A study of diagnostic effort documents low worker effort in both churchbased and government health facilities. Despite a strong perception among patients about good medical quality in church-based health clinics, health workers in these clinics do not ask more history taking questions or undertake more examinations. Effort levels are so low in both sectors that there is a real danger of inaccurate diagnoses and mismanagement. However, health workers in church-based facilities are more polite and communicate more with the patients about the diagnoses.