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Presents the concepts, principles, and tools of total quality management methods for health systems in low and middle income economies. Emphasizes integrated health systems management; fostering a genuine team approach in the face of an hierarchical tradition; central importance of community governance; interventions designed based on evidence and standards of practice and in an equitable fashion; introducing a measurement-based approach to problem solving, emphasizing analysis of service delivery process and outcome; and integrating implementation science as an integral component of the management system.