Objective To analyze the epidemiological characteristics of malaria and response capabilities of medical institutions in the malaria elimination phase in Guangxi Province, in order to provide scientific basis for consolidating the achievements of malaria elimination. Methods Malaria epidemic data during 2012-2019 in Guangxi were collected through the Information Management System for Parasitic Diseases and the data in 2010 and 2011 were obtained from the “individual questionnaire survey”. SPSS19.0 software was used to analyze the Plasmodium species, imported source country, case reporting situation, distribution of cases and the diagnosis. Results A total of 3 195 malaria cases were reported in Guangxi from 2010 to 2019, among them, one indigenous case was reported in 2012, and one case infected through blood-transfusion was reported in 2015, and the rest 3 193 were imported cases, including 7 cases of foreign nationalities, and 7 deaths. Of the imported cases, 72.3% were infected with Plasmodium falciparum (2 310/3 193), 9.8% with P. vivax (314/3 193), 13.9% with P. ovale (444/3 193), 1.4% with P. malariae (45/3 193), 2.1% with mixed infection (66/3 3 193) and 0.4% were clinically diagnosed cases (14/3 193), respectively. The malaria cases were distributed in 14 cities in Guangxi, with the top 5 being Nanning city (84.6%, 2 700/3 193), Guilin city (3.8%, 120/3 193), Hechi city (3.5%, 111/3 193), Liuzhou city (1.5%, 49/3 193) and Baise city (1.4%, 45/3 193). The cases were mainly at the age of 30-49 years (66.5%, 2 123/3 193), and the male-to-female ratio was 49.7 ∶ 1. The place of inporting source involves 33 African countries (93.8%, 2 994/3 193), 9 Southeast Asia countries (5.9%, 187/3 193), and Guyana of America (0.1%, 3/3 193). The cases at first visit in county-based centers for disease control (CDC) and medical institutions accounted for 80.4% (2 539/3 159) of all visited cases. The rate of confirmed diagnosis of malaria at first visit was 90.6% (2 862/3 159), which was significantly different among the medical institutions at different levels and between CDCs and medical institutions. The correctness rate of identification for parasite species was highest for P. falciparum (92.2%, 2 114/2 292), followed by P. oval (90.5%, 402/444), P. vivax (77.5%, 231/298), and P. malariae (75.6%, 34/45). The average time lag from primary to confirmed diagnosis was (3.15 ± 9.80) d for P. vivax, (1.73 ± 4.45) d for P. malariae, (1.16 ± 3.9) d for P. oval and (0.89 ± 4.81) d for P. falciparum. There was a statistically significant difference in the average time lag for confirmed diagnosis for P. vivax, P. falciparum, and P. oval (P < 0.01). Conclusion There has been no indigenous case of malaria reported in Guangxi Province since 2012. The imported cases were largely falciparum malaria cases, and mainly came from Africa. The county-level medical institutions and CDCs are the main body to respond to the epidemic.