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Client: United States Agency for International Development (USAID)
 The USAID Health Care Improvement Project builds on URC’s technical leadership of USAID’s global efforts to improve health care quality since 1990 through the Quality Assurance Project (QAP) I, II, and III. The five-year project, which was awarded on September 24, 2007, supports the USAID Global Health Bureau and country missions to address significant challenges in raising the quality of health care in developing and middle income countries. The contract’s task order mechanism allows USAID country missions and other U.S. Government agencies to issue separate task orders within the HCI mandate. The first task order, effective September 28, 2007, covers three years and the transition of field and centrally funded work from QAP.
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| Job Aids developed by HCI held community nurses like this one in Niger talk with mothers about infant feeding. |
The goal of the HCI Project is to improve quality and outcomes of health care in developing countries by adapting and applying modern methods of quality improvement (QI). The project is guided by a vision that health care quality can be significantly improved by applying proven QI approaches to curative, preventive, and chronic care.
Priority areas include scaling up evidence-based interventions and improving outcomes in child health, maternal and newborn care, HIV/AIDS, tuberculosis, malaria, and reproductive health. Other significant goals are expanding coverage with essential services; making services better meet the needs of underserved populations, especially women; improving efficiency and reducing the costs of poor quality; and improving health worker capacity, motivation, and retention. The project’s objectives are to:
- Document interventions implemented to improve the quality of health care, how quality is measured, and the impact of the interventions.
- Institutionalize modern quality improvement approaches as an integral part of health care in USAID-assisted countries.
- Expand the evidence base for the application of QI to human resources (HR) planning and management.
- Expand experience with the improvement collaborative approach in USAID-assisted countries.
- Expand experience with the spread collaborative approach in USAID-assisted countries.
- Expand the experience base for other specific QI approaches.
- Improve the cost-effectiveness of QI in USAID-assisted countries.
- Provide global technical leadership for QI in USAID-assisted countries.
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Roleplay of a hospital birth in Ecuador. HCI supports activities to increase institutional delivery by engaging health providers and community members in dialogue about safe and culturally appropriate birthing practices. |
The USAID Health Care Improvement Project is committed to sustaining and expanding the implementation of QI methodologies and tools throughout the developing world. A three-pronged strategy is being employed to improve the effectiveness of QI through effective use of (1) technical assistance to build capacity for quality improvement; (2) research and evaluation studies of QI applications; and (3) global dissemination and use of improvement knowledge generated by QI teams. The project provides technical services and support in the following areas:
- Institutionalization. The role of the HCI Project is to transfer capacity to host country providers to adapt modern QI approaches to their settings to improve health care. At the same time, the project seeks to strengthen human resource management and other systems needed to support the delivery of high quality services, including effective policy and management level support for continuous quality improvement and incentives for providers and teams to carry out improvement work.
- Collaboratives. HCI is expanding the use of the improvement collaborative approach in developing and middle income countries worldwide. URC has pioneered use of the approach in developing countries, having established 35 collaboratives in 13 countries since 2000. HCI is continuing to adapt the collaborative model to local needs and to actively develop collaboratives in specific topics where better improvement strategies are urgently needed. The project is implementing spread collaboratives to extend improved practices to new geographical and organizational areas.
- Human Resources Planning and Management. One of the major objectives is to expand the evidence base for the application of QI approaches to human resources (HR) planning and management. HCI will conduct research, technical assistance, and pilot-level demonstrations related to effective human resource and workforce development interventions, such as task shifting, use of job aids and other performance technology, alternative capacity-building strategies, supportive supervision, and strengthening district management.
- Other QI Approaches. The project's scope of work encompasses a wide range of modern quality improvement approaches to improving health care. In addition to improvement collaboratives, HCI supports application and testing of other QI tools and methods, including self and peer assessment, pay for performance and other provider incentives, medical audits, accreditation, and other regulatory approaches.
- Research and Evaluation. HCI is developing an evidence base that allows health care providers to replicate successful quality improvement interventions in developing country settings. The project will document QI and workforce interventions, methodologies, and tools and provide quantitative measurements of their impact. Both formal research studies and research undertaken in the context of continuous monitoring and evaluation of country programs contribute to this evidence base.
- Knowledge Management. HCI is developing a knowledge management system that links QI teams, country-level authorities and managers of QI initiatives to the global community. The system will provide web-based access to improvement results, narrative descriptions of the improvement interventions, and lessons learned by improvement teams across the world to stimulate expansion, replication, and learning within and across countries. In addition, the system will facilitate the efforts of collaboratives to rapidly diffuse improvement knowledge among teams to enable them to learn from each other’s successes and failures, harvest good ideas, and quickly apply them.
- Global Technical Leadership. HCI provides leadership for USAID's global program to improve health care in assisted countries and supports quality-related initiatives by other USAID partners, international agencies, regional health organizations, and national institutions with objectives related to health care improvement.
The HCI team includes the following subcontractors:
- Center for Communication Programs (CCP) of the Johns Hopkins University Bloomberg School of Public Health in Baltimore, MD, implements strategic communication programs and conducts research to enhance access to information and facilitate the exchange of knowledge to improve health and health care.
- ENCOMPASS,LLC, a Bethesda, MD-based firm that worked closely with URC on the Quality Assurance Project, making important technical contributions to the evaluation and documentation of improvement collaboratives.
- Family Health International (FHI), a nonprofit organization that manages research and field activities in HIV/AIDS and reproductive health in more than 70 countries.
- Initiatives Inc., a Boston, MA-based firm which specializes in human resources management and quality and performance improvement.
- Management Systems International (MSI), a firm based in Washington, DC, with expertise in large-scale organizational change through scale-up, monitoring and evaluation, and incorporating gender considerations into management and development programs.
HCI also collaborates with leading technical organizations to implement specific field activities:
• BroadReach Healthcare
• Harvard School of Public Health (HSPH)
• The Institute for Healthcare Improvement (IHI)
• Joint Commission International (JCI)
• MAXIMUS
• The New York State AIDS Institute (NYSAI)
• Singapore Health Services Pte. Ltd. (SingHealth)
Countries with current HCI activities:
- Africa: Benin, Cote d’Ivoire, Lesotho, Niger, South Africa, Swaziland, Tanzania, and Uganda
- Asia: India and Vietnam
- Eastern Europe: Russia
- Latin America and the Caribbean: Bolivia, Ecuador, Honduras, and Nicaragua
The new USAID HCI Project builds on the extensive body of work of the Quality Assurance Project, also funded by USAID. The QAP website contains a large number of reports related to health care quality improvement interventions in specific countries, operations research, and QI methods and issues. These documents may be accessed at http://www.qaproject.org/products.html.
For more information on the USAID Health Care Improvement Project, contact Dr. Lynne Franco, HCI IQC Manager, at lfranco@urc-chs.com.
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