Transforming the malaria landscape in the Sahel:
seasonal malaria chemoprevention
Diego Moroso, Malaria Consortium
February 13, 2017
Strategic intent
Shape the market
Demonstrate feasibility, safety and
effectiveness at scale
ACCESS-SMC: Goals and Achievements
Shaping the market
• SP+AQ procurement, delivery and administration
The Gambia,
331,664
The
Gambia,
363,868
Niger,
2,445,055
Mali,
3,501,318
Guinea,
1,038,334
Burkina
Faso,
2,900,000
Nigeria,
3,441,989
Chad,
1,075,824
2015: 14.7M treatments
Niger,
4,203,729
Mali,
5,666,788
Burkina Faso,
8,224,674
Nigeria,
7,636,650
Guinea,
1,665,707 Chad,
2,270,788
2016: 30M treatments
Shaping the market
120
100
Eligible target
(100M)
80
60
Funded treatments
40
67M
20
0
QA treatments
available
16.8M
2015
2016
SMC market comparison, 2015 vs 2016
Shaping the market
• Supported the introduction of child-friendly,
dispersible SP+AQ
 Administrative support (registration, packaging)
 Advocating for accelerated ERP process
• Support to additional manufacturers
2014
2015
2016
Feasibility at scale
Feasibility at scale
Achieving high administrative coverage
100
94.2
95
90
96.5
97.2
93.9
94.3
90.8
85
85.1
2015
80
2016
76.9
75
70
65
Cycle 1
Cycle 2
Cycle 3
Cycle 4
Feasibility: is SMC safe?
Safety monitoring and support to pharmacovigilance:
• Are there any major safety concerns in distributing SMC to
a large target population?
showed signs of severe adverse reactions
Feasibility and effectiveness
Coverage verified by surveys:
• Are the right children reached (age / geography)?
• Are they reached during all 4 cycles and effectively
protected?
ADMIN DATA
Weighted average coverage in the region:
91%
______________________________________________
SURVEY DATA
Received at least 4 treatments:
56%
Received at least 3 treatments:
74%
Feasibility and effectiveness
Reduction of malaria cases in children under 5
Human resources
At what cost?
What are the key cost drivers?
Is SMC expensive?
•
•
What are the benefits?
Is SMC cost-effective at scale?
Summary
• Contributed to shaping the market:
 Influencing supply
 Driving the introduction of a child-friendly formulation
• SMC at this scale is:




Feasible
Reasonably priced
Safe
Probably effective if all conditions are met
Challenges
• Supply chain:




Slow international QA processes
Slow registration processes in country
Complex post-shipment inspection procedures
Difficult balance between donor accountability and
country ownership of commodities.
• Definition of targets
 Late planning and quantification processes
 Lack of reliable figures (triangulation)
• Government accountability:
 Delays in contracting and expenses justifications
 Uncertainties in planning
Beyond ACCESS-SMC
Transition to other sources of funding
Uncertainties about funding:
 Keep the momentum for institutional demand
 Expand further
Government ownership (beyond MoH/NMCPs):
 Financing strategy
Coordination:
 Joint planning and procurement
 Data collection and monitoring (impact, resistance, PV)
 Regional coordination
Beyond ACCESS-SMC
Cost-saving initiatives:
 Innovative delivery approaches
 Prospects for integrating interventions  SMCPlus
Targets and duration of SMC
 Expand the target group (10 yrs)
 Plan the potential development for drug resistance
 Expand the geographical scope to SP resistant areas
Conclusions
SMC is not a magic bullet, but in the Sahel it is an effective
complementary prevention approach to malaria control.
The time to invest is now, while drugs are still efficacious,
and in line with a multi-faceted effort to reduce malariarelated cases and deaths in line with the WHO Malaria
Strategy.
Continued support to research is necessary to monitor
effectiveness and drugs efficacy
Over 10M children who could potentially benefit from this
intervention currently are not due to lack of funding
Thank you
www.access-smc.org