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IDJ-ENGLISH ”A Caring” Approach for Medical Equipment Provision

Special Feature Stories:  Japan’s Health and Medical Cooperation

“A Caring” Approach for Medical Equipment Provision

Caring from a “Post-Grant” Perspective, and the Voices of Nurses and Health-workers

As the Japanese government and JICA has announced that they will expand their medical cooperation projects, the International Development Journal has tried to outline how  Japanese-style-aid can contribute in healthcare and medical cooperation projects through our January edition, 2021.  What interested me the most was that many of the interviewers seems to describe Japanese aid as “Caring”.

Japan’s technical aid does take pride in its human-to-human approach.  Japanese experts have continuously been dispersed to local sites where they not only work, but also live together with the people for months and years.  By becoming a part of the community, they work to identify the problems, and together with the people, they construct a solution that will fit into the community.

But Japan’s aid is not only about human-to-human technical assistance.  For Japan to advocate itself as “Caring”, the concept also needs to be demonstrated in equipment procurement and infrastructure projects.

Who to “Care” for?

The principle of Japanese ODA is request based.  This means that the initiative of the project lies with the recipient.  The idea is that the Japanese government will not force their own priorities through the project, respecting the ownership of the recipient.

The requests for equipment and infrastructure, are mostly made by the recipient countries’ governments.  The government is, after all, the responsible body for pursuing the countries’ medium-to long-term interests.  So yes, the Japanese ODA “cares” for the recipient government’s needs.

However, there are critiques that point out that the smaller voices are not always cared for.  A medical equipment dealer, who has been involved in many Japanese ODA projects in East Africa points out that in the projects where he had provided medical equipment, the voices of the nurses and health workers, who actually handle the equipment, are often left out.

“These projects tend to not last very long” he says, explaining that there was equipment that did not even last three months.

“If an ODA procured equipment malfunctions, people often point to the nurses as being guilty.  This is partly true, in a lot of cases the equipment is damaged during the cleaning process, which is mostly done by the nurses.  However, it is crude to only point to them.  It could be because of the poor water quality from the rusted pipes that damages the delicate pieces. It could be the badly composed rooms that interferes with the cleaning and storing process.  It could be the shortage of nurses.  What I mean to say is, it might not only be the nurse’s fault.  If you talk with them personally, they can tell you why they might have damaged the equipment, and try to fix that problem first.  But not one really does “

Why are the nurses not involved?  The answer may be, that it would be too time and effort consuming.  The nurses may not speak English.  They may not be used to giving opinions.  In many countries, the social status of nurses and health workers is still very low and they are rarely asked for their opinions even by the doctors or management staff of their hospitals, let alone foreign donors.  But, by trying to encourage wide participation and “caring” for the many voices on the ground, the risk of equipment damage can be reduced, and also help the social statuses of nurses and health workers.

Post-Project Point of view

Interviewing a doctor at a hospital where endoscopes were provided through Japanese ODA in Africa, it has also come to our attention that a post-grant-perspective is important when talking about “caring”.

“Thanks to the provided endoscopes, the hospital is now able to identify cancers, a growing problem in the region.  However, that is all we can do, as there are not enough doctors with surgical skills or the medical facilities.  If the patient has money, they may go abroad for treatment.  But most people do not, so they have no choice but to wait and die.”

As the overall medical systems are still fragile in many developing countries, the effect of a one-time provision of equipment would be limited.  As the director of the Medical Corporation KNI’s Overseas Division, Ms. Mihoko Nakayama points out that it is important to provide packaged support.  Training on the proper use of the equipment of course, and also training and additional provisions based on newly identified needs will be vital in advancing the medical system as a whole.

In Vietnam, JICA has continuously worked on upgrading the medical system of the country.  They not only upgraded the three core hospitals, Bach Mai in the northern region, Fue in the middle, and Chowlai of the south, but they have also strengthened the links between them and the regional hospitals and health clinics.  This system was achieved not only with one project but through a mix of projects, equipment procurement, training and facility upgrading over a long period of time.  With this upgraded system, Vietnam is said to have been successful in combating the COVID-19 pandemic and minimizing the damage.

Encouraging Existing Experts

In being “caring”, it does not mean to just give whatever is requested.  It is important for the donor’s side to have medical experts to consult.  However, according to the medical equipment dealer introduced above, there are often no Japanese medical or healthcare specialists involved throughout the projects.

“Without experts from the donor’s side to scrutinize the plans, the effects cannot be guaranteed.  There is even the risk of corruption”

Of course, trying to encourage more people to work abroad is important but, as a Japanese member of the WHO comments, the number of Japanese medical specialists who are willing to leave their stable lives in Japan and dedicate themselves to improving the medical situation in developing countries is limited.

So at the same time as trying to increase the number of medical experts in the field, asking the already existing human resources on the ground would be effective for dealing with the situation in a timely manner.  There are indeed Japanese medical experts actively working toward medical improvement in developing countries, and we have introduced some through this edition.  ODA projects should actively include such experts in the future.  In particular the Medical Attaches of Japanese Embassies can also play vital roles.  Until now, the Medical Attaches have been mainly tasked with the health care of the Embassies staff and their families, and they have not been expected to get deeply involved in projects.

But now things have started to change.  Together with the announcement of the African Health Initiative by the Japanese government, the Medical Attaches are now encouraged to get involved in ODA projects. It is hoped that from now on the Medical Attaches not only of the Africa-based Embassies but also around the world, will play active roles as advisors.

Caring for..

The Japanese government has long promoted the principles and international initiatives such as the Universal Health Coverage (UHC) and the concept of “Human Security.”  On the other hand, it has been pointed out that the amount of cash input has been moderate.

The Japanese government seems to be trying to give its self a new name, as a big contributor and has announced large-scale schemes, such as the “COVID-19 Crisis Response Emergency Support Loan”, a two-year entity providing a total of 500 billion yen to developing countries dealing with the COVID-19 pandemic.  Prime Minister Suga himself has also pledged at the United Nations General Assembly that Japan will implement medical assistance worth over 170 billion yen.  JICA, too, announced their aim to implement over 100 projects in a wide range of countries to upgrade their medical capacities.

However, too much emphasis on the quantity can be damaging to the quality of each project.  A “caring” project is time and effort consuming, but when there are so many other donors that emphasize quantity, the caring, quality approach which does not only respond to the immediate COVID-19 needs, but also contributes to upgrading the medical system itself, may differentiate Japan as being a unique and effective donor.

For this, the Japanese government also needs to keep the number of those available for  project management in mind, particularly those at JICA offices and the Embassies.  These people on the sites are the ones who would be tasked to plan, implement, and follow the projects up.  The government will have to balance how many projects can realistically be done without undermining the quality. With the COVID-19 pandemic, some regions may have strict restrictions on human movement, making project management even harder.  A “caring” project can only be implemented by “caring” for the capacity of the implementors as well. (Natsu Kimura)

“International Development Journal” January edition, 2021


特集:日本の保健医療協力 機材供与で示す「寄り添う」姿勢






  波及効果の高い機材供与支援を行う上では、多様な声を取り入れることに加え、“供与後”の視点を持つことも重要だ。医療法人社団 KNIの海外事業部部長である中山美穂子氏は、「機材が継続的に活用されるよう、医療技術やマネジメントなどの人材育成も組み合わせたパッケージ型で支援していくことが大切だ」と語る。









(本誌編集部・木村 夏)









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