joanne lee - health systems program manager/designer, project portfolio

JOANNE LEEPROJECT PORTFOLIO

IN A NUTSHELL

I’m a program designer and project manager with experience in international development, public health policy and planning, & community-based programs in Zambia, India, and the Bay Area.

I am passionate about having an open, curious mind to design and innovate systems to empower communities and individuals to achieve what really matters to them.

That curiosity about the different and interrelated ways people live and think is why I got an anthropology degree and neurobiology minor 7 years ago, and it’s still what makes research and design exciting for me today.

My specialty is pairing community-driven field research with rigorous analysis and strategic management to design programs people want to use, usually to build or strengthen public systems and/or nonprofit partnerships.

SkillsProgram design, Project management, Community-centered assessment, Operational research and modeling, Health training, Copywriting

LanguagesSpanish (fluent)Korean (basic)

SoftwareExcel (modeling), Access, PowerPoint, Keynote, Adobe Illustrator, QuantiMed, Pipeline

Hi! I’m Joanne.

WHERE I’VE BEEN2013201220112010200920082007

Anthropology A.B., Neurobiology

secondary fieldHarvard College

Researcher-Writer, Greece

Let’s Go travel guides

Pediatric HIV AnalystClinton Foundation

Health Access Initiative (CHAI), Zambia

Senior Analyst, Human Resources in

Health InitiativeCHAI Zambia

Nutrition Program Manager Balasahyoga Project,

CHAI India

Residential CounselorCommunity Treatment Facility, Seneca Center

Strategic Partnerships Manager

San Francisco Child Abuse Prevention Center

Cambridge, MA / Mexico, India, New Zealand, Greece

Lusaka,Zambia

Hyderabad,India

San Francisco,CA

WHERE I’VE BEEN

SELECTED PROJECTS

San Francisco Children’s Advocacy CenterA multidisciplinary center for child abuse response and family wellness in the Bayview

Andhra Pradesh AIDS Control SocietyFirst-ever statewide comprehensive pediatric nutrition and food security strategy and zinc intervention plan in Andhra Pradesh, India

Zambia Ministry of Health

Health Workforce OptimizationNational public health workforce auditing system

Addressing the Health Worker Crisis in ZambiaAddressing the health worker shortage in Zambia through radical scale-up of health training schools

Early Infant DiagnosisNational roll-out of new methodology to diagnose <18 month old infants for HIV

Community Treatment Facility, SF General HospitalIndividual treatment plans designed by clinical care teams for traumatized foster teens in residential rehabilitation

SF Children’s Advocacy Center (CAC)Background: Despite the 1000+ suspected cases of child abuse in San Francisco, the city’s public agencies only opened files and investigated 250 cases in 2012.

Objective: Establish a CAC to streamline and expand San Francisco’s response to child abuse.

BEFORE: NEEDS ASSESSMENT‣ Mapped intake/referral processes through

immersive observation, expert interviews, and group discussion.‣ Shared interagency child abuse response map

with different agencies involved and led discursive re-design process.

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AFTER: A NEW OPERATIONAL MODELA child abuse victim has 1 multidisciplinary interview. Agencies co-locate in a CAC and collaborate on integrated case review.‣ Pipeline bottlenecks and redundancies removed:

Optimized scheduling, online data sharing, automated alerts, more interview rooms.

The new streamlined CAC model doubles San Francisco’s child abuse case review capacity in 3 years.

Facility RenovationObjectiveEstablish a CAC to co-locate and streamline the city’s response to cases of child abuse.

Partners involved- SF Child Abuse Prevention Center (lead)- Tom Eliot Fisch architects- Plant Construction- Center for Youth Wellness (nonprofit partner)- California Pacific Medical Center (pediatric clinic)- Tipping Point Community (donor)- +5 SF city agencies (Police, District Attorney,

Dept. Public Health, Child Protective Services, etc.)

ResultsRadically redesigned an existing 22,000 sq ft facility in the Bayview to be a family-friendly center for streamlined, multidisciplinary child abuse response, pediatric primary care, and wraparound

SF Children’s Advocacy Center (CAC)

Schematic designs

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1st floor: Lobby, IT, multipurpose room, parking

2nd floor: Pediatric clinic, counseling, wellness services

3rd floor: Children’s Advocacy Center (forensic area, social services, trauma therapy)

Andhra Pradesh AIDS Control Society, Pediatric HIV and MalnutritionBackground: India has the highest rate of pediatric acute malnutrition in the world. The India Ministry of Health and Andhra Pradesh State AIDS Control Society approached the Clinton Foundation for support on how to develop a strategic plan to address pediatric malnutrition and HIV.

Objective: Identify key areas for greatest impact among HIV-affected children in Andhra Pradesh, and design an effective government intervention.

Policy/ regulatory

•  Requires alignment with country’s physicians and pediatric societies as well as state systems in some cases

•  Zinc is on most but not all country EDLs

Demand side barriers and distribution are major impediments to uptake of ORS and Zinc

Summary of supply side barriers Summary of demand side barriers

Manufacturing

•  Local manufacture restricted due to GMP requirement by international donors

•  Zinc not widely formulated as tablets

Financing

•  Lack of global and national support and funding leads to volatile demand

•  Although inexpensive and cost effective compared to other treatments, price can still be a barrier in some regions e.g. Ethiopia

Distribution

•  Private vs. public dynamics vary greatly by country, requiring different approaches

•  Low profit margin for retailer creates bias towards treatments with higher margins (e.g. antibiotics)

Marketing

•  In many countries Zinc still not OTC, limiting direct marketing by suppliers

•  In India, for e.g. manufacturers have limited experience with direct-to-consumer marketing

Awareness of condition

•  Awareness of diarrhea is not the issue, but awareness of causes and effective interventions is

•  Lack of awareness of importance of oral rehydration and Zinc

Decision to seek care

•  Only use ORS when child looks weak

Ability to access care

•  Providers unaware and don’t regularly prescribe

•  Inexpensive; however, stores earn little margin

on treatment, so there is little incentive to stock

Locus of delivery

•  Private vs. public dynamics vary greatly by country, requiring different approaches

•  Lack of health care worker education and training impedes widespread use of ORS+zinc

•  Compliance of Zinc is an issue

Monitoring/ evaluation

•  Need for regular, reliable, consistent data on burden of disease and quality of care

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M&E conceptual framework will help us understand and prioritize zinc options

Zinc pilot: supply chain monitoring

Develop forecasting, procurement, and supply chain mgmt processes and procedures

Districts improve their supply chain practices

Zinc is distributed effectively in these districts, and knowledge is transferred

•  Patients are able to obtain zinc when they need it

•  Distribution resources are used more efficiently

Zinc pilot: training and behavioral change component

Collaborate with UNICEF on creating educational materials and including zinc training in current doctor trainings

Doctors and public have knowledge about benefits of zinc, and doctors understand how to prescribe it

Doctors prescribe zinc more frequently; more children are effectively treated with zinc

•  Less morbidity and mortality from diarrhea

Demand-building: advisory role in state-wide doctor training

Helping government/UNICEF develop state-wide doctor trainings at district level

Doctors across the state have knowledge about benefits of zinc, and understand how to prescribe it

Doctors prescribe zinc more frequently; more children are effectively treated with zinc

•  Less morbidity and mortality from diarrhea

•  Potential reduction in malnutrition indicators

•  Potential price decrease due to volume lift

Helping manufacturers interface with public sector

Forecasting, demand prediction

Manufacturers have adequate forecasts of demand to increase production and scale up

Sufficient quantities of zinc are readily available

•  Zinc is cheaper •  Market is more competitive

Nutrition referrals

Enable MUAC training and refer malnourished children to feeding centers

More children with MAM and SAM are treated in feeding centers

Diarrhea and malnutrition are addressed more closely together

•  Better health outcomes for children with diarrhea and malnutrition

•  More future cases of diarrhea/malnutrition prevented

HIV referrals Refer children with chronic diarrhea (indicative of HIV) for testing

More children who are HIV positive are identified

Prevalence becomes more widely known

•  Increase in child HIV tests •  Larger sample on prevalence

information for children

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Input Activity Output Outcome Impact Childhood diarrhea was identified as one key area where minimal investment could produce the greatest health returns for the largest population. Market research, feasibility testing, and an impact assessment were carried out.

Result: A recommended plan for implementation was presented to the Indian government, including possible suppliers, staged roll-out, ongoing evaluation, and intended impact.

Field implementation was also put in place in Andhra Pradesh in response to the state-identified need for immediate nutrition supplementation for underweight, HIV-affected children.

Result: Nutrition counselors hired for all 11 HIV clinics in Andhra Pradesh and trained in nutrition education for families, nutrition supplementation distribution, and anthropometric data collection. Nutrition support areas designed and incorporated into HIV clinic patient flow.

Andhra Pradesh AIDS Control Society, Pediatric HIV and Malnutrition

Cooking is not required. Eat 100g of Modified Therapeutic Food daily plain or mixed with boiled water or milk, as preferred by child. Do not eat if past expiration date on the package.Nutrition content is intended for a single child for

1 month and not to be shared with other family

members.

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child for 1 month and not to be shared with

other family members.

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Zambia Ministry of Health (MoH): Health Workforce OptimizationBackground: The MoH national health worker payroll database was inaccurately maintaining many retired, deceased, or transferred health workers as active.Objective: Update the national health worker payroll database and establish an accurate baseline number of health workers staffing public clinics and hospitals in Zambia.

Zambia Ministry of Health (MoH): Health Workforce OptimizationResults:‣Up-to-date national public health

staffing baseline‣District-level payroll audit tool‣National audit reporting model‣National annual auditing policy

to ensure ongoing accuracy of health worker database‣All national, provincial, and

district health officers trained on payroll audit tool and reporting

7

Methodology Build on existing

planning documents

Visit hospitals and interview experts

Analyze data and validate findings

• HRH Strategic Plan, HMIS, and payroll provide national overviews of postings and health needs

• Audit on site-by-site basis to verify funded posts in payroll and actual # of CHW’s

•  Interviews generate insights how health indicators translate into actual health worker need

• Synthesize findings from visits by analyzing data across all health facilities

• Liaise with national partners on CHW practices

Zambia MoH: A Health Worker CrisisBackground: In 2008, Zambia was having a health worker crisis; the country had <50% of the minimum recommended doctor-to-population and nurse-to-population ratios defined by the WHO.

Objective: Aggressively scale-up the output of health training institutions (TIs) to increase the number of health workers in Zambia.

Expert interviews informed field

questionnaire and logic of analytical model

Interviews conducted at 39 TIs to determine

feasible scale-up targets & priority resources

required

Using an Excel-based model and intake targets from the

assessments scale-up needs were calculated

for each TI

Five-year scale-up plans were developed for

each training institution detailing scale-up

timeline, costs, and activities

Operational Plans Expert Interviews Field

Questionnaire TI Scale-up

Model

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RESEARCH Open Access

Doubling the number of health graduates inZambia: estimating feasibility and costsAaron Tjoa1*, Margaret Kapihya2, Miriam Libetwa2, Joanne Lee3, Charmaine Pattinson3, Elizabeth McCarthy1,Kate Schroder1

Abstract

Background: The Ministry of Health (MoH) in Zambia is operating with fewer than half of the human resources forhealth (HRH) necessary to meet basic population health needs. Responding urgently to address this HRH crisis, theMoH plans to double the annual number of health training graduates in the next five years to increase the supplyof health workers. The feasibility and costs of achieving this initiative, however, are unclear.

Methods: We determined the feasibility and costs of doubling training institution output through an individualschool assessment framework. Assessment teams, comprised of four staff from the MoH and Clinton Health AccessInitiative, visited all of Zambia’s 39 public and private health training institutions from 17 April to 19 June 2008.Teams consulted with faculty and managers at each training institution to determine if student enrollment coulddouble within five years; an operational planning exercise carried out with school staff determined the investmentsand additional operating costs necessary to achieve expansion. Cost assumptions were developed using historicalcost data.

Results: The individual school assessments affirmed the MoH’s ability to double the graduate output of Zambia’spublic health training institutions. Lack of infrastructure was determined as a key bottleneck in achieving thisincrease while meeting national training quality standards. A total investment of US$ 58.8 million is required tomeet expansion infrastructure needs, with US$ 35.0 million (59.5%) allocated to expanding student accommodationand US$ 23.8 million (40.5%) allocated to expanding teaching, studying, office, and dining space. The nationalnumber of teaching staff must increase by 363 (111% increase) over the next five years. The additional recurringcosts, which include salaries for additional teachers and operating expenses for new students, are estimated at US$58.0 million over the five-year scale-up period. Total cost of expansion is estimated at US$ 116.8 million over fiveyears.

Conclusions: Historic underinvestment in training institutions has crippled Zambia’s ability to meet expansionambitions. There must be significant investments in infrastructure and faculty to meet quality standards whileexpanding training enrollment. Bottom-up planning can be used to translate national targets into costedimplementation plans for expansion at each school.

BackgroundMany resource-limited countries are facing the challengeof too few health workers to care for their population.Not enough doctors, nurses, clinical officers, midwives,medical assistants, and other key healthcare cadres areproduced from training institutions to staff the healthworkforce [1-5]. Critical staffing shortages prevent these

countries from delivering basic health services andmeeting their health-related Millennium DevelopmentGoals [1,6-9].In 2005, the Government of the Republic of Zambia

Ministry of Health (MoH) estimated that it had fewerthan half of the health staff necessary to deliver basichealth services across the country, with even more acuteshortages at rural clinics [10,11]. The Ministry of HealthNational Health Strategic Plan 2006 to 2010 providedseveral strategies to increase the size of the healthworkforce through the improvement of training,

* Correspondence: [email protected] Health Access Initiative, Boston, USAFull list of author information is available at the end of the article

Tjoa et al. Human Resources for Health 2010, 8:22http://www.human-resources-health.com/content/8/1/22

© 2010 Tjoa et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.

Field assessment and implementation:‣Trained and led MoH team to assess Zambia’s 39 health TIs.‣ Interviewed principals, teachers, students, and policymakers.‣ Immersed/observed (classroom, curriculum, etc.) to evaluate

scale-up feasibility, effectiveness, and sustainability.

Results:‣39 individual TI scale-up plans and impact assessments.‣Graduate output scaled-up +90% in 5 years.‣Zambia to reach its health workforce target by 2022.‣Secured +$20M funding from Global Fund & NGO partners.

Zambia MoH: A Health Worker Crisis

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One-off costs (USD '000) - Gap onlyTotal08-12

Current needs Scal e-up 08 09 10 11 12

Total one-off costs 1,484 852 632 351 683 449 - - - Hire add'l teaching s taff (recruiting only) 17 10 8 7 7 3 - - - Refurbish/expand existing c lassrooms 2 2 - - 2 - - - - Build new skills lab 27 27 - - 27 - - - - Update ski lls lab and equipment 31 31 - - 31 - - - - Build new student accom. 656 259 397 - 259 397 - - - Refurbish existing student accom. 18 18 - - 18 - - - - Build new library 44 44 - - 44 - - - - Buy new/add'l books 11 11 - 11 - - - - - Build/update kitchen/dining facility 43 43 - - 43 - - - - Build new staff office 119 72 46 72 46 - - - - Build new teacher accom. 478 301 177 257 176 45 - - - Buy new computers 8 4 4 4 - 4 - - - Purchase /repair transportation vehicles 31 31 - - 31 - - -

Recurring costs (USD '000) - Gap onlyTotal08-12

Current needs

Scal e-up 08 09 10 11 12

Total recurring costs 2,906 227 2,680 198 281 790 809 828 - Recurring salary add'l tutor 40 40 - - 10 10 10 10 - Recurring salary add'l clinical teacher 252 187 65 29 38 60 62 63 - Recurring cost add'l nursing/midw student 1,162 1,162 75 104 320 328 336 - Recurring cost add'l multi-program students 1,453 1,453 94 129 400 410 419

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Zambia MoH: HIV Early Infant DiagnosisBackground: As of 2007, dried blood spot sampling was the WHO standard for HIV Early Infant Diagnosis, but Zambia had still not implemented it. The MoH lacked the technical and HR capacity to plan a national-roll out.

Objective: Design and implement a national model for HIV early infant diagnosis (EID).

Operational Plan: Interviewed expert doctors, nurses, and international experts and designed an EID model based on WHO recommendations and Zambia-specific practices and constraints.

Training: Co-designed a physicians and nurses training on the EID model with Zambian leading pediatricians. Structured and co-led a national training of trainers and managed training for over +300 clinics.

Sample transport: Partnered with the Zambia Post to designed a sample collection and results distribution network to all public hospitals and clinics.

Testing: Working with the 3 national clinical labs, designed a hub-and-spoke model for sample testing and strategized the radical expansion of CD4 testing capacity to carry out national EID.

2

Training Agenda

Day I

•  8:30 Registration

•  9:00 Introduction and welcome

•  9:15 Introduction to early infant diagnosis »  Importance of Infant Diagnosis »  Identification of Infants

•  10:00 Tea Break

•  10:30 DNA PCR Testing Process at the Clinic »  Sample collection and DBS »  Sample referral to lab »  Results receipt and interpretation »  Documentation »  Record-keeping and data management

•  12:00 Video DBS Sample Collection

•  13:00 Lunch

•  14:00 Practical: DBS Collection, Handling, Storage and Shipping

•  16:00 Tea Break

•  16:30 Concluding Remarks

33

Sample Referral Systems

Packaging

Site Name: Date: D D / M M / Y Y

Number of Samples: # # #

Patient ID HIV

Elis

a

(red

- SST

tube

)

Infa

nt P

CR

(lave

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tube

)

CD4

(pur

ple tu

be)

Vira

l Loa

d

(pur

ple tu

be)

Chem

istr

y

(red

- plai

n tu

be)

Heam

atol

ogy

(pur

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f s f s f s f s f s f sf s f s f s f s f s f s






















Clinic Signature: Lab Signature:

Clinic Initials: Lab Initials:

LABORATOIRE NATIONAL DE REFERENCEHIV SAMPLE SUMMARY FORM

Testing

Transporting DBS Samples

Transporting Results

Drying

Laboratory

ART/PMTCT centre

Collecting Samples

Community Treatment Facility:Individual Treatment PlansBackground: The Community Treatment Facility in San Francisco General Hospital is a residential rehabilitation program for traumatized teens in the foster care system.

‣With teens, co-designed residential programs for behavioral development and life skills.

‣ Assessed teens’ backgrounds and community contexts to design individual transition plans.

‣ Tracked behavioral indicators and evaluated outcomes, refining treatment plans as needed.

‣ Counseled teens as primary caregiver during residence.

Objective: Work with teens and care teams (guardian, social worker, psychiatrist, therapist) to design and implement viable, safe transition plans for teens to rejoin their communities.

AND THE RESTMy work has always been community-driven because I know that my community will only be as strong as much as I put into it. That’s why I also volunteer with some pretty incredible organizations that innovate and push to make San Francisco stronger, more sustainable, and supportive:

La CocinaHayes Valley Urban Farm (formerly)Make-A-Wish

Thank you.

Joanne [email protected]/in/joannejlee

mailto:[email protected]

mailto:[email protected]

http://www.linkedin.com/in/joannejlee

http://www.linkedin.com/in/joannejlee

joanne lee - health systems program manager/designer, project portfolio

Career