Innovative Technologies

Innovative technologies like mobile devices, electronic medical records, and interventions based on human performance technology are increasingly being deployed to respond to health care delivery challenges in low-resource settings. To ensure that technologies achieve the greatest impact, they must be designed to respond to important system gaps and their introduction should be grounded in strategies that strengthen essential health system functions like health information systems, service delivery, and provider performance.

Improvement Framework for Leveraging mHealth and eHealth to Strengthen Systems

The USAID ASSIST Project is testing and evaluating how mHealth and eHealth can improve the efficiency and effectiveness of care and support processes, enhance the performance of human resources for health, and improve coordination and communication between health system levels and with clients.  The project’s Framework for Leveraging mHealth and eHealth to Strengthen Health Systems highlights critical system and quality gaps and describes how improvement science can enhance the development and testing of technologies to improve information systems and data, health workforce management, service delivery, and supply chain management

CHW Central Webinar - Integrating and scaling mobile community health data systems: Experience from India, Ethiopia and Madagascar


Mobile technologies show great promise in improving community health data, but how do we ensure they are integrated with national HMIS systems and how do we scale them to meet the need?

Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices with Newborns: Exploratory Qualitative Study

Quality improvement (QI) methods support frontline health workers to identify and address gaps in care, primarily through process changes. Teamwork and group discussion are key to identifying quality problems, analyzing their root causes and proposing solutions, but convening in-person meetings with all staff can be challenging due to workload and shift changes in health facilities.

New communication technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce infections in newborns.

This exploratory qualitative study, published in the Journal of Medical Internet Research (JMIR) - Medical Informatics, examines the experience of this improvement team and their coach with using WhatsApp as a communication tool to support their aim of improving adherence to aseptic protocols in the NICU.

Read the full article.

Virtual Collaboratives to Improve Maternal and Child Health

Modern quality improvement approaches offer methods to overcome common barriers related to quality of care, including in the context of weak health systems that face severe limitations in terms of materials and and human resources. Building on URC's extensive experience leading collaborates, the USAID ASSIST Project has proposed virtual improvement collaboratives as an innovative method to improve the quality of health services and share best practices in newborn health in Latin America.

mHealth for Maternal Health Meeting: Bridging the Gaps

Boston, MA

The Maternal Health Task Force (MHTF), in collaboration with Johns Hopkins Bloomberg School of Public Health and the World Health Organization, is convening a technical meeting on mHealth for maternal health: how it can be applied, who can use it, and to what effect it is needed. The meeting brings together a diverse group that includes representatives from high-, middle- and low-income countries who are  researchers, program implementers, and evaluators from both the maternal health and mHealth communities.

Leveraging mHealth to Strengthen Health Systems and Improve Care

Over the last fifteen years, mobile and electronic technologies have dramatically changed the health sector landscape. When used appropriately, mHealth technologies can help strengthen essential system functions as part of broader system strengthening efforts to improve quality of care and health outcomes. As health systems extend coverage of essential services in the era of Universal Health Coverage (UHC), it is imperative to optimize the design and use of mHealth technologies that can best augment health system and service delivery improvement efforts.

Bridging the Gaps: Leveraging m/eHealth to Achieve Strong Health Systems and High Quality Care in Low-Resource Settings

Washington, DC

This technical working group meeting was convened by the USAID ASSIST Project with key mHealth and eHealth stakeholders and experts for the purpose of reviewing a working framework for selecting technological solutions that can help bridge quality and systems gaps to improve health care in resource-limited settings.  The meeting also sought to build consensus on established, emerging, and needed mHealth and eHealth solutions that best address critical quality and systems gaps in low-resource settings and identify areas of collaboration for implementation and research.

The Potential of m/eHealth to Improve Systems, Care, and Gender Relations

Elizabeth Romanoff Silva


“Every system is perfectly designed to achieve exactly the results it achieves.” USAID Applying Science to Strengthen and Improve Systems (ASSIST) Deputy Director Kathleen Hill shared this quote from Deming with an audience of more than 40 leading experts in technology, health care, and international development that gathered on January 31st in Washington, D.C. for an m/eHealth Health System Strengthening technical working group meeting.

Computer-based Training for Tuberculosis Education in Indonesia

To support the National Tuberculosis Program (NTP) of Indonesia in its efforts to train private health care practitioners in tuberculosis (TB) directly observed treatment, the USAID Health Care Improvement Project was asked by USAID to update and adapt for Indonesia a computer-based training product that had previously been developed for Bolivia by the USAID-funded Quality Assurance Project.

In collaboration with the NTP, the Indonesian Medical Association (Ikatan Dokter Indonesia, or IDI), the Indonesian Midwife Association (IBI), and the Indonesian National Nurses Association (PPNI), HCI and its local partner One Comm developed a computer-based training package in Bahasa Indonesia for medical and other health practitioners. Launched in July 2011, the training program has nine modules that are based on the International Standards for Tuberculosis Care (ISTC):Cover of the Tuberculosis Training Course on CD

  1. Introduction, history, and epidemiology of TB
  2. Pathogenesis of TB infection and tuberculosis disease
  3. Diagnosis of TB infection and TB disease
  4. Treatment of TB infection and TB disease
  5. Treatment of TB in children
  6. Adherence to TB treatment
  7. TB and HIV infection
  8. Multi-drug resistant TB diagnosis and management 
  9. TB infection prevention and control

The English translation of the nine self-paced training modules developed for Indonesia may be accessed by clicking the image to the right or this link: Click to open training.

NOTE: To close the eLearning program, click the small "x" under the bottom right corner, not the larger, red "X" in the top right corner.  For optimal viewing in Internet Explorer, set your browser to Full Screen.

Care That Counts eLearning Course for Quality Improvement in Programs for Vulnerable Children

This eLearning course is designed for in-country Ministry personnel, international non-governmental organizations (NGO), national NGOs, USAID Mission staff, or anyone interested in learning more about using quality improvement principles to strengthen programs for vulnerable children. This course can also be used to educate and advocate for quality improvement in programming for vulnerable children.

Module 1 is an Introduction to Quality Improvement and takes about 30 minutes to complete. It includes a pre-assessment test for the learner to see what they know and what they can learn more about. It then introduces the principles of quality improvement and explains how they are used in improving the quality of programming for vulnerable children. Module 2 covers Best Practices in Improving Quality of Care for Vulnerable Children: The Quality Improvement Road Map. This module takes one to three hours to complete. Learners are guided along the steps in the quality improvement road map, which include creating awareness, building commitment, developing standards, implementing standards, and taking stock. The course ends with a post-test to see what learners have learned and a certificate of completion that can be printed.

Click the image to start each module.


Module 1


Module 2



This course can be downloaded for offline use on CD-ROM or flash drive. The file is 65.4 MB.


The major assumption underlying reminder interventions is that provider forgetfulness and/or lack of awareness are major barriers to performance in accordance with standards, as opposed to deficiency in knowledge or skill. Reminders consist of prompts either before or during a patient encounter that suggest a specific behavior should or should not be performed. The reminder may consist of a note in a patient’s chart; a message appearing on a computer screen; a verbal cue from an assistant; or a checklist, wall poster, flowchart, or other paper- or computer-based job aid that guides the health provider through the appropriate steps in a process.

Several systematic reviews have concluded that reminders have been proven effective in increasing provider adherence to preventive care standards and prescribing guidelines. The effects of reminders often disappeared after the reminders were stopped, suggesting that to be effective, reminders must be applied continuously and incorporated into daily routines.

Job aids are a type of reminder and have been widely used in developing country settings, especially with non-physician health workers. Job aids are visual tools used by the provider during a health care activity that give direction on what actions to take and how. The purpose of the job aid is to reduce the amount of recall necessary to correctly perform the task. Job aids are thought to be most appropriate when provider forgetfulness or lack of recall is an important barrier to performance, such as when the task to be performed is complex or infrequent.

Studies by the USAID-funded Quality Assurance Project (QAP) in Benin, Niger, Uganda, and Zambia found that job aids could be feasible and effective in hospital, primary care and community settings to prompt health workers to perform key tasks or communicate specific messages during patient counseling. In addition, job aids can contribute to help shift tasks from higher skilled to lower skilled health workers.

The QAP Issue Paper, The use of manual job aids by health care providers: What do we know?, provides a good overview of evidence related to effective use of job aids.