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Despite the change that occurred in Ghana�s malaria drug policy six years ago, some hospitals, clinics, health centres and pharmacy shops continue to prescribe chloroquine for the treatment of uncomplicated malaria. Worried over the situation, the acting Director-General of the Ghana Health Service (GHS), Dr Frank Nyonator, has directed all health facilities to stop prescribing chloroquine for the treatment of uncomplicated malaria (non-severe form of malaria). Speaking at a stakeholders� meeting of INDEPTH Effectiveness and Safety Studies of Antimalarials in Africa (INESS) in Accra Monday, Dr Nyonator warned that �any health facility having chloroquine and administering it for the treatment of malaria will have to answer why�. He said every effort must be made to ensure that chloroquine did not block the use of artemisinin-based combination therapies (ACTs) in the country. A study undertaken by INESS in Kintampo in the Brong Ahafo Region, Dodowa in the Greater Accra Region and Navrongo in the Upper East Region from 2009 to 2011 has shown that some health facilities in the country are still prescribing monotherapies such as chloroquine for the treatment of uncomplicated malaria, although the drug has been found to be ineffective in the treatment of malaria. In 2005, Ghana switched to the use of ACTs due to increasing resistance to chloroquine for the treatment of uncomplicated malaria. The first line ACTs for the treatment of uncomplicated malaria in Ghana are Artesunate Amodiaquine (ASAQ) and Arthemether-Lumefantrine (AL). Dr Nyonator said the results from the studies would be used to improve healthcare systems in the country. Buttressing Dr Nyonator�s directive to stop the use of chloroquine, the Principal Investigator of INESS, Prof Fred Binka, said something ought to be done to stop public health institutions from prescribing monotherapies to treat malaria. �People have been taking chloroquine for so long and see no need to change, and for public health facilities to be offering them this opportunity is unacceptable,� he said. On INESS, Prof Binka said the project was to provide national, regional and international health decision makers with independent and objective evidence on the safety and effectiveness of new anti-malarial drugs as a basis for a malaria treatment policy. The INESS project provides the platform for the safety, effectiveness and efficacy of antimalarials to be studied in real-life settings in Africa. The four-year project, which started in 2009 with Ghana and Tanzania, is being funded by the Bill and Melinda Gates Foundation. Mozambique and Burkina Faso are also involved in the project. Making a presentation on how certain factors in the health system, access to health facilities and patients� adherence to a treatment schedule could affect the efficacy of ACTs, Dr Frank Atuguba, the Site Co-ordinator for Navrongo, explained that, for instance, if 1,000 patients had fever/malaria and sought treatment in a health care facility, in the end only 70 out of the 1,000 would be treated effectively. That, he said, was due to many factors, such as the correct diagnosis of the case, access to a healthcare facility, compliance and patient�s adherence to treatment schedule. Dr Atuguba said there was the need to take a second look at the factors impacting negatively on the efficacy of drugs at the various levels in the health system. He said a lot of money was being used to purchase drugs but if, at the end of the day, the drugs were not working due to factors in the healthcare system, then it amounted to pouring money down the drain. Another presentation on the study of �Community and Provider Acceptability of ACTs� by Livesy Abokyi of the Kintampo Health Research Centre indicated that the first source of care for fever/malaria was herbal remedies. The study also found that most Community-based Health Planning and Services (CHPS) use Rapid Diagnostic Test (RDTs) but there were some shortages. However, it came to light that none of the private providers used malaria diagnostics but they had in stock many mono and combination therapies and the treatment was based on what patients asked for or what the drug store operator preferred.