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Contact General Specializations in Countries Contribution to the Global Plan Declaration

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Organization Contact Information

Name: John Snow, Inc.
Street 1: 44 Farnsworth Street
Street 2:
City: Boston
Province: MA
Post Code: 02210
Country: United States of America
Phone: 1 617 482 9485
Organization Email:
Web Site:
Other Online Presence:

Focal Point Contact Information

Salutation: Ms.
First Name: Sabrina
Last Name: Eagan
Title: Technical Advisor

Alternate Focal Point Contact Information

Salutation: Ms.
First Name: Paula
Last Name: Nersesian
Title: Senior Public Health Specialist

General Information

Board Constituency: Technical agencies
Is your organization legally registered in your country: Yes
If yes, please enter your registration number:
Organization Type - Primary: Academic / Research Institution
Organization Type - Secondary: None
Organization Description:
Established in 1978, JSI has successfully managed more than 1900 projects in 104 countries in Africa, Asia, the Caribbean, Central Asia, Eastern Europe, Latin America, the Middle East, and North America. JSI and its affiliate, JSI Research and Training Institute Inc., operate from 81 offices located around the world.

JSI`s staff is dedicated to improving the health of individuals and communities through public health projects in the United States and around the world. Our broad-based approach combines the expertise and
innovative talents of JSI`s more than 2000 staff with local partners to enable countries, communities, families and individuals to develop their own skills and identify solutions that address their public health
Do you know about the UNHLM declaration:

Specializations / Areas of Work

Delivery of health services and care
Provision of drugs, diagnostics and commodities
Technical Assistance

Other Organization Information

Total number of staff in your organization: 100 +
Number of full-time staff who are directly involved with TB: 51 - 99
Number of part-time staff who are directly involved with TB: 0
Number of volunteers who are directly involved with TB: 0
How did you hear about the Stop TB Partnership: Attendance at a TB related event
If you were informed or referred by another partner of the Stop TB Partnership please tell us who:
Why do you wish join the Stop TB Partnership: Technical assistance and advice
Are you a member of a Stop TB national partnership: No
Are you in contact with your national TB programme: Yes
Please tell us how your organization is contributing to your country's national TB control plan:
JSI provides support for and strengthens TB programs through technical leadership and technical assistance. Our efforts have focused in several critical areas, including: TB drug supply chain management, TB-HIV collaborative activities, and monitoring and evaluation. We also support community-based TB DOTS (Directly Observed Treatment, Short-course), and we strengthen laboratory systems.

Geographical Reach

Which country is your headquarters located in: United States of America
Which countries do you do operate in:
(This includes countries you are conducting activities in)
Cote d'Ivoire
United Republic of Tanzania
United States of America


Please tell us how your organization will contribute to the Global Plan to Stop TB by briefly describing its involvement in any of the areas of work listed below:

TB Care Delivery:
JSI, with JSB Consultoria is implementing the USAID-funded one year "Behavior Change Communication for More Effective Tuberculosis Control Program." We provide technical assistance for Behavior Change Communication (BCC) coupled with training and supervision in selected high TB disease burden municipalities in Sao Paulo State. The goal is to specifically improve TB case detection, treatment compliance, and cure as well as decrease defaults and mortality. Key interventions at the municipal level, in collaboration with the São Paulo State Tuberculosis Control Program and municipal tuberculosis control programs in the selected high TB burden areas, are:
• Training and supervision in DOTS
• Development of Behavior Change Communication (BCC) strategies and providers peer-to-peer interventions for tuberculosis control
• BCC intervention implementation
• Impact evaluation

In several project countries, including Zimbabwe, Tanzania, Nigeria, and Ghana, JSI is working with Ministries of Health to improve TB drug supply chain management systems to improve the availability, and accountability of TB drugs. Activities include developing distribution systems, performing logistics system assessments, supporting national quantification of TB drug requirements, improving storage facilities, designing and updating logistics management information systems.

CB-DOTS Evaluation in Liberia
JSI recently completed an evaluation of the community based TB drug distribution and administration approach in Liberia.

Since 2007, The Health Management and Quality Project (Gestión y Calidad en Salud) has worked to improve the quality of care for tuberculosis patients.

The implementation strategy of the continuous quality improvement (CQI) component is based on the formation of CQI teams comprised of multidisciplinary staff from health establishments. The teams work on quality standards, identified from the official norms and protocols of the Ministry of Health (MoH), from priority programs that need to be improved in the establishment. The solution to the identified problems are determined and resolved by the personnel themselves, based on innovative ideas, measured on a regular basis using rapid quality cycles. Results and innovative solutions are shared regularly with the other teams, providing further in-put to the teams and leading to further improvement of the application of norms by health providers.

To strengthen the tuberculosis program, with a main focus on the DOTS strategy (Directly Observed TB treatment), the Project started in 2007 implementing the collaborative quality approach to the TB program, establishing 35 CQI teams to improve the quality of the Tuberculosis Control Program at the local level, based on improving 21 indicators of quality, implemented in 3 regions in Bolivia.

With the lessons learned and the documentation and systematization of the best practices and innovative ideas developed during the demonstrative phase, the Project expanded this intervention, adding 3 additional regions and 30 additional CQI teams. In September 2008 the Project together with HCI (Health Care Improvement Project), further expanded this intervention to an urban setting with high population density, El Alto (La Paz), aiming to strengthen the TB program as well as institutionalizing this approach, establishing 64 additional ICQ teams.

The most successful experience that has occurred so far relates to the Collaborative Project of tuberculosis, in which 129 continuous quality improvement teams from five different regions of the country are working simultaneously, include:

• The treatment success rate (cured patients and patients who have finished treatment) has increased to 91% (demonstrative phase only); baseline data was 81%, as seen in the initial technical diagnosis document and information system of the Collaborative.
• Twenty-one quality standards of the TB program are being monitored and improved upon, up from the five that the Tuberculosis Control Program of the MSD regularly manages.
• 88% of laboratories perform correct BK analysis (more than 95% of the BK samples are correct) in intervention areas.
• Laboratory networks are being strengthened providing training to health personnel, providing specific materials and minor equipment, implementing “innovative” solutions to overcome operational burdens such as sample fixation and transport, and counter-referral of results.
• The “DOTS treatment boxes” have been implemented as a pilot intervention in one of the Project’s regions in 2008, and is being expanded at national level in 2009. These treatment boxes assure better adherence to treatment by TB patients, assure complete medication for each patient and improve medical logistics of TB drugs.
• The recruitment rate of new TBP BAAR (+) cases has also increased from 67% to 83% by the end 2008.
• The saliva samples decreased from 27% to 18% during 2007, and from 20% to 16% in 2008.
• 533 health providers have been trained in DOTS, clinical management of cases, and the registration and information management system of the Program, improving the management at the municipal level, management of networks and Departmental Health Services of MSD.
• Teamwork in each health establishment has been encouraged; 129 CQI teams have been formed with nursing and laboratory medical personnel in 28 municipalities of intervention.
• Institutionalization of this strategy is based on the close and on-going participation of the directors of the program at national, departmental and municipal level, development of activities by health personnel with technical assistance by Project and inclusion of “TB quality standards analysis” in regularly conducted health analysis committees, as well as introduction of certain procedures in national norms and training materials.

MEASURE Evaluation Project
JSI is a partner on the MEASURE Project. MEASURE’s work on TB is multi-phased. The first phase included a review of current global TB M&E systems—including a review of Stop TB’s and other global partners’ existing activities at both the global and country levels—and M&E systems used by USAID for examining TB programs. This facilitated a clear understanding of current M&E standards for TB programs and culminated in the development of a compendium for USAID and other global partners on monitoring and evaluating TB programs based on the five elements of DOTS. StopTB and other global partners, including JSI’s MEASURE staff, were engaged as coauthors of the document Compendium of Indicators for Monitoring and Evaluating National Tuberculosis Programs in order to ensure global compatibility and acceptability.

The second phase of work consisted of four MEASURE-sponsored regional TB M&E workshops entitled Monitoring and Evaluation of National Tuberculosis Programs in Mexico for the Latin America region, Tanzania for Sub-Saharan Africa, India for South and Southeast Asia, and Ukraine for the Eastern European Region. The workshops built the capacity of participants to design and implement M&E plans that can inform decisions related to TB programming. Participants included: national and sub-national TB program staff; M&E professionals and technical advisors from counterpart organizations; NGO and USAID Mission personnel responsible for TB program oversight; and representatives from global partner organizations (e.g., WHO, USAID, CDC, and Stop TB).The final products of the workshops were draft country TB monitoring and evaluation plans.

The final phase of work involves providing technical assistance to national tuberculosis programs and other partners in the field to build sound monitoring and evaluation practices and sustainable M&E systems.

United States: Uniform Data Service
Since 1999, JSI has been managing the Uniform Data System (UDS), the HRSA nationwide data collection tool that reaches all federally funded Community Health Centers nationwide, as well as from National Health Service Corps sites. Tuberculosis information is collected and analyzed. For example, Centers providing "Directly observed TB therapy" (defined as "delivery of therapeutic TB medication under direct observation of center staff") are identified along with the personnel actually providing therapy. The number of clients with tuberculosis and the number of client encounters are also enumerated annually.

In 2009, JSI entered its seventh year implementing programs for performance measurement and quality improvement through Project Heart, funded by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Efforts focus on examining a variety of health care services including HIV and AIDS, maternal and child health, and tuberculosis. The quality improvement programs are implemented in several countries and target HIV care and treatment sites. JSI has developed tools for rapid and thorough assessment of quality of care and has been training health workers on how to use these tools at their sites. In recognition of the important relationship between TB and HIV, and the challenges in TB diagnostic and treatment services for co-infected patients, the staff in one of the countries, Côte d’Ivoire, requested that a portion of the quality assessment tool address the diagnosis of TB in HIV-infected patients. Data on these indicators was collected in 2009 and the results will be used to direct activities to improve the identification and diagnosis of suspected TB cases at HIV care and treatment centers.

Uganda: STAR-EC
The Strengthening TB and HIV & AIDS Responses in East-Central Uganda (STAR-EC) project aims to increase access to, coverage of and utilization of quality comprehensive HIV/TB prevention, care and treatment services within district health facilities and their respective communities. JSI will work over 5 years starting from 2009 in demand creation for access to TB/HIV preventative and care and support services, increasing access to these services, conducting the Lot Quality Assurance Sampling (LQAS) surveys at the district level, and capacity building of civil society and indigenous organizations. The project is based in Jinja, Uganda.

STAR-EC supported training of 580 health workers on TB/HIV co-management and TB infection control in the six districts in which it operates. Following the training, there has been progressive improvement in documentation of TB/HIV variables in the unit registers and initiation of TB/HIV co-infected patients on Cotrimoxazole Prophylaxis. Screening for TB in HIV care settings is routinely done.

Following trainings on infection control, health care providers are now conscious of TB transmission at facilities and have developed and displayed TB infection control plans and are progressively adopting other administrative and environmental control measures.

STAR-EC trained a total of 200 health workers on TB DOTS and the Stop TB strategy with the aim of improving treatment success. Under this, a sub county health worker (SCHW) delivers drugs to the treatment supporters in the communities who in turn observe swallowing of drugs by the patient.

In order to increase Case Detection Rate, STAR-EC supported dissemination of Intensified TB Case Finding (ICF) tools to the six districts. Consistent use of the tools has been encouraged through continuous on job mentorship and support supervision by the Zonal and District TB and Leprosy Supervisors (Z/DTLS) and health sub district TB focal persons with support from STAR-EC. Additionally, the program facilitated sputum outreaches to 13 hard to reach sub counties in the districts. Out of these outreaches smear positive patients were generated.

Cognizant of the Ministry of Health policy, STAR-EC has supported training of Village Health Team members in the districts on intensified TB case finding, psychosocial and adherence support and patient follow up.

In line with the public- private partnership, STAR-EC supported training of 100 traditional healers on early recognition of a TB patient and timely referral of the suspects to the facilities for management. Additionally, support was lent to the training of 30 health care workers from private facilities on TB/HIV co management and TB infection control including ICF tools. This is going to be scaled up during the next financial year.

STAR-EC supported TB/HIV coordination meetings for partners and SCHWs review meetings at district levels. Challenges encountered during TB/HIV and TB DOTS implementation were shared.

STAR-EC supported the training of 80 sub-county health workers (SCHW) on TB DOTS implementation and interpersonal communication skills, introduced patients tracking using telephone contacts, quarterly review meetings and strengthened linkages with the District TB and Leprosy supervisor and the health sub-district TB focal persons through regular meetings and support supervision

Key points that STAR-EC has contributed to in support of the National TB Program specifically aimed at increasing TB Case Detection Rate are:

1. Provided Binocular microscopes (Olympus CX21) to 15 health facility laboratories.

2. Facilitated refresher training of trained 41 laboratory staff sputum TB microscopy aimed at improving their technical skills in TB diagnostic procedures and adherence to implementation of recommended infection control and quality control practices.

3. Facilitated DHOs, DTLSs and DLFPs to attend and participate in the 2009/2010 NTLP annual general meeting for the South East Zone

In one year of STAR-EC implementation, there has been improvement in TB DOTS coverage to 61 sub counties (100%),TSR to 79.1% for the July – December 2009 cohort and a 50% reduction in default rate to 10.9% in the same cohort.

Uganda: NUMAT
JSI's Northern Uganda Malaria AIDS & Tuberculosis (NUMAT) Program is helping to boost the quality and availability of health services for displaced populations and others affected by armed conflict in the region. The goal of this USAID-funded project that runs through 2011 is to expand access to and utilization of HIV, tuberculosis, and malaria prevention, treatment, care and support services. NUMAT strengthens local government responses, expanding the role of communities in planning, implementation and monitoring activities, and building upon existing networks.

Under the TB component of the project, NUMAT staff in collaboration with the National TB/Leprosy Program and the respective districts trained 192 health workers in supervision of Community-based Directly Observed Treatment Short course (CB DOTS) activities for tuberculosis treatment. NUMAT has supported and conducted an assessment of TB service delivery activities from 2008 until 2010 in eleven districts. The project also looked at TB-retreatment cases from those same years in order to determine why patients re-started treatment, the outcome of the treatment, and the length of time between treatments. A separate assessment of the periodic reports from the districts in the Central North Region of Uganda from 2005 until 2010 was conducted. These periodic reviews of all data collected through the routine TB reporting system can offer a comprehensive picture of the changing TB pattern at local level, highlight areas where further data collection and research may be needed, and indicate whether the control program is tuned to the changing epidemiological environment.

NUMAT also supports the quarterly TB technical review meetings and supervision from the Central MOH to the districts.

NUMAT has taken the lead to support TB/HIV collaborative activities in its priority districts including supporting joint planning of TB/HIV activities at district and lower- level health facilities. NUMAT has also supported the training of 35 health workers in TB/HIV collaborative activities. As a result of NUMAT’s support in 2010, important TB/HIV services were provided including testing 87.7% of TB patients for HIV. Of those tested, 50.3% were found to be HIV positive. IEC/BCC working groups have been supported in all the districts and these have in turn developed TB IEC materials that were disseminated in the second year of the project.

In 2008, NUMAT trained 80 health workers in CB DOTS; provided transportation of District TB Supervisors and Sub-county Health Workers so they can effectively connect with their colleagues; sponsored radio talk shows through 2 FM radio stations; implemented TB/HIV collaborative interventions through training of 540 health workers; and supported quarterly meetings at district and sub district levels.


Declaration of interests:
No conflicts of interest were delacred.

Application date:  
Last updated: July 19, 2013