James Heiby is medical officer in the Global Health Bureau of the U.S. Agency for International Development (USAID). On the basis of an earlier 12-country quality assessment study, in 1990, he developed the first USAID project dedicated to addressing quality of care issues in USAID-assisted countries. Since then, he has continued to lead the Agency's program in adapting modern quality improvement to the needs of health systems in lower- and middle income countries. The current Health Care Improvement (HCI) Project is the fourth 5-year project in this program. Working with a number of USAID country missions, the program has expanded from a $5 million annual budget initially, to over $30 million under HCI, working in over 30 countries. Throughout this period, the program has included an expanding research and evaluation component. Prior to joining USAID in 1978, Dr. Heiby served in the Bureau of Epidemiology of the Centers for Disease Control in Atlanta. He received an M.D. degree from Johns Hopkins University in Baltimore and an M.P.H. from the Harvard School of Public Health in Boston, and completed his clinical training at New York Hospital-Cornell Medical Center. He is a Fellow of Session 489 Making Health Care Better in Low and Middle Income Economies: What are the next steps and how do we get there?.