Over the past 25 years, Joel has gained skills and experience in program management, monitoring, and evaluation. He has also gained skills working with the private sector (Non-Governmental Organizations – NGOs) and with a bilateral government agency (USAID). He has worked at community level as an immersed project officer, at district level as a program manager, and at national level as a specialist/adviser. His roles have progressively increased in complexity from implementer to project manager to technical specialist/adviser. All his roles have an aspect of health system strengthening.