A Reproductive and Child Health Coordinator in Tanzania facilitates a mock village health committee meeting to prepare community representatives to be able to compare their data with facility date to identify gaps in community members receiving needed services. Photo credit: Rhea Bright

USAID Health Care Improvement Project (HCI)

The Challenge

Traditionally, global health efforts to save lives in low- and middle-income countries have focused on supporting selected, high-impact interventions by providing the required resources, such as training, drugs, and technical assistance. But in many countries, health system managers have limited knowledge about how well clinical and non-clinical processes for delivering these interventions are working and about how to improve them.

Overview and Objectives

Building on earlier projects and the experience of high-income countries, the USAID Health Care Improvement Project (HCI) directly examined how these neglected health care processes function and developed practical ways to help health workers and managers improve them.

HCI provided global technical leadership and expertise to improve health care delivery and health workforce capacity and performance in USAID-assisted countries. The project built the capacity of health systems to apply and institutionalize modern quality improvement approaches – particularly collaborative improvement – to strengthen facility- and community-based health services, human resources management, and services for vulnerable children and families.

The HCI statement of work also emphasized expanding the evidence base for cost-effective methods to improve the quality of health care through a large portfolio of HCI research and evaluation studies and knowledge management strategies to support the documentation and application of key learning from improvement activities.


HCI helped health workers and managers document the content and impact of improvement interventions so that effective ones could be replicated. The project developed and rolled out a series of tools to support documentation, analysis, and sharing of improvement team activities to improve care. Much of the project’s support for improvement in quality of care at the country level focused on support for facility and community teams to improve delivery of HIV services, including care and treatment for people with HIV, management of HIV/tuberculosis co-infection, services for orphans and other vulnerable children affected by HIV, and other services for people living with HIV, such as nutritional support and family planning. The second largest area of HCI assistance was supporting country efforts to improve maternal and newborn care.

Health workforce development and performance improvement activities also figured prominently in HCI country work, including strengthening the performance of community health workers. HCI used a combination of research and other tools – such as self- and peer-assessment – to expand the evidence base for and promote the application of interventions to strengthen health worker performance. The project received limited funding to support improvement of tuberculosis case detection and management, care for non-communicable diseases, and family planning, but also achieved important results in these areas.

During its seven years, HCI supported the design and implementation of 59 demonstration improvement collaboratives with over 1,000 improvement teams in 18 countries and 22 spread improvement collaboratives that sought to scale up (or “spread”) tested changes and better care practices that had been developed in a prior demonstration collaborative in the same setting.


Afghanistan, Albania, Armenia, Benin, Bolivia, Botswana, Burundi, Côte d'Ivoire, Ecuador, El Salvador, Eswatini, Ethiopia, Georgia, Guatemala, Haiti, Honduras, India, Indonesia, Kenya, Lesotho, Madagascar, Malawi, Mali, Mozambique, Namibia, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Russia, Senegal, South Africa, Tanzania, Uganda, Ukraine, Vietnam, Zambia

Africa, Asia, Eurasia, Latin America and the Caribbean

Community Health, Health Systems Strengthening, Health Workforce, HIV/AIDS, Infectious Diseases, Malaria, Maternal, Newborn, and Child Health, Noncommunicable Diseases, Nutrition, Quality Improvement, Reproductive Health and Family Planning, Tuberculosis, Vulnerable Populations


EnCompass, FHI 360, Harvard T.H. Chan School of Public Health, HEALTHQUAL, Initiatives, Institute for Healthcare Improvement (IHI), Johns Hopkins Center for Communication Programs