Resistance of Plasmodium falciparum parasites to antimalarial drugs has fuelled an increase in malaria prevalence and malaria specific mortality during the past decade in sub-Saharan Africa.¹ Promising efficacy results from field trials of artemisinin containing combination therapy (ACT) are a source of optimism and numerous African countries are considering changing first line malaria drug policy to ACT to counter high levels of resistance.² However, demonstrated drug efficacy is not enough to guarantee effective malaria treatment in Africa.³ Delivery of effective malaria treatment will not occur unless attention is also focused on the broader socio-cultural, economic, technical, and political environments in which it will be implemented.

Malaria is associated with retarded economic development in Africa and results in annual direct and indirect costs estimated to exceed US$2 billion.⁴ Intersectoral competition for resources in African countries is severe and social expenditure often receives a disproportionately small budgetary allocation. Within the health sector, the AIDS pandemic has placed an additional burden on limited health resources and, thus, resources available for malaria management are effectively shrinking.⁵ This is occurring at a time when …