As international funding for malaria programmes plateaus, it is critical to better understand how to
implement interventions such as first-line Artemisinin Combination Therapies (ACTs) most effectively
through an existing health system.
This thesis presents an expansion of a mathematical model of malaria transmission to provide insight to the
role of health systems factors as barriers to the effectiveness of ACTs, and interventions to overcome them;
considering dimensions of access to care, different sectors through which care is delivered, and the quality of
care provided. Data from the IMPACT 2 study in Tanzania was used to parameterise this approach.
Primary-care based interventions had most impact on transmission. In low-prevalence scenarios some single
interventions, e.g. ensuring 100% care-seeking, eliminated parasite prevalence. Diagnostic-led therapy with
adequate stocks of ACTs was as effective in all settings as a policy of presumptive treatment, reducing
parasite prevalence in under-fives in moderate transmission settings by up to 86% depending on the sector
of implementation.