What is SMC?
Seasonal Malaria Chemoprevention (SMC) is a relatively new, highly effective intervention to prevent malaria in children under five – those most vulnerable to the disease’s effects. SMC involves administering up to four monthly doses of antimalarial drugs to children aged 3 to 59 months during peak malaria transmission season. Since it was approved by the WHO in 2012, SMC has been found to prevent up to 75% of malaria cases.
Some 23.7m children are eligible for SMC, the vast majority of who live in the Sahel region. Areas are eligible for SMC are those where:
- The majority of malaria transmission falls within a short rainy season of no more than four months. Since a maximum of four ‘cycles’ of SMC can be given (giving children protection for four months) the intervention is not suitable for areas with a longer rainy season or where malaria transmission is spread over a longer period.
- Where resistance to the SMC drugs is low. This means that the current SMC drugs can be used in the Sahel, but means SMC is unfeasible in areas of seasonal transmission in southern Africa.
The potential for SMC is enormous – from saving lives and reducing illness to preventing school absenteeism and boosting economic growth. If all children eligible for SMC had access to it, some 175,000 lives could be saved each year, and 18 million malaria cases prevented.
How does SMC work?
- SMC is antimalarial medicine made up of two components: sulphadoxine pyrimethamine (SP) and amodiaquine (AQ).
- Children three to 59 months of age, living in areas with high seasonal malaria, receive a course of treatment with SP+AQ each month, for up to four months, during the high transmission period.
- Each month, one dose of SP and the first dose of AQ are given on the first day of treatment, and the second and third doses of AQ are provided to the caregiver to administer on the following two days.
- The treatments provide a high degree of protection, with about 90% efficacy for up to four weeks after treatment.
- This process is repeated monthly for up to four months of the year.
Why is SMC not more widely available?
While 23.7 million children are eligible for SMC, currently only 3.4% of them benefit from this intervention. Health ministries, donors and communities are have shown great interest in implementing SMC and scaling it up, but five critical barriers persist:
- Countries don’t yet have the systems in place to distribute SMC drugs and administer them to children, including trained staff, logistics, tools, plans and communications materials.
- Global production of quality SMC drugs falls far short of demand, and current formulations of SMC drugs are complicated for community health workers to administer.
- The delivery of SMC drugs, which are themselves relatively inexpensive, is considered to be costly, while a lack of analysis and cost benchmarking means SMC’s cost effectiveness is poorly evidenced.
- Although evidence of safety and efficacy of SMC drugs has been demonstrated in trials, there is limited evidence at scale. This uncertainty prevents drug manufacturers and implementers from making large-scale investment in SMC.
- Health ministries, donors and the private sector currently dedicate insufficient financial resources to expanding SMC, meaning resources for scale-up are not available.
ACCESS-SMC is supporting the NMCPs to scale up their SMC coverage, providing technical, logistical and financial support to implement SMC. We bring extensive experience and tested models of SMC delivery. Some of our main areas of work include:
ACCESS-SMC is a UNITAID-funded project, led by Malaria Consortium in partnership with Catholic Relief Services (CRS), which is supporting National Malaria Control and Elimination Programs in seven countries (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, The Gambia) to lead the first-ever at-scale roll out of SMC. Over the next two years, this project will provide an estimated 45 million treatments to vulnerable children.
Planning for SMC delivery
We are supporting countries to prepare to deliver SMC. This ranges from developing high level plans and policies at central level, right down to identifying the number of health workers needed in each remote village. To make sure that delivery goes smoothly, we are working to set timelines, assign responsibilities, develop materials and bring on board all of the different stakeholders – from ministers and health officials to the community health workers to administer the SMC drugs and town criers who inform communities about SMC. The whole ACCESS-SMC project partnership is supporting countries with a wide range of knowledge and expertise, including supply chain management, health worker training, community mobilization and safety monitoring.
Strengthening national SMC drug supply chain systems
SMC is a time-critical intervention andmaking sure the drugs are at the point of distribution in time for the rainy season is crucial. ACCESS-SMC is working with government supply chain agencies, making detailed plans of how the SMC drugs will flow through the system from arrival in country down to the point of distribution – and how they will be monitored and kept secure. Depending on the country needs, we will then provide technical logistical and financial support to make this happen.
Supporting delivery of SMC to beneficiaries
We will support countries to train community health workers to administer SMC (as well as their supervisors and other required health staff), put in place the logistics for delivery, funding mobilization of volunteer community health volunteers and support them to conduct social mobilization and disseminate behavior change communications materials to inform communities of SMC and how their children can access it.
Addressing the remaining 4 challenges
Our implementation of SMC on this massive scale provides us with a platform to address the remaining four challenges. During the two years of SMC administration, we will:
- Show SMC drug manufacturers that there is large, funded demand for SMC products, providing a stimulus to increasing global SMC drug production.
- Provide a platform for studies to improve efficiency of SMC delivery and to demonstrate effectiveness and safety.
- Create evidence to mobilize further resources for SMC.