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The Malaria Community Case Management (MCCM) program serves to improve access to health services in hard to reach and underserved communities through the use of village health workers and school health coordinators. They mainly educate, test and treat. This was introduced in Zimbabwe after the Alma Ata declaration of 1978, which underscored the role of primary health care in achieving health for all. A descriptive cross sectional was used to do the evaluation in Old Mutare, Ward 23 Mutasa district in the eastern province of Manicaland in Zimbabwe.VHWs and some community members were interviewed about the MCCM. Key informants from the provincial office and health facilities were also interviewed. The MCCM programme in Old Mutare was implemented by trained VHWs (83.3% female) who had strong malaria knowledge and enabled high community awareness, improved prevention practices, and better health-seeking behaviour. Case management outcomes were most evident for uncomplicated malaria through effective assessment, RDT testing, treatment, referral, and reporting. However, MCCM utilization was constrained by insufficient functional VHW coverage across villages (57.1% of estimated need), VHW absenteeism, and stock-outs/limited availability of essential commodities and supplies. In addition, transient and hard-to-reach populations—especially artisanal miners—reduced service uptake and limited the programme’s overall access and impact. Strengthening supply chains and supervision, scaling up VHW coverage near artisanal mining sites, and reintroducing school health coordination are therefore critical to sustain and optimize malaria control gains in Ward 23.