An integrated care pathway (ICP) is a structured chart that prompts for key observations and interventions in patients to be recorded at set times by medical and nursing staff. ICPs were introduced into the neonatal department of the Queen Elizabeth Central Hospital in Blantyre, Malawi. The number of observations of babies recorded in the year before and 2 years after the introduction of ICPs were compared. When ICPs were in use, 9-96% of the 18 possible daily observations were recorded as having been carried out, compared with 0-33% before their introduction. In the 2nd of the 3 years, there was a fall-off in some observations made, probably because of staff shortages. The ICPs proved effective and easy to use. When adapted to local needs they play an important role in delivering neonatal care.