P indicates a project with Initiatives Inc. as prime awardee
Community Health Systems Strengthening Program
Tanzania, 2014 – 2017
in partnership with prime awardee JSI Research & Training Institute, Inc.
As a PEPFAR-funded health systems strengthening program, the Community Health Systems Strengthening Program aimed to improve the health and wellbeing of Tanzania’s HIV affected and other key populations by strengthening community health and social service systems in ten of Tanzania’s 30 regions with high HIV prevalence rates. Initiatives’ team offered technical leadership and support for community health systems strengthening, civil society engagement in health planning and coordination, and organizational development.
Our in-country staff supported local government authorities (LGAs) to improve their capability to plan, budget, and implement services for key populations to HIV/AIDS. We tailored our work to link efforts to PEPFAR 3.0 and its 90-90-90 goals. In addition, staff led activities to improve the capabilities of LGAs to engage civil society actors, especially women, in health planning.
Initiatives also supported the Government of Tanzania to initiate and roll out a national community health worker (CHW) cadre, support policy analysis, develop the national CHW training strategy, and address CHW performance and supervision to strengthen health and social welfare service delivery at the community level. Innovative approaches included community health and social welfare collaboratives to strengthen leadership and management of community health services.
Challenge TB: Bangladesh
in partnership with prime awardee Management Sciences for Health
The USAID-funded Challenge TB Project is led by KNCV and managed in Bangladesh by Management Sciences for Health (MSH). Challenge TB provides technical leadership to support the National Tuberculosis Control Program (NTP) with implementation of the national strategic plan. The project helps the NTP in making strategic choices to maximize impact with limited resources.
MSH engaged Initiatives to support the NTP in the development of a National Costed Public Private Mix Strategic Plan (PPM SP). Bangladesh has a pluralistic health sector with public sector health services co-existing with qualified, semi-qualified and non-qualified private sector services. The goal of the PPM SP was to strengthen and expand the engagement of private sector providers, selected public institutions, non-governmental organizations (NGOs), corporations and professional associations.
Initiatives’ expert technical staff and consultants conducted a series of stakeholder meetings and guided a team of stakeholders – led by the NTP – to identify key strategic objectives for the PPM SP that were linked to the NTP strategic plan. Initiatives then worked with the stakeholder group to map out key interventions and activities, set targets, identify the human resources requirements of key interventions, and cost the plan. NTP will use the plan to guide the expansion of private provider involvement in TB control and monitor PPM achievements with the aim of reducing the 47 percent gap in case detection, sustaining treatment success at 90 percent for drug susceptible TB, increasing access to diagnosis for multi-drug resistant (MDR)-TB and contributing to the reduction of MDR-TB incidence.
Challenge TB: Nigeria
in partnership with prime awardee KNCV
Initiatives was part of an information-gathering mission team on childhood TB as part of the Challenge TB (CTB) project in Nigeria, implemented by the KNCV Tuberculosis Foundation. The goal was to recommend a pilot project plan to increase pediatric TB case detection and notification in Bauchi, Kano, Benue and Lagos States through USAID implementing partners Save the Children and CRS.
As part of a team of experts, an Initiatives Technical Advisor traveled to Nigeria to take part in an assessment of the two implementing partner organizations. The assessment included an identification of the referral system currently in place and a determination of the NGOs’ capacity to support their grantee community-based organizations and CVs to identify TB symptoms.
Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN)
in partnership with prime awardee URC
Initiatives worked with URC and two local NGOs to ensure continued provision and sustainable scale-up of HIV/AIDS diagnosis, treatment, and care at the Ministry of Health regional and district hospitals throughout the country. This USAID-funded cooperative agreement, known as “SUSTAIN,” focused on ensuring high-quality care and treatment for more than 26,000 Ugandans living with HIV/AIDS by introducing a chronic care model for patients and improving laboratory support services.
As its name indicates, SUSTAIN’s overarching goal was to set the stage for complete Ugandan ownership of the work in the future. Therefore, a major focus of this project was to work closely with the Ministry of Health to develop and implement a sustainability plan, so that the work continues after the end of the contract.
Initiatives’ work focused on one element of the program: identifying, managing, and securing human resources and human resource policies to sustain the work over time. Our Human Resources Development Technical Advisor guided SUSTAIN’s efforts to strengthen human resources management policies and procedures, with the goal of establishing a qualified, motivated, and efficient workforce at the project’s clinical care sites.
The activities that contributed to this outcome included designing and conducting human resource capacity assessments, workload projections, staff engagement assessments, and technical assistance and training to help partners and stakeholders plan for workforce sustainability. SUSTAIN’s NGO partners also coordinated with other national partners to stimulate innovative thinking around human resources policy for HIV/AIDS treatment and care.
Support to the HIV/AIDS Response in Zambia II (SHARe II)
in partnership with prime contractor John Snow, Inc.
Continuing the success of the USAID-funded Support to the HIV/AIDS Response (SHARe) project in Zambia, SHARe II worked to reduce the impact of HIV/AIDS and improve the quality of life of those affected by the disease. The project worked through strategic coalitions and partnerships with the National AIDS Council and other stakeholders to contribute to the Zambian government’s vision of a “nation free from the threat of HIV/AIDS.”
As a subcontractor to John Snow, Inc., Initiatives’ focus was organizational capacity building. Our team provided leadership and technical expertise to strengthen the Zambian government’s ability to coordinate the HIV/AIDS response at national, provincial, and district levels, and build the capacity of civil society organizations to coordinate, manage, and implement the HIV/AIDS response. As part of this work, we supported the expansion of successful, evidence-based interventions and use of best practices across sectors, and advise on the most efficient and effective use of resources.
Our primary counterparts were the National AIDS Council, provincial and district AIDS task forces (PATFs/DATFs), and “umbrella” civil society organizations that coordinate, manage, and implement the national HIV/AIDS response. We supported the National AIDS Council to develop and use tools and guidelines for management and coordination. We collaborated with national umbrella organizations, PATFs, and DATFs to apply an organizational capacity assessment-certification process that enables each organization to assess its strengths, identify capacity gaps, and develop action plans for closing those gaps.
Through these tools and assessments and by sharing evidence-based best practices, SHARe II created an enabling environment that supports a sustainable HIV/AIDS multi-sectoral response across Zambia.
Malaria Vaccine Development Project Support
TASC3 Task Order
The purpose of this Task Order was to provide the Bureau for Global Health with ready and timely acquisition of pilot vaccine and/or related materials from biotechnology companies and other vendors required to implement USAID’s MVDP.
During this three-year contract, Initiatives prepared (for USAID’s review) subcontract approval materials for the conduct of a toxicology study for a candidate vaccine, and purchased and distributed close to half a million dollars worth of laboratory equipment to MVDP partners for use in vaccine research and development.
Jordan Health Systems Strengthening Project II (HSS II)
in partnership with prime contractor Abt Associates
The USAID/Jordan Health Systems Strengthening Project II (HSS II) supported systems that institutionalize quality improvement in the Jordan Ministry of Health, increase sustainable access to high-quality health care, and improve the effectiveness of service delivery. Building on the close partnership its predecessor projects (HSS I and PHCI) developed with the Ministry of Health, HSS II placed a greater emphasis on institutionalization and sustainability.
As a core partner to Abt Associates, Initiatives’ focus was to assist with countrywide implementation of the project’s comprehensive quality improvement approach. As part of this effort, we assisted the Ministry of Health to prepare 200 primary health centers for accreditation by the Health Care Accreditation Council. Initiatives’ team was also responsible for strengthening management including support for strategic and operational planning, rationalization of job descriptions, establishment of functional referral and appointment systems linking health centers to hospitals, and supportive supervision.
At the community level, Initiatives contributed to the project’s efforts to raise awareness and generate demand for high-quality services with an emphasis on interventions that address health behaviors and attitudes. We helped to establish youth peer educator groups, trained women’s groups using the Arab Women Speak Out module, and assessed the effectiveness of health promotion programs and community health committees. In addition, Initiatives updated training curricula for health promotion and worked with Jordan’s health directorates to help them assume their supervisory role for health promotion.Through our close partnership with the Ministry of Health, this package of technical assistance and training supported a national culture of quality that contributes to sustainability.
Tuberculosis (TB) Task Order 2015
India, Bangladesh, DR Congo, Tanzania; 2009-2014
in partnership with prime contractor PATH
Initiatives provided technical expertise for human resources for health and organizational capacity strengthening under this global TB project. This included leading human resources assessments for the India Revised National TB Control program (RNTCP), the Bangladesh National TB Program, and the Tanzania TB and Leprosy Control Program.
Our staff led the design and pilot testing of integration initiatives to better integrate TB management and supervision structures in India and developed and field tested RNTCP job descriptions and task lists for staff and a performance appraisal process for RNTCP contractual cadres. Initiatives contributed expertise for the design and implementation of public-private mix (PPM) operations research and ASCM training for civil society organizations and government partners in India.
Initiatives’ staff also provided organizational capacity development support for civil society organizations contributing to TB control in DRC and to a regional referral and teaching hospital in Tanzania. Support to the referral hospital included strategic planning, financial and human resources policy development, standards development and dissemination, quality assurance and improvement systems development and implementation, management strengthening, and resource mobilization capacity building. Finally, Initiatives also supported the Central TB Reference Laboratory (CTRL) in Tanzania to assess and strengthen its human resources management systems.
Malaria Vaccine Development Project
TASC2 and TASC3 Task Orders
In 2004, Initiatives was awarded a task order under the TASC2 Global Health indefinite quantity contract to support USAID’s Malaria Vaccine Development Program (MVDP). In 2010, the task order was extended via the TASC3 IQC mechanism. MVDP is devoted to developing vaccines and new technologies to decrease illness and death due to malaria in endemic areas, and works closely with academia, the private sector, other government agencies, and international organizations to fill gaps in the global malaria vaccine development effort.
Initiatives’ role under the MVDP included coordination of the annual meetings of the USAID MVDP Scientific Consultant Group, a committee that provides strategic advice to the program. Our Senior Technical Advisor provided management support to program activities, advised on the application of biotechnology to parasitic vaccine development, developed regulatory affairs plans and documents, and coordinated program activities with MVDP partners such as the Malaria Vaccine Initiative at PATH and the National Institute for Allergy and Infectious Diseases.
Initiatives also provided a Legal Advisor to assist USAID in dealing with MVDP partners on issues involving intellectual property; contracted with laboratories to conduct toxicology studies on candidate vaccines; and purchased and distributed $220,000 worth of laboratory equipment to MVDP partners for use in vaccine R&D.
Guyana Safe Injection Project II
TASC3 Task Order
The aim of the Guyana Safe Injection Project II (GSIP II) was to create a comprehensive, sustainable, country-owned and managed infection prevention and injection safety program to safeguard health care workers, patients and communities.
GSIP’s central message was: “A safe injection does no harm to patients, providers or the community.” All of these stakeholders – patients, providers and the community – need to be involved to ensure that injections are used appropriately and needles and other sharps are disposed of safely. GSIP was designed to ensure that previously achieved gains were secured and sustained by the Ministry of Health (MOH) of Guyana and partner agencies.
In the GSIP II 12-month project, Initiatives worked more closely with various MOH units and other partners to ensure that injection safety-related activities were integrated into ongoing MOH and health care delivery activities. GSIP’s activities were focused on ensuring that systems, skills and people are in place to transfer “ownership” of injection safety to national institutions.
Final Evaluation of USAID/Senegal Community Health Program
TASC3 Task Order
USAID/Senegal commissioned a final evaluation of the USAID-funded Community Health Program (CHP) implemented by ChildFund (formerly known as Christian Children’s Fund) from 2006 to 2011. The findings of the evaluation were intended to shape the implementation of a follow-on project.
Initiatives provided technical assistance via a three-person evaluation team, who spent four weeks in-country meeting with key stakeholders, individuals and groups at all levels of the health system. The evaluation team spent two weeks visiting different areas of the country where the CHP is implemented. The team sought to assess whether CHP’s goal to ensure widespread access to a basic package of primary health care services in rural communities was successful. This goal was to be met by revitalizing and staffing a widespread (but underutilized) network of health facilities known locally as “health huts” or cases de santé.
Initiatives’ Lessons Learned / Final Evaluation Report addressed the necessity of learning from the experience to date and informing program expansion. In particular, the evaluation team focused on the quality and range of health services offered to communities, referral and follow-up systems, community awareness, socio-cultural barriers to accessing services, and sustainability.
Guyana Safer Injection Project
TASC2 Task Order
The Guyana Safer Injection Project (GSIP), a task order under USAID-funded TASC2 Global Health indefinite quantity contract, was part of the President’s Emergency Plan For AIDS Relief (PEPFAR) strategy to reduce the accidental transmission of HIV/AIDS and other blood-borne diseases by improving injection safety and reducing the number of unnecessary injections.
From 2004 to 2010, Initiatives and its subcontractors – AED, John Snow, Inc., and PATH – worked with health officials at national, regional, and public and private health facility levels to identify and address challenges to safe injections and sharps waste management. Through its work in injection safety, our team and its government partners helped create a culture of safety, improve performance, and strengthen the quality of care in Guyana. GSIP’s efforts were strategic, starting with a national policy and guidelines to provide the mandate for technical, logistical, and environmental changes to protect workers, patients, and communities.
GSIP built sustainability into the project design, integrating Ministry of Health counterparts into all activities from the start and concentrating on five overall themes: health worker safety, insulin use and disposal, health care waste management, rational drug use, and certification. After five years, the results were impressive. With project support, the Ministry of Health introduced national medical waste management guidelines and a worker safety policy. To guide training, GSIP developed and disseminated an Injection Safety Tool Kit, which Ministry of Health trainers have continued in an effort to support nationwide training for health care providers and waste management staff.
To further encourage sustainability, in 2008 GSIP worked with the Ministry of Health to pilot an Injection Safety Certification process in five ministry facilities. The pilot was a success, and the ministry began full implementation of the process. By March 2010, the ministry had certified 14 sites as meeting national injection safety standards. In February 2010, the Georgetown Public Hospital Corporation became the formal custodian for the Guyana Safe Injection Project.
Related publication: Safer insulin needle use and disposal: International Journal of Infection Control (2010)
Final Evaluation of USAID/Bénin HIV/AIDS Prevention Program
TASC2 Task Order
USAID/Bénin commissioned a final evaluation of the USAID-funded Bénin HIV/AIDS Prevention and Care Project (BHAPP) implemented by Africare in collaboration with JHPIEGO from 2002 to 2006. The findings of the evaluation were intended to shape the implementation of any follow-on project.
Initiatives provided technical assistance via a two-person evaluation team, who spent three weeks in-country meeting with the National AIDS Control Program, the National AIDS Control Committee, the World Bank and other key stakeholders, health center personnel, elected officials, and eight staff members from BHAPP’s NGO partners. The team sought to understand how the role of Centres d’Information, de Prospective et de Conseil, or CIPECs could be maximized in terms of National AIDS Control Program capacity building.
Initiatives’ Lessons Learned / Final Evaluation Report addressed the Mission’s primary evaluation objectives of assessing whether performance management plan (PMP) targets were met, but was framed less as an exercise in dissecting strengths and weaknesses than as one of synthesizing lessons learned from four years of activity. USAID/Bénin and the evaluation team hoped that this framework presented the best chance of positively impacting the work that will go forward under a new HIV and AIDS-focused initiative in Bénin.
Mid-Term Evaluation of Umoyo Network
TASC2 Task Order
USAID/Malawi commissioned a mid-term evaluation of Save the Children’s Capacity Building for Quality HIV/AIDS Services (the Umoyo Network), along with its partners ADRA, AED, and JHPIEGO, to assess the progress of Umoyo Network towards achieving the results outlined in their workplan and to decide whether or not to exercise the option to extend the project into a third year.
Initiatives provided technical assistance via a three-person evaluation team with expertise in the areas of HIV/AIDS, capacity building, and program evaluation. The team spent three weeks in-country meeting with the Umoyo Network administration, its NGO members, and other stakeholders. Initiatives’ Mid-Term Evaluation Report addressed Mission objectives with particular attention paid to local and international standards, impact on the NGO network members, sustainability, service coverage area, grants management, coordination and cooperation among Save the Children and its partners, and any delays in performance.
Jordan Human Resources Project
TASC2 Task Order
For the Jordan Human Resources Project, Initiatives was responsible for conducting a comprehensive human resources situation analysis including existing staff and training capacity, conducting research on staff motivation, and analyzing issues related to staff salaries and benefits. Initiatives also worked with the Ministry of Health to develop a comprehensive human resources plan to ensure the security of health service delivery in the public sector over the next decade.
Reproductive Health/Family Planning NGO Strategy Evaluation
Dominican Republic, 2004
TASC2 Task Order
USAID/Santo Domingo commissioned Initiatives to conduct an evaluation of its reproductive health/family planning NGO program in the Dominican Republic. USAID/Santo Domingo was particularly interested in the team’s findings in the context of an ongoing macroeconomic crisis in the Dominican – which has impacted the NGOs’ ability to reach underserved and vulnerable populations – and the anticipated reduction in funding by USAID and other donors.
To complete the evaluation, Initiatives identified a team of four highly qualified evaluators to complete the work and develop the final report. The evaluators spent several weeks in the Dominican Republic, working with Dominican NGOs ADOPLAFAM, MUDE, and Profamilia, as well as with other stakeholders, to respond to USAID’s questions regarding the sustainability of the NGOs’ reproductive health and family planning programs following technical and financial support from USAID, and to recommend both the direction and form of future support.