Quality Assurance Project (QAP) I, II, and III


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 Ecuador, Honduras, Jordan, Nicaragua, Niger, Russia, Rwanda, Tanzania, Uganda, and Vietnam show 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 implementing 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.

  • QAP demonstrated that in developing country settings the improvement collaborative approach can achieve significant results and public health impact in a short period. The project identified the essential elements and factors affecting the successful implementation of the approach, as well as mechanisms for facilitating sharing and rapid learning.
  • Through dozens of operations research studies, QAP documented numerous quality problems and approaches to their solutions. Findings were applied by QAP field programs to improve care in specific countries and were also disseminated to the wider public health community via presentations at international and regional conferences, over 100 research and technical reports, and over 25 articles in peer-reviewed journals, QAP publications.
  • Collaborated with the Jordanian government to design four model health centers to serve as examples of successful integration of primary care and maternal child services. In 1994, the project created the first center in Salt, Jordan, which demonstrated best practices in maternal and child health, family planning, and infection control.