Our Expertise

Over 35 years of close collaboration with Ministries of Health and the University of Washington, HAI developed a broad range of experience and expertise.  Below are a few of the public health areas in which HAI contributed to the integration and improvement of primary health care around the globe.

Click the tabs in the table below to learn more

HAI has a long history of expanding and integrating HIV services into primary health care delivery systems and advocating for equal access to care and treatment, especially in the global South. In addition to 20+ years of experience providing technical assistance in HIV/AIDS service delivery as a PEPFAR clinical implementing partner in Côte d’Ivoire and Mozambique, HAI designed and led numerous studies and evaluations aimed at making national HIV programs more effective, efficient, and accessible. In line with our commitment to health equity, HAI played a key role in advocating for expansion of HIV treatment programs in sub-Saharan Africa, assisting Mozambique’s Ministry of Health to elaborate the country’s first National HIV Treatment Business Plan alongside the Clinton Foundation.

Examples of HAI’s HIV/AIDS experience and expertise include:

  • Community outreach and HIV education
  • Community-based patient follow-up and linkage to HIV services
  • Community-based qualitative research
  • HIV/AIDS program monitoring & evaluation
  • Mental health screening within HIV-positive populations
  • National HIV Scale-up/Business Plan design and implementation 
  • Pilot and implementation of quality improvement tool (SAIA)
  • pMTCT national program evaluation
  • Network elaboration for social support services & surveillance
  • Supply chain systems support
  • Test and Treat program roll-out, integration, & technical assistance
  • Service integration, technical assistance, provider training, & monitoring & evaluation as PEPFAR clinical implementing partner
    [Prevention, Testing & Counseling, Adult & Pediatric Care, Adult & Pediatric Treatment, Prevention of Mother-to-Child Transmission of HIV (pMTCT), Laboratory, Orphans & Vulnerable Children, HIV/Tuberculosis Integration]

“One major lesson from the AIDS treatment scale-up effort in Africa is that treatment coverage and retention can be attained only through a strong comprehensive primary health care system. HIV-positive people may present at health facilities with a range of other conditions that might include malnutrition, malaria, TB, mental illness or dysentery, to name only a few. They may come with children in tow with their own health issues, and perhaps have moved multiple times, so they need comprehensive records that can follow them.”

James Pfeiffer, Executive Director, Health Alliance International &
Rachel Chapman, Associate Professor, University of Washington, Anthropology.
In NGOs, austerity, and universal health coverage in Mozambique, Globalization & Health, 2019


Explore HAI’s recent HIV/AIDS programs  »

From the very start, HAI was afraid to lead with our values. From 30+ years of experience standing up and speaking out, we know how to employ our global expertise and public health systems perspective to the fight for health justice. We have done this through the lens of our four advocacy pillars: 1) Strengthening Public-Sector Health Systems and the Health Workforce; 2) Macroeconomic Justice for Healthy Communities; 3) Using Public Health Solutions to Measure the Health Effects of Conflict and End War; and 4) Movement Building for Racial, Social and Health Justice.

Examples of HAI’s advocacy accomplishments include:

  • Drafting and advocating for the passage of policy resolutions, including for the American Public Health Association;
  • Drafting and advocating for the passage of policy resolutions, including for the American Public Health Association;
  • Leading multi-stakeholder engagement to produce best practice guidelines, including the NGO Code of Conduct;
  • Organization of multi-day activist workshops, including International People’s Health Universities (IPHU) in collaboration with the People’s Health Movement and University of Washington;
  • Participation in regional and global health advocacy networks, including steering committee roles;
  • Public health curriculum development, including a University-level War and Public Health course and online Macroeconomic Literacy Training modules;
  • Writing and editing textbooks, books, op-eds, and position papers related to HAI’s four advocacy pillars;
  • Participating in conferences, events, panel discussions, classes as guest speakers to talk on topics related to HAI’s four advocacy pillars;
  • Planning, implementing, and co-sponsoring events, speaker series, workshops, panel discussions, and demonstrations on topics related to HAI’s four advocacy pillars, recent examples include:
    • African Americans Against the Bomb: Nuclear Weapons, Colonialism, and the Black Freedom Movement, guest lecture
    • Celebrating the Origins of Health for All and UHC, panel discussion
    • Community & Legal Strategies to Stop Police Violence, panel discussion
    • Global Health Watch 4 Book Launch, event
    • Our Health is Not for Sale – Day of Action with Kshama Sawant, workshop/teach-in
    • Life in Baghdad Today: Thirteen Years After the U.S. Invasion, What is the State of Public Health?, guest lecture
    • Stephen S Gloyd Lecture at the University of Washington, speaker series
    • Too Late for Early Warnings? Cyclone Idai, Climate Change, & Global Health, panel discussion
    • Washington Fair Trade Coalition presents: WTO+20, demonstration/workshop/guest lecture  

Explore HAI Advocacy  »

For 20+ years, HAI’s work in malaria focused on improving the quality and use of routine malaria health information system data to inform national-level prevention and treatment strategy and policy. From 1998-2007, HAI played a key role in the development, testing and implementation of malaria in pregnancy prevention and treatment strategies in Mozambique and supported Mozambique’s Ministry of Health to develop and field test the national intermittent preventive treatment (IPT) for malaria guidelines. Over the next decade, HAI led and contributed to multiple malaria program evaluations and helped build internal malaria research capacity within Mozambique’s Ministry of Health.

Examples of HAI’s malaria experience and expertise include:

  • Clinical training and on-site coaching for malaria treatment in adults, at-risk children, and pregnant women
  • Community mobilization activities for adoption and use of insecticide-treated bednets (ITN)
  • Design and implementation of malaria monitoring & evaluation (M&E) tools, including user training
  • Development, testing and implementation of malaria in pregnancy prevention and treatment strategies, including national IPT guidelines in Mozambique
  • Distribution and retreatment logistics of ITN
  • Distributor, community leader, & health provider training on ITN use and retreatment
  • Implementation of cyclical performance review for malaria prevention and case management
  • Malaria data quality improvement and use in decision-making at clinical and management level
  • Malaria prevention impact evaluation, including IRS, ITN, ACT, and IPT strategies
  • National Malaria program evaluation, including development of National M&E plan, and associated M&E registers and reporting systems.

Explore HAI’s recent Malaria programs  »

HAI worked at the system-level to improve the delivery of evidence-based health care. Like cogs in a machine, getting the right intervention to the right patient at the right time requires a lot of moving parts to work in harmony. At HAI, we spent decades identifying, correcting, fine-tuning and building systematic, enduring solutions to health system bottlenecks and barriers. Our tool belt included: implementation science, health systems research, industrial and systems engineering, continuous quality improvement, training & supportive supervision, procedural and policy development, and when appropriate, advocacy. We don’t need to reinvent the wheel, we just need to make sure the axle is oiled and the road ahead is smooth.

Examples of HAI’s systems improvement experience and expertise include:

  • Development of integrated DR-TB laboratory testing database
  • Clinical and outreach provider training, follow-up after training, and on-site coaching
  • Coordinate, map, and systematize inter- and intra-service referral systems
  • De-centralized epidemiologic surveillance capacity building
  • Development of adapted care cascade metrics (HIV, PMTCT, mental health, tuberculosis, hypertension) to identify and target systems-level bottlenecks in delivery of care
  • Health facility rehabilitation and reorganization
  • Initiation and reinforcement of data quality review and feedback cycles to improve evidence-based decision making
  • Integrated program policy development and implementation at national and regional levels
  • Integration of vertically-organized health services into primary health care delivery to improve access to, efficiency, and effectiveness of service delivery
  • Introduce and systematize data tracking and information sharing technology to streamline surveillance and response
  • Leadership & management training and joint supervision support
  • Patient, data, and process flow mapping to inform systems modifications
  • Qualitative and quantitative program assessment and evaluation for quality improvement


Explore HAI’s recent Health Systems Strengthening programs  »








HAI’s maternal & child health (MCH) programs served to strengthen the ability of women to access and receive quality care for themselves and their children. HAI employed extensive experience developing, testing, implementing, and scaling up interventions that improve access to MCH services and MCH service delivery from family planning to newborn care and all the stages in between. We recognize that pregnant women, infants, and young children are at higher risk of infection than other groups, but often are the most dependent and least powerful members of society, requiring specialized care and attention.

Examples of HAI’s maternal & child health experience and expertise include:

  • Community-based prenatal & postnatal care promotion
  • Integration of infection screening in prenatal care
  • Design and implementation of birth-friendly facilities
  • Prevention of mother-to-child transmission of HIV
  • MCH national program assessment
  • MCH supervision tool development
  • Design & implementation of MCH mHealth program
  • Development of national MCH standards of care
  • In-service education for MCH providers
  • Identification of key MCH performance indicators
  • MCH service evaluation and quality improvement
  • MCH data analysis & interpretation training & integration
  • Promotion of skilled-birth attendance

“HAI’s technical assistance in the arena of Maternal and Newborn health is so widespread that they have contributed to every major initiative that has become a [Timor-Leste] government program.”
– External Evaluation of HAI-TL program, December 2008

Explore HAI’s recent MCH programs  »

HAI housed world leaders in designing, conducting, and providing training on implementation science and health systems research. Often what we know works in a controlled environment doesn’t work the same in practice. At HAI, we worked in partnership with Ministries of Health to test the real world effectiveness of evidence-based interventions, tools, and initiatives as they are implemented in public sector health systems. At the same time, we built the capacity of local researchers to continue the quality improvement cycle into the future.

Examples of HAI’s Implementation Research experience and expertise include:

  • Embedding implementation research skills within public sector health systems
  • Co-Creation of Beira Operations Research Center within Mozambique’s National Institute of Health
  • Development, pilot, and integration of provider-driven quality improvement tool using implementation research methodologies (SAIA)
  • Adaptation and testing of existing evidence-based public health methodologies to novel uses and/or environments (SAIA, CETA)
  • Curriculum development and implementation of Operations Research workshops in 10+ countries and 4 languages
  • Curriculum development for Implementation Science short courses, full courses, and advanced degree programs
  • Implementation research mentorship and technical assistance
  • Train the trainer workshops in implementation research
  • 100+ studies conducted and disseminated with technical assistance from HAI

Explore HAI’s recent Implementation Research programs  »

HAI’s commitment to comprehensive primary health care was underscored by our history of addressing one of the most significantly under-resourced health burdens worldwide: mental and self harm disorders. Mental disorders are the estimated leading cause of disability around the globe, but the lack of resources and attention given to this critical aspect of primary health care means at least 80% of people in low- and middle-income countries with disabling mental illness do not receive effective treatment. HAI focused on adapting and integrating mental health detection, care, and treatment while building expertise within public sector health systems to better track and respond to a wide spectrum of mental health disorders.

Examples of HAI’s Mental Health experience and expertise include:

  • Adaptation and implementation of the Common Elements Treatment Approach (CETA)
  • Improved integration of mental healthcare into primary care
  • Development of locally-adapted treatment approaches, included PHQ-9 for depression screening, AUDIT for alcohol use, and other screeners for common mental disorders, violence, and suicidal ideation
  • Elaboration of mental health care cascade, including performance indicators, visualization tool, and data tracking tools
  • Evidence-based systems readiness and mental health program assessments
  • Identification of barriers and facilitators to mental health care, mixed-methods analysis
  • Implementation and applied research training in mental health
  • Improving use and quality of routine mental health and self-harm data
  • Locally-adapted self-harm, substance abuse, epilepsy, schizophrenia, & depression screening and treatment
  • Mental health lay counselor training and implementation
  • Mental health screening with HIV-positive populations
  • Pilot and implementation of quality improvement tool (SAIA)


Explore HAI’s recent Mental Health programs  »

HAI worked directly with health system leaders & managers to systematize supportive supervision and routine health data review, analysis, and use for adapting and improving health care delivery. We also extended health leadership training beyond the national health systems where we worked to strengthen the engagement of local communities in health decision-making. At the University of Washington, HAI technical advisors and investigators continue to train tomorrow’s leaders in global health to approach their future careers with the same values that drove HAI’s work for 35 years: Solidarity, Equity, and evidence-based Action.

Examples of HAI’s leadership & management experience and expertise include:

  • Co-led, with the UW, the Population Leadership Program (1999-2007) that trained and mentored nearly 80 senior national health leaders from 15 low-income countries on capacity building in the area of leadership, policy, and management
  • Community Leader Health Council implementation and evaluation
  • Design and implementation of the Integrated District Evidence to Action (IDEA) approach which develops and systematizes data-driven decision-making skills among public sector health leadership and management at the provincial, district, and facility levels.
  • Developed and opened the Beira Operations Research Center (CIOB) in partnership with the Mozambican Ministry of Health, which provides training and research opportunities for Mozambicans in implementation science and operations research
  • Joint supervision to health facilities with district and regional health system management teams to improve data review, clinical coaching, and other management skills
  • Operations research training and train the trainer support to multiple national health research centers, including Côte d’Ivoire’s National Public Health Institute
  • Operations and Technical capacity building for local nonprofit organizations
  • Provision of embedded technical assistance within public sector health system via “assessor” placements
  • Public health curriculum development, teaching, and mentorship for undergraduate, masters and doctorate level students
  • Team-building and task-sharing training and support


Explore HAI’s recent Leadership & Management programs  »

HAI’s experience working in reproductive health taught us to move forward with communities at the pace of trust. Implementing family planning and sexual & reproductive health programming in a global health context requires both cultural sensitivity and an understanding of the historically-rooted power dynamics that accompany these topics.  That’s why HAI incorporated participatory design and local collaboration into all our SRH programs.

Examples of HAI’s reproductive health experience and expertise include:

  • Assessment of congenital syphilis burden and access to screening and treatment
  • Co-development with MOH of reproductive and perinatal health service delivery supportive supervision tool
  • Community-based participatory development and pilot of culturally-adapted, birth-friendly health facility spaces
  • Community-based sexual and reproductive health promotion, including child spacing
  • Data use for decision making to identify low utilization rates of perinatal care
  • Development of culturally-adapted child spacing, maternal health, and perinatal care health promotion and behavior change communication materials, including video, radio and other visual tools
  • Evaluation of the implementation strategy of Mozambique’s school-based HPV vaccine project
  • Gender-based violence screening and referral integration into reproductive and perinatal health services
  • Household survey of reproductive health knowledge, practice, and coverage
  • Integration of family planning and reproductive health messaging into national mHealth program
  • Provider training, follow-up after training, and on-site coaching for family planning services


Explore HAI’s recent Reproductive Health programs  »

At HAI we believe that mHealth technology can be an effective health promotion tool when it is employed in service of, and complimentary to, National Health System priorities. In Timor-Leste, HAI helped develop, pilot, evaluate, and scale-up the first ever mHealth program in the country. In Mozambique, we tested novel ways to streamline data sharing and data-driven decision-making using tablets. At HAI, we employed mHealth to build connections. Connections that both expand the reach of the health system while strengthening internal system responsiveness with real time data sharing.

Examples of HAI’s mHealth experience and expertise include:

  • Development and evaluation of a tablet-based clinical training for nurses introducing cART in pregnancy
  • Pilot and evaluation of at tablet-based tuberculosis case management system, including adverse effect screening
  • Development, pilot, evaluation, and scale up of mobile phone-based Liga Inan program connecting expectant and new mothers with their midwives
  • Baseline feasibility and user readiness study for mHealth program adoption
  • Scale up of mHealth program through National Health System, in coordination with Ministry of Health
  • mHealth program evaluation
  • Development and user testing of mHealth messaging
  • Coordination of multi-sector partnerships to establish mHealth program development, implementation, and sustainability plan
  • Provider training on mHealth program implementation and integration
  • Community-based promotion of mHealth program


Explore HAI’s recent mHealth programs  »

Despite having an effective treatment, TB continues to ravage some of the most vulnerable, impoverished and marginalized populations on the planet and remains the world’s leading infectious cause of death. Drug resistant organisms, and drug-resistant TB (DR-TB) in particular, are estimated to infect over half a million people globally. HAI partnered with ministries of health to evaluate and strengthen their TB, TB/HIV and DR-TB care cascades, not only improving traditional TB program indicators, but improving the quality of care to patients. We worked to pivot away from one-size fits all treatment strategies and towards patient-centered care models.

Examples of HAI’s tuberculosis experience and expertise include:

  • Development of integrated DR-TB laboratory testing database
  • Elaboration and implementation of laboratory referral system for TB samples from rural areas
  • Embedded technical assistance for policy development, research, evaluation, and program implementation
  • Identification of barriers to access and adherence to TB services
  • Implementation of national DR-TB clinical committee and case review videoconferencing network
  • Implementation of TB community health worker program
  • Integration of HIV/TB, including DR-TB, co-infection screening and referral
  • Pilot & evaluation of tablet-based diagnostic tool
  • Pilot, implementation and scale up of LED microscopy, Xpert MTB/RIF testing
  • Pilot, implementation and scale up of mHealth GxAlert platform
  • Quantitative and qualitative assessments of the TB care cascade
  • Strengthening clinical TB infection control skills and procedures
  • TB data quality improvement and use for clinical and management decision-making
  • Training and on-site coaching to health care providers in the diagnosis and management of TB infection and TB/HIV coinfection, including isoniazid preventive therapy (IPT)
  • Coaching community health workers on the offer of care and support services to TB patients (adherence counseling, support groups, home visits, Direct Observation of TB treatment), community education on TB control, and referral to TB testing for potentially exposed co-habitants and family members.


Explore HAI’s recent Tuberculosis programs  »

At HAI we know that evidence-based analysis and reflection is critical to continuous improvement of health care delivery. Not only did we embed robust monitoring and evaluation plans within our own HAI-led programs, we also conducted evaluations in collaboration with our health system partners and other institutions. HAI evaluations aimed to understand the functionality and effectiveness of interventions, programs, and policies that shape health care delivery; and provide data-driven recommendations for their improvement.

Examples of HAI’s program evaluation experience and expertise include:

  • Evaluation of:
    • Pilot Interventions and programs
    • Outcomes and Impact of projects, programs, and initiatives
    • Scale-up feasibility and success
    • National strategy and policy adoption and impact
  • Data quality auditing
  • Development of outcome and impact evaluation frameworks
  • Joint evaluation design and implementation with Ministry of Health, to evaluate public programs and initiatives
  • Technical assistance and supportive supervision for health system program monitoring & evaluation (data collection, collation, quality assessment, analysis, and use)
  • Time-motion study to determine patient flow in primary health care services
  • Training on routine health data quality assessment and use in program evaluation
  • Evaluation highlights include:
    • 5-country African Health Initiative
    • GAVI Full Country Evaluation
    • National PMTCT program assessment in collaboration with Côte d’Ivoire’s National HIV/AIDS Program
    • President’s Malaria Initiative Impact Evaluation
    • WHO Policy Brief development

Explore HAI’s recent Program Evalations  »

To see how and where we put our expertise in action, check out  HAI’s Program Portfolio

Or search through three decades of publications,  presentations, op-eds and media coverage in HAI’s Publication Library

Stand with HAI

Stand with HAI

Our Mission

Our mission is to promote policies and support programs that strengthen government primary health care and foster social, economic, and health equity for all. Our vision is a just world that promotes health and well-being, including universal access to quality health care.

Our History

Health Alliance International began in 1987 as a US-based international solidarity organization committed to supporting the public sector provision of health care for all.  Over 35 years, HAI conducted programs in 17 countries, with flagship programs in Mozambique, Côte d'Ivoire, and Timor-Leste.

Our Evolution

In line with HAI’s commitment to support and strengthen local public health leadership, as of October 2021, HAI fully transitioned global operations and active programs to locally-based, locally-led NGOs. Learn more about this shift toward local autonomy and equity in global health.

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