ARTICLE Background In the mid 1990s, the transformation of the South African

health system using the primary health care approach led many children’s health workers to feel optimistic about the impending changes. However, in moving from academic and metropolitan facilities into regional and district hospitals, it quickly became evident that the quality of care received by children was suboptimal. The challenge was how to change this. In 1996 the Perinatal Problem Identification Programme (PPIP),1 and in 1997 the Confidential Enquiry into Maternal Deaths (CEMD),2 were launched, with similar concerns about the quality of care received by babies (unborn and newborn) and pregnant women. Both PPIP and the CEMD pioneered the use of the mortality review process in South Africa for assessing and improving the quality of care received by these health populations. Drawing on the philosophy and experience of these two programmes, Dr Angelika Krug piloted an Under 5 Healthcare Problem Identification Programme in the early 2000s in four sites in the Mafikeng region of North West province.3 The programme was then field-tested in eight sites in 20044 giving rise to the first Saving Children report.5 After field-testing, the programme was extended to be able to include all children (0- 18 years) admitted to children’s wards, the software platform was substantially updated and improved, and the package was renamed the Child Healthcare Proble