A new study shows how to improve the delivery of seasonal malaria chemoprevention to countries facing barriers, such as extreme weather events or conflict.
Delivering life-saving malaria prevention services in areas affected by conflict and flooding continues to present unique operational challenges in many African countries. A new study published in Malaria Journal examines the key drivers and barriers to delivering seasonal malaria chemoprevention (SMC) in conflict-affected regions of South Sudan. The findings have important implications for maximising the impact of SMC as a national malaria prevention strategy and ensuring life-saving antimalarial medicines continue to reach those in complex settings.
“This research has generated actionable evidence that is already informing SMC improvements in South Sudan. The findings demonstrate how operational research can be translated into targeted actions to strengthen service delivery, improve coverage and maximise impact for vulnerable children,” says Dr Jamshed Khan, Country Technical Coordinator for Malaria Consortium South Sudan.
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Since its introduction in South Sudan in 2022, SMC has become a critical strategy for protecting children aged 3-59 months from malaria during peak transmission seasons. Yet ongoing civil conflict, population displacement, flooding and inadequate health infrastructure have made it challenging to deliver health services to communities. In Aweil South and Aweil West counties in Northern Bahr el Ghazal state, for example, seasonal flooding and conflict have resulted in essential health facilities becoming damaged or non-functional, hindering the local community’s access to care. In 2024, SMC coverage was at 79 percent, which is below the 90 percent target.
To help bridge SMC coverage gaps, the research team sought to understand the challenges and opportunities associated with SMC implementation in conflict-affected regions in Aweil South and Aweil West. The study found that community trust played an important role in supporting SMC delivery and is vital for programme sustainability. Local health workers (known as boma health workers) and community distributors ensure that communities understand the importance of SMC and how to administer it correctly, helping to increase acceptance and uptake. Since SMC has been implemented in Aweil South and Aweil West, malaria cases dropped by 72.2 percent between 2022 and 2024, according to national data.
Delivering SMC alongside complementary malaria control interventions, such as insecticide-treated net distribution and malaria case surveillance, was highlighted as another key enabler. The findings suggest that approaches that build on existing community networks and health system structures may support more sustainable implementation in challenging settings.
Alongside the factors contributing to successful delivery, stakeholders also highlighted several challenges that can affect programme implementation. Many of these interconnected barriers stem from the complex operating environment in South Sudan.
During the 2024 SMC campaign, conflict and population displacement made it difficult to accurately estimate the number of eligible children in an area, affecting planning and resource allocation. Project staff noted severely strained resources as a result. Poor road networks and infrastructure, coupled with flooding, additionally affected access for remote and mobile communities, further complicating the distribution of medicines.
Study participants also reported challenges relating to communication systems, workforce capacity and logistical coordination, all of which can influence the efficiency and reach of SMC campaigns.
The study demonstrates how implementation research can help programmes adapt to complex operating environments and identify practical solutions to delivery challenges, enabling a more targeted approach. In 2025, SMC coverage had exceeded 80 percent, with two cycles exceeding the 90 percent target, improving from the 2024 cycles. This is a powerful example of how systematically generating and using implementation data can support programme adaptation and improvement, particularly in complex and underserved humanitarian settings.
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“The findings provide valuable evidence for implementing teams and policymakers to develop targeted interventions that address challenges limiting access to and coverage of SMC. They highlight enabling factors that can be strengthened and scaled up to enhance SMC delivery, maximising its uptake and improving coverage among eligible children,” says Abubaker Rom Ayuiel, SMC Project Manager at Malaria Consortium.
The evidence generated on the drivers of successful SMC implementation in South Sudan — including strengthening drug supply chains, increasing the capacity of the healthcare workforce, and implementing innovative approaches such as mobile clinics — can help inform future malaria prevention efforts and strengthen access to life-saving interventions in other affected countries.