The World Health Organization aims at universal access to effective antimalarial treatment by the year
2015. Consequently, an enormous financial resource has been invested on Artemisinin Combination Therapy
(ACT))) subsidy. In Tanzania, strategies to increase access of artemether-lumufantrine (ALu) rural areas, where
the burden is highest, includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug
dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria
access ALu from the private sector in rural areas. A total of 1,235 under fives randomly selected from 12 rural
villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured
questionnaire, caretakers were interviewed about the child’s history of fever in the past 7 days; type of treatment
given and the source. Baseline data were obtained on demographic characteristics, caretakers’ knowledge about
malaria and social economic indicators of the household. Of the 1,235 children followed-up, 740 care-seeking
visits were recorded, of which, 264 (35.7%) were made at government health facilities and nearly a quarter
(24.1%; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22% of the
caretakers sought care from FBO and ADDOs. While 686 (86.6%) of the episodes were treated with
antimalarials, only 319 (43%) received ALu, the recommended antimalarial. Majority (83%) of the visits made at
government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0%)
and ADDOs (25.0%). In conclusion, this study has shown that less than a quarter of fever episodes suspected to
be malaria in rural areas were made at FBO facilities and ADDOs, of which, less than half were treated with
ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas,
where the malaria burden is highest. This cast some doubts if the target of universal access to effective
antimalarial, by 2015, will be reached. There is need to consider enlisting the services of community health
workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers’ /
dispensers’ preference for non-recommended antimalarials in the private sector and caretakers’ preference for
ordinary shops.