Community Health at the Frontline: Uganda Expands Free Malaria Diagnosis and Treatment from Under-Fives to All Ages

Uganda is advancing an ambitious transformation of community healthcare by expanding malaria diagnosis and treatment services from children under five years of age to people of all ages. This shift represents a major milestone in the country's efforts to reduce malaria morbidity and mortality while strengthening primary healthcare and accelerating progress toward Universal Health Coverage (UHC).

“Having a VHT nearby means my grandchildren can be tested quickly without wasting valuable time travelling to a health facility. This helps prevent delays in diagnosis and treatment, which can save lives,”  said Grace Auma, grandmother of  Joshua Ekimwere. 

Despite significant progress in malaria control, major barriers to timely treatment remain. Nearly half of malaria patients seek treatment more than 24 hours after the onset of symptoms, while many fail to complete treatment or rely on non-recommended or poor-quality medicines. As a result, severe malaria rates in Uganda remain substantially higher than the global average. Furthermore, households continue to bear a large share of malaria-related costs, creating a vicious cycle of illness, lost productivity, and poverty, particularly among vulnerable communities.

For many years, Integrated Community Case Management (iCCM) services in Uganda primarily focused on children under five. Under a new Ministry of Health-led approach, Village Health Teams (VHTs) and Community Health Extension Workers (CHEWs) are being empowered to diagnose and treat malaria among all age groups, including school-age children and adults. Using rapid diagnostic tests (RDTs), trained community health workers can identify malaria and provide life-saving artemisinin-based combination therapies (ACTs) free of charge at the village level.

This expansion is particularly important for rural and hard-to-reach communities where access to health facilities often requires long travel distances and additional costs. Families that previously struggled to access a simple malaria test can now receive quality diagnosis and treatment close to home, reducing delays in care and preventing severe illness.

The initiative is much more than the provision of free medicines. It represents a systematic strengthening of Uganda's primary healthcare system. By extending services beyond young children, the programme addresses a larger reservoir of malaria infection, helping reduce transmission and supporting the country's malaria elimination efforts.

Currently, approximately 85,000 Village Health Team members provide community-based health services across Uganda. The programme continues to expand into new districts, bringing essential malaria services closer to millions of people and reinforcing communities as the first line of defense against the disease.

Strong partnerships have been instrumental in making this vision a reality. Under the Ministry of Health leadership The World Health Organization (WHO) serves as the technical lead in supporting this paradigm shift, aligned with Uganda's innovative 24-2 Hours Initiative, which aims to ensure access to quality malaria diagnosis and treatment within 24 hours of symptom onset and life-saving pre-referral treatment for severe malaria cases within two hours. WHO provides strategic guidance to strengthen community-based malaria services and integrate them within the broader health system.

Looking ahead, WHO is supporting the transformation of community-based malaria case management into a comprehensive package of integrated malaria elimination services. This expanded approach includes malaria vaccination, social and behaviour change interventions, community engagement, social marketing of personal protection measures, support for environmental management and vector control activities, and the promotion of chemoprophylaxis among eligible populations.

Development partners continue to play a vital role. The Global Fund supports community health system strengthening, electronic Community Health Information Systems (eCHIS) commodities and implementation cost. The programme currently operates in 80 districts, with plans for further expansion into high-burden and epidemic-prone areas. The United States Government, through its malaria and health programmes, supports training, technical assistance, commodity availability, and digital health innovations. UNICEF, with support from partners, is contributing to the revitalization of Village Health Teams and strengthening community engagement.

The Government of Uganda has positioned community-based malaria case management at the centre of its national health agenda. The Uganda Malaria Elimination Strategic Plan (2026-2030) identifies iCCM scale-up as a key intervention to reduce malaria-related illness and death while improving access to healthcare in underserved communities. Importantly, the Government is institutionalizing community health services through sustained support for VHTs and CHEWs, ensuring that community-based care becomes a permanent pillar of the primary healthcare system.

By bringing free malaria diagnosis and treatment closer to where people live, Uganda is demonstrating how community health systems can save lives, reduce poverty, improve health equity, and strengthen resilience. The initiative is expected to improve access to quality-assured malaria services, reduce demand for hospitalization, lower malaria-related economic losses, and accelerate progress toward a malaria-free future. Uganda's experience offers a powerful example of how government leadership, community engagement, and strong partnerships can work together to deliver health services to those who need them most.