The World Health Organization recommended SMC in 2012, but the intervention struggled to garner momentum. Many believed that at-scale implementation – which relied on mobilizing community health workers to deliver malaria prevention drugs to children each month during the rainy season, reaching remote communities despite downpours, flooding and washed-out roads – would not be feasible or affordable.

In addition to implementation challenges, supplies of the preventive medicine were insufficient and didn’t exist in dispersible child-formulations.

The ACCESS-SMC project was a large Unitaid investment implemented by the Malaria Consortium that demonstrated delivery of SMC at scale in seven countries, reaching a quarter of all eligible children at that time. That work proved community-delivery of SMC to be a feasible and cost-effective approach, capable of preventing more than 88% of malaria infections in children treated.

Working in parallel, Unitaid, in partnership with Medcines for Malaria Venture, supported manufacturers to develop and market child-friendly formulations of the preventive medicine, while expanding production capacity to meet growing needs. Efforts to increase demand, foster healthy market competition and optimize delivery methods resulted in a 20% reduction in the cost of SMC delivery by the end of ACCESS-SMC in 2018. As of 2024, a full four-month course of SMC costs less than US$4 per child.