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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) work. SMC is an extremely cost-effective and evidence-backed way of protecting young children from malaria.

The Problem

Malaria, though almost nonexistent in affluent countries, is pervasive in low income countries in tropical and sub-tropical 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 5 are especially vulnerable: a child dies from malaria every two minutes.

The Solution

A new and effective method for protecting children from malaria which is showing great promise is to treat them prophylactically in countries or regions which have seasonal periods of high malaria transmission with amodiaquine (AQ) plus sulfadoxine-pyrimethamine (SP). This combination, known as seasonal malaria chemoprevention or SMC, is taken in 4 monthly courses and is easily administered to young children as a dissolvable tablet.

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 the incidence of clinical attacks and severe malaria by about 75%, and could avert millions of cases and thousands of deaths among children living in this area. When children don’t 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 health workers (CHWs) to deliver SMC treatments, primarily door-to-door, an approach that has been shown to achieve optimal coverage.

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 benefit 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 training for CHWs and supervisors, drug quantity assessment, procurement, storage, transportation and distribution, technical assistance, including logistical planning and design of social mobilization tools, program assessment and improvement, financial management, training materials development, monitoring, evaluation and research, advocacy, and fundraising for SMC programs.

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 the total cost for their delivery of four person-months of SMC to be as low as US$3.40; GiveWell’s more conservative estimate per child reached is US$4.54; According to Unitaid, the cost of delivering SMC per child fell by more than 20 percent over the life of the ACCESS-SMC project, and they estimate the current cost as US$3.40 on average, assuming 100% coverage. 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

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 and to track changes in malaria incidence and deaths, monitoring of drug resistance, and other research. Findings are shared with marlaria stakeholders and on the Resources page of the organization’s website.

Recognition and Partnerships

The Bill & Melinda Gates Foundation funded Malaria Consortium in Nigeria in 2012-14 to pilot, 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, 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, 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 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 programmes in 2016, with over 6.4 million children covered through the ACCESS-SMC project. It is estimated that the entire 3-year ACCESS-SMC program may have prevented over 10 million malaria cases and 60,000 deaths co-led by Malaria Consortium (see Partnerships above). Malaria Consortium continues to help protect children covered by the project through funding from Good Ventures and individual donors.

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.

Frequently Asked Questions

How does the SMC process work?

SMC provides protection for up to 1 month after each complete (3-day) course. CHWs administer the first dose of SP and AQ and advise the child’s caregivers on how to prepare and administer the remaining 2 doses of AQ. This is repeated each month for four consecutive months during the peak of the transmission season (broadly coinciding with a 3-4 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?

CHWs are trained to recognize symptoms and refer sick children to local health facilities where they can be tested and treated for malaria.

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 drugs quantification, health worker and CHW training, 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, 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, estimate 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.

Malaria Consortium itself estimates that a funding gap of roughly US$200 million exists for providing SMC between 2019-2021 to all children in eligible districts in the seven countries for which is has reasonable estimates.

Why does TLYCS recommend Malaria Consortium?

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

Is my donation to Malaria Consortium Tax-Deductible?

US donors can claim eligible tax-deductible donations to Malaria Consortium’s US organization. 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 by donating directly to Malaria Consortium's website, although these gifts will be used to fund whatever work Malaria Consortium thinks is highest priority rather than being restricted to just SMC work.

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 donating to Malaria Consortium through Effective Altruism Australia. These gifts will be restricted to the SMC program.

More Information

Image credits: All photos courtesy of Sophie Garcia.

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