Accelerating and sustaining system performance through time

The Salud Mesoamerica Initiative (SMI) is a results-based financing program supporting Ministries of Health in Central America and the state of Chiapas in Mexico improve reproductive, maternal and child health for the 20% poorest populations. During its first two phases, SMI supported Ministries of Health implement quality improvement (QI) strategies and improve management practices. As the third and last phase of SMI approaches, the question in hand is how to create capabilities for Ministries of Health to sustain quality improvement at the system level?

SMI and the Social System Design Lab designed and hosted a 2-day workshop with representatives of the Inter-American Development Bank, the Salud Mesoamerica Initiative, and outside experts to explore a model of accelerating and sustaining system performance through time.

Project Leads

Ellis Ballard

Jenny Nelson

Diego Rios Zertuche


December 2017


Washington, DC, USA

Project Goals

  • Generate preliminary framework/theory for accelerating sustaining system performance through time in Mesoamerica.
  • Bring in outside perspectives to pressure test, inform assessment of these perspectives.
  • Identify a set of potential experiments or pilot projects for implementation within upcoming SMI operations.