Malaria Consortium’s SMC programme
Across the Sahel, most malaria illness and deaths occur during the rainy season, typically between July and October. Seasonal malaria chemoprevention (SMC) is a highly effective intervention to prevent malaria infection during this peak transmission period among those most at risk: children under five.
SMC is defined as the intermittent administration of full treatment courses of an antimalarial medicine during the malaria season. The World Health Organization (WHO) recommends administering four monthly courses of two antimalarial drugs to children aged between three and 59 months: sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ). SMC is typically delivered household-to-household by volunteer community distributors. It is a safe, cost-effective and feasible intervention, which can prevent up to 75% of malaria cases in children under five. In 2018, SMC was implemented in 12 countries of the Sahel, reaching around 19 million children. It was also estimated, however, that around 12 million children who live in areas that could benefit from SMC were not covered.
Malaria Consortium has been a leading implementer of SMC since WHO issued its recommendation to scale up the intervention in 2012. Starting with an early implementation pilot in Nigeria in 2013, we then led the rapid scale-up of SMC through the Achieving Catalytic Expansion of Seasonal Malaria Chemoprevention in the Sahel (ACCESS-SMC) project in 2015–2017, reaching close to seven million children in Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria and The Gambia. Since 2018, Malaria Consortium has continued to implement SMC, mainly using philanthropic funding received as a result of being awarded Top Charity status by GiveWell, a non-profit organisation dedicated to finding outstanding giving opportunities through in-depth analysis. We also receive funding for SMC from other donors, including the Global Fund and DFID. In 2019, we reached around six million children in Burkina Faso, Chad and Nigeria and continued to expand our SMC programme in 2020 to reach over 12 million children across these countries and in Togo. We are also now undertaking research studies in Mozambique and Uganda to assess the feasibility, acceptability and protective effect of SMC outside of the Sahel, where malaria transmission is seasonal.
Malaria Consortium provides technical, logistical and financial support to SMC campaigns and works with governments and implementation partners to deliver the following SMC intervention components:
Planning and enumeration
Planning typically starts four to five months before the annual SMC campaign. This involves determining where and when the campaign will be implemented and estimating the target population of children aged three to 59 months, as well as recruiting the required number of community distributors and supervisors.
Procurement and supply management
Most of the SPAQ for use in Malaria Consortium’s SMC campaign is procured by our global operations team. Because as yet there is only one manufacturer capable of manufacturing quality-assured SPAQ in the required formulation and packaging for use in SMC, global production capacity is limited and orders must be placed around one year in advance. Our team manages the shipment of SPAQ from the manufacturer in China to the central warehouses in the countries in West Africa where we implement SMC. From there, the medicines and other SMC commodities, such as T-shirts, bags and pens for SMC implementers, are distributed to health districts and health facilities ahead of the SMC campaign.
To ensure maximum uptake, mass campaigns such as SMC need to be well accepted by beneficiaries. Ensuring communities understand the rationale for SMC and support its implementation is therefore essential. Typically, this includes sensitisation meetings with local leaders, airing of radio spots, and town announcers disseminating relevant information during the campaign. Malaria Consortium supports the development of health communication messages and social and behaviour change materials.
SMC implementers are typically trained through a cascade model starting at the national level about one month before the campaign, with each cadre of trainers subsequently training the next lower level of trainers and learners. All community distributors and supervisors attend a one- or two-day classroom training before the start of the campaign. Malaria Consortium has played a key role in developing the training materials used in the countries where we implement SMC.
SMC is delivered to eligible children door-to-door by community distributors, who typically work in pairs. Each monthly SMC course involves one dose of SP and three daily doses of AQ, with SP and the first dose of AQ given under the supervision of the community distributor, and the remaining two doses of AQ given by the caregiver over the following two days. Malaria Consortium has led the development of guidance for SMC implementers, as well as tools to ensure high-quality implementation, for example job aids for community distributors.
Supervision, monitoring and evaluation
During the SMC campaign, supervision is typically provided by salaried, facility-based health workers, with support from district, regional and central-level supervisors, as well as Malaria Consortium staff. Administrative monitoring data, including SPAQ doses provided and adverse events, are collected by community distributors on tally sheets, which are compiled by health workers and reported to the district level. To draw robust conclusions on program coverage, Malaria Consortium routinely conducts household surveys. Stock consumption and management data collected at health facilities and at district and national warehouses are further sources of monitoring and evaluation (M&E) data.
As an organisation, Malaria Consortium is committed to technical excellence. Within our SMC programme, much of our work is about continuous improvement of quality of SMC implementation, as well as contributing to the evidence base through M&E and research.
 World Health Organization. WHO policy recommendation: seasonal malaria chemoprevention (SMC) for Plasmodium falciparum malaria control in highly seasonal transmission areas of the Sahel sub-region in Africa. Geneva: WHO; 2012.
 WHO. World malaria report. Geneva: WHO, 2019.