USAID Health Care Improvement Project (HCI) | Afghanistan


With funding from USAID/Afghanistan, URC worked with the Ministry of Public Health (MOPH) to improve the quality of health services by adapting and institutionalizing the science of improvement to health care delivery in Afghanistan. The project supported the MOPH to advance the quality of obstetric care and outcomes for pregnant women through improvement collaboratives. 

Key Activities

  • Implemented quality improvement collaboratives at hospital, health facility, and community levels to support hospitals and health centers in reducing maternal and newborn mortality by improving the quality of antenatal care, labor monitoring, institutional delivery, and essential newborn care;
  • Supported the revision of the existing Medical Records Package for maternity hospitals and develop a Patient Master Index to measure the performance of maternity hospitals;
  • Implemented the Post Partum Family Planning Improvement Collaborative at Kabul maternity hospitals;
  • Improved prevention and management of birth asphyxia;
  • Worked with health posts to introduce evidence-based interventions at the community level to increase birth preparedness, exclusive breastfeeding, and appropriate care-seeking for maternal and newborn complications;
  • Supported the MOPH at the central level in building capacity in the science of improvement and in developing strategies to improve the quality of health care services nationwide.


Afghanistan’s first-ever National Strategy for Improving Quality in Health Care has been developed by the MOPH with HCI support. The Improving Quality in Health Care (IQHC) Strategy has been approved by the Consultative Group on Health and Nutrition (CGHN) and the MOPH Technical Advisory Group. The IQHC strategy has been presented to Executive Board for approval. It will introduce priorities and interventions to improve the quality of care for the next five years and will likely lead the way thereafter. The strategy was developed through a process that began locally, drew on international support, and was guided by international experience with modern approaches to improving health care quality.

HCI revised the Medical Records Package and developed an electronic Patient Master Index (registers, logbooks, and patient charts) in coordination with the MOPH Medical Records Committee; the index is ready, in mid-July 2011, to be piloted in three hospitals. The Medical Records Committee approved the package and index in June 2011. The index covers patient demographic and clinical information and supports the production of reports and analysis of data for different indicators for national- and hospital-level management. Improved medical records will support better understanding of the performance of maternity hospitals in preventing and treating maternal and newborn conditions and better decision making by the MOPH. After a successful pilot the package will be used countrywide in maternity hospitals.

Helping Babies Breathe (HBB) has conducted trainings on asphyxia for first-line providers in HCI-targeted provinces and has supplied newborn resuscitation and training materials, including 24 HBB mannequin sets, a translated participant’s book, wall charts, and pelvis models to 10 maternity hospitals.

Project work was presented at the International Forum on Quality and Safety in Healthcare in Amsterdam in 2011 [video].

2007 to 2014
US Agency for International Development (USAID)
Regions/ Countries 
Geographic Scope 
Balkh, Bamyan, Herat, Kabul, Kapisa, Kunduz, Logar, Panjshir, Parwan, Samangan, Saripul, and Wardak provinces.