Malaria prevention and control is a major foreign assistance objective of the U.S. Government (USG). In May 2009, President Barack Obama announced the Global Health Initiative (GHI), a multi-year, comprehensive effort to reduce the burden of disease and promote healthy communities and families around the world. Through GHI, the United States will help partner countries improve health outcomes, with a particular focus on improving the health of women, newborns, and children. Rwanda has been selected as a GHI Plus country.The President's Malaria Initiative (PMI) is a core component of the Global Health Initiative (GHI), along with HIV/AIDS, and tuberculosis. PMI was launched in June 2005 as a 5-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in 15 high-burden countries in sub-Saharan Africa. With passage of the 2008 Lantos-Hyde Act, funding for PMI has now been extended and, as part of the GHI, the goal of PMI has been adjusted to reduce malaria-related mortality by 70% in the original 15 countries by the end of 2015. This will be achieved by continuing to scale up coverage of the most vulnerable groups - children under five years of age and pregnant women - with proven preventive and therapeutic interventions, including artemisinin-based combination therapies (ACTs), insecticide-treated nets (ITNs), intermittent preventive treatment of pregnant women (IPTp), and indoor residual spraying (IRS). Rwanda officially became a PMI country in FY 2007, although the USG had been supporting malaria control activities for several years before that.Over the past ten years, Rwanda has scaled up malaria control interventions successfully and has set the ambitious goals in their 2013 - 2018 Malaria Strategic Plan (MSP) of achieving pre-elimination status (test positivity rate of less than five percent) and near zero malaria deaths by 2018. Malaria control efforts, combined with significant improvements in maternal and child health, vaccinations, and HIV/AIDS, have reduced all-cause under-five mortality by 50%, from 152 deaths per 1,000 live births in 2005 to 76 deaths per 1,000 live births in 2010. From 2005 to 2012, the Rwandan HMIS has shown remarkable improvements in malaria indicators: an 86% reduction in malaria incidence, 87% reduction in malaria morbidity, 74% reduction in malaria mortality, and a 71% reduction in malaria test positivity rate. However, the Rwandan HMIS also shows how fragile gains in malaria control can be as significant upsurges have been identified and responded to in 2009, 2012, and 2013.