The Case Study Series presents real applications of quality assurance (QA) methods in developing countries at various health system levels, from national to community. The series focuses on QA applications in child survival, maternal and reproductive health, and infectious diseases. Each case study focuses on one or more major QA activity areas: quality design, quality improvement, the communication and development of standards, or quality assessment. This case study focuses on quality improvement (QI), an effective and systematic process of addressing the gaps between current practices and desired standards. Approaches to QI include individual problem solving, rapid team problem solving, systematic team problem solving, and process improvement. These methods vary in the time and resources required and the number of people who participate. Regardless of the method's intensity, QI approaches share four basic steps: identification of opportunity for quality improvement, analysis of improvement area, development of possible interventions to provide improvement, and the testing of promising interventions and their implementation if successful. Sometimes, when the potential solutions to a problem are already clearly defined, a shorter QI activity focused on field testing the alternatives is used. This case study illustrates systematic team problem solving. A five-member team at a rural health center in Malawi used this QI approach to reduce the number of patients returning with malaria symptoms, reducing case load, drug costs, and the risk of accelerating drug resistance. (excerpt)