PROSALUD The Fully Functional Service Delivery Point in Nicaragua and other Highlights



The FFSDP application and methodology is a standards-based whole-systems QI tool that encourages health providers to change their predominantly clinical and curative focused behaviors and practices into behaviors and practices that foster team work, improve management, emphasize community health and prioritize prevention. These new behaviors are known to lead to more effective service delivery and thus to improved health outcomes. The concept of a “fully functional service delivery point”, or the place where clients obtain and health providers deliver defined services of defined quality, is central to this approach.

Tool description:

The FFSDP approach to quality assurance and improvement addresses the whole system at the health facility, through the application of three main components: (a) Quality standards-based evaluation; (b) Evidence-based work-planning; and, (c) Work-plan implementation using educational and intervention tools for performance improvement. The objective of the FFSDP is to turn health facilities into “fully functional service delivery points”. Progress toward this goal is measured by comparing baseline (pre-intervention) and follow-up (post-intervention) evaluations measuring the degree to which the health center complies with national quality standards.

HSS Building Blocks: Financing,Human Resources,Information,Leadership, governance, and management,Medicines, vaccines, and technologies,Service delivery and demand

Health Area: Chronic Diseases,Family Planning and Reproductive Health,HIV/AIDS and TB,Malaria and Communicable diseases,Maternal, newborn, child health

Cross-Cutting Areas:

  • Quality Assurance

Tool Type:

  • Assessment
  • Planning
  • Process Guide


After the introduction of the tool, no outside technical assistance is needed. This tool fosters team work, stimulates analytical thinking and planning, is a systems approach, and has been proven to improve quality of services.


The tool is time consuming.


  • English
  • Spanish


  • East Africa
  • Latin America and the Carribbean
  • Middle East
  • South Asia
  • West Africa

Contact Person:

Lisa Pelcovits (