USAID Health Care Improvement Project (HCI) | Niger


With USAID Office of Health research funding, URC collaborated with the Ministry of Health (MOH) to determine how improved care practices and quality improvement (QI) can be institutionalized within the routine operations of MOH facilities. With support from the President’s Emergency Funding for AIDS Relief (PEPFAR), the project also used the collaborative improvement approach to help the MOH address weaknesses in human resources, particularly in the areas of worker engagement, productivity, and retention. The health workforce performance improvement model tested in mid-2011 was scaled up to other provinces and applied in other high-HIV prevalence countries to help address health workforce shortages.

Key Activities

  • Assessed the institutionalization of (1) better care practices for essential obstetric and neonatal care and (2) QI;
  • Assessed baseline levels of key human resources (HR) management processes and worker engagement, productivity, and retention;
  • Assessed the effectiveness of strategies that the project had used to improve and/or maintain institutionalization;
  • Developed and introduced a change package based on the performance management cycle;
  • Worked with the MOH to build local management capacity to sustain improvements in (1) worker productivity and engagement and (2) the quality of maternal care; and
  • Supported the MOH to implement subsequent HR collaborative activities (QI teams, learning sessions, and coaching visits).


  • Compliance with standards for active management of the third stage of labor (AMTSL) at participating facilities increased from 5% to 98%, and the postpartum hemorrhage rate fell 92%, from 2.5% to 0.2%.
  • The percentage of health workers with job descriptions rose from 0% to 95% in 18 months.
  • Compliance with essential newborn care standards rose from 74% in January 2009 to 100% in July 2010.
  • Contraceptive prevalence among clients at sites participating in the HR collaborative rose from 11% in January 2009 to 23% in May 2010.
  • Based on pilot results, the MOH decided to incorporate the HR collaborative improvement strategies in its new five-year national health plan and to implement its performance management interventions countrywide.
  • HR improvement has been introduced at the central level in two key departments: Family Health and Human Resources.
  • The MOH supported scale up of the HR collaborative in two new regions: Maradi and Tillaberi.
2007 to 2013
US Agency for International Development (USAID)
Regions/ Countries 
Geographic Scope 
One of eight provinces