Bridging the quality gap in diagnosis and treatment of malaria

The rapid scale-up of malaria prevention and treatment over the past two decades has led to significant reductions in its related morbidity and mortality worldwide. In sub-Saharan Africa, where over 90% of global cases are reported, an estimated 663 million new cases and five million deaths have been averted since 2000.1 Despite these impressive gains, global control and elimination remain challenging.2 Billions of people worldwide are at constant risk of infection; resistance to insecticides and treatment regimens continues to spread; year on year reductions in incidence and mortality have stalled; and over 400 000 people die from malaria each year.3

Approaches to service delivery have assumed that increasing the coverage of services, such as vector control, treatment, and surveillance, is sufficient to achieve optimal outcomes. But to achieve the ambitious aim of eradicating malaria worldwide by 2050, the global response can no longer rely on coverage alone. The biggest gap in treatment remains the ability of a febrile patient to access healthcare, but once a patient enters the health system, delivery of high quality care is essential (table 1).

In this analysis, we highlight significant gaps in the quality of diagnosis and treatment of malaria and health systems with limited capacity to respond nimbly to these gaps. We contend that to maintain the gains of malaria control and elimination, health systems need to routinely monitor the quality of the diagnosis and treatment of malaria and develop sustainable approaches to bridge gaps in quality using quality improvement principles.