The Quality Assurance Project (QAP), funded by the US Agency for International Development, provides comprehensive, technical expertise in the design, management, and implementation of quality assurance programs in developing countries. As such, a monograph was created which represents an update on quality improvement methodology for health care delivery. Divided into nine sections, the monograph outlines the principles and frameworks underlying quality improvement in health care. A history of the QAP is presented in Section 1. Section 2 describes the spectrum that covers the range of quality improvement methods and defines four points along this spectrum, namely: individual problem solving, rapid team problem solving, systematic team problem solving, and process improvement. Sections 3, 4, 5, 6, 7, and 8 detail the methodology for improvement for each four approaches, with accompanying illustrations. Finally, Section 9 describes the tools used in quality improvement that include data collection, process description, and data analysis tools.