USAID Health Care Improvement Project (HCI)

Member profile

The USAID-funded Health Care Improvement Project (HCI) collaborates with local health systems, in order to apply improvement approaches that enhance health care in more than 30 countries within Africa, Asia, Europe and Latin America. The objective of the project is to capacitate health systems, in order to strengthen outcomes by applying improvement approaches to increase the quality and efficiency of health care; to expand coverage of services; and to improve health worker management, capacity, productivity, performance, and retention. HCI provides technical assistance, research and evaluation, knowledge management and technical leadership to support and institutionalize locally-driven improvement strategies and solutions for community-based services, facility-level care, human resources for health (HRH), and services for vulnerable children. The project is managed by University Research Co., LLC (URC), in partnership with EnCompass LLC, Family Health International (FHI), Health Research Inc., Initiatives Inc., The Institute for Healthcare Improvement (IHI) and Johns Hopkins University Center for Communication Programs (JHU CCP). HCI builds on the successes of the USAID-funded Quality Assurance Project (1990 – 2007).

Main activities

HCI strengthens health systems and improves the quality of care and health outcomes by providing technical support for HRH and community health worker (CHW) improvement projects that strengthen HRH management, performance and retention (e.g.,in Niger, Tanzania, Ethiopia, Zambia, and Mali). HCI also encourages stakeholders to apply innovative tools for Community Health Worker program functionality assessment and improvement (see the CHW Assessment and Improvement Matrix, CHW AIM, available at

HCI undertakes innovative research to develop and implement workable solutions that assess health workforce management and performance gaps (e.g., operational research on improving CHW programs, employee engagement and performance, CHW productivity, task-shifting, expert patients, and in-service training). The project has also developed CHW Central, a new online technical hub for resources, networking, the sharing of experiences, virtual learning and discussion on community health workers..

Links to the health workforce crisis

Human resources management is oftentimes top-down in approach, which does not adequately engage health workers and managers and may not always be successful in improving service delivery. In collaboration with Ministries of Health and health managers and workers, HCI has developed an innovative team-based approach to institute viable performance management systems. The approach supports health workers and managers to identify, test and implement their own solutions and quality improvement strategies to resolve HRH problems. This has resulted in improvements in both the quality and efficiency of care and has led to better health outcomes in maternal and newborn care and HIV services. Much attention has also been directed towards the development and utilization of community health workers that provide basic health services. HCI’s CHW AIM toolkit supports CHW program implementers to systematically assess program functionality and undertake action planning that addresses weaknesses.

There is growing evidence to support the development of HRH policies; however, there exists uncertainty regarding the extent to which HRH interventions and strategies impact health worker performance, retention, and outcomes. Studies designed and conducted by HCI, in collaboration with local partners, seek to answer the following questions:

  • What is the impact of HR management interventions on health worker performance and health outcomes?
  • What is the impact of CHW program improvements on performance, engagement, and sustainability?
  • What factors affect CHW productivity, and how can it be modelled?
  • What defines health worker engagement, and does it predict performance and retention?
  • How can in-service training be improved in order to become more effective, efficient, and sustainable?
  • What are the perceptions and experiences of stakeholders towards shifting self-management and HIV counselling roles to expert patients, and how can expert patients be more effectively integrated into the provision of HIV services?