This study assessed the effects of scaling-up Integrated Management of Childhood Illness (IMCI) on the quality of care received by sick children in 10 districts in Uganda. Health workers trained in IMCI were found to deliver significantly better care than health workers who had not yet been trained, but absolute levels of service quality remained low. Achieving training coverage alone is not sufficient as a strategy to improve and sustain care quality. Other factors including training quality, effective supervision, availability of essential drugs, vaccines and equipment, and the policy context are also important and must be included in child survival policies and plans.