Among 1,068 febrile patients, adherence to outpatient malaria guidelines was at 57% (5% CI 53.94-59.87), assessed using a composite “test and treat” indicator. About 61% of febrile patients were tested, 87% of malaria test-positive patients treated with Artemether Lumefantrine (AL), and 98% of test-negative patients not treated for malaria. At facilities with malaria diagnostics and medicines the composite performance was 60%. High-risk areas tested 7% more commonly for malaria. From 1,631 admissions with suspected malaria, adherence was at 57% (55.54-59.34), with 86% of febrile patients tested on admission, 95% of test-positive severe malaria cases treated with injectable Artesunate, and 6% of test-positive uncomplicated malaria cases treated with AL. Adherence was higher for children (60%) than adults (53%). In low-risk areas, antimalarial treatments were less commonly prescribed for test-negative patients.