At a time when public health systems in countries facing the greatest malaria burden are under intense pressure to deliver more with fewer resources, the importance of working more strategically and finding smarter ways to deliver life-saving care could not be clearer.
That’s why at Malaria Consortium, many of our programmes don’t simply deliver a single intervention. Where it suits the context, we take the opportunity to make healthcare go further, reach farther and save more people, especially those who are often missed because of where they live or the barriers they face to accessing care, including long distances and high costs required to travel, understaffed health facilities and lack of knowledge around access.
Integrated service delivery, where two or more health services are combined, or ‘layered’, is derived from a simple principle: if we’re already reaching communities through an established programme, that same platform could deliver multiple life-saving interventions at the same time. More broadly, integration is about making systems work together in tandem. And when health services work together, health programmes are stronger, reaching more people and protecting progress for the long term.
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This principle of making every contact with the health system count applies just as much to treatment as it does to prevention. The World Health Organisation recently announced the prequalification of the first ever malaria treatment designed specifically for newborns and young infants — a group that has long faced gaps in access to safe, appropriate care. Until now, the medication was effective for older children, but presented a risk of overdose if given to babies. This new formulation is suitable for this younger age group. The WHO’s prequalification means that public health systems can now procure it, representing a major leap forward for saving the lives of young children in countries affected by malaria, and a crucial opportunity to ensure treatment reaches children at the same points where families are already being reached with other services.
Maximising every point of contact with the health system in Nigeria
In the rural communities of Kebbi state, northwestern Nigeria, communities are experiencing first-hand the benefits of using trusted seasonal malaria chemoprevention (SMC) platform to raise awareness of the malaria vaccines for children under five, who are most susceptible to malaria. While the introduction of malaria vaccines marks a major breakthrough, getting those vaccines to the right children at the right time is still a huge challenge. Closing this access gap is critical, especially in a country facing one of the highest malaria burdens in the world.
“I did not miss a single dose,” says Aisha Bello, a mother in Koko-Besse local government area (LGA), talking about the malaria vaccine. With limited transport available, she often ended up walking to a health facility several kilometres away. “Even when it rained, even when I was tired, I knew I had to protect my child”.
Using existing SMC campaigns, the ENHANCE project, supported by Gavi, the Vaccine Alliance and implemented by Malaria Consortium and other partners, involves giving reminders to caregivers about bringing their child to receive the malaria vaccine when they visit the home to deliver SMC. SMC entails administering life-saving antimalarial medicines to children at 28-day intervals during the peak malaria transmission season, and has a huge reach, targeting over 30 million children in Nigeria last year. The project’s success revolves around using SMC household visits to identify unvaccinated children and to deploy targeted outreach to under-vaccinated areas. By integrating the malaria vaccine into its framework, it means millions more children can receive their vaccines without having to travel many kilometres to the nearest health facility.
Meeting people where they are, with healthcare they already trust
This trust in SMC is already deeply engrained in the community. SMC has been delivered in Nigeria since 2013 and has reached tens of millions of children in that time. As a result, members feel comfortable engaging during campaigns and recognise the importance of bringing their children to receive the vaccine. Mothers and caregivers like Aisha are crucial allies in promoting acceptance and uptake of both services. “People asked me why I was stressing myself,” she recalls. “But I have seen what malaria can do. I did not want to take that risk.” By the time her child received the fourth and final dose, Aisha had become an advocate. “I started telling other women, ‘If I can do it, you can too.”‘ Aisha encouraged other mothers to take part too, dispelling mistrust and suspicions around the vaccine.
In another remote settlement in Fakai LGA, Hauwa Musa faced similar challenges to reaching health services, only more severe. “There are days when the road is not even passable,” she explains. “But I made up my mind from the beginning that my children must complete [the vaccine schedule].” Hauwa enrolled two of her children into the vaccine programme, ensuring both received all four doses of the malaria vaccine.”Other mothers started following me,” she says. “They would ask, ‘Hauwa, when are you going next?’ We began going together.”
Health programmes work best when locally led and built around how communities realistically access care
Through these informal peer networks, mothers like Aisha and Hauwa have helped to build confidence in the malaria vaccine and strengthened trust in the broader health system.
And the project has led to real change. In Kebbi state, malaria prevalence plummeted from 13.6 percent to just 1.7 percent. Malaria vaccine coverage rose from 34 percent at baseline to 79 percent in one intervention, and from 47 percent to 89 percent in the second intervention. Caregivers themselves became far more conscious of malaria prevention methods, with awareness levels rising from 68 percent at the beginning, to just over 88 percent at the end. The encouraging results show that integrating the delivery of interventions can close the access gap, meaning more children protected from disease.
This hybrid delivery makes sure that when families in Kebbi come into contact with SMC, every visit counts.
Communities don’t experience disease in silos — healthcare shouldn’t be delivered that way either
In Kaipetor village in Karamoja, Uganda, Abura Clementine had grown weary of seeing her child fall ill with malaria, sometimes twice in a single month. The burden it put on her family was immense, forcing them to spend around 35,000 UGX (£7) and travel up to five kilometres to the nearest health facility. “It was not just the sickness,” she says. “It was the arguments at home, the stress of finding money for treatment.”
Her experience points to a systemic problem: services for malaria prevention, vaccination, nutrition and treatment were delivered separately, at different times, through different channels, which meant families had to make multiple difficult journeys.
This changed when village health teams (VHTs are local health workers in Uganda), told her about the malaria vaccine during a routine visit to deliver SMC. “The VHT came to our home and explained everything,” she says. “That is when I decided to go.”
Her child received their first and second doses at Acherer Health Centre II, while the third dose was delivered through a local outreach service. By bundling vaccines, preventive medicines and other essential services into a single contact point, Malaria Consortium’s SEND initiative — implemented as part of Uganda’s Essential Programme on Immunisation and in collaboration with Uganda’s National Malaria Control and Elimination Division, alongside Gavi, UNICEF and the World Health Organization — is designed to reduce the number of interaction families need to have with the health system in order to receive care.
In Karamoja, where some communities follow seasonal or mobile livelihoods, access to routine health services is often inconsistent – not only because of distance, but also because services are not always aligned with how and when people live and move. By coordinating delivery through outreach and aligning interventions like vaccination, SMC and insecticide-treated nets, SEND supports more comprehensive care. Minimising missed opportunities to access protection helps ensure that children are reached at the right time and no community is left behind.
Smarter delivery, tangible impact
“We used to see thirteen malaria cases per day during peak season,” says Moses Achuka, a community health worker in Kaipetor Village. “Now, with the vaccine and SMC working together, we are seeing fewer severe cases, and fewer repeat visits.”
The integrated initiative lies in taking what already exists — a trusted community health workforce and established SMC platforms — and building on it to use resources more wisely and reach more families. “We are not creating new systems,” says Steven, District Malaria Focal Person in Moroto district. “We are strengthening what already exists — and making it deliver more.”
Abura’s story is a testament to the power of consistent outreach, and her family’s transformation mirrors the broader data. Across the region, monthly malaria cases fell by around 50 percent, with vaccine uptake rising from 70 percent to 89 percent. Caregivers had to travel far shorter distances to receive healthcare, and the time per visit was dramatically reduced. For Abura, her family’s life has been changed for the better. “When my child is healthy, the home is peaceful,” she says. “There are no more arguments about money for treatment.”
Digital tools connecting making care go further care
Integration isn’t only about combining health services — though the stories of Aisha and Abura show that this can be highly effective. It is also about strengthening the mechanisms and tools that support the delivery of integrated care. In Mozambique, digital tools are making it possible for a single digital app to be a one-stop shop for a myriad of uses, including patient registration, diagnosis, treatment of illnesses such as malaria, pneumonia and diarrhoea, and referring on cases that require advanced care.
Curssumo Óscar José is a community health worker in the neighbourhood of Paquitequete in Pemba City in Mozambique. She provides services to close to a hundred households, teaching families about healthcare and how to prevent and screen for diseases such as malaria and, where cases are severe, referring them on to the health facility. Before she worked with a digital tool called upSCALE, Curssumo struggled with and felt limited by manual records.
“When encountering certain situations, I often did not know how to respond and had to consult my supervisor or refer the case to the health facility,” she says. But with upSCALE, the application allows her to analyse multiple aspects at once, update household records and organise data more effectively. One of the most useful features of the app is that it can be used to guide a diagnosis.
upSCALE is a community-based mobile health intervention designed to strengthen the quality and coverage of community-level health services. The same mobile application that helps health workers register children for seasonal malaria chemoprevention (SMC) can track vaccination histories, flag children who are overdue for routine immunisations, and coordinate follow-up for multiple health services. With upSCALE, a health worker visiting a household for SMC can instantly see whether children are up-to-date on their routine vaccines. The system can flag high-risk children who need multiple interventions for diseases such as malaria and pneumonia, schedule follow-up visits and provide support to health workers managing complex cases.
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Putting better decision-making skills in health workers’ hands
Curssumo recalls one incident where upSCALE caught something she would have missed otherwise. “In one case, a child presented with diarrhoea, poor feeding and low weight. We initially assumed it was only diarrhoea, but after completing the assessment in the app, the result indicated severe malnutrition.” The health facility later confirmed this diagnosis. “Without the app, we might not have identified the main issue.”
Traditional paper-based systems struggle to keep health records on children across multiple interventions, making it difficult for health workers to know which services a child has received and which they still need. Digital tools like upSCALEchange this equation entirely.
And the same digital tools also help to improve accountability and quality across all integrated services, resulting in more resilient health systems overall. Real-time dashboards allow programme managers to spot areas where specific services are lagging, and when problems emerge, such as vaccine coverage dropping in certain districts, teams can respond quickly rather than waiting for end-of-campaign reports.
No child left behind
The key to making these systems work is implementing them in a thoughtful, considered manner. Our research has shown that simply piling services on top of existing programmes without considering capacity doesn’t work. Instead, we conduct careful assessments of health worker workload, ensure adequate training and supervision, strengthen supply chains to handle multiple commodities, and monitor quality across all integrated services.
As new tools become available, whether additional malaria vaccines, new chemoprevention strategies, or innovations in diagnostics, the ability to integrate them into existing platforms and leveraging existing resources may determine how quickly we can scale their impact. Every campaign, every platform, every contact with communities should be viewed as an opportunity to deliver comprehensive, high-quality health services.
This approach means moving beyond disease-specific silos and taking a broader view of health systems and community needs. It means investing in flexible platforms like SMC and upSCALE that can accommodate multiple interventions. And it means working collaboratively across programmes, donors and implementing partners to make those efforts go further.
Through more intentional integration, we don’t just improve efficiency — we accelerate progress toward our ultimate goal: ensuring that every child, regardless of where they live, has access to the full package of interventions they need to survive and thrive.
