Managing A Health Project: HIV/AIDS in Thailand

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This three part case involves a broad, complex health project, funded by the Japanese International Cooperation Agency (JICA), and implemented as a collaboration between Japanese and Thai teams. Students confront the tension between the teams' differing perspectives on how best and most quickly to advance care and prevention of HIV/AIDS in a critical region. Underlying that tension is the more fundamental issue of balancing response to local initiatives against keeping a project on track toward its original objectives. As they follow the project through a major change of direction and observe its impact, students must determine how to weigh differing inputs into writing an evaluation.

The A case lays out the spread of HIV/AIDS in the country from the first case in 1984 to widespread prevalence in the 1998-2003 period of the project and zeroes in on the heavily afflicted province of Phayao, the project site. Early on, Dr. Phannee, director of the Phayao Provincial Health Office, surprises her Japanese colleagues and the visiting JICA consultation team by proposing to add developing health manpower to the planned interventions and to make it the project's top priority. She argues health staff need new attitudes, because they dare not assess conditions or take action on their own initiative. The Japanese experts counter that the project should stick to its planned priorities, giving HIV/AIDS victims better access to qualified care and mounting new measures to prevent the disease. Mr. Tani, the JICA program officer, is left with the dilemma of whether to go against their advice and accept Dr. Phannee's proposal.

The B case picks up the project after JICA's decision to follow Dr. Phanee's lead has gone into effect and moves on to the final phase, during which Mr. Tani's successor, Ms. Morino, comes to conduct a final evaluation. Dr. Phannee has put a number of health staff through her "Community Assessment Course" and trained others to lead it. Health staffs in the field reflect a positive attitude change. People with HIV/AIDS have gone from passive recipients of care to active agents of prevention. The rate of HIV/AIDS prevalence among pregnant women has dropped significantly. But, causal relationships are difficult to discern, and Ms. Morino must decide how to recognize the project's evident impact while still evaluating its effectiveness and efficiency in terms of its stated objectives.

A brief Epilogue reveals how Ms. Morino and her team decided to write up their evaluation.

The case was written for students of development project management, focusing especially on planning and evaluation. It is suitable for both practitioners in training and graduate students in international development, as well as for students of health administration and policy. The case can be taught in a single session of 75-90 minutes, though it may work well as discussions of the A and B cases taken up in separate sessions.

Author Yukako Matsuura prepared the case and teaching note with the sponsorship of the Foundation for Advanced Studies on International Development in Tokyo, Japan.