For over 25 years, USAID has played a global leadership role developing and supporting quality improvement (QI) programs in low- and middle-income countries. We have transitioned from a quality assurance approach (monitoring compliance with standards) in the early 90s, to a systems strengthening approach in which we now focus on building host country capacity to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the health and family services they provide.  

Modern quality improvement methods

USAID uses a range of strategies to improve quality of care across the globe. These include training and supportive supervision, which are used widely and foster improvement through practical teaching and implementation of objective standards. Strategies such as accreditation, management techniques or incentives are discrete interventions, which aim to improve the quality of essential services through provider behavior.

To understand how and where different strategies are most suitable and where the main gaps are in the evidence quality of essential services, USAID commissioned the National Academies of Sciences, Engineering, and Medicine (formerly known as the Institute of Medicine) to convene a two-day workshop on January 28–29, 2015. The workshop focused on six methods that currently make up the majority of USAID’s investments in quality improvement:

1. Accreditation;
2. COPE®;
3. improvement collaborative;
4. standards-based management and recognition (SBM-R);
5. supervision; and
6. clinical in-service training.

The workshop considered how the different methods work to improve quality, when and where certain approaches might be most effective, and the best ways to measure success and shortcomings. Participants reflected on the state of the evidence, finding that training and supervision have positive effects on provider performance. The workshop identified research opportunities to advance the global quality improvement agenda through policy, practice, and research.

Find a full report on the workshop:
Institute of Medicine Workshop on Improving Quality of Care in Low- and Middle- Income Countries