Funded by: US Agency for International Development
Project Duration: 1990-2008
Countries: Global, South Africa, Bangladesh, Philippines, Cambodia, Benin, Niger, Ecuador, Zambia, Uganda, Tanzania, Kenya, Guatemala, Jamaica, Jordan, Honduras, Russia, Malawi, Bolivia, Rwanda, Nicaragua, Peru, Chile, Mali, Indonesia, Mexico, Nigeria, Vietnam, Morocco, Eritrea, Pakistan, Egypt, Zimbabwe, Laos, Colombia, Trinidad, Poland, Costa RicaPartners:
Academy for Educational Development; Initiatives Inc.; Johns Hopkins University; and Joint Commission Resources, Inc.(subcontractors)
For nearly 20 years, URC and its non-profit affiliate, the Center for Human Services, provided global leadership for health care quality assurance in USAID-supported programs through the Quality Assurance Project (QAP) I, II, and III. QAP provided technical assistance and conducted operations research on health care quality improvement. This work helped to raise awareness in countries and internationally that quality improvement (QI) is an essential component of health system strengthening and that quality standards and QI capacity development are vital to the development of health care systems in even the most resource-constrained countries.
Working with partners at the national, regional/district, and facility levels, QAP supported countries to design, introduce, and ensure implementation of clinical guidelines and standards, quality monitoring and assessment methods, continuous QI, and effective training and job aids that contributed to sustainable improvements in the quality of care, improved interpersonal communications and patient satisfaction, and reductions in mortality.
The most significant element of QAP’s legacy is the project’s adaptation and widespread application of the Institute for Healthcare Improvement collaborative model in USAID-assisted countries. Through introduction of 36 collaboratives in 14 developing and middle-income countries, QAP helped Ministries of Health achieve large-scale improvements in compliance with health care standards and outcomes in diverse care areas, including essential obstetric and newborn care, prevention of mother-to-child transmission of HIV, AIDS treatment and care, pediatric hospital care, and tuberculosis treatment.
Data from countries such as Niger, Ecuador, Honduras, Nicaragua, Tanzania, Rwanda, Uganda, Vietnam, and Russia showed that the collaborative approach was highly effective in improving the quality of care: Compliance with standards generally attained levels of 80% or higher within 8–18 months of teams’ working on making improvements. Recent evaluative research offers compelling evidence that improvement collaboratives are linked to significant health care improvements in developing country settings and can be effective in spreading improvements to large portions of a health care system.