Rwanda Community-based management of malaria
In late 2016, Rwanda opened community-based treatment of malaria to also include children over 5 years and adults; the government also granted free malaria diagnosis and treatment to the most economically vulnerable populations. 
Community case management is provided by CHWs through complementary programmes of integrated community case management (iCCM) and home-based management of malaria (HBM). With expansion of community management of malaria, by early 2017, 56% of all malaria diagnosis and treatment in Rwanda was done by community health workers (CHWs).  The countrywide cadre of 45,000 CHWs is being expanded to 60,0000 with 2 CHWs per village focused on delivering iCCM and providing diagnosis and testing of malaria for persons of all ages in the community.  The MOPDD introduced a new rapid, short message service (SMS) system in late 2018 to coordinate the referral of severe case cases from CHWs to health facilities. 
iCCM refers to the integrated approach for diseases (including malaria, diarrhea, and pneumonia) among children aged 5 years or less while HBM is for the management of only malaria in community among children aged more than 5 years and adults. 
In 2019, the MOPDD was considering rectal artesunate for pre-referral intervention for severe malaria at the community level while pending transfer of the patient to health facility; there were concerns about cost effectiveness, however, with decreasing numbers of severe cases, particularly among children under five.