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Make a Difference TodayDonate to Malaria Consortium

Malaria Consortium’s Seasonal Malaria Chemoprevention Program

Malaria Consortium focuses on delivering programs that protect the poorest and most marginalized children in Africa and Asia from a range of deadly diseases, including malaria and pneumonia. The particular program that The Life You Can Save promotes, based on GiveWell’s exemplary analysis, is Malaria Consortium’s Seasonal Malaria Chemoprevention (SMC) project. SMC is an extremely cost-effective and evidence-backed way of protecting children under five years of age from malaria.

The Problem

Malaria, though almost nonexistent in affluent countries, is pervasive in low income countries in tropical and subtropical regions, taking an enormous toll in health, lives, livelihoods and national economies. When a family member contracts malaria, not only does it threaten their own health, but their family—usually already poverty stricken—falls further into destitution due to a range of factors such as navigating the logistics and expense of seeking treatment, losing education or wages from missing school or work due to illness or caregiving, and burial expenses for deaths. Such direct costs have been estimated to be over US$12 billion per year worldwide. Even greater costs in turn are sustained by communities and nations due to factors such as lost productivity and drains on medical systems.

It is no wonder therefore that the Centers for Disease Control and Prevention (CDC) characterizes malaria as “one of the most severe public health problems worldwide.” The World Health Organization estimates that there were 219 million cases of malaria globally in 2017 and more than 435,000 deaths, with over 90% of those in Africa. Pregnant women and children under the age of five are especially vulnerable: a child dies from malaria every two minutes.

The Solution

SMC is an effective method for protecting children from malaria that has been implemented in 14 Sahelian countries since 2013. SMC works by providing four monthly prophylactic treatments of amodiaquine (AQ) plus sulfadoxine-pyrimethamine (SP) during the period of greatest risk, which typically coincides with the rainy season. The tablets easily dissolve with water. Both SP and AQ are given to the child by directly observed therapy by a trained community distributor. The child’s caregiver is then instructed to give the child two remaining doses of AQ daily in the following two days.

Since 2012, the World Health Organization (WHO) has recommended SMC for children aged 3–59 months living in areas of high seasonal malaria transmission in the Sahel subregion of Africa. The WHO reports that SMC has been proven to reduce approximately 75% of all malaria episodes and 75% of severe malaria cases. . When children do not contract malaria, not only is their own health protected, but the transmission pool is reduced, which helps the whole community.

Malaria Consortium supports training of health workers and community distributors to deliver SMC treatments, primarily door-to-door. This approach that has been shown to achieve optimal coverage. The organization also ensures availability of SP and AQ for SMC distribution and works with national, state and district health authorities to ensure adequate supervision, monitoring and evaluation of the intervention.

In 2017, 15.7 million children in 12 countries in Africa’s Sahel subregion were protected through SMC programs—three of the countries were through the work of Malaria Consortium. However, an estimated 14-16 million children who could have benefited from this intervention have not yet been reached, mainly due to a lack of funding.

How Malaria Consortium is different from other charities

Malaria Consortium has been a global leader in SMC, exemplified by its work as the prime recipient and implementer of Unitaid’s large-scale ACCESS-SMC project between 2015-17 (see Track Record below). Their efficacy and transparency have earned them recognition and support from multiple important partners (see Partners below).

The organization supports a wide range of elements required for a successful SMC program, including: developing training materials and data collection tools, training all SMC implementation and evaluation staff; drug quantity assessment, procurement, storage, transportation and distribution of SMC medicines; advocacy and logistical planning and design of social mobilization tools; program evaluation, quality control, quality improvement; and financial management. In addition, Malaria Consortium is committed to monitoring and evaluating the SMC program and to conducting research to improve its efficiency. Malaria Consortium also engages with a wide range of SMC stakeholders for advocacy and fundraising purposes.

Malaria Consortium’s structure is designed to build and leverage local expertise and sustainability: 95 percent of their staff work in malaria-endemic areas and the organization collaborates with communities, governments, academic institutions, and local and international organizations.

Why Malaria Consortium's SMC work is Effective

Cost effectiveness

Malaria Consortium estimates that the total cost for their delivery of SMC was between US$2.85 and US$4.25 per child/per season in 2018. Cost varies by country based on scale and differences in economic prices. GiveWell’s more conservative estimate per child reached is US$4.54; GiveWell estimates Malaria Consortium’s cost to save the life of a child who would otherwise have died to be US$2,041, which is low compared to many other interventions.

Monitoring, Evaluation and Research

Malaria Consortium conducts extensive monitoring and evaluation to determine what proportion of children targeted by their SMC programs receive treatments. Staff directly observe program activities and collaborate with academic institutions and evaluation firms to conduct coverage surveys, track changes in malaria incidence and deaths, and monitor drug resistance. The organization also carries out implementation research to identify bottlenecks and improve efficiency and quality of SMC delivery. Findings are shared with malaria stakeholders and on the dedicated SMC page of the organization’s website.

Recognition and Partnerships

Malaria Consortium received support from the Bill & Melinda Gates Foundation and the DFID-funded Support for the National Malaria Programme in Nigeria in 2012-14 to pilot the feasibility of implementing SMC at scale and gain insights into SMC.

In 2015-17, Unitaid channeled US$68 million through Malaria Consortium for the signature ACCESS-SMC project, the first-ever at-scale roll out of SMC in seven countries, led by Malaria Consortium in partnership with Catholic Relief Services, the London School of Hygiene & Tropical Medicine, Medicine for Malaria Ventures, Management Sciences for Health and Speak Up Africa.

GiveWell has named Malaria Consortium’s SMC program a Top Charity recommendation since November 2016 and their number one Top Charity in 2018, noting that it “offers donors an outstanding opportunity to accomplish good with their donations.” In November 2018, Good Ventures approved a grant of US$26.6 million to Malaria Consortium on GiveWell’s recommendation.

Track Record and Proven Results

Malaria Consortium-supported SMC programs are focused on delivering quality-assured SMC treatment regimens that have been independently studied in rigorous trials and found to be effective. GiveWell notes that seven randomized controlled trials provide strong evidence that SMC substantially reduces cases of malaria.

Unitaid notes that the ACCESS-SMC project supported National Malaria Control and Elimination Programs in seven countries, “fulfilling more than 25 percent of the region’s need, while monitoring the safety, efficacy, cost, and public health impact of seasonal malaria chemoprevention at scale.”

Malaria Consortium estimates that approximately 12 million children were protected through SMC programs in 2016, with over 6.4 million children covered through the ACCESS-SMC project. It is estimated that the entire three-year ACCESS-SMC program may have prevented over 10 million malaria cases and 60,000 deaths co-led by Malaria Consortium (see Partnerships above). Since 2017, Malaria Consortium has continued to implement SMC, largely using philanthropic directed funding from Good Ventures and individual donors. In 2018, around four million children were reached in Burkina Faso, Chad and Nigeria.

Malaria Consortium’s accountability and sustainability

To ensure local insights, effectiveness and sustainability, Malaria Consortium’s staff are almost entirely located in the malaria endemic areas where they work and the organization collaborates with local governments, communities and academic institutions.

Besides its treatment delivery work, Malaria Consortium prioritizes collecting evidence and acquiring expertise useful in influencing governments and other funders to support SMC and playing an important role in motivating greater demand for and production of accessible, affordable, quality SMC drugs.

As an example of SMC’s sustainability, since the end of ACCESS-SMC, project countries have successfully transitioned to other sources of funding, and more countries have started SMC programs. Nigeria, where an estimated 10 to 12 million children could benefit from SMC, has seen a substantial increase in funding from other donors such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, USAID’s President's Malaria Initiative and UK Aid.

Frequently Asked Questions

How does the SMC process work?

SMC provides protection for up to 1 month after each complete (3-day) course.  SMC community distributors administer the first dose of SP and AQ and advise the child’s caregivers on how to prepare and administer the remaining two daily doses of AQ over the following two days. This is repeated each month for four consecutive months during the peak of the transmission season (broadly coinciding with a four month long rainy season).

In which countries does Malaria Consortium do its SMC work?

Currently Nigeria, Burkina Faso and Chad.

What if a child is already ill from malaria?

SMC community distributors are trained to recognize symptoms of malaria and refer sick children to local health facilities where they can be tested for malaria and treated if they test positive. The medicines used for treatment of malaria are different than those used for SMC.

What will my donation pay for?

Donations support Malaria Consortium in providing a range of elements required for a successful SMC program, e.g. planning and quantification of drugs and materials; health worker, supervisor, community distributor training; social mobilization; international drug procurement and shipment; local storage of medicines and other supplies; transportation and distribution; technical assistance, including development of implementation tools (training materials, monitoring tools, social mobilization approaches and tools); financial management; monitoring, evaluation and research; publications and advocacy; and fundraising for SMC programs.

What is Malaria Consortium’s capacity for growth?

According to the ACCESS-SMC project's research findings, both modelling estimates and the original clinical trials, it is estimated that SMC could save tens of thousands of lives per year. However, despite the success of the ACCESS-SMC project, nearly half of all children in need in the Sahel still do not have access to SMC due to lack of funding and limited production capacity for medicines.

GiveWell considers Malaria Consortium to be the best option among their recommended charities for donations at this time. They estimate that Malaria Consortium could absorb US$66 million for work in 2019-2020.

Why does The Life You Can Save recommend Malaria Consortium?

We recommend Malaria Consortium’s Seasonal Malaria Chemoprevention Program because it has been named a Top Charity since 2016 by GiveWell, a highly respected charity evaluator.

Is my donation to Malaria Consortium Tax-Deductible?

Yes. Malaria Consortium is a US registered 501(c)(3) charity. US donors can claim eligible tax-deductible donations to Malaria Consortium’s US organization EIN 98-0627052. Donations made through The Life You Can Save’s donation page will go to this US nonprofit and will be restricted for use on SMC programs.

Eligible UK donors may claim Gift Aid on their donation by giving directly through Malaria Consortium's website. (Please note: to restrict your donation to our SMC program specifically, rather than Malaria Consortium’s work more generally, please ensure that you include a note to this effect.) Donors can also click through from the website to the GiveWell portal and donate specifically to our SMC project there, though there is no option to claim Gift Aid.

Donors from Germany, Switzerland and the Netherlands can claim applicable tax advantages by donating to Malaria Consortium through the Effective Altruism Foundation. These gifts will be restricted to the SMC program.

Donors from Australia can claim applicable tax advantages by giving through The Life You Can Save Australia's Malaria Consortium donation page. These gifts will be restricted to the SMC program.

More Information

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Image credits: All photos courtesy of Sophie Garcia.

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