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Background: The attainment of the 6th Millennium Development Goal to halt and reverse the effects of malaria and other diseases by 2015 depends on the accessibility of Artemisinin Combination Therapy (ACT) which is now the first line antimalarial therapy for uncomplicated malaria. The main Objective of this study was to assess the availability and affordability of ACTs in Secondary Health Care (SHC) facilities in Lagos State and community pharmacies located within 200 meters of these facilities.Method: Two SHC facilities each were randomly selected from four (4) geographical zones and the only one (1) in the fifth zone was selected, making a total of nine (9) facilities which were surveyed. The eleven (11) community pharmacies located within 200 meters of these health care facilities were also used for the study. A modified HAI was used for data collection on medicine price and availability was used for the study.Results: ACTs (artemisinin/lumefantrine) were prescribed 90% of the time as first line antimalarial. About thirty seven percent (37.5%) of the hospitals did not have the drug in stock at the time of visit and drugs had been out of stock for upward of three weeks. Private partnership pharmacies do not stock antimalarials as a matter of policy, since the drugs are supposed to be obtained free from the hospital. This first line antimalarial cost about six hundred and forty naira (N640) in the private community pharmacies.Conclusion: ACTs are not always available in the hospitals in Lagos State; patients therefore depend on community pharmacies and patent medicine stores for their ACT supply. Since 93.9% of Nigerians live in subjective poverty, the cost of first line ACT antimalarial remains unaffordable and inaccessible.Keywords: Accessibility; Antim alarial;ACTs;Community Pharmacies; Secondary Health Facilities