This assessment examined the varying ways that the USAID Health Care Improvement Project (HCI) has facilitated the institutionalization of improvement at the national level across 17 HCI-supported countries. This was a qualitative descriptive investigation that relies on semi-structured interviews with HCI Chiefs of Party (COPs), conducted either in person or via telephone in the period September-October 2012. Based on each country’s quarterly and annual reports, the interview guides were tailored to focus on HCI’s role in supporting institutionalization. The semi-structured nature of the interviews gave COPs the opportunity to reflect upon and highlight those activities they found to be most effective or meaningful. Content analysis was performed to identify activities HCI carried out to support ministries. Using the aforementioned framework as a guide, data were also analyzed to identify facilitating factors and barriers to institutionalization.
The study found that the project, across 17 country programs, has supported the institutionalization of quality improvement at the national level in several key ways. First, HCI brought together key government, non-government, and sometimes private stakeholders to address quality improvement. HCI also worked to raise awareness and knowledge of these key stakeholders, not only about quality improvement but also around technical areas, such as tuberculosis. A related activity was advocating for a place for quality improvement, often through the use of data and demonstrating results. HCI’s passionate and committed staff also played an important role in advocating for quality improvement. HCI also supported ministries in integrating quality improvement into their existing systems though developing and testing standards, guidelines, and policies; working to incorporate improvement into pre-and in-service training; and providing other resources to support facilities to integrate and sustain improvement. Finally, HCI prepared national governments to take ownership over improvement work.
COPs were also asked their views on factors that facilitated or hindered institutionalization of improvement. Key facilitating factors included strong leadership and champions within the ministry and clear roles and responsibilities, including having individual positions or units/divisions dedicated to improvement. Regular meetings and visits between national level actors and those at other levels of the health system also facilitated institutionalization. Finally, the use of data and evidence supporting the benefits of quality improvement helped garner support among national level actors to institutionalizing quality improvement.