OBJECTIVES: The objective of the study was to assess availability and use of malaria RDT in health facilities in the Gomoa West district and investigate adherence patterns of clinicians to the incorporation of malaria RDT results in case management.METHODS: A cross-sectional study was carried out in selected health facilities to review stock records for malaria RDT, and to assess malaria RDT availability over one year period. A pretested data extraction sheet was used to extract data on the proportions of suspected malaria cases tested with malaria RDTs. A structured questionnaire was administered to prescribers to collect data on adherence to RDT use and incorporation of RDT results in case management. Data were analyzed and chi square test was used to assess associations. Detailed analysis was done with logistic regression model to assess strength of associations.RESULTS: Least malaria RDT availability of 87.7% was recorded in 3 facilities. Three facilities recorded 100% availability. Overall, 256(73.6%) out of 348 suspected malaria cases were tested with malaria RDT. No significant associations were found between malaria RDT testing and age (below 5 years and 5 years and above), temperature and caseload per day. However there was significant association between facility type and malaria RDT testing (p value<0.001). Out of 137 positive malaria RDT results, 132(96.3%) received antimalarial.68 (37.1%) out of 119 negative results did not receive antimalarial whiles 51(42.9%) received antimalarial.There was significant association between malaria RDT results and prescribing of antimalarial (p value<0.001).CONCLUSIONS: Malaria RDT availability and RDT testing rates were optimal in all health facilities with testing rates better in CHPS and health centers than district hospital. However, given the proportion of patients receiving presumptive treatment is high (26.4%) and some negative malaria RDT cases receive treatment, there is the need to intensify education if success in adherence to guidelines is to be achieved.