USAID ASSIST is focused on improving outcomes by strengthening the delivery of the following services:

• HIV and AIDS prevention, care, and treatment

• Maternal, newborn, and child health (MNCH)

• Non-communicable diseases and chronic conditions care

• Nutrition assessment, counseling and support to improve adherence and retention in care

• Care and support for vulnerable children and families

• Reproductive health and family planning

• Malaria, tuberculosis (TB), and other infectious diseases

The project also works to strengthen the performance of the health workforce as well as community-based services and community linkages with facility-based care.

In addition to supporting the implemen-tation of service delivery improvement strategies, the project seeks to generate new learning to increase the effectiveness and efficiency of applying improvement methods in low- and middle-income coun-tries through research, evaluation, and knowledge management activities. ASSIST currently has 33 research and evaluation studies underway in 13 countries.

USAID ASSIST PROJECT: STRENGTHENING HEALTH SYSTEMS FOR BETTER OUTCOMES

DECEMBER 2015

The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is made possible by the support of the American people through USAID’s Bureau for Global Health, Office of Health Systems. The USAID ASSIST Project is managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC’s global partners for USAID ASSIST include: EnCompass LLC; FHI 360; Harvard University School of Public Health; HEALTHQUAL International; Initiatives Inc.; Institute for Healthcare Improvement; Johns Hopkins Center for Communication Programs; WI-HER LLC; and the World Health Organization (WHO) Service Delivery and Safety Department. For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or contact assist-info@urc-chs.com.

What is USAID ASSIST?

T he USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is a five-year

project of the Office of Health Systems of the USAID Global Health Bureau designed to achieve measurable improvements in health care and social services in USAID-assisted countries.

The project supports the application of modern improvement methods by health care and social service providers at facility and community levels, by managers in both government and non-governmental orga-nizations, and by U.S. Government (USG) implementing partners. USAID ASSIST achieves sustainable results by building the capacity of host country systems to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the services they provide.

USAID ASSIST country programs are designed with host-country leadership at the forefront to ensure context appropri-ateness, local ownership, and alignment with USAID goals for Ending Preventable Child and Maternal Deaths and Achieving an AIDS-Free Generation. The project focuses on improving the effective implementation of high-impact interven-tions, taking into consideration the needs of marginalized and underserved populations and gender, age, and social differences that affect access to and utilization of care.

An auxiliary nurse-midwife and community health worker in India greet a mother who had chosen to deliver her baby at Chowlibasa Primary Health Center in Jharkhand, India. ASSIST supported this rural facility to find ways to improve the care provided, making sure they gave more complete counselling and ensuring they followed evidence-based guidelines as well as re-arranging the clinic for better lighting and privacy. As a result, the number of women delivering in the clinic increased five-fold. Photo by Simon Hiltebeitel, URC.continued on page 4

2 USAID Applying Science to Strengthen and Improve Systems Project

Botswana: ASSIST is working with district-level Ministry of Health (MOH) staff and other PEPFAR implementing partners to facilitate the engagement and linkage of existing community structures with the formal health system to increase retention in care of HIV-positive patients.

Burundi: The project is working with the MOH to improve the uptake of prevention of mother-to-child transmission (PMTCT) services for mothers, their partners, and their infants and to improve quality of care and retention of mothers and infants along the PMTCT cas-cade, including community-level support. The project is also build-ing the capacity of the National AIDS Control Program to monitor and evaluate the quality of PMTCT services nationally.

Cambodia: ASSIST is advising the MOH and the five health profes-sions councils that regulate doctors, dentists, pharmacists, nurses, and midwives on the development of a new law on regulation of health practitioners and supporting the councils to prepare for en-actment of the new legislation. The project is supporting the councils to design and test a harmonized system for registration and to es-tablish accountable business models to ensure the financial sustain-ability of the registration process.

Cote d’Ivoire: ASSIST is providing technical support to PEPFAR implementing partners to improve their capacity to support the MOH in delivering high quality HIV care and treatment services throughout the country. ASSIST is also helping to strengthen the leadership, management, and planning capacity of the MOH quality improve-ment unit and to develop a national quality policy. In addition, ASSIST is working to establish a quality improvement system in the country’s four university hospitals.

Democratic Republic of Congo: ASSIST is supporting the MOH to improve PMTCT services and retention in care for people living with HIV (PLHIV) in collaboration with other implementing partners. ASSIST is also strengthening the improvement capacity of national, provincial, and health zone managers to address technical and health systems gaps.

India: The project is working with key actors in the Indian health system at the community, facility, district, state and national levels to lead health care improvement activities focused on the reproductive health-MNCH-adolescent continuum in all USAID priority districts. Now in its final phase, the project is supporting all priority districts to scale up improvement activities and is advising new districts as well as institutions like the All India Institute of Medical Sciences on quality improvement strategies.

Indonesia: In partnership with the Universitas Indonesia Center for Family Welfare, the project is evaluating the quality of care provided in hospitals undergoing Joint Commission International (JCI) and Indonesian Hospital Commission (KARS) accreditation.

Jordan: In collaboration with the MOH and WHO, ASSIST is con-ducting a rapid assessment of prevention, screening, and care practices for clinical conditions contributing to the highest disease burden and premature mortality.

Kenya: ASSIST is supporting the MOH, the Ministry of Labor, Social Security and Services, the National AIDS and STI Control Program, USG implementing partners, and county governments to design and implement strategies that will enhance the quality of service deliv-ery in the health sector, including: MNCH and reproductive health services to reduce maternal and neonatal deaths; malaria case

USAID ASSIST Country Programs in FY16

Current USAID ASSIST Field Activities

LAC Virtual Collaborative on Newborn Sepsis

NicaraguaMali

South Africa

Cote d’Ivoire

Botswana

Zambia

Kenya

Democratic Rep. of Congo

BurundiTanzania

Swaziland

Malawi

Lesotho

UgandaIndia

Jordan

Cambodia

Indonesia

Maternal and Child Health

HIV/AIDS (including OVC)

Family Planning

Tuberculosis

Health Workforce and Community Health

Nutrition (including WASH)

NamibiaMozambique

West Bank

3USAID Applying Science to Strengthen and Improve Systems Project

management; HIV care and treatment; and child protection and care of orphans and vulnerable children (OVC). The project also supports the implementation of the Partnership for HIV-Free Survival (PHFS) in Kenya and is working with four medical training institutions to build the competencies of health professionals in improvement.

Latin American Virtual Collaborative on Newborn Sepsis: In part-nership with the LAC Newborn Health Alliance, the Pan American Health Organization, UNICEF, and the Mesoamerican 2015 Initiative, ASSIST is providing web-based technical support to hospitals in five countries in the region as part of a virtual improvement collabora-tive aimed at reducing cases of newborn sepsis by implementing evidence-based practices.

Lesotho: The project is supporting the Ministry of Health in the de-velopment of a national strategy to improve the quality of HIV and AIDS services and is providing intensive support to sites in high-burden districts to eliminate new infections among children, reduce HIV-related maternal deaths, and increase ART coverage and patient self-management of HIV as a chronic condition. ASSIST is also sup-porting district health management teams in “sustained response” districts to oversee and monitor the quality of services for PLHIV. With Harvard University School of Public Health, ASSIST is conduct-ing a study of HIV community cadres and how they can be harmo-nized with national community health worker (CHW) programs.

Malawi: ASSIST is building the capacity of the Ministry of Gender, Children, Disability, and Social Welfare, districts, and USAID partners to implement national standards to improve OVC services. In par-ticular, the project is building the capacity of District Social Welfare Officers to promote coordination, transparency, cost efficiency, and sustainability in OVC programing. The project is also supporting the MOH to improve the quality and safety of voluntary medical male circumcision (VMMC) services. ASSIST is also working with selected facilities to improve the correct diagnosis and management of febrile illnesses in pregnant women and children.

Mali: The project is working with the MOH to apply improvement methods at the health facility and community levels to improve the quality of essential obstetric and newborn care and post-partum family planning services in two regions and supporting the MOH to improve anemia prevention and control activities. In collaboration with the MOH and WHO, ASSIST is supporting testing of the Safe Childbirth Checklist and promoting patient-centered maternal and newborn care.

Mozambique: ASSIST, with Harvard University School of Public Health, is conducting a study of HIV community cadres and how they can be harmonized with national CHW programs.

Namibia: ASSIST is working with the Ministry of Health and Social Services, private providers, and PEPFAR implementing partners to improve the quality of VMMC services, infection prevention and control practices, HIV counseling and testing, and HIV care and treatment.

Nicaragua: The project is supporting the institutionalization of im-provement methods in pre-service training about HIV prevention and care in medical and nursing schools in Nicaragua, including the development of virtual diploma courses on research methodology, quality management, and HIV combination prevention and care. ASSIST is also supporting six NGOs serving populations of sexual diversity and people with HIV to implement quality management programs.

South Africa: The project works with the Department of Health at all levels, providing technical assistance to build capacity at national and provincial levels in strategic planning, supervision, program review, training, and mentorship in HIV prevention and treatment. ASSIST is directly supporting sites and implementing partners to in-tegrate continuous quality improvement (CQI) in VMMC programs. In coordination with WHO, ASSIST is also piloting a model for people-centered, integrated health services. The project is conducting a study of HIV community cadres and a second study on point-of-care HIV testing and counseling.

Swaziland: The project is supporting the MOH to strengthen the National Sample Transport System, improve laboratory-related care and treatment monitoring, and injection safety and waste manage-ment to reduce the transmission of blood-borne infections. ASSIST is also carrying out research to evaluate the sensitivity of the national TB screening algorithm in pregnant women and to validate the CHW performance logic model for community cadres supporting HIV and TB services.

Tanzania: The project supports the Ministry of Health and Social Welfare (MOHSW) and PEPFAR implementing partners to apply im-provement methods to increase the effectiveness of PMTCT, ART, VMMC, vulnerable children services and child protection, and com-munity-based services and linkages to promote ART adherence and retention in care, with a focus on high-volume facilities. ASSIST is collaborating on PHFS activities to eliminate HIV infection in children and reduce deaths among HIV-infected mothers in three districts, supporting the national scale-up of PMTCT Option B+, and support-ing the MOHSW to improve access to HIV testing and linkage to care for children under 15 years of age. ASSIST is also supporting the MOHSW to improve the integration of PMTCT in MNCH service delivery points.

Uganda: ASSIST is supporting the MOH, district management teams, implementing partners, and health facilities to improve the HIV continuum of response, improve the quality of VMMC services, improve TB care, and implement the PHFS initiative. ASSIST is pro-viding direct support for improving HIV and family health services to sites in Northern Uganda and supporting the implementation of the Saving Mothers Giving Life (SMGL) initiative in six districts in Northern Uganda. The project also provides above-site technical assistance to the MOH, Ministry of Gender, Labor and Social Development, and implementing partners to apply quality improvement methods to the prevention of HIV, care and treatment for PLHIV, MNCH, nutrition, TB services, and OVC services. In addition, the project is supporting a demonstration collaborative to improve the quality of antenatal care and management of pre-eclampsia and the pilot of an integrated management of newborn and child illness intervention in outpatient settings.

West Bank/Gaza: In collaboration with the MOH and WHO, ASSIST is conducting a rapid assessment of prevention, screening, and care practices for clinical conditions contributing to the highest disease burden and premature mortality.

Zambia: The project is working with the Ministry of Health and other implementing partners to integrate nutrition services into HIV care to improve health outcomes of HIV clients and increase their retention in care

USAID Applying Science to Strengthen and Improve Systems

Unfiversfity Research Co., LLC, 5404 Wfisconsfin Ave., Chevy Chase, MD 20815-4811 USA

TEL 301-654-8338 • FAX 301-941-8427 • www.usaidassist.org • assist-info@urc-chs.com

What Is Improvement Science?

The science underlying modern improvement in health care is grounded in a systems understand-

ing of work and draws on psychology, organizational behavior, adult learning, and statistical analysis of variation. The fundamental concept underlying all improvement is that, “Every system is perfectly designed to achieve exactly the results it achieves” (Paul Batalden).

Improvement requires change in the way we do work, though not every change is an improvement. The following core principles underlie improvement:

• The work of delivering health care happens in processes and systems. Understanding them and changing them in ways to produce better results is at the heart of improving health care.

• Working in teams of different providers involved in delivering care is key to making changes work and fostering ownership of the changes to enhance sustainability.

• Testing changes to determine whether they yield the desired results is at the heart of improvement. Data are used to analyze processes, identify problems, determine whether the changes have resulted in improvement, and act accordingly.

• Care should meet the needs and expectations of clients, patients, and communities.

• Shared learning, where multiple teams work on common aims and exchange what worked, what did not, how it worked, and why, is an essential part of improvement, producing better results in a shorter period of time than teams working in isolation from each other.

USAID ASSIST builds the capacity of host country implementers to apply the sci-ence of improvement to health care and other services for vulnerable populations, to ensure that high-impact interventions reach every patient or client, every time, and improve outcomes.

USAID ASSIST Services

Country programs developed under USAID ASSIST systematically address key questions related

to the evidence base for achieving improvements in the focus area of the work and the implementation strategy for the work planned. This deliberate design of country improvement programs under USAID ASSIST also addresses:

• How to create the conditions for sustaining results after the project’s support is completed;

• Scaling up the improvements in care to the rest of the health system;

• Building capability within host country institutions to be able to conduct other improvements without external assistance – making improvement a permanent, institutionalized part of delivering health services.

USAID ASSIST country improvement strategies also address the learning that will be accomplished through the work and how evaluation, research, and knowledge management activities will support the country program’s objectives.

How to Obtain Services of USAID ASSIST

The USAID ASSIST cooperative agreement is designed to provide a streamlined process for USAID

Missions, Offices, and Bureaus to obtain services in health systems improvement. USAID ASSIST services from URC and its pre-approved team of partners are ready to support country institutions in developing and executing improvement strategies and programs.

To access technical support through USAID ASSIST, contact the Agreement Officer’s Representative, Dr. James R. Heiby, Medical Officer, Office of Health Systems, Global Health Bureau, USAID/Washington.

Global Health eLearning Center course Improving Health Care, accessible at http://www.globalhealthlearning.org/course/improving-health-care-quality: This free course is the first of its kind to focus on quality improvement approaches and methodologies for low-resource set-tings. It is designed for anyone looking to understand how to improve health care, including health care workers and man-agers, government officials, donors, and implementing partners. It will help learn-ers to demystify health care improvement, describe its underlying principles, and ex-plain how proven interventions can be in-corporated into practice for every patient.

The course focuses on process improvement, drawing on a large body of evidence in USAID-supported countries.

USAID ASSIST Knowledge Portal, www.usaidassist.org: This hub for health care im-provement knowledge features tools, technical reports, and case studies related to im-proving HIV, MNCH, family planning, OVC, community health, and nutrition services as well as health workforce development and gender integration in low- and middle-income countries.

Improvement Resources