This is a careful plan of how each identified problem is going to be investigated and managed. It is of little help to complete a full general examination, make a careful problem list and possible diagnosis, but then fail to take any action. Each item of the problem list must be considered and a plan of action decided upon and documented for that problem. The plan of action must be clearly written in the patient’s record (if in hospital or at a clinic) as well as in the Road-to-Health Card.

When writing out the plan of action, it is useful to list each problem in turn and then note what action is needed for that specific problem. This helps to keep track of the various actions which are needed for the whole problem list. What is not wanted is a long, confused list of actions where it is uncertain which problems are being addressed by each action.

The clinical findings, assessment and plan of action must be simply and clearly explained to the parents. The patient and parents should be allowed to ask questions and discuss the important points. Always be patient, polite and caring. A translator may be needed.

The following is a typical plan of action:

1. Poverty: Refer to social worker to consider a grant.
2. Underweight for age: Provide food supplements and monitor weight gain.
3. Incomplete immunisation: Arrange for missing immunisations to be given.
4. Pneumonia: Start oral amoxycillin, check oxygen saturation, provide oxygen if needed, refer to hospital.
5. Dental caries: Book dental appointment and discuss dental hygiene with mother.