We observed in a randomised intervention trial in Bissau that mortality due to malaria could be reduced by half by adding a small monetary incentive to the staff and strict follow-up of a standard protocol for available drugs. The Government and donors are not able to sustain such incentives. We intend to evaluate whether strict organisation of a cost recovery system and the use of part of the funds for staff incentives would improve performance of the staff and contribute to reduction of hospital and post-discharge mortality.

A committee will organise collection and use of the money, and decide on incentives to be paid to the staff based on performance indicators. All children < 5 years of age admitted to the ward will be registered and followed-up until two months after the consultation. Data on the level of mortality before and after the study period will be collected. Furthermore, interviews on quality perception of the parents will be carried out before and after the study.

Inclusion Criteria:

• Children under five years of age admitted to the ward
• Parents of these children