USAID Health Care Improvement Project (HCI) | Nicaragua


HCI supports the Ministry of Health (MOH) in institutionalizing effective monitoring and improvement activities in essential obstetric and newborn care, the management of obstetrical complications, infection prevention and control, and family planning services. In addition, the project is helping the MOH improve the quality of HIV prevention, counseling, and testing services among high-risk populations and the quality of antiretroviral therapy for people with HIV. Efforts also focus on improving hospital case management of severely ill children.

Read more about the HCI Project.

Key Activities

  • Support the application of collaborative improvement to improve the management of obstetric and neonatal complications in eight health regions
  • Support the spread of best practices in infection prevention and control to 12 hospitals to reduce incidence and case fatality of catheter line-associated blood stream infections and ventilator-associated pneumonia
  • Provide technical assistance to health centers to improve the quality of HIV counseling and testing and the treatment of sexually transmitted diseases, including support to reduce HIV-related stigma and discrimination
  • Assist hospitals and health centers in improving care and treatment for HIV-positive patients in order to increase coverage of eligible patients with antiretroviral therapy and improve clinical outcomes
  • Support the four hospitals in the country with the highest case fatality rates for pneumonia to reduce mortality among severely ill children under five
  • Support MOH facilities, health training institutions, private health care clinics financed by the Nicaraguan Social Security Institute, and nongovernmental organizations to improve the quality of post-obstetric event family planning services
  • Help expand HIV counseling and testing among TB patients in seven regions
  • Introduce Kangaroo Care for premature newborns in a pilot hospital
  • Transfer of Family Planning management tools to the Ministry of Health.


  • At hospitals participating in a collaborative, the rate of perinatal asphyxia fell from 0.8% in January 2009 to 0.23% in Feb 2011 and has stabilized at that rate.
  • In nine maternal and child  health hospitals, the postpartum hemorrhage rate declined from 1.4% in January 2009 to 0.6% in January 2011
  • In 35 health facilities, HIV voluntary counseling and testing for patients with sexually transmitted infections increased from 17% for counseling and 9.6% for testing in May 2008 to 61% and 42%, respectively, in March 2010.
  • Condom use after an obstetric event rose from 6% in January 2009 to 15% in February 2010.
  • From October 2011 to May 2012, in four health units in three SILAIS, the number of people on Antiretroviral Therapy (ART) increased by 97%, attendance to ART treatments increased by 89%, and the clinical status of ART patients increased by 116%.
  • Completion of MNCH, Family Planning, and HIV teaching packages in order to develop competencies in health service providers and training institutions.
2007 to 2014
US Agency for International Development (USAID)
Regions/ Countries 
Geographic Scope 
All 17 health regions in the country