Instead of continuing to wait upon the MoH or any sympathetic partner to provide them with means of orderly storing their patient files, the facility QI team identified an un-used resource: empty boxes in which the therapeutic foods had been supplied by NuLife, a sister project to the USAID Health Care Improvement (HCI) project (both managed by the University Research Co., LLC).

Utilizing lessons learned from the support received under the USAID Health Care Improvement project's interventions to improve HIV records and data management, the health facility team had started sorting out patient files and arranging them in accordance with scheduled clinic appointments. However, due to lack of adequate space within the one-roomed clinic, the files would be arranged and stored in one corner of the room. From there, they would still get mixed up delaying retrieval on clinic days. In May 2010, the facility started receiving nutritional support from the USAID-supported NuLife project that provides therapeutic food for malnourished HIV patients. These foods are supplied in large strong boxes, which are rendered useless once emptied.

"During one of the clinic team meetings in which we review the quality of care" continued Mr. Okiror, "one of the nurse mid-wives suggested we could use the empty boxes to store patient files. It sounded like a good idea but one we had never though about. So we decided to try it".

Initially, unfortunately, the boxes did not work well. Even though the patient files were clearly labeled, the boxes were not and so files could get mixed up. In the subsequent team meetings after on-site coaching from HCI, the QI team decided to label the boxes as per the HIV clinic days, which were Tuesdays and Thursdays of each.