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⼂⠪䊧䊎䊠䊷㩷 ᣂẟᄢቇᄢቇ㒮කᱤቇ✚ว⎇ⓥ⑼࿖㓙ᗵᨴකቇ⻠ᐳⴐⴡ↢ቇಽ㊁ ㋈ᧁ ብ ᢎ ࿖┙੍㒐ⴡ↢⎇ⓥᚲ㧔㧕࿖┙ᗵᨴ∝⎇ⓥᚲ రᚲ㐳 ᰴ 㓶 ᳁ ┙㙚ࠕࠫࠕᄥᐔᵗᄢቇᄢቇ㒮ࠕࠫࠕᄥᐔᵗ⎇ⓥ⑼ ਃᅢ ⊥৻ ᢎ ࠤ࠾ࠕ࠽ࠟޔࠕࡆࡦࠩޔᗵᨴ∝⎇ⓥᣉ⸳⹏ଔ߆ࠄߩ ᓟߩᗵᨴ∝ኻ╷දജᒻᘒ߳ߩឭ⸒ ᣂẟᄢቇᄢቇ㒮කᱤቇ✚ว⎇ⓥ⑼ ࿖㓙ᗵᨴකቇ⻠ᐳⴐⴡ↢ቇಽ㊁ ㋈ᧁ ብ ᗵᨴ∝ኻ╷ߦ߅ߌࠆࠤ࠾ࠕߩ࠽ࠟޔࠕࡆࡦࠩޔ㧟⎇ⓥᚲࠍ⸰ߒ✚ޔว⊛ ⹏ଔࠍ⹜ߺߚߩࠄࠇߎޕᣉ⸳ߦ߅ߌࠆᵴേߪ15-25ᐕߦ߽ࠊߚࠅޔ㧟ࠞ࿖ߩᱴߤ ߢߪ࠙ࠗ࡞ࠬቇ⊛ಽ㊁ߣߒߡߪޟή⁁ߩޠᘒ߆ࠄߩ⊒ߢߞߚ߇ޔᣉ⸳ߣ⾗ ᧚ߩឭଏࠍߞߚᛛⴚ⒖ォ᧚ੱޔ⢒ᚑߩ㕙ߢ߽ᄢ߈ߥ⽸₂ࠍߒߚߣᕁࠊࠇࠆޕ ోߣߒޔᚒ⺞ߩޘᩏ⚿ᨐߛߌߢߪߥߊޔWHOߥߤߩ࿖ㅪᯏ㑐ޔᒰ࿖ߩஜ ⋭ࠍߪߓߣߔࠆ㑐ㅪ⻉ቭᐡ⻉ޔᄖ࿖ߩஜ㑐ㅪᯏ㑐ߩߕࠇ߆ࠄ߽㜞⹏ଔ ࠍᓧߡߚޕ ࠣࡠࡃ࡞ൻߣੱㅢᗵᨴ∝ߦࠃࠆᣂ⥝ᗵᨴ∝ߦ߅ߌࠆࠕࡈࠞߥߤߩᾲ Ꮺၞߩ㑐ࠊࠅ߇ࠄ߆ߦߥࠅߩߎޔၞߩᗵᨴ∝⋙ⷞߣኻ╷߇㊀ⷐⷞߐࠇߡ ࠆߩߎޕᄌൻߦട߃⎇ޔⓥᣇᴺߩㄭઍൻߣᗵᨴ∝ኻ╷ߩᄙ᭽ൻ߽ࠆࠇߎޕ ࠄߩ⁁ᴫਅޔᶏᄖߢߩᡰេ߇࿖㓙ஜߩಽ㊁ߦࠅ↢ⴡⴐޔቇ⊛ⷞ㊁߇ේὐ ߦࠆߪ൩⺰ߢࠆ߇ߩߢ߹ࠇߎࠆߌ߅ߦࠞࡈࠕޔ࿖㓙දജᯏ᭴㧔JICA㧕 ߩ⎇ⓥᡰេᒻᘒߩౝኈߣᣇะᕈ߇ᬌ⸛ߐࠇࠆߴ߈ᤨᦼߦ᧪ߡࠆߣᕁࠊࠇࠆޕ ⎇ⓥᡰេߩၮᧄ⊛ᣇะߪޔᗵᨴ∝∉ቇ߳ߩᡰេߢࠅᗵᨴ∝ኻ╷ߩᆎὐߣߥ ࠆޕᣢሽߩᗵᨴ∝ߩߺߥࠄߕᣂ⥝ᗵᨴ∝⊒↢ߩ㓙ߦߪᦨޔㆡߥᓮࡊࡠ ࠣࡓ╷ቯޔෂᯏ▤ℂ߳ߩ⎇ⓥᣉ⸳߆ࠄߩታ㛎ቶ⸻ᢿߦၮߠߊ⾗ᢱࠍឭଏߒ߁ ࠆߩࠇߎޕផㅴᯏ㑐ߣߒߡߩ⎇ⓥቶࠍਛᔃߣߔࠆᡰេᒻᘒߩ㊀ⷐᕈߪ߹ߔ߹ߔ Ⴧടߔࠆߣᕁࠊࠇࠆ⺞ޕᩏኻ⽎ߣߥߞߚ㧟ࠞ࿖ߩ⎇ⓥᣉ⸳ߩᓎഀߣߒߡޔ㐳ᦼ 㑆ߩᗵᨴ∝⎇ⓥᡰេ⛮⛯ߦࠃࠅᦨޔᣂߩᯏ᧚ࠍឥ߃ޔ㜞᳓Ḱߩᛛⴚࠍᜬߟࠬ࠲ ࠶ࡈࠍᠩߔࠆ⎇ⓥᚲߦ⢒ߡߡ߈ߚౕޕ⊛ᵴേߣߒࠝࡐޔᠡṌ߿HIV/AIDSߦ ߅ߌࠆ৻⇟㊀ⷐߣߥࠆታ㛎ቶ⸻ᢿࠍᜂᒰߒߡ߈ߚታ❣ߪޔ᰷☨ߩេഥߣߪ⇣ߥ ߞߚᵴേߣߒߡ㜞ߊ⹏ଔߐࠇߡࠆߩࠄࠇߎޕᚑᨐ߆ࠄޔ᰷☨ฦ࿖ޔ࿖ㅪᯏ㑐 ߆ࠄߩ⒳ߩޘห⎇ⓥⷐ⺧߇Ⴧടߒ⾗ޔ㊄㕙߆ࠄߡ߽ห⎇ⓥ⾌ߩഀวߪჇ ടߒޔJICA߆ࠄߩ⾗㊄េഥߪ⋧ኻ⊛ߦૐߊߥߞߡ߈ߚోޔࠄ߆ߣߎߩߎޕ߆ ࠄࠇ߫ᣣᧄ߽ห⎇ⓥߩ৻ຬߣ⟎ઃߌࠄࠇߟߟߞߚ⎇߫ࠊޕⓥᡰេߣ ߁ࠃࠅߪห⎇ⓥࠍߔࠆ┙႐ߣߥߞߚޕ ৻ᣇޔᣣᧄ࿖ౝߦ߅ߡ߽ᦨㄭෘ↢ഭ⋭߿․ߦᢥㇱ⑼ቇ⋭ߪࠕࡈࠞߥߤ ߩᾲᏪߩ⊒ዷㅜ࿖ߦ߅ߌࠆᗵᨴ∝⎇ⓥᡰេࠍᛂߜߒߡ߈ߡ߅ࠅߢ߹ࠇߎޔ 145 ◲නߦ᧪ߥ߆ߞߚᶏᄖߢߩ⎇ⓥ߇ኈᤃߦߥߞߡ߈ߚޔߒ߆ߒޕߢߩᣂߒ ᄢဳߩᯏ᧚߿ㄭઍ⊛ߥ⎇ⓥߦߞߚ⎇ⓥᣉ⸳ߩ⸳ᡰេߥߤߦኻߒߡߪߎޔ ࠇࠄߩ⎇ⓥ⾗㊄ߢߪᄢ߈ߥ㒢߇ࠅޔJICAߢߩᡰេ߇ᔅⷐߣߐࠇࠆޕᣇࠍ ᄌ߃ࠆߣ⎇ߩࠄࠇߎޔⓥߩ⋧ᚻవߪޔㆊߩJICAߩᗵᨴ∝ኻ╷ᬺߩᑧ㐳߆ࠄ ⴕࠊࠇࠆ߇ᄢඨߢࠅޔᣂߚߥၞߩㆬᛯߦߪߥ㗴߇ᱷߐࠇࠆޕዊߐߥ ࿖߆ࠄߩᗵᨴ∝ߦ㑐ߔࠆេഥⷐ⺧߇ߞߚ㓙ߦߪ⋧ޔᚻ࿖ߩᖱߦࠃߞߡߪ ࿁ߩ⹏ଔߩਛߢ߽․⇣⊛ߥࠩࡦࡆࠕߩߩࠃ߁ߦޔዊߐ⎇ⓥᣉ⸳ߩᑪ⸳߆ࠄ ᆎ߹ࠅߦ⊛⋡ޔᴪߞߚዊဳߩ⎇ⓥᡰេJICAᬺࠍ⛮⛯ߔࠆߪࠆߣᕁࠊࠇ ࠆߩߘޕ㓙ߦߪޔవߦㅀߴߚࠃ߁ߦⴐⴡ↢ቇ⊛ⷞ㊁ߦ┙ߜޔනߦ⎇ⓥᣉ⸳ߩ ᑪ⸳ߦߣߤ߹ࠄߕ߽߆ߒޔᛛⴚᡰេ⹏ଔࠍᔨ㗡ߦ⟎߈ޔᗵᨴ∝ኻ╷ߦ⋥⚿ߔࠆ ࡊࡠࠫࠚࠢ࠻ߣߔߴ߈ߢࠆߩߘޕ㓙ޔ႐วߦࠃߞߡߪᓟߢㅀߴࠆ᳃ෳടဳ ߣߩදหᬺ߽ࠅᓧࠆޕߥಽ㊁ߩᬺዷ㐿ߣߒߡޟޔᛛⴚ⒖ォ᧚ੱޟޔޠ ⢒ᚑࠍޠ㧟ࠞ࿖ߩ⎇ⓥᣉ⸳ࠍ↪ߚ╙㧟࿖⎇ୃߩల߿ᣣᧄ࿖ౝߩ⧯ᚻ⎇ⓥ⠪ ߩ⎇ୃ߽⠨ᘦߔࠆଔ୯߇ࠆߣᕁࠊࠇࠆޕ ߎߎ߹ߢㅀߴߚ⎇ⓥᚲࠍਛᔃߣߔࠆᗵᨴ∝ኻ╷߳ߩ㑐ਈߣߪߥᗵᨴ∝ኻ╷ ⎇ⓥ߽ࠆޕᗵᨴ∝ኻ╷ߪⴕߚ߈ߡࠇࠄ߿ߢ߹ࠇߎޔ߆ࠄߩ߈ߛߌߢߪ ਇචಽߢࠆߎߣ߇⼂ߐࠇߡ߈ߚ⊒ޔߚ߹ޕዷㅜ࿖ߢߪᜂᒰߔࠆක≮ᓥ ⠪ੱ᧚ߩᶏᄖߩᵹᄬߦࠃࠆੱ᧚ਇ⿷߇ࠃࠃᷓೞߥ⁁ᘒߦߥࠅߟߟࠆߎޕ ߩ⁁ᴫ߆ࠄޔ᳃ᵴേߣߩㅪ៤⸒ޔ឵߃ࠇ߫᳃ෳടဳߩᵴേ߇㊀ⷐߣߥࠆޕ ᳃ෳടߦࠃࠆⴐⴡ↢ቇ⊛┙႐ࠍၮᧄߣߒߡ߽߆ߒޔᩕ㙃㗴ߣߩ㑐ㅪ߆ࠄ ㄘᬺ⽺ޔ࿎߆ࠄߩ㑐ㅪ߆ࠄ⚻ᷣޔⅣႺⴡ↢㕙߿ᖚ⠪ャㅍߩ㕙߆ࠄߩᧁ↢ⴡޔ ᢎ⢒⫥ᵴേ߆ࠄቇᩞᢎ⢒╬ߣޘᄙᣇ㕙ߥಽ㊁ࠍ൮ߔࠆᗵᨴ∝ኻ╷߇⠨߃ࠄ ࠇࠆޕᓟߪᄙ㕙⊛ߥኻಣᴺߣ᳃ߩ࠾࠭ߦᴪߞߚᬺߢࠅߪࠇߎޔ᳃ ߩෳട⥄┙⛮⛯ࠍ⿰ᣦߣߔࠆࡊࠗࡑࡋ࡞ࠬࠤࠕߩᬺߢ߽ࠆޕ ᣣᧄߢߪߎߩᵴേߪⴕࠊࠇߡߪ᧪ߚ߇⑼ޔቇ⊛ᩮߦၮߠߊࠝࡍ࡚ࠪ࠽࡞ ࠨ࠴ߩᦝߥࠆផㅴߣJICA߆ࠄߩᣂߚߥᡰេಽ㊁ߣߒߡ⠨߃ࠄࠇࠆޔ߫߃ޕ ࠩࡦࡆࠕߢⴕࠊࠇߟߟࠆGIS㧔ℂᖱႎࠪࠬ࠹ࡓ㧕ߦࠃࠆޔᬺߩડ↹ߣ⹏ଔ ߳ߩ⾆㊀ߥ⾗ᢱࠍឭଏߒߟߟࠆᣂߚߥᵴേಽ㊁߇ࠆޕ 146 ࠕࡈࠞߦᑪ⸳ߐࠇߚᗵᨴ∝ᬌᩏ⎇ⓥᣉ⸳ ࿖┙੍㒐ⴡ↢⎇ⓥᚲ㧔㧕࿖┙ᗵᨴ∝⎇ⓥᚲ ᰴ 㓶 ᣣᧄ࿖㓙දജᬺ࿅㧔JICA㧕ߪᐭ㐿⊒េഥ㧔ODA㧕ߩ৻Ⅳߣߒߡᄙᢙߩ⊒ዷㅜ࿖ߦ ∛㒮ޔᬌᩏ⎇ⓥᣉ⸳ࡦ࠴ࠢࡢޔㅧᣉ⸳ߥߤߩකቇ㑐ㅪᣉ⸳ࠍᑪ⸳ߒߡ߈ߚ߮ߚߩߎޕ ࠕࡈࠞߦᑪ⸳ߒߚ 3 ߆ᚲߩᗵᨴ∝ᬌᩏ⎇ⓥᣉ⸳ߩᴫ⺞ᩏ߇ⴕࠊࠇߚޕኻ⽎ᣉ⸳ߪ 1986 ᐕߦᑪ⸳ߐࠇߚࠟ࠽ᄢቇߩ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔㊁ญ⎇㧕ޔ1979 ᐕએ᧪ߩ㐳ઃ߈วߢ ࠆࠤ࠾ࠕߩਛᄩකቇ⎇ⓥᚲ㧔KEMRI㧕ޔ1989 ᐕߦᑪ⸳ߐࠇߚࠩࡦࡆࠕᄢቇઃዻᢎ⢒∛㒮 ߩ࠙ࠗ࡞ࠬ߮⚿ᩭᬌᩏቶ㧔UTH㧕ߢࠆߡߟ߆ޕ᰷☨⻉࿖߇ޔᬀ᳃⚻༡ࠍ⋡⊛ߣߒߡޔ ߎߩ⒳ߩᣉ⸳ࠍฦߦᑪ⸳ߒߚߎߣ߇ࠅޔᣣᧄ߽ޔบḧᦺޔ㞲ޔḩᎺߥߤߦᄢቇ߿⎇ⓥ ᣉ⸳ࠍᑪ⸳ߒߚޕᚢ೨ߩᣉ⸳ߪᬀ᳃ߦ߅ߌࠆ⥄࿖᳃ߩ⼔ߣ߆⥄ޔ࿖ߩᐲߩㆡ↪ࠍ⋡ ⊛ߣߒߡᑪ⸳ߐࠇߚ߇ޔODA ߪ࿖㓙␠ળߩᐔߣ⊒ዷ߳ߩ⽸₂ࠍ⋡⊛ߣߒߡ⊒ዷㅜ࿖ߩ ⥄ഥദജࠍᡰេߔࠆ߽ߩߢޔᚢ೨ߣߪోߊ⇣⾰ߢࠆޕ ⎇ⓥߣߪᧂ⍮ߩ‛߿⽎ࠍ⑼ቇ⊛ߦ⸃ߔࠆ⍮⊛ᵴേߢࠆ߇ޔᢎ⢒ߣ߆⚻ᷣ⊛ ߥߤߩ␠ળ⊛ߥၮ⋚߇ᔅⷐߢࠆ⎇ޕⓥᣉ⸳ࠍᜬߜߚߣ㗿ᦸߒߡࠆ⊒ዷㅜ࿖ߪޔេ ഥࠍฃߌߡᑪ⸳ࠍᜬߟߎߣ߇᧪ߡ߽⥄ޔഥദജߦࠃࠆ⛽ᜬㆇ༡ߪኈᤃߢߪߥޕ࿁ߩ ⺞ᩏኻ⽎ᣉ⸳߽ೋᦼߩេഥᦼ㑆߇⚳ੌߒޔࠇߙࠇߘޔᄢቇޔᐭߥߤߩᚲዻᯏ㑐ߣߒߡ⁛ ⥄ߩࠍᱠࠎߢࠆޕᓥߞߡޔ࿁ߩ⺞ᩏߪ⥄ഥദജߩ⺞ᩏߣ߃ࠆޕฦᣉ⸳߇߁߹ߊᯏ ⢻ߒߡࠇ߫⋧ޔᚻߩ⥄ഥദജߩᚑᨐߢࠆ߇ޔᣣᧄߪᱜߒេഥࠍⴕߞߚߣ⹏ଔߢ ߈ࠆޕㅒߦ㗴ࠍᛴ߃߁߹ߊᯏ⢻ߒߡߥ႐วߦ⋧ޔᚻߩ⽿છࠍ♾ߔࠆߎߣߪ᧪ ߥޕេഥߒߚߩ⽿છ߇ࠊࠇࠆ⸶ߢޔଥࠊߞߚᣇߩޘ㐳ᐕߩദജ߇ႎࠊࠇߥ߫߆ࠅ ߢߥߊޔ⒢㊄ߩή㚝ߣ߁ߎߣߢޔJICA ߣߒߡߪޔ࿖᳃ߦ⋧ᷣ߹ߥߎߣߦߥࠆޕ ᗵᨴ∝ߩᬌᩏ⎇ⓥᯏ㑐 ᗵᨴ∝ߪᓸ↢‛߿ነ↢⯻ߥߤߩ∛ේ߇ᗵᨴߒߡ⊒↢ߔࠆ∛᳇ߢࠆ∛ޕේߩ⒳㘃߇ ᄙ߫߆ࠅߢߥߊޔᗵᨴ⚻〝߽ⶄ㔀ߢࠆޕᗵᨴ∝ߦߪޔ⎕்㘑ߥߤߩࠃ߁ߦᗵᨴ⠪ߛߌ ߇⊒∛ߒޔ࿐ߦᐢ߇ࠄߥ߽ߩ߽ࠆ߇ޔߦᤨޔߪߤߥࠩࡦࠛ࡞ࡈࡦࠗޔᄢᵹⴕࠍߔޕ ᄢᵹⴕߩᕟࠇߣ߆ේ࿃ਇߩ㊀◊ߥᗵᨴ∝ߩ⊒↢ߪ␠ળਇߩේ࿃ߣߥࠆޕᄢ߈ߥ⚻ᷣ⊛ ៊ᄬ߇⊒↢ߔࠆᕟࠇ߇ࠅޔ࿖ኅ⊛ᚗߪ࿖㓙⊛ߥኻ╷߇ᔅⷐߦߥࠆޕᗵᨴ∝ࠍߒޔ ਇࠍ㒰ߔࠆߚߦߪ⸻ޔᢿᴺޔᴦ≮ᴺ੍ޔ㒐ᴺߥߤࠍ⏕┙ߒߥߌࠇ߫ߥࠄߥޔߦᦝޕ ᵹⴕ㒖ᱛߩߚߦߪ␠ળᵴേߣ߆↢ᵴߩⷙߥߤ߽ᔅⷐߢࠆ∛ޕ㒮ߥߤߩක≮ᣉ⸳ޔᬌ ᩏ⎇ⓥᯏ㑐ⴕޔޔᴺᓞߥߤࠍᢛߒ੍ޔ㒐ធ⒳ࠍ᥉ߒߥߌࠇ߫ߥࠄߥޕ ᗵᨴ∝ߩᬌᩏ⎇ⓥᯏ㑐ߩⴕ߁ᬺോߪ∛ޔߪߦ⊛⥸৻ޔේ∛⊒ޔᯏᐨޔ㒐ᓮᯏᐨߥߤ ߩ⸃⎇ⓥ⸻ޔᢿᴺޔࡦ࠴ࠢࡢޔᴦ≮⮎ߥߤߩ㐿⊒⎇ⓥ∛ޔේߩಽ㔌ޔหቯⴊޔᷡᬌᩏ 147 ߥߤߩ⸻ᢿᬺോ∛ߣ∛∔ޔේߩታ⺞ᩏ㧔ࠨࡌࠗ㧕ޔࡦ࠴ࠢࡢޔ᛫ⴊᷡޔ᛫⩶ޔ᛫࠙ ࠗ࡞ࠬޔᄖ⸻ᢿ⮎ߥߤߩຠ⾰▤ℂᬺോ⥃ޔᐥ⸻ᢿߣᴦ≮⎇ⓥߥߤߢࠆޕ࿁ߩ⺞ᩏ ኻ⽎ᣉ⸳ߪߩࠇߙࠇߘޔ࿖ߩᗵᨴ∝ኻ╷ߩਛᔃ⊛ߥᓎഀࠍᜂ߁ᬌᩏ⎇ⓥᯏ㑐ߢࠆ߇ޔ ਛᄩᯏ㑐ߪޔ⸥ߩᬺോߦട߃ߡޔ࿖ౝߩᬌᩏᯏ㑐߆ࠄߩᆔ⸤ᬌᩏߩᒁ߈ฃߌߣⴕᐭߦ ኻߔࠆ⑼ቇ⊛ᩮߦၮߠߊ╵↳ޔഥ⸒ޔឭ⸒ߥߤߩ⟵ോࠍᜬߞߡࠆޕ ߎߩ᭽ߥਛᄩᯏ㑐ߩⷙᮨߣ߆⒳㘃ߪ࿖ߦࠃࠅ⇣ߥߞߡࠆ☨ޕ࿖ߦߪ࿖┙ஜᐽ⎇ⓥᚲ 㧔NIH㧕∛∔ޔᓮࡦ࠲㧔CDC㧕ޔක⮎㘩ຠዪ㧔FDA㧕ߩ㧟ᄢᯏ㑐߇ࠅޔNIH ߇ၮ␆ ⎇ⓥߣ㐿⊒⎇ⓥޔCDC ߇․ᱶ⸻ᢿߣታ⺞ᩏޔFDA ߇ຠ⾰▤ℂᬺോࠍಽᜂߒ⥃ޔᐥᴦ≮ ⎇ⓥߪ NIHޔᄢቇ╬ߩઃዻ∛㒮߇ⴕߞߡࠆޕᣣᧄߢߪᗵᨴ∝⎇ⓥᚲ㧔ᗵᨴ⎇㧕߇ၮ␆ 㐿⊒⎇ⓥޔຠ⾰▤ℂᬺോޔታ⺞ᩏᬺോ╬ࠍⴕ․ޔᱶ⸻ᢿߣ߆ࠨࡌࠗᬺോߪᣇⴡ↢ ⎇ⓥᚲߥߤߣߩࡀ࠶࠻ࡢࠢߦࠃࠅኻᔕߒߡࠆޕᗵᨴ⎇ߪ☨࿖ߩ㧟ᄢ⎇ⓥᯏ㑐ߣߪᲧセ ߦߥࠄߥᒙዊᯏ㑐ߢࠆޕᣣᧄߩၮ␆㐿⊒⎇ⓥಽ㊁ߪᄢቇߩ⎇ⓥᯏ㑐߇ୟ⊛ߢࠆ ߇ޔવ⛔⊛ߦᄢቇ߇⎇ⓥߩਛᔃ⊛ߥᓎഀࠍᜂߞߡ߈ߚߚߢࠆޕᗵᨴ∝ߩᬌᩏ⎇ⓥᯏ 㑐ߪޔᴦ 25 ᐕ㧔1892 ᐕ㧕ߦർ㉿ᩊਃ㇢ࠍㄫ߃ߡഃ⸳ߐࠇߚౝോ⋭ᚲ▤ߩવᨴ∛⎇ⓥᚲ ߆ࠄᆎ߹ࠆߣߐࠇߡࠆޕౝോ⋭ߣߩขࠅวࠊߖ߇⦟ߊߥ߆ߞߚߚ߆ޔᓟߦޔᢥㇱ⋭ߦ ⒖▤ߐࠇߡ᧲੩Ꮲ࿖ᄢቇߩઃዻ⎇ⓥᚲߦߥࠅޔർ㉿ߪㅌቭߒߡ⁛⥄ߦ⎇ⓥᚲࠍ⸳┙ߒߚޕ વᨴ∛⎇ⓥᚲߪᣣᧄߩᗵᨴ∝ਛᄩ⎇ⓥᯏ㑐ߣߒߡ⊒ዷߒߪߦᦼ⋓ᦨޔၮ␆㐿⊒⎇ⓥ߫߆ ࠅߢߥߊ⥃ᐥ⸻ᢿᴦ≮⎇ⓥߩߚߩઃዻ∛㒮ࠍᜬߜⴊ߿ࡦ࠴ࠢࡢޔᷡ≮ᴺߩㅧ߆ ࠄຠ⾰▤ℂᬺോ߹ߢࠍᚻ߇ߌࠆޔᄢ߈ߥ⚵❱ߦߥߞߚޕᢌᚢᓟޔභ㗔ァߩᜰዉߦࠃࠅવ⎇ ߇⸃ౣ✬ߐࠇ‛↢ޔߥߤߩຠ⾰▤ℂᬺോߥߤࠍಾࠅ㔌ߒߡෘ↢⋭ᚲ▤ߩ੍㒐ⴡ↢⎇ ⓥᚲ߇ഃ⸳ߐࠇߚޕߩᗵᨴ⎇ߪ੍㒐ⴡ↢⎇ⓥᚲߣࡂࡦࡦ∛ߩ⎇ⓥᯏ㑐ߢߞߚᄙ ⎇ⓥᚲ߇⛔วߐࠇߚ߽ߩߢࠆޕ ࿁ߩ⺞ᩏኻ⽎ߢࠆᬌᩏ⎇ⓥᣉ⸳ߪޔฦ࿖ߩᗵᨴ∝ᬌᩏ⎇ⓥߩਛᔃ⊛ᣉ⸳ߢࠆ ߇ޔㅀߩ᭽ߦޔ㊁ญ⎇ߪࠟ࠽ᄢቇઃዻ⎇ⓥᚲޔKEMRI ߪࠤ࠾ࠕ࿖ⴐⴡ↢⋭ᚲ▤ߩ⎇ ⓥᚲޔUTH ߪᄢቇઃዻ∛㒮ߩᬌᩏᣉ⸳ߢࠆޕ ߒ߆ߒᣣᧄߦ߅ߌࠆᄌㆫߢࠄ߆ߥࠃ߁ߦޔ ᗵᨴ∝ߩᬌᩏ⎇ⓥࠍⴕ߁ਛᄩᯏ㑐ߪߩࠇߙࠇߘޔ࿖ኅߩ⊒ዷᲑ㓏ߦ⋧ᔕߒᆫ߇ᒰὼߢ ࠆޕ㊀ⷐߥߎߣߪޔㅀߩਛᄩᯏ㑐ߣߒߡߩ⽿ോࠍᨐߚߒ߇ࠇߘޔ࿖ౝ߮࿖㓙⊛ߦ ⍮ߐࠇߡࠆߎߣߢࠆޕ ਛᄩᗵᨴ∝ᬌᩏ⎇ⓥᯏ㑐ߩ㊀ⷐᕈ 20 ♿ߪ⑼ቇᛛⴚ߇ᕆㅦߦ⊒ዷߒߚ♿ߢࠆޕᗵᨴ∝ߩಽ㊁ߢߪޔ᛫↢‛⾰੍ޔ㒐ࡢ ࠢ࠴ࡦߥߤߩᒝജߥኻ᛫ᚻᲑ߇㐿⊒ߐࠇߚ⋥ߩࠄࠇߎޕធലᨐߣޔਅ᳓ߥߤߩⅣႺⴡ ↢ߩᡷༀޔ಄ᯏེߦࠃࠆ㘩ຠක⮎ຠ╬ߩሽቯᕈߩᡷༀޔක≮ᛛⴚߩㅴᱠޔᢎ⢒ ࡑࠬࡔ࠺ࠖࠕߥߤߦࠃࠆⴡ↢⍮⼂ߩ᥉ޔ㔚ሶㅢାߩ⊒㆐ߦࠃࠆᖱႎવ㆐ߩᡷༀޔᩕ㙃ᡷ ༀޔᴺᢛߥߤߦࠃࠆ㑆ធലᨐ߇⋧ਸ਼ߒߡޔᗵᨴ∝ኻ╷߇⋡ⷡߒߊㅴዷߒߚ⚿ߩߘޕᨐޔ ⇇ਛߩᗵᨴ∝߇ỗᷫߒߚޕ⇇ஜᯏ㑐㧔WHO㧕ࠍਛᔃߣߔࠆ࿖㓙ද⺞ᵴേߦࠃࠆᄤὼ 148 ∧ߩ߆ࠄߩᠡṌߪ⽎ޔࠅߢ⊛ᦼ↹ޔᓽ⊛ߥᚑᨐߢࠅߦ⊛ᤨ৻ޔᗵᨴ∝ߪ⸃ߒ ߚߣߩᐛᗐࠍᛴ߆ߖߚߒ߆ߒޕᗵᨴ∝ߪੱ㘃ߣ߁↢‛ߣ∛ේߣ߁↢‛ߩ㑵ߢࠅޔ ◲නߦൎ⽶ߪ߹ࠄߥޕ♿ᧃߦߪㆊᐲߩ㐿⊒ޔㅢᚻᲑߩ⊒㆐ߥߤߦࠃࠅޔ࠭ࠗࠛޔ SARS ߥߤߩᣂ⥝ᗵᨴ∝ߣ߆⚿ޔࠕࡑޔᩭߥߤߩౣ⥝ᗵᨴ∝ޔMRSA ߥߤߩ⠴ᕈ⩶ᗵ ᨴ∝㗴ޔⴊᕈᄢ⣺⩶ᗵᨴ∝ߥߤߩੱ⇓ㅢᗵᨴ∝㗴⋧߇ޘ╬ޔᰴߢᶋߒߚޕ ᷷ᥦൻߩㅴⴕߦࠃࠅޔᓟࠣࡦ࠺ޔࠕࡑޔᾲߥߤߩ᷷ᥦၞߦ↢ᕷߔࠆᇦⰆߦࠃ ࠆ∔ᖚ߇ᄢߔࠆߢࠈ߁ߣ੍᷹ߐࠇߡࠆޕ᷷ᥦൻߦࠃࠆ᳇ߩᄌൻߪޔᵩ᳓ߥߤߩἴ ኂࠍ߽ߚࠄߒޔౝੂޔ᛫ߥߤߪᄙᢙߩ㔍᳃ࠍ⊒↢ߐߖࠆޕἴኂⵍἴޔ㔍᳃ኈᚲߥߤ ߩᗵᨴ∝߽ᷓೞߢࠆߥ߁ࠃߩߎޕᣂߚߥዷ㐿߇␜ߔࠃ߁ߦੱޔ㘃ߣᗵᨴ∝ߣߩ㑵ߦߪ ⚳ࠊࠅ߇ߥޕ వㅴᎿᬺ⻉࿖ߢߪޔਛᄩᗵᨴ∝⎇ⓥᯏ㑐ࠍਛᔃߣߔࠆ⎇ⓥࡀ࠶࠻ࡢࠢߥߤߩද⺞ᬺ ߦࠃࠅޔᲧセ⊛⍴ᦼ㑆ߩ߁ߜߦᄙߊߩ㗴ࠍ⸃ߒߚోޕ㕙⸃߇࿎㔍ߥ∔∛ߦߟߡ߽ ࠆ⒟ᐲߩᓮ߇น⢻ߦߥߞߚޔ᧚ੱߒ߆ߒޕᣉ⸳⾗ޔ㊄ߥߤ߇ਲߒ⊒ዷㅜ࿖ߢߪޔ 㗴߇৻ጀᷓೞൻߒߡࠆޕᗵᨴ∝߽ઁಽ㊁ߩ㗴ߣห᭽ߦ↢⊒ޔ႐ߢޔේ࿃⺃ޔ࿃ޔ ߘߩઁߩഥ㐳ߔࠆ⻉㗴ࠍ⏕ߒߡኻಣߒߥߌࠇ߫߇࿎㔍ߢࠆⴕޕߩ᳞ߦኻߒޔ ⑼ቇ⊛ᩮߦၮߠߊ࿁╵ޔഥ⸒ޔឭ⸒ߥߤࠍⴕ߁⟵ോࠍᜬߟᗵᨴ∝ߩਛᄩᬌᩏ⎇ⓥᯏ㑐 ߪᄙߊߩ㗴ࠍᛴ߃ߡࠆㅜ࿖ߦߎߘᔅⷐߣ⸒߃ࠆޕᗵᨴ∝ߦ⧰ߒห⢩ߩ㗴⸃ߦ ⋉ߢࠆ߫߆ࠅߢߥߊޔWHO ߥߤࠍਛᔃߣߔࠆᗵᨴ∝ߩᬌᩏ⎇ⓥߩ࿖㓙ࡀ࠶࠻ࡢࠢ ߦෳടߔࠆߎߣߦࠃࠅޔ⇇ߩੱߩޘஜᐽჇㅴߦ⽸₂ߔࠆ߽㐿߆ࠇࠆޕ ߒ߆ߒ⊒ޔዷㅜ࿖ߦ߅ߌࠆ⎇ⓥᯏ㑐ߩ┙ߜߍߪᭂߡ࿎㔍ߥᬺߢࠆޕᄙߊߩ࿖ ߦߪ⎇ⓥᚲࠍᡰ߃ࠆੱ᧚߇ਲߒޕකቇ‛↢ޔቇಽ㊁ߩ㜞╬ᢎ⢒ࠍฃߌߚੱߦ㒢ࠄߕޔᄙ ߊߩ႐วޔቇᬺᚑ❣߇ఝ⑲ߥੱ߶ߤᢎ⑼ᦠ߆ࠄቇ߱ߎߣߪᓧᚻߢࠆ߇⎇ޔⓥቶߢߩᬺ ߇⧰ᚻߢࠆޕఝࠇߚᜰዉ⠪ߦࠃࠆታ㛎ቶ⸠✵ࠍฃߌߥߢஉߊߥࠆߣޔᭂ┵ߥ႐วߪޔ ᄬᢌࠍᕟࠇߡታ㛎ቶᬺ߇᧪ߥ႐ว߇ࠆޕᣣᧄߩ⎇ⓥ⠪ߪ⥄ࠄᚻࠍേ߆ߔߎߣࠍ ࠊߥ߇ޔᵷ㆜ߐࠇߚᜰዉ⠪߇⥄ಽߢᬺࠍߒߡߒ߹߃߫ޔੱߪᗵᔃߔࠆߛߌߢ߅ޔ ᚻᧄߦߥࠄߥߎߣ߽ࠅߥ߁ࠃߩߎޔᆫࠍߖࠆߎߣߦࠃࠅ߇᧚ੱޔ⢒ߟ႐ว߽ࠆޕ ߎࠇࠄߩᬌᩏ⎇ⓥᣉ⸳ߩ┙ߜߍ߆ࠄᒁᷰߒ߹ߢߩᦼ㑆ޔᄙᢙߩᗵᨴ∝ಽ㊁ߩవヘߚߜ ߪᧄᒰߦ⧰ഭࠍߐࠇߚߎߣߣᕁ߁ޕᐘߥߎߣߦޔ3 ߆ᚲߩᬌᩏ⎇ⓥᣉ⸳ߪޔᣣᧄߩេഥ ߦࠃࠅ⸳⟎ߐࠇߚవ┵ᯏེߣవヘߚߜߩ⧰ഭߦࠃࠅ⢒ߞߚੱ᧚ߦࠃࠅޔ࿖ౝߩߺߥࠄߕޔ ࿖ᄖ߆ࠄ߽㜞⹏ଔࠍฃߌߡࠆࠃ߁ߢࠆߪߢޕฦ⒳ᗵᨴ∝ߩᬌᩏቶߣߒߡ WHO ߩ ⍮ࠍฃߌޔදജᬌᩏቶߩᜰቯࠍฃߌߡࠆߦᦝޕవㅴ⻉࿖ߩᄢቇߣ߆⎇ⓥᯏ㑐ߣߩห ⎇ⓥ߽ⴕࠊࠇߡࠆߪࠄࠇߎޕᗵᨴ∝ߩᧄ႐ߦᣣᧄ߇ᑪ⸳ߒߚᣉ⸳ߢࠆޕᓟޔᄙᢙߩ ᣣᧄߩ⎇ⓥ⠪߇ߦਸ਼ࠅㄟߺޔห⎇ⓥࠍᆎࠄࠇࠆߎߣࠍ㗿ߞߡࠆޕ 149 ․ቯ࠹ࡑ⹏ଔࠞࡈࠕޟᗵᨴ∝ኻ╷⎇ⓥߡߟߦޠ ┙㙚ࠕࠫࠕᄥᐔᵗᄢቇᄢቇ㒮 ࠕࠫࠕᄥᐔᵗ⎇ⓥ⑼ ਃᅢ ⊥৻ ᧄ⹏ଔႎ๔ᦠߪޔኻࠕࡈࠞஜᬺߣߒߡᗵᨴ∝ኻ╷ߩ㊀ⷐಽ㊁ߣߒߡታᣉߒߚࠟ࠽ ࿖㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔㊁ญ⎇㧕ࠕ࠾ࠤޔ࿖ࠤ࠾ࠕਛᄩක≮⎇ⓥᚲ㧔KEMRI㧕ࠕࡆࡦࠩޔ ࿖ࠩࡦࡆࠕᄢቇઃዻᢎ⢒∛㒮㧔UTH㧕ࠍ⎇ⓥᯏ㑐ߦኻߔࠆදജߩࠤࠬߣߒߡណࠅߍ⹏ ଔࠍታᣉߒߚ߽ߩߢࠆ⹏ᧄޕଔߪޔJICA ߩදജኻ⽎ᯏ㑐߳ߩᛛⴚ⒖ォࠍ⋡⊛ߣߒߚౖဳ ⊛ߥදജߦኻߔࠆ⹏ଔߢࠆ߇ޔදജኻ⽎ᯏ㑐ߢࠆฦ⎇ⓥᯏ㑐ߩ⹏ଔߦ⇐߹ࠄߕ․ቯ ᩺ઙߩ⹏ଔࠍ߃ߡ⎇ⓥᯏ㑐߳ߩදജߩ൮⊛ߥ⹏ଔ⚿ᨐࠍᓧࠆߣߣ߽ߦᓟߩ⎇ⓥᚲ ߳ߩදജߦኻߔࠆឭ⸒ࠍឭ␜ߒߡ߅ࠅ⥝߽ᷓߩߣߥߞߡࠆ⹏ᧄޔߚ߹ޕଔߪ⹏ޔଔኻ ⽎⎇ⓥᯏ㑐߿ JICA ߩදജߩᄌㆫߩ⏕ൻ⎇ޔⓥᯏ㑐ߩᯏ⢻ᓎഀࡕ࠺࡞ߣ⹏ଔߩಽᨆᨒ⚵ ߺߩ⸳ቯߥߤ⹏ଔᚻᴺߦߟߡ߽↪ߥ␜ໂࠍឭ␜ߒߡࠆޕ એਅ⹏ᧄޔଔႎ๔ᦠߦߟߡએਅߩ 3 ὐߦߟߡࠦࡔࡦ࠻ߔࠆޕ 㧝 ⹏ଔߦ߅ߌࠆࡊࡠࠫࠚࠢ࠻ߩᄌㆫߩ⏕ൻߩ㊀ⷐᕈ ᧄ⹏ଔߢߪޔදജኻ⽎⎇ⓥᯏ㑐ߩᄌㆫࠍᝒ߃දജࡊࡠࠫࠚࠢ࠻ߩ⹏ଔࠍⴕߞߡࠆޕදജ ኻ⽎ߢࠆ⎇ⓥᯏ㑐ߪᤨߩ⚻ㆊߣߣ߽ߦᄌൻߒߡ߅ࠅߥ߁ࠃߩߎޔදജኻ⽎⎇ⓥᯏ㑐ߩᄌㆫ ߪޔJICA ߩදജࡊࡠࠫࠚࠢ࠻⥄ߩᓎഀ߿⊒ዷࠍᄢ߈ߊⷙቯߔࠆޕJICA ߩදജࠍ⹏ଔߔࠆ ߦߪߥ߁ࠃߩߎޔᄌൻࠍ〯߹߃ߡ⎇ⓥᯏ㑐ߩᄌㆫߩᢥ⣂ߩਛߢ⹏ଔࠍ߅ߎߥ߁ߎߣ߇㊀ⷐߢ ࠆ⹏ᧄޕଔߢߪߩ❱⚵ߥ߁ࠃߩߎޔᄌൻࠍㆡಾߦᝒ߃ࠆദജߥ߁ࠃߩߎޔߚ߹ޔᄌൻߦ߅ ߌࠆ JICA ߩදജࠍ⟎ߠߌࠆദജ߇ⴕࠊࠇߡࠆޕ ⹏ଔኻ⽎ߩ⎇ⓥᯏ㑐ߦߟߡߪޔJICA ߇ߘࠇߙࠇߩᯏ㑐ߩ⸳┙߆ࠄ㑐ࠊࠅᄙᄢߥᓇ㗀ࠍ ਈ߃ߡࠆߎߣࠍࠄ߆ߦߒߡࠆ⹏ޕଔኻ⽎ߣߥߞߡࠆ㊁ญ⎇ޔKEMRI ߪᣂ⸳ߩ⚵❱ ߢࠅޔᛛⴚදജߦട߃ޔήఘ⾗㊄දജߦࠃߞߡᣉ⸳ߩᢛ߇ⴕࠊࠇߡࠆޔߚ߹ޕUTH ߦኻߒߡᛛⴚදജߩᣉ⸳ᢛ⾌ࠍ↪ᣉ⸳ࠍᢛߒߡࠆઁޕᣇ⹏ޔଔߪ⚻ߩᤨޔㆊߣ߽ߦ JICA ߩදജߩഀวޔᓎഀ߇ᓢߦޘዊߐߊߥߞߡߞߚߎߣ߽ࠄ߆ߦߒߡࠆ⹏ޔߚ߹ޕ ଔߪ JICA ߩදജߩផ⒖ࠍ⎇ⓥᯏ㑐ߩ⊒ዷߦೣߒߡᢛℂߒߘߩᓎഀࠍㆡಾߦᛠីߒߡ߅ࠅޔ JICA ߩදജ߇ߘࠇߙࠇߩ⎇ⓥᯏ㑐ߩࡊࡠࠫࠚࠢ࠻ߦὶὐࠍᒰߡߚදജࠕࡊࡠ࠴ߢ ࠆߎߣࠍࠄ߆ߦߒߡࠆ⊒ߪ❱⚵ߦ⥸৻ޕዷߣߣ߽ߦߘߩ╷ᚢ⇛ࠍࠄ߆ߦߒ╷ޔቯ ߒߚ╷ߩਅߦᬺߜࠊߥߔޔࡊࡠࠫࠚࠢ࠻ࠍዷ㐿ߒߡߊߎߣߦߥࠆ߁ࠃߩߎޕ ߥ⚵❱ߩ⊒ዷߩᢥ⣂ߩਛߢޔJICA ߩදജߪޔ╷ᚢ⇛ߦኻߒߡࠃࠅޔߩޘᬺࡠࡊޔ ࠫࠚࠢ࠻߳ߩදജߦὶὐࠍᒰߡߡታᣉߐࠇߡࠆߎߣ߇ࠃߊ⸃ࠆޕ 㧞 ᗵᨴ∝ኻ╷⎇ⓥᯏ㑐ߩᯏ⢻ᓎഀࡕ࠺࡞ߩ⸳ቯߣࡊࡠࠣࡓ⹏ଔߩน⢻ᕈ ᧄ⹏ଔߢߪޔᣣᧄ☨ޔ࿖⧷ޔ࿖ߦ߅ߌࠆᗵᨴ∝ኻ╷⎇ⓥᯏ㑐ߩᯏ⢻ᓎഀࠍࡆࡘߒޔ ࡆࡘ⚿ᨐࠍၮߦᗵᨴ∝ኻ╷⎇ⓥᯏ㑐ߩᯏ⢻ᓎഀࡕ࠺࡞ࠍ⸳ቯߒࠍࠇߎޔಽᨆߩᨒ⚵ߺ ߣߒߡ⹏ଔࠍⴕߞߡࠆ⹏ߥ߁ࠃߩߎޕଔߩᨒ⚵ߺࠍ⸳ቯߒߡ⹏ଔߔࠆߎߣߦࠃߞߡ⹏ޔଔ ኻ⽎⎇ⓥᯏ㑐ߩฦ࿖ߩᗵᨴ∝ኻ╷ߦ߅ߌࠆ⟎ߠߌࠍ⏕ߦߒ߃ࠆߣߣ߽ߦޔฦ⎇ⓥᯏ㑐ߩ ᯏ⢻ޔᓎഀ߇⏕ߦߔࠆߎߣ߇ߢ߈⹏ޔଔኻ⽎ߩࡊࡠࠫࠚࠢ࠻ߩ⟎ߠߌ߽⏕ߔࠆߎߣ߇ ߢ߈ߡࠆޕ࿁ኻ⽎ߣߒߚ JICA ࡊࡠࠫࠚࠢ࠻ߦߟߡㆊߦታᣉߐࠇߚ⹏ଔߢߪޔኻ⽎ ⎇ⓥᯏ㑐ߩᯏ⢻ޔᓎഀ߇⏕ߦߐࠇߡ߅ࠄߕޔኻ⽎ࡊࡠࠫࠚࠢ࠻ߦ⹏ଔߩὶὐ߇ᒰߡࠄࠇߡ ߚ⹏ߥ߁ࠃߩߎޕଔߢߪ⚿ޔᨐߣߒߡࡊࡠࠫࠚࠢ࠻ࠍታᣉߒߡࠆදജኻ⽎⎇ⓥᯏ㑐ߩᯏ ⢻ᓎഀ߇ℂ⸃ߐࠇߕޔߪߡ߭ޔදജࡊࡠࠫࠚࠢ࠻ߩᓎഀߩᛠី߽ㆡಾߥ߽ߩߣߪߥࠄߕޔ ㆊዊߥ⹏ଔ߇߅ߎߥࠊࠇࠆะߦߞߚ⹏ᧄޕଔߦࠃߞߡ⹏ޔଔኻ⽎ᯏ㑐ޔදജࡊࡠࠫࠚࠢ ࠻ߩㆡᱜߥ⹏ଔ߇น⢻ߦߥߞߚߣ⠨߃ࠆޕ 150 ߹ߚߥ߁ࠃߩߎޔኻ⽎ᯏ㑐ߩᯏ⢻ᓎഀߩ⏕ൻߪޔኻ⽎ಽ㊁ߩදജᵴേࠍᗵᨴ∝ኻ╷ߩ ࡊࡠࠣࡓߣߒߡᝒ߃ࠆน⢻ᕈࠍ␜ໂߒߡࠆߩࠇߙࠇߘߩࠕࡆࡦࠩޔࠕ࠾ࠤޔ࠽ࠟޕ࿖ ߢߪஜᚢ⇛⸘↹߇ታⴕᕈࠍᜬߟ߽ߩߣߥߞߡ߈ߡࠆޕ╷ޔᣉ╷߇ࠄ߆ߦߥࠅࡠࡊޔ ࠣࡓࠕࡊࡠ࠴ߪ㊀ⷞߐࠇࠆࠃ߁ߦߥߞߡ߈ߡ߅ࠅޔฦදജࡊࡠࠫࠚࠢ࠻ߩ⟎ߠߌߩ ⏕ൻ߇㊀ⷐߦߥߞߡ߈ߡࠆ⹏ᧄޕଔߪߦ⺧ⷐߥ߁ࠃߩߎޔᔕ߃ࠆ߽ߩߢࠅ⎇ޔⓥᯏ㑐 ߩᯏ⢻ᓎഀࠍ⏕ߦߔࠆߎߣߦࠃߞߡޔJICA ߩදജࠍࡊࡠࠣࡓߣߒߡ⼂ߔࠆᄾᯏࠍ ਈ߃ࠆ߽ߩߣ߽ߥߞߡࠆޕ 㧟 ࠕ࠙࠻ࠞࡓߩ㊀ⷞߣ⎇ⓥᯏ㑐ߦኻߔࠆදജࠕࡊࡠ࠴ߩᔅⷐᕈ ᧄ⹏ଔߢ߹ߛචಽߥ⼏⺰߇ߢ߈ߡߥ߆ߞߚὐߣߒߡ⎇ޔⓥᯏ㑐߳ߩදജࡊࡠࠫࠚࠢ࠻ߩ ࠕ࠙࠻ࠞࡓߣࠕ࠙࠻ࡊ࠶࠻ߦߟߡߩᦝᬌ⸛ߩᔅⷐᕈࠍᜰ៰ߒߡ߅߈ߚޔߪࠇߎޕၮᧄ⊛ ߦߪߩ߳࠴ࡠࡊࠕࡓࠣࡠࡊࠄ߆࠴ࡠࡊࠕ࠻ࠢࠚࠫࡠࡊޔᄌ឵ߣⵣࠍߥߔ߽ߩߣ ⠨߃ߡࠆޕ ৻⥸⊛ߦᧄઙߩࠃ߁ߥ⎇ⓥᯏ㑐߳ߩ JICA ߩදജߢߪޔኻ⽎දജᯏ㑐߇⎇ⓥታᣉ⢻ജࠍ⏕ ߔࠆߎߣࠍ⋡⊛ߣߒߡࠆߎߣ߇ᄙ⎇ޔߦ߃ࠁࠇߘޕⓥᯏ㑐ߩ⎇ⓥታᣉ⢻ജߩ⏕ߦࠃ ߞߡᛛⴚදജߩᔅⷐᕈߪḩߚߐࠇߚ߽ߩߣߥࠅදജࠍ⚳ੌߔࠆߣ߁ߩ߇৻⥸⊛ߥ⠨߃ᣇߣ ߒߡᶐㅘߒߡࠆࠃ߁ߦฃߌࠄࠇࠆޕ㧔ߎߩࠃ߁ߥࠕࡊࡠ࠴ߪޔදജኻ⽎ᯏ㑐߇⎇ⓥ⢻ ജࠍะߐߖࠆߦᓥޔදജࠍჇ߿ߒߡߊࠆઁេഥᯏ㑐߿㑐ㅪᯏ㑐ߩࠕࡊࡠ࠴ߣ㆑߇ ࠄࠇࠆޕ㧕 ߒ߆ߒߥ߁ࠃߩߎޔᛛⴚදജߩදജࠕࡊࡠ࠴ߩᣇᴺߪㆡಾߥ߽ߩߥߩ߆⇼߇ᱷࠆޕኻ ⽎දജᯏ㑐߇⎇ⓥታᣉ⢻ജࠍ⏕ߒߚߣ߁ታᘒߪߦࠝࡓࠣࡠࡊޔᾖࠄߒߡߺࠇ ߫ࠆ߃ߒ↥↢ࠍ࠻࠶ࡊ࠻࠙ࠕޔ⢻ജࠍ⏕ߒߚߦㆊ߉ߥ⁁ᴫߢࠆߺ↢ࠍ࠻࠶ࡊ࠻࠙ࠕޕ ߒ߃ࠆࠃ߁ߦߥߞߚ߇ߩࡊ࡞ࠣ࠻࠶ࠥ࠲ޔᄌൻ␠ߪߡ߭ޔળߩᄌൻߢࠆࠕ࠙࠻ ࠞࡓࠍ㆐ᚑߒߚࠊߌߢߪߥޕදജኻ⽎ᯏ㑐ߩ⎇ⓥ⢻ജࠍᡰេߔࠆߎߣߦࠃࠆදജߩ⚿ᨐߪޔ ᚑᨐߢࠆࠕ࠙࠻ࠞࡓࠍ↢ߺߒ߿ߔ⁁ᴫࠍ᭴▽ߒߚߣ߁ߣߎࠈߢขࠅ߿ࠄࠇࠆߎߣ ߦߥߞߡࠆޕ ઁᣇޔᣣޔ࿖㓙දജߪᚑᨐߢࠆࠕ࠙࠻ࠞࡓࠍᒝߊ᳞ࠄࠇߡࠆޕදജߩ⚿ᨐߪࠕޔ ࠙࠻ࡊ࠶࠻߆ࠄࠕ࠙࠻ࠞࡓߦὶὐࠍ⒖ߒߡ߈ߡࠆ⎇ޕⓥᯏ㑐߳ߩදജߦ߅ߡ߽ޔදജߦ ࠃߞߡ⎇ⓥᯏ㑐ߩ⎇ⓥᚑᨐ߇╷ޔᣉ╷ޔᬺߦ↢߆ߐࠇߩࡊ࡞ࠣ࠻࠶ࠥ࠲ޔᄌൻޔ ␠ળߩᄌൻࠍ߽ߚࠄߔߎߣߦࠃߞߡᆎߡ⋡⊛ࠍ㆐ᚑߒߚߎߣߦߥࠆޕ ߎߩࠃ߁ߥⷰὐߦ┙ߟදജߩࠕ࠙࠻ࠞࡓߩ⏕ࠍ⋡⊛ߣߔࠆߥࠄ߫ޔߩදജࠍ⎇ⓥ⢻ ജߩ⏕ߦߣߤࠆߩߢߪߥߊޔදജኻ⽎ߢࠆ⎇ⓥᯏ㑐ߩ⼾߆ߦߥߞߚ⢻ജࠍࠬ࠰ޔ ᵴ↪ߒߡ⎇ⓥࠍⴕ╷ޔᣉ╷߳ߩᓇ㗀ജࠍਈ߃࠲ࠥ࠶࠻ࠣ࡞ࡊߩᄌൻ␠ߡߒߘޔળ ߩᄌൻࠍ߽ߚࠄߔࠃ߁ߥදജࠍⴕ߁ߎߣ߇㊀ⷐߣߥࠆޕᣣᧄߩදജᯏ㑐ߩ࠰ࠬߣߣ߽ߦޔ දജኻ⽎࿖ߩ⎇ⓥᯏ㑐ߩ࠰ࠬࠍᦨᄢ㒢ᵴ↪ߦߒߡ␠ળߦᄌൻࠍਈ߃ࠆදജࠍᔒะߔߴ߈ ߢߪߥߛࠈ߁߆ޔߪߦࠇߎޕᓥ᧪ߩ⎇ⓥᯏ㑐ߦኻߔࠆ⎇ⓥ⢻ജߩะࠍ⋡⊛ߣߒߚࠕ࠙࠻ ࡊ࠶࠻ᜰะߩදജࠕࡊࡠ࠴߆ࠄࠃࠅࡊࡠࠣࡓᜰะߩ⎇ⓥᚑᨐࠍᵴ↪ߒߚ╷ឭ⸒⢻ജޔ ╷ᓇ㗀ജߩะࠍ⋡ᜰߒߚදജࠕࡊࡠ࠴߳ߩォ឵ࠍ࿑ߞߡߊߎߣ߇ᔅⷐߢࠆߩߎޕ ࠃ߁ߥࠕࡊࡠ࠴ࠍᜰะߔࠆߎߣߦࠃߞߡ⎇ޔⓥᯏ㑐߳ߩදജ߇ࠃࠅ␠ળߣߩ㑐ㅪࠍᜬߟ߽ ߩߣߒߡታᣉߒ߃ࠆၮ⋚ࠍ᭴▽ߢ߈ࠆߎߣߦߥࠆޕ 151 ኻ⽎࿖ᄖㇱ⼂⠪䊧䊎䊠䊷㩷 ࠟ࠽ Dr. Anthony T. Seddoh ࠟ࠽ஜ⋭ਅߩஜࠨࡆࠬታᣉᯏ㑐ߢࠆࠟ࠽ஜࠨࡆࠬޔ╷ஜࠪࠬ ࠹ࡓ㐿⊒⺖㐳࠽ࠟޕஜࠨࡆࠬߢߪޔ╷ࡕ࠾࠲ࡦࠣ⹏ଔߦ៤ࠊࠅޔWHOࠕ ࡈࠞၞ࿖දജᚢ⇛⽺࠽ࠟޔ࿎ᷫᚢ⇛ஜࠦࡦࡐࡀࡦ࠻╬ߦ㑐ߔࠆࠦࡦࠨ࡞ ࠲ࡦ࠻ᄾ⚂ߩฃᵈታ❣߇ࠆޕᢎ⢒⋭ᚲ▤ߩ㊁ญ⎇ߩᗵᨴ∝ኻ╷ߦ߅ߌࠆ⽸₂ࠍஜⴕ ߩታᣉਥߩ┙႐߆ࠄߣࠅ߹ߣߚޕ ࠩࡦࡆࠕ Mr. Stephen L. Muyakwa ࠩࡦࡆࠕ⹏ଔቇળળຬޕᐲ᭴▽⚵❱㐿⊒ޔHIV/AIDSߩ␠ળ⚻ᷣ㕙߳ߩࠗࡦࡄࠢ࠻ ╬ࠍኾ㐷ߣߒߦߢ߹ࠇߎޔUNDPߦࠃࠆHIV/AIDSࡊࡠࠫࠚࠢ࠻⹏ଔ⛔ࠕࡆࡦࠩޔวஜ ࡊࡠࠣࡓ㧔ZIHP㧕߳ߩ╵↳╬ߦ៤ࠊߞߚޕ Report of the thematic evaluation on Communicable Disease Control in Africa Prepared by: Anthony Theophilus Seddoh This report is prepared by Dr. A. T. Seddoh, as a result of a thematic evaluation of Noguchi Memorial Institute for Medical Research (NMIMR) from 9th – 25th September 2004. Dr. Seddoh participated as an independent third party evaluator to JICA. The purpose is to present the key findings, challenges and lessons learnt to assist the JICA office to evaluate: x x The impact of NMIMR’s activities on the population with respect to communicable disease control including administration, training and dissemination of information The current roles and functions of NMIMR’s since its establishment vis-à-vis the vision for the future with regard to communicable disease control Key Findings 1. The administrative mandate, roles and functions of NMIMR Noguchi Memorial Institute for Medical Research (NMIMR) is a semi-autonomous research based academic institution under the University of Ghana, Ministry of Education. The establishment of the NMIMR in 1979 is seen as the physical manifestation of the collaboration between Ghana and Japan in promoting evidence-based health care development, that begun with Hideyo Noguchi since 1928. The institute had the mandate to (i) conduct research into infections and communicable diseases and nutritional problems (ii) provide training opportunities for post-graduate training in medical research and (iii) to provide specialised laboratory and diagnostic monitoring services to improve public health. Over the years, a number of projects have been executed by NMIMR with support through JICA: 1986 1991-1997 1999-2003 2004- - NMIMR phase I project NMIMR phase II project Infectious Diseases Project West African Centre for International Parasite Control Key researches conducted among others within and in addition to the project areas are tuberculosis, HIV/AIDS/STIs, viral haemorrhagic fevers, measles, malaria, schistosomiasis, maternal mortality analysis, intestinal helminths, leishmaniasis and filariasis. The capacity of NMIMR The laboratories are highly equipped with facilities for molecular, biological, immunological (including flow cytometry), biochemical and haematological research. It also has an electron microscopy. The institute is also staffed with high calibre scientific personnel with most of them holding post-graduate qualifications in their various fields of expertise. The capabilities acquired and the extended expertise has enabled NMIMR to undertake the following activities to international standard: x x x Delineate the epidemiology and pathogenesis of HIV/AIDS, STDs, and vaccine preventable diseases and thus contribute to vaccine development Laboratory research for tuberculosis and drug efficacy testing The training of laboratory and research fellows in medical and public health up to the highest post-graduate level in their areas of activities 152 In recent times, the institute has added to its portfolio, research into non-communicable diseases in response to the increasing incidence and significance of hypertension, diabetes and anaemia on public health in Ghana. 2. Training NMIMR has been able to train as part of its project activities, personnel mostly laboratory technicians in basic parasitology, TB microscopy, quality assurance and basic bacteriology in general and as related to STIs. It has also creditably performed the required 25% of duty hours to teaching required of its senior staff to the University of Ghana resulting in the direct and indirect production of graduate, masters and doctoral level professionals. 3. The impact of NMIMR on policy development, diagnosis and treatment practices The relationship between the NMIMR, the Ghana Health Service and its National Public Health Reference Laboratory (NPHRL) is very positive. There is however no formal or administrative relationship between NMIMR and the GHS/NPHRL. The NPHRL and its subunits, the Zonal PHRL is the government’s lead laboratory in diagnostics and not research. Its capabilities are limited to bacteriological investigations and an almost rudimentary capacity for viral case detection. NMIMR functionally fills the gap as a leading medical research institute of great repute with capacity for virology investigations and cutting-edge research. This positioning by NMIMR has lead to it becoming a centre of last resort in medical and pharmaceutical investigations, diagnosis, treatment, policy development and research in Ghana and the sub-region. The institute takes lead in medical investigations with regard to HIV/AIDS, yellow fever, measles, general vaccine preventable diseases and microbial quality monitoring for nutrition and food security. The studies into yellow fever for instance lead to the change of the international regime to accept that yellow fever vaccine can effectively be given in concert with other EPI vaccines. NMIMR was also actively involved in the development of population dynamics statistics under the Demographic and Health Surveys in Ghana. The institute also assume the following responsibilities among several others: x x x x x 4. Serves as the main virology centre and the national reference laboratory for TB control, HIV/AIDS and STIs and vaccine preventable diseases Undertook the research into chloroquine resistance that lead to the change in the country’s anti-malaria drug policy in 2003 and are managing the change over to an artemisinin-based combination therapy Effectively supports studies into the effective use of ITNs in Ghana and its monitoring Is currently the WHO Collaborating Centre for Polio in the sub-region and does all the vaccine potency tests for Ghana and Togo Undertakes the mandatory testing of anti-snake serums imported into the country WACIPAC The test of versatility of NMIMR to combine a purely laboratory based scientific research orientation with an operations community focused program of research came with the advent of the West African Centre for International Parasite Control (WACIPAC). The project has proven to be the much needed bridge between the institute and the population at a local government level. Through WACIPAC, NMIMR has shared expertise with the population and some African Countries in operations research for parasitic disease control and trained their personnel for parasitic disease control programs. This ‘third country training’ program appears to have a high regard in the GHS and Ministry of Education, Youth and Sports (MOEYS) as a program worth sustaining. The impact on revitalising a slumbering school 153 health program using the WACIPAC has been tremendous. The MOEYS and the GHS have indicated their intention to scale-up the project implementation across the whole country. All donor partners consider this program a worthwhile project even though they do not necessarily agree with the coordinating mechanisms. 5. Dissemination Most of the findings of NMIMR activities have been published or are in the process to be published in both local and international journals. Annual three day dissemination seminars have also been instituted by NMIMR with the theme ‘Bridging the research-policy divide’. Different presentations are made at these meetings with the aim of sharing research findings with policy makers and peers in academia. The outcome of these meetings has led to policy reviews that have no doubt contributed to addressing the health needs of the population. 6. The future role of Noguchi in disease control There is a functional rather than an administrative role for Noguchi in disease control in Ghana. Indeed, the evaluation shows that the NMIMR functional priority areas – communicable and non-communicable diseases - are closely related to the core of programs implemented in the Ghana Health Sector and the African region and is likely to increase the demand of their services for a long time to come. The demand from the health sector is likely to continue to be diagnostic support and research to promote prevention, case containment and eradication activities. The functions in supporting non-communicable disease research also provides a good orientation for NMIMR to help Ghana and countries in the region to address key issues regarding health and the environment, health and poverty and sustainable development within the framework of poverty alleviation strategies and activities of partners. The emphasis on policy advice and advocacy is appropriate as it focuses more on how best to support countries to deliver services. In effect, there is a unique opportunity for NMIMR to continue to use its comparative advantage in virology and technical competency to assist Ghana and countries in the sub-region in infectious disease control. The WACIPAC project is a very positive development. However it cannot be considered that this is an area that NMIMR has the needed competency. This area is a social science related field. It may therefore be more appropriate for NMIMR to relinquish their role in WACIPAC to the field research centres in Navrongo, Dodowa or Kintampo or indeed the Health Research Unit who have the competency and capacity for this. 7. Challenges NMIMR is an important institution with a unique competency that will be required for the advancement of health care in the region. The main challenge however to the institute is funding and staffing. The Ministry of Education, Youth and Sports, who confirms this difficulty that the institute has, put it down to competing needs. To this end, donor and partner collaboration is inevitable to its survival and continuing viability. Currently, aside of JICA and a limited bilateral cooperation with the US Navy in anti-malaria drug research, no other donor agency appears to have any significant direct funding support to the institute. This situation is unlikely to change soon as most of the additional funding is through competitive tendering via proposal submission by the institute. 154 REPORT OF FINDINGS ON THE THEMATIC EVALUATION ON COMMUNICABLE DISEASE CONTROL IN ZAMBIA PREPARED BY: STEPHEN L. MUYAKWA P. B. RW 87X , Lusaka, Zambia Date: 24th September 2004. Contents 1.0 Purpose of the Study 2.0 Scope of the Evaluation 3.0 Methodology 4.0 4.1 4.2 4.3 5.0 Background Socio-economic Context The Health Sector in Zambia Institutional Framework of the Health Sector JICA/ UTH Cooperation 5.1 Infectious Diseases Project 5.2 Infectious Diseases Control Project 5.3 HIV/ TB Project. 6.0 National Medical Laboratory Policy 7.0 UTH Mission 8.0 Findings 8.1 Relationship between the Japanese and Zambian Governments 8.2 Factors that contributed to success of the JICA/ UTH Cooperation 8.3 Challenge Facing the JICA/ UTH Cooperation 8.4 Impact of the JICA/ UTH Cooperation 9.0 Recommendations List of Acronyms Bibliography List of people interviewed 155 1.0 Purpose of the Study The purpose of this thematic evaluation is to verify the achievements of the technical cooperation interventions by JICA in Zambia to medical research institutes, and its impacts on communicable disease control on the population generally and in the medical and health sectors. 2.0 Scope of the Evaluation The scope of the evaluation of the external evaluators is as follows. a) To evaluate achievements of Japanese representative projects on communicable disease control in Zambia in terms of the roles and functions curried out by research institutes ever since their establishment in comparison with the expected roles and functions of the research institutes in communicable disease control b) To verify the impact of the cooperation on the population and administrative systems in Zambia and surrounding countries through the cooperation including personnel training, and dissemination of information on communicable disease control. 3.0 Methodology The evaluation utilised the following evaluation tools: a) Literature review. Literature in the custody of JICA, UTH and other institutions was closely reviewed to determine the achievements and impacts of the HIV/ AIDS and TB project. b) Key informant interviews. The senior staff at the UTH, CBoH, NAC and international organisations such as UNDP and WHO were interviewed. The list of interviewees is attached to this report. c) Groups discussions. A group of senior staff at the virology laboratory held discussions with the research team. 4.0 Background 4.1 Socio-economic Context Zambia is a sub- Saharan country in southern Africa with a population of 9.9 million. The population growth rate is quite high and exceeds 2%. The latest population census was conducted in 2000. Educational attainment is relatively high by African standards with an adult literacy rate at 75.% and gross primary school enrolment at 72.4%. There is a growing issue of malnutrition, however, and more than 40% of children under five are stunted. Zambia’s per capita GNP is now below the average for Sub-Saharan Africa and was at $490 in 19990-96. Data from the Zambia Central Statistics Office indicates that nearly 70 per cent of Zambians fell below the poverty line in 1996. Further more, Zambia’s debt burden remains astronomically high at $6.5 billion. The debt service consumes a significant portion of government expenditures, equalling to 69% of the entire budget for all sectors combined. A recent analysis concluded that Zambia’s external public debt would remain high at unsustainable 156 levels for many years to come. Therefore, budget reform and restructuring, including the decisions to seek exceptional debt relief under the Heavily Indebted Poor Countries (HIPC) initiative and to explore alternative debt swap mechanisms, are considered essential for the Government overall ability to mount an effective and sustainable response to the current HIV/AIDS and TB pandemic. Instability of the major macroeconomic indicators such as inflation, unemployment rate, dollar-Kwacha exchange rate would seriously affect the amount of resources available for health sector development, which is already severely constrained. The national health expenditure per capita in Zambia is estimated to be at US $10.5 in 2000. It is not sufficient even to provide the most essential health care package at district level which requires US $ 11.5 per capita. The socio-economic context suggests the preponderance of conditions inimical to the effective prevention and control of HIV/AIDS and TB in Zambia. If new resources are not found, the decline in available public resources for HIV/AIDS and TB control may severely undermine the government’s ability to amount a timely and effective response. 4.4 The Health Sector in Zambia The health sector in Zambia is currently facing a crisis. Mortality rate is quite high with IMR at 109/1,000 and U5MR at 197/1,000 in 1992-96, and they are increasing since the mid 1980s. The burden of diseases is also increasing, while the national resources to combat the problems is shrinking. It is considered that the promotion of the health reforms is the only way for the Zambian health sector to revive. The HIV/AIDS pandemic and coincidental TB resurgence are two of the most serious risks which are threatening the health of the Zambian population. The decentralization of the health service delivery system is being promoted at the moment. It is, however, essential that disease control strategy and operation which are integrated with the decentralised system are also developed. For that purpose, the roles and functions of central level organisations and local organisations need to be clearly defined, and effective coordination mechanisms among those organisations need to be established. The capacity of the frontline organisations, i.e., District Health Management Teams, District Hospitals (First Referral Hospitals) and Health Centres, have to be strengthened in order for any disease control activities to produce any health impact on community. At the same time, regulatory and supervisory functions of the central organisations need to be strengthened so that the system performance of the entire health sector could be assured and sustainable. 4.5 Institutional Framework of the Health Sector The reforms of the health care system in Zambia is comprised of several structural layers. There are currently plans to merge some of the activities of the CBoH with those of the MoH so as to prevent overlaps in responsibilities. Under the health reforms, the main focus was first referral facilities in order to reduce congestion at the top referral hospitals. 157 It is in this line that the Zambian Government requested the Japanese Government to assist in implementing and financing the HIV/ TB project. It is considered that District Hospitals (First Referral Hospitals) and Health Centres with laboratory service will be the focal point in the implementation of the HIV/AIDS and TB control project activities. 5.0 The JICA UTH Cooperation The JICA/ UTH cooperation ran for three phases. The phases are itemised below: 5.1 Infectious Disease Project – 1989 - 1995 The Infectious Disease Project (IDP), a technical cooperation between the Japanese and the Zambian governments, commenced in April 1989 and ended in March 1995. The project was implemented by the Japan International Cooperation Agency (JICA). Japanese experts were dispatched for the purpose of technological transfer in the field of clinical virology. A total of 22 Japanese (7 as long term and 15 as short-term experts) were dispatched for this project. These experts helped to lay the foundation for the various activities of the virology laboratory. According to earlier evaluation mission reports, a total of 19 Zambians were sent to Japan for training in various fields including virology, and medical equipment maintenance at the virus research centre, Sendai National Hospital, Japan. The main objectives of the IDP were: To establish the laboratory diagnostic procedures for infectious diseases, particularly for viral infections at the University Teaching Hospital. To analyse the aetiology among Zambian patients with infectious diseases by means of laboratory diagnosis. To standardise the treatment measures for infectious diseases in Zambia by analysing the aetiology of the disease. During the six years of the project a number of activities were done in the field of virology, paediatrics and medical equipment maintenance. The virology laboratory was opened in February 1992 as the first specialised laboratory for viral infections in Zambia. Projects in scientific research in clinical virology, public health in Zambia were commenced. In September 1993, an evaluation team consisting of Japanese and Zambians evaluated the activities and achievements of the IDP and agreed that further collaboration between Zambian and Japanese Governments was necessary to achieve better control of infectious diseases in Zambia. It was further decided that technical cooperation of IDP be extended to March 1995. During this one year follow up period, two Zambians were sent to the virus Research Centre at Sendai National Hospital, Japan for training. 158 5.2 Infectious Diseases Control Project – 1995 - 2000 The new project “Infectious Diseases Control Project (IDCP)’ started after the final evaluation of the previous project under the agreement between the Zambian and Japanese Governments in April, 1995. The IDCP started in April 1995 and ended in March 2000. Three Japanese experts were sent from Japan to work on the IDCP. The main purposes of IDCP are described as follows:1. To improve the quality of laboratory diagnosis of infectious diseases at UTH 2. To conduct etiological and epidemiological studies on infectious diseases for prevention and control at the hospitals and in the community. 3. To strengthen the diseases surveillance systems for infectious diseases, in particular, poliomyelitis, measles, acute respiratory infection (ARI) and HIV 4. To transfer essential laboratory techniques on infectious diseases to district hospital staff 5. The transfer laboratory techniques in immunology was to be an important function of the IDCP 5.3 The HIV/ TB Project – 2001 - 2006 The third and currently running phase of the JICA/ UTH cooperation is the HIV/ TB project. The Zambian Government requested this project after noticing that HIV/ AIDS and TB are very serious diseases in Zambia that needed immediate attention. It has the following expected outputs: (1) (2) (3) (4) (5) 6.0 Performance of laboratory techniques, data management and overall laboratory management are improved. Performance and quality of peripheral labs for HIV/AIDS and TB testing and surveillance are improved. Utilization of laboratory services by health workers (private, public and NGOs) is improved Information on HV/AIDS and TB generated by the project is utilized widely by majority of stakeholders in planning and implementing programmes (i.e. GRZ, other donors, health workers, NGOs, schools, youth and communities). Collaboration with HIV/AIDS and TB Working Groups is institutionalised. National Medical Laboratory Policy The Japanese funded project, being a laboratory-based intervention, operates within the framework of the national laboratory policy. This policy, according to Muyakwa who carried out an assessment of health policies in 2001, deals with all medical and 159 laboratory issues in the country including capacity building, standardisation of procedures and equipment, legal issues and organisational structures needed to implement the policy. The vision of the policy is to provide Zambians with quality, cost-effective, appropriate laboratory services as close to the family as possible. The policy goals are: x x x To improve and maintain laboratory services at an optimum standard To provide national technical guidelines for the improvement and provision of laboratory services at each level of health care delivery To fully integrate laboratory standards and systems in the various components of health sector reforms The implementation Strategy is: x x x x x x 7.0 Full and active participation of all stakeholders Significant infusion of resources to raise standards to a basic minimum acceptable level and therefore the need for a co-ordinated response from government and co-operating partners to achieve the set goals Short-term priorities to focus on the improvement in basic inputs (equipment, supplies, human resources, infrastructure and utilities) and the full integration of the sector in improvements to delivery quality care in the health reforms process In the long term, quality to be achieved through the development of a sustainable system to support the laboratory services at all levels. The implementation is guided by a five-year implementation plan. Monitor various stages of the implementation process The situation analysis provides baseline indicators against which the progress can be measured. UTH Mission The JICA/ UTH cooperation is under the overall management of the UTH. In an interview during the course of this thematic evaluation, the UTH Executive Director Dr. T. Lambart stated that the UTH Mission Statement is: “To provide affordable quality health care, function as a referral centre, train health providers, conduct research to find solutions to existing health problems and for the development of science.” 8.0 Findings 8.1 Relationship between the Japanese and Zambian Government The study revealed that the relationship between the Japanese and Zambian Governments and people is very cordial. The support and cooperation efforts by the Japanese government are very highly regarded in Zambia. In one report evaluating the relationship between the European Union and the Zambian Government under the 160 ACP-EU Cotonou Agreement, the Private Sector in Zambia urged the EU to emulate the Japanese in terms of effective project implementation. The Japanese Infections Diseases Project (IDP) is one of those projects the Zambians treat as being highly successful and beneficial to the country. 8.2 Factors that contributed to success of JICA/ UTH Cooperation A number of factors can be isolated to determining the high rating that the JICA/ UTH cooperation is receiving. These can be summarised as follows: x x x x x x x 8.3 High political commitment by both the Japanese and Zambian Governments. Clear, achievable and measurable objectives and indicators in the project document. High motivation by both Zambian and Japanese staff associated with the JICA/ UTH project Skilled and trained manpower on both the Zambian and Japanese sides of the laboratory staff Integration of the laboratory into the regular work of both the UTH and the UNZA School of medicine. Regular monitoring and evaluation by joint teams of Zambian and Japanese experts The training of Zambian staff in Japan has helped to introduce the staff to Japanese culture, which has made it easy for both Zambian and Japanese staff to work together. Challenge Facing the JICA/ UTH Cooperation The JICA/ UTH cooperation faced and continues to face some challenges. These can be summarised as follows: 1. The virology laboratory is the only one of its type in Zambia and in neighbouring countries. This has meant that it has a lot of work. The staff is, however, limited. 2. UTH has been suffering from an image problem in the eyes of the public and the media for a long time. The perception in the general public, which may be different from the reality, is that UTH is inefficient, poorly equipped with technical staff and equipment. This has meant that the virology laboratory, which is part of UTH, has not been able to escape this negative image despite its excellent work and outputs. 3. The ART has been introduced in Zambia without an all-encompassing policy framework. Private and Government health providers have been distributing ARV drugs without proper supervision. This has resulted in many types of drugs reaching the patients/ consumers. It is reported that some drugs do run out thus forcing patients/ consumers to use different drugs at short notice. This is likely to cause serious HIV resistance problems in the near future. The virology laboratory will be flooded with requests to deal with the HIV drug resistance problem. 161 8.4 Impact of the JICA/ UTH Cooperation The impacts of the JICA/ UTH cooperation can be summarised as follows: 1. The JICA/ UTH cooperation has resulted in the construction of the virology laboratory and the supply of laboratory equipment. The cooperation, being part of UTH, has continued rendering laboratory services to the patients in the hospital and for training purposes at the UNZA School of Medicine. This has saved lives of patients and the trained human resources will contribute to infectious diseases control in Zambia. 2. The Zambian Staff at the JICA/ UTH cooperation has been exposed to a lot of intensive training both locally and in Japan in various medical fields such as tissue culture, serology/ immunology, electron microscopy, molecular virology and the repair and maintenance of medical equipment. These trained professionals sit on various working groups both within UTH and at the NAC, CBoH and MoH providing much needed expertise to the working groups. 3. The WHO has designated the virology laboratory to an inter country reference laboratory. Thus the virology laboratory has possibilities to offer its services to the surrounding countries. This development can act as a catalyst for other cooperating partners to work with UTH on the control of infectious diseases in the country. 4. The JICA/ UTH cooperation is involved in various research projects in the fields of polio, measles, HIV and TB. These research projects have been disseminated to various relevant stakeholders and also published in important local and international medical journals. Some of the institutions found the research work very useful in their daily work. 5. The JICA/ UTH cooperation has continued to offer training to staff in various institutions such as ZIHP, district hospitals and provincial hospitals as well as the armed forces. This has greatly increased these institutions ability to carry out laboratory diagnosis of infectious diseases. 6. The JICA/ UTH cooperation has been testing medicines from traditional healers to assess the potency of these medicines. These medicines are forwarded to the JICA/ UTH project by the NAC. These tests, though negative so far, are helping in the search for a cure for HIV. 7. The JICA/ UTH cooperation has continued to serve the country by responding to emergency disease outbreaks. This service is critical to saving lives. 9.0 Recommendations In view of the above findings, concrete and actionable recommendations are hereby made. These are as follows: 1. Infectious diseases, including HIV/AIDS, are still a serious public health problem in Zambia. JICA has demonstrated great capacity to assist in 162 developing interventions to control these diseases. It is therefore recommended that the JICA/ UTH cooperation should be continued and the Japanese government should support it. 2. The Zambian Governement has introduced ART in Zambia. There are plans to scale up the number of HIV patients with access to the ART. There is, therefore, need to focus more on the possibility of resistance of the HIV to ART drugs. The diagnostic services are crucial in this exercise. The Zambia Government should strive to increase funding to both UTH and the virology laboratory to cope with this task. 3. The current narrowing of the project to HIV/ TB has left other infectious diseases such as polio and measles without support. It is recommended that the project supports the entire virology laboratory activities and not be restricted to HIV and TB alone 4. The Japanese support to the JICA/ UTH cooperation has helped strengthen the manpower base at the UTH generally and the virology laboratory in particular. During interviews in the course of this thematic evaluation, the Zambian management team at the virology laboratory stated that they feel sufficiently empowered to run the laboratory without long-term Japanese experts. In view of this, it is recommended that the Japanese support be reduced to supply of laboratory equipment, research partnerships and short-term consultancies. The number of long-term experts should be gradually reduced. 163 List of Acronyms ACP ANC AZT BTS CboH CDC CDL DOTS EU ELISA DHS HAART LDHMB IMR MTCT NVP HIPC SOP STI TB TDRC UNZA UTH VCT WHO ZIHP African Caribbean and Pacific Antenatal Care Azidothymidine/Zidovudine Blood Transfusion Service Central Board of Health Centers for Disease Control and Prevention (United Stated) Chest Disease Laboratory Directly Observed Treatment Short-course European Union Enzyme Linked Immunosobent Assay Demographic and Health Survey Highly Active Anti-retroviral Theraphy Lusaka District Health Management Board Infant Mortality Rate Mother to Child Transmission (of HIV) Nevirapine Highly Indebted Poor Country Standard Operating Procedures Sexual Transmitted Infection Tuberculosis Tropical Disease Research Centre University of Zambia University Teaching Hospital Voluntary Counselling and Testing World Health Organisation Zambia Integrated Health Project 164 Bibliography Central Board of Health: (2000) Laboratory Capacity Building for HIV/TB Control, Project Document (draft). Lusaka, Zambia. JICA: (1999) Minutes of Meetings Between the Japanese Project Consultation Team and Authorities Concerned of The Government of the Republic of Zambia, on the Japanese Technical Cooperation for HIV/AIDS and Tuberculosis Control Project. Lusaka, Zambia. JICA: (2002) Minutes of Meetings Between the Japanese Project Consultation Team and Authorities Concerned of The Government of the Republic of Zambia, on the Japanese Technical Cooperation for HIV/AIDS and Tuberculosis Control Project. Lusaka, Zambia. JICA: (2003) Minutes of Meetings Between the Japanese Project Consultation Team and Authorities Concerned of The Government of the Republic of Zambia, on the Japanese Technical Cooperation for HIV/AIDS and Tuberculosis Control Project. Lusaka, Zambia. Muyakwa S.L/ ZIHP (2001): Health Policy Status Report 2000. Lusaka, Zambia National AIDS Council: (2003) National HIV/AIDS/STI/TB Intervention Strategic Plan 2002-2005. Lusaka, Zambia. National AIDS Council: (2004) Joint Review of National HIV/AIDS/STI/TB Intervention Strategic Plan 2002-2005. Lusaka, Zambia University Teaching Hospital: (1994) Viral Infections in Zambia. Lusaka, Zambia University Teaching Hospital: (1994) Viral Infections in Zambia Volume 2. Lusaka, Zambia. University Teaching Hospital: (1996) Viral Infections in Zambia Volume 3. Lusaka, Zambia. University Teaching Hospital: (No Date) Viral Infections and Tuberculosis in Zambia, 1989-200. Lusaka, Zambia. University Teaching Hospital: (1993) Laboratory Support for Polio Eradication in Zambia. Lusaka, Zambia. University Teaching Hospital: (1994) Final Report of Infectious Diseases Project 1989-1994. Lusaka, Zambia. University Teaching Hospital: No Date) Action Plan and Budget for 2003. Lusaka, Zambia. 165 Zambia Trade Network/ Friedrich Ebert Stiftung (2004) The Private Sector Views on the Mid- term Review of the ACP- EU Cotonou Agreement, Lusaka, Zambia List of people interviewed NAME 1. Dr. T. Lambart 2. Dr. B. Chirwa 3. Dr. M. Monze 4. Dr. Handema 5. Mrs. Mulundu 6. Dr. M. Sinkala 7. Prof. N. Luo 8. Dr. C. Musumali 9. Dr. R. Kumwenda 10. Dr. M Maboshe 11. Dr. Sinyinza 12. Dr. Kafwebulula INSTITUTION UTH CBoH UTH UTH UTH LDHMB Private Consultant ZIHP UNDP WHO CBoH CBoH 166 ઃዻ⾗ᢱ㩷 1. ⹏ଔࠣ࠶࠼ 1.1 ㊁ญ⎇㧔Noguchi Memorial Institute for Medical Research㧕 1.2 KEMRI 1.3 UTH 2. ⺞ᩏᣣ⒟ 3. ࿖ౝ⺞ᩏදജ⠪৻ⷩ 4. ⺞ᩏ㕙⺣⠪৻ⷩ 5. 㓸⾗ᢱ৻ⷩ 6. ෳ⠨ᢥ₂৻ⷩ ઃዻ⾗ᢱ1 1.1 Noguchi Memorial Institute for Medical Research Evaluation Questions 1. Program components and effects of the program 1.1 Impact on research activities 1.2 Impacts on administrative services Information / Indicators Survey Items Data Sources Survey Methods How was the infectious disease control in Ghana improved by the activities of NMIMR? How were the outputs of research activities reflected on administrative services? 1) How many technical articles does NMIMR contribute to internal/ external journal? 2) Are there any researches of which results were utilized for or were reflected on the actual infectious disease control activities? VPD 1) Did the MOH introduce the quality control technology for measles, polio and yellow fever vaccines which was developed by the “Noguchi Memorial Institute Project Phase II (1991-1996)”? 2) Did MOH introduce AIK-C vaccine for measles at 6 months in Ghanaian children? TB 1) Please explain the role of NMIMR and PHRL as the reference laboratory of TB respectively. Diarrhoeal Diseases 1) How was the cereal-based ORS developed by the “Noguchi Memorial Institute Project Phase II” contributed to infectious disease control? Parasites 1) How was the urine-based dipstick assay for Schistosomiasis diagnosis developed by the Noguchi Memorial Institute Project Phase II contributed to the Ghana medical sector? How was the administrative service for infectious disease control improved? 1) How did the middle-level manpower training improve level of medical service? 2) How does NMIMR have communication with MOH for infectious disease control? 1 No. of contribution and publishing NMIMR Document review NMIMR MOH Document review interview NMIMR MOH Interview MOH NMIMR MOH NMIMR MOH NMIMR MOH MOH Existence of council/ committee and their activities MOH/ GHS/ NMIMR Document review/ Interview ઃዻ⾗ᢱ1 Annual action plan, mandate/ aim of the institute 3) Does NMIMR set the priority research according to the national programme? 1.3 Impacts on human resources development How does NMIMR contribute to improve human resources development in infectious disease control? Annual report/ 1) Did NMIMR conduct middle-level manpower training in STD after Record of training termination of the Infections Disease Project? course Annual report/ 2) Did NMIMR conduct additional middle-level manpower training in Record of training Parasite and TB after termination of the Infections Disease Project? course Annual report/ 3) Did the NMIMR hold any training courses in cooperation with MOH Record of training and/or NTP after termination of the Infections Disease Project? course 4) How did the training courses contribute to improve the infectious disease control in Ghana? Resume/ career of staff 5) How does NMIMR train researcher/ technical staff? Method of Quality 6) Does NMIMR keep the technical skill level for experiment/ routine control work? If yes, how does it prove as status ‘good practice laboratory/ bio-safety/ guideline’? No. of programmes 7) Does NMIMR have constant cooperation with external research and joint research organization? Grading of publish researcher on MOH/ MOE 8) Does MOH/ MOE stipulate the status and the salary for human resources in NMIMR? 1.4 Impacts on information services What kinds of information does NMIMR send to? And how was it utilised? 1) Have you received any information (results of research activities) from Report system to MOH the NMIMR? If yes, how do you utilize that information? 2 NMIMR Document review/ Interview NMIMR Interview NMIMR Interview NMIMR MOH Interview MOH Related organizations NMIMR MOH/ NMIMR/ WHO Interview Document review Document review/ Interview NMIMR/ donors (USAID, Document review/ CIDA,DANIDA,WB, Interview etc.) MOH/ MOE MOH/GHS Document review/ Interview ઃዻ⾗ᢱ1 2) Does NMIMR have a channel for free access to epidemiologic information? 3) Does NMIMR have a survey network and skill? 1.5 Impacts on nations How did NMIMR contribute to improve the health condition of nations? 1) A series of pilot project aimed to improve PHC at 4 villages, namely Gomoa Fetteh, Gomoa Onyadze/Otsew, Jukwa, Mprumen in Central Region until 1997. Did the NMIMR have any activities at these villages after termination of the JICA Project? 2) Does NMIMR have any activities target on communities or rural population? 3) Did the 4 villages establish sustainable PHC system in the villages? Report system to MOH/ GHS MOH Free access to epidemiologic information system in NMIMR Structure of HMIS and MOH/ HMIS the research method Document review Report of the activities NMIMR Document review/ Interview Annual report Document review/ Interview Interview NMIMR Operation condition of Village people Health station at Onyadze village. Health condition of village people. Village people 4) Did people in Mwachinga and Mtsangatamu have any kinds of positive / negative impacts from the project activities? 1.6 Historical NMIMR 1) Were there any incidents in Ghana health sector that affected JICA changes of Projects and/or NMIMR’s activities? program If yes, what were those incidents? And what kind of actions you take approach and its for counter measures? adequacy. 2. Roles of research What kinds of roles does NMIMR have as a research institute for infectious organization in disease control in Ghana and/or Africa region? infectious disease control 2.1 Confirmation of How does the Government of Ghana tackle on the infectious diseases the infectious control? diseases control 1) Is the infectious diseases control prioritized in the National Health Plan National health plan, MOH/ GHS in the health sector programme and programmes in the health sector? 3 Interview Interview Interview Document review/ Interview ઃዻ⾗ᢱ1 policy Health budget of MOH MOH 2) How much budget is allocated for infectious diseases control in the health budget? NMIMR/ donors (USAID, 3) Is the infectious diseases control prioritized technical assistance of each Donor report CIDA,DANIDA,WB, donor’s policy? etc.) SWAp concept paper SWAp participants (WB) SWAp concept paper SWAp participants (WB) SWAp concept paper 6) How many programmes in SWAp for supporting NMIMR itself or using the NMIMR’s function? 2.2 Position of What is the role of NMIMR on the infectious diseases control system? NMIMR on the 1) Please explain the infectious disease control system in Ghana, that is to infectious say key players (organizations) and their roles/functions. diseases control 2) Who is the responsible research organization for infectious disease prevention / control? 3) What is the role of NMIMR on the infectious diseases control system? SWAp participants (WB) 4) Who participates and what are the priority subjects in SWAp of health sector? 5) How many infectious diseases control programme is in SWAp? 4) What is the position of NMIMR among other institutes? (What is the difference between NMIMR and other institute/ research center?) 5) Does NMIMR execute its expected role completely? 6) Is there a resemblance technical assistance by other donor agency? 7) Is there a duplication of role with resemblance institutes in MOH 2.3 Function of NMIMR What kinds of functions does KEMRI have? 1) What is the mandate and aim of NMIMR? 2) What is the activity of NMIMR? 3) How is the structure of NMIMR and how many staff? 4) How much is the budget and how does NMIMR provide budget? 4 MOH Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview MOH NMIMR/ MOH (NACP, NTBP/NTP, etc.) MOH/ MOE/ NMIMR Interview Interview MOH/ MOE/ NMIMR Document review/ Interview Donor TA programme NMIMR/ donors (USAID, Document review/ CIDA,DANIDA,WB, Interview etc.) Structure and flow of MOH/ NPHLS, Univ. Document review/ HIMS Ghana etc. Interview Brochure, publishing document Annual Plan/ Report NMIMR Brochure, publishing document Budget sheet NMIMR NMIMR NMIMR Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview ઃዻ⾗ᢱ1 5) What kind and how many experimental equipment for research NMIMR has? 6) Are there any malfunctioned equipment? Equipment list NMIMR Maintenance record NMIMR MOH/ MOE/ NMIMR 7) What is the out put of NMIMR and how does NMIMR / MOH/ MOE evaluate it? 8) What is the role of NMIMR in MOH/ MOE? 9) How important infectious diseases researches are for NMIMR? 10) What kinds of researches are studied in NMIMR? 11) NMIMR is appointed as WHO Reference Laboratory/ National Reference Laboratory. How this status helps/burden with activity of NMIMR? (ex: raising up the whole status of NMIMR, reputation, budget provision, quality of staff, burden of hard research requirement, etc.) 3. Necessary What is the expected role of NMIMR as a research institute for infectious condition for disease control in the future? playing expected 1) Do you have any plan to expand NMIMR’s roles/functions in the roles infectious disease control system? If yes䋬please explain your plan. 2) Besides research activities, what kind of development does NMIMR want in the field of empowerment of human resources and/ or announcement of epidemiologic information? 3) What is necessary implementation to satisfy above mentioned development plan? 5 MOH/ MOE/ NMIMR MOH/ MOE/ NMIMR NMIMR WHO report MOH/ NMIMR/ WHO MOH/ MOE report MOH/ MOE/ NMIMR MOH/ MOE report MOH/ MOE/ NMIMR MOH/ MOE report NMIMR Document review/ Interview Document review/ Interview Document review/ Interview Interview Interview Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview ઃዻ⾗ᢱ1 1.2 KEMRI Evaluation Questions 1. Program components and effects of the program 1.1 Impact on research activities Information / Indicators Survey Items Data Sources Survey Methods How was the infectious disease control in Kenya improved by the activities of KEMRI? How were the outputs of research activities reflected on administrative services? No. of contribution 1) How many technical articles does KEMRI contribute to internal/ and publishing external journal? 2) Are there any researches of which results were utilized for or were reflected on the actual infectious disease control activities? Diarrhoeal Diseases 1) Does the vaccine for Rota virus vaccinated at 6 months in Kenyan children? Hepatitis 1) Please explain the future plan for producing and disseminating HEPCELL II. 2) How did the HEPCELL II contribute to the infectious disease control in Kenya? Sales record 3) How many kits of HEPCELL II does the MOH purchase annually? 4) Are there any competitive diagnostic kits for Hepatitis B? If yes, what is the share of HEPCELL II and others? 5) How do you estimate the marketability of HEPCELL II? 6) Does KEMRI have any plan to export HEPCELL II to neighboring countries? 7) What is the role of the Liver Disease Diagnostic Center? And what kinds of activities does it have? 6 KEMRI JICA Expert KEMRI MOH Document review MOH KEMRI Document review interview KEMRI JICA Expert MOH KEMRI KEMRI MOH KEMRI MOH Hospital MOH KEMRI JICA Expert KEMRI Document review interview Interview KEMRI JICA Expert Document review interview Document review interview Document review interview Document review interview ઃዻ⾗ᢱ1 ARI 1) According to the evaluation report, KEMRI recommended to change the standard curative drugs based on the result of drug sensitivity test of major bacterial and fungal ARI䇯 Was this recommendation realized? 2) Does the KEMRI continuously conduct community based health education in Kibera, Nairobi after termination of the Project on research and control of infectious diseases Phase II (1996-2001)? 3) How does KEMRI contribute to improve the ARI control? HIV/AIDS 1) Please explain the current situation of PA and developing plan of HIV diagnostic kit. 2) It was reported that 10 extracts with reverse transcriptase inhibitory activity and 8with HSV inhibitory activity was identified as the result of antiviral plant screening during the project on research and control of infectious diseases Phase II. Does KEMRI continuously conduct additional study about theses extracts? 3) KEMRI confirmed the efficacy of short-course AZT for the prevention of mother to child transmission of HIV during the project on research and control of infectious diseases Phase II. Does KEMRI continuously conduct additional study about AZT? Or was this result utilized to improve the national intervention programs? 4) How did KEMRI contribute to improve the HIV/AIDS control? 1.2 Impacts on administrative services How was the administrative service for infectious disease control improved? 1) How does the MOH plan to utilise the diagnosis kits developed by KEMRI? 2) How does KEMRI have communication with MOH for infectious disease control? 3) Does KEMRI set the priority research according to the national programme? 7 Existence of council/ committee and their activities Annual action plan, mandate/ aim of the institute KEMRI JICA Expert Document review interview KEMRI JICA Expert Document review interview MOH KEMRI Interview KEMRI JICA Expert KEMRI JICA Expert Document review interview Document review interview KEMRI JICA Expert Document review interview MOH KEMRI Interview MOH Document review interview Document review/ Interview MOH/ KEMRI KEMRI Document review/ Interview ઃዻ⾗ᢱ1 4) How was the result of Schistomiasis research reflected on the government program? 5) How does KEMRI utilise the research facilities at Malindi and Kwale? 1.3 Impacts on How does KEMRI contribute to improve human resources development in human resource infectious disease control? development 1) Did KEMRI have continuously conducted seminars / workshops on hepatitis and liver disease after termination of the Project on research and control of infectious diseases (1990-1996)? 2) How did the seminars / workshops contribute to improve the infectious disease control in Kenya? 3) Does KEMRI employ high qualified researcher/ technical staff? 4) Does KEMRI keep the technical skill level for experiment/ routine work? If yes, how does it prove as status ‘good practice laboratory/ bio-safety/ guideline’? 5) Does KEMRI have constant cooperation with external research organization? What kinds of information does KEMRI send to? And how was it utilised? 1) Does KEMRI have a channel for free access to epidemiologic information? Interview KEMRI JICA Expert Document review interview MOH/ KEMRI Interview Resume/ career of staff KEMRI Method of Quality MOH/ KEMRI/ WHO control No. of programmes and joint research grading of publish researcher on MOH/ MOE 6) Does MOH/ MOE stipulate the status and the salary for human resources in KEMRI? 1.4 Impacts on information services Records of seminar / workshop MOH KEMRI KEMRI Document review Document review/ Interview KEMRI/ donors (USAID, Document review/ CIDA, EU, WB, AMREF Interview etc.) MOH/ MOE Document review/ Interview Report system to MOH MOH Free access to epidemiologic information system in NMIMR Structure of HMIS and MOH/ HMIS 2) Does KEMRI have a survey network and skill? the research method MOH 3) Have you received any information (results of research activities) from WHO the KEMRI? Internal organizations If yes, how do you utilize the information? 8 Interview Document review Interview Interview ઃዻ⾗ᢱ1 1.5 Impacts on nations 1.6 Historical changes of program approach and its adequacy. 2. Roles of research organization in infectious disease control 2.1 Confirmation of the infectious diseases control in the health policy How did KEMRI contribute to improve the health condition of nations? Research report 1) A series of research activities on Parasitology were conducted at Mwachinga and Mtsangatamu in Kwale district from 1979-1996. The Plan International (NGO) and the Institute of Tropical Medicine, Nagasaki University took over the project activities after termination of JICA project at the sites. Were Schistosomiasis and Filariasis exterminated at the villages? 2) Did people in Mwachinga and Mtsangatamu have any kinds of positive / negative impacts from the project activities? 3) Do people in Kibera improve their knowledge about ARI prevention through the health education program implemented by the Project on research and control of infectious diseases Phase II? 1) Were there any incidents in Kenya health sector that affected JICA Projects and/or KEMRI’s activities? If yes, what were those incidents? And what kind of actions you take for counter measures? Plan International KEMRI Document review/ Interview Village people Interview Mothers in Kibera Interview Additional information; A part of Kibera was demolished due to the Government decision on February 2004. Existing situation in Kebera is not clear. Document review/ Interview KEMRI What kinds of roles does KEMRI have as a research institute for infectious disease control in Kenya and/or Africa region? How does the Kenyan Government tackle on the infectious diseases control? 1) Is the infectious diseases control prioritized in the National Health Plan National health plan, MOH sector programme and programmes in the health sector? Health budget of MOH MOH 2) How much budget is allocated for infectious diseases control in the health budget? 9 Document review/ Interview Document review/ Interview ઃዻ⾗ᢱ1 3) Is the infectious diseases control prioritized technical assistance of each Donor report donor’s policy? USAID-JAPAN Partnership concept paper 5) How many infectious diseases control programme is in USAID-JAPAN USAID-JAPAN Partnership concept Partnership? paper 6) How many programmes in USAID-JAPAN Partnership for supporting USAID-JAPAN Partnership concept KEMRI itself or using the institute function? paper 2.2 Position of the What is the role of KEMRI on the infectious diseases control system? KEMRI in the 1) Please explain the infectious disease control system in Kenya, that is to infectious say key players (organizations) and their roles/functions. diseases control 2) Who is the responsible research organization for infectious disease prevention / control? 3) What is the role of KEMRI on the infectious diseases control system? 4) What is the priority subject in USAID-JAPAN Partnership of health sector? 4) What is the position of KEMRI among other institutes? (What is the difference between the institute and other institute/ research center?) 5) Does KEMRI execute its expected role completely? 6) Is there a resemblance technical assistance by other donor agency? 7) Is there a duplication of role with resemblance institutes in MOH? 2.3 Function of the KEMRI What kinds of functions does KEMRI have? 1) Is there a clear mandate and aim of KEMRI? 2) What is the activity of KEMRI? 10 KEMRI/ donors (USAID, Document review/ CIDA, EU, WB, AMREF Interview etc.) USAID Document review/ Interview USAID Document review/ Interview USAID Document review/ Interview MOH Document review/ Interview Document review/ Interview Interview MOH KEMRI/ MOH (NPHLS, IEPI, NASCOP, NMCP, NLTCP, etc.) MOH/ MOE/ KEMRI Interview MOH/ MOE/ KEMRI Document review/ Interview Donor TA programme KEMRI/ donors (USAID, CIDA, EU, WB, AMREF etc.) Structure and flow of MOH/ Univ. Nairobi/ HIMS Univ. Moi etc. Document review/ Interview Brochure, publishing document Annual Plan/ Report Document review/ Interview Document review/ Interview KEMRI KEMRI Document review/ Interview ઃዻ⾗ᢱ1 Brochure, publishing document Budget sheet 3) How is the structure of KEMRI and how many staff? 4) How much is the budget and how does KEMRI provide budget? 5) What kind and how much experimental equipment for research KEMRI Equipment list has? 6) What is the out put of KEMRI and how does KEMRI/ MOH/ MOE evaluate it? 7) What is the role of KEMRI in MOH/ MOE? 8) How important infectious diseases researches are for KEMRI? 9) What kinds of researches are studied in KEMRI? WHO report 10) KEMRI is appointed as WHO Reference Laboratory/ National Reference Laboratory. How this status helps/burden with activity of KEMRI? (ex: raising up the whole status of KEMRI, reputation, budget provision, quality of staff, burden of hard research requirement, etc.) 3. Necessary What is the expected role of KEMRI as a research institute for infectious condition for disease control in the future? playing expected 1) Do you have any plan to expand KEMRI’s roles/functions in the MOH/ MOE report roles infectious disease control system? If yes䋬please explain your plan. 2) Besides research activities, what kind of development does KEMRI want in the field of empowerment of human resources and/ or announcement of epidemiologic information? 3) What is necessary implementation to satisfy above mentioned development plan? 11 KEMRI MOH/ MOE/ KEMRI KEMRI MOH/ MOE/ KEMRI Document review/ Interview Document review/ Interview Document review/ Interview Interview MOH/ MOE/ KEMRI MOH/ MOE/ KEMRI KEMRI Interview Intervie Document review/ Interview MOH/ KEMRI/ WHO Document review/ Interview MOH/ MOE/ KEMRI Document review/ Interview Document review/ Interview KEMRI KEMRI Interview ઃዻ⾗ᢱ1 1.3 UTH Evaluation Questions 1. Program components and effects of the program 1.1 Impact on research activities Information / Indicators Survey Items Survey Methods How was the infectious disease control in Zambia improved by the activities of UTH? How were the outputs of research activities reflected on administrative services? 1) How many technical articles does UTH contribute to internal/ external journal? 2) Are there any researches of which results were utilized for or were reflected on the actual infectious disease control activities? Polio 1) Does UTH continuously conduct vaccine potency testing program for poliovirus vaccine? And how is the result of test utilized? HIV/AIDS 1) How are new technologies introduced by UTH such as CD4/CD8count utilized? 1.2 Impacts on administrative services Data Sources How was the administrative service for infectious disease control improved? 1) How are the following manuals and guidelines prepared by UHT utilized? a. National Guidelines for Infectious Diseases b. Laboratory Manual for Technicians in Zambia c. Surveillance guidelines and laboratory testing guidelines for notifiable viral diseases 2) How does UTH contribute to national EPI programme? 12 No. of contribution and publishing UTH Document review MOH/ CBoH UTH JICA Expert Document review interview National EPI manager UTH Document review interview MOH/ CBoH UTH JICA Expert MOH/ CBoH UTH JICA Expert Document review interview MOH/ CBoH UTH JICA Expert Document review interview ઃዻ⾗ᢱ1 3) How the UTH support surveillance for ARI, influenza, measles virus and polioimyelitis? 4) How does UTH have communication with MOH for infectious disease control? 5) Does UTH set the priority research according to the national programme? 1.3 Impacts on How does UTH contribute to improve human resources development in human resource infectious disease control? development 1) Does the UTH have any training programmes for staff members of hospitals in rural areas except the training programmes under JICA projects? 2) How the training programmes held by JICA projects contribute to infectious disease control in Zambia? 3) Does UTH employ high qualified researcher/ technical staff? 4) Does UTH contribute technical articles to internal/ external journal? 1.4 Impacts on information services Existence of council/ committee and their activities Annual action plan, mandate/ aim of the institute Annual report MOH/ CBoH UTH MOH/ CBoH/ UTH Document review interview MOH/ CBoH UTH Document review/ Interview UTH Document review/ Interview MOH/ CBoH/ UTH JICA Expert Resume/ career of staff UTH No. of contribution UTH and publishing MOH/ UTH/ WHO 5) Does UTH keep the technical skill level for experiment/ routine work? Method of Quality If yes, how does it prove as status ‘good practice laboratory/ bio-safety/ control guideline’? No. of programmes UTH/ donors (USAID, 6) Does UTH have constant cooperation with external research and joint research CIDA, DANIDA, WB, organization? etc.) grading of publish MOH/ MOE 7) Does MOH/ MOE stipulate the status and the salary for human researcher on MOH/ resources in UTH? MOE What kinds of information does UHT send to? And how was it utilised? WHO, UNICEF, 1) Have you received any information (results of research activities) from UNAIDS the UTH? If yes, how do you utilize that information? 13 Document review/ Interview Interview Document review Document review Document review/ Interview Document review/ Interview Document review/ Interview Interview ઃዻ⾗ᢱ1 Report system to MOH/ CBoH MOH Free access to epidemiologic information system in UTH Structure of HMIS and MOH/ HMIS the research method 2) Does UTH have a channel for free access to epidemiologic information? 3) Does UTH have a survey network and skill? 1.5 Impacts on nations. How did UTH contribute to improve the health condition of nations? 1) Was the disposable type syringe introduced for avoiding hospital-acquired infection into the hospital? 2) Was the recommendation about the advancing vaccination for measles and polio realized? 1.6 Historical 1) Were there any incidents in Zambia health sector that affected JICA changes of Projects and/or UTH’s activities? program If yes, what were those incidents? And what kind of actions you take approach and its for counter measures? adequacy. 2. Roles of research What kinds of roles does UTH have as a research institute for infectious organization in disease control in Zambia and/or Africa region? infectious disease control 2.1 Confirmation of How does the Zambia Government tackle on the infectious diseases the infectious control? diseases control 1) Is the infectious diseases control prioritized in the National Health Plan in the health and programmes in the health sector? policy 2) How much budget is allocated for infectious diseases control in the health budget? 3) Is the infectious diseases control prioritized technical assistance of each donor’s policy? 4) Who participates and what are the priority subjects in SWAp of health sector and USAID-JAPAN Partnership? 14 Hospital/ MOH/ CBoH MOH/ CBoH UTH JICA Expert National health plan, MOH/ CBoH sector programme Health budget of MOH MOH Donor report SWAp/ USAID-JAPAN Partnership concept paper Document review Interview Interview Document review/ Interview Document review/ Interview UTH/ donors (USAID, Document review/ CIDA, DFID, WB, etc.) Interview SWAp participants (WB), Document review/ USAID Interview ઃዻ⾗ᢱ1 5) How many infectious diseases control programme is in SWAp and USAID-JAPAN Partnership? 6) How many programmes in SWAp and USAID-JAPAN Partnership for supporting UTH itself or using the institute function? 7) Is there a resemblance technical assistance by other donor agency? 8) Is there a duplication of role with resemblance institutes in MOH? SWAp/ USAID-JAPAN Partnership concept paper SWAp/ USAID-JAPAN Partnership concept paper Donor TA programme Structure and flow of HIMS 2.2 Position of What is the role of UTH on the infectious diseases control system? UTH on the 1) Please explain the infectious disease control system in Zambia, that is infectious to say key players (organizations) and their roles/functions. diseases control 2) Who is the responsible research organization for infectious disease prevention / control? 3) What is the role of UTH on the infectious diseases control system? 4) What is the role of UTH in MOH/ MOE? 5) What is the position of UTH among other institutes? (What is the difference between UTH and other institute/ research center?) 6) How important infectious diseases researches are for UTH? 7) What kinds of researches are studied in UTH? SWAp participants (WB), Document review/ USAID Interview UTH/ donors (USAID, CIDA, DFID, WB, etc.) MOH/ CBoH laboratory/ ASTL/ Chest Diseases Laboratory/ NASTLP/ NTLP/ NTP Document review/ Interview Document review/ Interview MOH/ CBoH Document review/ Interview MOH/ CBoH UTH/ MOH MOH/ MOE/ UTH MOH/ MOE/ UTH Interview Interview Interview MOH/ MOE/ UTH UTH Interview Document review/ Interview Document review/ Interview MOH/ MOE/ UTH 8) Does UTH execute its expected role completely? 2.3 Function of UTH SWAp participants (WB), Document review/ USAID Interview What kinds of functions does UTH have? 1) Is there a clear mandate and aim of UTH? 2) What is the activity of UTH? 3) How is the structure of UTH and how many staff? 4) How much is the budget and how does UTH provide budget? 15 Brochure, publishing document Annual Plan/ Report UTH Brochure, publishing document Budget sheet UTH UTH MOH/ MOE/ UTH Document review/ Interview Document review/ Interview Document review/ Interview Document review/ Interview ઃዻ⾗ᢱ1 Equipment list 5) What kind and how much experimental equipment for research UTH has? 6) What is the out put of UTH and how do UTH / MOH/ MOE evaluate it? 7) UTH is appointed as WHO Reference Laboratory/ National Reference WHO report Laboratory. How this status helps/burden with activity of UTH? (ex: raising up the whole status of UTH, reputation, budget provision, quality of staff, burden of hard research requirement, etc.) 3. Necessary What is the expected role of UTH as a research institute for infectious condition for disease control in the future? playing expected 1) Do you have any plan to expand UTH’s roles/functions in the MOH/ MOE report roles infectious disease control system? If yes䋬please explain your plan. 2) Besides research activities, what kind of development does UTH want in the field of empowerment of human resources and/ or announcement of epidemiologic information? 3) What is necessary implementation to satisfy above mentioned development plan? 16 UTH MOH/ MOE/ UTH Document review/ Interview Interview MOH/ UTH/ WHO Document review/ Interview MOH/ MOE/ UTH Document review/ Interview Document review/ Interview UTH UTH Interview ઃዻ⾗ᢱ 2 ╙ 1 ᰴ⺞ᩏᣣ⒟䋨䉬䊆䉝䊶䉱䊮䊎䉝䋩 䉬 䊆 ᣣ ᣣ 㗅 7/17 1 䋨䋩 18 2 䋨ᣣ䋩 19 3 䋨䋩 20 4 䋨Ἣ䋩 21 5 䋨᳓䋩 22 6 䋨ᧁ䋩 23 7 䋨㊄䋩 24 8 䋨䋩 25 9 䋨ᣣ䋩 26 10 䋨䋩 27 11 䋨Ἣ䋩 28 12 䋨᳓䋩 29 13 䋨ᧁ䋩 14 䉝 30 䋨㊄䋩 31 䋨䋩 8/1 16 䋨ᣣ䋩 15 17 2 䋨䋩 ⴕ㩷 㩷 ⒟ ᧲੩⊒ 䋨ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ䇮⹏ଔ⋙ℂ䋩 䊨䊮䊄䊮⚻↱䊅䉟䊨䊎⌕ ⺞ᩏ࿅ౝᛂว䈞 䉬䊆䉝ਛᄩකቇ⎇ⓥᚲ䋨KEMRI䋩ᢘ䊶ද⼏ ஜ⋭ᢘ JICA 䉬䊆䉝ോᚲ䈍䉋䈶ᣣᧄᄢ㙚ᢘ䊶ද⼏ KEMRI ද⼏ KEMRI䇮ᗵᨴ∝⎇ⓥኻ╷䊒䊨䉳䉢䉪䊃⡬ข KEMRI䇮ᗵᨴ∝⎇ⓥኻ╷䊒䊨䉳䉢䉪䊃⡬ข ஜ⋭ᗵᨴ∝ኻ╷⺖⡬ข KEMRI䇮JICA 䊒䊨䉳䉢䉪䊃㑐ଥ⠪⡬ข ⺞ᩏ࿅ౝᛂว䈞 ⾗ᢱᢛℂ KEMRI䇮࿖㓙ነ↢⯻ኻ╷䊒䊨䉳䉢䉪䊃⡬ข ࿖ኅ䊙䊤䊥䉝ኻ╷䊒䊨䉫䊤䊛⡬ข ஜ⋭⡬ข KEMRI䇮࿖㓙ነ↢⯻ኻ╷䊒䊨䉳䉢䉪䊃⡬ข ࿖┙ⴐⴡ↢䊤䊗䊤䊃䊥䊷䉰䊷䊎䉴䇮࿖┙ャⴊ䉶䊮䉺䊷⡬ข KEMRI ⡬ข USAID䇮☨࿖∔∛▤ℂ䊶੍㒐䉶䊮䉺䊷䋨CDC䋩䇮AMREF䋨NGO䋩䇮䉡䉤䊦䉺䊷䊶䊥䊷䊄 䋨☨ ࿖㒽ァකቇ⎇ⓥ䊡䊆䉾䊃䋩⡬ข 䊅䉟䊨䊎⊒䊝䊮䊋䉰⌕䋨࿖ౝ⒖േ䋩 䉪䊪䊧⺞ᩏ䋨ᬺ⹏ଔ䇮⹏ଔ⋙ℂ䋩 WHO䇮UNICEF ⡬ข䋨⎇ⓥᚲᯏ⢻ಽᨆ䋩 䊝䊮䊋䉰⊒䊅䉟䊨䊎⌕ ⺞ᩏ࿅ౝᛂว䈞 ᧲੩⊒䋨✚䋩 ⾗ᢱᢛℂ 䉼䊠䊷䊥䉾䊍⚻↱䊅䉟䊨䊎⌕䋨✚䋩 JICA 䉬䊆䉝ോᚲ䈍䉋䈶ஜ⋭⡬ข ⺞ᩏ࿅ౝᛂว䈞 KEMRI ᢘ䇮ⷞኤ䋨✚䋩 ࿖ኅ䉣䉟䉵ኻ╷䊒䊨䉫䊤䊛䈍䉋䈶ஜ⋭⡬ข KEMRI ᚲ㐳ᢘ䋨✚䋩 3 䋨Ἣ䋩 4 19 䋨᳓䋩 5 KEMRI ႎ๔ 20 䋨ᧁ䋩 6 ᣣᧄᄢ㙚䈍䉋䈶 JICA 䉬䊆䉝ോᚲႎ๔ 21 䋨㊄䋩 18 17 ઃዻ⾗ᢱ 2 䉱 䊮 䊎 䉝 ᣣ ᣣ 㗅 7 22 䋨䋩 8 23 䋨ᣣ䋩 9 24 䋨䋩 10 25 䋨Ἣ䋩 11 26 䋨᳓䋩 12 27 䋨ᧁ䋩 13 28 䋨㊄䋩 14 29 䋨䋩 15 30 䋨ᣣ䋩 16 31 䋨䋩 17 32 㩿Ἣ㪀 18 33 䋨᳓䋩 19 34 䋨ᧁ䋩 20 35 䋨㊄䋩 21 36 䋨䋩 22 37 䋨ᣣ䋩 23 38 䋨䋩 24 39 䋨Ἣ䋩 25 40 䋨᳓䋩 ⴕ㩷 㩷 ⒟ 䊅䉟䊨䊎⊒䊦䉰䉦⌕ 䋨✚䇮ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ䇮⹏ଔ⋙ℂ䋩 ⺞ᩏ࿅ౝᛂว䈞 䉱䊮䊎䉝ᄢቇකቇㇱ䇮ห㒝ዻᢎ⢒∛㒮䋨UTH䋩䇮ਛᄩஜዪ䋨CBoH䋩䇮 䉱䊮䊎䉝ᣣᧄᄢ㙚䈍䉋䈶 JICA ോᚲᢘ䍃ද⼏ 䉣䉟䉵䈍䉋䈶⚿ᩭኻ╷䊒䊨䉳䉢䉪䊃ⷞኤ䈍䉋䈶ኾ㐷ኅ䊶䉦䉡䊮䉺䊷䊌䊷䊃⡬ข ஜ⋭ᢘ䊶ද⼏ 䉡䉟䊦䉴ᬌᩏቶ䊶⚿ᩭᬌᩏቶ⡬ข ࿖ኅ䉣䉟䉵ᆔຬળ䈍䉋䈶 UTH 㑐ଥ⠪⡬ข 䉡䉟䊦䉴ᬌᩏቶ䇮⚿ᩭᬌᩏቶ䇮䊦䉰䉦䊶䉼䉢䊧䉴䊃䊮ஜ䉶䊮䉺䊷⡬ข 䊦䉰䉦⊒䋨⹏ଔ⋙ℂ䋩 CBoH ᬌᩏቶᛛⴚ⠪⡬ข 䊣䊊䊈䉴䊑䊦䉪䊶䉲䊮䉧䊘䊷䊦⚻↱᧲੩⌕䋨⹏ଔ⋙ℂ䋩 䊦䉰䉦⊒䊥䊎䊮䉫䉴䊃䊮⌕䋨࿖ౝ⒖േ䋩 䊥䊎䊮䉫䉴䊃䊮ਛᄩ∛㒮ⷞኤ 䊥䊎䊮䉫䉴䊃䊮⊒䊦䉰䉦⌕ UTH 䉡䉟䊦䉴ᬌᩏቶ䇮CBoH䇮UNDP䇮CDC ⡬ข 䊦䉰䉦⊒䋨✚䋩 WHO䇮⇇㌁ⴕ⡬ข 䊣䊊䊈䉴䊑䊦䉪䊶䉲䊮䉧䊘䊷䊦⚻↱᧲੩⌕䋨✚䋩 UTH䇮ஜ⋭ㅊടᖱႎ㓸 UNAIDS䇮UNICEF ⡬ข UTH䇮ஜ⋭ㅊടᖱႎ㓸 DFID ⡬ข JICA ஜᜂᒰᚲຬ⡬ข ⾗ᢱಽᨆ UTH䇮ᣣᧄᄢ㙚䈍䉋䈶 JICA ോᚲႎ๔ 䊦䉰䉦⊒ 䋨ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ䋩 䊣䊊䊈䉴䊑䊦䉪䊶䉲䊮䉧䊘䊷䊦⚻↱᧲੩⌕ 18 ઃዻ⾗ᢱ 2 ╙ 2 ᰴ⺞ᩏᣣ⒟䋨䉧䊷䊅䋩 ᣣ㗅 ᣣ 9/10 1 㩿㊄㪀㩷 11 2 㩿㪀㩷 12 3 㩿ᣣ㪀㩷 13 4 㩿㪀㩷 14 5 㩿Ἣ㪀㩷 15 6 㩿᳓㪀㩷 16 7 㩿ᧁ㪀㩷 17 8 㩿㊄㪀㩷 18 9 㩿㪀㩷 19 10 㩿ᣣ㪀㩷 11 20 㩿㪀㩷 12 21 㩿Ἣ㪀㩷 13 22 㩿᳓㪀㩷 14 23 㩿ᧁ㪀㩷 24 15 㩿㊄㪀㩷 25 16 㩿㪀㩷 26 17 㩿ᣣ㪀㩷 27 18 㩿㪀㩷 28 19 㩿Ἣ㪀㩷 29 20 㩿᳓㪀㩷 30 21 㩿ᧁ㪀㩷 ⴕ㩷 㩷 ⒟ 䊦䉰䉦⊒㧔ᗵᨴ∝ኻ╷㧕 䋨䉱䊮䊎䉝䈪䈱⍴ᦼኾ㐷ኅᵷ㆜䈎䉌⋥ធෳട䋩 䊣䊊䊈䉴䊑䊦䉪⚻↱䉝䉪䊤⌕䋨ᗵᨴ∝ኻ╷䋩 ᧲੩⊒㧔✚䇮ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ㧕 䊨䊮䊄䊮⚻↱ࠕࠢ⌕㧔✚䇮ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ㧕 ஜ⋭䇮䉧䊷䊅ᣣᧄᄢ㙚䈍䉋䈶 JICA 䉧䊷䊅ോᚲᢘ ㊁ญ⸥ᔨකቇ⎇ⓥᚲ䋨㊁ญ⎇䋩䇮䉝䊐䊥䉦࿖㓙ነ↢⯻ኻ╷䉶䊮䉺䊷䊒䊨䉳䉢䉪䊃ᢘ 䉧䊷䊅ஜ䉰䊷䊎䉴䇮⽷䊶⚻ᷣ⸘↹⋭ᢘ䇮EU ⡬ข DFID 䈍䉋䈶 UNFPA ⡬ข UNICEF䇮⇇㌁ⴕ䇮WHO ⡬ข䇮㊁ญ⎇䊒䊨䉳䉢䉪䊃㑐ଥ⠪⡬ข USAID䇮䉥䊤䊮䉻ᄢ㙚䇮DANIDA ⡬ข䇮ᢎ⢒⋭ᢘ 䉝䉪䊤⊒䋨✚䋩 ⺞ᩏ࿅ౝᛂว䈞 䉝䉪䊤⊒䋨ᗵᨴ∝ኻ╷䋩 ⾗ᢱᢛℂ 䊨䊮䊄䊮⚻↱᧲੩⌕䋨✚䋩 ㊁ญ⎇䊒䊨䉳䉢䉪䊃㑐ଥ⠪⡬ข 䊨䊮䊄䊮⚻↱᧲੩⌕䋨ᗵᨴ∝ኻ╷䋩 UNAIDS䇮࿖┙ⴐⴡ↢䊤䊗䊤䊃䊥䊷⡬ข ㊁ญ⎇䊒䊨䉳䉢䉪䊃㑐ଥ⠪⡬ข ㊁ญ⎇䊒䊨䉳䉢䉪䊃㑐ଥ⠪⡬ข ⺞ᩏ㑐ㅪᯏ㑐ㅊട⺞ᩏ ⺞ᩏ㑐ㅪᯏ㑐ㅊട⺞ᩏ ⺞ᩏ࿅ౝᛂว䈞 ⾗ᢱᢛℂ ㊁ญ⎇ႎ๔ 䉧䊷䊅ᣣᧄᄢ㙚䇮JICA 䉧䊷䊅ോᚲႎ๔ 䉝䉪䊤⊒䋨ᬺ⹏ଔ䇮⎇ⓥᚲᯏ⢻ಽᨆ䋩 ⒖േ 䊨䊮䊄䊮⚻↱᧲੩⌕ 19 ઃዻ⾗ᢱ 3 ࿖ౝ⺞ᩏදജ⠪৻ⷩ㩷 㩷 ᳁ฬ㩷 ᚲዻ㩷 ᩙ㩷 ᢘ㩷 ᄢ㒋ᄢቇฬᢎ㩷 ᾖᴧ 㩷 ක≮ᴺੱ␠࿅ඳᔃෘ↢ળᲑࠢ࠾࠶ࠢ∉≮ᴺㇱㇱ㐳㩷 ጊፒ ୃ ࿖┙ᗵᨴ∝⎇ⓥᚲฬᚲຬ㧔రᚲ㐳㧕 ᩣᑼળ␠ਃ⪉ൻቇࡆࠪࠛ࡞㘈 ᧻ᶉ ♿ ࿖┙ᗵᨴ∝⎇ⓥᚲ✚ോㇱㇱ㐳 ᄙ ᔀᄥ㇢ ࿖┙ᗵᨴ∝⎇ⓥᚲᗵᨴ∛ℂㇱㇱ㐳 ⼱ญ ᷡᎺ ࿖┙ᗵᨴ∝⎇ⓥᚲᗵᨴ∝ᖱႎࡦ࠲ᗵᨴ∝ኻ╷⸘↹ቶቶ㐳 రࠟ࠽㊁ญ⸥ᔨකቇ⎇ⓥᚲࡊࡠࠫࠚࠢ࠻ࡈࠚ࠭Τ࠴ࡓ࠳ ᧖ᶆ ᐽᄦ ࿖┙࿖㓙ක≮䉶䊮䉺䊷࿖㓙ක≮දജዪᵷ㆜╙৻⺖㩷 ర䉬䊆䉝ᗵᨴ∝⎇ⓥኻ╷䊒䊨䉳䉢䉪䊃䊐䉢䊷䉵㸈䉼䊷䊐䉝䊄䊋䉟䉱䊷㩷 ర䉬䊆䉝ᗵᨴ∝䈶ነ↢⯻∝ኻ╷⎇ⓥ䊒䊨䉳䉢䉪䊃䊐䉢䊷䉵㸈䉼䊷䊐䉝䊄䊋 䉟䉱䊷㩷 ⧯᧖ ߥ߅ߺ㩷 ࿖┙࿖㓙ක≮ࡦ࠲⎇ⓥᚲ∉ቇ⛔⸘⎇ⓥㇱㇱ㐳 ർᎹ ቯ⻞ ⽷࿅ᴺੱᣣᧄⴐⴡ↢දળℂ㐳 ⮮ጊ ૫⑲ ṑ⾐ක⑼ᄢቇౝ⑼ቇ⻠ᐳᢎ రࠤ࠾ࠕᗵᨴ∝⎇ⓥኻ╷ࡊࡠࠫࠚࠢ࠻ࡈࠚ࠭Τ࠴ࡈࠕ࠼ࡃࠗࠩ ⷺ㊁ ᢥᒾ ṑ⾐⋵ḓർၞᝄ⥝ዪၞஜㇱㇱ㐳㧔㐳ᵿஜᚲ㐳㧕 రࠤ࠾ࠕᗵᨴ∝⎇ⓥኻ╷ࡊࡠࠫࠚࠢ࠻ࡈࠚ࠭Τ࠳ ⍹↰㩷 ⒤ᒾ㩷 ජ⪲ᄢቇකቇㇱ㒝ዻ∛㒮ዊఽ⑼㩷 ర䉧䊷䊅㊁ญ⸥ᔨකቇ⎇ⓥᚲᗵᨴ∝ኻ╷䊒䊨䉳䉢䉪䊃䉼䊷䊐䉝䊄䊋䉟䉱䊷㩷 ၳ㩷 ᶈ᮸㩷 ਃ㊀ᄢቇකቇㇱዊఽ⑼ഥᢎ㩷 ర䉧䊷䊅㊁ญ⸥ᔨකቇ⎇ⓥᚲ䊒䊨䉳䉢䉪䊃䊒䊨䉳䉢䉪䊃䊥䊷䉻䊷㩷 ర䉧䊷䊅㊁ญ⸥ᔨකቇ⎇ⓥᚲ䊒䊨䉳䉢䉪䊃䊐䉢䊷䉵㸈䊒䊨䉳䉢䉪䊃䊥䊷䉻䊷㩷 ┻ᧄ ৻ ⁛┙ⴕᴺੱ࿖㓙දജᯏ᭴ࠕࡈࠞㇱਛㇱࠕࡈࠞ࠴ࡓ ᳰ↰ ବ৻㇢ ⁛┙ⴕᴺੱ࿖㓙දജᯏ᭴ੱ㑆㐿⊒ㇱ╙ 4 ࠣ࡞ࡊᗵᨴ∝ኻ╷࠴ࡓ ቯᧄ ࠁߣࠅ ⁛┙ⴕᴺੱ࿖㓙දജᯏ᭴ੱ㑆㐿⊒ㇱ╙ 4 ࠣ࡞ࡊᗵᨴ∝ኻ╷࠴ࡓ 㧔㕙⺣ᒰᤨ㧕 ’ᧄ ዊᨑ ⁛┙ⴕᴺੱ࿖㓙දജᯏ᭴ੱ㑆㐿⊒ㇱ╙ 4 ࠣ࡞ࡊᗵᨴ∝ኻ╷࠴ࡓ ਅ↰ ㅘ ⁛┙ⴕᴺੱ࿖㓙දജᯏ᭴⺞㆐ㇱᯏ᧚ࠣ࡞ࡊᐡ↪ຠᓎോ⺞㆐࠴ࡓ ࠴ࡓ㐳㩷 㩷 20 ઃዻ⾗ᢱ 4 ╙ 1 ᰴ⺞ᩏ䋨䉬䊆䉝䋩㕙⺣⠪৻ⷩ ᚲዻ ᳁ฬ ஜ⋭ Dr. A. O. Misore Dr. S. Nzioka Dr. Muhamed Dr. Sam Ochola Mr. Kitenge KEMRI Dr. Davy K. Koech Mr. Dunstan M. Ngumo Dr. F. A. Okoth Dr. P. M. Nyakundi Dr. Charles. S. Mwandawiro Mr. G. A .O. Seko Dr. Phoebe Josiah Dr. Solomon S.R. Mpoke Dr. Evans Amukoye Dr. Njeri Wamae Dr. Willie Abela Githui Dr. Hellen Meme-Murerwa Dr. Peter M. Tukei Mr. Peter Kaiguri ࿖㓙⯻↢ℂቇ䊶↢ᘒቇ⎇ⓥᚲ Dr. John I. Githure USAID Dr. Bedan Gichanga CDC Mr. Bill Galo Ms. Heather Burke African Medical Research Foundation (AMRF) Dr. Mette Kjaer Walter Reed (USA Medical Research Unit) Mr. Norman Peterson WHO Country Office Dr. Eliki UNICEF Dr. Iyabode Olusanmi 䉬䊆䉝ᣣᧄ࿖ᄢ㙚 ḡỈ ᙗ ᗵᨴ∝⎇ⓥኻ╷䊒䊨䉳䉢䉪䊃 ᄢ⍹㩷 ഞ ฝㄭ㩷 ᥓ㓶 ᭢㢬㩷 ⟵ੱ ᄢ㊁㩷 ᑝਃ ነ↢⯻ኻ╷䊒䊨䉳䉢䉪䊃 ᄤ㊁㩷 ⊥ᤘ ☿Ỉ㩷 ବ᮸ ਃ㩷 ⟵ೣ ዊᨋ㩷 ൕ ᓎ⡯ ੍㒐䊶⊒ක≮䉰䊷䊎䉴ዪዪ㐳 ᗵᨴ∝ኻ╷⺖⺖㐳 ࿖ኅ䉣䉟䉵䊶ᕈᗵᨴ∝ኻ╷䊒䊨䉫䊤䊛䊙䊈䊷䉳䊞䊷 ࿖ኅ䊙䊤䊥䉝ኻ╷䊒䊨䉫䊤䊛䊙䊈䊷䉳䊞䊷 ࿖┙ャⴊ䉶䊮䉺䊷ਥછᬌᩏᛛᏧ ᚲ㐳 ᚲ㐳 䉡䉟䊦䉴⎇ⓥ䉶䊮䉺䊷㐳 ⥃ᐥකቇ⎇ⓥ䉶䊮䉺䊷䉶䊮䉺䊷㐳 䉝䊐䊥䉦࿖㓙ነ↢⯻ኻ╷䉶䊮䉺䊷㐳 ༡❲ㇱ ࿖㓙දജㇱ ↢‛ൻቇ⎇ⓥ䉶䊮䉺䊷/ర JICA 䊒䊨䉳䉢䉪䊃⺞ᢛຬ ๆེ♽∔ᖚ䉶䊮䉺䊷㐳 ⚦⩶⎇ⓥ䉶䊮䉺䊷㐳 ๆེ♽∔ᖚ䉶䊮䉺䊷⚖⎇ⓥຬ/ WHO ᬌᩏቶ ๆེ♽∔ᖚ䉶䊮䉺䊷⎇ⓥຬ/ WHO ᬌᩏቶ KEMRI ᚲ㐳ઍℂ/㩷 CDC/KEMRI ᬌᩏቶ㐳 ⴊᶧోᕈ䊒䊨䉳䉢䉪䊃ᜂᒰ ஜ⺖⺖㐳 䊒䊨䉫䊤䊛䉥䊐䉞䉰䊷 ᚲ㐳 ⎇ⓥຬ ᚲ㐳 ോቭ ᚲ㐳 ஜ䊒䊨䉫䊤䊛䉥䊐䉞䉰䊷 ৻╬ᦠ⸥ቭ 䉼䊷䊐䉝䊄䊋䉟䉱䊷 ᣣᗵᨴ∝ વ⛔කቇ䋨⍴ᦼኾ㐷ኅ䋩 ᬺോ⺞ᢛ 䉼䊷䊐䉝䊄䊋䉟䉱䊷 ነ↢⯻ኻ╷ ⴐⴡ↢ ᬺോ⺞ᢛ 21 ઃዻ⾗ᢱ 4 ᚲዻ ᳁ฬ JICA 䉬䊆䉝ോᚲ: ⁚㊁㩷 ⦟ᤘ ੳ↰㩷 ⍮᮸ ਛᎹ㩷 ੨ਯ ┻ਛ㩷 િ৻ Dr. Willie Nyambati ᓎ⡯ ᚲ㐳 ᰴ㐳 ᚲຬ䋨ஜಽ㊁ᜂᒰ䋩 ડ↹⺞ᩏຬ䋺HIV/AIDS ኻ╷䋨ᐢၞ䋩 䉲䊆䉝䊒䊨䉫䊤䊛䉥䊐䉞䉰䊷 ╙ 1 ᰴ⺞ᩏ䋨䉱䊮䊎䉝䋩㕙⺣⠪৻ⷩ ᚲዻ ᳁ฬ ஜ⋭ Mr. Chimfwenbe Mr. Alex Simwanza ਛᄩஜዪ Dr. Ben Chirwa Mrs. G. Kahenya Dr. E. Syninza 䉱䊮䊎䉝ᄢቇකቇㇱ㒝ዻᢎ⢒∛㒮 Dr. T. K. Lambart Dr. Francis Kasolo Dr. Mwaka Monze Dr. Ray Handema Mr. David Lubasi Ms. Charity Habeenzu Ms. Mazyanga Liwewe Dr. Zulu Wamemba Ms. Idah Mweene Ndumba Ms. Gina Mulundu 䊦䉰䉦Ꮢஜዪ Dr. Moses Sinkala 䊥䊎䊮䉫䉴䊃䊮ਛᄩ∛㒮 Dr. Makani ೨ஜᄢ⤿ Prof. N. Luo UNDP Dr. Rosemary Kumwenda CDC Dr. Marc Bulterys Dr. Lin Parsons Dr. Alwyn Mwinga Dr. Bereneice M. Madison WHO Dr. Maboshe Dr. K. Sunkutu ⇇㌁ⴕ Dr. Musonda Rosemary Sunkutu ᓎ⡯ ⸘↹㐿⊒ዪዪ㐳 ࿖ኅ䉣䉟䉵⹏⼏ળ⸘↹ㇱㇱ㐳 ዪ㐳 ᬌᩏቶᛛᏧ㐳 ⴐⴡ↢⎇ⓥㇱㇱ㐳 㒮㐳 䉡䉟䊦䉴ᬌᩏቶቶ㐳 ⚖⎇ⓥຬ 䉡䉟䊦䉴ᬌᩏቶ⡯ຬ ⚿ᩭᬌᩏቶ⡯ຬ ⚿ᩭᬌᩏቶ⡯ຬ 䉡䉟䊦䉴ᬌᩏቶ⡯ຬ ⚿ᩭᬌᩏቶ㩷 ቶ㐳 ᓸ↢‛ᬌᩏቶ㩷 ቶ㐳 䉡䉟䊦䉴ᬌᩏቶ⡯ຬ ዪ㐳 㒮㐳 䉣䉟䉵ኻ╷䉝䊄䊋䉟䉱䊷 ዪ㐳 ⴐⴡ↢䉮䊮䉰䊦䉺䊮䊃 ∉ቇ⠪ ஜቇ⠪ ⚿ᩭ䉼䊷䊛䉝䊄䊋䉟䉱䊷 䉣䉟䉵䉼䊷䊛䉝䊄䊋䉟䉱䊷 ⚖ஜኾ㐷ຬ 22 ઃዻ⾗ᢱ 4 ᚲዻ ᳁ฬ UNAIDS Dr. Catherine Sozi UNICEF Dr. Birthe Locatelli-Rossi Dr. Flint Zulu DFID Mr. Anthony Daly 䉣䉟䉵䈍䉋䈶⚿ᩭኻ╷䊒䊨䉳䉢䉪䊃 ᳓⼱㩷 ືᄦ ਭ㩷 ੧ Ꮏ⮮㩷 ⍮ሶ ᐢ↰㩷 ⋿⟤ ศ↰㩷 ㇌ੳሶ 㑐㊁㩷 ⦟৻ 䉱䊮䊎䉝ᣣᧄ࿖ᄢ㙚 ḡᧄ㩷 ஜ৻ JICA 䉱䊮䊎䉝ോᚲ ੇ㩷 ⧷ੑ Ⴚ㩷 ൎ৻㇢ ർỈ㩷 ᔒ㇢ ᐳ㑆ᥓሶ Mr. Festus Lubinga ᓎ⡯ 䉱䊮䊎䉝࿖ઍ ஜㇱㇱ㐳 ዊఽஜ䊒䊨䉳䉢䉪䊃ᜂᒰ ஜ䊶䉣䉟䉵䉝䊄䊋䉟䉱䊷 䉼䊷䊐䉝䊄䊋䉟䉱䊷 HIV 䉡䉞䊦䉴ቇ䊶∉ቇ ⚿ᩭኻ╷ ⴐⴡ↢䊶∉ቇ ARV ᴦ≮ ᬺോ⺞ᢛ ੑ╬ᦠ⸥ቭ ᚲ㐳 ᰴ㐳 ᚲຬ䋨ஜಽ㊁ᜂᒰ䋩 HIV/AIDS 䈶⚿ᩭኻ╷䊒䊨䉫䊤䊛䉮䊷䊂䉞䊈䊷䉺䊷 䊒䊨䉫䊤䊛䉥䊐䉞䉰䊷 ╙ 2 ᰴ⺞ᩏ䋨䉧䊷䊅䋩࿖㕙⺣⠪৻ⷩ ᚲዻ ᳁ฬ ஜ⋭ Dr. Edward Addai Dr. Robert Azumah Mr. Jones Ofosu Ms. Salamata Abdul-Salam 䉧䊷䊅䊓䊦䉴䉰䊷䊎䉴 Dr. Sam Adjei Dr. George Amofa Mr. A. Manu Sarpong Dr. Alex Asamoah Adu Dr. John Gyapong Ms. Evelyn Quaye Dr. K. O. Antwi-Agyei Dr. Frank Bonsu Dr. L. Ahadzio ⽷ോ⋭ Dr. Sam Archer Mr. N. B. Sowah Ms. Yvonne O. Quansah ᓎ⡯ ╷╷ቯ䊶䊝䊆䉺䊥䊮䉫䊶⹏ଔ⺖䊝䊆䉺䊥䊮䉫䊶⹏ଔ⽿ છ⠪ વ⛔කቇ≮ᴺ⺖⺖㐳 ੱ᧚㐿⊒ㆇ༡⺖⺖㐳 ോㆇ༡⺖⺖㐳 GHS ✚ⵙ ⴐⴡ↢⺖⺖㐳 ⴐⴡ↢⺖⒁ᦠቭ ⴐⴡ↢䊥䊐䉜䊧䊮䉴䊤䊗䊤䊃䊥䊷䋨NPHRL䋩ᚲ㐳 කቇ⎇ⓥ⺖⺖㐳 䉬䉝䊶ᡰេ䉮䊷䊂䉞䊈䊷䉺䊷䇮࿖ኅ䉣䉟䉵/STI ኻ╷䊒 䊨䉫䊤䊛 EPI 䊒䊨䉫䊤䊛䍃䊙䊈䊷䉳䊞䊷 ࿖ኅ⚿ᩭኻ╷䊒䊨䉫䊤䊛䊶䊙䊈䊷䉳䊞䊷 䉰䊷䊔䉟䊤䊮䉴䍃䊡䊆䉾䊃㐳 ᣣᧄេഥ䋨䉳䊞䊌䊮䍃䊂䉴䉪䋩ᜂᒰቭ ੍▚ᜂᒰቭ េഥ⺞ᢛਥછᜂᒰቭ 23 ઃዻ⾗ᢱ 4 ᢎ⢒⋭ Mr. Ato Essuman Ms. Mary D. Ouaye ᧻↰ᓼሶ ㊁ญ⸥ᔨකቇ⎇ⓥᚲ Prof. David Ofori-Adjei Dr. Margaret Armah-Klemesu Mr. Okyere Boateng Mr. E.O. Lamptey Prof. Michael D. Wilson Dr. Daniel Boakye Dr. Nana K. Ayisi Dr. William Ampofo Mr. Jacob Arthur-Quarm Dr. Mubarak Osei-Kwasi Dr. Kwasi Addo Dr. Kwadwo Koram Dr. Batholomew Akanmori Dr. E.E.K.Takyi Prof. Alexander Nyarko Dr. Phyllis Addo Dr. Daniel Kojo Arhinful EU Ms. Janet Appiah DFID Mr. Will Gust UNFPA Dr. Emmanuel Tofoatsi Dr. Gifty Addico UNICEF Dr. Aliu Bello ⇇㌁ⴕ Ms. Georgia Dawson Amoah WHO Country Office Dr. Melvin George Dr. Messeret Eshetu Dr. Morkor Newman Dr. Felicia Owusu-Antwi USAID Ms. Ursula Nadolny Dr. Peter Wondergem Dr. Goel K. Paradeep 䉥䊤䊮䉻ᄢ㙚 Dr. Janvan der Horst DANIDA Dr. Kobina Baison UNAIDS Dr. Warren Naamara 䉧䊷䊅ᣣᧄ࿖ᄢ㙚 ᵻ ሶ㩷 ਛἑ㩷 ፏᢥ ᰴቭ ࿖ౝ⺞ᢛᜂᒰቭ䇮 GES-SHEP JICA ኾ㐷ኅ䋨ᢎ⢒╷䋯េഥ䉝䊄䊋䉟䉴䋩 ᚲ㐳 ᚲ㐳 ✚ോㇱㇱ㐳 䊜䊮䊁䊅䊮䉴䊡䊆䉾䊃㐳 ነ↢⯻ቇ䊡䊆䉾䊃㐳 ነ↢⯻ቇ䊡䊆䉾䊃⎇ⓥຬ 䉡䉟䊦䉴ቇ䊡䊆䉾䊃㐳 䉡䉟䊦䉴ቇ䊡䊆䉾䊃⎇ⓥຬ 䉡䉟䊦䉴ቇ䊡䊆䉾䊃㐳䇮ਥછᛛⴚ⠪ 䉡䉟䊦䉴ቇ䊡䊆䉾䊃ᛛⴚ䉝䊄䊋䉟䉱䊷 ⚦⩶ቇ䊡䊆䉾䊃㐳 ∉ቇ䊡䊆䉾䊃㐳 ∉ቇ䊡䊆䉾䊃㐳 ᩕ㙃ቇ䊡䊆䉾䊃㐳 ⥃ᐥ∛ℂቇ䊡䊆䉾䊃㐳 ታ㛎േ‛䊡䊆䉾䊃㐳 IMPACT 䊒䊨䉳䉢䉪䊃䊶䊥䉰䊷䉼䉮䊷䊂䉞䊈䊷䉺䊷 ␠ળㇱ㐷䊒䊨䉫䊤䊛䊶䉥䊐䉞䉰䊷 ੱ㑆㐿⊒䊒䊨䉫䊤䊛䊶䉥䊐䉞䉰䊷 䊅䉲䊢䊅䊦䊒䊨䉫䊤䊛䊶䉥䊐䉞䉰䊷 䉥䊐䉞䉰䊷䋨䊥䊒䊨䉻䉪䊁䉞䊑䊓䊦䉴䋩 䊒䊨䉳䉢䉪䊃䉥䊐䉞䉰䊷 䊒䊨䉳䉢䉪䊃䉥䊐䉞䉰䊷 ᚲ㐳 ∉ቇᜂᒰቭ HIV/AIDS/ STI ஜ䊒䊨䉫䊤䊛䍃䉥䊐䉞䉰䊷 䊙䊤䊥䉝ஜ䊒䊨䉫䊤䊛䍃䉥䊐䉞䉰䊷 ஜ䍃ੱญ䍃ᩕ㙃䊡䊆䉾䊃㐳 ஜ䍃ੱญ䍃ᩕ㙃䊡䊆䉾䊃䇮HIV/AIDS 䉝䊄䊋䉟䉱䊷 ஜ䍃ੱญ䍃ᩕ㙃䊡䊆䉾䊃䇮ዊఽஜ䉝䊄䊋䉟䉱䊷 ৻╬ᦠ⸥ቭ䇮ක≮䊶䉳䉢䊮䉻䊷㐿⊒䉝䊄䊋䉟䉱䊷 ක≮ಽ㊁ᡰេോᚲஜක≮ᜂᒰቭ 䉦䊮䊃䊥䊷䉮䊷䊂䉞䊈䊷䉺䊷 ․ోᮭᄢ ኾ㐷⺞ᩏຬ 24 ઃዻ⾗ᢱ 4 WACIPAC ⩆ේ㩷 ਭ⟵ ฎ㑄㩷 ↱૫㉿ JICA 䉧䊷䊅ോᚲ ባᚭ㩷 ஜ৻㩷 ዊᷗ㩷 િม㩷 ᐢἑ㩷 ᕺ⟤ ᷡ᳓㩷 ᴦઍ㩷 䉼䊷䊐䉝䊄䊋䉟䉱䊷 ᬺോ⺞ᢛ ᚲ㐳 ᰴ㐳 ᚲຬ䋨ஜಽ㊁ᜂᒰ䋩 ડ↹⺞ᩏຬ䋺ஜ䉶䉪䉺䊷䊒䊨䉫䊤䊛ᡰេ 25 ઃዻ⾗ᢱ 5 㓸⾗ᢱ৻ⷩ㩷 ╙ 㪉 ┨㩷 ᣣᧄ䊶᰷☨䈮䈍䈔䉎ᗵᨴ∝⎇ⓥᯏ㑐䈱ᯏ⢻㩷 㓸వ ⾗ᢱ ⴐⴡ↢ክ⼏ળવᨴ∛੍㒐ㇱ ޟᣂߒᤨઍߩᗵᨴ∝ኻ╷ߦߟߡޠႎ๔ᦠ ળ ෘ↢ഭ⋭㧔1997㧕 ෘ↢ഭ⋭㧔1998㧕 ᗵᨴ∝ߩ੍㒐߅ࠃ߮ᗵᨴ∝ᖚ⠪ߦኻߔࠆක≮ߦ㑐ߔࠆᴺᓞ㧔ᐔᚑ 10 ᐕ 10 2 ᣣᴺᓞ 114 ภ㧕 ᧲੩ᄢቇක⑼ቇ⎇ⓥᚲ㧔2002㧕 ᧲੩ᄢቇක⑼ቇ⎇ⓥᚲⷐ 㐳ፒᄢቇ㧔2004㧕 ᾲᏪᗵᨴ∝⎇ⓥࡦ࠲ⷐ AFRO-WHO㧔2003㧕 Communicable Diseases Epidemiological Report AFRO-WHO㧔2004㧕 WHO collaborating centre AFRO-WHO㧔2004㧕 WHO laboratory equipment HIV AFRO-WHO㧔2004㧕 WHO regional lab HIV CDC㧔1997㧕 Lab bio-safety USAID㧔2001㧕 USAID-Japan partnership ╙ 㪋 ┨㩷 䉧䊷䊅㊁ญ⸥ᔨකቇ⎇ⓥᚲ㩷 㓸వ ࿖㓙දജᯏ᭴㧔2004㧕 ⾗ᢱ ᐔᚑ 16 ᐕᐲ JICA ࿖ᬺታᣉ⸘↹ ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR ࡦ࠲⚵❱࿑߅ࠃ߮ࠬ࠲࠶ࡈᢙ ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR ࠨ࠴ࡊࡠࠫࠚࠢ࠻ࠬ࠻ ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/Abstracts of Publications 1979-1999 ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ ANIMAL staff development updated ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/committees members ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ Final National Training Course in TB Microscopy-Report 2 ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ Final NTP SP2 ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ HIV QC report JICA final ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ Letter for HIV short course -JICA Infect Diseases ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ Parasitology staff dev plan㧔2003-2008㧕 ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ QA TRAINING ㊁ญ⸥ᔨකቇ⎇ⓥᚲ㧔2004㧕 NMIMR/ TB final Review report Ghana ㊁ญ⎇/JICA㧔2004㧕 Apoptosis Report ㊁ญ⎇/JICA㧔2004㧕 Lab Animals Evaluation Plan ㊁ญ⎇/JICA㧔2004㧕 GPCI Report1 ㊁ญ⎇/JICA㧔2004㧕 Schistosomiasis Report ㊁ญ⎇/JICA㧔2004㧕 STD Report ㊁ญ⎇/JICA㧔2004㧕 TB Report ㊁ญ⎇/JICA㧔2004㧕 VHF Serology Report Ministry of Health㧔2003㧕 Financial Report 26 ઃዻ⾗ᢱ 5 Ministry of Health㧔2004㧕 HRU Annual report 2003 IMMPACT㧔2004㧕 Brochure ╙㪌┨ 䉬䊆䉝ਛᄩකቇ⎇ⓥᚲ㩷 㓸వ ⾗ᢱ JICA ࠤ࠾ࠕോᚲ㧔2004㧕 ஜක≮ಽ㊁ េഥࡊࡠࠣࡓ㨯࠷ JICA ࠤ࠾ࠕോᚲ㧔2004㧕 SWAps ࡢ࡚ࠢࠪ࠶ࡊ⼏㍳ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CMR ࡦ࠲⚵❱࿑߅ࠃ߮ࠬ࠲࠶ࡈᢙ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CMR ࠨ࠴ࡊࡠࠫࠚࠢ࠻ࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CMR ᵴേౝኈ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CMR ࠻࠾ࡦࠣฃߌࠇᩞࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CMR ⺰ᢥࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR ࡦ࠲⚵❱࿑ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR ࠨ࠴ࡊࡠࠫࠚࠢ࠻ࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR ᵴേౝኈ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR ⺰ᢥࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR WHO TB reference laboratory guideline ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CRDR ⺰ᢥࠬ࠻ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CPHR ࡦ࠲⚵❱࿑ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CPHR ᵴേౝኈ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI/CCR ࡦ࠲⚵❱࿑㧗ࠬ࠲࠶ࡈᢙ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 ESACIPAC Implementation of the parasitic diseases control program ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 ESACIPAC ࡦ࠲⚵❱࿑㧗ࠬ࠲࠶ࡈᢙ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 ESACIPAC ᵴേౝኈ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI ౠሶ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI ో⚵❱࿑ ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔1999㧕 About KEMRI ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI Annual Report ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔1999㧕 Guideline of KEMRI ࠤ࠾ࠕਛᄩකቇ⎇ⓥᚲ㧔2004㧕 KEMRI Master Plan 2004-2014 IC/R KEMRI/ JICA㧔2004㧕 JICA ᗵᨴ∝ኻ╷ࡊࡠࠫࠚࠢ࠻ AIDS in Kenya Brochure KEMRI/ JICA㧔2004㧕 JICA ᗵᨴ∝ኻ╷ࡊࡠࠫࠚࠢ࠻ HIV/AIDS ࿖㓙ળ⼏㧔ࡃࡦࠦࠢ㧕⊒ KEMRI/ JICA㧔2004㧕 JICA ᗵᨴ∝ኻ╷ࡊࡠࠫࠚࠢ࠻ Baseline Survey 2003 AMREF Brochure ╙ 㪍 ┨㩷 䉱䊮䊎䉝ᄢቇઃዻᢎ⢒∛㒮䉡䉟䊦䉴ᬌᩏቶ䊶⚿ᩭᬌᩏቶ㩷 㓸వ ⾗ᢱ ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 JICA ࡊࡠࠫࠚࠢ࠻ᵴേ TB ࡏ㨯ࠨࠗ࠻࿑㧔22 ࡨᚲ㧕 ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH ᬌᩏㇱᵴേౝኈ ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH ᬌᩏㇱ⚵❱࿑߅ࠃ߮ࠬ࠲࠶ࡈᢙ ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH ᬌᩏㇱ࠻࠾ࡦࠣฃߌࠇᩞࠬ࠻ 27 ઃዻ⾗ᢱ 5 ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH ᬌᩏㇱࠨ࠴ࡊࡠࠫࠚࠢ࠻ࠬ࠻ ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH ᬌᩏㇱ⺰ᢥࠬ࠻ ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 ANNUAL REPORT 2002㧔UTH TB lab.㧕 ࠩࡦࡆࠕᄢቇ∛㒮㧔1997㧕 UTH laboratory guide line ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 UTH TDRC CDL ࠩࡦࡆࠕᄢቇ∛㒮㧔2004㧕 Zambia GR R4 Implementation Plan FINAL National AIDS Council㧔2004㧕 NAISP Policy Measure 28 ઃዻ⾗ᢱ 6 ෳ⠨ᢥ₂৻ⷩ㩷 ╙㪉┨ ᣣᧄ䊶᰷☨䈮䈍䈔䉎ᗵᨴ∝⎇ⓥᯏ㑐䈱ᯏ⢻㩷 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 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