• Developed and rolled out a PHC efficiency assessment tool, now used for budgeting and policy at facility and national levels
• Prepared the 2020 HIV Investment Case, demonstrating that full strategy implementation would avert 15,000+ new infections and save $13M by 2022.
• Delivered a 20-year Global Fund investment review, guiding future strategy and highlighting the need for integration and sustainability.

• Designed evaluation tools and analytical approaches used across the mid-term evaluation.
• Led analysis on efficiency, sustainability, capacity strengthening and cross-cutting themes.
• Contributed substantially to recommendations, lessons learned and quality control in the final joint report

• Reviewed proposals across the health system “pillars” (policy, workforce, service delivery, financing, governance, infrastructure, information systems, medicines and technologies, and community systems).
• Assessed whether proposed health system investments were technically sound, strategically coherent and feasible within country financing, institutional and implementation constraints.
• Co-led a deeper strategic review of RSSH investments and the resulting report, later adopted by the Global Fund Board and used to inform future planning for RSSH investments.

• Evidence-Based Program Design: Conducted the country’s first behavioural and biomedical surveys to inform targeted prevention and care for high-risk groups.

• Capacity Building: Trained 250+ clinic staff and 389 peer educators, including police, military, and community members.

• Service Delivery: Established VCT and STI services, reaching 145+ for HIV testing and 65 for STI care; initiated ART for the first 10 patients.

• Prevention Impact: Distributed 260,000+ condoms and developed national behaviour change communication strategies.

• Policy and Funding: Supported the Ministry of Health in developing the first National HIV/AIDS Strategic Plan and secured major Global Fund investment for scale-up.

• Recognition: Program recognised for technical and management excellence by the Minister of Health and USAID.

For further details, see the full final report (PDF).

• Developed and rolled out a PHC efficiency assessment tool, now used for budgeting and policy at facility and national levels
• Prepared the 2020 HIV Investment Case, demonstrating that full strategy implementation would avert 15,000+ new infections and save $13M by 2022.
• Delivered a 20-year Global Fund investment review, guiding future strategy and highlighting the need for integration and sustainability.

• As RSSH Focal Point in the Technical Review Panel, advised on technical quality and strategic merit of $12B+ in grant proposals (2017–21).
• Co-led the TRP’s 2021 “deep dive” and report that shaped the Global Fund Board’s RSSH investment framework.
• As OIG consultant, identified gaps in RSSH and pandemic preparedness investment monitoring and recommended improvements in performance measurement and risk management.

• Led rapid baseline assessments in Bhutan, Mongolia, the Philippines, and Sri Lanka.
• Identified gaps and opportunities in financial sustainability, strategic information, programmatic sustainability, and human rights.
• Recommendations included formalising social contracting, integrating community-led monitoring, scaling up innovative service models, and enhancing legal protections
• Led team of 12 international and national experts

• Guided the Ministry of Public Health in fair contracting for essential services in 31 provinces.
• Developed risk analysis tools and process recommendations to strengthen procurement and accountability.

Financial Efficiency

• Reduced duplication: Coordinating care across services (like HIV, TB, and maternal health) minimises unnecessary tests and procedures, lowering costs for patients and health systems.
• Preventive savings: Focusing on prevention through PHC, such as immunisations and chronic disease management, reduces the need for expensive hospital care.
• Optimised workforce: Cross-trained community health workers and nurses deliver a broader range of services, making better use of available staff.
• Equitable financing: Integrated funding models help reduce out-of-pocket expenses, making care more accessible.

Quality Improvements

• Holistic care: Addresses physical, mental, and social health needs together.
• Accountability: Digital tools and community-led monitoring reduce stockouts and improve responsiveness
• Continuity and trust: Ongoing provider relationships improve adherence and satisfaction

Looking Ahead

Countries adopting integrated PHC are seeing positive results—such as improved surveillance in Malawi and increased TB/HIV case detection in Zimbabwe. Integration is a practical path toward universal health coverage and more resilient systems.

In summary, integrated PHC makes health systems more efficient, equitable, and responsive to community needs.

• Context and approach
  Drawing on the WHO estimate that up to 40% of global health spending is lost to inefficiency, we have seen in Papua New Guinea and other settings how targeted efficiency gains and smarter procurement can identify opportunities to redirect resources to frontline health services.
  
  In Papua New Guinea, Jim led the development and piloting of the Primary Health Care (PHC) Efficiency Assessment Tool and the Intervention Scalability Assessment Tool under the PATH program. These Excel-based tools, designed in collaboration with the National Department of Health and Provincial Health Authorities, systematically identify inefficiencies in:
  • Deployment and productivity of health personnel
  • Use and procurement of health equipment and pharmaceuticals
  • Use of health facilities (bed occupancy, average length of stay, cost per patient day

• How the Tools Work
  Facility managers and provincial leaders were trained to use these tools to pinpoint where resources might be wasted—such as underused staff, procurement of overpriced or expiring medicines, or costly patterns of hospital admissions. For example, the tools highlight when facilities are overstaffed with administrative personnel, underusing expensive equipment, or maintaining too many empty beds, all of which drive up costs without improving patient care.

• Implementation and Lessons Learned
  Although the project was discontinued following the initial advisory phase due to a reprogramming of the overall investment, the approach demonstrated how practical, context-driven reforms can identify opportunities to turn wasted spending into new resources for health—even in challenging environments
  • Building trust with facility managers, adapting tools to different levels of care, and ensuring data quality all required persistence and flexibility
  • The experience in PNG illustrates the value of targeted efficiency analysis and procurement review as strategies to help health systems make the most of every available dollar.
• Results Achieved (advised):
  • Reallocated staff to better match patient needs
  • Switched to generic medicines and improved stock management
  • Adjusted bed numbers or referral patterns to reduce unnecessary costs

• Summary:
  Through developing and piloting these efficiency and scalability tools, we have shown how practical, evidence-based reforms can help health systems identify and unlock new resources—even when full implementation is not possible.

Analytical Approach

• Designed a comprehensive evaluation plan, including a 10-day field mission across Vientiane and Bokeo, to validate desk review findings and ensure actionable recommendations.
• Used the full suite of OECD/DAC criteria—relevance, coherence, efficiency, effectiveness, sustainability, and impact—to structure the assessment and reporting.
• Introduced a traffic-light framework to categorise 42 HRH interventions by performance and urgency, enabling rapid strategic prioritisation.

Data Collection and Triangulation

• Conduct 28–35 semi-structured interviews with central and provincial health officials, facility managers, scholarship recipients, and development partners.
• Carry out facility walk-throughs to observe EMR use, licensing logs, and staffing boards, directly validating reported data and practices.
• Audit programme datasets (EMR, HPIMS, DHIS2, HRIS, licensing, financial reports) to measure efficiency, retention, and system integration.
• Cross-check findings by comparing interview insights, observations, and quantitative data for robust, evidence-based conclusions.

Key Insights and Results

• Strategic Alignment: All interventions mapped to HRH Strategy 2030 objectives, with strong policy alignment and local ownership (20% provincial co-financing, updated HRH plans).
• Efficiency and Digital Transformation: EMR rollout in 120 facilities saved staff two hours per week; digitalisation and co-financing reduced donor dependency.
• Quality and Equity: 80% female scholarship participation and a 15% reduction in clinical errors; persistent gaps in licensing coverage and rural workforce distribution remain.
• Actionable Recommendations: Establish a technical working group for data integration, develop bonding and career pathway schemes for rural retention, and deploy mobile assessment teams for quality assurance.

Lessons Learned

• The combination of structured planning, advanced data evaluation, and mixed-method triangulation provided a robust evidence base for decision-making.
• Systematic stakeholder engagement and participatory validation workshops ensured recommendations were grounded in real-world realities.
• The traffic-light framework and real-time validation dashboard enabled rapid identification of priorities and responsive programme adaptation

Summary
This evaluation demonstrates how advanced analytical skills, strategic planning, and a rigorous DAC/OECD approach—combined with deep stakeholder engagement and data triangulation—can drive practical, evidence-based improvements in health workforce resilience and system performance in Laos.