Background: Despite a falling incidence of malaria infection, severe malaria remains a major cause of admission and mortality in Kenyan hospitals. In 2012, the National Malaria Control Programme (NMCP) launched the new guidelines for the management of severe malaria recommending change of treatment from quinine to parenteral artesunate. In the following years, the implementation of the new policy was supported with procurement and distribution of new medicines alongside the training of health workers on broader aspects of severe malaria management in line with standards specified in national guidelines, and other job aids which are distributed to hospitals and health workers nationwide. Despite the importance of quality-of-care provided to inpatients, no information is available in Kenya about health workers readiness to implement case-management policies and their actual assessment, diagnosing and treatment practices in delivering hospital care for severe malaria.

Objective: To monitor the trends in health system readiness and quality of inpatient malaria case-management using innovative, biannual hospital surveys at all County referral hospitals in Kenya.

Method: Data collection methods include hospital assessments, interviews with in-patient clinicians and retrospective reviews of patient medical files admitted to paediatric and adult wards. The analysis of monitoring indicators is completed at patient, health worker and hospital levels. Following completion of each survey the reports of individual surveys, including trend monitoring over time, are prepared and disseminated.

Key questions to be addressed by the project include:

• What are the trends in the quality of severe malaria case management for admitted children?
• What are the trends in the quality of severe malaria case management for admitted adults?
• What are the trends in the availability of hospital commodities, equipment and services necessary for care of patients with severe malaria?
• What are the trends in the coverage of inpatient health workers with interventions targeting severe malaria management?
• What is the knowledge of inpatient health workers on the management of severe malaria in accordance with new national guidelines?