Health worker in Uganda shows a flip chart used in counseling TB patients. Photo credit: URC

USAID ASSIST Project – 25 Essential Resources for Health Care Quality Improvement

From 2012-2020, the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project worked in over 40 countries, building the capacity of service delivery organizations and implementing partners to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the health and social services provided. As URC’s parting contribution, we offer this curated collection of 25 quality improvement (QI) resources from ASSIST that capture key learning from our work that we hope will inform yours.


  1. A Promising Approach to Scale Up Improvements in Low- and Middle-Income Countries: The Wave-Sequence Spread Approach and the Concept of the Slice of a System
    This article, published on F1000Research, describes the wave-sequence approach, which enables effective improvement interventions to spread or scale-up in a systematic and sequential way by using “spread agents” — people who participated in the original demonstration sites.
  2. Effective Leadership for Quality Improvement in Health Care: A Practical Guide  ( English | French )
    This guide is for those who lead (or want to lead) quality improvement activities from design to post-implementation. Oriented to leaders of all levels, it builds on existing leadership and quality improvement frameworks.
  3. Evaluating Complex Health Interventions: A Guide to Rigorous Research Designs
    Provides a framework to guide decision-making around appropriate designs to evaluate public health and other service interventions, including quality improvement. The guide is aimed at implementors who are involved in evaluation but may not be evaluators.
  4. Guide for Developing Sustainability and Transition Plans – Version 2.0
    Created for USAID ASSIST Project teams to outline factors to consider in meetings with in-country stakeholders when developing plans to fully transition activities to local control and to sustain achievements beyond the project’s end. An illustrative example of a country sustainability plan is provided.
  5. Guide to Integrating Gender in Improvement
    Describes gender and gender integration, details how to integrate gender in improvement activities, encourages additional areas for consideration, provides resources that improvement teams can use to integrate gender, and lists resources to learn more.
  6. Health Facility Guide for Assessing Treatment of Febrile Illness
    Guidance for facility quality improvement teams to assess the quality of care processes to diagnose and treat common illnesses that present with fever, focusing on populations with the greater burden of illness and mortality for febrile illness, children under five and pregnant women.
  7. Improving Care of Mothers and Babies: A Guide for Improvement Teams  ( English-Africa | English-Asia | Spanish | French )
    Describes a simple six-step approach through which health care providers and improvement teams can plan, test, implement, continuously assess, refine, and sustain interventions to improve care of mothers and babies. There are two versions of the guide available in English – one developed for Africa and another for use in Asia – as well as a version in French and in Spanish.
  8. Improving Quality of Basic Newborn Resuscitation in Low-resource Settings: A Framework for Managers and Skilled Birth Attendants
    Highlights common health system and quality of care gaps impeding provision of life-saving basic newborn resuscitation services in low-resource settings and describes how quality improvement and health system strengthening approaches can help overcome these gaps.
  9. Improving Quality of Post-Partum Family Planning in Low-Resource Settings
    Designed to help managers and care providers understand common challenges in post-partum family planning service delivery. The framework offers specific solutions that may help to close these gaps using improvement methods that have proven effective and cost-effective in other settings.
  10. Point of Care Quality Improvement (POCQI): Coaching for Quality Improvement
    A guide for those who want to learn how to coach point of care quality improvement teams that provides an introduction to team coaching, oriented towards the initial practical needs of coaches, along with case scenarios to introduce and address common challenges new coaches face.
  11. Point of Care Quality Improvement (POCQI): Setting Up and Managing a Quality Improvement Program at District Level
    A guide for those who want to design and manage a large-scale quality improvement program at the district level.
  12. Supporting Most Vulnerable Children in Accessing HIV and Social Services in Tanzania through Community Quality Improvement Activities
    Describes the process undertaken to improve quality of services for vulnerable children in Tanzania and documents change ideas that improved access to HIV and social services among vulnerable children and strengthened facility and community linkages.
  13. Tips and Tools for Learning Improvement  ( English | Spanish )
    A set of competency-based materials that can be used by individuals or trainers to support targeted skill-building in key improvement competencies among health care providers, health care managers, ministry of health counterparts, and public health professionals who are new to improvement.
  14. Learning for Quality Improvement: Knowledge Management Approaches and Tools from the USAID ASSIST Project
    Describes knowledge management concepts, approaches, and tools to enhance the effectiveness and efficiency of health care improvement interventions, consolidating related content from the USAID ASSIST website.
  15. Improvement Methods Toolkit from the USAID ASSIST Project
    This document consolidates the main quality improvement methods and tools content from the USAID ASSIST website to provide guidance for the application of improvement methods to achieve measurable increases in service quality in USAID priority health topics.
  16. USAID ASSIST Project’s Approach to Improving Health Care in Low- and Middle-Income Countries
    Describes USAID ASSIST Project’s use of quality improvement principles and methods to produce sustainable results and results at scale, institutionalize improvement, and generate learning. It outlines the project’s Integrated Design Plan and its implementation.


  1. Assessment of Quality of Integrated Reproductive, Maternal, Newborn, Child and Adolescent Health and HIV Care in Uganda and Kenya  ( Report | Assessment Toolkit )
    Shares findings from a study conducted in Uganda and Kenya to assess the quality of reproductive, maternal, newborn, child and adolescent health care, and provides the data collection tools used.
  2. Empowering Community Groups to Support Access and Retention in HIV Care in Muheza, Tanzania
    Describes the application of the Community Health System Strengthening (CHSS) model to engaged community groups to support the work of home-based care volunteers and increase linkages between communities and health facilities to improve HIV prevention, treatment, and care.
  3. Improving Health Care in Low- and Middle-Income Countries: A Case Book
    Presents a collection of real-life case studies to show program managers, health professionals, and students how quality improvement approaches are applied in practice, providing on-the-ground examples from a range of health topics and geographic regions.
  4. Salzburg Global Seminar Session 565 “Better Health Care: How Do We Learn About Improvement?”
    This special supplement of the International Journal for Quality in Health Care captures and disseminates insights from this seminar, which sought to identify effective ways to learn about improvement and address questions of attribution, generalizability, and rigor.
  5. Lessons Learned from Applying Collaborative Improvement Methodologies to Strengthen the Performance and Productivity of HIV Human Resources
    Describes eight applications of collaborative improvement to address human resources for health (HRH) challenges and describes key lessons learned on increasing HIV health worker effectiveness, performance, and productivity.
  6. The Partnership for HIV-Free Survival (PHFS) Special Collection of AIDS Care
    This collection of eight papers, published in the Journal of the International Association of Providers of AIDS Care (JIAPAC), describes the results of the Partnership for HIV-Free Survival (PHFS), a six-country quality improvement initiative supported by USAID aimed at keeping HIV-positive pregnant and lactating women healthy and their exposed infants healthy, nourished, and HIV-free.
  7. Case Study Compendia  ( HIV and AIDS | Reproductive, Maternal, Newborn, and Child Health | Zika | Other Topics )
    This compendia of case studies, organized by technical area, describe improvement in action: how teams identified gaps, set aims, designed and tested changes, and measured results. The cases reflect on challenges faced, strategies to overcome those challenges, and lessons learned.


  1. Global Health eLearning Center Course “Improving Health Care Quality”
    This course introduces learners to principles and approaches that can help health care workers continually improve the work that they do. It introduces a wide range of methods to improve health care quality, focusing on process improvement.
  2. Improving Health Care eLearning Course
    English: online course | download LMS/SCORM course | training guides
    Spanish: online course | download LMS/SCORM course | training guides
    French:  online course | download LMS/SCORM course | training guides
    This interactive virtual course is structured to give a broad overview of the science of improvement, going over key principles and methods necessary to understand how improvement projects can be implemented in any setting to improve health care.