Between 2024 and 2025, the integrated Community-Led Monitoring (iCLM) pilot assessed malaria service delivery at both facility and community levels in Gasabo, Bugesera, and Rwamagana districts. Testing coverage remains high: Bugesera achieved 94%, Gasabo 90%, and Rwamagana 85%. However, in Rwamagana, 15% of patients were treated without testing, revealing a gap in adherence to the national test-before-treat policy, and treatment drops significantly after diagnosis, where only 63% of individuals who tested positive received treatment, highlighting a critical continuity-of-care gap.
From Diagnosis to Neglect: Rwanda’s Malaria Test-and-Treat Gap Demands Immediate System Accountability
The most urgent finding is the diagnosis-to-treatment gap, classified as a Critical priority. High testing coverage without corresponding treatment undermines the effectiveness of malaria surveillance and reactive response systems.
Pediatric ACT shortages and stockouts for both health facility and community emerged as a major driver of untreated positive cases, particularly affecting children under five, who are most vulnerable to severe malaria. This represents a systemic supply chain weakness. Without consistent availability of treatment commodities, even well-functioning surveillance systems cannot deliver impact.
At the same time, strong community-level testing performance is a clear success. CHWs are demonstrating capacity to detect cases effectively, offering a strong foundation for strengthening treatment continuity and supervision.
To achieve Rwanda’s 2030 malaria elimination goal, service delivery gaps must be urgently addressed. District and national authorities should strictly enforce test-before-treat and treat-after-positive guidelines, strengthen supervision and real-time digital stock monitoring for RDTs and ACTs, and prioritize pediatric treatment. Clear accountability mechanisms must ensure every confirmed malaria case receives prompt, documented treatment.