technology and development · 2016-04-19 · technology and development ... keiko osaki / yasuhide...

Technology and Development

No.13 January 2000

ARTICLE

On the East Asian Economic Crisis‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Yonosuke HARAThe Current Situation in Vietnam and Japan’s ODA

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Motoo FURUTA

A Consideration of Infrastructure Development in Developing Countries― Appropriate Design Based on Optimal Destruction Probability ―

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 ‥‥‥‥‥‥‥‥‥‥‥Koji TSUNOKAWA/ Fumio NISHINO

CASE STUDY

Diffusion of Maternal and Child Health Handbook Program in Indonesia

‥‥‥‥‥‥‥‥‥Keiko OSAKI / Yasuhide NAKAMURA /Yoko WATANABE /Yoshiko SATO /Hiromi OKUNO

Adult Literacy Education as an Entry Point for Community Empowerment― Evolution of Self-Help Group Activities in Rural Nepal ―

　　　　　　　　　　　　　　　　　　　　　　　　　‥‥‥‥‥‥‥‥‥‥‥Chizu SATO/ Masamine JIMBA/ Izumi MURAKAMI

NOTEEducation and Research of Veterinary Public Health - Knowledge and Experience Gained

through International Cooperation in Zambia ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Takao FUJIKURAInternational Cooperation in Hospital Improvement Projects in Developing Countries

― A Study of Basic Principle ‥‥‥

Katsuhiro YOSHITAKE / Yasuhiro ARASAKI / Shuzo KANAGAWAA Study on Labor-Based Technology in Kenya

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Eiichi ASANO

Globalization and Environmental Issues for Sustainable Development in Developing Countries

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Takashi HAYASE

SPECIAL REPORT

Post-Conflict: A Gap between Emergency Assistance and Long-Term Development Assistancein the Post-Conflict Period

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Post-Conflict and Development Study Group, JICA

INFORMATION

Committee on the Country Study for Japan’s Official Development Assistance to the Republic of PeruCommittee on the Study of the DAC’s New Development StrategyInternational Symposium “Health Initiative in Asian Economic Crisis ― Human Centered Approach”Committee on the Country Study for Japan’s Official Development Assistance to the Lao People’s

Democratic RepublicReport on the JICA International Symposium on “Local Development and the Role of Government

― A New Perspective of Assistance”The Second Country Study for Japan’s Official Development Assistance to the People’s Republic of China

JICA

Institute for International CooperationJapan International Cooperation Agency


Institute for International Cooperation

Japan International Cooperation Agency

EDITORIAL BOARDManaging Editor: KATO, Keiichi Managing Director, Institute for International Cooperation, Japan International

Cooperation Agency (JICA)

Members: (Alphabetical order in family name)ASANUMA, Shinji JICA Guest Development Specialist / Professor at Hitotsubashi UniversityENDO, Akira Managing Director, Medical Cooperation Department, JICAKANO, Yoshiaki Managing Director, Forestry and Natural Environment Department, JICANISHIMAKI, Ryuzo Managing Director, Agriculture, Forestry and Fisheries Development Study

Department, JICASAKURADA, Yukihisa Managing Director, Social Development Study Department, JICATAKAHASHI, Toshihiro Managing Director, Planning and Evaluation Department, JICAUTSUMI, Seiji Professor at Osaka University

Technology and Development (English edition) is published once a year by the Institute for International Cooperation(IFIC). The articles are selected and translated from its Japanese edition, Kokusai Kyoryoku Kenkyu. Kokusai Kyoryoku Kenkyu , having been published twice a year by the IFIC since 1985, specializes in studies of tech-nical cooperation regarding developing countries’natural, socio-economic, and cultural environment. It aims to provideopportunities for presenting papers to those engaged in development projects and thereby to contribute to the furtheranceof international technical cooperation. Kokusai Kyoryoku Kenkyu accepts papers in Japanese. For more detail, please refer to the back of its front page or theexplanatory manual. The IFIC introduces the latest information related to JICA through the JICA Home Page (http://www.jica.go.jp/).Users who have access to this Home Page can read all the contents of research papers and case studies presented inTechnology and Development, No.9 to No.12 (http://www.jica.go.jp/E-info/Index.html) and the Japanese Journal KokusaiKyoryoku Kenkyu, the original version of Technology and Development. from No.24 (http://www.jica.go.jp/J-info/Index-kenkyu.html).

Views expressed herein are those of the authors and do not necessarily reflect the view or policies of the Japan Interna-tional Cooperation Agency (JICA), or of any organization with which the authors may be associated.

Published byInstitute for International CooperationJapan International Cooperation Agency

Ichigaya Honmura-cho 10-5, Shinjuku-ku, Tokyo 162-8433, Japan

ｃ 2000 Japan International Cooperation AgencyAll rights reserved

Printed in Japan on recycled paper


No.13 January 2000CONTENTS

ARTICLEOn the East Asian Economic Crisis

Yonosuke HARA‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

The Current Situation in Vietnam and Japan’s ODAMotoo FURUTA‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥


Koji TSUNOKAWA / Fumio NISHINO‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

CASE STUDYDiffusion of Maternal and Child Health Handbook Program in Indonesia

Keiko OSAKI / Yasuhide NAKAMURA / Yoko WATANABE / Yoshiko SATO /Hiromi OKUNO‥‥‥‥

Adult Literacy Education as an Entry Point for Community Empowerment― Evaluation of Self-Help Group Activities in Rural Nepal ―

Chizu SATO/ Masamine JIMBA/ Izumi MURAKAMI‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

NOTEEducation and Research of Veterinary Public Health - Knowledge and Experience Gained through InternationalCooperation in Zambia

Takao FUJIKURA‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

International Cooperation in Hospital Improvement Projects in Developing Countries― A Study of Basic Principle

Katsuhiro YOSHITAKE / Yasuhiro ARASAKI / Shuzo KANAGAWA‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

A Study on Labor-Based Technology in KenyaEiichi ASANO‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Globalization and Environmental Issues for Sustainable Development in Developing CountriesTakashi HAYASE‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

SPECIAL REPORTPost-Conflict ― A Gap between Emergency Assistance and Long-term Development Assistance

in the Post-Conflict PeriodPost-Conflict and Development Study Group, JICA‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

INFORMATIONCommittee on the Country Study for Japan’s Official Development Assistance to the Republic of Peru‥‥‥‥‥‥‥‥‥‥

Committee on the Study of the DAC’s New Development Strategy‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

International Symposium “Health Initiative in Asian Economic Crisis ― Human Centered Approach”‥‥‥‥‥‥‥‥‥‥

Committee on the Country Study for Japan’s Official Development Assistanceto the Lao People’s Democratic Republic ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Report on the JICA International Symposium on “Local Development and the Role of Government ―A New Perspective of Assistance”‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

The Second Country Study for Japan’s Official Development Assistance to the People’s Republic of China‥‥‥‥

Institute for International Cooperation

Japan International Cooperation Agency

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JICAJapanInternationalCooperationAgency

IFICInstituteForInternationalCooperation

was established on 1 August 1974 as an official aid agency of Japan under thesupervision of the Ministry of Foreign affairs. In order to help promote the economicand social development of the developing world, JICA extends various kinds ofcooperation including technical cooperation, grant aid, dispatch of Japan OverseasCooperation Volunteers (JOCV).

was established on 1 October 1983 as one of JICA’s affiliated organs. Its purpose isundertaking recruitment of development specialists, training qualified Japaneseexperts, research and study, and collection and dissemination of information oftechnical cooperation.


No.13 January 2000

ARTICLE

On the East Asian Economic Crisis‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Yonosuke HARAThe Current Situation in Vietnam and Japan’s ODA

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Motoo FURUTA


　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 ‥‥‥‥‥‥‥‥‥‥‥Koji TSUNOKAWA/ Fumio NISHINO

CASE STUDY

Diffusion of Maternal and Child Health Handbook Program in Indonesia

‥‥‥‥‥‥‥‥‥Keiko OSAKI / Yasuhide NAKAMURA /Yoko WATANABE /Yoshiko SATO /Hiromi OKUNO

Adult Literacy Education as an Entry Point for Community Empowerment― Evolution of Self-Help Group Activities in Rural Nepal ―

　　　　　　　　　　　　　　　　　　　　　　　　　‥‥‥‥‥‥‥‥‥‥‥Chizu SATO/ Masamine JIMBA/ Izumi MURAKAMI

NOTEEducation and Research of Veterinary Public Health - Knowledge and Experience Gained

through International Cooperation in Zambia ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥

Takao FUJIKURAInternational Cooperation in Hospital Improvement Projects in Developing Countries

― A Study of Basic Principle ‥‥‥

Katsuhiro YOSHITAKE / Yasuhiro ARASAKI / Shuzo KANAGAWAA Study on Labor-Based Technology in Kenya

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Eiichi ASANO

Globalization and Environmental Issues for Sustainable Development in Developing Countries

　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　 ‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Takashi HAYASE

SPECIAL REPORT

Post-Conflict: A Gap between Emergency Assistance and Long-Term Development Assistancein the Post-Conflict Period

‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥‥Post-Conflict and Development Study Group, JICA

INFORMATION

Committee on the Country Study for Japan’s Official Development Assistance to the Republic of PeruCommittee on the Study of the DAC’s New Development StrategyInternational Symposium “Health Initiative in Asian Economic Crisis ― Human Centered Approach”Committee on the Country Study for Japan’s Official Development Assistance to the Lao People’s

Democratic RepublicReport on the JICA International Symposium on “Local Development and the Role of Government

― A New Perspective of Assistance”The Second Country Study for Japan’s Official Development Assistance to the People’s Republic of China

JICA

Institute for International CooperationJapan International Cooperation Agency

5

On the East Asian Economic Crisis

ARTICLE


Yonosuke HARADirector and Professor,

Institute of Oriental Culture, The University of Tokyo

The economic crisis in East Asia that took place in the summer of 1997 originated and deteriorated in theprocess in which the development-oriented economic system, which had realized the “miracle,” was swal-lowed by global capitalism expanding at unprecedented speed and magnitude. While the East Asian coun-tries were achieving economic growth, their government-business relations were evaluated positively asthe factor in the economic miracle because they successfully prevented a coordination failure of invest-ments. The present crisis, however, has started to change this view, holding governments responsible forgenerating nothing but “crony capitalism,” which lacks transparency. Was the East Asian economic crisis really caused by government intervention lacking transparency?The current crisis may have resulted from the globally moving money capital rather than from defects inthe East Asian-model economic system. In either case, we must acknowledge that interpreting the EastAsian economic crisis is fundamentally inseparable from interpreting the basic characteristics of the mar-ket economy. In doing so, it will be important that we abandon the paradigm of a completely competitivemarket under the neo-classical school, which is not a model that reflects reality, but is only a model forreorganizing reality. In order to survive this age of globalism, we must take a good look at the real marketeconomy and abandon “extreme simplification and ideology.” The present economic crisis in East Asiamay be a reminder of this simple, but crucial fact.

I From Rapid Economic Growth toCurrency/Financial Crisis

1. East Asian MiracleFrom the beginning of the 1980s, East Asian coun-tries began to compete against each other to attractforeign capital. In response to the stronger yen andcurrencies of the newly industrialized Asian countiesafter the Plaza Accord, the Association of SoutheastAsian Nations (ASEAN) members, in particular, at-tempted to draw foreign direct investment into theproduction of exportable goods which they could notfully develop by themselves. These countries at-tempted to create economic enclaves, or “export plat-forms,” by inviting multinational cooperation, in theocean of traditional economy, which was consider-ably vulnerable and not necessarily compatible withcapitalistic, global economic activities.1 In additionto implementing policy measures such as establish-ment of export processing zones, bonded warehouses,and refunding of export tax, they liberalized tradethrough drastic reductions in the import duties onmanufactured products and parts. Each governmentpromoted this strategy through a series of macroeco-

nomic policies including the realistic adjustment ofexchange rate to give incentives for exporting labor-intensive products.

Frankly speaking, East Asia became a borderless,single economic area because of the economic liber-alization policies employed by each country in theregion. The wage differentials that had existed amongthese countries became more apparent as a profit-ratedifferential, the sole indicator of capitalistic econo-mic activities. As a result, shifts in direct investmentsoccurred on a massive scale. A “self-circulationmechanism” was developed in the East Asian region,seeking not only further mutual-dependency of ex-ports, but investment funds supplier within the re-gion. Savings accumulated in the region were opti-mally invested within the region, leading to theregion’s rapid economic growth. This “East Asianmiracle” drew worldwide attention. During this pe-riod, East Asian countries shared the same optimismthat economic prosperity could be achieved by virtueof universal strengths intrinsically endowed in themarket as long as the economy was freed from ineffi-cient government interventions.

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu, Vo. 14 No.2 (October 1998).

1. Radelet, S., and J. Sachs, “Asia’s re-emergence,” Foreign Affairs (November/December 1997).

Technology and Development, No.13, 2000

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2. To Currency/Financial CrisisAfter entering the 1990s, East Asian countries fur-ther proceeded with economic liberalization under thisbelief. In an attempt to attract funds from the globalmarket, the countries rapidly carried out internationalliberalization of their financial transitions. As theireconomies started booming, international investorsinjected funds without thoroughly investigating howthe funds were being used. This kind of behavior bysome investors lured other investors into believingthat there was a lot of money-making opportunities,and kept the economic boom going. This is a typicalphenomenon of the so-called self-fulfilling expecta-tion formulation. People began to believe that mak-ing money was honorable and business chances wereunlimited These unrealistic expectations were des-tined to be unfulfilled when they came up against therealities in East Asia, where political power, familyand personal connections are highly influential. Thecurrency crisis started when the expectations of in-vestors proved to be unrealistic.

The funds that flew in from the international mar-ket during the miraculous economic growth were notapplied to strengthening the economic fundamentalsin order to sustain the economic growth. Funds werenot invested in the manufacturing industry that re-quires longer-term investment, but were invested inreal estate and consumer credit business. It is unde-niable that this distribution of funds was primarilyinduced by the financial policies of the authorities tocontinue to buy US dollars at a fixed rate and stabi-lize the various exchange rates against the US dollar.Particularly in Thailand where the current currencycrisis originated, these foreign exchange rate policiescaused an increased domestic money supply and ap-propriate real exchange rate. As a result, a relativeprice system, in which the price of traded goods suchas exportable goods was low and that of non-tradedgoods such as real estate was high, was formed inthe country. Under this distorted incentive-structureIn this unbalanced system, funds were allotted pri-marily to real estate.

As currency instability spread, it gradually becameapparent that there were various problems in the waybanks in East Asia accommodated loans. Becausegovernments, although not explicitly, indicated thatthey would not allow any banks to go bankrupt, banks’loan operations became morally hazardous, and theirbad debts accumulated. As a result, Southeast Asiancountries lost their credibility in the global market,which accelerated the selling of currencies. The do-mestic financial market in these countries had notmatured enough to create a completely competitivemarket. Because of this immaturity, liberalization ofthe financial system resulted in the worsening of the

economy. This is the phenomenon which is impliedin international financial transactions as the“secondbest proposition”in welfare economics. 2

3. The End of the Development-orientedEconomic System in East Asia?

The current East Asian economic crisis took place inthe big wave in which the development-oriented eco-nomic system that had produced rapid growth beganto be swallowed by the global capitalistic system ex-panding at unprecedented speed and in magnitude.

In May of 1998, almost one year after the mon-etary crisis began, the Suharto administration in In-donesia collapsed. The Indonesian currency, rupiah,continued to be sold in global markets, because theglobal market hated the non-transparent policies andgovernment-business relations. Unemployment andinflation rates accelerated, provoking frustrationamong the people, which resulted in the resignationof President Suharto. The market rocked the nationto the extent that the dictatorial administration col-lapsed. This was the beginning of phasing out anyeconomic institution or system that was unfit to standup to ongoing economic globalization.

When East Asian countries were running at topspeed on the turnpike of economic growth, govern-ment and business relations in those countries werepositively regarded as a primary factor in the miracu-lous growth. For example, in South Korea, the gov-ernment was actively involved in the loan operationsof banks. The government extended loans at low in-terest and allocated scarce foreign exchange to entre-preneurs who they judged to be running promisingbusinesses. In many developing countries, interven-tions by the government resulted in facilitating rent-seeking activities. By contrast, in South Korea, loansand foreign exchange were allotted based on its ex-port performances. As a result companies were moti-vated to improve management efficiency, and gov-ernment intervention proved to be successful. Gov-ernment and business relations in East Asia wereevaluated positively as the factor that prevented a co-ordination failure of investments.3

The present crisis, however, has started to changethis view, holding governments responsible for gen-erating nothing but“crony capitalism”, which lackstransparency.4 Because the global Monetary Fund(IMF) required that domestic institutions and struc-tures be reformed, the international market began tothink that East Asian countries could not resolve theprivate sector’s bad loan problems, without carryingout fundamental structural reform. The global com-munity has gradually formed the consensus that theEast Asian economic system was inefficient and un-fair crony capitalism.

2. Krugman, P.,“What Happened to Asia,”Mimeo (1998).3. World Bank, The East Asian Miracle (The Johns Hopkins University Press, 1993).4. Stiglitz, J.,“Sound Finance and Sustainable Development in Asia,”Mimeo (1998).

7


Robert Lucas, a laureate of the Nobel Prize for eco-nomics, once called the East Asian-model of economicdevelopment the“Michael Jordan model.”5 His ar-gument was that government interventions in EastAsian countries and Michael Jordan were essentiallythe same in the sense that they are both exceptions,that is, they produce excellent outcomes no matterhow much they go against common practice (the com-mon practice of market economies in the case of EastAsia, and the common practice of basketball in thecase of Jordan). Lucas must be chuckling to himselfthat East Asia was not a genius like Jordan.

II Reconsideration of the Market Economy

1. Neoclassical Economics as an IdeologyWith the beginning of the economic crisis in East Asia,neo-classical economics, which serves as a basis forthe liberal political-economic order advocated by theUnited States, gained popularity worldwide. Neo-clas-sical economics presents an ideological model not forunderstanding current events but for putting them inorder. Some economists deprecate the current situa-tion in East Asia, where political authorities have in-fluence over economic matters. They argue, based onthe neo-classical model, that it is necessary to restorethe market economies to its ideal condition throughthorough deregulation. They also claim that nepotism,a custom widely practiced, especially among ethnicChinese, should be rectified, and that all economicactivities must be regulated by global standards.

Neoclassical economists believe that actual eco-nomic systems could be reconstructed according to acompletely competitive market model that has beenproved, from the formative theory perspective, to besuccessful in achieving efficient allocation of re-sources. 6 One does not need to read an entire text-book on the neoclassical approach to realize that thepremises, upon which a completely competitive mar-ket can exist, are both numerous and strict. The areawhere all premises overlap is so narrow, almost likea pinpoint. Neoclassical economists claim that everycountry in the world should look for this minute com-mon ground.

Neoclassical economists apparently pay little at-tention to the factors which could cause a failure of amarket economy, such as incompleteness of informa-tion and economies of scale. If one had paid closeattention to the economic boom in East Asia, it wouldhave been easy for one to realize the following facts:A large amount of capital flew into newly liberalizedfinancial markets attracted by expectations of short-run high profit-rate. As a result, asset inflation oc-

curred, which facilitated further inflow of capital. Bycontrast, the manufacturing industry experienced capi-tal shortage. Because the manufacturing industry re-quires long-term fixed capital, manufacturing is notlikely to generate a high profit ratio in the short-run.A harmonious relationship cannot be easily formedbetween the financial sector, a“home of capitalism”,

and the manufacturing sector,“ a stranger to capital-ism.” Such disharmonious relations between the twosectors have been repeatedly observed during the longhistory of capitalism. The neoclassical approach, how-ever, does not accurately grasp this divergence as itdepends on the false premise that a market is com-plete. One who pays enough attention to the realitiesof a market economy could easily see that an economydoes not reach overall equilibrium even if each mar-ket of every sector moves into its equilibrium throughits own mechanism and at its own time axes. Neo-classical economics, therefore, presents only an un-realistic view that all sectors and variables can be co-ordinated at once and full-scale equilibrium can beeffectively reached.

2. Incompleteness of a Market EconomyIt is evident that a completely competitive marketeconomy does not exist even in the developed world.Under realistic conditions, each individual has tomake a strategic decision, taking the presence of oth-ers into consideration, and carry out economic ac-tivities based on that decision. In such a situation, itis inevitable for a non-linear order to appear in deci-sions made by individuals. As a result, the perfor-mance of an economy as a whole portrays complexand unstable patterns woven by individuals’ activi-ties. A market economy cannot escape from this com-plexity.

Neo-classical economists argue that the more op-tion each individual is given through deregulation,the better the outcomes that can be achieved. It isnecessary to remember that this view is plausible onlyin a neo-classical model.7 In the Walrasian model ofa completely competitive economy, each individualreceives information from an auctioneer, and makesa decision completely independent from others. Theideal outcome that is promised by this model is im-plausible in real socioeconomic life where one has todecide one’s own action depending on the behaviorof others. The Walrasi model can be effective for “amodel for market socialism.” However, as“a modelfor market economy,” it is utterly impractical.

As non-cooperative game theory has taught us,Nash equilibrium exists in the sense that the expecta-tions of an individual can be realized. Nash’s equi-librium means a lack of incentives for any player to

5. Lucas, R. E.,“Making a Miracle,” Econometrica 62 (2) (March 1993).6. Hara, Yonosuke, “Tasoteki Jiyu Shugi Rulu no Kozu” Kaihatsu to Bunka Dai 7 Kan (Portrayal of Multi-phased Liberalism, Development and Culture Volume 7)

(Iwanami Shoten, 1998).7. Kandori, Michihiro,“Game Riron Niyoru Keizaigaku no Shizukana Kakumei,” K. Iwai and M.Ito (eds.), Gendai no Keizai Riron (Silent Revolution of Econom-

ics Based on Game Theory, Contemporary Economic Theory) (Tokyo Daigaku Shuppankai, 1994).


8

alter his decision because everyone’s expectation isfulfilled in the course of reciprocal interactions withothers. The process of a certain custom becomingdominant in a society can be appreciated within thescope of evolutionary game theory. In this process, akind of Nash’s equilibrium is also reached in a sensethat everyone opts to follow a custom if others chooseto do so. However, realizing Nash’s equilibrium is,in most cases, inefficient unless one considers the prosand cons of pursuing one’s own interests.

The market economies of industrialized countriesare far from being completely competitive. Even inaffluent countries, a market economy formed on theinteractions of self-interest pursuits among individu-als is not free from incompleteness.8 It is extremelydifficult, even in a mature society, to coordinate de-cisions made by individuals so that they bring effi-cient outcomes to the society overall. In developingcountries that are trying to catch up with affluent in-dustrialized countries, if each private entity makesand executes its own investment plan separately, theentire economy is unlikely to benefit from the invest-ments. Therefore, the author believes that govern-ments should play a key role in development-plan-ning. Holding governments responsible for creatingcrony capitalism is not totally misdirected criticism.However, putting too much emphasis on this pointand denying the government’s role in development isinappropriate. It is necessary to learn from cases inwhich government intervention proved to be success-ful.

3. Market Economy and Cultural BeliefsIn discussing market economies further, it is impor-tant to remember that non-cooperative games cannothave one unique equibria. Which equilibrium is cho-sen in a particular society depends on the history andthe cultural beliefs and values shared by the mem-bers of that society. 9 It is most likely that the eco-nomic institution emerging in a society which valueskinship is different from that of a society which em-phasizes individualism. No matter what equilibriumis chosen, it is certain that there is no completely com-petitive economy, contrary to what neoclassicaleconomists claim. People must carry out their eco-nomic activities in imperfect market economies. Eachimperfect market is imperfect in its own way, eventhough all perfect markets are alike. Therefore, themeasures to cope with this incompleteness need tobe diverse. Actions universally applicable to all econo-mies simply do not exist.

As the economic crisis deepened, it became appar-ent that banks in East Asia extended loans intensivelyto the firms belonging to the same kinship. Some in-

ternational investors argue that this non-transparentpractice, and not liberalization of the financial sys-tem, was the cause of the economic crisis in the re-gion. International financial organizations, includingthe IMF, advocate establishing regulatory systemswhich meet global standards immediately.

The reform of the financial systems in East Asiancountries is recognized to be necessary. However, itis dangerous to make hasty decisions about this mat-ter. Since the cultural beliefs of a society has relevanceto the way of conducting financial transactions, it isextremely important to be aware that each society hasits own way of forming and devolving its marketeconomy. 10 It is most urgent to accept that each mar-ket economy has its own characteristics and to be freeof the idea that restructuring laws in an economy tomeet global standards will, without question, improvethe economic efficiency of the country.

III A Policy for Overcoming the Crisis

In this section, the author would like to draw yourattention to conditionalities that the IMF imposed onThailand and Indonesia. Although fiscal deficits werenot the primary reason for the crisis in those coun-tries, the remedies applied by the IMF were the sameas those once applied in Latin America: a combina-tion of tighter budgets and credit. This policy, how-ever, is expected to slow economic recovery. The do-mestic economy is likely to go further into a reces-sion because of tax increases and cutbacks in spend-ing. In addition, there is a danger that even promis-ing companies that have fallen temporarily into li-quidity crisis may go bankrupt because of unneces-sary hikes in interest rates and drastic depreciation ofexchange rates.

The IMF, in exchange for its financial aid, imposedcertain conditions on Thailand and Indonesia. It canbe said that those conditions are not like the ones theIMF introduced in Latin America to stabilize macro-economics, but are rather like the ones imposed onRussia in an attempt to implement comprehensivestructural reform and cope with corruption. It is un-deniable that structural reform is good for these econo-mies in the long-term. However it is problematic that,because the IMF put too much emphasis on it, globalinvestors have begun to believe that in these coun-tries, especially in Indonesia, private foreign debtscannot be paid back without carrying out structuralreform. It is very likely that the Indonesian economyfailed not because of an excess of debts, but becauseof insufficient liquidity, or a temporary shortage offoreign exchange. The IMF should not force pro-

8. Matsuyama, Kiminori, “Economic Development as Coordination’s Problem,” M. Aoki et. al. (eds.), The Role of Government in East Asian Development(Claredon Press, 1997).

9. Grief, A.,“Economic History and Game Theory: A Survey,”Handbook of Game Theory (North-holl, forthcoming).10. Hara, Yonosuke, “Shonin to Kokka no Keizaigaku” Sekai Rekishi 15 (Economics for Merchants and Nations,World History 15) (Iwanami,1998).

9


grams that require the fundamental reform of finan-cial, economic, and political systems, even thoughthese programs may be good in the long run.11 It canbe said that the IMF’s proposal of too much larger-scale programs, based on an incorrect approach ofneoclassical economics, has worsened the economiccrisis in East Asia.

Neoclassical economists completely ignore the factthat rapid industrialization in East Asia has resultedin the over-production of labor-intensive goodsaround the world, which is contributing to the cur-rent economic crisis. The unrest in East Asian econo-mies since the summer of 1997 must be understoodnot as a short-term cyclical recession, but as an inter-mediate- to long-term recession in investments.12 InASEAN member countries, the income distributionbecame more unequal during the rapid growth. Inaddition, consumption did not increase very much,which enlarged the gap between production and ef-fective demand. As a result, East Asian countries ex-perienced a hike in exports to Europe and the UnitedStates, which triggered the rise of protectionism inwestern countries. The world economy as a whole isentering a cyclical recession. There is a great dangerthat pursuing export-promotion policies after the cri-sis may force East Asian countries, as in the 1930s,to devalue their currencies.

In ASEAN member countries, the domestic incomedistribution is rapidly becoming uneven. This is oneof the biggest problems which economic globaliza-tion has caused in this region. Neoclassical econo-mists argue that the widening gap between the richand the poor will cease once labor-intensive industryis back on track, thanks to various economic mea-sures including exchange rate adjustment. However,the gap between those who are able to take advan-tage of opportunities in the booming financial andreal-estate industries due to economic globalization,and those who do not have such capabilities, like farm-ers and blue-collar workers, is not likely to be cor-rected easily. Increase in part time employment inmany corporations is also contributing to the unfairincome distribution.

As argued in the “new economic” argument that isgaining popularity in the United States, is it reallypossible that Southeast Asia can achieve full employ-ment through increasing the flexibility of its labormarket? It is very likely that workers, stripped ofopportunities to improve their skills and trapped in avicious cycle of low income and productivity, willultimately lose a stable basis for their lives. Krugmanpointed out that technological advances and produc-tivity increases do not take place as much as antici-

pated in the manufacturing industry of ASEAN coun-tries.13 The reason is that the traditional social infra-structure in these countries was not compatible to aglobal labor market due to the lack of worker’s senseof commitment to the firm. To survive in global com-petition, workers must be committed to improvingtheir skills and maintaining loyalty to their company.These countries do not have the necessary social struc-tures, including educational systems and social cus-toms, to raise productivity that would enable them towin severe competition in the global market. In short,cheap labor is the only reason why these countrieswere once internationally competitive. There is a greatpossibility that ongoing restructuring of the labormarket in the region may weaken the region’s eco-nomic production capability in the long run.

East Asia must escape from the spell of market-fundamentalism that idealizes drastic globalization.In response to the increasing speed of communica-tion fueled by advances in information technology ,the circulation of global money is also becoming veryrapid. As long as short-term speculative capital in-flow continues, stock prices will rise, and economicactivities will remain brisk. However, once capitalbegins to flow out, interest rates will increase, ex-change rates and stock prices will plunge, and eco-nomic activities overall will head toward stagnation.Mobile global money is not likely to flow into themanufacturing sector, which takes long time to real-ize the profits. The current economic crisis was causednot because the East Asian-model of economic sys-tems has ended, but by global money capitalism, inwhich money circulates all over the world too rap-idly. There is no complete market economy anywhereon the planet. Contrary to what the IMF believes, it isimpossible for political and economic systems to be-come complete in a short period of time even if forcedto carry out structural reforms. Each country’s politi-cal and economic systems must evolve individually,based on the history and the social structure of thatcountry. In order to survive this age of globalization,we must take a good look at the real market economyand abandon “extreme simplification and ideology.”14

It is also, now, time to reevaluate the idea of J. M.Keynes, who clearly recognized the strengths andweaknesses of capitalism. He said “Knowledge shouldbe international. Produce goods domestically. Financeespecially should be domestic.” 15 East Asian coun-tries should seriously reconsider his idea. It is neces-sary for every country to establish a system whichencourages long-term capital flows into the manu-facturing industry, while learning how to tame a roughanimal, namely, the global money market. Obviously,

11. Feldstein, M.,“Refocusing the IMF,”Foreign Affairs (January/February, 1998).12. Shinohara, Miyohei,“Higashi Asia Keizai no 21 Seiki wo Kangaeru”(East Asian Economy toward 21st Century), This is Yomiuri (June 1998).13. Krugman, P.,“The Myth of the Asia's Miracle,”Foreign Affairs (November/December 1994).14. Stiglits, op. cit.15. Keynes, J. M., “National Self-efficiency,” The Collected Writings of John Maynard Keynes, Vol. XXI (Macmillan, 1933).


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Southeast Asian countries have no other way but tonurture their export industry to acquire foreign ex-

change. The most pressing issue today is to formu-late the most effective policy for realizing this goal.

11

The Current Situation in Viet Nam and Japan’s ODA

ARTICLE

The Current Situation in Vietnam and Japan’s ODA

Motoo FURUTAProfessor

Graduate School of Arts and Sciences, The University of Tokyo

Introduction

Since the Official Development Assistance (ODA)Charter was enacted in 1992, Japan has supported thedemocratization and promotion of market-orientedeconomies in developing countries by extending ODAwhenever movements favorable to the spirit of theODA Charter have taken place. The ODA White Pa-per in 1997 cited Vietnam as an example of a typical“positive linkage,” where the implementation ofJapan’s ODA Charter positively influenced thechanges in the recipient country.1

In November 1992, Japan resumed full economicassistance to Vietnam. Since then, Japan has consid-ered Vietnam to be a priority and has actively extendedassistance with the aim of supporting Doi Moi (inno-vation). Up to the fiscal year of 1997, Japan extended391.804 billion yen in loan assistance, 37.769 billionyen in grant aid cooperation (both based on the Ex-change of Notes), and 14.837 billion yen in technicalcooperation (based on the real term of JICA’s expen-diture).2

At the same time, starting with the Fist EconomicCooperation Policy Council held in January 1992,Japan and Vietnam had repeated policy dialogs at ahigh level regarding economic assistance. In January1994, the Committee on the Country Study for Japan’sOfficial Development Assistance to the Socialist Re-public of Vietnam was established at the Institute forInternational Cooperation, JICA. The committee wasresponsible for establishing the basic principles ofJapan’s assistance to Vietnam, and examining the ar-eas of priority for assistance. Based on the outcomeof committee deliberations, the Japanese governmentdispatched a comprehensive study mission for eco-nomic cooperation to Vietnam in October 1994.

Based on the study carried out by the Japanese sideand policy discussions with the Vietnamese govern-ment, Japan’s assistance to Vietnam has come to bebased on the following four points: (1) Stability andeconomic development in Vietnam is essential toachieve regional stability and prosperity not only ofEast Asia, but also of Asia and the Pacific as a whole;(2) Following the Cambodian Peace Agreement in

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu, Vol. 15 No.1 (April 1999).1. Economic Cooperation Bureau, Ministry of Foreign Affairs, Waga Kuni no Seifu Kaihatsu Enjo: ODA Hakusho Jokan (Japan’s Official Development Assis-

tance: The ODA White Paper Volume 1) (Kokusai Kyoryoku Suishin Kyokai, 1997) p. 75.2. Economic Cooperation Bureau, Ministry of Foreign Affairs, Waga Kuni no Seifu Kaihatsu Enjo: ODA Hakusho Gekan (Japan’s Overseas Economic Assistance:

The ODA White Paper Volume 2 (Kokusai Kyoryoku Suishin Kyokai, 1998) p. 42; In the fiscal year 1998, loan assistance 88 billion, grant aid cooperation8,186 billion, technical cooperation 4,636 billion. Economic Cooperation Bureau, Ministry of Foreign Affairs, Wagakunino Seifu Kaihatsu Enjo: ODA HakushoGekan (Japan’s Overseas Economic Assistance: The ODA White Paper Volume 2) (Kokusai Kyoroku Suishin Kyokai, 1999) p.44.

Japan is currently the biggest ODA donor country to Vietnam. In 1992, Japan resumed full-scale economicassistance to Vietnam. Since then, assistance has been implemented based on new policies on the Japaneseside, such as the ODA Charter. At the same time, it has also been carried out by taking in claims andopinions from the Vietnamese side, which has been proceeding with Doi Moi through political dialog. At present, the rapid growth that Vietnam experienced during the mid-1990s is slowing down due to adecrease in foreign investment and the stagnation of exports arising out of the economic crisis in Asia. Inthese circumstances, one reaction of the Vietnamese government to the crisis is that it is finally attemptingto seriously tackle long-neglected issues such as how to mobilize“domestic resources”thoroughly andcarry out rural and agricultural development. Although the importance of these problems had long beenrecognized, they had been left virtually unsolved because of abundant foreign direct investment. In thissence, the current economic crisis in Asia has helped to deepen and facilitate Doi Moi. ODA to Vietnam has been growing relatively smoothly and its role, especially from Japan, is becomingincreasingly important. The basic principle which Japan drew up in the 1990s for its economic assistanceto Vietnam is also gaining in significance: 1) it relies more on government intervention instead of simplyliberalizing and privatizing the economy in order to nurture a market economy; and 2) it attaches impor-tance to performing sustainable development that is stable and well-balanced rather than focusing on rapidgrowth.


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October 1991, Japan-Vietnam relations entered a newera when yen loans were resumed. Through talks atthe highest level, the relationship between the twonations has started to see anew phases of advance-ment in the political and economic arenas, as well asin the fields of security and culture; (3) Since 1986,the Vietnamese government has facilitated the imple-mentation of a market economy under Doi Moi, andstriven to improve and expand its relations with othercountries, including Japan; (4) With a population ofsome 76 million, Vietnam’s per capita GNP is stilllow and the country needs assistance. Based on thesepoints, actual assistance has been carried out with anemphasis on forming a foundation for sustainable de-velopment and securing a fair distribution of eco-nomic resources among different social strata. Theareas of assistance include: (1) human capital devel-opment and institutional development (especially tosupport the efforts toward a market economy); (2)electricity and transportation; (3) agriculture; (4) edu-cation and public health; and (5) environment.3

Japan’s assistance to Vietnam in the 1990s is dis-tinctive in that it has been carried out based on Japan’snew policies which include the ODA Charter, and ithas been extended by incorporating opinions andneeds proposed from the Vietnamese side throughpolicy dialogs. This article is intended to present anoutline of the current situation in Vietnam during theAsian economic crisis since 1997, and to note thechallenges facing Japan’s ODA to Vietnam.

I Vietnam and the Asian Economic Crisis

The economic crisis which has prevailed since 1997is seriously affecting Vietnam. Since the country,where there is no established stock market and thelevel of financial liberalization remains low, has notsuffered from either the outflow of short-term capitalor a fall of its currency like many other countries inthe region. However, this does not mean that Viet-nam is untouched by the economic crises in Asia.

First of all, one of the major impacts of the Asianeconomic crisis has been that foreign investment inVietnam has plunged. Foreign exchange, which in-creased steadily after 1990, began showing signs ofstagnation in 1997 and ended at 60% of its 1995 level.This downward trend became even more visible in1998. By the end of 1998, foreign investment totaled1.795 billion dollars, which is a 23% drop from 1997.If compared to 1996 when it reached its peak, for-eign investment fell by almost 60%.4

The decrease in foreign investment started evenbefore the influence of the Asian economic crisis wasperceived. It is thought that factors particular to Viet-nam, including delays in developing a favorable en-vironment for foreign investment, must have contrib-uted to the drop in investment. However, it is alsoquite obvious that the regional economic crisis ac-celerated this trend. Asian countries account for a highpercentage of foreign investment to Viet Nam. Be-fore September 1998, when it was calculated cumu-latively, 19.7% of investment came from Singapore,13.3% from Taiwan, 11.6% from Hong Kong, 11.4%from Japan, 9.8% from South Korea, 4.5% fromFrance, 4.4% from United States, 4.3% from Malay-sia, and 3.4% from Thailand.5 Among the major in-vestors, Hong Kong, Japan, South Korea, Malaysia,and Thailand were all severely hit by the economiccrisis, which had a huge impact on investment in Viet-nam.

Cheap labor was the largest incentive Vietnam hadto attract foreign investment. However, the countrylost its comparative advantage when neighboringcountries drastically devalued their currencies in re-sponse to the economic crisis in the region and theaverage per capita income in Vietnam surged to 40-50 dollars, which making the country less attractiveto foreign investors.

Another major impact of the Asian economic cri-sis on Vietnam was a stagnation in exports. Vietnam-ese exports grew by 25% on average per year (on amonetary basis) over the 12 years between 1986, whenDoi Moi started, and 1997. However, starting in 1998,this growth began to slow. As of October 1998, ex-ports had increased by only 3.6% over 1997 levels(on a monetary basis).6

According to 1997 statistics, exports to East Asiaaccounted for 44% of all Vietnamese exports, fol-lowed by 22% to Southeast Asia, 19% to WesternEurope, and 3.8% to North America. Obviously, thefocus is on the Asian region, and the economic stag-nation in the area had a direct negative impact on thecountry.7 Moreover, due to the currency devaluationin neighboring countries, the competitiveness of Viet-namese exports saw a relative decrease, and the priceof exports dropped 20-22% on average, overall. Thiscaused the previously mentioned stagnation in exportson a monetary basis despite the fact that in 1998 Viet-namese exports increased by 9% in volume over thatin 1997.

Besides foreign investments and exports, the Asianeconomic crisis caused severe damage to the Viet-namese economy in the service industry in aviation

3. Economic Cooperation Bureau, Ministry of Foreign Affairs, Waga Kuni no Seifu Kaihatsu Enjo: ODA Hakusho Gekan (Japan’s Overseas Economic Assistance:The ODA White Paper Volume 2) (Kokusai Kyoryoku Suishin Kyokai, 1997) pp. 43-44 ; Economic Cooperation Bureau, Ministry of Foreign Affairs, op. cit. ,Note 2, pp. 41-42.

4. Legal capital excluded from the projects, VIETSOVDETRO. General Statistical Office Socialist Republic of Viet Nam, Statistical Yearbook 1998 (StatisticalPublishing House, 1999) p.247.

5. Vietnam Investment Review (December 1998) pp. 7-13.6. Vietnam Investment Review (November 1998) pp. 2-8.7.0Dau Phi Thuan, “Xu Huong Chuyen Dich Co Cau Thi Truong Xuat Khau Cua Vietnam,” Nghien Cuu Kinh Te (4) (1998) p. 63.

13


and tourism which have close connections with theoutside world. As a result, the economic growth rate,which reached 9% between 1995 and1997, is expectedto decrease to 5.8% in fiscal 1998 according to esti-mates by the Vietnamese government (and even loweraccording to international organizations).8

II Reaction of the VietnameseGovernment to the Crisis

The Vietnamese government is obliged to review itsambitious goal to double the per capita GDP of 1990before the year 2000 now that the rapid economicgrowth of the mid-1990s is obviously slowing. Ini-tially, it was estimated that Vietnam needed a total of41 billion dollars in investments over the five yearsfrom 1996 to 2000 in order to achieve its goal. From1996 to 1998, it gained 21 billion dollars. However,as of the beginning of October 1998, only 16 billiondollars are anticipated for 1999 and 2000, 10% lessthan the original projection.

A breakdown of the original projection shows48.5% in public investment (including ODA funds),15.5% in private investment, and 36.0% in foreigndirect investment (FDI). A revised estimate shows52.7% in public investment, 20.5% in private invest-ment, and 26.8% in FDI. In other words, FDI is ex-pected to be lower by almost 25% from the originalestimates. Private investment needs to increase closeto 10%.9

Under these circumstances, the Vietnamese gov-ernment stresses the importance of maximizing “do-mestic resources.”10 The percentage of total invest-ments against GDP in Vietnam which registered10.9% in 1987 when Doi Moi was implemented, hasincreased steadily, and went up to as high as 29.4%in 1997. By contrast, the domestic savings ratedropped to 19.9% in 1996 after reaching a peak of21.4% in 1995. It improved slightly to 20.5% in 1997,but did not recover to its 1995 level. Similarly, thepercentage of domestic capital investment againstGDP declined to between 16 to 17% in 1997 afterreaching a peak of 19% in 1996.11 While this meansthat economic development in the country was highlydependent on foreign capital, the importance of fullymobilizing domestic capital was neglected under asmooth inflow of FDI and ODA.

The Asian economic crisis, especially decreases inforeign capital inflow, brought the vulnerability in theVietnamese rapid economic growth during the mid1990s into sharp focus. Mobilizing “domestic re-

sources” is not a new issue but one that has long beenrecognized. People now realize that the resolution ofthis pressing issue not be further delayed.

The government has finally launched upon privati-zation, which has long been proposed as a remedy totransform inefficient government enterprise. It is an-ticipated that 134 state enterprises will be privatizedby the end of 1998. In 1992, the public sector ac-counted for 30.6% of the GDP while the private sec-tor amounted to 69.4%. However, in 1997, the publicsector increased to 38% of GDP. The same trend isalso observed in the growth rate of the public sector.In 1997, the public sector grew by 12.26%, while theprivate sector increased by only 7.8%. The privatesector potential has not been fully developed.

There are four possible ways to rectify this situa-tion: (1) enhance the public sector; (2) implementdrastic privatization, and minimize the extent of thepublic sector; (3) improve the efficiency of the pub-lic sector while maintaining its size, and expand theprivate sector as much as possible; (4) scrutinize thesize and role of the public sector, develop the privatesector, and nurture a mutual supplemental relation-ship between the two sectors. Remedies (1) and (2)are not plausible in Vietnam. The government andthe communist party are currently taking the thirdapproach. Some economists argue that the time hascome to opt for the fourth path.12

Approximately 80% of the entire population livesin rural areas in Vietnam, where in mobilizing “do-mestic resources” how to develop rural areas and theagricultural industry is a vital issue. The importanceof this issue has often been discussed within the coun-try; however, little action has been taken. Ten per-cent of total social investment was allocated to agri-culture, forestry, fisheries, and irrigation projects in1991. However, that percentage fell to 7% in 1997.13

The price indices of 1997 increased to 103.4 as awhole, 104.4 for non-food products, and 108.1 forthe service industry from the previous year. By con-trast, the indices for agriculture-related products didnot grow as much, for instance, 100.4 for staples, and102.1 for other types of food. Evidently, the prices ofagricultural products are unfavorable for producerscompared to the prices of industrial goods and ser-vices. In 1991, GDP of rural areas accounted for 28%of that in urban areas. Since then, the gap betweenrural and urban areas has worsened, and it is said thatthe percentage of GDP in rural areas against urbanareas fell to as low as approximately 16.4% in 1996and 1997. It is believed that these circumstances limitthe development of rural economies, and create huge

18. General Statistical Office, Vietnam, op. cit ., p.28.19. Vietnam Investment Review (October 26 - November 1, 1998).10. The perspective of the mobilization of “domestic resources” was proposed at the fourth general meeting of the Communist Party Central Committee during the

eighth session: “Nghi quyet Hoi nghi lan thu BCH Trung uong Dang ve tiep tuc day manh cong cuoc doi moi, phat huy noi luc, nang cao hieu qua hop tac quocte, can kiem de cong nghiep hoa, hien dai hoa, phan dau hoan thanh cac muc tieu kinh te-xa hoi den nam 2000.” (Nhan Dan, January 3, 1998).

11. Nguyen Minh Tu, “Chinh Sach Tang Truong Kinh Te Cua Viet Nam: Tu Goc Do Nan Kinh Te Hai Khu Vuc,” Nghien Cun Kinh Te (7) (1998): p. 10.12. Ibid., pp. 3-15.13. Vietnam Investment Review (November 23-29, 1998).


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obstacles to the expansion of the entire national econo-my.14

Agriculture and the rural economy are very impor-tant not only because agriculture remains a key in-dustry which employs a vast majority of Vietnam’speople, but also because their function as a safety netregained attention during the current economic crisisin Asia. In the government briefing presented at theNational Assembly in the fall of 1998, Prime Minis-ter Phan Van Khai proposed that the primary chal-lenge for managing the economy in 1998 was “tostrive further to develop agriculture and rural econo-mies so that they serve as a foundation for socioeco-nomic stability and development under any circum-stances.”15 It is estimated that some 12.6% of socialinvestment will be allocated to agricultural produc-tion and development of rural areas.16 The reactionof the Vietnamese government to the crisis is that itis finally attempting to seriously tackle issues whoseimportance has long been recognized but neglecteddue to a steady inflow of FDI. In this sense, the cur-rent economic crisis in Asia has helped to deepen andfacilitate Doi Moi.

III Significance of ODA and Japan’s Position

Mobilization of “domestic resources” involves diffi-cult and time-consuming challenges, including engen-dering trust among the people toward the government,and developing “good governance.” In this regard,although ODA has always had a significant role indevelopment issues in Vietnam, its role is greater thanever given the current crisis in Asia.

While FDI to Vietnam decreases, ODA extendedto the country has increased steadily. Between 1993,when Japan resumed its assistance, and 1997, Viet-nam was pledged a total of 10.8 billion dollars in ODAby donor countries and international organizations(8.8 billion dollars in ODA on an Exchange of Notesbasis). The issue is no longer how much ODA is ex-tended, but rather how effectively the country utilizesthe funds. The ODA execution rate has been improv-ing year to year. However, up to 1997, only 3.8 bil-lion dollars had been disbursed. In 1998, 1.43 billiondollars of ODA is expected to be extended.17 If Viet-nam can double the rate of 1998, about 20% of thepreviously mentioned total investment planned in1999 and 2000 may be covered by ODA.

Japan’s role in ODA to Vietnam is becoming in-creasingly important. In 1996, Japan was the numberone donor country among the Development Assis-tance Committee (DAC) members, and its contribu-tion accounted for approximately 13% of the total

ODA to the country. In 1997, Japan became the big-gest ODA provider among other donor countries andinternational organizations, including the World Bankand the International Monetary Fund (IMF), when itscontribution surged to 31.5% of the total ODA.

Japan’s ODA largely contributes to the construc-tion of the socioeconomic infrastructure in Vietnam,which includes power plants, roads, port facilities,and water and sewage systems. In addition, it has aconsiderable ripple effect. First, Japanese corporationscontinue to have a presence in Vietnam, encouragedby the Japanese government’s consistent support tothe country. For example, Japanese companies winbids in most yen-loan projects. Second, the Vietnam-ese government is more willing to listen to voicesfrom the international community as it is involved inkeen competition to win either foreign investment orODA. Japan is the largest ODA donor, and its pro-posals are becoming increasingly important to Viet-nam. These two effects suggest that there is an op-portunity to further improve the economic relation-ship between Japan and Vietnam during the currentcrisis in Asia.

IV Japan’s ODA Policy to Vietnam

One characteristic of Japan’s economic assistance toVietnam since 1992 is that it has been carried outbased on Japanese new aid policies, such as the ODACharter. In 1994, the Committee on the Country Studyfor Japan’s ODA to the country was formed. In 1995,the committee’s activities were succeeded by a projectnamed “the Comprehensive Policy Support to Viet-nam toward a Market Economy,” which was respon-sible for making proposals to the country regardingthe ODA master plan and in other important areassuch as macro-economy, rural development, agricul-ture, and finance. At the same time, conclusionsreached by the committee formed a basis of Japan’sODA to Vietnam after the visit of the Comprehen-sive Study Mission for Economic Cooperation to thecountry in 1994. Japan’s efforts to expand economicassistance in more comprehensive ways have contin-ued. In September 1998, the Mission for EconomicCooperation Policy Dialogue was sent to Vietnam inan attempt to hold comprehensive discussions withthe government regarding grant aid, technical coop-eration, and yen loans. It is believed that this seriesof efforts will play a vital role in sending a clear mes-sage that Japan is committed to assisting Vietnam.

Although the details of the policy conferences andprojects are not open to the public, judging from theinformation available, the author believes that Japan’s

14. Nguyen Thi Thu Hang, “Nguyen Nhan Giam Sut Toc Do Tang Truong Va Cac Giai Phap,” Nghien Cun Kinh Te (9) (1998) pp. 3-16.15. General Statistical office, Vietnam, op. ci t., p.2816. Vietnam Investment Review (October 26-November 1, 1998).17. Vietnam Investment Review (November 16-22, 1998).

15


economic assistance to Vietnam is based on two ba-sic principles.18 The first is that appropriate govern-ment intervention is more effective than simple lib-eralization and privatization in promoting a marketeconomy in a low-income country with underdevel-oped economy like Vietnam. Thus it is extremelyimportant to develop the capabilities of the Vietnam-ese government in this regard.

The second is that it is equally important to recog-nize the great potential of the country and to activelyextend not only grant aid assistance, but also yen loansto the nation. However, support should be also fo-cused to macroeconomic stability and implementingwell-balanced sustainable development, not merelystaging rapid economic growth. Issues that need tobe considered in the assistance policy include how toform the foundation for long-term growth, how toachieve social stability, how to correct the gap be-tween urban and rural areas resulting from economicreform (for example, by preparing agricultural infra-structure), and how to eradicate poverty.

To the author, the first principle seems to : (1) giveVietnam a sense of security in that Japan’s ODA isnot intended to overthrow the socialist regime; and(2) prevent policies implemented by its governmentfrom going off the market-oriented right path. Thesecond principle, active extension of yen loans, wasa source for caution and concern for the Vietnamesebecause of accumulating debts and the possibility ofthe debts increasing due to the appreciation of theyen. Because of this, the Vietnamese government pre-ferred grant aid cooperation. Recently, however, theVietnamese have begun to have a more positive atti-tude toward yen loans based on the notion that yenloans are helpful for the country. In addition, Jap-an’s aid principle of helping Vietnam achieve well-balanced and sustainable development corresponds

perfectly with Vietnam’s goal of reconciling economicdevelopment with social equality. With the onset ofthe Asian economic crisis, Vietnam became moreaware that it was necessary to resolve these problems.It is therefore expected that Vietnam will continue torespond positively.

The Project of Comprehensive Policy Support toVietnam toward a Market Economy (In the country,the project is know as the Ishikawa Project, namedafter its leader, Shigeru Ishikawa, Emeritus Profes-sor at Hitotsubashi University) has been highly re-garded by top level Vietnamese leaders includingFormer Communist Party General Secretary, Do Muoiand current Communist Party General Secretary, LeKha Phieu. At a meeting with the mission for eco-nomic cooperation policy dialogue held in Septem-ber 1998, the Vietnamese government expressed itsapproval for Japan’s plan: (1) Among the five priori-ties, nurturing human capital development and insti-tutional building should be emphasized; (2) Withinthe scope of the five priorities, the two governmentsshould consider redressing the gap between urban andrural areas accompanying economic reform, and con-sider narrowing disparities between the social classesto eradicate poverty. The positive response from theVietnamese government shows that Japan’s assistanceis based on the proper principles.19

It has been six years since Japanese ODA to Viet-nam was resumed full-scale. Six years might be tooshort to judge the outcome of the assistance. How-ever, the ODA to Vietnam has been extended as apilot case which represents Japan’s overall principlesfor ODA in the 1990s, and the course of the assis-tance is becoming increasingly important with theongoing economic crisis in Asia. The author sincerelyhopes that the valuable experience of the 1990s willbe wisely utilized in the 21st century.

18. The author referred to “The Report by the Committee on the Country Study for Japan’s Official Development Assistance to the Socialist Republic of Viet Nam”(1995), etc.

19. Kokusai Kyoryoku Plaza: News and Data (International Cooperation: News and Data) November, and December (1998).


16

17

A Consideration of Infrastructure Development inDeveloping Countries

ARTICLE

A Consideration of Infrastructure Developmentin Developing Countries

―Appropriate Design Based on Optimal Destruction Probability

Koji TSUNOKAWAProfessor,

Faculty of Engineering, Saitama UniversityFumio NISHINO

Professor,National Graduate Institute for Policy Studies

Infrastructure development in developing countries is accompanied by many problems particular to developingeconomies, such as funding and technology shortages, insufficient demand and incapability to bear costs, and alack of maintenance and management systems. Of these problems, this article discusses an approach to anappropriate design which corresponds to different levels of economic development. To be more specific, itpresents an analysis of a choice of optimal destruction probability balanced with the developmental stage of aneconomy in the planning and designing process from a perspective of economic efficiency.

Infrastructure design is done based on specifications that are systematized as design standards. Design stan-dards determine the specific content of various specifications, and the conditions of the structures, such asimportance of infrastructure, expected size of demand, natural conditions, to which each specification is applied.Economic efficiency is taken into consideration only indirectly and partially in connection with the categoriza-tion of structures as to the importance and the demand for them. Among those stipulated in design standards,such factors as design flood volume, design earthquake strength, maximum loading and considerations forhuman error (for example, a safety allowance against maximum loading) are extremely important because theyare the major determinants of the design destruction probability of the structures. This article aims to analyzehow costs can be reduced through the deliberate optimization of destruction probability and can contribute to anoptimal allocation of resources.

Analysis has shown that, in general, except for cases where destruction causes human casualties, it is desir-able when designing a structure in developing countries to adopt a destruction probability that is higher than thatin industrialized countries from the perspective of efficient resource allocation. This is because social discountrates are higher in developing countries and, in case of destruction, economic loss before restoration is expectedto be small. It is not necessarily good, particularly in the case of partial destruction, to adopt such extremelysmall destruction probabilities in these countries as those tacitly used in industrialized countries. Wheneverpartial destruction requiring repair occurs after the completion of an assistance-related infrastructure develop-ment project, there are criticisms that there was a design error. These criticisms, however, are not necessarilyaccurate.

Foreword

Recently, the development assistance community hasbeen faced with various new challenges such as globalenvironmental issues, stabilization of the internationalmonetary system, etc. The importance of infrastructurein development should not be blurred by these prob-lems. Infrastructure will continue to play a central rolein various facets of the growth of developing countries,and the need for more flexible and innovative approachesto infrastructure development has become even greaterthan before.

Infrastructure development in developing countriesis accompanied by many problems particular to devel-oping economies, such as funding and technology short-ages, insufficient demand and incapability to bear costs,and a lack of maintenance and management systems.Among these problems, this article discusses an approachto appropriate design which corresponds to different lev-els of economic development. To be more specific, itpresents an analysis of a choice of optimal destructionprobability balancing with the developmental stage ofan economy in the planning and designing process froma perspective of economic efficiency.

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu Vol. 15, No.1 (April 1999).


18

I Cost Reduction, Economic Feasibilityand Optimum Resource Allocation

It is not a problem particular to developing countries toallocate valuable resources efficiently among differentcompeting needs under severe financial constraints. Itis with these countries, however, that the problem is mostacute, since they have to rely heavily on external re-sources for their development funds. For this reason,many aid organizations, including Japanese organiza-tions, be they multilateral or bilateral, attach great im-portance to the economic feasibility of individual projectswhen deciding whether to provide financing or not. Thatis, it is a presupposition to financing a project to scruti-nize the costs and benefits, and to confirm that the ben-efits outweigh the costs. Therefore, stricter cost con-sciousness is required when designing a project in thesecountries.

Figure 1 demonstrates the importance of cost con-sciousness in the design of a project to secure economicfeasibility. The horizontal axis represents the scale ofthe project (e.g. width of a bridge), and the vertical axisthe costs and the benefits of the project. Assume thatthe project under consideration generates benefit as afunction of scale as represented by the schedule denoted

“benefit”in the figure. Assume further that the two

“cost” schedules in the figure represent those of theproject under different design standards that affect con-struction costs. For example, the “cost 1” curve mayrepresent the cost schedule based on the design stan-dard of an industrialized country, and the “cost 2”curvethat of an appropriate standard for the developing coun-try in question. The net-benefit, which is the differencebetween the benefit and the cost, is represented by thetwo “net-benefit” curves for these cases.

In infrastructure projects in developing countries,cases such as that depicted by “cost 1” are not uncom-mon. This illustrates a case where, if designed using thestandards of industrialized nations, economic feasibil-ity is not secured at any level of the project because ofthe shortage of benefits. Benefits often depend on thedevelopmental stage of the economy such as is indi-cated by per capita GNP. Even if there is the sameamount of physical demand expected (e.g. number ofusers), the amount of benefit is apt to be insufficient inprojects in developing countries compared to those inindustrially advanced nations. Under these circum-stances, if it is possible to reduce the cost as in “cost2”under a more suitable design standard, then economicfeasibility will be ensured. It is interesting to note herethat the optimal scale of the project (s1 and s2 in Figure1) that produces the maximum net-benefit differs de-

Figure 1 Economic Feasibility of a Project

19


pending on the case. If it is possible to cut costs, a largerscaled project will become optimal. Feasibility will im-prove for two reasons: increased benefit resulting froma greater demand and reduction in cost. If this is true,how can costs be curtailed in a concrete manner? As anexample, we will discuss the choice of the optimumdestruction probability during the planning and design-ing stage.

II Cost of Infrastructure Provision andDestruction Probability

Infrastructure design is done based on specifications thatare systematized as design standards. Design standardsdetermine specific content of various specifications, andthe conditions of the structures (importance of infrastruc-ture, expected size of demand, natural conditions, etc.)to which each specification is applied. Economic effi-ciency is taken into consideration only indirectly andpartially in connection with the categorization of struc-tures as to the importance and demand. Therefore, it isevident that certain cost reduction will be achieved ifdesign is done with an explicit attempt to optimize thedesign with respect to cost.

Among those stipulated in design standards, such fac-tors as design flood volume, design earthquake strength,maximum loading and considerations for human error(for example, a safety allowance against maximum load-ing) are extremely important because they are the majordeterminants of the design destruction probability ofstructures. We will examine below how we can achievecost reduction, and hence contribute to better resourceallocation by explicitly optimizing the destruction prob-ability. The destruction of a structure does not necessar-ily mean a total collapse, which would entail rebuildingthe structure from scratch. Large structures tend to col-lapse in parts, rather as a whole; it is rare that an entirestructure gives way all at once. A case in point is thebreaking of a levee; if it breaks at all, it does so at verylimited locations, not over its entire stretch. The extremedeterioration of pavement resulting from excessive load-ing and/or lack of strength is another example.

Let us consider a structure that is expected to func-tion for a given period of time. It may be created sostrongly that it will not fail during the entire service pe-riod, but the construction cost will be prohibitively high.If built cheaply, the probability of failure will be largeand extra cost will be incurred for repairs to completeits service life. The lower the initial construction cost,the shorter the expected life of the structure, and theincreased likelihood that it will need repairing more thanonce. Associated with the failure of a structure, is theloss to society due to its failure to serve its purpose.

1. We do not explicitly deal with the cost of routine maintenance in this analysis because it can be considered to be constant for a given service life regardless of whethera structure needs repair or not during its service life. To be more precise, since routine maintenance is not required during repairs, total cost of routine maintenance maybe reduced depending on the number of repairs. Such effect, however, may be incorporated in the analysis by reducing the miscellaneous social cost of failure by thesaving in total routine maintenance cost.

2. To be more precise, it is the net cost excluding benefit due to failure such as savings in routine maintenance costs.

These considerations indicate the importance of exam-ining the likelihood of destruction with which to con-struct a structure. To do such an analysis, it is neces-sary to represent the net present value of the total socialcost of a structure (total provision cost, hereinafter) as afunction of the likelihood of failure (destruction prob-ability, hereinafter). The total provision cost is definedhere to include not only the initial construction cost, butalso the repair and miscellaneous social costs incurredwhen the structure goes unused for a period because ofa failure.1 The initial construction cost of a structure canbe considered to be the function of the destruction prob-ability, p, which is defined as the probability that thestructure will fail within one year after construction. Forexample, if a structure is designed according to a designflood that corresponds to the repetition period of 100years, the destruction probability will be 0.01. Sincethe stronger the design of a structure is, the higher theconstruction costs are, the cost of initial construction,C(p), is considered to be a decreasing function of p.Furthermore, since there appears to be a certain mini-mum at which construction cost cannot be made cheaperno matter how humble the structure’s design, C(p) canbe assumed to approach a certain lower bound as p comesclose to unity.

Assuming that repair work is to restore a damagedstructure to the condition of its original design used inthe initial construction, the cost of repair can be consid-ered to be a function of the extent of the damage and theinitial construction cost. Including the debris removalcost in the miscellaneous social cost of structure failure,the ratio of repair cost to initial construction cost (here-inafter damage ratio) is a positive number smaller thanor equal to unity, with unity corresponding to the caseof total destruction. Since the damage ratio can also beconsidered to be implicit in the design standards as isdestruction probability, it is also important to examinethe possibility of reducing costs by choosing the opti-mal damage ratio. Because of the stochastic nature offailures, it is extremely difficult to precisely predict theextent of damage a priori, and so design standards shouldbe understood to implicitly contain an average damageratio. Without going into further details, we will assumethat the average repair cost is given by the product ofthe initial construction cost, C, and a given damage ra-tio, s.

In addition to repair outlay, various miscellaneouscosts will be incurred by the society once a structure isdamaged and its service interrupted. We will denote Xto represent the total of such miscellaneous costs.2 Al-though some constituencies of X, such as the loss due tocessation of use and the costs of removing debris, canbe considered as functions of damage ratio, s, they arealso affected by other factors such as the size of demand


20

at the time of the failure. In this analysis, we will con-sider X to be a constant representing the average mis-cellaneous cost of damage during a structure’s servicelife. Having thus defined various components, the netpresent value of the total cost of a structure repair for agiven service life (hereinafter denoted by L) that includesrepair cost and miscellaneous social costs of failure (here-inafter denoted by R(L) and called total repair cost) isgiven by

where, r is the social discount rate. The function g(t) isthe probability density distribution function of destruc-tion probability. Assuming that the destruction prob-ability density at any point in time is independent of theprevious history of destruction, g(t) is given by the fol-lowing Poisson distribution:3

g(t) = q exp(－ qt) (2)

where q = － ln(1 － p). (3)

Expression (1) implies that the total repair cost for aservice life L, R(L), is given as the expected value of thenet present value at the beginning of the analysis pe-

riod, t = 0, of the sum of the average repair cost sC, themiscellaneous social cost of failure X and the total re-pair cost for the rest of the service life, R(L ― t), at eachmoment of the service life, t. Solving this,4 the totalrepair cost, R(L), is given as a function of destructionprobability, p, as follows:

R(L) = kq(sC+X) (4)

Where k = {1－ exp(－ rL)}/r. (5) Therefore, the total provision cost for a service pe-riod of L, F(L), which is the sum of the initial construc-tion cost, C, and the total repair cost, R, is given by

F(L) = C + kq(sC+X). (6)

III The Optimal Destruction Probabilityand the Minimum Total Provision Cost

In the following discussion, the initial construction cost,C, and total provision cost, F, are considered to be func-tions of q because destruction probability, p, can beuniquely transformed to parameter q through equation(3). Since the initial construction cost, C, is assumed tobe confined by a lower bound (denoted as C), expres-

3. This distribution is known to approximate those of the occurrences of very infrequent events.4. From equations (1) and (2), the equation to be solved is given by the following expression:

Differentiating both sides with respect to L yields:

Eliminating the integrals from equations (7) and (8), we obtain:

Equation (4) is obtained by solving this first order linear differential equation.

R(L) = q ∫0L {sC+X+R(t)}e － (q+r)(L－ t)dt (7)

R’(L) = q{sC+X+R(L)} － q(q+r) ∫0L {sC+X+R(t)}e － (q+r)(L － t)dt (8)

R’(L) = － rR(L)+q(sC+X)

R(L)= ∫0L g(t){sC+X+R(L ― t)}exp (― rt)dt (1)

Figure 2 Relationship between Design Destruction Probability and Total Provision Cost

y

C

y = C+kq(sC+X)

y = C+k(sC+X)qy = C

q ＊ q

21


sion (6) implies that the total provision cost function,F(L), asymptotically approaches a straight line with aslope of k(sC+X) as the destruction probability increases(i.e., p→1, q→∞). However, when the destruction prob-ability becomes very small (i.e., p→0, q →0), the chang-ing ratio of the total provision cost curve asymptoticallyapproaches the sum of the changing ratio of the con-struction cost function C and k(sC+X). Therefore, if thesensitivity of the initial construction cost function, C, todestruction probability (i.e., the absolute value of thechanging ratio) at zero destruction probability is largerthan a certain value (i.e., k(sC+X)), the total provisioncost function becomes a minimum value at a certainpositive value of destruction probability.5 If this condi-tion is not met, then the total provision cost becomes aminimum value at zero destruction probability.6 In thiscase, repair costs and other costs associated with de-struction are so large that reducing the initial construc-tion cost by adopting a large destruction probability isnot effective. Figure 2 depicts a case where the socialdiscount rate r = 0.07, the service life L = 20, the miscel-laneous costs X = 20, the damage ratio s = 0.2 and theinitial construction cost C = 100+300exp(－1000q). Inthis case, the total provision cost becomes a minimumvalue in the neighborhood of q = 0.00660, or a destruc-tion probability p = 0.00658.

IV Implications for InfrastructureConstruction in Developing Countries

The specifications used in designing infrastructure im-plicitly specify the destruction probabilities of the struc-tures through different design parameters such as de-sign flood volume, design earthquake strength, safetymargin against human error, etc. Specifications are sys-tematized within a design standard, which also definesvarious conditions of structures under which differentspecifications should be applied. These conditions in-

clude natural conditions, the size of the demand for andthe importance of the structures, all of which are closelyrelated to the initial construction cost of structures andthe miscellaneous costs of failure due to destruction,Therefore, a design standard may be considered to be aguideline that stipulates the appropriate design destruc-tion probabilities based on empirically established rela-tionships between destruction probability and total costsof structure provision including various losses incurredin the event of failure. That is, It can be taken as desig-nating, based on empirical laws, provisions that are closeto the solutions to the aforementioned minimizationproblem of the total cost of structure provision. It shouldbe noted here that these empirical laws are constrainedby the developmental stage and socioeconomic condi-tions of the society in which they have been established.This means that if a design standard is applied in a soci-ety that is very different from where the standard hasbeen developed, the destruction probability implied bythe standard will likely be very different from the opti-mum. This may be the case if the standard of a highlydeveloped country is applied in a developing countrywithout having been properly modified. This is becauseall the parameters of the total provision cost minimiza-tion model can be different depending on the develop-mental stage of a society.

The initial construction cost function is different ifmaterial and labor costs are different. The social dis-count rate, r, which is closely related to the marginalproductivity of capital, tends to have a larger value indeveloping countries where capital is relatively scarcecompared to investment opportunities.7 In contrast,losses associated with structure failures, X, are smallerin developing countries. The relationships between theseparameters and the optimal destruction probability, q*,may be examined by further differentiating the first or-der conditions8 of equation (6) with respect to the pa-rameters. Since the expressions dq*/dk and dq*/dX thusobtained9 imply that they take negative values in the

5. The initial construction cost function, C, is assumed to be appropriately continuous and differentiable.6. The first derivative of the total infrastructure provision cost function, F, is assumed to be monotonic.7. Another reason for this is that the economic growth ratio is generally assumed to be higher in economies in lower stages of development.8. The first order conditions are obtained by equating the derivative of equation (6) with respect to these parameters to zero.9. The first order condition for the minimization of F(L) is derived as follows from equation (6):

Considering the optimizer q* as a function of X, the following expression is obtained by differentiating equation (9) with respect to X:

Substituting this expression with the result obtained from the partial differentiation of the right hand side of equation (9) with respect to X yields the following:

The denominator of the right hand side of the above equation is positive due to a second order condition of the minimization of F(L). Therefore, we have,

Similarly, considering the optimizer q* as a function of k, the following expression is obtained by differentiating equation (9) with respect to k:

From equation (9), we have

Finally, from equations (10) and (11) the following inequality is established:

(Note that C’ is negative by assumption)

dq ＊

(10)

(11)

∂ = 0∂ XdFdq

∂∂ q+ dF

dq dX

∂ = 0∂ kdFdq

∂∂ q+ dF

dqdq ＊

dk

dXdq ＊

＜ 0

= ＜ 0dq ＊

=dkk

d2Fdq2

C’

dq ＊

= －dXk

d2Fdq2

dqdF = C’+ksC+kqsC’+kX = 0 (9)

∂∂ k

dFdq = sC+qsC’+X = － C’

k


22

vicinity of the optimal destruction probability, q*, theoptimal destruction probability becomes large as thesocial discount rate increases and the miscellaneous so-cial cost of failure becomes small. [Note that equation(5) implies that the value of k becomes small as the so-cial discount rate, r, increases.] That is, the lower thedevelopmental stage of an economy, the larger the opti-mal destruction probability of infrastructure to be con-structed becomes.10

It follows from the above analysis that enough caremust be taken when applying the design standards ofindustrialized countries in developing economies. Anexplicit analysis of the optimal destruction probabilitythat suits the particular conditions of the developingcountry may be in order necessary to reduce the projectcost in such a way that the economic feasibility of theproject is substantially enhanced as discussed in section 1.

V An Example of a Project Financed by ForeignAssistance Where Destruction ProbabilitiesWere Adjusted

In designing the Jamuna Bridge in Bangladesh, whichwas inaugurated in June 1998, two distinct destructionprobabilities were used for the bridge structure itself anda related structure: one adopted from the design stan-dard of an industrialized country and the other, a valuelarger than that in the standard. The Jamuna Bridge isthe first structure to connect the eastern and the westernparts of the country that are divided by the Jamuna River.It is the largest bridge in the country, costing US$ 940million and was constructed with the joint financing ofBangladesh, the World Bank, the Asian DevelopmentBank and the OECF of Japan.11

The design of the main structure of the bridge wasbased on the British standard without modifications. Theload conditions of the bridge were also specified by thestandard. According to the results of the above analy-sis, in order to reduce the construction costs, it was pos-sible, and may have been desirable, to design the bridgewith a larger destruction probability and hence, a smallersafety margin than that in the British standard. It ap-pears that cost of repairs and losses due to partial ortotal closure in the event of a failure would be muchsmaller in Bangladesh than in Britain.

There is no significant difference between the weightof a single vehicle in Bangladesh and one in Britain.However, it is quite unlikely that, in the next ten years,the four lanes of the Jamuna Bridge would receive thesame traffic load as that of a most heavily used bridge inBritain. It may well be that the bridge was designed forunrealistically large loads and hence with a smaller de-struction probability than is warranted by the British stan-dard. The contrary may also be true.

We cannot completely deny the possibility that thebridge will be exposed to the same traffic loading con-ditions as in Britain within the next 120 years of its verylong service life. If it happens, it should be at a timewhen the country’s economy is much more developedand there is a high possibility of constructing a secondbridge based on a design standard similar to those inindustrialized countries. It may also be possible to co-pe with additional loading by moving the track of theexisting railway to a second bridge. In Japan, there aremany old bridges that are still used with restrictedaccess.

The width of the Jamuna River reaches more than 15km during flood seasons. The cost of constructing abridge over such a width was estimated to be extremelyhigh. Therefore, a plan was adopted to contain the riverwithin a 5-km width at the site of the bridge. The ideawas to secure a large enough cross-section to accom-modate a full flood by utilizing the velocity of the floodand letting allowing it to dig its own channel. Masonryprotection banks were constructed for the double pur-poses of restraining the river and protecting the banksfrom the increased water velocity resulting from thenarrower width. Figure 3 illustrates the masonry on theJamuna Bridge.

When the Japan International Cooperation Agency(JICA) conducted a study on the feasibility of buildingthe bridge more than 20 years ago, it was found that theprotective banks should be 3.5 km long. The bridgewas not built at that time because it was economicallyunjustifiable. When the World Bank carried out a simi-lar study later, the length of the protective banks wasreduced to 2.8 km with the bridge in the same location.The study concluded that banks of this length wouldprovide enough safety and secure the economic feasi-bility of building the bridge.

The possibility of further reducing the length of thebanks was examined when economic feasibility wasscrutinized before entering into the detailed design stage.A large-scale model experiment established that the mini-mum length of the protection banks had to be 2.2 km toensure safety. Of course, there are clear differences be-tween the conditions in a model and those in reality. Amodel cannot replicate the precise conditions of a realriver. Despite the limitations of the model, the 2.2-kmprotective banks were adopted in the design with theconfidence that the likelihood of the bridge collapsingin a single large flood occurring shortly after its comple-tion would be very small. It was also understood thatgroins vertically sticking into the river could be con-structed upstream of the bridge later if the protectivedikes did not provide enough safety. Careful observa-tion of the condition of the banks during floods is a pre-requisite for this option. Taking all of this into consider-ation, it would be safe to assume that a larger destruc-

10. Although this analysis assumes that the optimal destruction probability is not equal to zero, the result also holds in such a case. This can be concluded by the fact thatwhether a positive optimal destruction probability exits or not depends on the relative magnitude between the value of the derivative of the initial construction costfunction

11. OECF Newsletter, November 1998.

23


tion probability than those of industrialized countrieswas adopted in the design of the protective banks.

One of the motivations for writing this article was thefact that different destruction probabilities were used ina very ad-hoc manner in designing the different compo-nent structures in a single project without any discus-sions based on sound probability theories. It does notmatter per se that different destruction probabilities wereused in a single project because it is not uncommon toapply different destruction probabilities depending onthe importance of the structures or the frequency of natu-ral phenomena such as earthquakes. Rather, it is thefact that a more important structure was designed with alarger destruction probability when the converse shouldbe the case. In the case of the Jamuna Bridge, the pro-tective banks should have been considered to be moreimportant than the bridge itself.

Although the case of the Jamuna Bridge is not a goodexample, it may be argued that it is more natural to usea destruction probability in a project in a developingcountry that is different from those of industrializedcountries. Whenever partial destruction requiring repairoccurs after the completion of an assistance-related in-frastructure development project, there are criticisms thatthere was an error in the design. However, these criti-cisms are not necessarily valid.

In this article, we presented a theoretical analysis re-garding the choice of optimal destruction probabilitiesthat correspond to the developmental stage of aneconomy. More elaborate empirical studies that followup on the findings of this analysis and provide practicalguidelines in the field of official development assistance

are warranted.

Concluding Remarks

In general, except for cases where destruction causeshuman casualties, when designing a structure in devel-oping countries, it is desirable to adopt a destructionprobability that is higher than those in industrializedcountries in order to efficiently allocate resources. Thisis because social discount rates are higher in developingcountries and if the structure is destroyed, the economicloss before restoration is expected to be small. In devel-oping countries, it is not necessarily good, particularlyin the case of partial destruction, to adopt such extremelysmall destruction probabilities as those tacitly used inindustrialized countries.

This conclusion may be reinforced by the observa-tion that there is no big difference between industrial-ized and developing countries in the likelihood of hu-man error in the design and construction of aid-relatedlarge-scale infrastructure projects. This is because theseprojects tend to be implemented with the participationof engineers from industrialized countries.

Although this cannot be discussed quantitatively be-cause of the lack of empirical data, our point may beillustrated by the following example. Consider twocases. In the first case, one hundred similar structuresare built that serve their given service life without fail-ure. In the second case, a hundred-and-thirty similarstructures are built, out of which five are prematurelypartially destroyed while the rest complete their service.If the total cost, including repair and miscellaneouslosses, is the same in both cases, the latter will be more

Figure 3 River Works of Jamuna Bridge


24

desirable. Although merely illustrative, this exampleclearly shows the advantage of adopting larger destruc-tion probabilities in developing countries than those indeveloped nations. Larger destruction probabilities en-able more infrastructure to be constructed with the sameamount of resources, and thus contribute to accelerat-ing economic growth in these countries.

References1) Baum, W.C. and S.M. Tolbert, Investing in Develop-

ment: Lessons from the World Bank Experience, Ox-ford University Press, 1985.

2) Parzen, E., Stochastic Processes, Holden-Day, SanFrancisco, 1962.

Diffusion of Maternal and Child HealthHandbook Program in Indonesia

25

CASE STUDY


Keiko OSAKIResearch Resident, Imperial Gift Foundation BOSHIAIIKU-KAI

Yasuhide NAKAMURAProfessor, Faculty of Human Sciences, Osaka University

Yoko WATANABEJICA Expert, Visiting Researcher,

School of International Community Health, The University of TokyoYoshiko SATO

JICA ExpertHiromi OKUNO

Former JICA Expert, Lecturer in the Faculty of Nursing,Shizuoka Prefectural University

Since its start in the Central Java Province, Indonesia in 1993, the Maternal and Child Health Handbook Pro-gram has been expanded to cover two thirds of the province’s population following a trial run in a pilot area. Theprogram is soon to be applied to all of the 35 districts/municipalities of the Central Java Province and to otherprovinces.

The Indonesian version of the Maternal and Child Health Handbook (MCH Handbook) is, in one respect, ahealth education material as it contains health information. It is also a comprehensive record book of severalexisting health cards which has been used for community health services. As a result of efforts made in thecompilation process, the Indonesian MCH Handbook is not a mere translation of the Japanese version, but hasdeveloped into a version filled with originality. Its effectiveness was proved in the pilot area.

The pilot programs generally aim at the development and application of the activities in other areas. Thisobjective, however, is not always achieved because of a number of reasons. This report, therefore, will analyzethe factors behind the success of the MCH Handbook Program in Indonesia, whose application has been ex-panded from a population of 150,000 in the pilot area to 18 million in total.

The following five points can be considered to have dedicated significantly to the success of this program.Firstly, the program’s concept, the sense of ownership toward the program and the consideration of its adaptabil-ity to local sites were correct. Secondly, there was a need for this program in each related group, namely, policy-makers, implementing personnel and users. Thirdly, resources and infrastructure were adequately arranged tosupport community health services. Fourthly, efforts were made to ensure the sustainability of the program andfinally, the role of catalyst in the program was performed effectively by the Japanese side.

Introduction

The Indonesian version of the MCH (Maternal and ChildHealth) Handbook was developed during the course ofthe Family Planning/Maternal and Child Health Project(1989 – 1994: hereinafter cited as FP/MCH) which theJapan International Cooperation Agency (JICA) imple-mented in the Central Java Province in Indonesia (Fig-ure 1). The Indonesian version of the MCH Handbookis used as health education material for health informa-tion. It can also be used as comprehensive health recordbook instead of the several existing health cards which

have been used for community health services in Indo-nesia.As health education material, the MCH Handbook con-tributes to improve mothers’ knowledge and behaviorregarding maternal and child health. As a comprehen-sive record book, it enables integration of health check-up records. This was not possible with conventionalhealth cards because each card served for a differentpurpose in a different period, for example, keeping trackof mothers’ health during pregnancy, immunizations, andthe growth monitoring of children. With the introduc-tion of the MCH Handbook, for example, in case a preg-

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu Vol. 14, No.2 (October 1998).


26

nant women returns to her parents’ home to give birth,her health records can be passed from the health per-sonnel who examined during pregnancy to the person-nel who will attend delivery.

Following a pilot run, the MCH Handbook Programhas been implemented in all 35 districts and municipali-ties of the Central Java Province1 and in other provinces.In general, any pilot programs aim at those applicationin other areas at the starting point of the programs. How-ever, for a number of reasons, these objectives have notbeen always achieved. This report, therefore, will ana-lyze the factors which contribute to the success of theexpansion of MCH Handbook Program in Indonesia inorder to identify essential points to put the program infull practice.2

I A Case Study: The MCH HandbookProgram in Indonesia

1. BackgroundMaternal and child health is an important issue of pub-lic health policies in Indonesia. It is reported that the

country’s infant mortality rate of Indonesia in 1996 was47 per 1,000 live births. The maternal mortality rate wasalso as high as 650 per 100,000 deliveries in 1990 (Table-1). The infant mortality rate has been gradually decreas-ing. By contrast, the maternal mortality rate, although itis extremely difficult to get accurate data, has remainedhigh compared to that in other member countries of theAssociation of Southeast Asian Nations (ASEAN).

The Indonesian government has put priority on es-tablishing a community health service system. Healthcenters, which exist in a ratio of one to every thirty tofifty thousand people, provide basic health services in-cluding both preventive and curative services. At thedistrict or municipality level, there is a district or mu-nicipality hospital which serves the surrounding com-munities as the core health facility. Pregnant women andnursing mothers seek health care at both the public andprivate sectors: the public sector includes health cen-ters, sub-health centers, and community midwives whoare stationed one per village; and the private sector in-cludes midwives in private practice (who often hold apost at health centers in the daytime), and traditionalbirth attendance.

Table 1 Basic Statistics of Indonesia

Population (1,000)

GNP per Capita (US$)

Average Life Expectancy (years)

Infant Mortality Rate (per 1,000 live births)

Under 5 Mortality Rate (per 1,000 live births)

Maternal Mortality Rate (per 100,000 deliveries)

Literacy Rate (%)

200,453 (1996)

980 (1995)

64 (1996)

47 (1996)

71 (1996)

650 (1990)

84 (1995)

Source: UNICEF, State of World Children (1998)

1. In Indonesia, “province” is the first grade local government (Dati I), while “district” and “municipality” are the second grade (Dati II). “District” and “municipality” areclassified as being at the same level.

2. In this report, the term “project” refers to project-type technical cooperation, while the term “program” refers to an individual undertaking included in a project).

Figure 1 Map of Indonesia


27

Before the MCH Handbook was introduced to Indo-nesia, several types of health cards, including cards formaternity, family planning, growth monitoring, and childdevelopment coexisted nationwide. These cards wereused primarily for community health services and healthcenters. The Ministry of Health aimed at achieving a100% distribution of these cards to the related parties.However, the distribution rate varied from card to card.Cards were often misplaced because it was difficult formothers to keep track of the different cards. In addition,the cards were not used in an integrated manner. Forexample, if a mother consulted at more than one healthfacility, her health records were not shared by the vari-ous health personnel in different facilities.

2. The Beginning of the MCH Handbook ProgramThe MCH Handbook Program started by the request ofIndonesian doctors who learned about the Japanese ver-sion of the MCH Handbook during their visit to Japanthrough the training scheme of the FP/MCH Project.They strongly requested that the handbook needs to beintroduced to the country. After examining the feasibil-ity of the program with long discussions, developmentof the MCH Handbook began in the Central Java Prov-ince.

3. Preparation Period of the MCH Handbook(1993 - 1994)

Behavior of pregnant women and mothers has an im-pact not only on their own health, but also on that oftheir children. In order to facilitate their appropriate be-havior, it is important to provide them with basic andessential information about maternal and child health.Because there was almost no health education materialwhich mothers could keep for reference at home, devel-oping the handbook as educational material became aprimary objective of the program. The second objective

was to integrate the existing health cards so that preg-nant women and mothers could keep their health recordsin one form. With the consent of the Ministry of Healthof Indonesia, the use of existing health cards was stoppedin order to prevent any confusion in the pilot area wherethe MCH Handbook was planned to be introduced.

Salatiga, a municipality of about 150,000 people, waschosen as the pilot area. There were several factors whichwere favorable to designate the pilot program, such asthe appropriate population size, easy accessibility, thesolid foundation of the public health activities, and thestrong leadership of the Head of the Municipality HealthServices. The Head of the Municipality Health Serviceswas also sent to Japan to observe maternal and childhealth services with the MCH Handbook in Japan.

The Indonesian version of the MCH Handbook con-tains every item that was included in the existing healthcards and additional important information with illus-trations (Figure 2). The initial draft was prepared by theofficials of the provincial office of the Ministry of Health3

and the Municipality Health Services of Salatiga, withthe help of Japanese experts. Then, the contents of thehandbook were examined by pediatricians and obstetri-cians at the municipality hospital. Focus groups werealso formed in order to better understand the needs ofmothers. After pre-tests, the contents of the MCH Hand-book were approved in a final meeting in the presenceof provisional and municipality officials of the Ministryof Health involved.

4. Pilot Period (1994 - 1996)The MCH Handbook was introduced through seminarsand training sessions. First, a seminar at the provinciallevel was held to share the objectives of the project. Sec-ond, technical training which included how to use thehandbooks was provided to the personnel who imple-mented the program. This technical training consisted

Breast-Feeding Promotion

Family Planning

Health Cards Health Records Health Education Material

Maternity Card

Family Planning Card

Growth Monitoring Card

Child Development Card

Pregnant Women

Lactating Women

Neonate

Infant

Under 5 Year-old

ANC Nutrition

Immunization Dental Check

Growth Charts

Psychology

Child Infection Diarrhea

Figure 2 Contents of the MCH Handbook

3. At the provincial level, officials both from the provincial office of the Ministry of Health and the Provincial Health Services were involved.


28

of two stages. At the first stage, Japanese experts andthe provincial officials trained key officers of the Mu-nicipality Health Services of Salatiga, including the headsof health centers, to be trainers. At the second stage grouptraining was provided to the staff of each health center.At the same time, training was also provided at eachhealth center to volunteers who conducted communityhealth services at grassroots called “Posyandu”.

The MCH Handbook was distributed through thesame routes as conventional health cards: from the Mu-nicipal Health Services to each health center, and thento health service facilities in each area (both public andprivate hospitals/clinics). Introduction of the handbookat each health service facility was made through semi-nars and meetings of professional associations, includ-ing provincial associations of doctors and midwives.What was different from the distribution of conventionalhealth cards was that the staff of health centers weremore actively involved in management of distribution.The handbook was distributed to all pregnant womenand mothers with children under five. At the time ofdistribution, the previous health records on the conven-tional health cards were transferred to the handbook.The handbook was distributed free of charge to motherswho resided in the pilot area.

In order to monitor the progress of the program, checklists were prepared. The team of the staff from the Mu-nicipal Health Services, the Head of health centers andJapanese experts monitored the progress at each healthcenter, health facility and “Posyandu.” Monthly meet-ings were also held at the Municipality Health Servicesoffice, which were attended by various health center staff,including the heads of the centers (doctors), midwives,and dietitians. At the meetings, each health center rep-

resentative reported on the maternal and child healthservices as well as on the handbook. The provincial of-ficers and Japanese experts were always present at thesemeetings. Based on the issues brought up during themeetings, an action plan for the following month wasprepared. The outcomes of the plan were examined andreviewed at the end of each month.

5. Expansion Period (1997 - present)A mid-term evaluation survey was conducted after eightmonths to assess how the MCH Handbook was beingaccepted in the pilot area. Since only a short time hadpassed since the introduction of the handbook, only fewchanges were observed in the behavior of the mothers.However, it was clear that the handbook had been highlyaccepted among them. Based on this evaluation, the pro-gram was continued. From the beginning, the personnel who implementedthe program at the province level demanded that theMCH Handbook be expanded to other districts andmunicipalities of the province. They approached theWorld Bank, which was then carrying out a communityhealth project in the province, and acquired funds to printthe handbook. Thanks to these efforts, the MCH Hand-book was distributed to new eight districts (a popula-tion of some 7.7 million) in the Central Java Province infiscal 1995. After the completion of the FP/MCH Project,Japanese experts who were independently dispatchedto assist the provincial office of the Ministry of Healthin expanding the handbook program and following upon the activities in the pilot area (Figure 3).

Steps of the diffusion process was similar to that ofthe introduction process. First, the personnel who wereimplementing the program were trained to be trainers.

Figure 3 The MCH Handbook Program in the Central Java Province


29

Second, representatives from health centers, includingthe heads of the centers, were trained at the district level.Third, other health center staff and community midwiveswere trained at each health center through the existingmonthly meetings. Last, volunteer representatives weretrained at the monthly meetings so that they could trainother volunteers in the community. In general, the num-ber of staff, and the amount of time and money allo-cated in a newly expanded area can be much less thanthose injected into a pilot area. Therefore, the primaryconcern was how to reduce the burden of implementa-tion in the new areas. The personnel in the pilot areagreatly contributed to the expansion of the program bybeing sources of information and communicating theirhands-on experience.

The final evaluation survey of the handbook programin the pilot area proved that the program contributed toimproving the behavior and knowledge of maternal andchild health among mothers. In 1996, the project wassucceeded by the Procurement Scheme of Provision ofEquipment on Population, FP/MCH. Coupled with theproject undertaken by the World Bank, the MCH Hand-book Program was diffused to 22 districts and munici-palities (about 18 million people) and all the 35 districtsand municipalities (about 29 million people) in the Cen-tral Java Province in 1998. Starting in fiscal 1997, fourother provinces adopted the program (Figure 4).

II Discussions

In this section, we would like to examine the five fac-tors which enabled the MCH Handbook Program toexpand beyond the pilot area. These factors are: (1) theprogram was carefully designed; (2) the Indonesiansneeded the program; (3) the resources and infrastruc-ture were in place to support the program; (4) effortswere made to ensure the sustainability of the program;and (5) the Japanese worked as effective catalysts forthe program.

1. Points to be Considered in Designing the Program

1) Steps Taken before Implementing the Program

Before starting the MCH Handbook Program, thefollowing points were agreed to by both the Indonesianand the Japanese sides: (1) 50 years’ Japanese experi-ence on the handbook can be referred to However, it isnecessary to localize, not simply translate, the handbookto the needs and situation of Indonesia; and (2) in addi-tion to developing the contents of handbook, it is equallyimportant to establish a system in which the handbookcan be effectively utilized.

Introduction of the handbook meant replacement ofthe conventional health cards in the pilot area, whichwas done by the National Policy. Therefore, the Direc-tor General of Community Health of the Ministry ofHealth was consulted on the matter, and his approvalwas obtained prior to the implementation of the pro-

gram. With assurance from central agencies, there wasa better chance for a program to be expanded beyond apilot area.

2) Respect for Ownership

During the course of the MCH Handbook Program,great importance was placed on the development pro-cess, which largely contributed to create the sense ofownership among the personnel involved. Developmentof the handbook took more than one year because dis-cussions were held with focus groups of mothers, andwith officials of the provincial office of the Ministry ofHealth and medical specialists of the municipality hos-pital in the pilot area. These measures were consideredimportant for developing a handbook that was suited toneeds of the region, and for reaching consensus amongthose who were involved. With the approval of the localmedical specialists, staff at health centers became veryconfident of the handbook’s contents. Doctors also be-came very positive about using the handbook at theirhospitals and clinics because of their own involvementin the development process of the handbook. Spendinga large amount of time on the development process con-tributed to nurturing the sense of ownership amongpeople involved in the implementation.

A picture of a Central-Javanese mother embracing achild was used for the front cover of the handbook, whichgreatly contributed to creating the sense of ownershipamong mothers. The picture, more realistic than illus-trations, generated positive feedback from mothers. Thepicture helped them to feel that the handbook belongedto mothers like themselves. Whenever meetings are heldto discuss the possibility of expanding the program intoareas outside the Central Java, changing the picture toone of a mother from the region in question is alwaystalked about. This discussion supports the assumptionthat the picture on the front cover plays a vital role increating a sense of ownership among mothers.

When the program was expanded from the pilot areato eight other districts in the province, it was necessaryto modify the title from the“Salatiga Edition” to the

“Central Java Province Edition,”and this change wasessential to make the handbook belong to the new ar-eas. Similarly, when the program was introduced to otherprovinces, it was essential to change the title from the

“Central Java Province Edition”to“The IndonesianMinistry of Health Edition.”As in the process of de-veloping the handbook, the revision process also in-volved discussion, revision, and approval from thoseinvolved. For instance, when the title of the handbookwas changed to“The Indonesian Ministry of HealthEdition,”the contents were revised and then approvedunder the participation of all the departments concernedof the Ministry of Health. It was also necessary to ob-tain a registration number from the Ministry of Healthto prove that it was an official publication of the Minis-try.


30

3) Adopting Educational Material to the Region

Appropriateness of educational material involves threedimensions: (1) technical appropriateness; (2) sociocul-tural appropriateness; and (3) economic appropriateness.First, technical appropriateness means compatibility withtechnologies available in the region. The contents of thehandbook were ensured to be in accordance with healthservices available (or that should be available accord-ing to the Ministry of Health) at health centers, whichare the core of community health services in Indonesia.

There were some health centers which have not pro-vided the required services. However, the situation wasexpected to be changed within five years.

Second, sociocultural appropriateness means thatcontents are suitable for the sociocultural backgroundof the region. To this end, various points were taken intoconsideration. First, many illustrations were used in thehandbook to ensure that mothers understood. Indonesiais a multi-ethnic and multilingual country. With thespread of primary education, the Indonesian languagehas functioned well as the official language. The literacy

Figure 4 Flowchart of the MCH Handbook Program in Indonesia

Printing CostsJapan's Assistance

1994 ～JICA

Project Pilot Area

Family Planning/Maternal and ChildHealth Care Project

World

Bank

1995 ～First Expansion: CentralJava Province 8 districtsPopulation: 7.7 million

IndependentDispatch of Experts

1996～Second Expansion: CentralJava Province 19 districts:

Population 15.5 million

Provision ofEquipmenton Population,FP/MCH*, World Bank

1997～

Third Expansion:CentralJava Province 22 districts: Population 17.5 million

Provision ofEquipmenton Population,FP/MCH*, World Bank

West Sumatra Province andthree other provinces

Provision ofEquipment onPopulation,FP/MCH*

1998～Provision ofEquipment onPopulation,FP/MCH*,World Bank,Indonesia

Central JavaProvince

All 35 districtsPopulation:29 million

Provision ofEquipment onPopulation,FP/MCH*New Project

MCH HandbookProjectWest SumatraProvince, NorthSulawesi ProvinceAll districts

MCH HandbookProject

IndependentDispatch ofExperts

～ 2003

Indonesian Budget +International AssistanceOrganizations (ADB, WorldBank, UNICEF, WHO, UNFPA,OECF, JICA)

Other 21 Provinces

Nationwide 27 provinces (Population: 200 million)

Sources: ADB: Asian Development Bank, UNFPA: United Nations Population Fund* FP/MCH: family planning/ maternal child health


31

rate is relatively high: 90% among male adults and 78%among female adults.4 In spite of this, illustrations arestill more effective than written text in displaying andconcretely communicating information.

Because of its concreteness, whether or not an illus-tration is effective in communicating information is de-pendent on whether it is designed to fit the tastes of itsintended audience. For example, the illustrations whichare preferred by Japanese women, which generally arecute, appear childish and cartoon-like to Indonesianwomen, and are considered to be not at all suitable forcommunicating important information on health issues.Therefore more realistic illustrations were used in theIndonesian version. The color chosen for the front coverwas pink. Pink appeals to Indonesian mothers very muchalthough it may seem rather loud to Japanese taste. Thebackground to this color appeal is the color sensitivityoften observed during election campaigns to symbolizethe various political parties in the country (yellow forthe ruling party, and red and green for the two opposi-tion parties at that time).

The third point, economic appropriateness, refers tobeing appropriate in terms of price. The bright color ofthe handbook is attractive to its users, but may give theadministration the impression that the handbook is ex-pensive. An expensive handbook hinders the sustain-able implementation of the program, and makes hand-book unsuitable for practical use. Therefore, specialmeasures were taken to ensure that the printing costs ofthe handbook were competitive with those of the fourmajor health cards. Initially, the costs of printing thehandbook and the four cards were about the same. How-ever, as the cost of printing the health cards graduallyincreased over the years (1,500 rupiah for three cardsexcluding the family planning card), those of the hand-book remained relatively low (1,000 rupiah before themonetary crisis in July 1997). The handbook is morecost-effective than the four health cards both in terms ofprinting costs and the amount of information that can beincluded.

2. Needs for Expansion

1) Needs of Policy-makers

It was fortunate that policy-makers who were in chargeof the program at the provincial level had a clear visionof the MCH Handbook Program and a strong demandfor its implementation. Instead of taking the initiativeentirely only by one-side, both were able to concentrateon clarifying obstacles and finding solutions together.In general, there are frequent transfers to officials and iterodes the political will to continue one program. How-ever, in this case, even though some officials are freguenttransferred, fortunately, the program continued to growthanks to support from both inside and outside of theprogram. The program was able to expand because therewas still a need on the side of new policy-makers.

Provincial officers who were involved in the MCHHandbook Program wanted to expand it beyond the pi-lot area to other parts of the province. They held provin-cial wide meetings with officials from all districts andmunicipalities and discussed the outcomes of the pilotarea in an attempt to increase their awareness. They alsopersuaded the World Bank to give them enough fundsto print handbooks for eight districts in total. In duecourse, more and more districts and municipalities be-gan to show their interests in the program. One of themprinted handbooks on their own using funds they hadraised from a local NGO (the Sumarang branch of theRotary Club). The Mother Friendly Movement, advo-cated since 1996 by the Ministry of the Interior, alsogave momentum to local governments to develop com-prehensive maternal and child health programs. Somedistricts began to implement the MCH Handbook Pro-gram as a part of the movement.

2) Needs of the Implementing Organization

The Head of the Municipality Health Services of Sala-tiga, who was supervising the entire implementing per-sonnel, was also very enthusiastic about the program.She believed that the MCH Handbook Program was agood chance to improve whole maternal and child healthservices. With this belief, she supervised staff, kept closecontact with hospitals and women’s associations (com-munity volunteers), and actively advocated the use ofthe handbook. We believe that her experience in Japanand her deep understanding of the Japanese MCH hand-book program helped her tremendously in guiding theprogram. Her leadership contributed to the success ofthe program in the pilot area. For example, she encour-aged her staff by saying “Japan started its MCH Hand-book Program fifty years ago. When will we Indone-sians do it if not now?” The monitoring meetings arestill maintained even Japan’s cooperation period wasover.

When the program was first implemented, some staffat health centers complained about the increase in theamount of work. The Head Officer replied in saying

“We can quit if you all want to quit.” In response to thiscomment, they expressed their desire to continue theprogram stating“Mothers in our community will beupset if we quit now. They are satisfied with the con-tents of the handbook due to its completeness. We canno longer go back to the conventional health cards.”By the time the program had expanded to other districts,the original staff had gained confidence and began ac-tively assuming the responsibilities of trainers on request.In addition, community midwives, who are the focalpoints of maternal and child health services in the dis-tricts, were glad to have a more useful tool for educat-ing mothers in their community. It is clear that the hand-book also fulfilled the needs of the implementing per-sonnel.

4. UNICEF, State of the World's Children (1998)


32

3) Needs of the Users

The demand for information among mothers was clearlyhigh as evidenced by such positive feedback as“wecan refer to the handbook anytime depending on the ageand condition of my child.”According to the finalevaluation survey conducted two and a half years afterthe implementation of the program, mothers’ behaviorconcerning maternal and child health improved over thatof the pre-implementation era. Knowledge was alsoadvanced especially among mothers with less educa-tion (Completion of 6 years’ elementary education orless. In Indonesia 9 years’ education is compulsory). Thisindicates that the handbook is an important source ofinformation among mothers with less education, whoin general have limited access to health-related infor-mation. In addition, there were lots of inquiries frommothers who lived just outside of the pilot area wantingto buy the handbook (if it is not provided), which alsoshows how high the demand for information was.

The handbook also facilitated the participation ofsome fathers in child-rearing; there were cases that theyread the handbook, took their children to immunizationand other community health services, and explained thehandbook's contents to illiterate mothers.

Community volunteers also welcomed the program.These volunteers were looking for effective ways toimprove life of their villagers. It is interesting to notethat the women’s association which was engaged in com-munity volunteering proposed to the Municipality HealthServices of Salatrga to hold a quiz contest based on thecontents of the handbook.

4) Needs of the Times

Development of the MCH Handbook was a timely un-dertaking. Reducing the infant and maternal mortalityrates was a top priority of the Sixth National Develop-ment Five-year Plan (1993 - 1997) in Indonesia. In re-sponse to this, various international aid organizationswere carrying out projects to protect maternity in thecountry. However, many of these projects underwent acontinuous process of trial and error, lacking concreteand effective methods. The MCH Handbook Program,which was producing the fruitful results, drew attentionfrom both the Indonesian government and internationalaid organizations. This is how the program came to bein partnership with international organizations.

3. Resources and Infrastructure to Supportthe Program

1) Solid Systems/ Resources and Infrastructure

for Health Activities

Health centers are the core of providing basic healthservice in communities. In these days, the first priorityin community health services is shifting from“securingthe number of centers”to“ensuring the quality ofservices.”Although the number of doctors per capitais still limited, the country is striving to ensure safe de-

liveries with the help of midwives, who began to be sta-tioned in every village in the begining of 1990s. In addi-tion, there are community volunteers who support com-munity health services from the grassroots. Indonesiahas a long history of community-based health activi-ties, and is regarded by other countries as a model. Inshort, Indonesia had adequate resources, including vol-unteers, for implementation of the MCH Handbook Pro-gram. Moreover, various health cards were widely spreadand the distribution route was long established. There-fore, the handbook was easily accepted by both moth-ers and staff involved in health services. The concept ofhandbook was new, but the foundation was already thereto accept it.

2) Important Factors to be Considered to

Choose The Pilot Area

It was considered inappropriate to implement the MCHHandbook Program in areas which had very low healthindices and insufficient resources because the implemen-tation of the program would aim to up-grade the exist-ing systems. Another factor that was regarded crucial inselecting the pilot area was the strong leadership andenthusiasm displayed by the implementing personnel.Considering these factors, the provincial office of theMinistry of Health selected the pilot area. The criteriafor selecting a pilot area may vary depending on thenature of the program; however, strong leadership is al-ways essential.

4. Efforts to Ensure the Sustainability ofthe Program

In 1996, three years after introducing the program to thepilot area, the printing costs of the handbook began tobe partially covered by the municipal budget. This wasachieved by the continuous efforts to hold seminars tar-geting not only the health service sector, but also otherrelated sectors, to increase awareness of the municipalpolicy-makers. People’s pride in the program becamemore apparent as more and more visitors were broughtto the pilot area. The increase in visitors indirectly raisetheir awareness and contributed to more of the budgetbeing allocated to printing the handbook.

The provincial office of the Ministry of Health hascontinued its effort to request international organizationsto provide the printing and training costs. It has beenconfirmed that a part of the funds of a new World Bankproject will be allotted to the program. Also the budgetwhich was formerly allocated to the Ministry of Healthfor printing conventional health cards has been partiallyallocated for printing the handbook.

From the beginning of the program, each district andmunicipality has striven to acquire its budget from theprovincial government. Some people involved in theprogram have suggested selling the handbook to raisenecessary funds. This is one of the alternatives that needsto be studied in the future in order to ensure thesustainability of the MCH Handbook Program.


33

5. Japan’s Role as a CatalystWhen the MCH Handbook Program began to be dif-fused to other provinces, Japanese experts continued toplay a role as a catalyst. Japanese experts shared theirexperience in the Central Java Province while the Min-istry of Health officials, who had visited Japan, tried toraise the awareness of those concerned and convincethem that“We can learn from Japan’s experience.” TheJapanese experts’ role was not teaching about the Japa-nese handbook, but to support the process to learn fromthe experiences of Japan and others so that they couldadopt it in others developing their own MCH Handbook.

Conclusion

At present, a new project-type technical cooperationusing the MCH Handbook has been implemented sinceOctober, 1998. This new project is a step toward ex-panding the MCH Handbook Program nationwide. TheWest Sumatra Province and the North Sulawesi Prov-ince are the areas being targeted by the new project. Inthe midst of the economic crisis in the region, coopera-tion in the field of public health, especially assistance tosocially vulnerable people like mothers and children, isbecoming increasingly more important.

AcknowledgementsWe would like to take this opportunity to express ourgratitude to Dr. Sri Astuti, former Director of the Cen-tral Java provincial office of the Ministry of Health; Dr.Budi Shinggin, former Director of Communicable Dis-ease Control and Environmental Health, the Central Javaprovincial office of the Ministry of Health; Dr. SriYamtini, Head of Municipality Health Services ofSalatiga; Mrs. Surosso, Chief Officer of the MCH Sec-tion, Municipality Health Services of Salatiga; Dr. Irwan,Director of the Department of Planning of the CentralJava provincial office of the Ministry of Health; Dr.Rettono and Dr. Hajah from the Central Java provincialoffice of the Ministry of Health; Dr Ina Herwati, ChiefOfficer of the Family Health Bureau of the Ministry ofHealth; Dr. Andrianshah Arifin of the National Instituteof Health Research and Development; Mr. Suwa, formerResident Representative of the JICA Indonesia office;and last, but not least, the Japan International Coopera-tion Agency.


34

35

Adult Literacy Education as an Entry Point forCommunity Empowerment

CASE STUDY


―Evolution of Self-Help Group Activities in Rural Nepal―

Chizu SATOMassachusetts University,

Center for International Education Master ProgramMasamine JIMBA

JICA Expert, Community HealthIzumi MURAKAMI

JICA Expert, Maternal and Child Health

The movement to increase the adult literacy rate in Nepal has been growing since democratization in 1990. Inrecent years, about 300,000 people have participated annually in literacy programs. However high drop-outrates and low literacy retention require that we consider not only the numbers served, but the quality of theliteracy education provided.

The School and Community Health Project (SCHP), a collaborative project by the Japan International Coop-eration Agency, the Japan Medical Association, and the Ministry of Health/Nepal, has been implementing lit-eracy education programs in a rural part of the Kavrepalanchowk district since 1994, paying attention to itspotential to facilitate community empowerment for creating healthy villages. This comparative study was con-ducted to evaluate the impact of basic and post-literacy education programs in the two places of this target areausing Participatory Rural Appraisal (PRA) as a tool for collecting field data.

We found that those who finished a basic literacy program had low literacy retention and, therefore, limitedcommunity participation in community development activities. However, for those who finished a post-literacyprogram, complemented by a Self-Help Group (SHG), the literacy level was relatively well-retained. In addi-tion, the activities through BLC to PLC raised the awareness of the participants for community empowerment,which allowed adult literacy education to play a role as an entry point for empowerment. Furthermore, onceSHG started its activities, the members of SHG satisfied more basic needs, improved access to resources, achievedmore participation, and controlled more power. These results demonstrate that SHG became a driving force forcommunity empowerment. Also, this study shows that it was effective to categorize the evolutionary process ofSHG into four stages for desirable cooperation between SHG and outside agencies.

In conclusion, this study indicates that adult literacy education can function as an entry point for communityempowerment, after which a variety of SHG activities play a role in the drive for empowerment.

Introduction

Since 1990 when the United Nations DevelopmentProgramme (UNDP) first published their Human De-velopment Report, adult literacy has been a primarycomponent of educational attainment in the UNDP’sHuman Development Index (HDI).1 Coincidentally,1990 was also the year that the United Nations desig-nated the Year of Literacy and the year that democrati-zation started in Nepal.

These two events led to a dramatic increase in thefocus on adult literacy education in Nepal. According tothe 1998 World Education Report,2 the number of non-literate adults in developing countries in 1995 was 872million. Of that, Asia, including China and India, ac-counted for about 70% of the non-literate population.This same report placed the literacy rate for adults greaterthan 15 years of age at 27.5% (male: 41%, female: 14%)in Nepal.3 Other studies in Nepal have found similarconditions.4 Responding to these troubling findings, lit-

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu Vol.15 No.1 (April 1999).1. UNDP, Human Development Report 1990 (New York: Oxford University Press, 1990).2. UNESCO, World Education Report 1998 (UNESCO, 1998).3. Ibid.4. Comings, J.P., C.K. Shrestha, and C. Smith, “A secondary analysis of a Nepalese National Literacy Program,” Comparative Education Review, 36(2) (1992): 212-226;

Robinson-Pant, A., “Literacy in Nepal, looking through the literature,” Education for Development (London: 1995); Smith, C., J.P. Comings, and C.K. Shrestha, “Aresearch study on effectiveness and achievement in the Nepal National Literacy Programme,” World Education(Nepal) (Kathmandu:1996); Research Center for Educa-tional Innovation and Development(CERID), Impact Study of Adult Education in Nepal (Kathmandu: CERID, 1997).


36

eracy education was provided for about 1.4 million adultsbetween 1992 and 1997.5

One criticism of this heavy investment in adult lit-eracy training is that, even though the projects may beindividually successful, literacy in low-income coun-tries is still 51%, and donors fear that they can makelittle difference to a problem of this dimension. Theyregard their efforts as a drop in a bucket, and illiteracyas a bottomless pit.6

Contrary to this belief, adult literacy education hasbeen shown in a number of contexts to have an impactthat goes beyond the mere improvement of literacy skills.For example, in several countries literacy education hasbeen found to produce changes in the population thatare normally associated with community development.First, Chiba et al. notes that some graduates from theCambodian Temple School Campaign were transformedby their experience and became key facilitators in thedevelopment of their communities.7 Next, the literacycampaign in the Indian district of Pudukkottai is wellknown because it served as a key element in commu-nity empowerment.8 Further, case studies conducted inIndonesia and Thailand showed that non-formal educa-tion that included adult literacy education helped par-ticipants to increase their control over decisions affect-

ing their lives and to increase their self-reliance; there-fore, it played an important role in their empoweringprocess.9 Finally, one case study in Nepal demonstratesthat non-formal education can be an important tool forcommunity development work.10 These findings sug-gest that adult literacy projects contribute to ‘commu-nity development’ undertaken by project beneficiariesand to ‘empowerment’11 - a central concept in the newdevelopment paradigm. If these findings are wellgrounded, adult literacy programs can be implementedwithin development projects as a means of sustainingtheir impact.

Japan International Cooperation Agency (JICA) re-ferred to non-formal education in its report entitled“Study on Development Assistance for Developmentand Education.” Despite taking issue with some points,JICA has shown substantial interest in this field.12 Byway of example, JICA’s Community Development andForest Watershed Conservation Project and PrimaryHealth Care Project in Nepal have implemented adultliteracy education as a part of their activities.

The School and Community Health Project (SCHP),13

a collaborative project between JICA, the Japan Medi-cal Association, and the Nepalese Ministry of Health,implemented two basic literacy classes (BLCs) followed

15. Ibid16. Mueller, J., “Literacy and non-formal(Basic) education: Still a donor priority?” Education for Development (London: 1996): 1-2.17. Chiba , A., F. Kojima, Y. Tozuka, et al., “Cambodian Temple School Campaign Project,” A. Chiba (eds.), Why Literacy?: The Status Quo of the Developing Countries

(InternationalChristian University, Education Research Center, 1996) 105-165.18. Athreya, V., and S. Chunkath, Literacy and Empowerment (New Delhi: Sage Publications, 1996).19. Kindervatter, S., Non-formal Education as an Empowering Process with Case Studies from Indonesia and Thailand (Amherst: Center for International Education,

Massachusetts University, 1979).10. Van Riezen, K., “Non-formal education and community development: Improving the Quality,” Convergence, 29(1) (1996): 82-95.11. Kukita, J, “What is empowerment?” J. Kukita and F. Watanabe (eds.), Empowerment: New Paradigm for the People Centered Society (Gendai no Esupuri 376, 1998):

10-34 (hereafter cited as Kukita, “What is empowerment?”)12. Japan International Cooperation Agency, Study on Development Assistance for Development and Education (1994) pp. 14-15.13. Kuratsuji, T., “The Joint JMA-JICA Project in Nepal,” Acta Paediatrica Japonica, 35 (1993): 571-575.

Figure 1 Kavrepalanchowk District Nepal

37


by post literacy classes (PLCs) as pilot studies in theKavrepalanchowk district between 1994 and 1996(Fig.1). This project paid particular attention to the po-tential of adult literacy education to contribute to thedevelopment of healthy communities through encour-aging community empowerment. The cost of providingthe BLCs was borne by the Nepal Red Cross Society(NRCS) and that of the PLCs was carried by SCHP.

Literacy education was taken up as part of SCHP ac-tivities for two reasons. First, the literacy componentcould improve the sustainability of the project’s impactas mentioned above; and second, the effects of the inter-action between literacy training and health training wouldincrease the overall effectiveness of the project. For ex-ample, one recent report from Nepal showed that in-creasing rural female community health volunteers’ lit-eracy levels improved the quality of their services.14 Asecond report stated that an improved literacy level wasthe main contributor to reducing infant mortality rates.15

Within the context offered above, this study has twoaims. First, it examines the significance of adult lit-eracy education by comparing the programs in tow vil-lages: one that hosted a pilot BLC and PLC, and an-other neighboring village that offered a comparable BLCimplemented by a different organization at the same time.Second, it investigates the role played by a self-helpgroup (SHG) that was formed after the PLC in facilitat-ing community empowerment following the comple-tion of the adult literacy classes.

I Target Population and Methodologies

1. Target PopulationThe project was located in the Taldhunga area of theKavrepalanchowk district in Nepal (Fig. 2). The north-ern part of the district is easily accessible and quite de-veloped. However, the southern part is difficult to ac-cess because the Mahabharat mountain range falls acrossthe center of the district. Thus, it takes a day or two onfoot to reach the area from the nearest motor road. Thisarea does not have telephones or electricity.

In addition to the two BLCs implemented by NRCSand SCHP in the Taldhunga area, another two BLCswere implemented by an international NGO called Pri-vate Agencies Collaborating Together (PACT). As such,there were four BLCs held in the region. Regarding theformer, the NRCS covered the operational expenses, andselected and trained the literacy instructors. SCHP pro-vided monitoring and evaluation. The classes offeredby PACT were payed for by USAID, and offered withthe permission of the Government of Nepal. PACT se-lected and trained the instructors, conducted the classes,and undertook their own monitoring and evaluation.Both of these literacy classes trained their facilitatorsfor a period of one week and used “Naya Goreto (NewTrail)”as their primer. In both cases the entire expen-diture was in the range of 15,000 Nepalese rupees (US$250 or 30,000 Yen) and followed the standards pro-vided by the Ministry of Education of Nepal. With theexception of the variables of interest, there were no sig-nificant differences between the two projects.

14. Bentley, H., “The organization of health care in Nepal,” International Journal of Nursing Studies, 32(3) (1995): 260-270.15. Thapa, S., “Infant mortality and its correlates and determinants in Nepal: A district-level analysis,” JNMA, 34(118 & 119) (1996): 94-109.

Figure 2 Target Area of School and Community Health Project(SCHP)


38

This study focused on two of the available four classes.One was a BLC conducted by NRCS and SCHP, andthe second was the BLC conducted by PACT. There werea total of 27 female participants ranging in ages from 15to 45 years in Kholmedanda village (K village) admin-istered by the Milche Village Development Committee(VDC) and 26 adult women registered for the class heldin Shreekhanba village (S village) administered by theSaldhara VDC.

After completing the BLC in K village, SCHP imple-mented a PLC that used the “Koseli (Present)” primerdeveloped by Save the Children Fund/USA for a periodof seven months in late 1995 to the middle of 1996.SCHP bore the entire expense of 15,000 Nepalese ru-pees, which covered the local instructors’ salaries, teach-ing materials and expendable supplies, etc. There wasno request from S village for a PLC and none was of-fered.

In May 1997, Kholmedanda village had 54 house-holds consisting of a total of 342 people. The house-holds were crowded and about a half of the total popu-lation was the under 15 years of age. The village is lo-cated in a valley and had an elementary school that of-fered classes up to the fifth grade. The nearest sub-healthpost was a hard one-hour walk away in a village on thelip of the valley. Most of the inhabitants are subsistencefarmers and their only and meager source of cash in-come is the fish they catch in the Bagmati River thatruns nearby. Some men supplement their cash incomeby seasonally migrating to the cities. The majority ofthe inhabitants are of the Magar ethnic group (89%) andpractice Buddhism.

Shreekhanba village, selected as the control, alsohosted a BLC for six months starting in December 1994.The village had a population of 461 people in 80 house-holds. As with K village, more than half the populationwas less than 15 years of age. In contrast to K village,the households in S village were quite dispersed. It tookabout three hours on foot to travel from K village to Svillage. There was neither a school nor a health post inthe village; both were located in Taldhunga village, ahalf-hour walk downhill from S village. As with K vil-lage, most inhabitants are subsistence farmers and lacka local source of cash income. The majority of the in-habitants are of the Brahman and Chhettri ethnic groups.S village was selected as a control because their BLCtook place at approximately the same time and they usedthe same primer, and the two villages are located closeto each other.

2. MethodologiesBefore starting the study, SCHP and New ERA, are-

search organization based in Nepal, undertook a Par-ticipatory Rural Appraisal (PRA)16 in K village in 1997from April 11 to 15 to gain a better understanding of thecommunity. The present study draws heavily on the find-ings of that investigation.17 Further, in order to improveour understanding of literacy, health, SHG in the vil-lage, and development, we conducted a number of semi-structured interviews18 that were developed by anthro-pologists and used within the context of PRA. At thesame time, we intensively carried out participant obser-vations19 from April 21 to 27.

To supplement this work, we then undertook a groupinterview and held discussions with the literacy classes’participants and the local SCHP facilitators in each area.Further, in K village, we also held a group interviewwith the literacy participants’ male family members. Af-ter completing this field research, we filled in any weak-nesses in our data with interviews of the SCHP programofficers. At all points in our field work, when needed,we employed a female Nepalese interpreter to assist us.We chose to work with a female interpreter as the ma-jority of our participants were female and they may havebecome too embarrassed and hesitant to discuss someof the topics of interest in the presence of a male inter-preter.

Our participant and participatory observation enabledus to observe the outcome of the community health careeducation program and kitchen gardening activities, notethe condition and use of the pit latrine, record cattle rais-ing techniques and study participants’ use of the firstaid kit. During group interviews, we watched for andnoted the power relationships between group membersand who had what kinds of information. We attemptedto confirm through observation what we were told inthe group and individual interviews.

We followed criteria commonly used in Nepal at thethird grade or equivalent level to assess reading, writingand arithmetic skills.20

II Results

1. Literacy Skills of the Participants in theLiteracy Classes

Research was conducted in K and S villages two yearsafter the completion of each BLC. The two villages dif-fered, as mentioned above, in that the participants in Kvillage took a PLC following the completion of theirbasic literacy training. Thus, in the case of K village,research was conducted nine months following thecompletion of their PLC.

We began by looking for the positive effects of basic

16. Chambers, R., “Participatory rural appraisal(PRA): Analysis of experience,” World Development, 22(9) (1994): 1253-1268; Chambers, R., “The origins and practice ofparticipatory rural appraisal,” World Development, 22(7) (1994): 953-969; Chambers, R., “Participatory rural appraisal (PRA): Challenges, potentials and paradigm,”World Development, 22(10) (1994): 1437-1454; Mukherjee, N., Participatory Rural Appraisal: Methodology and Applications , (Delhi: Concept Publishing Co.,1993).

17. HMG, JICA, JMA, “Participatory baseline study of School and Community Health Project(HMG, JICA, JMA): Bhugdeu, Taldhunga I, II,” New ERA and School andCommunity Health Project (Katmandu: 1997).

18. Bernard, H.R., Research Methods in Anthropology: Qualitative and Quantitative Approaches (Walnut Creek: AltaMira Press, 1995) pp.208-236.19. Ibid, pp.136-164.20. Nepal South Asia Centre, Nepal Human Development Report: What is literacy? (Kathmandu: 1998) p.76.

39


and post literacy training. During our PRA, we foundthat in K village, the adult female literacy rate increasedfrom about 28% to about 55%. Six out of 17 graduatestook a formal system equivalency exam: four were ad-mitted into the fourth grade, one into the fifth grade, andone into the sixth grade. Of the graduates, two enteredformal education and one transferred to a middle schoolwhere she became the first female middle school stu-dent ink village.

The project was not an unmitigated success. Aftercompleting the basic literacy training, ten of the 27 fe-male participants (37%) dropped out due to marriage,leaving the village, domestic demands and other condi-tions. Further, we found that the literacy skills of someparticipants dropped in the two years following thecompletion of their BLC (within nine months in the caseof K village’s PLC). This became evident when someparticipants were challenged by our request to fill in aquestionnaire that they might not have found difficult atthe completion of their programs. During our discus-sions, participants mentioned that they feared that theywould loose their literacy skills. While most of the par-ticipants acknowledged the importance of education,many did not permit their daughters to attend school.They justified this by stating that in a patriarchal societyeducating girls is thought to be a waste of money.

In five village, the effects of basic literacy trainingwere almost completely lost. That program suffered asimilar high dropout rate of 31% (8 of the 26 partici-pants). At the time of our study, two years after thecompletion of their class, while all could write theirnames, none of the participants could read, write or domath at a third grade equivalency level. Like K village,they did not send their daughters to school even thoughthe school was located within a half-hour walk of thevillage.

2. The Development Process of the Self-HelpGroup in Kholmedanda Village

A self-help group called “Khushiyali (happy) Women’sGroup (KWG)”was formed in K village after thecompletion of the BLC and PLC. While Handy21 offersa popular description of the development process ofgroups, we considered that the development process inthis case was quite similar to that of the patients’ asso-ciation and its family association where participants havethe same illnesses and their families have common con-cerns. We chose this framework because the women’sgroup was formed around issues faced by all of the mem-bers, such as poverty. We, thus, chose to draw on theframework developed by Hill for the study of patientsand their family associations.22 The development pro-cess of KWG and a description of the cooperative rela-tionship between KWG and SCHP is offered in Chart 1.

1) The Process of Forming

According to Hill, in the process of forming, membersfind people who are similar to themselves and talk withthem about issues that they have in common. Then,through a process of repeated meetings and conversa-tions, the group members develop relations of mutualtrust.

We observed that participants’ consciousness of adultliteracy education itself was increased, which appearsto be part of the process of group formation. Initially,there was no public building for the literacy class. Tak-ing initiative, and without external assistance, the pro-spective participants and their families constructed abuilding for the class by collecting lumber and deadgrasses within the community. Basic literacy class par-ticipants made speeches on the importance of educationin the community on National Education Day and raisedthe awareness of community members by creating andperforming songs and dances on literacy.

After these consciousness raising activities, the par-ticipants became more interested in improving healthcare in their community and in developing the commu-nity itself. For example, some BLC participants startedto clean up the public paths and repair public water pipes,others gave advice to community people, recommend-ing that they go to a health post when they are ill. Fi-nally, participants bought oral rehydration salts to copewith diarrhea. After finishing the BLC, participants re-ceived kitchen gardening training from NRCS and SCHPand each started their own kitchen garden.

In December 1995, (six months after the completionof the BLC) SCHP started PLCs. There were no newactivities during this class, but participants learned howto build pit latrines, improved their knowledge of healthcare management, learned how to prevent some illnesses,and improved their community organization skills. Allof this helped them to move from the more de-contextualized material of the literacy class to the prac-tical material of their daily lives.

In August 1995, participants in the PLC formed a SHGon the recommendation of SCHP. They called their group“Khushiyali” Women’s Group (KWG) because, as mem-bers of that group, they would learn skills relevant totheir daily lives and they were more content. Chart 1shows the steps in the growth of the SHG in K village.A quick glance at Chart 1 reveals heavy support fromSCHP for KWG which is indicated by arrows pointingto the left. It is clear that there were more approachesfrom SCHP to KWG than vice versa, and that mostactivities, during this stage, were undertaken on SCHP’sinitiative.

21. Handy, C., Understanding Organizations (New York: Oxford University Press, 1999), pp.165-167.22. Hill, K., Helping You Helps Me: A Guide Book for Self-Help Groups (Ottawa: Canadian Council on Social Development, 1987).


40

2) The Process of Norming

According to Hill, in the next stage of group develop-ment, members form relationships with other organiza-tions, experts, and influential members in their commu-nity. During this stage the group develops a consistentpattern of organizing meetings and members begin to

adopt specialized roles.Once the participants of KWG had named their group,

the eldest, an active community member, was selectedas the chairperson. Following this, and at the same meet-ing, a vice-chair, secretary and treasurer were chosen.They then chose community development as their man-date. Within this mandate, they chose to focus on in-

Chart 1 The Growth Steps of the Self-Help Croup in Kholmedanda Village

StepsFormingNorming

YearPerform-

12/94

05/95

12/95

06/96

Month/ 08/96

12/96

SHG Activities

l. Built the literacy class building

2. Participated in a basic literacy classa) Five day classes per weekb) Acquired literacy skills

3. Undertook a literacy campaign within Kvillageon the National Education Campaign Day

4. Started development activities other than literacywithin the communitya) Cleaned public paths and repaired public

water pipesb) Provided health consultations for

community membersc) Supported the diffusion of kitchen

gardening within the community

5. Layout of kitchen gardens at each house　　　　　　　　　　�

Started kitchen gardening

6. Asked SCHP to offer a post literacy class �

7. Participated in the post literacy classa) Acquired skills relevant to their daily lives

8. Birth of KWG as a self help group

1. Group Worka) Established group rules and regulations,

distributed among membersb) Started monthly meetings

2. Requested training on how to build pit latrinesfrom SCHP �

　　　　　　　　　 �Built a pit latrine at each member’s house(17 latrines)

3. Requested support from SCHP to build areading and community development center　　　　　　　　　　　　　　�

4. Cooperated with SCHP on the NationalImmunization Day Campaign Against Polio　　　　　　　　　　　　　　�

5. Requested first aid training　　　　　　　　 �

6. Requested income generation training　　　　�a) Collected 28 rupees from each member

　　　　　　　　�

b) Started a livestock bank(added 7,122 rupees within three months)

7. Revised group regulations

Requests of and Support from SCHP

� Hosted a needs assessment meeting

� Implemented the basic literacy class (monitoringand technical support)

Completion of the basic literacy class

� Provided training on kitchen gardening (Providedseeds and nutritional education)

� Provided a second kitchen gardening training(session about counterplan of blight)

� Provided a literacy instructor with five days oftechnical training

� Implemented a seven-month post literacy class

� Provided a four day refresher course for theliteracy instructors three months after the postliteracy class

Completion of the post literacy class

� Recommended that the graduates form a SHG

ing 03/97 1. Three members from KWG provided technicalsupport to a neighboring SHG on how to build apit latrine

2. Supported a mother who had a sick child3. Participated in the Bagmati River Conservation

Project without external prompting4. Inhabitants of K village who were not members

of KWG observed and copied the construction ofpit latrines

� Provided technical training for constructing pitlatrines (5 days)

� Provided fund for constructing a reading andcommunity development center

� Requested the cooperation of KWG on theNational Immunization Day Campaign AgainstPolio

� Provided first aid training (2 days)

� Provided five days of income generation trainingand lent 5,000 rupees as seed funds

�Suggested that the KWG share their knowledge ofhow to build pit latrines with the SHG in aneighboring village

�：Request from SHG to SCHP�：Support and Request from SCHP to SHG

41


come generating activities, promoting health educationand female participation in a range of developmentprojects. The group also established some rules and regu-lations. They decided that decisions were to be made byconsensus and, failing that, by a large majority. Eachmonth they would collect five Nepalese rupees fromeach member and an additional five Nepalese rupeeswould be collected from those who missed a meeting.They then began to discuss the content of their activitiesand how to best use the group fund.

After completing the post literacy training, in whichpit latrines were mentioned, KWG asked SCHP for prac-tical training in constructing pit latrines. Following fivedays of training, as its first major activity, KWG con-structed pit latrines at each of the 17 participants’ houses.The group did this with no external support, financial orotherwise, and used nothing but local materials. We ob-served that group members were diligent in their atten-tion to ensuring a supply of water and to keeping thelatrines clean, which may have contributed to the fewernumber of flies in and around group members’ houses.

The second activity undertaken by the group was theestablishment of a library. The group submitted a re-quest to SCHP, which provided two books for each par-ticipant. The participants quickly read those books andrepeatedly requested SCHP to supply them with morereading materials. Responding to this, and building onland donated by one of the member’s family, SCHP pro-vided the 200,000 Nepalese rupees needed to build areading and community development center and stockedthe shelves with books on health and development. WhileSCHP covered material costs, the community providedthe labor needed to build the facility.

The third activity undertaken by the group was train-ing in first aid. Even after the completion of their PLC,participants did not have enough information to improvetheir situation. SCHP provided the group with a first aidkit and offered two days of training in its use. Duringthe period of our field research, one of the participant’sfamily members fell from a ladder. We observed thatthe participant quickly accessed the first aid kit and ap-plied an ointment and bandage to the injury. When weinquired about the condition of the first aid kit, we weretold that when medicines ran out the group raised fundsto replace them.

The fourth, and most fascinating activity for KWGwas income generation. Each member began by her-self. During the DASHAIN festival23 they raised fundsby visiting neighbors and dancing for them. The group,however, did not know what to do with the money theyhad raised and asked SCHP to provide them with sometraining in income generation. During the training, theparticipants learned how to manage and invest their fundsand, at the completion of the training, they received aloan from SCHP that they used to establish a livestockbank. While they kept their breeding pairs, participants

sold offspring to raise cash.To deal with money, the group added one new rule

that had not been necessary in the beginning. The groupdecided that if a member left the village because ofmarriage or for any other reason, she should appoint afamily member to take her place in the group. They es-tablished this rule to ensure that the fund was evenlydistributed. Further, they decided to bar political issuesfrom their SHG activities for fear of their group dissolv-ing over political differences. As indicated in Chart 1,the number of arrows from the right increased duringthis stage. This reflects SCHP’s responses to KWG’srequests for support. Thus, during this stage, the SHGgradually began to initiate more activities than SCHP.

3) The Process of Storming and Performing

According to Hill, there is a transition period after thegroup has developed in that there are often disagree-ments that surface within the group. However, in thecase of KWG, they anticipated and dealt with these pos-sible divisions by creating new rules that dealt with is-sues related to money and politics. As such, this groupdid not seem to suffer greatly during the ‘storming’ pe-riod.

The final stage, again according to Hill, is that of per-forming. In this stage the group sets about their real workand each member’s task is quite clearly defined. Theactivities of KWG in this period are best seen from theperspective of their contribution to community devel-opment. This period coincided with some aspects nor-mally associated with more developmental stages.

First, and at the request of SCHP, KWG promotedthe National Immunization Day Campaign Against Po-lio run by the Ministry of Health of Nepal. Second, KWGoffered training on how to build pit latrines to a women’sgroup in a neighboring community. Third, KWG pro-vided some money from their group fund for a motherin a neighboring village to transport her seriously ill childto a health post. Last, the members of KWG partici-pated in the Bagmati River Conservation Project, and,rather than keeping their full salaries, they chose to puthalf of their incomes into the group fund. Through theseactivities the group became well known in their com-munity.

During the PRA portion of our investigation, we hadcommunity members draw an organization map of theircommunity. Most of the people we interviewed notedKWG, though it was often indicated by a tiny circle.Thus at the time of our research, KWG was considered,by the community, to be a group that focused on com-munity development.

The impact of the KWG’s activities spread from theirvillage to neighboring villages. For example, membersof K village who were not members of the SHG builttwo pit latrines just by observing the latrines built by thegroup. Following this example, people in neighboring

23. Much like Halloween in North America, in this region of Nepal, there is a festival during which young people go from house to house and perform traditional dances,after which they are offered some treats or, in some cases, a small amount of money.


42

villages began to build pit latrines. This case study showsthat the one innovation introduced by KWG was gradu-ally transmitted to nearby villages.

Chart 1 indicates that during this period the SHGstarted to become more self-reliant. In keeping with this,the relationship between KWG and SCHP moved from‘aid agency’ and ‘beneficiary’ to ‘partners’ as the SHGwas able to respond to SCHP’s requests. Thus, in thisperiod the partnership between us developed.

By way of comparison, there were no activities in Svillage following the BLC. Thus, no SHG was foundedand participants did not engage in any particular com-munity developmental activities.

III Discussion

1. Adult Literacy Education and CommunityEmpowerment

In western countries, adult literacy education is seen asa mechanism for self-actualization. In developing coun-tries, however, adult literacy education is seen as a toolfor national development.24 Recently, the goal of devel-opment has shifted from pure economic growth to hu-man and social development. ‘Empowerment’ is nowintegrated as a key word in this new development para-digm.25 Within this framework, it is meaningful to askhow adult literacy education can concretely contributeto empowerment in the process of national development.This study showed that adult literacy education servedas an entry point for community empowerment. Build-ing on this basis, a SHG was able to facilitate commu-nity empowerment.

However, not all adult literacy education programslead inevitably to community empowerment. Eventhough participants, such as those in S village, may ac-quire literacy skills in BLCs, without follow-up they losethem. Further, the absence of development activitiesundertaken by participants in S village demonstrated thattheir training had no effect on their awareness of devel-opment issues. Abadzi provides a global summary ofthe outcomes of literacy programs over the last 30 years.26

Archer and Cottingham restated its major findings asfollows:27

On average, 50% of those who enroll in adult literacydrop out within a few weeks; of those who remain, onaverage, 50% fail to complete the literacy program suc-cessfully; of those who do complete, about 50% losetheir skills within a year for lack of follow-up.

In Nepal, more than 500 organizations implementedBLCs for 1.4 million adults between 1992 and 1997 andit was said that 934,000 adults acquired literacy skills.

Therefore, in Nepal about half a million registrants didnot acquire literacy skills.28

One possible intervening variable in our study of Kand S villages was ethnicity. The economic, social, andphysical conditions of the villages were similar. TheBLCs in K and S villages drew on the same materialsand their dropout rates were comparable. Were ethnicitya significant variable, it would have manifested itself inone of these other factors. There was little or no varia-tion in these other factors and, as such, we could notconclude that ethnic variation was a major factor.

Rather, the issue may lie with a focus on quantityrather than quality. That is, while it may be possible tooffer many people basic literacy training, this by itselfwill yield very little. For literacy to contribute substan-tially to national development, the focus must be shiftedto ensuring that the work done yields results. That is,BLCs need to be complemented by PLCs and ongoinggroup interaction.

2. Adult Literacy Education as an Entry Pointfor Community Empowerment

Attempts have been made to raise the quality of adultliteracy education in Nepal. For example, adult literacystrategies such as PLCs and REFLECT (RegeneratedFreirean Literacy though Empowering CommunityTechniques), created by Action Aid, a British basedNGO,29 and introduced in Japan by Nishimura,30 havebeen brought to Nepal. Action Aid and other groups us-ing REFLECT, however, seem to be having difficultyfinding trained facilitators which, combined with the highvalue placed on PLCs as a means to improve literacyretention and life skills,31 has lead to the increased popu-larity of PLCs in Nepal.

SCHP offered a PLC in K village with the intentionof improving the retention of literacy skills, improvingindividual life techniques and forming a group that couldundertake community development activities. SCHPoffered training for kitchen gardening between the BLCand the PLC. This training provided a good bridge be-tween the basic and the post literacy training.

The farming season in the Nepalese hilly region isfrom May to October and, as such, it is only during theoff season from November to April that farmers canparticipate in BLCs and PLCs. This six-month hiatusbetween the BLCs and PLCs may weaken the groupcohesion formed during the BLCs. Further, at the con-clusion of the BLCs, not all of the participants could seedirect benefits, which may have reduced some partici-pants’ interest in returning for the PLCs. At the conclu-sion of the kitchen gardening program held after the BLCand during the agricultural season, however, all of the

24. Rogers, A., Adults Learning for Development (London: Cassell Education Ltd., 1992) pp. 1-5.25. Kurita, “What is empowerment?,” 10-34.26. Abadzi, H., “What we know about acquisition of adult literacy: Is there hope?” World Bank Discussion Paper 245, (Washington D.C.: 1994).27. Archer, D., and S. Cottingham, REFLECT Mother Manual : Regenerating Freirean Literacy through Empowering Community Techniques (London: ACTIONAID,

1996).28. CERID, Impact Study of Adult Education in Nepal (1997)29. Archer and Cottingham, op.cit.30. Nishimura, M., “On Development Assistance for Education: A Focus on Non-formal Education,” International Cooperation Frontier, 7 ( 1990): 54-64.31. Comings, J.P., “Literacy skill retention in adult students in developing countries,” International Journal of Educational Development, 15(1) (1995): 37-45.

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participants could see tangible benefits of their BLC.The focus of the PLC was to enable the participants

to gain practical knowledge in health care and commu-nity organization skills. After the completion of theirPLC, several of the participants were able to, were ad-equately motivated to and had sufficient confidence tocontinue their education by entering the formal educa-tion system, whereas graduates from the BLC did notchoose to transfer to the formal system. Further, all ofthe BLC participants in the PLC engaged more activelyin the life of their communities outside of their moretraditional domestic roles. Thus, in these ways, the PLCencouraged each participant to raise her self-confidenceand motivation.

Acknowledging his debt to Freedman,32 Kukita foundthat there is a common theme in the discussion of ‘em-powerment’ and redefined empowerment as “a processto place value on bringing into existence an equal andjust society through believing in human capacity andcreating the conditions within which that capacity canbe made fully manifest.”33 He then suggests that em-powerment has the five steps of ‘basic needs,’ ‘access,’‘consciousness-raising,’ ‘participation,’ and ‘control’.34

While providing this framework, he notes that identifi-cation of a solid entry point into the process of empow-erment is a problem that must be solved in the future.35

Looking at the processes in K village through the lensprovided by Kukita reveals that consciousness raisingoccurred from the outset of the BLC. This early mani-festation of raised consciousness may be attributed tothe motivation of the female participants who were de-lighted by and appreciated the opportunity to partici-pate in a development activity created specifically forthem. Kitchen gardening bridged the BLC and PLC andoffered participants visible benefits that further contrib-uted to their increased awareness of community devel-opment. Adult literacy education, understood as a mecha-nism that raises participants’ consciousness and providesa base from which participants may subsequently un-dertake group activities, may be seen as a possible entrypoint in the process of community empowerment de-scribed by Kukita.

3. Self-Help Group as a Driving Force forCommunity Empowerment

After the completion of the PLC, SCHP strongly en-couraged its graduates in K village to undertake com-munity empowerment activities. Contrary to this, theparticipants in S village received no outside encourage-ment to form a SHG. In other words, it seems that the

focus in S village was an immediate improvement inliteracy rates. Thus, the sponsoring organization did notoffer PLCs nor did they encourage the formation ofSHGs.

Sadamatsu introduced a detailed case study whichindicated that SHGs are key in the process of commu-nity empowerment;36 however, adult literacy educationwas not integrated into that work. A common critique ofcommunity empowerment is that females are often notadequately represented. The activities sponsored bySCHP in K village can be identified as an example ofcommunity empowerment that drew on adult literacyeducation wherein females were very well representedand, as such, provides an example that complementsthe work done by Sadamatsu.

As indicated in Chart 1, there are materials in Japanbased on Hill’s work regarding the stages of the growthof SHGs.37 Drawing on this material enables us to bet-ter understand the relationship between SHGs and theirsupport organizations. After KWG was formed in K vil-lage, the relationship between the participants and SCHPchanged dramatically. In the initial stages, SCHP ap-proached KWG much more frequently than was true ofthe opposite. During the process of norming, the rela-tive frequency of contact initiated by KWG increasedto the point where SCHP was more commonly respond-ing to requests from KWG. As the group moved throughstorming into the performing stage, SCHP requested thatKWG cooperate with them in the National Immuniza-tion Day Campaign Against Polio. This request indi-cated the transition from dependency to partnership.

As will be discussed in the following paragraphs, theactivities of the SHG in the norming, storming and per-forming stages can meaningfully be evaluated from aperspective of empowerment. While there have beenprevious attempts to assess empowerment,38 all havebeen tentative. In this study, we attempted to applyKukita’s five steps for community empowerment be-cause his work is well suited to investigating the per-forming stage of the SHG.

First, at the ‘basic needs’ level, KWG built pit latrinesand managed a first aid kit entirely with their own fundsand resources. The KWG also built a community libraryto maintain their literacy skills through a process of ‘com-munity participation’ supported by SCHP’s supply ofbuilding materials. Further, KWG initiated income gen-erating activities without external prompting. AfterKWG laid this foundation, the group asked SCHP tosupport their activities. In the performing stage of theirgroup’s development, the activities of KWG resulted in

32. Freedman, J., Empowerment: The Politics of Alternative Development (Basil Blackwell Ltd., 1992).33. Kukita, “What is empowerment?,” 10-34.34. Ibid.35. Kukita, J, “Dynamics of empowerment and social reformation,” Kukita J. and F. Watanabe (eds.) Empowerment New Paradigm for the People-centered Society

(Gendai no Esupuri 376), (Tokyo : Shibundo 1998) 183-194.36. Sadamatsu, E., “NGO and empowerment in Nepal,” C.Saito (ed.), NGO is Changing South Asia: From Economical Growth to Social Development (Tokyo: Comonzu,

1998) pp.119-153.37. Hasegawa, K., S. Hayasaka, M. Jimba, et al., “Growth of self-help groups after obesity prevention classes,” Proceedings of 49th Annual Conference of the Japanese

Public Health Association III (1990) p.282.38. Kukita, “What is empowerment?,” 10-34; Fetterman, D.M., S.J. Kaftarian, and A. Wandersman, Empowerment Evaluation: Knowledge and Tools for Self-Assessment

& Accountability (Thousand Oaks: Sage Publications, 1996); Minkler M., Community Organizing and Community Building for Health (New Brunswick: RutgersUniversity Press, 1997).


44

changes in people outside of the group. This could beseen as actions at the ‘control’ level, which is character-ized by activities that are appealing to people externalto the group. Further, the profile of KWG in the com-munity increased to the point that it was considered bymost inhabitants as a faciotator of community develop-ment.

After these activities commenced, the group under-took other activities that appear to fall into the ‘basicneeds,’ ‘access,’ ‘participation,’ and ‘control’ levels ofcommunity empowerment. Many of these activities,however, were partial and did not occur exactly in thesequence predicted by the literature. For example, thegroup moved to later higher order activities before ful-filling their ‘basic needs.’ Further, even though the modelpredicted that the process of ‘consciousness-raisingwould result in changes in the value system, at the timeof our study two years following the completion of theBLC, gender awareness had not changed significantly.This lack of change was reflected in the SHG members’common decision not to send their daughters to school.This choice could be shaped by their acceptance of con-ventional patriarchal values or be nothing more than aprudent choice on the part of the participants, whosedaughters face life in a traditional patriarchal society.The members’ choice in this regard may shift over timeif they maintain their participation in the SHG and be-come critically aware of the consequences of traditionalgender and other roles, and conventions in their dailylives.

As mentioned above, SCHP provided 200,000Nepalese rupees to purchase the materials needed to buildthe reading and community development center. How-ever, it is not feasible to provide the same level of sup-port to the more than 60 SHGs anticipated to form bythe end of 1998 in the target area of SCHP. As such,SCHP has been considering the construction of regionalcenters that would serve not only as libraries, but also ascommunity development centers where people couldhold meetings and host other community developmentactivities. These centers would supply surrounding vil-lages’ SHGs with tin box libraries that contain 50 to 100rotating books. If successful, this system will enableSHGs to circulate their tin box libraries among them-selves as supported by such regional centers.

4. Two Paths of Adult Literacy EducationWe have shown that adult literacy education can taketwo paths. In the first case, isolated BLCs result in tem-porary acquisition of literacy skills. In the second case,a BLC may provide an entry point to a process of com-munity empowerment that moves through transitionalactivities, such as a PLC, and evolves, with some en-couragement, into a self-maintaining SHG. This studydemonstrated that SHGs formed after PLCs can be adriving force in developing their communities and high-lighted the usefulness of a rough understanding of theprocess of group development, that is, forming, norming,storming and performing, by those who aim to supportthese groups.

The relationship between the SHG and the supportagency can shift from one of donor and beneficiary toone of partnership as the SHG moves through the stagesof group development and the support agency is willingto relinquish control. Through this process, it is possiblefor target community members to sustain the outcomesof the project’s activities and to further develop thoseoutcomes by themselves and on their own terms. Com-munity empowerment, thus, can continue to show itsvalue, not as a final goal, but as a process for achievingfurther goals through the activities of SHGs that do morethan merely sustain themselves, but become living or-ganizations integrated into the life of and serving theneeds of their communities.

AcknowledgementOur ability to produce this work depended entirely onthe thoughtful contributions of many people who arenot credited with authorship. We would like to take thisopportunity to acknowledge the patience and effort ofthose who live in the villages where we worked, thefield workers and staff on the project, and the interpreterwho assisted us in this study, without whose assistancethis would have been impossible, and the translator whohelped us to write the English version. As with all worksof this nature, any credit is their due and all faults re-main, of course, ours.

45

Education and Research of Veterinary Public Health

NOTE

Education and Research of Veterinary Public Health-Knowledge and Experience Gained through

International Cooperation in Zambia

Takao FUJIKURAFormer Lecturer

Faculty of Biological Production Science, Hiroshima University

The author had a chance to participate in the Veterinary Education Project Phase II, project-type technicalcooperation of the Japan International Cooperation Agency(JICA) at the University of Zambia. The author’smajor tasks were to support and contribute to education and research in the field of veterinary public health aswell as cooperate and actively participate in the promotion of extension activities closely related to veterinarypublic health. The existing undergraduate program curriculum was reorganized and strengthened by combining urgent andimportant subjects, taking into consideration the present and future socioeconomic and cultural development inZambia and other southern African countries. The scientific curricula included communicable diseases commonto man and animals (zoonoses), food hygiene, environmental health, emergency veterinary medicine, rodentecology and rat elimination, handling animal waste and carcasses, prevention and first aid for animal bites andinsect stings, veterinary medicine in the conservation of nature, social veterinary medicine in traditional farmingcommunities, biohazards in endemic areas, disinfecting of contaminated areas, wildlife veterinary medicine,and ethics in animal experimentation. In the graduate program, the author provided two M.A.’s students with guidance in their research. There weretwo research subjects: 1) the dynamics of bovine tubercle bacillus (Mycobacterium bovis) found in sour milk, atraditional drink, in areas where bovine tuberculosis is rampant; and 2) the application of the hazard analysiscritical control point (HACCP) system, aimed at slaughterhouse hygiene. As to research activities, we con-ducted: 1) observations and research in dog ecology with a view to preventing and controlling rabies in tradi-tional farming areas; 2) observations and research on the contamination of the environment in anthrax endemicareas by Bacillus anthracis; and 3) research in veterinary public health in traditional farming areas. These werethe most important research subjects in veterinary public health in Zambia. The extension activities included: establishing the Zambian Journal of Veterinary Science; organizing a work-shop on rabies control, attending international conferences in other southern African countries on the formationof a veterinary diagnostics network; assuming the role of external examiner in two faculties of veterinary medi-cine in South Africa, and drafting guidelines for using the animal experiment facilities at the university. On the basis of the above achievements, counterpart scientists of the School of Veterinary Medicine at theUniversity of Zambia are expected to further develop education, research and extension activities. The activitiesshould be strengthened in close collaboration with scientists in other southern African countries according tomedium and long-term plans to improve the public health in their communities, and the productivity in theirlivestock production.

Introduction

In the southern African region including the Republicof Zambia, it is evident that there are many problemsparticularly related to socioeconomics, health and hy-giene.1 These include increasing population, increasingpopulation density in urban areas, refugees, poverty, star-vation, epidemics, climate change related with globalwarming, water shortages, the destruction of forests andnature, tourism development in natural reserves and wild

animal conservation areas, the contamination of waterand food and many other related biohazards. Furthermore, these problems create a complex criti-cal situation on which there is an immediate and urgentneed to take action. Under these circumstances, contactbetween people, livestock and wild animals has increasedand as a result, has led to an increase in the incidence ofbites and injuries due to animals, and the prevalence ofrabies, anthrax and other zoonoses among villagers.Highly contaminated water and meat, in particular un-

* This article was first published in Japanese in Kokusai kyoryoku Kenkyu,Vol.14,No.2, (October,1998).1. World Health Organization (WHO), “Our Planet, Our Health,” Report of the WHO Commission on Health and Environment (Geneva: WHO, 1992) pp.1-269.


46

inspected meat and meat taken from carcasses found inthe field or village, cause enormous hygienic and healthproblems in communities. In addition, disinfectants,medicine, and vaccines are not only quite expensive,but also difficult for villagers to procure. In view of thesecircumstances, it is critical to extend support and coop-eration to the region to improve the health and hygienestandards and develop productivity. Veterinary publichealth should play an important role through observa-tion, research, education and the training of technicalpersonnel, research and surveillance.

The author was provided with an opportunity to con-tribute to the technical cooperation project (phase II) inthe School of Veterinary Medicine at the University ofZambia, which has been developing since 1993. Theauthor was assigned to carry out research and educationin veterinary public health as a professor. His activityincluded 1) promoting and supporting undergraduateprograms, 2) contributing to graduate education by pro-moting research, 3) being fully involved in research ac-tivities in veterinary public health, and 4) cooperatingin extension activities. The author was involved in theseactivities for three years, beginning in June 1994. In thepresent paper, the knowledge and experience gainedthrough these activities are described.

I Undergraduate Education

During the three-year assignment (1994-1997), the au-thor was responsible for 63 students over four academicyears. All the students actively and eagerly participatedin lectures and practices. Most of the students made fa-vorable achievements and all passed their final exami-nations. Each academic year was 30 weeks with threeto four hours of lectures and four hours of practice eachweek. The program in Veterinary Public Health consistedof a 31-subjects which did not sufficiently reflect thescience and technology needed to solve the problems inZambia and the southern African region. The author re-organized the curriculum to meet the present socio-eco-nomic development stage of the region, by groupingsubjects as zoonoses, food hygiene (including food mi-crobiology and slaughter house hygiene), social veteri-nary medicine, environmental veterinary medicine, wild-life veterinary medicine, and laboratory animal science,and adding 60 new subjects and sub-subjects.

The newly added and strengthened subjects includedrat ecology and elimination technology, prevention andfirst aid for animal bites and insect stings, science andtechnology of livestock waste and carcass management,the disinfecting and disinfestation of epidemic areas, sci-ence and technology of biohazard management, emer-gency veterinary public health, social veterinary medi-cine in traditional villages among others. Lectures andpractice were conducted, pointing out recently occur-

ring problems in Zambia with a view to introducingcurrent information and knowledge (Table).

In practices, the subjects focused on and strengthenedinclude analysis of contaminated food and water qual-ity, diagnostic methods for zoonoses’ infection, tech-niques for safely handling pathogenic microorganismsin the laboratory, methods for collecting samples forobservation and research in epidemic /endemic areas,training, education planning and management of earlydetection of hazards, and management of preventivemeasures. Furthermore, the students participated in suchactivities as practice in slaughterhouse meat inspection,tours to milk plants, water purification plants, waste wa-ter treatment station, and laboratories attached to thosefacilities, as well as observation at the Central Veteri-nary Research Institute and the canine rabies vaccina-tion campaign sites, observation and control of anthraxin endemic areas, field studies of veterinary public healthat traditional farming villages, handling of laboratoryanimals, practical training in containment systems forpathogenic microorganisms and biohazard control atanimal experiment facilities.

Throughout the thirty weeks of lectures and practice,the author aimed to train and educate, recognizing thecurrent situation of the country, and provided sufficientbasic information and technology to apply to solvingthe country’s problems. The content of the program metthe recommendations made by the FAO/WHO Joint Ex-pert Committee on Veterinary Public Health.2

II Graduate Education

During the assignment, the author was responsible forguiding two graduate students, Dr. A.C.M. Sitima andDr. J. Bwalya Muma, to their Master degrees. The au-thor was responsible for teaching them how to set up aresearch subject, plan and manage the research work,treat and analyze research data, collect references andresearch information, and coordinate the research withrelated institutions and scientists. The author was alsoinvolved in the entire process of preparing the studentsfor their dissertations and defense, and helping them tomake improvements based on the criticism they receivedfrom internal and external examiners.

Dr. Sitima’s research subject was the occurrence ofbovine tuberculosis in the Namwala area in SouthernProvince in Zambia and the fate of Mycobacterium bovisin fermented sour milk. In this research, the prevalenceof tuberculin reaction positive cattle (17%) and epide-miological distribution was elucidated with the isola-tion of M.bovis in fresh milk, and in the lungs and lymphnodes. Pathological diagnosis of the lungs and other tis-sues was also carried out. In traditional farming vil-lages, where the frequent occurrence of this bovine epi-demic is reported, fermented sour milk is produced and

2. WHO, “Veterinary contribution to public health practice,” Report of a Joint FAO/WHO Expert Committee on Veterinary Public Health (Technical Report Series, 573)(Geneva: WHO, 1975) pp.5-55.

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Table: Veterinary Public Health Curriculum in International Cooperation (School ofVeterinary Medicine, the University of Zambia 1994-1997)

Veterinarian’s Roles in Veterinary Public Health

● Health triad (Three tiers - a. nutrition, zoonoses control, animal protection, animal population managementhusbandry, b. animal production, vector and pest control, nature conservation, c. physical and chemicalfactors, nutrition - form a triangle with health/hygiene, animal health, environmental health at the apex. Thegaps between each tier should be covered by research, administration and extension services in a systematicand cooperative manner.)

● Relationship betweeen veterinary environmental health, veterinary public health and medicine)1

● The Roles of a veterinarian in veterinary public health: Purpose and scope, activities, functions and ser-vices2

● Introduction of terminology and definitions3,4

● International cooperation: international organizations, governmental and non-governmental activities andextension services5

● Publications, journals, documents and audiovisual materials

Zoonoses (Infections and Diseases Common to Man and Animals)

● Definition and classification of zoonosees3

● Grouping by mode of transmission3

● Classification of causal pathogenic agents (i.e. viral, ricketsial, bacterial, parasitic, mycotic, etc.)3

● Vehicles transmitting contaminated materials (food, soil, water, insects, rats, others)● Epidemiology monitoring, surveillance (monitoring incidence and transmission of zoonoses, evaluation of

preventive and control measures), data collection and analysis, diagnosis, prevention, control, elimination,risk assessment and management,6,7 “influence tree” 8,9

● International cooperation in information/technology exchange, technology transfer, international meetings,working groups and collaborating centers.

Food Hygiene

● Hygiene management of livestock, safety and efficient production of food of animal origin10

● Effect of circumstantial temperature to the bacterial growth in food10

● Preservation of food at lower temperatures10

● Introduction of HACCP scheme and food safety 10,11

● Structure of slaughterhouse, meat processing and hygiene control12

● Examination and control of animals to be slaughtered (ante-mortem examination)13

● Slaughtering methods12

● Meat inspection (post-mortem examination)12

● Edible organs and tissues13

● Methods of preparing, checking and examining carcasses and organs during the slaughtering process13

● Emergency preparedness and action to be taken in the event anthrax is detected and/or suspected in theslaughtering process13

● Regulations and laws for emergency slaughter13

● Inspection procedures for poultry and fish13

● Methods and procedures for the safe disposal of animal waste13

● Safe management of slaughterhouse waste water with special attention to environmental protection13,14

● Slaughterhouse waste management and procedures of how to process slaughterhouse wastes13,14

● Utilization of livestock waste13,14

● Milk collection, transportation, pasteurization, and quality control15

● Hygiene problems and diseases caused by milk and milk products and preventive measures15

● Selecting, preserving, cooking and marketing food of animal origin10

● Food additives and chemical residues (i.e. chemical substances, veterinary drugs, hormones, disinfectants,insecticides, antiseptics), and food safety16,17

● Problems in hygiene control of milk and meat products in developing countries (collecting, transporting,sterilizing, refrigerating, preserving, marketing, cooking and consuming in tropical and subtropital cli-mates)10

● Prevention of complex contamination10

● Bacteriology in milk and meat: mechanisms of decay10

● Zoonoses transmitted in milk and meat, infections / poisoning caused by contaminated food and pre-vention and treatment3,4,11

● Essential factors to secure food (i.e. clean environment, optimal handling, refrigeration and cooking))10

● General precautions and practices in food hygiene10


48

Environmental Health

● Health and the enviromnet, the environment and ecology18

● Food and agriculture19

● Food and water contamination18

● Examination of drinking and industrial water for bacteria and chemicals● Waste water treatment technologies: industrial and household waste water● Technology for rodent and insect extermination and prevention of the disease caused by them4,20

● Characteristics and applications of various disinfectants21

● Technology for disinfecting and decontaminating materials14,21 and the air● Disinfecting and decontamination of livestock population21

● Survival and ecology of & Zoonotic pathogens in nature21

● Safety and biohazard control in the laboratory22

Social Veterinary Medicine

● Community health and dog ecology23

● Methods for surveying dog ecology23

● Socio-ecological classification of dogs24

● Dog population management, surgical methods and elimination technology24

● Human and animal co-habitation, and animal welfare and well-being23

● Twelve golden rules for the development of good relationships between human and animals23

● Prevention and first aid for animal bites and insect stings23,25

● Methods and conditions for post-exposure treatment immediately after a dog bite with special reference torabies prevention26,27,28

● Rabies vaccine: types, specific features, transportation, preservation and duration of immunity26

● Designing, organizing, and implementing dog rabies vaccination campaign26

● Management and safe disposal of animal carcasses14,23

● Organizing and managing a rat and poisonous insect elimination campaign in the community20

● Maintenance and protection of pure and clean water sources in the community25

● Water contamination and community health25

● Disinfecting and treating drinking water25

● Infectious diseases transmitted by contaminated water25

● Management and safe disposal of animal waste25

● Veterinarian’s role during natural disasters29

● Animal health centers: their activities, functions and roles, and services29

Wildlife Veterinary Medicine

● Nature and wildlife conservation, Washington Treaty and wild life conservation30

● Wildlife ecology and diseases30

● Wildlife protection and veterinarian’s role30

● Merits and demerits of developing wildlife tourism in Africa

Laboratory/Animal Veterinary Medicine

● Laboratory animals: species, features, and minimum requirements31

● Definition, and purposes and procedures for breeding conventional laboratory animals specific pathogenfree (SPF) animals ) free from specific pathogens). Gnotobiotic animals (animals whose parasitic organismsare known), germ-free animals (free from any detectable organisms)31

● Breeding, reaing, hygiene management and prevention of infectious diseases in laboratory animal popu-lations31

● Animal handling and techniques in animal experimentation31

● International ethics of animal experiment and animal welfare32

Representing major scientific areas.Block characters are expressing previously/presently used curricula. Subjects covered by both lectures and practices.Numbers in the table correspond to the Reference for the Table at the end of the text.

49


consumed as an important daily source of protein.The sour milk is very acidic and prepared in special

containers or bottle gourds (KARABASH) in the locallanguage). One of the most important points of the re-search was to elucidate whether M.bovis contaminatedfresh raw milk would eliminate and/or inactivate the mi-croorganisms in the fermentation process under veryacidic conditions. This process would also be extremelyimportant from a public health point of view sinceM.bovis can be transmitted from milk to humans world-wide. Studies focused more on the fate of M.bovis withdrastic changes in pH from 7.0 to 3.0 and changes inbacterial flora in the fermentation process. It was foundthat microorganisms in the fermented milk were noteliminated even when the above changes took place.The research results show that fermented sour milk trans-mits M.bovis to those who drink it, and therefore is un-safe and remains a critical health risk factor in epidemicvillages and areas. In his thesis, Dr. Sitima proposedpreventive measures and the Academic Committee ofthe University of Zambia awarded him a Master’s de-gree in 1994.3

Dr. J. Bwalya Muma’s research subject was entitled“Surveillance and research for the establishment of aslaughterhouse hygiene scheme in Zambia using theHACCP (Hazard Analysis Critical Control Point)concept.” Dr. Muma developed and proposed a newscheme for establishing slaughterhouse hygiene as aresult of the observations and research in basic bacte-riological studies based on hygienic status with selectedfour slaughterhouses in Zambia.

The research found that meat most heavily contami-nated with bacteria was found when the slaughteredanimals were skinned and eviscerated, and carcasseswere dipped prior to refrigeration. Salmonella enteriti-dis, a pathogenic microorganism, was found in samplescollected from the slaughterhouse facilities as well ascarcasses. In these observations and study, HACCP wasidentified useful to develop systematic hygiene controlscheme. It is expected that the proposed scheme will beintroduced into the national meat hygiene control pro-gram and will contribute to securing safe meat in Zam-bia.4 This observations and research was fully supportedfinancially by the Japan-Zambia Friendship AssociationFellowship.

III Research Activities

Three additional issues concerning veterinary publichealth in Zambia were identified and research was car-ried out.

1.Observations and Research on Canine Ecology

Aimed at Rabies Control in Traditional FarmingVillages in Zambia

In view of the fact that rabies in dogs and humans iscommon all over Zambia, observations in 21 areas innine Provinces of the country were carried out on 5,702persons in 827 households. In the surveyed areas, 1,015dogs were kept in 452 households (2.2 dogs / householdwith one dog per 5.6 persons). The major reasons forkeeping a dog were for security and for hunting; dogsare even essential in traditional farming areas. Most ofthe dogs are not tied up (79.2%) and 114 out of 590persons (19.3%) had been bitten by a dog within thepast year. In some cases, some people had been bittenup to six times. The dogs had frequent contact with wildanimals such as jackals, coyotes, foxes, skunks, lions,elephants, and many other types of wild animals on theedges of their territories in the villages. The opportunityfor contact increases the likelihood of rabies being trans-mitted to the dogs.

Only 25 % of surveyed dogs had received rabies vac-cination. Among the vaccinated dogs, however, thereseems to have been included some dogs whose immuneprotective period (6 months) had already been invalid.In view of the fact that a 80% vaccination rate is neces-sary to prevent rabies epidemics, the 25% found in thesurvey in Zambia is too low. At the date of the presentobservations, there were 25 human rabies cases alongwith some dog bite injuries in the surveyed areas. Ter-minal cases of rabies were the result of the victims nothaving been able to receive post-exposure vaccinationimmediately after having been bitten, or having beeninitially improperly vaccinated with the human rabiesvaccine. Most of those people who had received properpost-exposure immunization had been cured (93%).

It is highly recommended that rabies be prevented inhumans and dogs. To do this, dogs must be tied, vacci-nation against rabies must be promoted to improve therate of vaccination of the dog population of the country,and a post-exposure immunization scheme with first aidtreatment immediately after dog bite must be establishedand strengthened in areas where rabies is endemic.

The life expectancy of dogs in Zambia is only threeyears on average. Fighting among dogs, being struck byvillagers, being poisoned or bitten by snakes and wildanimals, being poisoned by agricultural chemicals, andsuccumbing to infections and diseases including rabiesamong others are some of the causes of the short lifeexpectancy of dogs in the surveyed areas.5 This sug-gests the further need to improve health protection andcontrol of dogs in Zambia. The author would like topoint out that the results of the present observations areextremely important to incorporate into the NationalRabies Prevention and Control Programme in Zambia.

The above observations and research were carried out

3. WHO, Report of the Working Group Meeting on Tuberculosis in Man and Animals (Geneva: WHO, 1992) pp.2-23; WHO, Report of the WHO Meeting on ZoonoticTuberculosis(Mycobacterium bovis) with the Participation of FAO (Geneva: WHO, 1992) pp.2-25.

4. Jacob, M., Safe Food Handling: A Training Guide for Managers of Food Service Establishments (Geneva: WHO, 1978) pp.1-118; WHO, “Salmonellosis control: Therole of animal and production hygiene,” Report of a WHO Expert Committee (Technical Report Series 774) (Geneva: WHO, 1988) pp.7-77.

5. WHO, WHO/WSAVA Guidelines to Reduce Human Health Risks Associated with Animals in Urban Areas (Geneva: WHO, 1984) pp.5-24; WHO, WHO/WPSA Guide-lines for Dog Population Management (Geneva: WHO, 1990) pp.9-107.


50

in close collaboration with a team from the Ministry ofAgriculture and Fisheries at the Central Veterinary Re-search Institute in Lusaka, Zambia.

2. Isolation of Bacillus Anthracis from theEnvironment in Anthrax Epidemic Areasin Western Province, Zambia

Between 1980 and 1990 , anthrax epidemics in live-stock, wildlife and human populations were reported inthe Western Province of Zambia. Between 1996 and1997, it was anthrax which predominantly occurred, inboth the livestock (mainly in cattle) and human popula-tions in the western part of the Western Province. Re-search work has been carried out to elucidate the envi-ronmental contamination due to B.anthracis in the epi-demic areas in order to assess the risk of the emergenceof anthrax and to take measures to prevent its occur-rence. This research will contribute to elucidating themechanism of the epidemic.

Survey areas were selected in Mengo, Lweve, andMuhunguo Villages where the Senanga and Kalabo Vet-erinary Offices were located. Seven strains of B.anthracis were isolated by means of standard diagnos-tic techniques and the selective PLET medium from 22samples from soil, hides, and dried meat collected fromthe above epidemic villages. Furthermore, in the samearea, Sihole Missionary Clinic, the author met anthraxpatients with skin lesions (on the cheek of one womanand on the hip of a small child, etc.). The patients weretreated with penicillin everyday. Eleven patients visitedthe clinic for treatment on the day that the author visitedthe clinic. In Muhunguo Village, there were also somepatients with skin lesions on their cheeks. Also, twofarmers’ houses had been left without inhabitants due tothe death of most family members in the most recentanthrax epidemic.

B.anthracis was not isolated in non-endemic areasand/or areas where anthrax epidemics had occurred along time before. This may led researchers to developefficient and effective detection methods for identify-ing B.anrhracis contamination in the environment sinceit can remain in the environment in a spore-form for adecade or even longer. The occurrence of anthrax in thehuman population of traditional farming villages in Zam-bia should be investigated because of their common habitof eating the carcasses of animals found in fields whichcarry unknown diseases including anthrax.6

This research work was carried out in close collabo-ration with the Department of Livestock Production andHealth in the Western Province, and the Veterinary Of-fices in Senanga and Kalabo.

3. Surveillance and Research in TraditionalFarming Villages with Special Attention

to Veterinary Public HealthIn the Chalimbana and Chikankata traditional farmingareas of the Mazabuka District in the Southern Prov-ince, observations of the villagers’ livelihood were car-ried out from a veterinary public health point of view.An observation team visited and collected data on 38and 29 households in the respective villages. Of thesehouseholds, 61.1% and 57.1% , respectively, kept live-stock animals (mostly cattle). Furthermore, 55.6 and69.6%, respectively, of livestock holding householdswere found to prepare meat at home that had not beeninspected and even consumed carcasses which had beenfound in their fields (36.1% and 51.7%). The uninspectedmeat was transported long distances to be sold or givenas gifts to their relatives and friends. The meat was pre-served at home with salt and/or dried.

Many villagers suffered from animal bites and/orother problems due to animals, including dog bites(33.3% and 34.5%), snake bites(11.1Aiand 13.9%), andinjuries caused by cattle horns (33.3% and 24.1%). Therates of vaccination against rabies in these villages wereas low as 45.2% and 65.5%, respectively. The drinkingwater in the villages was supplied from water sources(public wells and running river) 1 to 3 km from theirhomes. The daily supply of water depended on women’sas well as children’s labor in most households in thevillages. Villagers consumed unboiled drinking waterbecause of a shortage of wood or fuel. In terms of ill-nesses, malaria, dysentery, and tuberculosis were pre-dominantly seen in the villages, whereas livestock ani-mals suffered from corridor diseases such as protozoaninfection, blackleg, brucellosis, and tuberculosis as bac-terial diseases among others.

It was found that because of the close contact andrelationship between villagers, livestock animals, dogsand wild animals, there are some problems that need tobe urgently addressed from the point of view of veteri-nary public health and Primary Health Care (PHC). Byfurther extending Veterinary Public Health observationto other traditional farming areas, it should be possibleto contribute to the health of villagers on the basis ofPHC.

The present observations and research have been con-ducted in close collaboration with the Mazabuka Vet-erinary Office of the Southern Province. The outcomeof the above research and observations was presentedto an international meeting held in Lusaka, Zambia in1997.7

IV Extension

The author actively participated in the following exten-sion services in the School of Veterinary Medicine at

6. Fujikura, T. et al., “Anthrax control and research with special reference to national programme development in Africa: Memorandum from a WHO meeting,” Bulletin ofWHO, 72(1) (1994):13-22; Fujikura,T., et al., Guidelines for Surveillance and Control of Anthrax in Human and Animals (Geneva: WHO, 1993) pp.5-73; Dietvorst,D.C.E., “Farmer's attitudes towards the control and prevention of anthrax in the Western Province of Zambia,” Livestock Development Project Phase II (WesternProvince, Zambia: 1997): 1-15.

7. The University of Zambia (UNZA), “Impact of veterinary education on health and production of livestock in Southern Africa,” International Meeting Abstract (Lusaka,Zambia: School of Veterinary Medicine, UNZA, 1997): p.32,35 and 38.

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the University of Zambia, contributing to and promot-ing education and research.

1) The author took initiative in planning and managingthe veterinary public health and environmental healthresearch activities in the school as chairperson of one ofthe seven panels officially organized in the ResearchPromotion Committee of the school. The research con-ducted by the Veterinary Public Health Panel includedseven research programs, five of which were conductedby the author’s group. The remaining two were on thewater quality of the Kafue River flowing through theSouthern Province. Prior to commencing the research,research proposals had to be thoroughly discussed bythe panel before being approved and obtaining financialsupport from the university. A progress report also hadto be submitted to the committee every six months.Through this process, research work which has priorityis selected and promoted efficiently with funding fromthe regular research budget of the university. The sys-tem developed in the committee, induced cooperativeresearch work with other interested institutions not onlyin the country, but also internationally.

2) The author contributed to publishing the ZambianJournal of Veterinary Science, which is the first academicjournal publication in veterinary medicine in this coun-try. He was responsible for elaborating an explanatorymanual for the contributors, designing the cover page,reviewing manuscripts submitted for publication, coor-dinating with printing companies, convening the edito-rial committee, and doing other related business. Thejournal was first published in 1997.

3) Since rabies epidemics are predominant in Zambia,the author took the initiative to organize a workshop onthe prevention and control of rabies throughout Zambiawith support from the Dean and scientists in the school.The workshop was held in November 1995 with theactive participation of many scientists from the Minis-try of Agriculture, the Central Veterinary Research In-stitute, the University Teaching Hospital, the School ofMedicine of the University of Zambia, the Ministry ofHealth, and the Lusaka Province Veterinary Office. Inthe workshop, recent epidemiology including the preva-lence of rabies, its prevention and treatment, vaccineproduction plans, and future trends in rabies controlprogrammes were actively and enthusiastically dis-cussed. As a fruitful outcome of the meeting, a workinggroup was organized to promote continued cooperationamong different sectors including the health, publichealth, and agriculture sectors (intersectoral cooperation)in campaigning to eliminate rabies in the country. A re-port of the workshop was prepared and circulated.

4) The author was assigned as an external examiner in

veterinary public health in the Faculty of VeterinaryMedicine at South Africa Medical University (MEDUNSA) near Pretoria and in the Faculty of VeterinaryMedicine at the University of Pretoria (Onderstepport)in the Republic of South Africa. All written, oral, andpractical examinations were conducted impartially andthe result was satisfactory with the level of the exami-nations being appropriately high. This experience wasvery valuable to future developments in the author'steaching activities. Because of this opportunity, the au-thor would like to emphasize that many scientists inveterinary institutions in the Republic of South Africadesire more opportunities for close contact with Japa-nese scientists to exchange views, opinions and researchinformation in the field of veterinary science.

5) In March 1996, the International Workshop on Train-ing in Veterinary Diagnostics in Southern Africa, whichwas organized by SADC (Southern African Develop-ment Community) and OIE (Office Internacional desEpizooties), was held in Matobo Hills, Blawayo, Zim-babwe. The author was invited to participate in thismeeting as a representative for JICA. In the meeting,developments in surveillance and diagnostics method-ology, the opening of a training course for participatingcountries, the creation of an information network, theconvening of regular meetings, the choosing of a secre-tariat and the opening of an office among others thingswere adopted. Since the workshop was so fruitful, it ishighly expected that the resolutions adopted in the meet-ing will be implemented.8

6) On completion of the Animal Experimentation Facil-ity in the School of Veterinary Medicine at the Univer-sity of Zambia, built by the JICA Project to facilitatesmooth and safe processing of animal experiments, andin handing over the establishment to the Animal Ex-perimentation Committee of the school, the author vol-unteered to elaborate a manual to facilitate planning andmanagement of animal experimentation and the use ofthe facility. The manual focuses on bio-safety aspects,including disinfection of the facilities, mode of asepticoperation, and the safe disposal of animal waste frominfected animals and carcasses died in the experiments.The ethics of animal experimentation was also elabo-rated in an appendix.

Many other aspects were incorporated into the manualwith the hope that it would be workable and useful forthe scientists who use the facility for animal experimen-tation. The manual includes a list of pathogenic agentsgrouped according to degree of risk (which should beused); instructions on how to prepare for animal experi-mentation; a list of the equipment and chemicals whichmust always be prepared; instructions on how to intro-duce and handle experimental materials; an explanationof methods for disinfecting facilities prior to and imme-

8. OIE, Report of a Workshop on Training in Veterinary Diagnostics in Southern Africa (Marobohills, Lodge, Zimbabwe: March 1996)


52

diately after an experiment; and an outline of the basicwork procedures in the facility.9

Discussions

The veterinary public health curriculum that was intro-duced to the newly established School of VeterinaryMedicine at the University of Zambia early in 1980. Itwas based mainly on well-recognized knowledge andtechnology devised chiefly in countries like Japan, theUSA and other developed countries and provided ameans of knowledge and technology transfer. Exceptfor three years during the mid-1980s, there were no pro-fessors who were responsible for veterinary publichealth. Thus education in veterinary public health wascarried out partly by professors in microbiology, andinfectious diseases until the author was assigned. Thissituation may have prevented active and systematic de-velopments in veterinary public health education in theschool by not taking into full account the socioeconomicand environmental problems, animal and human popu-lations, nature, public health and the many other issuesin Zambia and the southern African region that requiredimmediate attention.

When the author was assigned to the school in 1994,the curriculum was as it was in 1980. Thus, Zambianveterinary public health education, whose activities werevery limited, needed to be developed, taking into ac-count the actual situation and problems of the country.And for this, veterinary public health’s involvement, re-sponsibility and contribution to the region were required.

One of the reasons of this inactivness might have de-rived from the fact the local people involved had notaspired at further improvement of veterinary publichealth education and had rather kept the curriculum un-touched since it was introduced ten years ago from west-ern industrialized countries and Japan.

The other reasons for the delayed action for improv-ing the education could be that the curriculum adoptedin this region was initially developed in industrializedcountries and therefore contained various socioeco-nomic, environmental and natural components whichwere not compatible with the social values of Zambiaand other South African countries.

In view of the above, they still need to make enor-mous efforts to improve veterinary public health educa-tion and research by themselves based on a principle ofself-reliance. The author hopes that the present paperwill be of a help in promoting science and technology inveterinary public health in Zambia and other interesteddeveloping countries.

Conclusion

Phase II of the JICA Project for Veterinary Education

and Technical Cooperation in the School of VeterinaryMedicine at the University of Zambia was successfullycompleted in 1997, four years after the project was com-menced. However, in veterinary public health educa-tion and research, several important areas need to bedeveloped further. They include the elaboration of long,and medium-term programs for sustainable education,research and extension services in the school, improve-ments to graduate courses, highly prioritized researchand collaboration and cooperation with other institutions,the regular publication of an academic journal, initia-tives to organize academic meetings, the further devel-opment of in-service training and other extension ser-vices, and the establishment of financial resources forthese functions and activities.

To further develop these programs on the basis ofsuccessful developments of JICA Project in the school,the University would need to make enormous efforts ofits own now and in the future. The university may alsoneed to deepen their cooperation and collaboration withSADC countries to access common problems in humanand animal populations, nature and the environment, andfood production with special attention to veterinary pub-lic health. The author hopes that the School of Veteri-nary Medicine at the University of Zambia will take theinitiative to play a leading role in promoting extensionservices in SADC countries and other African regions.

AcknowledgementsThe present author wishes to express his sincere appre-ciation to Prof. Kouji Kanagawa (School of VeterinaryMedicine, Hokkaido University), Chairperson of theOrganizing Committee of the JICA Project at the Schoolof Veterinary Medicine, University of Zambia, for pro-viding the opportunity to join these fruitful projects. Theauthor also wishes to thank all of the organizing com-mittee members, JICA colleagues and experts, Mr J.Hanai, the JICA coordinator, and all the staff membersat the Agriculture Development and Cooperation Divi-sion, JICA Headquarter in Tokyo for their valuable sup-port to the author’s activities. The author specially thanksDr Yuusuke Tada, the JICA Team Leader of the project,for his kind advice and support. . The author also wishes to thank the staff members ofthe School of Veterinary Medicine at the University ofZambia, the Ministry of Agriculture, and the CentralVeterinary Research Institute, and many other institu-tions which were actively involved in and cooperated inthe author's activities. Last, but not the least, the author also thanks all theexperts from the British Overseas Development Agency(ODA) as well as those from the European Union (EU)for the kind encouragement, support, and friendship thatthey extended to the author.

9. OIE, Manual of Standards for Diagnostic Tests and Vaccines ( Paris: OIE, 1992) pp.1-675; WHO, Laboratory Bio-Safety Manual (Geneva: WHO, 1993) pp.1-119.

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Reference for the Table1) Office Internacional des Epizooties, (OIE): Veterinary

Public Health, 11(1), p.219 -239, 1992.2) Food and Agriculture Organization of the United Na-

tions (FAO):Guidelines for Strengthening AnimalHealth Services, FAO, Rome, p.11-48, 1991.

3) Acha, P.N. & Szyfres, B.: Zoonoses and Communi-cable Diseases Common to Man and Animals, SecondEdition, Pan American Health Organization (PAHO),Washington D.C., p.3-890, 917-924, 1987.

4) Benethon, A.B., ed., “Control of Communicable Dis-eases in Man,” An Official Report of the American Pub-lic Health Association, Washington, D.C., p.497- 509,1990.

5) World Veterinary Associations (WVA) :Veterinary Di-rectory in Collaboration with FAO/OIE/WHO, Madrid,p.11-192, 1991.

6) OIE: Manual of Standards for Diagnostic Tests andVaccines, OIE, Paris, p.1-675, 1992.

7) OIE: International Animal Health Code, OIE, Paris,p.3-550, 1989.

8) FAO: Animal Health Year Book, FAO/OIE/WHO,Rome, 1993.

9) Braglehole, R. : Basic Epidemiology, WHO, Geneva,p.1-170, 1993.

10) Jacob, M.: Safe Food Handling: A Training Guide forManagers of Food Service Establishments, WHO,Geneva, p.1-118, 1978;

11) WHO: “Salmonellosis Control: The Role of Animaland Production Hygiene,” Report of an Expert Com-mittee (Technical Report Series 774), WHO, Geneva,p.7-77, 1988.

12) FAO: “Slaughterhouse and Slaughtersrab : Design andConstruction,” FAO Animal Production and HealthPaper, 8, FAO,Rome, p.1-19, 1978.

13) Mann, I.: Guideline for Small Slaughterhouse and MeatHygiene for Developing Countries, WHO, Geneva, p.5-96, 1983.

14) Oosterom, J.: Guidelines on the Hygienic DisposalRendering of Dead Animals and Animal Waste to Pro-tect Human and Animal Health, WHO, Geneva, p.6-49, 1985.

15) WHO: Joint FAO/WHO Expert Committee on MilkHygiene, 3rd Report, (Technical Report Sereise 453)WHO, Geneva, p.47-70, 1970.

16) WHO: Evaluation of Certain Veterinary Drug Resi-dues in Food (Technical Report Series813), WHO,Geneva, p.1-48, 1991.

17) Heizman, R. J. ed., : “Veterinary Drug Residues in FoodProduction,” Animal and other Products: ReferenceMaterials and Methods, Commissions of the EuropeanCommunities (CEC), Backwell Scientific Publications,Oxford, London, 1994.

18) WHO :Report of the WHO Commission on Health andEnvironment , (Summary), WHO, Geneva, p.1-22,1991.

19) WHO: Report of the Panel on Health and Agriculture,WHO Commission on Health and Environment, WHO,Geneva, p.1-180, 1993.

20) WHO: “Ecology and Control Rodents of Public HealthImportance,” Report of a WHO Scientific Group (Tech-nical Report Seriese553), WHO, Geneva, p.6-29, 1974.

21) Russel, A.D.: Guidelines on Disinfection in AnimalHusbandry or Prevention and Control of Zoonotic Dis-eases, WHO, Geneva, p.6-52, 1984..

22) WHO: Laboratory Bio-Safety Manual, WHO, Geneva,p.1-119, 1993.

23) WHO: WHO/WSAVA Guidelines to Reduce HumanHealth Risks Associated with Animals in Urban Areas,WHO, Geneva, p.5-24, 1984.

24) WHO:WHO/WPSA Guidelines for Dog PopulationManagement, WHO, Geneva, p.9-107, 1990.

25) WHO: “Community Health Workers,” A WorkingGuide, WHO, Geneva, p.29-76, 266-272, 1987.

26) WHO: WHO Expert Committee on Rabies (TechnicalReport Series 824), WHO, Geneva, p.1-84, 1992.

27) International Labor Office (ILO): Guide on Hygieneand Agricultural Work, ILO, Geneva, p.196-217, 1979.

28) Debbie, J. & Fujikura, T.: “Beasts that bite,” WorldHealth, December, WHO, Geneva, p.11-13, 1987.

29) Istituto Speriore di Sanita, (ISS), “Veterinary PublicHealth in Disaster Situation,” Veterinary Public HealthReport, WHO Collaborating Center for Research andTraining in Veterinary Public Health, ISS, Rome, p.1-60, 1988.

30) ISS: “Note on the Wildlife in the Epidemiology ofZoonoses,” Veterinary Public Health Report, WHO/FAO Collaborating Center for Research and Trainingin Veterinary Public Health, ISS, Rome, p.1-80, 1992.

31) Fujikura,T.,et al., WHO/ICLAS Guidelines for Breed-ing and Care of Laboratory Animals, WHO, Geneva,p.1-162, 1993.

32) Council for International Organizations of MedicalScience (CIOMS): International Guiding Principlesfor Bio-Medical Research involving Animals, CIOMS,Geneva, p.1-27, 1985.


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55

International Cooperation in Hospital ImprovemtntProjects in Developing Countries

NOTE

International Cooperation in Hospital ImprovementProjects in Developing Countries―A Study of Basic Principles―

Katsuhiro YOSHITAKEDirector, Expert Service Division, Bureau of International Cooperation,

International Medical Center of Japan, Ministry of Health and Welfare, JapanYasuhiro ARASAKI

Expert Service Division, Bureau of International Cooperation,International Medical Center of Japan, Ministry of Health and Welfare, Japan

Shuzo KANAGAWAExpert Service Division, Bureau of International Cooperation,

International Medical Center of Japan, Ministry of Health and Welfare, Japan

Hospital services along with PHC (primary health care) activities play an essential role in the national healthservice delivery system. In developing countries, priority, however is often given to the prevention and controlof disease because financial, technical and human resources are limited, and on the other hand PHC is one of thehigh priorities in aid programs extended by foreign aid organizations. The low priority given to the hospitalservices compared with the prevention and control of diseases and PHC is also justified by the fact that themodalities of hospital-based medical care do not necessarily benefit the entire range of socio-economic strata ina country. It is noteworthy that the ratio of noncommunicable diseases leading to mortality is increasing indeveloping countries

Another fact is that, although mortality due to preventable diseases is gradually decreasing with the effects ofPHC activities, there are still many very sick people who are hospitalized for treatment and require urgent andmore intensive hospital-based care after all preventative or alleviating measures have failed. Under these cir-cumstances, it is essential to strengthen the function of hospitals in order to achieve the goal, “Health for All bythe Year 2000” being advocated by WHO and UNICEF.

Dr. Mahler, the former Director General of WHO, has asserted that “the hospitals do not contribute to thehealth of people” so long as they confine their activities inside the premises called ‘hospital’ and provide onlyhighly technologically-oriented medical services. It seems to be impossible for anyone working in health sec-tors in developing countries to refute this criticism.

We have attempted here to establish the basic principles for international cooperation in hospitals improve-ment projects which both the donor and the recipient parties can use as a common guide in formulating projectplans and policies to improve the quality of medical and health services in collaboration with PHC activities. Wehave also tried to clarify the stage at which these basic principles can be applied in a project cycle.

Introductory Remarks

The improvement of hospital function is a very impor-tant task which directly affects the health of people indeveloping countries. The World Bank and WHO jointlyconducted the Global Burden of Disease Study for fourand half years in the beginning of 1992. According tothe study, approximately 40% of the causes of death wereattributed to infectious diseases, and maternal and peri-natal mortality, 50% to non-infectious diseases, and theremaining 10% to trauma.1 Thus, on-infectious diseases

are becoming a big health issue in present developingcountries as in the case of industrial countries. There-fore, the role of hospitals for adequate medical care indeveloping countries is becoming increasingly impor-tant in cases of non-infectious diseases, not to mentionthe case of infectious diseases which is often aggravatedas a result of failed preventive efforts and maternal andperinatal disorders. Consequently, the importance ofhospitals in developing countries cannot be said to bedecreasing, on the contrary it is increasing.

Hospital improvement projects in developing coun-

* This article is based on the results of “Research on Technical Transfer to Hospitals in Developing Countries” funded by the International Medical Cooperation ResearchProgram, Ministry of Health & Welfare, FY1997. This is first published in Japanese in Kokusai Kyoryoku Kenkyu Vol. 14 No.2 (October 1998).

1. Murray, C.J.L, “Evidence-based health policy-lessons from the global burden of disease study,” Science , 274(1) (1996): 740-743.


56

tries extended by foreign donor countries need to beimplemented with principles taking into account theactual socio-economic factors of the country. The hos-pitals in developing countries are featured differentlyfrom those in industrial countries due to scarcity of fi-nancial and human resources. For example, in devel-oping countries, disease prevention and control (publichealth activities) works more effectively and are givenhigher priority than treatment of established disease en-tities (hospital-based medicine), and therefore hospitalsfunctions should have unique roles co-active with dis-ease prevention and control activities. Efficient hospi-tal administration with clearly defined objectives is allthe more important in developing countries since hospi-tals require coordinate efforts in a variety of areas intheir functioning.

The purpose of this paper is to establish, from theabove viewpoint, the principles to be referred prior tothe implementation of hospital improvement projectsextended to developing countries in international coop-eration.

This paper is derived from the author’s experience intechnical cooperation projects implemented or coordi-nated by Japan International Cooperation Agency(JICA). The projects include the Rheumatic Fever andRheumatic Disease Prevention and Control Project basedat the Institute of Cardiovascular Disease Research Hos-pital in Bangladesh and the Family Planning and Ma-ternal and Child Health Project based at the NagaharnadyAluminum Corporation Hospital in Egypt, the Commu-nity Health Project in collaboration with Khon Ken Pro-vincial Hospital in Thailand, in all of which the author,Yoshitake had worked. The technical cooperation withSanta Cruz General Hospital in Bolivia in which the co-author, Arasaki had worked, and the Cairo Children’sHospital in Egypt in which the co-author, Kanagawahad worked, as well as the authors’ experience in JICAas technical advisors for grant aid projects with the sup-port of the International Medical Center of Japan arereflected in the paper. The result of a forum, “FocusGroup Discussion” participated by former leader of theprojects related to the hospital improvement is also in-corporated.

I Status of Hospitals in Developing Countries

The idea of the collective treatment of a group of pa-tients within a facility was originated in Europe. Inthe beginning, such ways of treatment were conve-nient for care-givers. As a result of modernized di-agnostic and therapeutic modalities advanced by vari-ous technological innovations in the post-industrialrenovation era, it was found that good outcomes couldbe achieved by collecting patients with similar symp-toms in one place for repeated treatment,2 and thus

hospital-based medicine has been established as anefficient care modality.

On the other hand, there had been no concept of“hospital-based medicine” in the southern countries nowreferred to as developing countries. Hospitals were con-structed in these countries by European powers whosecolonialistic activities became increasingly more intensein the 19th century with the advent of industrialized so-cieties in Europe. Their chief mission was to serve thecolonial rulers from Europe.

Following the end of the World War II, one after an-other, countries won independence and were concomi-tantly forced to accept European style medical caremodalities, i.e., “hospital-based medicine” remained asa legacy of their colonial rulers. Naturally, these newlyindependent countries lacked the financial, technical andhuman resources to run these modalities, and thereforehad to depend a lot on assistance from the industrialworld. Furthermore, this type of medical service wasavailable only to those urbanites who could afford topay for the service or afford access to hospitals; ruralresidents, who represented the majority of the country,had nothing to do with the hospitals.

When hospitals similar to those in urban centers werebuilt by national policy in smaller rural towns to offerfree or less expensive services, they were of little helpbecause they had poor technology, lacked equipmentand supplies, and benefited only those who lived closeto the facility. The level of health had hardly been im-proved under these circumstances. While mortality dueto infectious diseases, malnutrition and maternal or peri-natal disorders remained high, even higher populationgrowth, which surpassed the mortality, kept the viciousspiral of many births and many deaths unsolved.

Various aid organizations and groups which are con-cerned with developing countries have been strugglingwith the difficult problem of how to promote health withlimited material and human resources. Thus, Dr. Mahler,the then Director General of WHO, declared “Healthfor All by the Year 2000” by means of PHC activities atthe Alma Ata Conference in 1978 which was co-spon-sored by WHO and UNICEF.3 Urging people not to relyonly on western-style medical technologies, the decla-ration advocated the promotion of community partici-pation and initiatives, and the development of health careservices appropriate to the respective countries by em-phasizing prevention based on epidemiological prior-ity. Thus, it aimed to create the conditions whereby allpeople could attain health by the year 2000. The Alma-Ata Declaration, however, did not mention the role ofthe hospitals.4

Responding to this movement, an international con-ference was held in Karachi in 1981 on the “Role ofHospitals in PHC”. It was co-sponsored by the Aga KhanFoundation and the Canadian International DevelopmentAgency (CIDA) under the auspices of WHO. Dr.

2. McNeil, W.H., Shippei to Sekaishi (Epidemics and World History:Japanese translation) Shincho-sha (1985) p.215.3. WHO and UNICEF, Alma-Ata 1978: Primary Health Care, (Geneva: WHO, 1978).4. Hardie, M., “Hospital and primary health care (PHC),” Int. Nurse. Rev., 31(2) (1984): 43-46.

57


Mahler, who did not mention the role of hospitals at theAlma-Ata Conference, raised the criticism “… but theyhave all too often become ivory towers of high and so-phisticated technology needed by relatively few and ac-cessible to fewer.”5

Henceforth, activities in health promotion in de-veloping countries have been deployed with PHC ac-tivities participated in by residents of rural commu-nities with emphasis on disease control, and primaryhealth and medical care. As a result, primary healthand medical care facilities have been strengthened inalmost all developing countries steadily producing thefruits of PHC, and mortality due to diarrhea, diseasesand other preventable infections have been decliningsignificantly. Thus, developing countries had gotteninto an era of many births and a few deaths.

II Historical Relationship betweenHospital Functions and PHC

The declaration of “Effective linkage between hospi-tals and PHC” advocated at the Karachi Conferencehad failed to provoke full discussions from the pointof view of the overall role of hospitals in supportingthe health and medical care delivery system at thenational or regional level. Discussions had been car-ried out almost exclusively from the point of view ofthe role of secondary hospitals (district hospitals orthe first referral hospitals) as recipients of patientsreferred from primary care facilities, and no mentionhas been made as to the role of tertiary, specialized ortraining hospitals.6 It can be said that all diseases arenot preventable nor is all early treatment effective.Patients in aggravated conditions cannot be managedby primary care facilities or secondary hospitals. Inmany cases patients ended up in a situation requiringcare at tertiary or specialized hospitals located in ur-ban centers, overcrowding hospitals with patients toosick to treat.

Recently PHC activities have lost some of theirinitial luster although the importance of PHC as abasic concept remains unchanged. “Health for All by2000” has been difficult to achieve and now requiresmodifications, as was clearly shown in the GlobalBurden of Disease Study mentioned earlier. In thedeveloping countries, the number of deaths due to

chronic diseases and traffic accidents are increasingwhile many deaths still resulted from infectious dis-eases. In many countries, people forgo primary carefacilities, the basic units of PHC activities, to visithigher-level hospitals.7 In addition to this, reports invarious forms indicate how difficult it is to establishPHC activities in the community.8

Hospitals, on the other hand, are suffering fromshortages of funds, medical supplies, equipment andhuman resources, and some opine that not only dothey fail to deliver satisfactory medical services, butthey also negatively affect the health and medical caredelivery system of the country by monopolizing pre-cious medical resources.9 Such hospitals are detest-able from the standpoint of prioritized PHC.

Given this background, it has been proposed thathealth care delivery systems should be consideredmore comprehensively from the perspective of na-tional health policy.10 Specifically, beginning in andaround 1992, movements have been activated in de-veloping countries which demand reformation of theoverall health care delivery system accompanied withas health sector reform, health care reform and healthreform.11 The Western Pacific Regional Office ofWHO is about to add new problems of urbanization,environmental deterioration and chronic diseases as-sociated with human behavior to the future approachof PHC.12 Furthermore, the Development AssistanceCommittee (DAC) held in May 1996 formulated aglobal strategy for the 21st century,13 and set targetsin health for decreasing the infant and under 5 yearsold mortality by one third and maternal mortality byone fourth by the year 2015. The specific strategieshave yet to be formulated.

III Principles to be Confirmed Prior toImplementation of HospitalCooperation

Under these circumstances the hospitals in the devel-oping countries will be questioned about their raisond’être if they only wait for patients to turn up andrender business-as-usual services. The time has comefor hospitals in developing countries to reawake them-selves to tackle the task of increasing hospital func-tions. The cooperating party also has to have a clear

15. Mahler, H., “The role of hospitals in primary health care,” Report of a Conference Sponsored by WHO and Age Khan Foundation (Karachi, Pakistan: Nov.1981): 22-26.

16. WHO Expert Committee on the Role of Hospitals at the First Referral Level, Hospital and Health for All (WHO Technical Report Series, 744) (Geneva: WHO,1987); WHO Study Group on the Function of Hospitals at the First Referral Level, The Hospital in Rural and Urban District (WHO Technical Report Series,819) (Geneva: WHO, 1992).

17. Health Planning Division, Ministry of Public Health, Thailand, The Seventh Five-Year National Health Development Plan (1992).18. Bryant, M., and R.O. Essomba, “Measuring time utilization in rural health centers,” Health Policy and Planning, 10(4) (1995): 415-421; Maclure, R. , “Primary

health care and donor dependency: A case study of non-government assistance in Burkina Faso,” International Journal of Health Services, 25(3) (1995): 539-558.

19. Uehara, N., and A. Wagatsuma, “Tojokoku-niokeru byoin iryo: iryou shigenno kanntenkara (Hospital-based medicine in developing countries, from a point ofview of medical resources),” Kokusai Kyoryoku Kenkyu 6(2) (1990): 43-60.

10. Unger, J. P., and B. Criel, “Principles of health infrastructure planning in less developed countries,” International J. Health Plan. Manage, 10 (1995): 113-128.11. Hasegawa, T., “Sekaiwo nomikomu kennkou henkaku - Soron (Tidal current of health sector reform inundating the world - General discussions”, Koshueisei

(Public Health), 62(1) (1998): 70-79.12. WHO, The World Health Report 1995: Bridging the Gaps (Geneva: WHO, 1995).13. OECD, Shaping the 21st Century: The Contribution of Development Cooperation (May 1996).


58

picture of what the proposed cooperation will bringabout, relative to the country or region, before theproject is started. From this point of view, the prin-ciples to be applied in hospital cooperation will bestated below in three parts divided by the loci of ap-plication of the respective principles, i.e., the recipi-ent side, donor side and both sides.

1. Principles Applicable to Developing Countries

Principle l: As a precondition to implementinga hospital cooperation project, it has to be shown thatthe community residents have access to the primaryhealth care facilities.

Even if a hospital (secondary or tertiary care in mostcases) is built where no primary care is available, onlya limited number of residents will have access to thehospital. In other words, even if the hospital can pro-vide high quality medical care, those living in areaswhich are outside access will not benefit from it. Themedical services of a higher level hospital will bebetter utilized only where the basic health and medi-cal service is provided by a primary care facility. Itis essential to have a primary care facility accessible(Fig.1). Where there is no such establishment, a pri-mary care facility should be given priority over a sec-ondary or a tertiary hospital as the target of coopera-tion project. Even if it exists, often it may not befunctioning effectively, but, as stated below, it maybe reactivated for better primary care service throughcooperation or linkage with a hospital. It is vital as aprecondition for cooperation to take place, a primarycare facility must be established.

Principle 2: The National Health Policy specificallydefines the role of the target hospital in the coopera-tive efforts to improve health on the national or re-gional level.

Even if efforts are made to improve the function ofthe target hospital, it is not clear what contribution ismade to the community when its role is not specificallydefined by the National Health Policy. Accordingly, therelevance of the cooperation with the hospital also be-comes vague. The project (improvement in hospitalfunction) has to be shown unequivocally to help a na-tional program (health policy) (Figs.1, 2 and 3). Thefunction of a hospital as a component of the health andmedical care delivery system should be carefully iden-tified. As the system comprises prevention, health pro-motion, curative medicine and rehabilitation, each hos-pital must be designed to fulfil its pertinent role in eachnecessary field.14

Principle 3: Sufficient funds must be budgetedfor improving the functioning of the target hospital.

Even if foreign financial assistance is needed, the tar-get hospital should be operated and maintained by thecounterpart country as the responsible party, and it isessential for the counterpart country to budget the cor-responding funds (Fig.4). Any foreign financial assis-tance constitutes only a portion of the operation of thehospital. Whether the hospital can maintain its activi-ties following the termination of the cooperation willdepend on how properly budgetary actions were takenduring the cooperation period. Any cooperation thatcreates dependency on foreign assistance will be counter-productive to the self-reliance and -development of therecipient counterpart country.

14. Mahler, op. cit.

Figure 1 Hospital in National Policy

Teaching ortraining hospital

Tertiary Care Provincial hosp.

Secondary Care District hosp.

PHC center

PHC volunteer

Primary Care

Urban city

Province

District

Sub-district

Village

National policy of

“Health for all”

59


Principle 4: The target hospital is prepared to accepttechnical cooperation.

The hospital has to be well organized and staffed inorder to achieve its defined objectives with the coopera-tion of the Japanese side, that is, the organization of per-sonnel to respond to the technical cooperation (Fig.4).It is necessary to have a director who is in charge of theoverall project, someone who is responsible for the de-partment that will receive technical cooperation, and di-rect target personnel who will carry out the technicalcooperation through specifically assigned tasks. In ad-dition, various types of committees will need to be held

to make the technical cooperation effective and efficient.Furthermore, as this is an international cooperationproject based on an agreement between two countrieson the national level, the responsibility at the nationalgovernment level has to be clearly indicated so that thecooperation can be carried out smoothly and effectively.

2. Principle Applicable to the Donor

Principle 5: The Japanese side should beprepared tocooperate in such a way as to satisfy the needs of thecounterpart.

Figure 2 Improvement of hospital function

Nationalhealth policy

Impact

Outcome

Process

Structure

Policy proposal

Communityinvolvement

Inprovement inPatient service

Policy proposal

Human Resources,Equipment & Facility

Whole nation

Community

Patients

Administrators

Employees

Government Level Action Beneficiary

→

→

→

→

→

→

→

→

→

→

→

→

→

→

→

↑

↑

↑

↑

Budget/

Personnel/

Manitoring/

Supervision/

Evaluation

Clinical activitiers

Figure 3 Hospital Functions

Hospital managementServicesNursing LaboratoryPharmacyResearchLibrary

Financial managementPersonnelMedical RecordsPublic relations

Better patientservices

Construction & maintenance

Functions improved

Delivery system Centralized

Referral systemLinks with other institutionsCooperation with local PHC activities

MaintenanceCentral supplyKitchenLaundry

Building, remodeling,replacement of equipment


60

The cooperator should, upon launching technical co-operation, be well prepared to satisfy the needs of thecounterpart in terms of personnel, funding and contents(needs-oriented) (Fig.4). The cooperator should neverforce its own interests on the counterpart (provider-oriented), neglecting the latter’s needs. For example,the cooperator should never be engaged in the hospitalcooperation project in order to obtain results for its ownresearch studies.

3. Principles Applicable to the Both Sides

Principle 6: The hospital cooperation project shouldaim specifically to improve the patient service.

What is important is how the improved hospital func-tion contributes to improving the patient service, i.e.,improved cure rate, shortened admission period, in-creased patients’ satisfaction, and raised level of healthin the community. The hospital cooperation does notnecessarily serve to improve the patient service. If newconstruction at the facility, and rebuilt or newly-pur-chased equipment only please those connected with theinstitution and do not lead to improved patient service,then all these cooperative efforts will be meaningless(Fig. 2). Recognizing that any problems with the pa-tient service concern not only the facilities and equip-ment, it is necessary to clarify problematic points anddefine objectives toward which the workers in the es-tablishment should direct their efforts.

Principle 7: The technologies to be transferred andshould be appropriate to the counterpart.

Appropriate technology is defined as that which iseffective for the objective, is highly cost-effective, prac-

tical and widely applicable, and has been scientificallyproven. Often in developing countries, doctors educatedin or influenced by Europe and the United States waywish to introduce the medical technologies of the in-dustrialized world so hastily that they might request tech-nical cooperation inappropriate to their country in termsof cost effectiveness.

The kangaroo care15 developed in Colombia is an ex-ample of appropriate technology. This is a method toaccommodate an extremely low weight newborn in anincubator for a few days after birth to wait for improve-ments in its condition by standing it, dressed only in adiaper, between the breasts of the mother, who wearsher clothes over it to keep it warm and can breast feed it.With this method, the survival rate of extremely lowweight newborns has been improved (up to then, oneincubator had been used to accommodate two or threepremature babies because of the shortage of incubators,and inadequate care had complicated them with infec-tion, causing many of them to die), and as a result of thecontact with the mother, baby abandonment is said tohave decreased. The kangaroo care helps shorten thetime which an incubator is required and requiresfewer professional personnel, thus enhancing cost-effectiveness.16

Principle 8: It should be recognized that improving thecapabilities of hospital administration is important forthe hospital to function effectively.

In order for a hospital to fully function, it must oper-ate in such a way that the various sections of the hospi-tal are organically linked with each other so that eachsection functions collaboratively, effectively and effi-ciently. If the various sections of a hospital are not linked,

15. Whitelaw, A., and K. Sleath, “Myth of the marsupial mother: Home care of very low birth weight babies in Bogota, Colombia,” Lancet, May. 25 (1985): 1206-1208.

16. Charpak, K., J.G. Ruiz-Palaez, and Y.Rey-Martinez Charpak, “Kangaroo Mother Program: An alternative way of caring for low birth weight infant? Yearmortality in a Two Cohort Study,” Pediatrics , 94 (1994): 804-810.

Input from Japan

Program（after the project）

Self-reliance

Input from the Recipient Country

Project（in the contracted term）

Training in Japan Dispatch of Experts Donation ofEquipment

HealthPolicy

PostingStaff

Maintenanceof Equipment

Budget ProjectOrganization

Sustainability Achievement ofPurpose

Figure 4 Project-Type Technical Cooperation (JICA)

61


their potential may not be fully realized (Fig. 3 and Table1). This should be recognized not only by the hospitaladministrator but also by those responsible for each sec-tion.

Principle 9: As a component of the function of the hos-pital targeted for cooperation, a PHC section should beestablished to play an active role in disease preventionand health promotion on the national or regional level.

The hospital should have activities to strengthen PHCas a component of its functions. In developing coun-tries, most patients coming to the hospital are those suf-fering from preventable, but contrarily aggravated, dis-eases because they have not benefited from PHC. It isnot enough for the hospital to just treat these patients. Ahospital takes care of many such patients, and that isexactly why it is in a better position to advocate the im-portance of prevention and early treatment. The hospi-tal has a greater role to play in standardizing diseasespecific treatment at primary care facilities, establish-ing an adequate patient referral system, training healthand medical personnel at the respective levels, consoli-dating and adequately using health and medical infor-mation, linking various types of health and medical in-formation, and evaluating health and medical service inthe community (Fig.1). Those concerned should be thor-oughly made aware of this concept, which is fundamen-tally different from that of hospitals of the industrial-ized world, so that this section may be firmly established.

Principle 10: The statistical data to demonstrate theactivities of the target hospital should be collected on ayearly basis, especially those indicators that measure thedegree of improvement in patient service.

The various types of statistical data to demonstratethe status of the target hospital are not only essential butalso should be available at all times from an establishedsystem. Above all, it is important to establish a system

to annually obtain indicators such as the rate of dischargeupon recovery or amelioration, rate of postmortem dis-charge, rate of intra-hospital complications, duration ofhospitalization, the wait for surgery, patients' satisfac-tion rate, and patient referral rate to accurately show thequality of the patient services. Developing countriesare in no condition to sufficiently collect these data. Morethan therapeutic technique or anything else, it is impor-tant to be able to collect these data. Without the data, wecannot measure the effects of the improved functionsmade possible through cooperation or define targets formodification.

Principle 11: It is necessary to establish a method toevaluate the impact of technical cooperation.

The input of the technical cooperation on the part ofthe donor and that on the part of the recipient should beclearly laid out, the targets to be achieved should be spe-cific, and the method for evaluating the degree ofachievement should also be specific. Mutual understand-ing and agreement is indispensable to achieve the over-all goal, the specific objectives, the outputs and the ac-tivities. For this purpose the project design matrix shouldbe prepared with the active participation of both parties(Table 2).

IV Positions of “Principles of HospitalCooperation”

Among the 11 principles stated above, six principles,that is, Principle 1 through Principle 5 and Principle 7are the preconditions for launching a project. If theseconditions are not satisfied, then either the cooperationitself becomes difficult, or the impact of the coopera-tion and the effectiveness of the objectives may not beassured. Regarding the other principles, the principlesthemselves can be target areas for the cooperation, and

CONCEPT OF HOSPITAL MANAGEMENT

RESOURCES OBJECTIVES FIELDS INVESTIGATION

Manpower Organization Personnel affairs No. of personnel,Organization,Payment

Materials Equipment,Facilities,Medicine, etc.

Procurementand maintenanceof materials

Inspection,Inventory

Money Financial affairs Medical affairs,Accounting

Book-keeping

Information Medical records,Medical statistics

Record-keeping,Statistics center

State of patientrecords,information andstatistics

Table 1 Hospital Administration


62

so they may be realized after the commencement of theproject. However, their feasibility should, at least, bedetermined beforehand.

Many developing countries request technical coop-eration or grant aid cooperation to their hospitals fromJapan. These two types of cooperation will be contin-ued in the future, as they are principle forms that feature

Japan’s bilateral assistance. Considering the presentconditions of developing countries requiring the estab-lishment of comprehensive health and medical care de-livery systems, it is an urgent issue that we define theprinciples for hospital cooperation. Using the principlesoutlined in this paper as a basis, more effective policiesfor hospital cooperation can be worked out.

Project design matrix (PDM)

Objectivelyverifiableindicators

Means ofverification

Assumption

Overall goal

Project purpose

Outputs

Activities Inputs

Preconditions

Table 2 Planning Evaluation and Monitoring of Project

63

A Study on Labor-Based Technology in Kenya

NOTE


Eiichi ASANOJICA Expert

Project for Jomo Kenyatta University of Agriculture and Technology

Introduction

In Kenya, compared to other means of transportation,the greatest volume of travel is by road. Road devel-opment, however, is progressing at a snail’s pace. Theconstruction rate continues to be low. Because thereare insufficient funds for road development, the fo-cus has been on maintaining and repairing existingroads rather than constructing new ones. The country’seconomy has been unstable, undergoing irregularcycles of rapid growth and contraction resulting fromsudden fluctuations in coffee prices, the oil shock,and natural calamities such as drought and El Niño.Compared with the rapid population growth (3.4%)over the last 30 years, the growth of the gross domes-tic product (GDP) has been as low as 3.1%. As a re-sult, GDP per capita has been forced lower and thenation has never been able to achieve real affluence.Moreover, in paying close attention to the industrialstructure of the country, one realizes that the agricul-tural sector, although it accounts for 26% of the GDPand absorbs some 60% of the entire work force, isexperiencing low growth (0.5%) and is lowering over-all economic growth. In short, there are no major in-

dustries other than agriculture, and tertiary industries,such as government and financial services, which haveto provide employment for the unemployed. More-over, because of the lack of job opportunities in ruralareas, more and more people are migrating to the city(Nairobi) year after year, raising public safety con-cerns and causing poor sanitation and overpopulationin impoverished areas.

Since the late 1970s, the country has been imple-menting road construction projects through labor-based technology (LBT), advocated by the ILO (In-ternational Labor Organization), which utilizes therural workforce and the surplus labor in urban areasto build and maintain roads. LBT applies traditionalmethods using tractors and manpower. In 1980, thecountry began to receive structural adjustment assis-tance from the World Bank to prop up its economy.In the following year, the World Bank imposed a full-scale structural adjustment as a basic developmentstrategy in African countries. Since then, countries inAfrica have been faced with the two principle issuesin pursuing structural adjustment. One is how to iden-tify the way appropriate for each country in imple-menting structural adjustment, and the other is how

Since its independence in 1963, Kenya’s economy has been unstable, undergoing irregular cycles of rapidgrowth and contraction, caused by sudden fluctuations in coffee prices, the oil shock, and natural disasterssuch as drought and El Niño.

In the late 1970s, the government of Kenya adopted Labor-based Technology (LBT) advocated by theInternational Labor Organization (ILO) prior to receiving structural adjustment assistance from the WorldBank and International Monetary Fund (IMF). LBT utilizes the rural work force and surplus labor in urbanareas to build and maintain roads. LBT applies traditional methods using tractors and manual labor. Trac-tors are mainly used for transporting earth and sand while the rest of work is done by manual labor. Thework force consists of local farmers who are efficient construction workers since they are used to tilling.Moreover, cash incentives make it possible to utilize a large number of workers in a short period of time.However, Kenya is faced with various problems involving operation efficiency and regional developmentowing to the climatic diversity of east Africa. There are a large number of climatic zones within thecountry, which include semi-arid areas, plains, coastal areas, in and around Lake Victoria, highlands, andmountainous areas.

In comparing road construction costs in rural areas with those in the suburbs of big cities, and the meritsand disadvantages of LBT with that of other methods which utilize heavy construction equipment, LBT islimited by the road specifications being constructed and labor costs. In order to fully understand whatneeds to be done in the future, it is necessary to address the existing problems and need for technologydevelopment. It is also required to conduct comprehensive analysis of LBT based on an engineeringexamination of its relationship to other appropriate technologies, the society, the economy and the regionaldevelopment of the country.

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu, Vol. 15 No.1 (April 1999).


64

to overcome economic difficulties. Eighteen yearsafter the introduction of structural adjustment, Afri-can countries are still far from reducing poverty, letalone appreciating self-supporting, sustainable devel-opment. In parallel with structural adjustment, theKenyan government started road construction in fourareas of the country, based on a pilot project design.So far, a total of 800 kilometers of road has been com-pleted using LBT, which accounts for 10% of the ini-tially planned 8,000 kilometers.

In this article, the author introduces the Labor-basedRoad Construction and Improvement Plan, which wascarried out using LBT, and to meet future challengesand make improvements, proposes an analysis ofLBT. The analysis includes assessing existing prob-lems and needs for technology development, and con-ducting scientific examinations of LBT’s relationshipto other appropriate technologies, to society, and to

the economy and regional development of the coun-try. Owing to the limited space in this article, the au-thor would like to add that the contents of basic andcomprehensive road construction design are not dis-cussed here.

I. LBT and the Labor-Based RoadConstruction and Improvement Plan

There are a large variety of climatic zones withinKenya, including semi-arid areas, arable plains,coastal areas, the area in and around Lake Victoria,highlands, and mountainous areas. Roads in the coun-try are classified into five categories: Class A - inter-national truck roads; Class B - national truck roads;Class C - primary roads; Class D - secondary roads;and Class E - access roads (Figure 1 shows Kenya’s

67


country, LBT is only applicable to rural areas.

2. The Advantages and Limitations of LBT inthe Context of Regional Development

Social and regional development in Africa after in-dependence and the accompanying growth of citiescreated urban problems as rapidly as or more rapidlythan the Industrial Revolution. Many African coun-tries became independent in the 1960s. Within 25years, many African countries, including Kenya, ex-perienced more severe urban problems than at anyother time in human history. When oil prices weredramatically increased by the Organization of Petro-leum Exporting Countries (OPEC), many Africancountries whose primary method of acquiring foreignexchange was exporting agricultural products sufferedfrom income decline in foreign currency. As a result,severe shortage of foreign exchange forced thesecountries to cut imports of raw materials and inter-mediate commodities, which resulted in stagnationof industrial development and diversification policiesby their governments. At the same time, a large num-ber of people began to move to the big cities. A short-age of labor in rural areas caused a decrease in thecountries’ self-sufficiency in food production.

One measure to alleviate the rapid populationgrowth in urban areas is to prevent population influxfrom rural areas, which, in other words, means todevelop rural areas. Rural development includes re-vitalizing villages by constructing access roads andenabling the mass transportation of agricultural prod-ucts. Advancement of rural development providesmuch opportunities to rural residents for more cashincome, which serves as an incentive for them to stay.

However, Class D and E roads are not free fromphysical limitations as any type of road is limited byits durability and transportability. These two factorsare affected by thin roadbeds. The transportation ofagricultural products damages the road surface androadbeds. Also, because of the narrowness of theroads, large-sized trucks are not able to pass each otherefficiently, which also enhances the physical limita-tions of the roads. As the economic situation in ruralareas improves, labor costs also increase. After a cer-tain time lag, LBT no longer works effectively, andthe rate of development starts to level off.

3. The Advantages and Limitations of LBTas a Construction Method

Generally speaking, before starting construction, one

Table 2 Comparison of Construction Costs

Cost Comparison in Rural Access Road Construction(Rural Areas)Construction by Heavy Equipment Construction by LBT

Component

Construction Worker

Skilled Construction Worker

Site Foreman

Small-sized Equipment

Heavy Equipment

Culvert

Other Materials

Indirect Construction Cost

Total

Details

100 workers, $1.00 per day


25 foremen, $2.00 per day

Shovels, wheel barrows, etc.

Bulldozers, graders, etc.

$/km

100

300

50

150

2,750

600

200

200

4,350

%

2.3

6.9

1.1

3.4

63.3

13.8

4.6

4.6

100.0

Details





Tractors

$/km

1,000

400

100

250

750

600

200

200

3,500

%

28.6

11.4

2.9

7.2

21.4

17.1

5.7

5.7

100.0

Comparison in Rural Areas Construction by heavy equipment $4,350 > LBT $3,500LBT is moreeconomical

Cost Comparison in Access Road Construction(Outskirts of Bog Cities)Construction by Heavy Equipment Construction by LBT

Component

Construction Worker

Skilled Construction Worker

Site Foreman

Small-sized Equipment

Heavy Equipment

Culvert

Other Materials

Indirect Construction Cost

Total

Details



25 foremen, $5.00 per day


Bulldozers, graders, etc.

$/km

250

750

125

150

2,750

600

200

200

5,025

%

5.0

15.0

2.5

3.0

54.6

11.9

4.0

4.0

100.0

Details





Tractors

$/km

2,500

1,000

250

250

750

600

200

200

5,750

%

43.5

17.4

4.3

4.3

13.1

10.4

3.5

3.5

100.0

Comparison in Outskirts of Big Cities Construction by heavy equipment $5,025 > LBT $5,750LBT is lesseconomical

Note : All unit costs are based on Kenya’s Fluctuation Clause Price List, 1998.


68

chooses a particular construction method based on acomprehensive analysis which includes comparingdifferent methods, examining possible problems thatmay emerge during the construction, and consider-ing its feasibility.

In comparing estimated construction costs, oneshould not only include direct costs, but also tempo-rary and indirect construction costs. No final deci-sion should be made based solely on the estimatedcosts because the hardness or ease of a constructionproject is difficult to express numerically. In addi-tion, the least expensive method does not necessarilyguarantee the lowest construction costs. If the methodlacks considerations for safety, accidents may occurwith higher frequency, which ultimately increases theoverall cost of construction.

Another factor that plays a vital role in selecting aconstruction method is equipment. How much moneyis spent on construction equipment and facilities de-pends on the size and length of the project concerned.In developing countries like Kenya, such expensesshould be minimal because cheap labor is available.

Table 3 shows a comparison of heavy constructionequipment and LBT. Heavy construction equipmentincludes only equipment that is absolutely necessary.Naturally, construction using heavy equipment ismore efficient than construction using LBT in con-struction speed and work volume. However, this istrue only in theory. Situations in developing coun-tries are different. One reason is the difficulty in pro-curing spare parts for maintenance purposes. Unlikein industrial countries, one can almost never procurespare parts in developing countries by making onephone call. Although distributors of heavy equipmentare located in almost every country, spare parts inmany cases have to be imported from headquarters.Not only is it time-consuming, but it is also expen-sive because of the duties on imports. People in de-veloping nations, therefore, do not believe in main-tenance.

Another reason is that construction projects thatinvolve heavy equipment are, in most cases, carriedout by contractors. Contractors are supposed to chooseequipment depending on the capacity and efficiency

Table 3 Comparison of Merits and Demerits

Construction by Heavy Equipment Construction by LBT

Description of Work Method and Input Capacity and Efficiency Method and Input Capacity and Efficiency

Measuring and

surveying

Digging topsoil

Removing and

transporting soil

Removing bedrock

Digging earth

Transporting earth

Banking

Compressing

Protecting slopes

Theodolites and levels

Bulldozers, and motor

rakedozers


scrapers

Dynamite, and rock drills


scrapers


scrapers

Bulldozers, and trucks

Rollers, and compactors

Extending protective

measures

Precise, swift and requires

maintenance

Swift, expensive, and

requires maintenance

Swift, and requires training

to handle dynamite







Expensive

Temporary markers, chains

for measuring distance

Shovels, pickaxes, and

hoes

Shovels, pickaxes, levers,

and iron clubs


tractors

Shovels, wheel barrows,

and tractors

Shovels, wheel barrows,

and tractors

Manual compactors, trac-

tors, natural compression

Leaving them as they are

Imprecise, and does not

require special calculations

Time lost, but low-cost

Low-cost, but deterioration

due to heavy rainfall

Managing springs Building culverts Concrete materials Buliding culverts Concrete materials

Felling trees and

removing roots




hoesTime lost, but low-cost


scrapers



Shovels, pickaxes, wheel

barrows, and tractorsTime lost, but low-cost




requires maintenanceTime lost, but low-cost



Finishing the surface Rollers, and compactors Swift, expensive, and


Tractors, and natural

compression

Time lost, deterioration due

to heavy rainfall, but low-

cost

Note : Maintenance includes regular maintenance and procurement of spare parts(all imports).

69


of the equipment, and the size of the project in ques-tion. Equipment with too much capacity will increaseoperating costs. Whether or not the equipment is easyto acquire is also a concern in choosing equipment.In recent years, African countries have implementedfew public undertakings as a consequence of beingforced to take tight financing policy, as a result ofreceiving less assistance due to aid fatigues of indus-trial countries. Many contractors who own heavy-dutyequipment, therefore, use their equipment wheneverthey can, regardless of the size of the construction,which has a negative impact on cost performance.

III Analysis

LBT is a practical idea that effectively utilizes therural workforce and the surplus labor in urban areasto build and maintain roads for the purpose of facili-tating regional development and transporting agricul-tural products on a massive scale. Lately, LBT hasalso begun to be used for preparing infrastructure inslum areas. LBT is expected to produce a wide rangeof positive effects. Improved infrastructure not onlymitigates the flow of rural-urban migration by revi-talizing rural areas, but also impedes rapid popula-tion growth and creates job opportunities in the slums.However, the greatest challenge of LBT now requiredis how to overcome the loss of time, money and la-bor. This problem is a result of difficulties in settingthe best time for construction, organizing the com-munity, and allotting an appropriate portion of workto each worker.

1. Existing Problems and the Need forTechnology Development

It is essential to examine traditional constructionmethods from various angles, and find the most suit-able method for each community. The following aretwo major challenges and approaches used to over-come existing problems.

1.1 Approach to existing problems

1.1.1 From a perspective of regional developmentRoads need to be constructed and maintained for thepurposes of establishing a wide coverage of trans-portation network for agricultural products.1.1.2 From a perspective of promoting agricultureThe agricultural industry accounts for a large percent-age of the country’s GDP at present. In addition tosupporting the industry as a whole, it is important toresolve employment issues resulting from rapid popu-lation growth and ensure the stable transport of agri-cultural products. If these issues are not taken careof, neither assistance to the actual agricultural indus-try nor further agricultural development can beachieved.1.1.3 Controlling the expansion of slums owing to

the influx of people to urban areasIt is possible to drastically curb the influx of peopleto big cities by facilitating employment in rural ar-eas. People living in slums in big cities will also re-turn to rural areas, which prevents slums from ex-panding.

1.2 Approach to technology development

1.2.1 Socio-economic researchSocio-economic research includes surveying the em-ployment rate and the mobility rate among residents,examining the impact of the project in question bycomparing the results of implementing the project isimplemented and those of not implementing theproject (the so-called do or do-nothing research), es-timating the future demand for roads, examining therelationship between road construction and regionaldevelopment, and analyzing the road network.1.2.2 Examining engineering and technology

developmentThe Kenyan government opened a vocational train-ing center and began providing vocational training tocommunity representatives and engineers. However,little has been done with regard to technology devel-opment. It is necessary to conduct an engineeringevaluation of the traditional methods that utilize trac-tors and manual labor, and also an evaluation of opti-mum construction methods taking into account dif-ferent soil types.1.2.3 Finding the most suitable construction

technology and method by regionIt is necessary to elaborate an implementation planbased on the most suitable construction technologyand method for different soil types by region andseason (heavy rainy season, light rainy season, dryseason, and regions with extremely high instabilityclay formation).1.2.4 Management developmentIt is necessary to organize and develop local commu-nity in rural areas and slums. To achieve this perti-nent management and education should be estab-lished.

Conclusion

In both industrial and developing countries, heavyequipment has been used in road construction. Onealways conjures up an image of heavy-duty equip-ment whenever one hears the word “construction.”The roads in this project are unpaved access roadsthat connect villages to primary roads. In rural areasof Africa, there aren’t any roads that are passable bytrucks, and the term “revitalization of rural areas”has already begun to disappear. The LBT describedin this article applies traditional methods using trac-tors and manual labor. It is very simple and yet pro-duces tremendous results from minimal input. LBT


70

can be made more rational if incorporated with themanagement technology that has been developed, andif each traditional method involved in LBT were ra-tionalized as well. Organizing the community con-cerned is also essential for the rationalization of LBT.

At present, Jomo Kenyatta University of Agricul-ture and Technology is conducting research on thesoil properties particular to Africa, namely, black cot-ton soil and red coffee soil. These soils present themost difficult technical problem to LBT. In the past,this problem has been primarily dealt with by intro-ducing different types of soil during the construction.The author believes that the results of this researchwill lead to improvements in construction methodsin the future.

There will be many counter-arguments and objec-tions to the issues discussed in this article. In humanhistory, whenever a new idea or method is presented,there have always been doubts and anxiety. It is ex-tremely important for developing countries to con-tinue their efforts to improve construction methodsand overcome limitations. This is not a problem par-

ticular to international cooperation or economic as-sistance, but is a technological challenge that will leadto a new era. This article presented new approachesand issues that need to be addressed. During thecourse of collecting the data for this article, the au-thor often encountered fragmented official publica-tions, documents in unreadable condition, economicanalysis formulas that had no grounds, wrongly-statedconstruction costs, and disparities between reports andwhat had actually taken place at the construction site.In the future, it is necessary to conduct an economicand technological analysis of regional communities,and examine ways to take the research results andput them to practical use in solving actual problems.The author sincerely hopes that this article will beused as a reference in establishing new methods inthe future.

Reference1. Training Elements and Technical Guide for Spe-

cial Public Works Program, Booklet 1 (ILO 1993).

71

Globalization and Environmental Issues for SustainableDevelopment in Developing Countries

NOTE


Takashi HAYASEProfessor

Faculty of Environmental Studies, Nagasaki University

Introduction

In examining many types and conditions of humanactivity in relation to the problems which arise in theefforts toward sustainable development, it is usefulto plot their positions on an axis of coordinates. Forexample, if you plot the activities of various partiesor individuals on an axis, it is possible to see the re-lationships between their activities, and the restric-tions and conditions posed by other activities. Thus,we are better able to inquire into ways of evaluatingand improving the human activities affecting variousissues such as problems with the environment. Tograsp the structure of the causes of environmental is-sues, Miyamoto conceived an ordinate of economicsystems, in-between systems and materials.1 He stud-

ies domestic in-between systems, as the most impor-tant factors deciding the environment, and then pro-pounds the necessity of making them environmen-tally friendly.

In this paper, several environmental issues relatedto sustainable development are examined in relationto various systems lying between complex global-scale society and individual activities, by drawingexamples from Indonesia. In the course of the ex-amination the focus is placed on the basic relation toissues posed by the entire global community, whichare beyond the scope of individual developing coun-tries and domestic socio-economic systems. Theseglobal-scale issues, which are influenced by othercountries, can be considered in the context where theyare interacting with their domestic systems or directly

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu Vol. 15, No.1 (April 1999).1. Miyamaoto, K. Kankyokeizaigaku (Environment Economics) (Tokyo: Iwanamishoten, 1989) pp.47-48.

The author attempts to understand the environmental issues in developing countries undertaking sustain-able development and their relationships with globalization by drawing on Indonesia’s experience. Theauthor finds that there are four types of environmental problems which arise as internationalization andglobalization proceed: industrial pollution associated with expanding developed-country-type industrial-ization through direct investment (Type1); increased population density and worsening living conditionsin urban areas (Type 2); destruction of the natural environment and resources caused by gaps between theinternational economy and that of the individual developing country (Type 3); and disruption of localcommunities and worsening of the environment in rural areas (Type 4). The author examines how these environmental problems relate to the internal socio-economic systemsof developing countries, drawing on the case of Indonesia. The internal systems include; 1) industrial andregional structures; 2) transportation and energy systems; 3) ways of living; 4) systems of science, technol-ogy and education; and 5) government policy and administration. The author then considers whether ornot, and to what extent, the four types of environmental problems can be resolved by improving internalsystems. Those that cannot are accepted as beyond the capabilities of the individual developing countriesand therefore need to be regarded as issues of the entire global community. Finally, based on this analysis, the author proposes several considerations that need to be given inextending international assistance, based on the characteristics of each type of environmental problem.Specifically, for problems which belong to Type1, it is vital to fully understand our own experience withpollution and utilize what we have already learned within the framework of conventional environmentalassistance projects to benefit those who are coming after us. As for problems in Type 3 and 4, it is neces-sary to take measures to reduce the gaps in economic opportunities between urban and rural areas not onlywithin environmental assistance projects, but also within every economic assistance project. As to prob-lems of Type 2 and 4, it is important to implement cooperation in the areas of science, technology andenvironmental education. It is essential to take steps to include people from more regions in the planningand implementation process of sustainable development.


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playing as major factors in environmental destruc-tion. The domestic socio-economic structure, or theinternal system, exhibits characteristics of the nationalsystem, and is intrinsically related to that nation’scharacter, its realization of sustainable development,and the environmental destruction it suffers.

In the main subject, environmental issues and prob-lems related to sustainable development in develop-ing countries are sorted in relation to global issues,and the possibilities and bottlenecks are anticipatedwhen these countries try to take action with existinginternal systems to cope with those issues and prob-lems. Finally, the international development assis-tance projects which will be carried out to supportthe sustainable development of developing countriesare studied.

I Global Factors and Environmental Issuesin Developing Countries

In the last few decades, the global scale of develop-ments in fields like economy, society, politics, cul-ture, and technology has been remarkable. The glo-bal factor, which should first be considered with re-gard to environmental issues is globalization takingplace through internationalization. Giddens has statedthat globalization occurs when the different links in achain, for example political, economic and social ac-tivities, expand to global size and their mutual ac-tions and levels increase and diversify among and invarious countries and systems.2 Also, Robertsonwrites that the world’s tendency toward unificationis unstoppable.3 If the tendency toward globaliza-tion is so firm, then we need to make the repercus-sions known and look into the many issues affectingdevelopment and the environment.

Free trade brings products manufactured by ad-vanced technology overseas into developing coun-tries, and new industries and production technologyfollow as direct investment or technical assistance.They stimulate the flow of people and money, andrevitalize the mutual influence of culture and infor-mation. This kind of action in developing countriesdoes not happen uniformly. It creates gaps betweendifferent areas within a country and causes stress be-tween local communities. In other words, when thesituation in a particular area begins to change, therelationship between areas starts changing. The con-sequences of internationalization lead to the imbal-ance between areas, and the energy for initiating so-cial changes. Issues of differentiation (such as dis-parities and polarization) between metropolitan or bigcities, which are the front line and window into inter-nationalization, and remote rural areas are also com-prehended in the context of social energy resulting

from globalization through internationalization.In Indonesia, the flow of people, goods, and money

taken as a central part of direct investment, trade andcommerce, economic assistance, and technical assis-tance from abroad is becoming increasingly moreactive. The global factors that should be studied arethe conditions which are imposed by other countries,such as investment, and the global flow of people andmoney related to them. Besides, there are some phe-nomena surging in a world wide trend, which are morethan given conditional factors and should be consid-ered as global issue. In Indonesia these issues havecome unavoidable when the country examines indus-trialization and urbanization backed by science andtechnology advancement.

Internationalization is progressing with a two-sidedlogic of industrial promotion and development for theeradication of poverty. One side is built on the ideathat the acceleration of development to gain benefitfrom industry, especially from manufacturing is theonly effective way to save the people at the bottomof the social scale. The other side gives priority toinvestors and industries to pursue profit. Althoughpoverty eradication is the pretext given by develop-ing countries for industrial promotion, this kind ofindustrial promotion and development can not play afull role in eradicating poverty, because the indus-trial advancement of this kind can not fill the gapbetween the two sides. As a response to internation-alization, many socio-economic issues are causingdifficulties for sustainable development.

There are four relationships between globalizationthrough internationalization, and environmental is-sues and problems related to sustainable development.

1. Industrial Pollution Associated withExpanding Developed-Country-TypeIndustrialization through Direct Investment,Etc.

Industries and technologies newly brought in fromabroad, because of cheap labor in the developingcountries, often cause environmental problems be-cause there are insufficient measures for protectingthe environment. Another reason is that developingcountries are sometimes indecisive about implement-ing strict environmental regulations as they are seek-ing to promote direct investment. This kind of issueis often raised concerning actual water pollution,which mainly threatens the poor in urban areas whohave benefited from clean and safe water for living.In suburban areas, not only is there damage to drink-ing water, but there is also water pollution in tradi-tional industries such as agriculture and fish-farm-ing, which causes friction and confrontation betweenthe secondary industries newly brought in throughinternationalization and these traditional industries.

2. Taguchi, F., and K. Suzuki, Grobarizeshon to Kokuminnkokka (Globalization and Nation States) (Tokyo: Aokishoten, 1997) p.16.3. Robertson, R., Globalization (Japanese edition) (Tokyo: Tokyoudaigaku Shuppankai, 1997) p.15.

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With regard to issues of pollution generated on theside of incoming industries, there are two possiblereasons. One is that they have little understanding ofthe necessity for having concern for the environmentand for sufficiently investing in environmental pro-tection utilities. The other is that, even though theyrecognize this, they still make little of these necessi-ties or have technical difficulties in the process ofoperation control. These new industries, brought inbecause of cheap labor, often have keen competitionin the global market, and their severe competitiveconditions are often followed by pollution and a wors-ening of environmental resources.

2. Increased Population Density and WorseningLiving Conditions in Urban Areas

Internationalization brings urban centralization of thepopulation. One reason why this happens is the bigeconomic gap that exists between the global marketand the domestic market. In both industrial and de-veloping countries, the domestic economy and theinternational economy interact. This interaction re-sults in various issues,4 particularly in the develop-ing countries. In developing countries in rural areasaway from cities, the limited food production in thevillage unit spontaneously controls the size of thepopulation by forcing people’s migration when theyget overpopulated. As internationalization and popu-lation mobility increases, those people choose to livein the cities, which is the window to the internationaleconomy. Also, information and culture from abroadnot only increases the desire to live in the city, butalso depreciates the meaning of the existence andnecessity of a close traditional community.

The concentration of population in urban areas iscausing serious environmental issues associated withpoverty and the changing mode of life. This is seenin the sudden increased population in Jakarta, whichincreases by 200,000 people a year, about the sameas the population of local core cities in Japan. As aconsequence of this rapid growth, many slums havesprung up, resulting in very poor living environments.In addition, the basic infrastructure for city life suchas water supply and sewage systems, transportation,electricity, and telephone-lines cannot keep up withthe speed of the city’s growth. Water treatment plantsare even moved away by expanding cities upstreamlooking for cleaner sources.

As internationalization progresses, foreign ex-change rates fluctuate, competition for jobs becomesgreater, and the issues of poverty in cities are affected.Poverty spurs degradation in livelihood and economicprovisioning of the poor people living in urban cit-ies, marginalizing them from a city life benefited bybasic urban infrastructure. In addition poverty itselfbecomes one of the factors that impede basic social

infrastructure development to ease the environmen-tal issues.

Although Western culture and lifestyles, includingthe production and consumption patterns of indus-trial countries, have a positive effect, they change themode of life in the cities and throw a shadow overenvironmental issues such as the vastly increasednumbers of cars on the streets. Moreover, most ofthese cars are old-fashioned or not maintained wellenough, emitting a large amount of exhaust. In addi-tion, the popularization of plastic products worksagainst natural material circulation, and is a negativefactor in keeping cities clean.

3. Destruction of the Natural Environment andResources Caused by Gaps between theInternational and the Domestic Economy

When industrial activity based on the global economyappears in a local economy that depends mainly onbarter or hunting, the shock is quite big. Associatedwith the imbalance of power between the two kindsof economies, a lot of natural environmental resourcesare being lost. Natural beaches are being handed totourist developers, and suburban farms to develop-ers. Richly blessed mineral resources are being ex-ported abroad, and not aiding domestic industrial pro-duction or people’s income enough, only resulting inserious damage to the environment. The tropical rainforest is being cut down to produce marketable cropssuch as palm oil and rubber for export. Soerjani re-ports that the huge recent forest fire in EastKalimantan was caused by the clearing of the forestto plant trees to produce palm oil, etc.5

4. Disruption of Local Communities andWorsening of the Environment in Rural Areas

The community of developing countries was a closedsociety where the life was based on a natural circula-tion mechanism. Daily life basically depended onthe traditional cycle of material within the family unitand villages through strong connections with nature,such as direct use of river-water and restoration ofwaste to the soil. However, as has already been statedas a factor in the increase in population, internation-alization is threatening the existence of village com-munities in rural areas, and is becoming one of thefactors in their disintegration and transfiguration.

There are more choices in ways of living, for ex-ample, living in the city where there are more em-ployment opportunities and a better quality of life,and there are changes to the old type of agriculturalproduction in suburban areas through improved agri-cultural chemicals and machines. Incidentally, thenumber of agricultural tractors used in Indonesia in1985 was just over 12,000, which by 1994 had in-creased to over 55,600, more than 4.6 times.6 Also,

4. World Economic Forum, Global Competitiveness Report (1996).5. Soerjani, M., Environmental Degradation as Related to Human Behaviour and Activities: A Case of Indonesia, Approaching the Globalization Era (1998).6. United Nations, Statistical Yearbook for Asia and the Pacific (1996).


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the number of farmers who do not own their own landis increasing. The number of farms with less than0.2 hectares was 9,530,000 in 1983 and had increasedto 10,380,000 by 1993. 7 Community regulations invillages started changing, and important commonproperty controlled by regulations, like the water en-vironment, the water utilization system, and farmland,were removed. Sometimes the appearance of an al-ternative water supply system backed by foreign capi-tal investment and technology, makes these traditionalsystems redundant and they collapse.

II Environmental Issues and the InternalSystems of Developing Countries

As an externally imposed conditional factor, global-ization taking place with internationalization is ex-amined in relation to the four types of environmentalissues and problems mentioned previously. In thissection, by examining these four issues in relation tothe internal systems, the issues and problems whichcan be solved by making improvements or by mak-ing the best use of the internal systems will be arguedseparately from the issues and problems which havearisen purely from global conditions coming fromabroad. Through this sorting process, it is possible tograsp the situation in developing countries and find away to resolve environmental issues by improvingtheir internal systems.

With regard to internal socio-economic structure,Miyamoto proposes six kinds of ‘in-between sys-tems’: capital accumulation structure, industrial struc-ture, regional spatial structure, transportation, way ofliving, and government.8 In developing countries,the fact that the relation between scientific technol-ogy and people’s lives has strong links, for good orbad, with environmental issues cannot be ignored. Thecases in Indonesia, therefore, are examined accord-ing to the following five systems: (1) industrial struc-ture and regional structure, (2) transportation and en-ergy systems, (3) way of living, (4) systems of sci-ence, technology, and education, and (5) governmentpolicy and administration.

1. Industrial Pollution Associated with ExpandingDeveloped-Country-Type Industrializationthrough Direct Investment, Etc.

Industrial pollution has become a serious problemin developing countries associated with developed-country-type industrialization, which has expandedthrough foreign direct investment. For environmen-tal pollution, compared with consumer issues, it isrelatively much easier to find a solution by improv-ing internal systems. Regarding “industrial and re-gional structures,” it is necessary to plan regional spa-

tial arrangements of industrial land and residentialareas. With regard to “government policy and ad-ministration,” enacting and implementing regulationsto effectively control the pollutants discharged andtransferred out of industrial activities is helpful toresolving environmental issues.

Moreover, it is important to suitably prepare basicinfrastructure. However, it should be pointed out thatincreasing non-governmental investment from abroadsometimes becomes a negative factor in appropriatelyproviding basic infrastructure such as waterworks andsewage because it results in an investment imbalancebetween the private and public sectors. This suggeststhat the delay in constructing basic infrastructure can-not simply be due to internal systems.

With respect to “transportation and energy sys-tems,” it is extremely important to improve the pricesystem to save energy and resources. Negative effectsof subsidies in this field also need to be solved. Toprevent industrial pollution, transferring experienceand skills from industrial countries to developingcountries is advisable. From a larger perspective, therole of “science, technology, and education” in fos-tering better relations between society and industryis irreplaceable.

These issues are a result of the increasing mobilityof people, goods, and money as internationalizationproceeds. Because of the characteristics of these is-sues, many of them could be dealt with by improvinginternal systems. There is plenty of room for this. Itis also necessary to take notice of the increasing up-ward mobility and inflow of foreign investment. Theincreased mobility accompanies the influx of globalstandard-products or global standard-culture, whichoften ignores the regional characteristics of the origi-nal culture, while the unbalanced investment in theprivate and public sectors impedes the constructionof the basic infrastructure development necessary forthe prevention of pollution.

2. Increased Population Density and WorseningLiving Conditions in Urban Areas

Many kinds of distortion, such as gaps between theglobal and domestic economies resulting from inter-nationalization, lead to increased population densityin urban areas and deteriorate the living environment.To seriously address this issue, it is critical to makepolicy redress the gap between urban and rural areasin economic opportunities, and not to have counter-measures such as policies that promote migration toremote islands. For example, if additional value wasput on primary industrial products from farming andfishing villages for the global market, this would con-tribute greatly to returning profits to local areas. Thiswould be more effective than trying to push the peoplein the cities back to rural areas through incentives. In

7. State Ministry for Environment, Agenda 21 Indonesia: A National Strategy for Sustainable Development (Jakarta: 1997) p.333.8. Miyamoto, op. cit.

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the case of Indonesia, even when people were movedto rural areas, ironically, more environmental prob-lems, such as further destruction of the forest, werecreated.

With regard to the tapioca industry, Soerjani sug-gests that the value added profits gained from pro-cessing cassava to produce tapioca as an export prod-uct, should be returned to the farmers. In other words,he believes that it is necessary to improve “industrialand regional structures” to rectify the profit-monopo-lizing mechanism controlled by the capital from theurban areas, and from abroad.

Air pollution, water pollution and contamination,and waste pollution are major environmental prob-lems affecting people’s lives and living conditions inurban areas. With regard to air pollution, measures toregulate “transportation and energy systems” shouldbe taken. The extreme dependence on cars for trans-portation needs to be rectified through the develop-ment of alternative mass transportation systems. Also,measures related to energy should be taken; for ex-ample, constructing a supply system for lead-freegasoline. To address waste and water pollution, thegovernment needs to promote a policy for construct-ing sewage and waste disposal systems, and otherinfrastructure through “government policy and admin-istration.”

In terms of lifestyle, it is essential not to accept tooeasily a global standard, but to pursue a lifestyle suit-able to the tropical climate and regional characteris-tics in order to reduce the impact of the changedlifestyle on the environment. To actualize these mea-sures and call attention to concerns about the envi-ronment, disseminating information, such as accurateinformation about environmental pollution in the ur-ban areas, through “system of science, technology,and education” is essential.

Even after carrying out these measures, it wouldstill be quite difficult to resolve all of the conditionsresulting from globalization, namely, unbalanced in-vestment in the private and public sectors, and de-struction of traditional material cycles by bringing innew materials. It is also not clear how much, regard-ing issues such as the gaps between the rich and thepoor and between urban and rural areas, can be re-solved by improving internal systems.

3. Destruction of the Environment and NaturalResources Resulting from Gaps between theInternational and the Domestic Economy

Destruction of the environment and natural resourcesis brought about by many kinds of distortion betweenthe international economy and domestic economy. Tosolve this problem, it is necessary to correct the gapin economic opportunities between urban and ruralareas. Through “government policy and administra-tion,” it is important to expand the participation oflocal communities and citizens, which is extremelylimited with regard to development planning and de-

cision-making processes, in projects. It is also nec-essary to make good use of tax systems to contributeto mitigating and eliminating poverty.

Correcting the gap between urban and rural areascould be achieved by increasing value added produc-tion in the output of natural resources such as miner-als and timber, while alleviating the pressures to thenational land, and by returning profits to citizensthrough the country’s macro-economic policies likeimproving tax systems,.

Before this can happen, through “system of sci-ence, technology, and education,” it is essential to ex-amine the value and functions of the ecological sys-tem and internalize the economical value as much aspossible. Even in a difficult case, at least it is neces-sary to make all the actors understand ecological valueand functions. It is necessary to build an internation-ally common understanding of the function and valueof the natural ecological system, and to prepare anyagreements or regulations which will lead the way tocorrecting the many distortions existing between theinternational economy and domestic economies.

4. Disruption of Local Communities andWorsening of the Environment in Rural Areas

Disruption of local communities and the worseningof the environment in rural areas result from manykinds of distortion existing between the internationaland domestic economy, and the increases in the flowof people, money, and goods.

The following approaches are expected to be takenwithin the internal systems: First, through a “systemof science, technology and education” it is possibleto get people aware of the environmental issues ofthe urban areas. It is also possible to pursue the origi-nal life style that is not a global standard, respectingregional characteristics through the ways of living.

Through “government and administration,” it isnecessary to establish new decision-making systemsthat reflect the opinions of the people or communi-ties concerned. Also, through “industrial and regionalstructures,” it is necessary to implement policies, asmentioned in the example of cassava, to correct thegaps in economic opportunities between urban andrural areas. Policies on financial support such as softloan programs need to be improved. Even if thesemeasures are enacted, it is questionable how muchmitigation and control they will have on the economicgap and the flow of people and goods resulting fromglobalization.

Conclusion

In conclusion, I would like to mention how interna-tional assistance should support sustainable develop-ment in developing countries. The figure shows therelation between four types of environmental issuesand the economic gaps, and flow of people, money,and goods which have come about through global-


76

ization; these factors cannot be coped with by inter-nal systems alone. The four types of environmentalissues are placed on the horizontal plane, which rep-resents the gaps between the international economyand those of developing countries, and on the verti-cal axis, which demonstrate the complexity and thevarieties of groups concerned. These complexity anddiversity represents one aspect of the developmentaccompanied by the increased flow of people, money,and goods.

The right side of the figure holds issues of urbanareas which have close contact with the internationaleconomy, the upper part of the figure holds the issueswhich still have weak infiltration among the socialgroups. In other words, the horizontal axis showsthe movement of the energy caused by economic gapstoward the left side of the figure, and the vertical axisshows the depth of issues concerning the mobility ofpeople and goods toward the lower part of the figure.As globalization progresses in developing countries,with the energy coming from the economic gaps andthe power of mobility from outside the country, envi-ronmental issues will occur by the factors shown inthe upper right side of the figure, and then expand tothe lower and the left, involving a wider range of ar-eas in the developing country.

The problems of type 1 have a relatively simplestructure, so it is possible to cope by expanding andenforcing laws and regulations, or by bringing in ex-perience from industrial countries. However, in the

problems of type 2 and 4 are derived from the diver-sified groups concerned and their activities widelyextended in the society. The problem is deeply-rootedin society and is affected by people’s way of livingand receptivity of science and technology. It will bequite difficult to find a solution unless a wide rangeof groups participate. Type 3 and 4 problems, whichhave resulted from gaps with the internationaleconomy, cannot be avoided by developing countriesuntil they become developed, and so, are basicallyunsolvable even though internal systems can mitigatethe problems to some extent.

To extend international assistance, it is necessaryto understand the nature of these 4 types of issues.For the problems which belong to type 1, it is vital tofully understand and utilize our own experiences withpollution in the framework of conventional environ-mental assistance projects to benefit those whosecountries are currently embarking for development.“Full understanding” mentioned above means digest-ing the actual situation in developing countries andthe progress of time, and also realizing that cleaner-production technology is preferable to the end-of pipetechnology mainly used for measures against pollu-tion in Japanese experience. As for type 3 and 4 prob-lems, it is necessary to take measures to reduce thegaps in economic opportunities between urban andrural areas, not only within environmental assistanceprojects, but also within every economic assistanceproject. As to type 2 and 4 problems, it is essential to

Figure Composition of Environmrntal Issues Caused by Globalization

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implement cooperation in the areas of education andenvironmental education from a long-term point ofview. Furthermore it is vital to support the introduc-tion of the democratic decision making process, andto take steps to include people from more regions inthe planning and implementation processes of sus-tainable development. Once these changes have beenachieved, the direction for creating a lifestyle suit-able to the regional characteristics and improving thelife in fishing and farming villages will be found.

ReferenceNihon Kankyo Kaigi (ed.), Ajia Kankyo Hakusho

1997/98 (Asian Environment White Book), (Tokyo:Toyokeizai Shinposha, 1997).

Soerjani, M., An Overview of the National Planning

for Sustainable Development in Indonesia DonorCoordination and Harmonization, Workshop onNational Planning for Sustainable Development(Paris: OECD-DAC, 1995).

Ueda, K. “Sustainable Development and InternationalEnvironmental Policy,” K. Ueda et al.,

Kankyokeizaigaku (Environment Economics) ,Yuhikaku Books (Yuhikaku, 1991).

World Bank, Indonesia: Energy and Environment(1993).

Yatsu, R., K. Hayase, and M. Iwata, “Jizoku kanonakaihatsunimuketa wagakunino kankyo-kyoryoknsituiteno kousatsu (A study on Japan’s environ-mental cooperation for sustainable development),”Kokusai Kyoryoku Kenkyu 11(2) (Tokyo: JICA,1995): 89-97.


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79

SPECIAL REPORT : Post-Conflict

SPECIAL REPORT

Post-Conflict― A Gap between Emergency Assistance and Long-term

Development Assistance in the Post-Conflict Period ―

Post-Conflict and Development Study Group, JICA(Edited by Hiroto Mitsugi, Planning Division, Planning Department, JICA)

Introduction

Since the Cold War ended, there have been ongoinglocal conflicts such as the Gulf War, the civil war inRwanda, and the ethnic cleansing in Bosnia andHerzegovina. These regional disputes have drawnworldwide attention not only as diplomatic problems,but also as challenges to development assistance.Development assistance in the post-conflict periodincludes removing land mines, giving relief to landmine victims, and supporting the countries in formu-lating restoration plans. The Japan International Co-operation Agency (JICA) has also strengthened itsinvolvement in this regard.

As assistance by the international community hasbegun to produce outcomes, various international or-ganizations such as the Development Assistance Com-mittee (DAC) of the Organization for Economic Co-operation and Development (OECD) have started dis-cussions on how to establish concepts and institutionsthat direct overall process of the post-conflict period,prevention of new conflicts (preventing reoccurrenceand creating peace), and embarkation for develop-ment. On January 15, 1999, the Brookings Institu-tion of the United States held an unofficial meetingon humanitarian aid and post-conflict development.This meeting was attended by the heads of many in-ternational organizations, including James D.Wolfensohn, President of the World Bank, and SadakoOgata, High Commissioner of the United NationsCommissioner for Refugees (UNHCR).

Following from this, this report is aimed at ana-lyzing the current situation facing post-conflict as-sistance, and determining the right path for such fu-ture assistance.

I The Gap between Emergency Assistance andLong-Term Development Assistance in thePost-Conflict Period

1. Changes in Characteristics of ConflictsDuring the Cold War, there were two kinds of con-flicts: 1) conflict that caused tension between theSoviet Union and the United States and could havepotentially triggered the outbreak of a third world war,and 2) conflict that was confined within a particularregion. The latter type of conflict was called a localconflict, and this term did not include disputes inEurope, which was then considered the Cold Warfront-line, or disputes in which both the Soviet Unionand the United States were deeply involved, such asthe Cuban Missile Crisis in 1962.

As the possibility of a third world war decreasedwith the end of the Cold War, it can be said that thepresent conflicts in the world all became local con-flicts. However, even though the Cold War has offi-cially ended between the Super Powers, the Cold Warmentality still remains and disputes among them arenot called local conflicts. The term still only refers todisputes and confrontations within a country or amongnations in the Third World.

Conflicts in the Third World, namely in devel-oping countries, not only have an impact on the coun-tries involved in the conflict, but also have an impacton donor countries.Some of the impacts on the countries include:a) Conflicts often involving armed clashes that ulti-

mately cost the lives of many citizens.b) Armed clashes cause chaos in the political system,

and disrupt the socioeconomic infrastructure of thecountries involved coupled with attrition and geno-cide.

c) Destruction and killing destroy the everyday livesof citizens, threaten political, economic and social

* This article was first published in Japanese in Kokusai Kyoryoku Kenkyu, Vol. 15, No. 1 (April 1999).


80

stabilities, and displace people and cause them toflee, resulting in large-scale refugee problems.1

The impact on donor countries includes:a) Humanitarian aid for refugees and displaced people

is necessary. In particular, there is a high demandfor emergency aid during and immediately after aconflict.

b) Before the situation finally stabilizes after a con-flict ends, animosity remains among those directlyinvolved in the conflict, and public security is pre-carious. Therefore, it is important to ensure thesafety of aid personnel.

c) In a post-conflict period, development assistanceis needed to restore political, economic, and socialsystems.

d) Support for peace-keeping advocacy so that theconflict does not reoccur and to establish a demo-cratic system and good governance to strengthenthe basis for international cooperation toward peaceis necessary.

2. Existence of RefugeesAs mentioned previously, conflicts produce refugees,which increases the need for emergency assistance.According to the UNHCR, it extends protection andaid to more than 2.2 million people who have suf-fered because of war and persecution. The number ofuprooted people, including those who are displacedinternally, amounts to 50 million worldwide. This

means that one in every 120 people is forced to takeshelter (Table 1).Table 2 shows the top five countries that either shel-ter or produce refugees.

3. The Gap between Emergency Assistance andLong-Term Development Assistance

Assistance in the post-conflict period includes hu-manitarian aid to refugees, support for restoring thepolitical, economic, and social systems of the coun-tries concerned, and assistance for preventing the re-occurrence of conflicts. However, the question iswhether this assistance can be implemented smoothly.This issue has been raised, as explained in the intro-duction of this report. The Brookings Institution andthe UNHCR have the following views with regardsto this issue.

The Brookings Institution believes that there is agap between emergency assistance and long-term de-velopment assistance in the post-conflict period. Un-der the current assistance system, neither bilateral normultilateral mechanisms for narrowing the gap exist.The reason is that there is a lack of political assis-tance toward peace activities. To narrow the gap, it isnecessary to identify the political and economic fac-tors contributing to the situation, and to establish aframework for international cooperation.

In 1992, Ms. Ogata of the UNHCR made the fol-lowing comment concerning the gap between emer-

Table 2 The Number of Refugeees by Country

Host Country1. Iran(2.0 million )

2. Germany(1.3 million)

3. Pakistan(1.2 million)

4. United States(0.6 million)

5. Yugoslavia(0.55 million)

Country of Origin1. Afghanistan(2.7 million )

2. Bosnia andHerzegovina

(0.7 million)

3. Iraq(0.63 million)

4. Liberia(0.48 million)

5. Somalia(0.45 million)

InternallyDisplaced People

1. Sierra Leone(1.5 million )

2. Liberia(0.97 million)

3. Bosnia andHerzegovina

(0.8 million)

1. A refugee is a person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social groupor political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country;or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, isunwilling to return to it.”(Convention Relating to the Status of Refugees, 1951)

Table 1 The Number of Refugees by Region

Region Refugees (person) Returnees (person) Others (person) Internally DisplacedPeople (person) Total (person)

Africa

Asia

Europe

Latin America

North America

Oceania

4,341,000

4,809,000

3,166,000

88,000

720,000

75,000

1,693,000

1,241,000

308,000

70,000

―

―

―

156,000

1,209,000

―

―

―

8,091,000

7,925,000

5,749,000

169,000

720,000

75,000

Total 13,200,000 1,365,000 22,729,000

2,058,000

1,719,000

1,066,000

11,000

―

―

4,854,000

Source : Created from Reference(1).Note : Because of rounding off, flgures shown in the total do not necessarily match the sum.

81


gency assistance and long-term development assis-tance:“I would like to touch upon one issue in which we allare interested, that is, how to build a bridge betweenemergency assistance and development. After urgentconcerns are taken care of, it is necessary for the tran-sition from emergency assistance to development as-sistance to be carried out smoothly. One recent ex-ample is Northern Iraq. … [T]his issue is important,especially in the context of facilitating voluntary re-patriation among refugees. There are increasing op-portunities for refugees to return to their homelands.However, their countries remain devastated as a re-sult of longtime conflicts, and are in desperate needof comprehensive assistance for restoring their na-tions. However, if we look into this problem further,it is apparent that there is an institutional gap betweenemergency assistance and development assistance.Roles and responsibilities of international organiza-tions lack a continuum.”2

II Post-Conflict Phases and MajorDonors in Assistance

This section is aimed at analyzing how internationalassistance organizations tackle the issue of smoothand continuous transition from humanitarian aid todevelopment assistance, using the World Bank as anexample.

In “A Framework for World Bank Involvementin Post-Conflict Reconstruction,” which was com-piled for its staff in April 1997, the World Bank sum-marizes the relationships between conflict and devel-opment assistance, and the World Bank’s role in post-conflict assistance as shown in Table 3 and Table 4.

As indicated in Table 3, the World Bank clearly

intends to confine itself to intervening to prevent con-flicts and to analyzing and monitoring the state ofaffairs before and during the conflict. It is notewor-thy that the World Bank begins preparations in theearly stages of a conflict so that it can resume assis-tance immediately after the conflict is over.

Table 4 shows the responsibilities assumed by theWorld Bank, donor countries, and other assistanceorganizations [UN, European Union (EU), North At-lantic Treaty Organization (NATO), and non-govern-mental organizations (NGOs)]. It is clearly indicatedthat the World Bank will not engage itself in emer-gency assistance during a conflict.

As to Japan’s humanitarian aid, JICA categorizedemergency aid and development assistance, as shownin Table5, in the course of examining possibilities ofits involvement in land mine issues.

1. Coping with the Gap between EmergencyAssistance and Long-Term DevelopmentAssistance in the Post-Conflict Period

Based on the experience and example of the WorldBank, the UNHCR, and the Japanese government, itis necessary to examine ways to narrow the gap be-tween emergency aid and long-term development as-sistance.

a) Construction of a consensus - What is the gap?

Because there is a variety of organizations and per-sonnel (referred to as actors) involved in emergencyaid and development assistance, it is important toclarify and reach consensus on what the gap is. Tothis end, what follows is a list of the characteristicsand harmful results of the gap which need to be dis-cussed in order for a way to be found to narrow thegap.

Table 3 Conflicts and Development Assistance Cycle of the World Bank

Progress in Time

Sustainabledevelopment

Stagnant and setbacksof development

Vicious cycleof stagnation Return to development phase Sustainable

development

Process ofdevelopment

Increase in violent activities,Failure of crisis management

Vicious cycleof violentactivities,Failure ofpeace moves

Decrease in violent activities,Cease-fire, etc.,Opportunities foroutside intervention

State of affairsin a country

In the processof development Dangerous situation Armed clashes Post-coflict period Resumption of

development

Programs ofthe WorldBank

Regularoperation

1) Intervention that does notworsen the conflict,

2) Coordination of interventionto correct unfair incomedistribution and to supportmarginalized groups

1) Analysis and monitoring of the state of affairs2) Preparation of strategies to support transitions3) Reconstruction assistance in the early stages of

transition4) Reconstruction assistance in the post-conflict

period5) Recovery of regular operation

Regularoperation

2. Statement by the UNHCR at the Board of Directors meeting of UNICEF in 1992.


82

(1) Problems such as shortages in funds, personneland goods, which arise if assistance organiza-tions such as the UNHCR and NGOs have toextend humanitarian aid and emergency assis-tance for a longer period of time than antici-pated.

(2) The lack of coordination and decision-makingmechanisms that include all actors who provideassistance, and the accompanying challengessuch as the time wasted and the incentives lost.

(3) Functional vulnerabilities existed in the orga-nizations involved in sharing responsibilities,reaching consensus to create a shared recon-

struction plan, and monitoring the developmentof the shared plan, and the accompanying chal-lenges such as the time wasted and the incen-tives lost.

(4) Difficulties of understanding the real needs ofrefugees, and the lack of ownership on the partof recipient countries.

(5) Needs for healing the trauma of the parties con-cerned (emotional conflicts, fear of death, lossof assets, and dispersion of families), by ex-tending period of time before a reconstructionplan can be implemented.

Table 4 Role of the World Bank and Other Organizations

Policies & Diplomacy

(Crisis Management,Resolution, and prevention)

Security

(Prevention of violence, andpeacekeeping activitiesthat enable rehabilitation)

Emergency Assistance

(Maintenance of basicgoods, and human and socialcapital)

Reconstruction

(Reconstruction of nationaland economic assets, andrestoration of institutionalcapability)

Donorcountry

Bilateral/multilateral(Regional grouping likeOSCE)

Peacekeeping forceUtilization of armed forcesthrough UN & NGOs

Bilateral aid and assistancethrough aid agencies

UN UN Security Council Peacekeeping force UN organizations UN organizations

EUEuropean Commission,European Parliament

ObserverOffice of the HumanitarianAffairs of the EuropeanCommission

European Community

NATO Office of the Secretary General Peacekeeping force

NGOsHuman rights, Preventionof conflicts

Independent activities/role asan aid agency of governments,the UN and the EU

IMF Macroeconomic assistance

World BankEconomic impact appraisalof peace plans

Does not extend assistancebut monitors conditions dur-ing a conflict or while finan-cial assistance is discontinued

Flexibly extends financialand non-financial assistanceto resume regular operation

Independent activities/role asan aid agency of governments,the UN and the EU

Note : OSCE : Organization for Security and Co-operation in EuropeUN Organizations : Office for the Coordination of Humanitarian Affairs (OCHA), the UNHCR, the United NationsChildren’s Fund (UNICEF), etc.; IMF : International Monetary Fund

Table 5 Assistance during a Conflict and Development

Progress of Time (1) Emergency periodafter a conflict ends (2) Reconstruction phase (3) Development phase (4) Conflict prevention

phase

Types ofAssistance

Actors

・Emergencymedicalsupport,

・Provision of goodsincluding food, clothing,and medical supplies

・Preparation ofsocioeconomicinfrastructure andservices,

・Development of humancapital,

・Development anddissemination oftechnologies

・Support fordemocratization,

・Governance,・Support for human right,・Elimination of poverty

International organizations,PKO (Japan), NGO (JICAassumes this responsibilityincases where there arerequests from the countriesinvolved or fromneighboring nations.)

International organizations,JICA, NGOs



・Removal of abandonedweapons,

・Preparation of basicinfrastructurefor maintaining lives,

・Vocational training,・Creation of job

opportunities

83


(b) Measures to Narrow the Gap

Based on the above characteristics and accompa-nying challenges, the following is a list of gaps andthe measures to correct each gap.

(1) Narrowing the gap in funds* Coordination and cooperation between the

United Nations, international organizations, andbilateral assistance organizations;

* Creation of a foundation within an internationalframework;

* Facilitating support and awareness toward con-flicts at the global level (financial contributions,etc.);

* Active support for NGOs. (2) Narrowing the time gap

* Strengthening the function and authority of theUNHCR and the United Nations DevelopmentProgramme (UNDP) as a coordinator;

* Clarifying the responsibilities of different typesof assistance and organizations: bilateral andmultilateral assistance, and aid and develop-ment organizations;

* Having on-going dialogues with NGOs in or-der to share information and prioritize.

(3) Narrowing the gap in awareness among the ac-tors

* Sustaining the level of interest in the interna-tional community toward the activities of post-conflict assistance extended by international or-ganizations (such as the UNHCR, two-timewinner of the Nobel peace prize);

* Continuing conflict-prevention efforts, such asdisarmament, through the United Nations.

(4) Narrowing the gap in motivation to reconstruct(refugees and the governments of recipientcountries)

* Restoring the lifeline in the early stages of thepost-conflict period to nurture a desire to re-construct the country;

* Building a democratic foundation, and estab-lishing a government through democratic elec-tion;

* Facilitating the establishment of good gover-nance (legitimacy, responsibility, protection ofhuman rights, decentralization of power, andcivilian control).

Conclusion

The issue of the gap between emergency aid and long-term development assistance is a new problem whichhas emerged as the number of regional conflicts in-creased in the post Cold War era. Donor countriesand assistance organizations have not had enoughexperience with these kinds of conflicts. Differentfrom ordinary development assistance, this type ofassistance is conducted under precarious political,economic, and social circumstances. In addition, refu-gees are under a tremendous amount of emotionalstress. As a result, there are a large number of diffi-culties accompanying this type of assistance. In con-clusion, JICA recognizes the necessity of not onlytackling this new challenge, but also being activelyinvolved in resolving the issue as a forerunner to de-velopment assistance.

Reference1. Refugee No. 2, (1998).

Members of the Post-Conflict and DevelopmentStudy Group, JICAMitsuaki, Kojima

(Managing Director, Planning Department, JICA)Eiji Hashimoto

(Resident Representative of Kenya Office, andformer Director of Planning Division, PlanningDept., JICA)

Yoshinari Oshima(Director of Reformation and Promotion Unit, Gen-eral Affairs Department,, and former Director ofRegion III Division, Planning Dept., JICA)

Ikuhumi Tomimoto(International Cooperation Specialist, JICA)

Hideomi Oi(International Cooperation Specialist, JICA)

Hiroaki Takashima(Deputy Director of Planning Div., Planning Dept.,JICA)

Hiroto Mitsugi(Planning Div., Planning Dept., JICA)


84

During the Cold War, local conflicts were often regarded as secondary disputes. With the end of the Cold War, some localconflicts that were primarily proxy wars between the East and the West came to an end or were scaled back. Although thereare still a small number of classic international conflicts over territory, the number of conflicts within nations has surged andcome to account for the majority of ongoing conflicts.

The following is a list of resolved and ongoing conflicts in the post-Cold War period:

【Asia】*Cambodia: Anti-government movement by the Pol Pot faction. Armed clashes within the coalition government.

**Sri Lanka: Armed Tamil separatist movement**Indonesia: Independence movements in East Timor and Irian Jaya. *Philippines: Peace agreement reached between the government and Moro rebels in 1996.**Myanmar: Democratic movement.**India/Pakistan: Armed clashes due to boundary disputes over Kashmir.**Afghanistan: Ethnic conflicts among different guerrilla groups. Worsening civil war due to the emergence of Talibaan.

【The Middle and Near East】 *Israel: Middle East peace treaty reached. Ongoing clashes with Palestinians.**Egypt: Anti-government movement by Islamic fundamentals (ex. El-Jihad)

*Iraq/Kuwait: Iraqi invasion of Kuwait in 1990. Kuwait liberated by a multinational force in 1991.**Iran: Independence movement by the Democratic Party of Iranian Kurdistan.**Iraq: Independence movement by Kurds against the Iraqi government. Conflicts among different Kurdish groups.**Turkey: Independence movement by the Kurdistan Workers’ Party (cleanup operation carried out by the government in

1995).

【Africa】*Djibouti: Anti-government movement by the Front for the Restoration of Unity and Democracy. Peace agreement reached

in 1994.** Somalia: Country experiencing a state of anarchy. Known as the “Failed Nation.”

*Uganda: Anti-government movement by the Lord’s Resistance Army, a rebel group supported by Sudan.**Rwanda: Conflict between Hutus and Tusis. The International Criminal Tribunal for Rwanda established. Progress of

trials slow.*Mozambique: Civil war ended in 1992. General election held in 1994 under the supervision of the United Nations.*South Africa: Discord within the black community before and after the end of apartheid.*Angola: Civil war ended in 1994. Peace agreement reached between the government and National Union for the Total

Independence of Angola.**Cameroon/Nigeria: Armed clash in 1996 over Bakasi Peninsula, the location of an oil field.**Democratic Republic of the Congo: 30-year-old Mobutu administration overthrown by Kabila and his allies in 1997.**Senegal: Casamance separatist movement.

*Liberia: Civil war between 1989 and 1996. Presidential election held in 1997.**Sierra Leone: Anti-government movement by Revolutionary United Front. Peace agreement in 1996, and a coup d’etat in

1997.**Western Sahara: Polisario Front demanding independence from Morocco.

【Eastern Europe and Central Asia】*Bosnia and Herzegovina: Outbreak of civil war in 1992. Dayton Accord reached in 1995.*Croatia: Ascendancy gained by the Croatioan government over the Republic of Serbia (Kraine).

**Moldova: Clashes between the Moldovan army and the Russian army in 1990. Cease-fire agreement reached in 1995.Conditions still chaotic.

**Georgia: Sporadic violence between Georgian partisans and Abkhazia forces in 1992. Cease-fire was agreed upon in 1994.Situation unresolved.

*Chechnya: Independence declared in 1991. Invasion by Russian forces in 1994. Cease-fire agreed upon in 1996. The issueof independence unresolved.

*Azerbaijan: Discord with Armenia over Nagorno-Karabakh region. Cease-fire agreed upon in 1994.

【Central and South America】*Mexico: Revolt by the revolutionary army against the government in Chiapas and Guerrero, in 1994 and 1996, respec-

tively.*Guatemala: Anti-government movement by the revolutionary army. Peace agreement reached in 1996.

**Colombia: Anti-government movement by left-wing guerrillas.*Ecuador/Peru: Armed conflict between Ecuador and Peru in 1995 over the Condor Mountains, an area abundant in natural

resources.**Peru: Anti-government movement by left-wing guerrillas including the Sendero Luminoso and the Tupac Amaru Revolu-

tionary Movement (MRTA).

【Western Europe】**United Kingdom: Northern Ireland separatist movement. Cease-fire agreed upon in 1994. Terrorist attacks resumed in

1996.**Spain: Basque separatist movement by Euskadi Ta Askarasuna (ETA).

In addition to the above, there are other conflicts such as the issue of North Korea and the China-Taiwan relations. Thereasons behind conflicts are becoming increasingly diverse, ranging from traditional territorial disputes to conflicts based inpolitical, economic, and social factors (ethnicity, culture, social institutions, and religions).

ReferenceExamples of resolved conflicts* and ongoing conflicts**

85

INFORMATION

I Committee on the Country Study for Japan’s Official Development Assistance to the Republic ofPeru

1. Committee Organization

The Committee was organized in April 1996, beingchaired by Prof. Akio Hosono (University ofTsukuba), for the purpose of studying the basic di-rection of Japan’s ODA for the Republic of Peru,which had reached the stage of carrying out economicand social development from a long-term viewpoint,after having taken emergency measures to cope witheconomic and social crisis. The murder of Japaneseexperts from JICA in July 1991 caused the suspen-sion of Japanese cooperation extended in dispatch ofpersonnel. This restricted the access to informationfrom the sites receiving assistance in Peru. Giventhis situation the Committee made a preparatory fieldsurvey in July 1996 in order to obtain the latest infor-mation and conducted a full-scale field survey inOctober of that year. The survey was conducted withthe intention of exchanging views on a broad scalewith the Peruvian government organizations con-cerned and major aid organizations assisting Peru.The steady progress in the study activities was, how-ever, interrupted by the hostage-taking incident at theJapanese Ambassador’s residence in Lima in Decem-ber 1996. As a consequence, it took about two yearsfor the Committee to finish the study and compile areport

The Committee studied the conditions inside andoutside of Peru, Peru’s basic development views, thedevelopment challenges, and the trends in interna-tional assistance to Peru. Based on the study resultsthe Committee made recommendations on Japan’sfuture assistance to Peru.

2. Committee Composition

■ ChairpersonAkio HOSONO

Professor, Institute of Policy and Planning Scien-ces, University of Tsukuba

■ Committee MembersAkira ISHII

Professor, Department of Humanities, Universityof Kochi

Yoshio ONUKIProfessor, in Program in Cultural Anthropology,The University of Tokyo

Shigeo OSONOIProfessor, Faculty of Foreign Studies, NanzanUniversity

Mitsuhiro KAGAMIDirector, Development Studies Department,Institute of Developing Economies

Yasuo SAITOChief, Department of International Studies andCooperation, National Institute for EducationalResearch

Takashi NAKAMURADirector, Third Division, Operation DepartmentIII, Overseas Economic Cooperation Fund

Yukio NOGUCHIDirector, Second Regional Division, PlanningDepartment, JICA

Kenji HAYASHIDirector, Department of Demography and HealthStatistics, National Institute of Public Health

Toru YANAGIHARAProfessor, Faculty of Economics, HoseiUniversity

3. Report Summary

The composition of the report is shown in the figureon the following page. The Committee regardspeople-centered, sustainable development as the ul-timate goal of assistance to Peru. This is in line withinternational development principles such as sustain-able development, people-centered development, andthe DAC’s New Development Strategy. The Com-mittee defines four assistance objectives, namely,good governance and the promotion of participation,poverty alleviation and social development, sustain-able economic growth, and maintenance of sustain-able environmental systems. It also defines six pri-ority areas in assistance: the promotion of adminis-trative improvement and participatory development,assistance for the poor, people’s capacity developmentand social infrastructure-building, strengthening ofproduction capacities and systems, provincial devel-opment, and the strengthening of environmental con-servation technologies and systems. The Committeemakes recommendations as to priority issues in eacharea.


86

INFORMATION

[Identifying initial conditions]

I. Internal and External Conditions in PeruThe land and people

Heritages from the past and attainments of reforms ・Political, economic, and social conditions until 1990 ・Economic liberalization by the Fujimori Administration ・Social measures by the First Fujimori Administration ・Attainments of the First Fujimori Administration

New international environment for Peru ・Economic globalization ・Progress in regional integration

[Framework of development(basic ideas)]

II. Basic Perspective on Peru’s Development

Viewpoints of the international community ondevelopment ・People-centered development ・Sustainable development ・DAC’s New Development Strategy

(Shaping the 21st Century: The Contribu-tion of Development Co-operation)

Framework for development ・People-centered, sustainable development ・A country and regional individuality

Basic perspective on Peru’s development ・Present conditions of development in Peru ・Basic perspective on future development

[Description of the present conditions in Peru]

III. Development Issues in Peru

Challenges in economic development ・Addressing by the Government ・Considerations in economic

development ・Issues by sector

Challenges in social development ・Addressing by the Government ・Economic recovery and social

development ・Considerations in social development ・Issues by sector

Good governance and participation ・Restructuring the role of the

Government ・Challenges for administrative system

reorganization

Environmental conservation ・Addressing by the Government ・Present environmental conditions by

region ・Present conditions and challenges of

industrial pollution, urban environments,and the natural environment

[Issues to be considered]

IV. Trends of International Assistance for Peru

Assistance for Peru by international financialinstitutions ・Assistance for returning to the international

financial community ・Assistance for Peru by international financial

institutions ・World Bank ・Inter-American Development Bank (IDB)

Assistance for Peru by major industrializedcountries ・United States ・Canada

Japan’s assistance for Peru ・The first Fujimori Administration - before the

Huaral case ・The first Fujimori Administration - after the

Huaral case ・The Second Fujimori Administration ・Japan-U.S. Common Agenda

[Direction of assistance/recommendations for Peru]

V. Framework for Japan’s Assistance to Peru

Basic direction of assistance ・Basic perspective - implementation of the

DAC’s New Development Strategy ・Priority issues in assistance

Priority areas in assistance ・Assistance for the poor ・People’s capacity-building and social

infrastructure-building ・Strengthening of production capacities and

systems ・Provincial development ・Strengthening of environmental

conservation technologies and systems ・Administrative improvement and

promotion of participatory development

Considerations in assistance and necessaryimprovements

Figure Composition of the Country Study Report for Japan’s OfficialDevelopment Assistance to the Republic of Peru

87

INFORMATION

1. Outline of the DAC’s New DevelopmentStrategy and Organization of the Committee

“Shaping the 21st Century: The Contribution of De-velopment Co-operation” (the DAC’s New Develop-ment Strategy), adopted at the High Level Meetingof the Development Assistance Committee (DAC) ofthe OECD, held in May 1996, regards “the improve-ment of the quality of the lives of all” as the mostimportant development goal. The Strategy defines adevelopment vision focusing on poverty alleviation,social development, environmental sustainability andregeneration (social development and environmentalimprovement), economic growth through developingcountries’ participation in globalization from a long-and medium-term perspective, and the appropriaterole of governments which support them. As a meansof realizing these the Strategy shows comprehensiveideas on development and assistance, such as devel-oping countries’ self-help efforts (ownership) andcoordination with industrialized countries assistingthem (partnerships); comprehensive approacheswhich mobilize governments at all levels, the privatesector and NGOs; individual approaches that addressdifferent conditions in each developing country; andresults-oriented approaches.

JICA considered that this Strategy could become aguideline for Japan’s future assistance for develop-ing countries and organized the Committee fromNovember 1996 to March 1998 in order to positivelypursue the Strategy. The Committee worked out thepolicy to effectively and accurately direct Japan’s ef-forts toward the realization of the Strategy and com-piled the results into a report with recommendations.

2. Outline and Report Composition

The report consists of four volumes as mentionedbelow.○ Volume 1 Summary OverviewThis volume provides a comprehensive understand-ing of the DAC’s New Development Strategy. Thevolume proposes basic ideas and approaches in imple-menting the strategy, on the basis of the sectoral stud-ies (Vol. 2) and country studies (Vol. 3). Then gen-eral recommendations are provided.○ Volume 2 Sectoral StudiesThe Strategy defines specific goals to be attainedthrough development in the areas of poverty, educa-tion, health care, and the environment. This volume

analyzes the details of these goals and the currentconditions in these areas. The volume also analyzesaid trends among other aid organizations, studies theframework for Japan’s sectoral assistance, and makesrecommendations for each area.○ Volume 3 Country StudiesThis volume conducts a study of Cambodia, Ghana,and Zimbabwe where Japan has been taking the ini-tiative in promoting policy dialogues and strengthen-ing aid coordination. There is an analysis of the cur-rent social and economic conditions in these coun-tries and the direction of their development. Thenthe framework for Japan’s assistance to these coun-tries is studied in line with the Strategy and the re-sults are compiled into recommendations.○ Volume 4 Country InformationThe DAC’s New Development Strategy places im-portance, from a results-oriented perspective, onmonitoring the outcomes of development programs.This volume selects basic indicators for measuringresults, compiles statistical data, and provides infor-mation on developing countries’ individual ap-proaches in relation to the Strategy and the currentconditions of assistance of other donors for each sec-tor identified in the strategy.

3. Outline of Summary Overview andRecommendations

Regarding various approaches mentioned in theDAC’s New Development Strategy, the sectoral stud-ies in this report provide useful suggestions for inter-national aid coordination, multi-sectoral approachesand comprehensive approaches, and the country stud-ies give clarification on country approaches and re-sults-oriented approaches. The Summary Overviewintegrates these and studies the framework of Japan’sassistance, giving recommendations for implement-ing the Strategy. This volume defines seven basicideas as follows and shows specific ways of approachin line with these ideas.

a. Emphasis on ownership by developing countries,assigning them a central role in the implementa-tion of the DAC’s New Development Strategy

b. Emphasis on international aid coordination inan age of globalization

c. Support for development that is balanced in termsof growth and distribution

d. Emphasis on establishment and reinforcementof good governance in developing countries

II Committee on the Study of the DAC’s New Development Strategy


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INFORMATION

e. Emphasis on country approachf. Aid priority for countries committed to imple-

mentation of the DAC’s New DevelopmentStrategy

g. Development of implementation system of Japa-nese aid in keeping with the DAC’s New Devel-opment Strategy

The report mentions the necessity of improvingJapan’s assistance system for the Strategy’s imple-mentation and studies issues confronting the system.The strengthening of the country approach is impor-tant, among others, and the report recommends thatthe assistance system be improved, for this purpose,through a review of the functions of the policy-mak-ing organizations, implementing agencies, the head-quarters, and local offices.


■ ChairpersonYoshiaki ABE

Professor, Institute of Asia-Pacific Studies,Waseda University

■ Committee MembersShigeru ITOGA

Coordinator, APEC Study Center, Institute ofDeveloping Economies

Ichiro INUKAIProfessor, Faculty of International Relations,In-ternational University of Japan

Senro IMAIDevelopment Specialist, Institute for InternationalCooperation, JICA

Seiji UTSUMIProfessor, Faculty of Human Sciences, OsakaUniversity

Hideki ESHOProfessor, Faculty of Economics, HoseiUniversity

Akira KASAITechnical Advisor, JICA

Etsuko KITAChief Field Supporter and Logistics, Emergencyand Humanitarian Action, WHO

Kaoru HAYASHIChief Researcher, Research Institute ofDevelopment Assistance, The OverseasEconomic Cooperation Fund

Katsumi HIRANOSenior Research Fellow, Area Studies II, Instituteof Developing Economies (IDE/JETRO)

89

INFORMATION

The international symposium “Health Initiative inAsian Economic Crisis–Human-Centered Approach”was held at the United Nations University (Shibuya-ku, Tokyo) on April 27, 1997. The symposium wasorganized by the Ministry of Foreign Affairs, theMinistry of Health and Welfare, JICA, the OverseasEconomic Cooperation Fund (OECF), and the Foun-dation for Advanced Studies on International Devel-opment (FASID). There were 18 speakers and com-mentators from Japan and abroad, and an audience ofover 450 people.

1. Symposium Purpose

The symposium was intended to promote a human-centered approach emphasizing the social dimensionsof development, focusing on health care, in South-east Asian countries, where the socially vulnerable,including the poor, have been greatly affected in theirbasic human needs, as a result of their governmentshaving undertaken austerity measures and severestructural adjustment policies in order to overcomemonetary and financial crises. The purpose of thesymposium was to study and analyze the current con-ditions of social development in these countries, onthe basis of broad knowledge obtained from past ex-periences in coping with the economic crisis in LatinAmerica in the 1980s. The symposium aimed also toseek directions for the self-help efforts of developingcountries and desirable policies for the internationalcommunity including Japan.

2. Outline of the proceedings

(1) On behalf of the organizers, Minister for ForeignAffairs Keizo Obuchi, in his opening address, ex-pressed his great concern about the impact of theAsian economic crisis on the health of the sociallyvulnerable in the affected countries. He empha-sized two points as the purpose of the symposium,namely, learning from the past experiences of theworld community and understanding the currentsituation exactly and sharing information on it.

(2) The symposium proceeded in four sessions on thebasis of the four themes mentioned below.a. Session I “Economic Crisis: current situation

in health/medical care/social sector in Asiancountries in crisis”Participants from Indonesia and Thailand and

Japanese researchers explained the actual situa-

tions in these countries. They mentioned a steeprise in medicine prices due to fallen exchange ratesand reductions in health services due to curtailedbudgets. They pointed out the importance of iden-tifying the socially vulnerable and defining prior-ity areas.b. Session II “Lessons from past experiences

(Latin American crisis)”As applicable lessons learned from the past cri-

ses, Dr. Michael Reich (Professor, Harvard Schoolof Public Health) pointed out the importance ofintroducing health care, not as a supplement tostructural adjustment policy, but as an integral part.Dr. Richard Jolly (Special Adviser to the Admin-istrator, UNDP) pointed out the importance ofadjustment with a human face from a long-termperspective.c. Session III “Issues to be tackled and policy di-

rections”Policy-makers from Japan, the United States,

and Malaysia and an economist from the AsianDevelopment Bank explained the donor nations’approaches and the Malaysian experience in so-cial development. Mr. Kenzo Oshima (Director-General of the Economic Cooperation Bureau, theMinistry of Foreign Affairs, Japan) pointed outthe importance of not looking at the negative as-pects of the economic crisis, but of regarding it asan opportunity to review and improve the ongo-ing policies in Asian countries.d. Session IV “Wrap-up Panel Discussion”

Participants from Japanese and US NGOs ex-plained their activities in the sectors of health, nu-trition, and medical care.

3. The Chairman’s Summary

(1) Matters basically agreed○ It is essential to identify the socially vulnerable

who need to be provided with assistance withpriority.

○ The Asian economic crisis should be regardedas a good opportunity to strengthen the socialsectors of the affected countries.

○ It is necessary to formulate an action plan forestablishing sustainable and stronger systems,taking account of the situation after the crisis.

○ Projects need flexibility in planning and imple-menting, and the importance of NGOs’ rolesneeds to be recognized.

III International Symposium “Health Initiative in Asian Economic Crisis ― Human Centered Approach”


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INFORMATION

(2) Emergency responses○ Short-term measures for earning foreign cur-

rency indispensable for obtaining basic medi-cines should be implemented.

○ Investment-effective measures for the poor andthe vulnerable should be promptly identified andtheir implementation given priority.

○ A system of monitoring and reporting the im-pact on women and children, who can be mostaffected, should be established.

(3) Longer-term responses○ Adjustment programs need to be growth-ori-

ented and also need to include social measures.○ A strengthened monitoring and evaluating sys-

tem is needed for appropriately responding tothe needs of the poor.

○ It is necessary to invest in the development ofnew social systems and establish an Asian Insti-tute for Strategic Studies (tentatively named).

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INFORMATION

1. The Committee Background

The Lao PDR has been promoting their transition toa market economy since 1986, under their open eco-nomic policy named the New Economic Mechanism,intending to emerge from their position as a least lessdeveloped country by 2020. Laos, however, beinglandlocked, is operating at a disadvantage concern-ing trade. It is also a disadvantage that the mountain-ous regions covering the greater part of the countrydivide its domestic economy into sections. It is anundeniable fact that historical and geographic condi-tions have produced serious insufficiencies in humanresources and basic economic infrastructure such asthe transport network. In short, the Lao PDR can beclassified as one of the poorest Asian countries andas lacking the organizations and systems needed torun a market-oriented economy.

Japan has adopted country approaches and regionalapproaches in providing active assistance for threeIndochinese countries, which are making efforts tointroduce market-oriented economies since 1980when assistance to these countries was resumed.Assistance from Japan, the top bilateral donor for theLao PDR, could have great influence on the directionof Laos’s development.

Social and economic conditions in the Lao PDRhave been greatly changed by their entry to ASEANin July 1997, recent increased opportunities of re-gional development in Indochina, and the outbreakof the Asian monetary crisis.

JICA, keeping these circumstances in mind, orga-nized the Committee on the Country Study for Japan’sOfficial Development Assistance to the Lao People’sDemocratic Republic for the purpose of studying thenecessary measures for assisting the nation, which isunder various constraints, in smoothly addressingglobalization.

2. Study Process

The Committee had met six times, with the first meet-ing held on August 29, 1997 and the last on February16, 1998. Focusing on understanding the conditionsfrom 1986 when the Lao PDR announced their inten-tion to introduce a market economy under their NewEconomic Mechanism policy to the present, the Com-mittee analyzed the general socioeconomic conditionsin Laos and the trends of assistance from major do-nor nations and international organizations to the

country. The Committee made efforts to identify themajor development challenges confronting the coun-try, taking into consideration their integration into theregional market as a consequence of their enteringASEAN in July 1997, as well as trends of interna-tional development plans in Indochina. The Com-mittee, based on these studies, compiled a report onthe framework of Japan’s assistance to Laos.

In the process of the study, the Committee con-ducted a field survey in December 1997, for the pur-pose of exchanging views with the Government ofthe Lao PDR, major donor nations and organizations,the JICA Laos Office, and the Japanese Embassy inVientiane.


(1) Committee■ ChairpersonYonosuke HARA

Professor, Institute of Oriental Culture, TheUniversity of Tokyo

■ Committee MembersTetsusaburo KIMURA

Professor, Faculty of International Relations, AsiaUniversity

Kenji DOMOTOAssociate Professor, Faculty of Economics, ShigaUniversity

Motoyoshi SUZUKIAssociate Professor, Faculty of Humanities andSocial Sciences, Mie University

Seiichi FUKUIProfessor, Faculty of Economics, Osaka-gakuinUniversity

Akihiko ONOAssociate Professor, Faculty of Economics,Osaka City University

Satoshi CHIKAMIFaculty of Social & Information Sciences, NihonFukushi University

Satoshi IIJIMADirector, 4th Division Operations Department 1,Overseas Economic Cooperation Fund (OECF)

Miyoko SHIMAZAKILecturer, Department of Economics, NihonFukushi University

Kazuo KURODAAssistant Professor, Center for the Study ofInternational Cooperation in Education,

IV Committee on the Country Study for Japan’s Official Development Assistance to the Lao People’s Demo-

cratic Republic


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Hiroshima UniversityHiroaki NAKAGAWA

Director, First Regional Division, PlanningDepartment, JICA

(2) AdvisersHiroyuki TSUBURAYA

Counsellor of Regional Plan for National Forest,Management and Planning Division, NationalForest ManagementDepartment, Forestry Agency, MAFF

Hayao ADACHIDevelopment Specialist, JICA

4. Report Outline

In the report, the Committee regarded the Lao PDRnot only as a country in transition to a marketeconomy, but also as a less developed country in theprocess of transforming the domestic economy fromself-sufficient and fragmented economies into an in-tegrated market economy. The Committee studiedhow economic growth could be attained and whatshould be done to improve the BHN level that wasstill low in the country, while being confronted withthe two challenges of domestic market integration andtransition to a market economy. This was viewed inlight of the merits and demerits produced from enter-ing ASEAN which are getting into the Asian network(regional tariff liberalization) called AFTA (ASEANFree Trade Area) by 2008.

The Lao economy was stable from 1986 until theAsian monetary crisis in July 1997. The report con-cludes that this is attributable to comparatively goodperformance in the agriculture sector, which accountsfor 60% of the GDP, and successful economic reformsthrough the introduction of a market economy. Thereport, however, points out the following problemsin promoting a market economy and economic glo-balization in the Lao PDR.○ There is an extreme deficiency of personnel ca-

pable of addressing these issues and human re-sources development is urgently needed.

○Hydroelectric power generation and forestry are theonly sources of foreign exchange.

○Because of the sparse population, neither the directforeign investment of labor-intensive downstreamindustries nor export-oriented industrializationwould be effective.

○ The country has only insufficient domestic trans-port and communications infrastructure to estab-

lish domestic markets.In rural areas where the greater part of the people

and the poor among them live, the people are facedwith various challenges: raising agricultural produc-tivity, measures against environmental degradationdue to short cycle slash-and-burn farming from in-creasing population pressure, the necessity of creat-ing employment other than farming, extending edu-cation, and the expansion of health care services.

The report defines, based on the above, the fol-lowing four points as priority areas for Japan’s assis-tance.(1) Agricultural and rural developmentIncreased food production and the promotion of ru-ral industries should be pursued, in recognition of thefact that improved rural conditions will result in bothpoverty alleviation and an improved BHN. Small-scale and multiple approaches would be effective inaddressing such issues as health care services andeducational system building at the local level. Thisis relevant also to (2) below.(2) Human resources developmentAssistance should be provided for two issues in par-allel in human resources development: higher-levelcapacity development for fostering human resourcescapable of dealing with a market economy, and theextension of basic education among the people in therural and the mountainous areas.(3) Development of infrastructure and energyThe establishment of an integrated domestic marketis indispensable for the sound development of a mar-ket economy in the Lao PDR, and is of critical im-portance in extending social services. Assistanceshould be provided in coordination with other donors,with due consideration given to the improvement ofthe management and maintenance systems and com-patibility among sub-sectors. Electricity will continueto need to be used as a valuable source of foreignexchange and its development is increasingly beingfunded by the private sector. Assistance in these areais needed.(4) Environmental conservation and environmental

resource managementForest conservation is indispensable for the develop-ment of the Lao PDR. It is desirable that cooperationbe focused on participatory forest conservation, incombination with measures for stabilizing slash-and-burn farming. Assistance in river basin managementplanning is also important from the viewpoint of landutilization, soil conservation, and water source culti-

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vation. Assistance would be also needed in systembuilding, with the Science, Technology, and Environ-mental Organization at the core.


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V Report on the JICA International Symposium on “Local Development and the Role of Government― A New Perspective of Assistance”

1. Symposium Background

It is said that, in more than 60 among 75 developingand transition countries with a population of morethan 5 million, power is being decentralized to localgovernments in some form. The change in the rela-tions between the central governments and the localgovernments in developing countries is greatly affect-ing their development and in particular the develop-ment at local levels. In assisting the promotion oflocal development and narrowing regional gaps, evenin countries where little progress has been made indecentralization, it is becoming increasingly impor-tant to understand the situations of the local govern-ments and their administrative and financial capaci-ties and relationships with the central government.In other words, the functions of the domestic institu-tional framework, which have been regarded as given,needs reconsideration from the view points of localdevelopment. It is required to review local develop-ment and the reduction of regional gaps, in referenceto domestic governance including central-local rela-tionships in developing countries.

In this new environment, it has become necessaryto pay attention to governance in developing coun-tries, in extending cooperation that contributes to re-gional progress. Providing assistance, without care-ful study on systems such as central-local relation-ships and local governments’ administrative capaci-ties being left as a kind of black box, could dilute theefficiency and effectiveness of the assistance, particu-larly when the assistance is implemented in regionalareas. The areas of poverty, health care, and educa-tion, which are prioritized in the DAC (DevelopmentAssistance Committee) New Development Strategy,require detailed plan of implementation with closeattention to the conditions in each region and needlocal capacities for providing services and planningand implementing programs. The promotion of ef-fective cooperation in these areas will require mea-sures for improving regional administrative capacityand local governance.

JICA, recognizing these circumstances, conductedan issue-wise study from 1996 to 1997 under the titleof “Local Development and the Role of Government.”

This symposium, being based on the results of thestudy, was intended to study central-local relation-ships in developing countries where the trend of de-centralization is growing, the impact on local devel-opment, and an ideal way of assistance for address-

ing these issues.

2. Symposium Outline

Date: March 5, 1998Attendance: about 130 people<Program>○Keynote address “Governance and development ―

reform of decentralization”Speaker: Dr. Michio Muramatsu, Professor, KyotoUniversity

○Session I “Decentralization in developing countries―current situation, and influence on economic de-velopment”

Speakers : Yuji Suzuki, Professor, Hosei UniversityDr. Chen Yao, Western China Develop-ment Research Centre, Chinese Academyof Social Sciences

• Session II “Local Development and the Role ofGovernment.”Speakers : Dr. Michio Muramatsu, Professor, Kyoto

UniversityDr. Adrian Panggabean, University of In-donesiaHon. Mayor Alvin B. Garcia, Cebu CityMayor, the Philippines

• Session III “The Role of ODA”Speakers : Mitsuaki Kojima, Managing Director,

Planning Department, JICADr. Michael M. Calavan, Chief, Office ofGovernance and Participation, USAID,ManilaRobertson Work, Principal Technical Ad-viser,Management Development and Gover-nance Division, UNDP

In the keynote address, Professor Muramatsu re-ferred to the significance of decentralization and therole of the central government. He asked the audi-ence to pay attention to the existence of various typesof central-local relationships. He gave an explana-tion of central-local relations of the integrated typeand that of the separate type. He pointed out the im-portance of the residents’ participation and owner-ship, as well as various forms of partnerships such asthose between the capital and the provinces, and be-tween the government and aid organizations.

In Session I, Professor Suzuki made a conceptualarrangement of the total framework for understand-ing the issue of decentralization in developing coun-

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tries. Then, Dr. Chen spoke about a case of decen-tralization in China.

In Session II that followed, Professor Muramatsudiscussed Japan’s experience in narrowing regionalgaps. Then Dr. Panggabean presented his paper onIndonesia’s approach to and issues in narrowing re-gional disparities, focusing on intergovernmental fi-nancial transfer. Mayor Garcia from the Philippines,where decentralization has been progressing since theestablishment of the Local Government Code, talkedabout opportunities created by the Code and prob-lems awaiting solutions, from the standpoint of thehead of a local government.

In Session III, Managing Director Kojima ex-plained JICA’s approach, focusing on the role of de-velopment assistance. Dr. Calavan presented theUSAID program in the Philippines, and Mr. Workexplained the UNDP’s idea of development assistancein the area of decentralization and illustrated it bygiving some examples.

The symposium was attended by over 130 people.Among others, there were many participants includ-ing ambassadors from Latin American and Africancountries. It seemed that they were greatly interested

in the theme because decentralization was either un-der way or an imminent political issue in their coun-tries. In questions and answers, views and questionswere lively set forth from among the audience on howto address the theme, challenges in promoting decen-tralization, and approaches by aid organizations, re-flecting their deep interest in the theme. In this sym-posium both donor and developing countries indicateda common recognition of the importance of thistheme, and deep interest was aroused with the largeaudience. This certainly was the first step towards afurther study of local development and the role of thegovernment.

3. Symposium Report

A report is being compiled in Japanese and English,based on the minutes and the materials distributed atthe symposium. It will be distributed to the organi-zations concerned in 1998. For details, please referto Mr. Ozawa, Director of the Research and Devel-opment Division, Institute for International Coopera-tion, JICA.


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VI The Second Country Study for Japan’s Official Development Assistance to the People’s Republic of China

1. Study Background

The Committee on the First Country Study for Japan’sOfficial Development Assistance to the People’s Re-public of China was organized in 1989 and waschaired by the late Mr. Saburo Okita. The Commit-tee compiled the final report in 1992. In those daysChina had been promoting reform and open policyfor about 10 years. Macroeconomically being un-stable, there was the possibility that the reform andopen line could result in a setback. The First Coun-try Study Report, in support of the reform and openpolicy, made recommendations focusing on the eco-nomic stability, inflation control, and the eliminationof bottlenecks in the infrastructure.

In August 1997, about five years after the recom-mendations were made, the Committee on the Sec-ond Country Study for Japan’s Official DevelopmentAssistance to the People’s Republic of China wasorganized. The Committee studied the direction ofJapan’s ODA to China, with 2005 as the target year,based on China’s development and result analysis ofJapan’s assistance to China since the First Study Re-port was compiled. The Committee completed theirreport in February 1999.


(1) Committee members■ ChairmanToshio WATANABE

Professor, Graduate School of Decision Scienceand Technology, Tokyo Institute of Technology

■ MacroeconomyKyoichi ISHIHARA

Professor, Faculty of Cross-Cultural Studies,Kobe University

■ Industrial DevelopmentKazuyoshi UEHARA

Professor, Kyoto Institute of Economic Research,Kyoto University

■ Education/Human ResourcesDevelopment

Yutaka OTSUKAProfessor, Graduate School ofInternational Development, Nagoya University

■ Regional DevelopmentHiroyuki KATO

Professor, Faculty of Economics, Kobe Univer-sity

■ PoliticsTomoyuki KOJIMA

Professor, Faculty of Policy Management, KeioUniversity

■ AgricultureToshio TAJIMA

Professor, Institute of Social Science, The Uni-versity of Tokyo

■ Public FinanceMinoru NAMBU

Professor, School of Economics and BusinessAdministration, Kobe University of Commerce

■ InfrastructureHiroshi OITA

Director, 1st Division, Operation Department II,The Overseas Economic Cooperation Fund (UntilMay 1998)

Kaoru HAYASHIDirector, 1st Division, Operation Department II,The Overseas Economic Cooperation Fund (FromMay 1998)

■ Health and Medical CareKenji HAYASHI

Director, Department of Demography and HealthStatistics, National Institute of Public Health

■ The EnvironmentKazuo HISHIDA

Technical Adviser, The Overseas EconomicCooperation Fund

■ Aid TrendsTsuguo YASHIMA

Advisor of Center for Research and Developmen-tal Conservation, International Good Neighbor-hood Association

(2) Task force■ Chief of the Task ForceIkufumi TOMIMOTO

Development Specialist, Institute for Interna-tional Cooperation, JICA

■ Education/Human ResourcesDevelopment

Eiko IZAWAAssociate Specialist,Second Project Study Division, Grant Aid ProjectStudy Department, JICA

■ PoliticsKyoko OKUBO

Research and Development Division, Institute for

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International Cooperation, JICA■ InfrastructureShoichi OKUMURA

Development Cooperation Division, EconomicCooperation Bureau, Ministry of Foreign Affairs

■ Mining, Industry/EnergyToshinobu, KATO

Deputy Director, Industrial Development StudyDivision, Mining and Industrial DevelopmentStudy Department, JICA

■ PovertyHirofumi SUZUKI

Administration Division, Training Affairs Depart-ment, JICA

■ Health and Medical CareMasao TATEBA

Deputy Director, Administration Division,Procurement Department, JICA

■ The EnvironmentKoji FUJIYA

Deputy Director, Second Development StudyDivision, Social Development Study Department,JICA

■ Women in DevelopmentYuri HONDA

Research and Development Division, Institute forInternational Cooperation, JICA (Researcher,Japan International Cooperation Center) (UntilFebruary 1998)

■ Social SecurityHiroko MAEDA

Lecturer, Faculty of Foreign Languages, KyotoSangyo University

■ MacroeconomyTomoo MARUKAWA

Researcher, Economic Development ResearchDepartment, Institute of Developing Economies

■ AgricultureYoshiko MURATA

Research and Development Division, Institute forInternational Cooperation, JICA (Researcher,Japan International Cooperation Center) (UntilJanuary 1998)

■ Aid TrendsMasato WATANABE

Second Regional Division, Planning Department,JICA

■ SecretariatRitsuko NAKAMURA

Research and Development Division, Institute forInternational Cooperation, JICA (Researcher,Japan International Cooperation Center) (UntilSeptember 1998)

Shiomi MIKIResearch and Development Division, Institute forInternational Cooperation, JICA (Researcher,Japan International Cooperation Center)

3. The Committee’s conclusion

(1) Japan’s official development assistance to China(which has been provided for 20 years) has beencontributing greatly to the country’s moderniza-tion, reform and open policy since the organiza-tion of the First Committee.

(2) Current social and economic conditions in Chinadiffer considerably from those when the FirstCountry Study was under way. A number of is-sues to be addressed more seriously than ever haveemerged including poverty, the environment, food,and the building of an institutionalized marketeconomy.

(3) In view of Japan’s limited resources for ODA inthe future and China’s extensive land and largepopulation, it is necessary to focus cooperationon the top priority issues which cannot be solvedby China’s self-help efforts alone. It is also nec-essary to construct a model for extending the fruitsof assistance.

(4) The purpose of Japan’s ODA is to contribute toChina’s stable growth, which is desirable for Asiannations including Japan and also for the entireworld.

4. Priority Issues and Regions

(1) Priority issuesa. Poverty eradication and regional gap removal

Priority issues(i) Poverty eradication and regional gap removal(ii) Environmental conservation(iii) Agricultural development and food supply(iv) Building an institutionalized market economy


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Priority regionsAssistance should be focused on central and west-ern China where the people are especially poor.

Strategic assistance is needed in poverty eradica-tion and narrowing regional gaps. It is also impor-tant to build, with yen loans, infrastructure, and in-dustrial foundations in poor regions and to go furtherto support the implementation of projects relevant topoverty alleviation. Japan’s ODA for China needs toshift focus, on the whole, from economic develop-ment to social development (health care, education /human development, social security etc.). The Com-mittee studied specific items in the areas of healthcare, education / human development, poverty alle-viation in rural regions, social security, and womenin development. It is necessary to pay careful atten-tion to China’s diversity in terms of developmentstages and geographic conditions in implementingassistance.b. Environmental conservationIn view of China’s appropriations for environmentalconservation not necessarily being adequate, the pointis how to provide efficient cooperation in this area.The environmental model city initiative now underway is designed for providing cooperation which willprovide a very noticeable demonstration and result-ing effects so that experiences there will be extendedto other regions. At the same time, it is not enough todeal with pollution problems in only the model city.It is important to have a regionally extensive envi-ronmental perspective. This perspective must considerthe direction of change in the city’s industrial struc-ture with the introduction of a market economy andthe relationship with industrial structures and pollu-tion conditions in nearby regions and other industrialcities in the upper and lower reaches of the river. TheCommittee studied specific items in the area of mea-sures against air pollution, acid rain and water con-tamination, urban environmental conservation, for-est conservation, flood control, and disaster preven-tion.c. Agricultural development and food supplySo far, cooperation has been focused on the construc-tion of facilities, the installation of equipment andapparatuses, and the transfer of production-related

technologies. Now the cooperation priority, however,needs to shift to joint research for providing a stabi-lized food supply and agricultural structure reform,policy making and institutional building, and jointdevelopment with China of technologies that will helpfarmers increase their incomes. In order to attain aproper regional balance, cooperation should be fo-cused on the poor regions in central and western Chinato reduce poverty and regional gaps. The Committeestudied cooperation for increasing farmers’ incomesand reducing poverty and regional gaps, cooperationtoward the industrialization of agriculture, coopera-tion for building infrastructure needed in distributingagricultural products, cooperation in market manage-ment, and agricultural cooperation from which far-reaching effects were expected.d. Building of an institutionalized market economyIt is thought that China has already passed throughthe stage of system building and policy orientation toinstitutionalize a market economy. Future coopera-tion should therefore place importance on the con-solidation of the existing systems, improvement ofoperational efficiency, and enhancement of the reformresults. The Committee studied specifically the re-form of state-owned enterprises, fostering of and as-sistance for small- and medium-scale enterprises, fi-nancial and monetary systems, macro-economic con-trol, cooperation in the energy sector, and coopera-tion in infrastructure building.(2) Priority regionsThe priority of Japan’s assistance will shift from thecoastal region to the inland areas, particularly the poorregions in central and western China. It is necessaryto give due consideration, in identifying projects, toregional individuality and characteristics, as well asregional capacities of formulating and acceptingprojects, and to take account of per-capita GDP andpoverty-related indicators, as common criteria in se-lecting target regions. Japan’s definite intention, asthe largest bilateral donor, to aim assistance at thepoorest regions will induce more domestic supportin China for these regions. Collaboration and coop-eration that are consistent with other bilateral and mul-tilateral aid organization’s policy on assistance forChina will become possible.

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