URC’s Dr. David Nicholas with Ministry of Public Health officials in Niger. QAP operated in Niger from 1993-2007, fostering strong capacity for quality assurance at national and regional levels. Photo credit: URC

Quality Assurance Project (QAP)

The Challenge

Numerous studies and evaluations commissioned by USAID in low- and middle-income countries in the 1990s pointed to deficits in the quality of care for child survival and other basic health services.  While much progress had been made to apply quality assurance strategies to health care in the US and other developed economies, practical approaches to assessing and improving the quality of care in less-developed country programs were lacking.

Overview and Objectives

The Quality Assurance Project (QAP) I, II, and III supported USAID-assisted countries with the development, refinement, and institutionalization of practical approaches to improve the quality of basic health services. QAP I, implemented from September 1990 – March 1997, sought to develop, refine, and institutionalize practical approaches to assessing the quality of care provided in large-scale, less-developed country programs that deliver child survival and other basic health services.  QAP I provide long- and short-term technical assistance in 21 countries.

Based on positive reception to QAP I, USAID funded QAP II to establish sustainable quality assurance approaches in health, population, and nutrition services in 15-20 countries by conducting research and evaluation, global technical leadership, and support to USAID missions and other field-based organizations. QAP II provided technical assistance in 19 countries, demonstrating strong joint interest on the part of USAID Missions and Ministries of Health in institutionalizing quality assurance approaches.

QAP III followed, implemented from July 2002 through June 2007, serving 25 countries with long- and short-term technical support for the development of institutionalized QA programs and the application of a full range of modern QA methodologies.


QAP transformed the practice of health care quality assurance (QA) in USAID-assisted countries through the development of a large number of methodological guides, tools, and training materials and technical assistance to country institutions and implementing partners. The projects supported the implementation of diverse QA approaches, including team-based problem-solving, accreditation, clinical guidelines, computer-based training, job aids, coaching, supportive supervision, performance improvement, workforce development, and quality design. The projects also implemented operations research to evaluate QA approaches and supported numerous countries to develop national QA programs and policies.

Keeping abreast of the state-of-the-art of health care quality approaches being applied in the US and other developed countries, QAP III began testing the collaborative improvement approach developed by the Institute for Healthcare Improvement and adapting it to the context of low- and middle-income countries.  Through a series of evaluations, QAP III generated strong evidence for the effectiveness of collaborative improvement in measurably improving services on a large scale in a wide array of health care areas. This groundwork set the stage for wide-spread application of collaborative improvement under the subsequent global USAID Health Care Improvement Project.


Bangladesh, Benin, Bolivia, Cambodia, Chile, Costa Rica, Ecuador, Egypt, Eritrea, Eswatini, Guatemala, Honduras, Indonesia, Jamaica, Jordan, Kenya, Lesotho, Malawi, Mexico, Morocco, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Peru, Philippines, Poland, Russia, Rwanda, South Africa, Tanzania, Thailand, Trinidad and Tobago, Uganda, Vietnam, Zambia, Zimbabwe

Africa, Asia, Eurasia, Latin America and the Caribbean, Middle East

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


Academy for Educational Development (AED), EnCompass, Initiatives, John Snow, Inc. (JSI), Johns Hopkins University, Joint Commission International (JCI)