This month (December) we celebrate Universal Health Coverage day and recognize that health is not a privilege but a human right. Universal Health Coverage makes health care more accessible, more equitable, and more effective and ACCESS-SMC seeks to do just that by bringing all eligible children lifesaving Seasonal Malaria Chemo-preventive medicine in an effective and sustainable way.
Since July 2015, teams of thousands of Community Health Workers (CHWs) have been mobilized to bring Seasonal Malaria Chemoprevention (SMC) to 3.4 million children under 5 in 7 countries  across the Sahel. To reach all these children, two approaches of mass drug administration were adopted: house to house and fixed point distribution (e.g. from health centers or schools etc.).
As part of the 2015 SMC campaign in Niger, one of the 7 supported countries involved in the ACCESS-SMC project, Catholic Relief Services (CRS), the National Malaria Control Program and the Ministry of Health collaborated closely to establish the most effective way to bring this treatment to the greatest number of eligible children possible.
It was initially thought that in the urban setting of Maradi, the fixed point distribution approach would be the most effective way to deliver the SMC treatment. Extensive communications activities were carried out prior to the launch of the campaign in order to raise awareness about the benefits of SMC and sensitize families to the implementation process. However, in spite of increasing national coverage rates between the first and third cycles (from 58% to 72%), the city of Maradi was stuck at a meagre 15% for the first, second and third cycles. With no increase in coverage rates, a new strategy had to be adopted to increase the number of children receiving SMC.
In time for the fourth cycle, the house to house approach was adopted in Maradi and teams of CHWs began to scour the city for eligible children, visiting families at their homes to ensure that no child was left untreated. The house to house approach, while more costly and time consuming, has many benefits as it allows families one-on-one time with the CHWs. This time is invaluable as it gives them the opportunity to discuss questions and fully understand the importance of SMC.
This strategic change in drug delivery had a positive impact, with coverage rates soaring from below 15% to almost 90%. Not only did this change in approach mean that more eligible children were able to benefit from SMC, the house visits also gave teams of CHWs and supervisors the opportunity to better understand why the fixed point distributions had not been successful. “We rely mainly on community health workers to relay our messages as they are in constant contact with our target populations. We cannot afford to not involve them in our campaigns,” asserted the Deputy Chief Medical Officer of Maradi District.
It was feared that the low level of community engagement and resulting coverage rates and were due to suspicions, fears of side effects, religious objection and/or misunderstanding at the community level, however when asked why they had not sought this preventive treatment, families simply replied: “Women have lots of things to do during the day in our households. We cannot let them spend the whole day at the health center” (Head of household, Maradi).
After a challenging start, the decision to adopt the house to house distribution strategy in Maradi created a significant transformation in coverage, triggering 80% coverage at the 4th cycle. “This result is very encouraging for the next year’s campaign when the house to house method of distribution will be applied to the urban area in Zinder as well”, said Lantonirina Razafindralambo, CRS’s ACCESS-SMC Deputy Project Director.
 Burkina Faso, Chad, Guinea, Mali, Nigeria, Niger, The Gambia