USAID Health Care Improvement Project (HCI) | Bolivia


With field support from USAID/Bolivia, URC supported the Ministry of Health to scale up best practices in tuberculosis (TB) diagnosis, case management, and Directly Observed Treatment Short course (DOTS) in urban health networks. The project worked to increase the detection of new TB cases, improve the quality and coverage of TB control activities, and improve laboratory support to the TB program.

Read more about the HCI project or visit the USAID ASSIST Project website.

Key Activities

  • Supported facility-level quality improvement teams to monitor TB program quality indicators and introduce improvement activities through Plan-Do-Study-Act cycles
  • Assisted teams in planning and carrying out community-based activities to engage patients and their families in the prevention, detection, and treatment of new TB cases
  • Developed the capacity of the health management teams to provide coaching support to the facility-level teams
  • Assisted the National TB Program to document and disseminate best practices and develop training materials and tools to support the spread of these practices to other regions
  • Trained health care professionals in TB detection and management using a CD-ROM training  and distance-learning modules developed by HCI and National TB Control Program (PNCT)


El Alto

  • Pulmonary TB patients cured per month at 47 participating facilities increased from 74% in February 2009 to close to 90% in September 2009
  • “Bad quality” sputum samples, unusable by laboratories, at 42 participating facilities declined from 42% in February 2009 to 24% in December 2009
  • DOTS boxes, designed to ensure availability of TB drugs and reduce stock-outs, put into use at all facilities


  • A new wave of improvements focused on improving the availability of TB drugs using “DOTS boxes” and other interventions were started at the second spread learning session. Forty QI teams designed a PDSA cycle to be implemented during July and August.
  • The spread of improvements resulted in a decline in “bad quality” sputum samples, unusable by laboratories, from 44% in February 2011 to 5% in May 2011


2008 to 2012
US Agency for International Development (USAID)
Bolivia Ministry of Health
Regions/ Countries 
Geographic Scope 
City of El Alto (La Paz Province), the city of Cochabamba (Cochabamba Province) and Central Ministry of Health Tuberculosis Program