USAID/Moscow is funding the Quality Assurance Project (QAP), implemented by The Center for Human Services (CHS), to work in healthcare quality improvement in the Russian Federation. The activities are conducted under the umbrella of the US-Russia Joint Commission on Economic and Technological Cooperation, Access to Quality Health Care priority areas. Background: In 1997, Respiratory Distress Syndrome (RDS) in the Tver Oblast was the fourth disease by frequency of newborn morbidity and the first disease by early newborn mortality (accounting for 66 percent of premature newborn mortality). Sixty-seven percent of RDS was found to be associated with premature births, the majority of which were associated with Pregnancy-Induced Hypertension. In 1994, mortality of children with RDS was 13 percent, compared to 20 percent in 1997. One problem is that many newborns die prior to arrival at the hospitals because of inadequate care in maternity hospitals, during transportation, and in emergency rooms. (excerpt)