Black Lung Clinic Program Evaluation
The Black Lung Clinic Program (BLCP), under the auspices of HRSA's Office of Rural Health Policy, was established to provide support for health clinics to evaluate and treat coal miners with respiratory impairments. Located in 11 states throughout the Mid-Atlantic and the East North Central portion of the Midwest, BLCP-funded clinics provide unique pulmonary and respiratory care as well as outreach and education through 16 community-based organizations.

The goals of the project are to 1) determine the number and location of current and retired miners living in the US, and 2) conduct a general program assessment, including an in-depth cost study. Through these efforts, the Office of Rural Health Policy hopes to gain important information that will help them improve outreach efforts, guide grantee technical assistance activities, and ultimately, improve the overall quality of services to the target population.
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CCHN Primary Care Fund Review
An increase in Colorado's tax on cigarettes and tobacco products became effective January 1, 2005 and created a cash fund that was designated for health-related purposes, including a Primary Care Fund. The Primary Care Fund provides an allocation of moneys to health care providers who make basic health care services available in an outpatient setting to residents of Colorado who are considered medically indigent.

Primary Care Fund dollars are allocated based on the number of medically indigent patients served by one health care provider in an amount proportionate to the total number of medically indigent patients served by all health care providers who qualify for moneys from this fund.

Each provider applying for the fund must have an outside entity certify the patient numbers submitted in the application. JSI developed a protocol for certifying these numbers and conducted on-site certifications for ten applicant agencies.
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Evaluation and Support to Achieve Healthy People 2010 Objectives for Children and Youth with Special Health Care Needs
This evaluation project is designed to provide the Division of Services for Children with Special Healthcare Needs (DSCSHN) with technical support and expertise to meet its mission of achieving quality community-based systems of services for children and youth with special healthcare needs and their families by the year 2010. JSI is conducting an evaluation and strategic planning to assess the DSCSHN's progress in achieving the Healthy People 2010 Goals and the President's New Freedom Initiative; completing mini-evaluation studies of four initiatives aimed at specific Healthy People 2010 performance measures (Health Insurance, Medical Home, Healthy and Ready to Work and Family/Professional relations); and evaluating and supporting the State Implementation Grantees and National Centers funded under the President's New Freedom Initiative.
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HCPF Center for Improving Value in Health Care
JSI has been engaged to assist in the design of a Center for Improving Value in Health Care for Colorado. Governor Bill Ritter issued an Executive Order establishing the Center in February 2008. JSI, under contract with the Colorado Department of Health Care Policy and Financing (HCPF), will assist a Steering Committee of stakeholders in forming recommendations for the structure and scope of the Center.

JSI's work with the Steering Committee will result in a report to the Governor outlining the findings of the research, priorities identified for quality improvement and cost containment, recommendations for the structure of the Center and recommendations for any legislation needed to support the Center.
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Managed Care and Health Services Financing Technical Assistance Center
JSI has operated the Managed Care and Health Services Financing Technical Assistance Center (MCTAC) for the Health Resources and Services Administration (HRSA) since 1998. MCTAC's goal is to assist HRSA grantees and other safety-net providers, including public health departments and public hospitals, to remain strong. JSI taps a national network of experts to develop materials, conduct training and provide consultation on topics such as cultural competence, financing for school-based health centers, and public health and managed care. MCTAC's services provide grantees with the skills necessary to maximize participation in their state's Medicaid and State Children's Health Insurance Program (SCHIP), as well as private managed care and other insurance plans. MCTAC also facilitates access to HRSA-funded technical assistance resource publications and materials and supports a website to facilitate access.
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Plan to Improve Primary Care Access for La Plata County Residents
Primary care access for individuals covered by Medicare and Medicaid has reached crisis proportions in La Plata County, Colorado. In response to this crisis, the Primary Health Care Community Coalition (PHCCC) along with Mercy Health Foundation sought to create a plan to provide sustainable primary care access to La Plata County's most vulnerable residents.

JSI was contracted to compile an overall assessment of La Plata's primary health care environment and determine appropriate solutions that would result in sustainable primary care services for residents of La Plata County, particularly the underserved. JSI reviewed and updated past quantitative analyses regarding the capacity of primary health care providers in La Plata County, and used qualitative research methods to substantiate the findings from the quantitative analyses.
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Robert Wood Johnson State Action for Oral Health
Under contract with the State of Vermont, JSI managed the State Action for Oral Health Initiative, the goal of which is to strengthen the community-based response to oral health access, improve state reimbursement policies, integrate successful state initiatives and sustain its base of Medicaid providers. This strategy employed community partners, schools, dental offices, state policy-makers, statewide organizations and consumers in order to accomplish its goals. The project is indicative of our ability to manage multifaceted programs on behalf of the state. Within this project, JSI has had primary responsibility for:

• Issuing RFPs and reviewing proposals
  
• Working with State staff on development and execution of contracts
  
• Oversight of project budget and management of existing contracts
  
• Meeting with RWJF staff
  
• Developing financial, programmatic and data reports for RWJF on behalf of the State
  
• Working with advisory groups and State teams

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Vermont 340B Drug Pricing Program
Heinz Family Philanthropies contracted JSI to write a concept paper for the State of VT, Dept of Corrections, that presents options for operationalizing a 340B Drug Pricing Program in VT facilities. Specifically, this paper was written using Federally Qualified Health Centers as the preferred provider of medical services and the most viable qualifying entity for this type of program (340B).
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Bolivia Gestion y Calidad en Salud Project
In 2005, the United States Agency for International Development (USAID) awarded JSI a contract for the Health Management and Quality Project (Gestión y Calidad en Salud/GCS) in La Paz, Bolivia. The project seeks to improve the health of Bolivians through work at the facility, municipal, and departmental levels to (1) improve the management capacity of local health services; (2) increase the coverage and quality of services included in the basic package; (3) improve local health care management through the availability of municipal matching funds, and (4) procure essential health equipment and provide logistical support to local partners.

During the last several years the capacity of the health care system in Bolivia has increased considerably. The decentralization process has moved forward, giving more decision-making power to the departments and municipalities, and the coverage of maternal and child health services has increased with the introduction of Universal Insurance for Mothers and Children (SUMI) in 2003. Despite efforts to improve quality and to increase coverage, rural and excluded populations and indigenous communities still have limited access to health services. This is reflected in the persistence of sub-par basic health indicators.

With the change of government in early 2006, "la salud" (health) and "el vivir bien" (living well) have become major goals for the Bolivian population as set forth by the new government. Functionally, this has translated into the restructuring of the Ministry of Health at all levels as well as in the development of policies and strategies that focus a multisectoral approach. Family health, community health and the intercultural factors affecting Bolivians' health are integral parts of the new strategy to strengthen primary health care, with a special emphasis on excluded populations and indigenous communities. New goals, such as "Zero Malnutrition" are part of this new strategy.

GCS is a five-year project (2005-2009) made possible through the United States Agency for International Development (USAID). It is implemented by John Snow, Inc. (JSI) in partnership with the Population Council and CARE/Bolivia. Other partners include EngenderHealth, Socios para el Desarrollo, PROCOSI (NGO network), the Ministry of Health, and regional and local health departments. JSI works with 46 municipalities and has offices in: Tarija, Santa Cruz, Beni, Chuquisaca, and Yungas.
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Central Asia Quality Health Project (ZdravPlus II Project)
The break-up of the Soviet system and transition to a market economy led to a deterioration of health care in Central Asia. Health systems are under-financed, resources are used inefficiently, and clinical practices are outdated. As a result, the region has experienced increasing rates of mortality and morbidity from both infectious and chronic diseases, and declines in life expectancy. JSI is addressing these public health problems as a subcontractor on the ZdravPlus project, implemented by Abt Associates, Inc. The project provides technical assistance and training to improve the quality and efficiency of health care services in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Project activities are implemented at pilot sites where working variations of the health reform model, emphasizing primary health care (PHC), are developed and tested for expansion and adaptation to other sites, and for national-level implementation. JSI plays a lead role on the project in improving quality of care and enhancing the population's involvement in health care. Read the following success story about the project: "Stop Diarrhea" in Uzbekistan
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Ethiopia Essential Services for Health (ESHE) Project
In Ethiopia, civil conflict, poverty, and the widespread drought of 2002-2003 have dealt a huge blow to its people, straining financial and human resources, and leaving women and children particularly vulnerable. Most of the population have inadequate access to basic services, including health, education, clean water and sanitation. JSI's Essential Services for Health in Ethiopia (ESHE) project is an integrated program of child survival interventions and health sector reform designed to improve family health. Funded by the United States Agency for International Development (USAID), ESHE works in collaboration with health offices at all levels to reduce child deaths and strengthen the health system. The Project takes a three pillar approach that addresses health provider skills, strengthens the health system, and engages families and communities to improve family health.

ESHE works in three regions and assists health offices in improving the quality and utilization of high-impact child survival interventions in the form of the Extended Program of Immunization (EPI), Essential Nutrition Actions (ENA), and Integrated Management of Childhood Illnesses (IMCI). Key approaches include capacity building, community mobilization, and behavior change communication. Other selected activities include: development of the special pharmacies program, policy reform to allow retention of user fees at health facilities and revision of exemption/waiver practices, and creating a more enabling environment for increased private sector development. Abt Associates, AED, and Initiatives Inc. are sub-contractors to JSI in implementing the project.

Read the ESHE Program Year 4 Annual Report.
Read the ESHE Program Year 3 Annual Report.
Read the ESHE Program Year 2 Annual Report.


Read a success story about ESHE's work in SNNP: Creating Accountability and Reaching Communities: SNNP Region Experiences a Change
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GAVI CSO Study
JSI Research & Training Institute, Inc has been contracted by the GAVI Alliance to construct a monitoring and evaluability study to guide the development of a sound and practical system for measuring the progress and effectiveness of the GAVI Alliance support for civil society organizations (CSOs) in 10 pilot countries. This M&E system will be the first attempt to track the performance and effectiveness of the new and innovative CSO support mechanism after two full years of the funding cycle. Convincing evidence on the pilot phase of GAVI Alliance CSO support, generated through a well-designed monitoring and evaluation system, is essential to enable the Alliance and its partners to manage the support mechanism and learn and think strategically about the role of GAVI Alliance CSO support in the short term. It is also potentially important for establishing M&E approaches beyond the pilot phase and informing the wider public health and CSO community on best practices in supporting immunization and health system strengthening, and optimal modes of partnering.
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IMMUNIZATION basics
IMMUNIZATION basics is a five-year cooperative agreement that aims to increase the ability of governments and collaborating organizations to deliver quality routine immunization services. The project builds on the important work in immunization systems strengthening carried out in recent years by the BASICS project, as well as the successful immunization financing work of the Partners for Health Reform (PHR) and PHRplus projects. By consolidating its global immunization support under IMMUNIZATIONbasics, USAID expects to make that support more readily available to its missions and bureaus, while also increasing the Agency's impact in this critical arena.

The program has four primary objectives:

• Strengthening and enhancing the quality of routine immunization services;
  
• Improving the financial sustainability of these services, including helping countries address financial challenges arising from the introduction of new vaccines and safe injection technologies;
  
• Sustaining measles mortality reduction in a manner consistent with capacity building and the strengthening of the routine immunization system;
  
• Introducing new vaccines in a sustainable and effective manner.

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Kenya: Support to the National Leprosy and TB Program (NLTP)
In 2001, The Royal Netherlands Tuberculosis Association (KNCV) technical assistance agreement ended with the Kenyan Ministry of Health National Leprosy and TB Program (MOH-NLTP). In order to meet the funding gap in the NLTP five year (2001-2005) Development Plan budget, The Canadian International Development Agency (CIDA) entered into a grant agreement with KNCV to provide funds for continued technical assistance to the Kenya MOH/NLTP. Through this agreement, CIDA-KNCV is also providing additional funds to the Kenya MOH/NLPT for DOTS expansion nationwide. The grant supports specific program activities presented in the NLTP Development Plan which include assisting in human capacity building (training), strengthening laboratory services, strengthen IEC and TB advocacy, and strengthening supervision activities of the Provincial TB and Leprosy Coordinators. Since 2002, JSI has been assisting KNCV-CIDA with the local administration of the funds to support these activities. In 2004, KNCV expanded JSI's scope to include funds administration to support a national survey to assess the prevalence and trend of tuberculosis infection throughout Kenya. JSI is also assisting in the procurement and distribution of vehicles and laboratory equipment.
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Performance-based contracting of NGOs in Liberia
The Ministry of Health and Social Welfare (MOH&SW) of Liberia contracted John Snow Inc. (JSI) to work with a Ministry team to conduct a situational assessment of Liberia's capacity to contract with NGOs to deliver a basic package of health services (BPHS). JSI also developed a National Health Strategy/Policy on Contracting, and, based upon the Contracting Strategy, designed a contracting model for Liberia that will increase access to services included in the basic package of health.

The assessment is a general overview of Liberia's capacity to contract with NGOs to deliver the BPHS. Given that Liberia is currently in the process of building its health care system from the bottom up, the assessment touches upon the key systems within the Liberian health sector that are imperative for successful contracting with NGOs for the BPHS. Through this assessment, the MOH&SW explored the best ways to ensure a smooth transition from humanitarian relief to development and sustainable strengthening of the health care sector.

Based upon the assessment, JSI helped the MOH&SW develop a strategic framework (policy) for contracting as well as an implementation plan and contract template.

Download the report
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