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Purpose

– The purpose of this paper is to provide an “inside” account of efforts to enhance the quality of care in a paediatric hospital department in Malawi.

Design/methodology/approach

– The authors describe the problems they face as health workers in an overcrowded, under-resourced emergency departments in a low-income setting. Where it is helpful, the authors combine reports of their experience with reference to reports emanating from other African countries.

Findings

– There is increased awareness of the need for a good health system to be able to provide quality care. The authors emphasise the importance of teamwork and the need for cross cutting activities that are not disease-centred or vertically driven. Task sharing and multi-tasking have helped fill the gaps left by inadequate staffing but specialists in emergency medicine are needed to advocate for the specialty and be role models in departments.

Practical implications

– This paper is aimed at a broad audience of fellow clinicians, funders and policy makers, and those who have an interest in clinical governance in support of quality improvement in developing countries.

Originality/value

– This is a firsthand account of efforts to enhance the quality of emergency care from a paediatric hospital department in Malawi.

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