USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project
Welcome to the temporary website of the USAID ASSIST Project! We will be launching our USAID ASSIST Knowledge Portal soon at this URL. In the meantime, please visit the Health Care Improvement Portal at www.hciproject.org for more information on the kinds of improvement approaches and resources that will be available in the future on the USAID ASSIST site.
A New Five-year Cooperative Agreement in the USAID Office of Health Systems
Despite the availability of evidence-based, simple, high-impact interventions capable of saving lives and alleviating suffering, many patients and clients are not benefiting from them. Evidence-based care is not reaching the people who most need it, despite an abundance of evidence-based guidelines and consensus on what should be done.
Much of this implementation gap is related to weak health systems and processes of care delivery. Such weakness manifests itself in various aspects of the quality of care, including effectiveness, efficiency, patient/client-centeredness, equity, safety, accessibility, timeliness, community involvement, and inability to achieve Millennium Development Goal targets.
The USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project is a new five-year project of the Office of Health Systems of the USAID Global Health Bureau designed to address this challenge by improving health care in USAID-assisted countries, strengthening their health systems, and advancing the frontier of the improvement science.
Objective of USAID ASSIST
The overall objective of USAID ASSIST is to foster improvements in a range of health care processes through the application of modern improvement methods by host country providers and managers in USAID-assisted countries. The project's central purpose is to build the capacity of host country systems to improvement the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the services they provide. In addition to supporting the implementation of improvement strategies, the project seeks to generate new knowledge to increase the effectiveness and efficiency of applying improvement methods in low- and middle-income countries.
What Is Improvement Science?
The science underlying modern improvement draws on psychology, organizational behavior, adult learning, and statistical analysis of variation and is grounded in a systems understanding of work. The fundamental concept underlying all improvement is that every system is perfectly designed to achieve exactly the results it achieves (Batalden).
Improvement requires change in the way we do work, though not every change is an improvement. The following core principles underlie the science of 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, and determine whether the changes have resulted in improvement and act accordingly.
· Care should meet the needs and expectations of patients, clients, 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 and faster results.
USAID ASSIST will build the capacity of host country implementers to apply the science of improvement to health care and other services for vulnerable populations, to ensure that high-impact interventions reach every patient or client, every time, in order to improve outcomes.
A Learning Agenda for Improvement
Learning is a fundamental part of improvement. Knowledge management activities will be built into each USAID ASSIST country program to more effectively and efficiently capture and disseminate learning about what improves outcomes. Evaluation activities will help show country programs how and why investment in improvement adds value to their work. Research activities will answer specific questions needed to enhance the scale-up and sustainability of results and accelerate the achievement of improvement objectives.
As a global project, USAID ASSIST's learning agenda also seeks to contribute to global U.S. Government initiatives and inform the larger field of health care improvement. Research supported under USAID ASSIST will address key implementation challenges for the Global Health Initiative (GHI), such as how to better meet the needs of women and girls and strengthen country ownership. Each program will also document how the improvement strategy has addressed gender issues.
To enable learning at the local level, USAID ASSIST will incorporate knowledge management strategies and approaches in its programs. Each improvement effort will emphasize systematic documentation of what teams learn as they find better ways to deliver care and will make use of technology to share improvement experiences supported by the project, other implementers, and the literature. USAID ASSIST will also facilitate connecting implementers – in conversation, on the web, and through social media – to transfer knowledge learned from their experiences.
Another aspect of the USAID ASSIST research and evaluation agenda is to build up the body of evidence of what works and what does not in terms of improvement methods. The project will test and evaluate ways to improve the rigor of data and the cost-effectiveness of interventions.
USAID ASSIST Services
USAID ASSIST can accept field support, population, OHA, regional, and other USAID funding to apply improvement science to achieve better outcomes in support of USAID objectives. The project team brings expertise in applying improvement methods to improve outcomes in child health, maternal and newborn care, nutrition, family planning and reproductive health, HIV/AIDS, tuberculosis, non-communicable diseases, chronic care, programming for vulnerable children, health workforce development, and community-based health care.
The project's country-level technical assistance emphasizes not only better results, but sustained improvement at scale and institutionalizing improvement through competency development at the pre- and in-service levels as well as engaging with host-country governments at the policy level. The project will enable the flexible application of evidence-based improvement approaches within a given context to achieve the best possible outcomes while building the improvement competencies of host-country partners.
The design of country programs under USAID ASSIST uses a deliberate strategy to systematically address the key questions related to the evidence base and strategy for the work planned, including technical content, improvement strategy, human performance factors, scale-up, sustainability, and institutionalization. It also includes deliberate design of the learning that will be accomplished through the work and how knowledge management, research, and evaluation activities will be incorporated into each country program.
USAID ASSIST country programs will be designed with host-country leadership at the forefront to ensure context appropriateness and local ownership and will be in alignment with global initiatives, including the GHI, USAID Forward, HIV-free Survival, the Child Survival Call to Action, and Saving Mothers, Giving Life. Aligning with these priorities and policies ensures that considerations for marginalized and underserved populations and gender, age, and social differences are taken into account at all levels of implementation.
Field activities of the USAID ASSIST Project build on the work of the USAID Health Care Improvement Project and currently involve programs in 24 countries in Africa, Asia, Europe & Eurasia, and Latin America.
USAID ASSIST Team
University Research Co., LLC (URC), prime recipient of the USAID ASSIST cooperative agreement, is a global leader in adapting modern, evidenced-based improvement approaches to the needs of low- and middle-income countries. USAID ASSIST builds on URC's work under the USAID Health Care Improvement Project (HCI) and Quality Assurance Project. While the mainstay of the company's work over the past 20 years has been improving the quality of clinical health care, URC has helped host country implementers apply improvement approaches to other health system building blocks, including workforce performance management, supply chain, information systems, financial management, and decentralized program management.
The World Health Organization's Patient Safety Programme (WHO PSP) is a major force for accelerating patient safety improvement globally, supporting the development of patient safety policy and practice across all WHO Member States. Currently, the WHO PSP leads worldwide efforts to test and scale up the use of safe surgery and safe childbirth checklists, and with its sister program at WHO, the Evidence-informed Policy Network (EVIPNet), promotes the use of scientific evidence in health policy making.
The Institute for Healthcare Improvement (IHI) is the US national leader in health care improvement. IHI developed the improvement collaborative approach and has sponsored over 50 collaboratives since 1995, including HIV/AIDS collaboratives in South Africa, a child survival collaborative in Ghana, and an essential obstetric care collaborative in Malawi. Recently, IHI launched the Quality Track of the Joint Learning Network for Universal Health Coverage, an initiative of 10 countries in Africa and Asia pursuing universal health care access.
The Johns Hopkins University Center for Communication Programs (JHU-CCP) is a leader in strategic communication and research to facilitate access to information and exchange of knowledge to improve health. JHU-CCP's knowledge management and E-learning expertise are demonstrated by their management of the Knowledge for Health (K4Health) Project and the Global Health E-Learning Center.
EnCompass LLC brings expertise in participative evaluation, facilitation, strategic planning, training, and knowledge management to document best practices and translate lessons learned into implementation strategies. On HCI, EnCompass designed and implemented 17 field-based studies examining cost and cost-effectiveness of QI approaches.
FHI 360 leads worldwide research, including clinical trials; other epidemiologic methods; and behavioral, programmatic, and operations research to evaluate health technologies, services, and programs. FHI 360 works to strengthen PMTCT services, with a focus on integration of PMTCT into HIV treatment and care and on building links between PMTCT and other services, such as maternal, newborn, and child health and family planning.
Harvard School of Public Health (HSPH) brings expertise in health policy, health sector reform, and applied research and health program evaluation.
Health Research, Inc. (HRI) is the vehicle through which the New York State Department of Health AIDS Institute provide research, training, and program support through its HEALTHQUAL team. HEALTHQUAL strengthens health systems to create sustainable, self-sufficient local quality management programs tailored to national guidelines, resources, and care models.
Initiatives Inc. specializes in human resources management and quality and performance improvement. Under HCI, Initiatives provided technical guidance for the development of the CHW AIM toolkit and manages the CHW Central community of practice website.
Women Influencing Health Education and Rule of Law (WI-HER) is a woman-owned small business specialized in gender analysis and integration. WI-HER designs country assessments and approaches to address gender issues as part of improvement and develops field staff capability in addressing gender.
Broad Branch Associates, LLC is a leader in the design, implementation and evaluation of systems that link payments to both providers and consumers to results through performance-based incentives.
Regional Partners on USAID ASSIST:
Center for Family Welfare – Universitas Indonesia (CFW UI), the research center in the Faculty of Public Health, Universitas Indonesia, supports data collection in an ongoing hospital accreditation research study begun under the USAID Health Care Improvement Project.
Georgia Family Medicine Association (GFMA) collaborates on the dissemination of evidence-based care models and practices through its website and through periodic GFMA publications and provide technical assistance in Georgia to strengthen internal quality assurance systems at primary care facilities.
Regional Center for Quality of Health Care (RCQHC) in Kampala, Uganda, provides technical assistance in the design of improvement programs, the development of policies to support improvement, pre-service training in improvement methods, and regional knowledge management.
Regional Psychoscocial Support Initiative (REPSSI) is a technical leader in promoting a holistic approach to child and family safety and well-being and developing strategies for bridging policy, science, and practice through the engagement of multiple stakeholders, including governments, civil society, international organizations, communities, private sector, families, children, and caregivers. Headquartered in South Africa, REPSSI has national offices in Tanzania, Zambia, and Zimbabwe.