In recent years, severe flooding has posed a significant challenge to delivering seasonal malaria chemoprevention (SMC) medicines, threatening access to life-saving malaria prevention for children under five. In 2024, after severe flooding affected SMC campaigns in countries including Chad, Nigeria and South Sudan, Malaria Consortium's operations team updated its protocols and created adaptive principles for SMC delivery in affected areas, based on countries' insights and lessons learnt. This ensures that even in the most flood-prone areas, eligible children can continue to receive protection against malaria.
In Nigeria, severe flooding disrupted health services, displaced thousands and created challenges in ensuring children received their scheduled doses of SMC medicines. For example, in Borno state, heavy rains submerged communities and cut off essential infrastructure. In South Sudan, seasonal flooding has repeatedly hindered SMC implementation. In 2024, severe flooding once again threatened to derail the SMC campaign, leaving thousands stranded in waterlogged villages, exacerbating already high malaria transmission rates, and potentially leaving many eligible children without timely access to SMC. Chad also experienced devastating floods in 2024. In areas where Malaria Consortium supports SMC, almost all health districts were affected, forcing thousands of households to seek refuge in public buildings such as churches, mosques and schools.
The widespread displacement and destruction of roads created immense logistical challenges for SMC delivery, requiring innovative adaptations to reach vulnerable children in their temporary shelters. Despite these challenges, Malaria Consortium was able to reach those most at risk through rapid response and collaboration with local communities. For example, in anticipation of severe flooding, local SMC implementers strategically stocked SMC medicines and other commodities before roads became impassable. In Borno, medicines were stored in higher-ground warehouses and in health centres serving camps for internally displaced persons (IDPs), ensuring availability when needed. In South Sudan, medicines were sent to functional health facilities which have the capacity to store medicines in flood-prone areas to prevent delays. In Chad, additional tracking tools such as notebooks were provided to community distributors, enabling them to register displaced children and link them to their designated health districts.
When traditional door-to-door distribution became impossible, fixed-point sites were established in IDP camps and accessible communities. In Nigeria and South Sudan, boats and canoes were deployed to transport medicines and implementers to isolated villages. In Chad, implementers turned to animal-drawn carts and motorbikes provided by local communities to reach children in need in areas that were inaccessible for cars, demonstrating strong local ownership of SMC.
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In the face of adversity, these adaptive strategies helped maintain good SMC coverage. In Borno, administrative coverage was very high, demonstrating SMC's ability to track and reach displaced children. In South Sudan, pre-positioning and mobile distribution significantly reduced delays and made SMC delivery possible in areas where villages were cut off and roads impassable, allowing children to receive SMC medicines on time. In Chad, the use of alternative transport methods and strengthened tracking systems ensured that children in temporary settlements continued to receive SMC, mitigating the impact of displacement on malaria prevention efforts.
Implementing SMC in flood-affected areas in 2024 has reinforced key lessons learnt from maintaining SMC during the COVID-19 pandemic. Proactive planning and flexible distribution models are essential for reaching vulnerable populations, while strong collaboration with local communities enhances efforts to map affected communities and improve service delivery in crisis situations. These strategies are central to Malaria Consortium's SMC flood adaptation principles. With the climate crisis increasing the frequency and severity of extreme weather events, adaptations are more essential than ever. By fostering innovation and strengthening partnerships, Malaria Consortium continues to demonstrate that SMC delivery can be maintained despite severe flooding. Ensuring that children in the most vulnerable communities receive the protection they need remains a priority, now and in the future.
