Quality improvement in the developing world

A Quality Improvement (QI) team in a small clinic assessed children’s compliance with a standard treatment plan for a common infectious disease. Compliance was poor. Studying why, the staff discovered that the bad taste of the medicine was a principal problem. Working with mothers, the QI team identified popular foods that could be used to conceal the taste, and they placed in the waiting area a poster showing how to use the foods to do it. In the next test cycle, compliance with the treatment protocol had risen from 48% to 70%. The story is familiar—a successful quality improvement project—but the setting is not. The project team was not in a wealthy American health maintenance organization or a primary care practice in Sweden. In was in a remote African village, the disease was malaria, and the drug was chloroquine. (December 2002)