Fostering Change in Health Services

Building and parking lot

This course is designed to build the skills of those who are in a position to support change agents in health service delivery. These change agents may be either local health practitioners and managers or mid-level program managers who champion a change in their programs.

Their potential supporters "you, the primary audience for this course" include USAID mission staff, as well as representatives of cooperating agencies and the organizations those agencies work with. Many elements of the course can be useful for and shared with change agents at all levels.


By the end of this course, you will be able to:

  • Describe an effective pathway to changing and improving health care practices in developing countries.
  • Define eight principles for supporting a change in health care practices.
  • Identify success factors that build local capacity and smooth the way for effective change in health care practices.
  • Describe the steps to support a change in practices, from initiation through widespread use.
  • Discuss the process for building scale-up into the change process from the beginning.
  • Describe the principles for effectively communicating change to varied audiences and generating long-term commitment throughout the process.


The original course authors (2010) wish to acknowledge the contributions of the Management and Supervision Working Group of the USAID-supported Maximizing Access and Quality (MAQ) Initiative and the Implementing Best Practices (IBP)/MAQ Task Team on Fostering Change, who contributed to the ideas presented in the paper from which this course is based.

Those authors also wish to thank the following individuals for their valuable input into this initial course:

  • Chris Davis, INFO Project
  • Ann Lion, USAID
  • Rushna Ravji, USAID
  • Jim Shelton, USAID

The course author of this update would like to acknowledge contributions that have been added as resources from the WHO and the Implementing Best Practices Consortium's 2013 revised Guide to Fostering Change to Scale Up Effective Health Services, in particular new resources from ExpandNet/WHO. Please see the Reference tab for these resources as well as new materials from the USAID Health Care Improvement Project, University Research Co. (URC), and the Institute for Healthcare Improvement (IHI)


  • 2 hours


  • Wednesday, April 22, 2015

Course Authors: 

  • Claire Bahamon, MSH; Ann Buxbaum, MSH; Joseph Dwyer, MSH

  • 2015 Course Revision Author: Joseph Dwyer, MSH Consultant

Course Managers: 

  • Kate Wilson, MSH
  • Lorine Ghabranious, MSH

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