The China Polio Project – Results and Lessons Learned

Background:
There was a nationwide outbreak of polio in China during 1989-90 affecting Pi and Shuyang Counties in Jiangsu Province. Norwegian Mission Alliance was well known for its polio work in Taiwan and started collaborating with Amity Foundation in China in 1992 supporting polio victims in Huaiyin. In 1993, Amity requested NMA to support the children affected by polio in Pizhou and Shuyang Counties. Following a pilot period (1993-1996), there have been two phases in the project – one from 1997 to 2001 and the next from 2002 to 2006. The project has been funded by the Norwegian Mission Alliance for 15 years and with support by Norad for 10 years. Total funds allocated to the polio project have been approx. 25 mill CNY (or 22 mill NOK).

Purpose/objective:
According to Terms of Reference, the overall purpose of the evaluation is to summarise and assess the major achievements of the polio project, identify important lessons learned and provide recommendations for future activities. The objectives are to document and assess the relevance of objectives and models used for rehabilitation, results achieved, efficiency of project management and use of funds and prospects for future institutional and financial sustainability.

Methodology:
The evaluation has used three main methods for collecting information. It started with a review of project documents and plans, previous studies and evaluations and other relevant reports. The main part of the evaluation was carried out during an eight day visit to Pizhou Country and the New Hope Center (NHC) in October 2008. Interviews were conducted with NHC management and staff, government and NGO partners and not least with youth that had been benefited from the project, their families, teachers and employers. Finally, a small survey was carried out of their physical status and need for further surgeries. The various team members prepared contributions to various thematic areas, the draft report was compiled by the team leader and shared with NMA and NHC and finalised based on their comments.

Key findings:
The polio project has been well implemented and followed its target group for fifteen years, has reached most of its objectives and should be considered a success. The physical rehabilitation of children has been extensive and corrective surgeries have shown good results in combination with use of orthosis. The project has helped polio children to enter normal schools and most have achieved very good academic results. Later a considerable number has completed or is in the process of completing vocational training and higher education. Polio children have been assisted to take more active part in family and community life and events. An increasing number have obtained jobs and started to earn an income helping them to become gradually independent of their families and the New Hope Center. The polio project has achieved impressive results within sport and culture – not least demonstrated by the ten athletes from NHC taking part in the Paralympics in Beijing 2008 winning six gold medals and nine medals in total. The micro finance programme has been well implemented and benefited a large number of families with polio children. The original capital has not been reduced and should be used for helping young people to enter the job market. The most visible and measurable results can be found at the individual level – in the physical, educational and social improvements for a group of polio-affected children.

There have also been changes at community level in terms of increased awareness and reduced discrimination, and among teachers and in schools in terms of willingness to take in disabled children and facilitate “inclusive education” by removing physical and psychological school barriers.

The project has exclusively focused on the targeted children and their families and not other individuals and groups in the community with similar or even larger problems and disabilities. We have not been made aware of problems and conflicts created by such an exclusive approach, but it could be seen as a weakness in the design or at least a limitation – given that a major investment benefited a relatively small target group in a poor environment for a long period of time.

The ideas and practices underpinning the concept of holistic rehabilitation are found relevant and also sustainable and replicable in China. The entire model – or complete “package” of institutional and community services supported from the New Hope Center on the other hand is neither sustainable nor replicable. It is too costly. Large amounts of external funds have been necessary to realize the model and achieve all the impressive results.

Funds have been spent efficiently and prudently, but there have been no analysis and discussion about issues of cost effectiveness – or to what extent the same or better results could have been achieved through alternative models and methods. Most counties will not have the necessary resources to support the combined model – or they may not be willing to spend so many resources.
Promoting and advocating for disabled people’s rights was never an objective for the polio project. The main emphasis was on service delivery and model building – and mostly on the former. It was also mentioned that a strong advocacy profile – emphasizing that disabled people have rights and can also claim their rights based on Chinese laws and international conventions signed by China, is still a foreign idea and could be politically unacceptable at the local level. However, the mere existence of a polio project demonstrating potentials and abilities of disabled children and youth have had a significant “silent” advocacy effect.

The polio project is in the process of being successfully completed and does not need to be sustained. It is one of few examples of a development project coming to an end – because most objectives are achieved! It is questionable if NHC has the managerial and technical capacity and sufficient financial resources to establish a new project for cerebral palsy children. The Center may be able to attract more people and money, but should first clarify and build a more solid organisational foundation.

Recommendations:
The overall recommendations:
1. NMA should assist New Hope Center to:
- Clarify issues of ownership and organization
- Prepare plans for management models (including role and composition of Board, appointment of Director, etc) and consult with partners.
- Prepare financial plan and identify sources of funding
2. The Polio project should prepare a phasing out plan (3-5 years) with budgets covering:
- Medical follow up and surgeries
- Vocational training and educational scholarships
- Job creation
- Establish member organization
- Documentation and research of the polio project and experience
- Dissemination of and training in the rehabilitation model
3. Future funding of the new cerebral palsy project should primarily come from sources in China.

Comments from the organisation, if any: