The basis for POR, as for the achievement of malaria-free status, is the early detection, management, and reporting of any malaria case, whatever its origin, by the health services. For early detection to be possible, health services must be universally distributed, and accessible, and primary level service providers must be alert to the possibility of malaria in patients with symptoms compatible with a locally appropriate case definition of suspected malaria. All programmes in the POR phase include training of health care providers and supplies of diagnostics and medicines, but the training does not always reach the primary level, and, consequently, case detection is delayed. In Sri Lanka, the absence of indigenous malaria led to a loss of awareness among the medical profession, resulting in delayed diagnosis despite the widespread availability of malaria diagnosis service, and this had to be remedied systematically by a multi-pronged educational approach [
4]. The readiness of the general health services to deal with suspected malaria should be monitored. In the past, annual blood examination rate (ABER) was considered a good indicator; the validity may be compromised, because the numerator can be inflated by misguided active case detection. Annual blood examination rate based on data exclusively from passive case detection could be better, but it is difficult to establish benchmarks, because the occurrence of patients with a relevant travel history varies in time and space. The “1-3-7”approach, which has proven practical and useful, monitors the timeliness of reporting of detected cases [
5], but ignores cases that are missed or not reported. Some scientists are exploring questionnaire surveys and simulated patient methodologies [
6]. Such methods are more laborious, but also more valid.