training activity. Moreover, it could be observed the aid effectiveness on longer term. Three of the Brazilian experts were participated the training program in Japan in the field of Hopital Administration, Microbiology and Humanized Maternal care for midwife. The training course contributed the capacity development of Brazilian institute and participants themselves on that field and the participation of expert who had experience of bilateral cooperation between Japan and Brazil was strengthened and facilitated the triangular initiative.
--Was national leadership and ownership supported?
In Angolan side, Ministry of Health in Angola supported to the project. And the second fase which three countries are formulating, they stressed the importance of leadership and ownership of Ministry of Health.
In Brazilian side, there is strong initiative for the enhancement of international cooperation and triangular cooperation. And this project is formulated as a follow up of the meeting between Minister Celso Amorin and President of JICA, Sadako Ogata. In this context, the project was supported the national leadership of Japan and Brazil.
--To which extent was the experience aligned to national priorities and systems?
The grant aid was based on the Five Year Health Development Plan' (2000-2004). And the project was recognized as the activity of the Ministry of Health's Action Plan" Medium term Plan for Economic and Social Development" 2009-2012.
--Has there been an effort to harmonize and coordinate with other programmes and development actors?
No. there was no activity of other actor on that moment.
--Was managing for results included in the experience?
This part was not very strong on this project because of the lack of time, experience and expertise when three countries formulated this triangular cooperation project. However it can be seen some facts. In the planning period, the project made the participants of the training course as indicator for achievement. And two joint monitoring mission was held and these two mission was contributed the improvement of the project implementation. And the final evaluation was conducted on Japanese Project Cycle Management through participation of three parts.
--Describe any specific capacity development benefits from this SSC activity at the individual, organizational or systemic level.
Concerned to the final evaluation activity, more than 90% of participants of the training course answered that the course contributed the improvement of service. And it can make the befit for the health care in Angola.
For HJM, it could be observed the capacity development in administration of training activity. And for Brazilian and Japanese side, it could be observed the development the capacity for the triangular cooperation activity in beneficiary country.
This project contributed to establish the regulation of Joint Cooperation Project under the JBPP. This fact can say the capacity development benefit of the project.
--Are there any lessons learned from this SSC activity that improve the overall enabling environment, especially through improved incentives for better public services?
- The institutional participation of Brazilian institutions is important to guarantee the quality of services. If the JBPP activities are implemented in larger scale, the institutional participation is obviously essential.
- In triangular cooperation project, the local coordinator must to be enlightened for all the stakeholders about the differences and the comparative advantages to develop the project under this concept. It will allow the more involvement of the three concerned parts (Japan, Brazil and the third country) in the process of project management.
April 2007 – March 2010
Share of Japan's Contribution :US$ 549,450.00 （76.04%） Share of Brazil's Contribution :US$ 173,129.97 （23.96%） The budget of former Grant Aid Project by Japanese Government was approximately US$ 40 million
Name of Primary Contact Person:
Mr. Kota Sakaguchi; Mr. Wofsi Yuri de Souza
Title of Primary Contact Person:
Assistant Representative, JICA Brazil Office; Coordinator of Bilateral Cooperation, ABC