Figure 1 summarizes the outcome of studies conducted in Tanzania to determine why highly efficacious anti-malarial treatments low effectiveness when implemented at the community level.

Clinical trials show that artemisinin-based combination therapies (ACTs) have very high efficacy for the treatment of uncomplicated malaria: About 98% of patients who receive treatment within carefully conducted efficacy trials were cured of malaria. A community-based survey found that only 60% of suspected malaria patients accessed treatment at a clinic that had ACTs. Studies within the clinics showed that 95% of those who came to the clinics had an appropriate diagnostic test performed, and that 95% of those diagnosed with malaria were prescribed the correct treatment. Further studies showed that only 70% of patients who received the correct prescription of ACT adhered to the treatment as recommended.

Taken together, these series of studies showed that less than 40% of people with uncomplicated malaria in the community were effectively treated, despite the availability of ACTs, an intervention with an efficacy of 98%. Such studies not only document and measure the failings in the health system, but can also be used to investigate the reasons behind these problems and the potential actions that can be taken to address them.