In low-and middle-income countries,10 to 20% percent of sick children seen in primary care need referral to hospital [1,2]. To improve child mortality in low-resource settings, the quality of first referral level hospital care -the "critical link" -needs to be addressed [1,3]. Resources to improve the quality of hospital care for children in settings with limited resources exist, including the Integrated Management of Childhood and Neonatal Illnesses (IMNCI), the WHO