For 40 years, the barangay health workers (BHWs) have been at the frontline of primary health care in the Philippines. In the 1990s, through a (then) AusAID grant, BHWs in one province in Mindanao Island were trained to perform malaria microscopy in an effort to expand malaria diagnostic and treatment services. This was met with much opposition from the academe and medical societies. In 2002, the Department of Health, Philippines released an administrative order that allowed BHWs to diagnose malaria through the use of rapid diagnostic tests, and, based on the results, administer first-line antimalaria drugs. There was a second attempt around this period through the Philippines’ Global Fund grant for AIDS, TB and Malaria, to allow BHWs to perform malaria microscopy as a basis for malaria treatment. The Malaria Control Program persisted in this endeavour despite the opposition. By 2009, the role of BHWs in malaria diagnosis and treatment was official and the Malaria Microscopy Quality Assurance System in the Philippines now includes malaria microscopy proficiency-testing and refresher-training of the BHWs including the use of malaria RDTs. The BHWs have contributed much to the detection and decline of malaria cases in the Philippines, diagnosing more than 70% of the reported malaria cases in remote and hard-to-reach areas. However, a study conducted in 2013 revealed that this unique role of the BHWs is threatened by the Philippines’ decentralized health system. Political changes at the level of the municipality affect their job security and motivation, among others. It recommended maintaining a support structure for these frontline workers, whose role is the initial step of malaria surveillance, and who often work in remote and difficult to access places. The Philippines’ National Malaria Program must involve other sectors and government institutions to retain and support BHWs to reach its 2030 goal.