Research and Evaluation | USAID Health Care Improvement Portal
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Research and Evaluation

The USAID Health Care Improvement Project's Research and Evaluation program supports global learning in health care improvement by:

  • Generating and synthesizing learning on priority areas related to QI, including: institutionalization of better care practices and QI, spread of improvements, QI team performance and coaching, cost-effectiveness of QI, QI applied to community level services.
  • Improving methods, approaches and tools for documenting, analyzing, sharing and synthesizing learning from improvement efforts
  • Providing technical support for strengthening rigor of data collection and analysis

Priority Areas of Learning

In collaboration with country programs, HCI is implementing studies that address key issues for improving the effectiveness and efficiency of health care improvement efforts, including spread, institutionalization, employee engagement, and cost-effectiveness of QI methods.

Improved Methods for Documenting, Analyzing, Sharing, and Synthesizing Learning from Quality Improvement Efforts

Quality improvement (QI) is focused on answering the question, “Is this change an improvement?” When multiple teams are working together on a common health issue, this question is transformed to, “Which changes are the most robust, effective, and efficient across QI teams?”

Efficiently and effectively harvesting the answers to these questions across a large-scale improvement activity, such as an improvement collaborative, is often hampered by weaknesses in processes of documentation and analysis at the QI team level. A major HCI effort to support QI teams in documenting their results and important learning is the project’s Documentation, Analysis, and Sharing (DAS) System.

HCI’s DAS tools are designed to help improvement teams analyze their results and determine which changes actually led to improvement. The tools also facilitate the work of synthesizing what is being learned across teams, to enable these good practices to be spread to new sites.

Currently available tools include:


Institutionalization of better care practices and quality improvement is a key outcome of quality improvement efforts. HCI’s first efforts to comprehensively study institutionalization are taking place in Niger. Related studies are planned in Honduras and Nicaragua. Link below to a graphic depicting the conceptual framework for HCI’s research on institutionalization. More information on the Niger institutionalization study (including the study protocol and preliminary findings) may be found in the Niger study link under “HCI Research and Evaluation Studies” below.


Spread of improvements is key to achieving better care at scale. While collaborative improvement will generate robust learning about effective changes in systems and processes to ensure consistent provision of high quality care, these changes must be spread to other sites to achieve results at scale. HCI’s first efforts to comprehensively study spread are currently taking place in Ecuador, where the Ministry of Health is directing the spread of better care practices and quality improvement methods to the remaining half of the country not covered by prior QI efforts. Other studies related to spread are now planned in Cote d’Ivoire, Guatemala, Nicaragua, Russia, and Uganda.

Link below to a graphic depicting the conceptual framework for HCI’s research on spread. More information may be found in the Ecuador spread study link under “HCI Research and Evaluation Studies” below.

HCI Research and Evaluation Study Profiles

Read more about current and completed studies:

HCI Research and Evaluation Publications