After several laboratory and clinical studies, the value of rapid diagnostic tests (RDTs) as efficacious tests for the timely identification of malaria infection was established. Malaria RDTs became an important component of malaria diagnostic testing in the clinical management of febrile illness.

In 2012, WHO launched the ‘T3’ (Test, Treat, Track) initiative, which anchors key policy messages of WHO recommendations – on diagnostic testing, treatment and surveillance of malaria – such that every suspected case of malaria should be tested; every confirmed case should be treated with a quality-assured antimalarial medicine; and all cases should be tracked through a timely and accurate surveillance system.³ Accordingly, RDTs should be deployed in the health system as a cornerstone of malaria case management.

In many settings, however, and due to several health system and patient-related factors, the use of RDT’s has not been as effective as anticipated. For example, the tests may not be available at the health facilities that need them. Even in facilities where they are available, some patients may not have access to the facilities, and hence to the test (because they cannot reach the facility). Providers may not always comply with RDT results and treat for suspected malaria solely on the basis of clinical symptoms. Patients may also decide to self-treat for malaria despite negative RDT results. Taken in combination, such factors can render an efficacious test ineffective, thereby increasing costs and undermining health outcomes in the complex, real-life context of the health system.