This short report describes the improvement framework for in-service training programs that was developed by the USAID Health Care Improvement Project in collaboration with key stakeholders. In-service training (IST) represents a significant proportion of investments made by Ministries of Health and development partners in building the capacity of health workers to competently, safely and efficiently provide quality health services.  The report describes the final set of 40 in-service training improvement recommendations developed through a consensus process with representatives of key stakeholder groups.