Internal Ex-Post Evaluation for Technical Cooperation Project conducted by China Office: January, 2019 Country Name Project for Capacity Development on Mental Health Services for Reconstruction Support of People's Republic of China Sichuan Earthquake I. Project Outline In the disaster-affected area hit by the Sichuan Earthquake on May 12, 2008, reconstruction works were steadily being implemented with focus on infrastructure development. Programs on mental health and psychosocial support for those affected were also started right after the Earthquake by various governmental agencies and other organizations in and out of China. However, it was said that the average incidence rate of post-traumatic stress disorder (PTSD) in the quake-affected area was estimated as more than 10% (at the time of ex-ante evaluation) and cases of secondary damage including suicide were continuously reported. This indicated that there had still been Background urgent needs of the metal health and psychological support. What still remained as challenges were: how to cope with the lack of mental health care workers, how to ensure the quality of care program, how to secure the sustainability of care provision system, and what to do with the lack of comprehensive coordination and management. It was confirmed that these challenges were aggravated over the time. It was also pointed out that the self-care of mental health care workers should be given full consideration as it was often the case that they themselves were the disaster victims. In the disaster-affected area hit by the Sichuan Earthquake (Sichuan Province, Gansu Province, and Shaanxi Province), the project aims to establish the appropriate and sustainable community-based psychosocial support system(1) through human resource development of mental health care workers in multi-sectoral areas (education, psychology, social work and medicine) as well as strengthening of collaboration and cooperation among sectors with focus on affected people, thereby having the concept of established support system well accepted in those project areas. Objectives of the (1) Psychosocial support system: All kinds of service provision to maintain and promote the psychosocial health as well as to Project prevent and treat mental disorder. Under this project, it includes the organizational implementation and management system, appropriate intervention by respective professional category, appropriate referral system and policy support. 1. Overall Goal: Concept on sustainable psychosocial support system, which appropriately reflects local culture, social character and other aspects, is well accepted in the Project areas. 2. Project Purpose: Sustainable psychosocial support system, which appropriately reflects local culture, social character and other aspects, is established at model sites. 1. Project Site: Sichuan Province, Gansu Province, and Shaanxi Province Model site: Five (5) sites (Jiange County, Guangyuan City, Sichuan Province; Chongzhou City, Chengdu City, Sichuan Province; An County, Mianyang City, Sichuan Province; Chencang District, Baoji City, Shaanxi Province; Qinzhou District, Tianshui City, Gansu Province) 2. Main Activities: (1) Establishment of operation and management mechanism for psychosocial support at model sites, (2) Development of human resources engaged in psychosocial support through trainings of trainers, (3) Enhancement of awareness and understanding toward psychosocial support among governmental agencies and local people. 3. Inputs (to carry out above activities) Activities of the Japanese Side Chinese Side Project 1. Experts: 19 persons; (Long-term) 3 persons, 1. Staff allocated: (Coordination team members) 56 (Short-term) 16 persons persons 2. Trainees received: 177 persons 2. Chinese Experts: 10 persons 3. Equipment: Vehicles for monitoring; office 3. Facilities and equipment: Office space, psychology equipment such as personal computers and room and its facilities, books, existing care facilities printers; furniture such as desks, chairs and (schools, psychology stations, governmental offices, bookshelves for office and library; reference medical facilities, etc.) books, etc. 4. Local expenses: 4. Local expenses Project Period June 2009 – May 2014 Project Cost (ex-ante) 330 million yen, (actual) 380 million yen Implementing Main implementing agency: All-China Women's Federation (ACWF); Ministry of Health; Ministry of Education; Agency Institute of Psychology, Chinese Academy of Sciences Hyogo Institute of Traumatic Stress; Energy and Rescue Team by school staff of Hyogo (EARTH); Hyogo Cooperation Agency University of Teacher Education; Research Institute of Nursing Care for People and Community, University of in Japan Hyogo; Association of Japanese Clinical Psychology; Japanese Society of Certified Clinical Psychologists; Japanese Society for Traumatic Stress Studies, etc. II. Result of the Evaluation < Special Perspectives Considered in the Ex-Post Evaluation > (Assessment of continuous status of psychosocial support system) ・The psychosocial support system aimed by the project consists of four aspects; 1. Organizational implementation and management system, 2. Appropriate intervention by respective professional category, 3. Appropriate referral system, and 4. Policy support. In assessment of continuation status of these aspects, the achievements of 1, 2 and 3 were examined through the continuation status of the Project Purpose at the time of ex-post evaluation and that of 4 was examined through the achievement status of the indicator 1 of the Overall Goal at the time of ex-post evaluation. (Evaluation of achievement status of the Overall Goal) 1 ・To assess the achievement of the Overall Goal “Concept on sustainable psychosocial support system, which appropriately reflects local culture, social character and other aspects, is well accepted in the Project areas”, two indicators are set, namely, “Psychosocial support is mentioned in related policy documents (indicator 1)”, and “Psychosocial support not limited to post-disaster support is continuously implemented (indicator 2)”. In addition to these indicators, the achievement status of the Overall Goal in the target areas other than the model sites of the project was examined as supplementary information. 1 Relevance <Consistency with the Development Policy of China at the Time of Ex-Ante Evaluation and Project Completion> At the time of ex-ante evaluation, the project was consistent with “The Comprehensive Plan for Rehabilitation and Recovery after Sichuan Earthquake (2008-2015)” by the State Council, which states that in severely affected areas of Sichuan, Gansu and Shaanxi Provinces hit by the Earthquake, 15 agendas for restoration and reconstruction including the mental health care services should be promoted. At the time of project completion, this “planning” was still effective. <Consistency with the Development Needs of China at the Time of Ex-Ante Evaluation and Project Completion > As described in “Background” above, the project was consistent with the development needs for mental health and psychosocial support at the time of ex-ante evaluation. At the time of project completion, human resource development of high-quality mental health care workers was still important. The project was consistent with the needs of ACWF and those, involved in medicine, education, and communities, who were responsible for promoting mental health care activities. <Consistency with Japan’s ODA Policy at the Time of Ex-Ante Evaluation> The project was placed under the special issue “Assistance for reconstruction after the Sichuan Earthquake”. The Japanese government had a series of meetings including policy discussion of governmental missions in late June as well as the Japan-China summit meeting held on July 9 in 2008 and made a decision to implement assistance in each aspect of five pillars (1. Health and welfare, 2. Society and culture, 3. Industry and employment, 4. Disaster prevention, 5. Community development). The assistance for mental health was targeted under the above pillars 1 (health and welfare) and 4 (disaster prevention). <Evaluation Result> In light of the above, the relevance of the project is high. 2 Effectiveness/Impact <Status of Achievement of the Project Purpose at the time of Project Completion> The Project Purpose, “Sustainable psychosocial support system, which appropriately reflects local culture, social character and other aspects, is established at model sites” was achieved by the time of project completion. Three types of tools to introduce and manage psychosocial support system were completed and shared with those at the model sites and related organizations (indicator 1). The expansion of activities such as training of second core human resources by core human resources1 (through cascade system) and establishment of human resource network (as a function of platform for psychosocial support system) was confirmed by monitoring reports of all model sites (indicator 2). In addition, the experiences and lessons learned at the model sites were shared with other cities and countries in project target sites through training in China and Japan as well as the web-site of Women’s Federations at all levels (indicator 3). <Continuation Status of Project Effects at the time of Ex-post Evaluation> The project effects have continued since the project completion. Questionnaire survey and interview conducted in the ex-post evaluation confirmed that the management tools developed and the support system established by the project as