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Khunyangu Sub-County Hospital in Busia County, Western Kenya provides preventive and curative services through outpatient and inpatient departments. The USAID Applying Science to Strengthen and Improve Systems project (ASSIST), with funding from the President’s Malaria Initiative (PMI), began supporting quality improvement to improve malaria case management in Busia County in May 2014. Khunyangu Sub-County Hospital is a high malaria case load facility and was selected, along with four other facilities, for initial implementation of malaria quality improvement within the county. ASSIST is currently implementing malaria quality improvement activities in 25 facilities across three counties in Kenya.

Khunyangu Sub-County Hospital formed a work improvement team (WIT) in May 2014 to improve malaria case management. They reviewed their data to look for gaps for the first time and quickly saw they had high rates of presumptive treatment for malaria, with more than half of patients receiving artemisinin-based combination therapies (ACTs) without confirmation of malaria. The WIT developed a number of changes to test, including conducting continuing medical education sessions at the facility, displaying job aids, extending laboratory hours, informing clients of changes in procedure, and reordering patient flow. Through these efforts, 58.8% of their yearly supply of ACTs has been saved as a result of rational use, which provide approximately 10 months of additional ACTs to the facility. As a result, there have been no stock-outs of anti-malarials, despite erratic supplies.