Malaria remains one of the leading causes of illness and death in Niger, particularly among children under five and pregnant women. Yet across the country, a growing body of evidence is showing that the way malaria is addressed matters as much as the tools used to fight it.

Through the U.S. Bureau of Global Health Security’s Advancing Health and Malaria Services Program in Niger (AHMS Niger), our team is demonstrating that a more holistic approach to malaria prevention and care reduces the burden of disease, drives efficiencies and strengthens the health system itself.

For decades, malaria responses across many low-resource settings have been built in silos alongside other healthcare: one campaign for malaria, another for maternal and newborn health, another for nutrition or tuberculosis. That approach has yielded important gains, allowing programs to rigorously test what works. But in places like Niger, where health workers are few, distances are long, and communities face multiple health challenges at once, a narrow disease-by-disease approach no longer makes sense.

“When a health worker walks several kilometres to reach a household, they don’t find a single issue,” says Paula Wood, Palladium Director of Malaria. “They may meet a sick child, a pregnant woman at risk of malaria, and a parent using traditional treatments because the health facility feels too far or too costly.” A holistic approach recognises this reality and makes every visit count.

At the centre of the Palladium-managed AHMS Niger’s malaria strategy is Seasonal Malaria Chemoprevention (SMC), a flagship life-saving intervention that delivers antimalarial medicines to children aged 3–59 months during the peak transmission season in the Dosso and Tahoua regions. The first dose of each round is administered directly by trained distributors, ensuring adherence and immediate protection. Yet SMC in Niger has evolved beyond drug delivery alone.

During each household visit, community distributors also measure children’s mid-upper arm circumference. Malnourished children are referred to health facilities for follow-up care. Malaria messaging is paired with guidance on recognising danger signs and when to seek care, helping to counter long-standing reliance on ineffective traditional treatments and misconceptions about the cost of clinical services.

The same principle of integration extends to maternal, newborn and child health. Intermittent preventive treatment of malaria in pregnancy is embedded within antenatal care (ANC), encouraging women to attend more than three ANC visits. Those visits, in turn, improve detection and treatment of HIV and other conditions, strengthen the full maternal health package, and contribute to better birth outcomes.

Beyond the Silos

One promising addition to this holistic model came in 2025, when AHMS Niger supported the National Malaria Control Program to formally integrate larval site reduction into SMC campaigns. “Rather than launching a separate vector control effort, supervisors, community health workers, and distributors were trained to identify and eliminate mosquito breeding sites during routine household visits,” explains Wood.

The results were striking. Across the Dosso and Tahoua regions, more than 231,000 larval sites were eliminated during a single SMC campaign period. Radio, television, and community messaging reached more than five million people with practical guidance on malaria prevention. While malaria trends are influenced by many factors such as rainfall and parasite prevalence, teams recorded a reduction in malaria rates during the campaign period, reinforcing the value of adding prevention at the source.

Just as importantly, this integration reduced costs. By digitising elements of the SMC campaign, the team lowered supervisory expenses, reduced the number of vehicles required, and relied more heavily on locally placed distributors rather than large mobile teams. Social mobilisation was streamlined, supervision became more efficient, and overlapping activities were combined rather than repeated.

“These cost savings matter,” Wood emphasises. “Reducing the cost of proven interventions is what allows governments to eventually take them on.” In Niger, this efficiency has brought the program closer to transitioning responsibility to local government systems, a critical step for long-term sustainability.

Community trust has grown alongside efficiency. On-the-job training, hands-on mentoring, and consistent supervision have improved the quality of care and, perhaps just as importantly, how communities perceive it. Mobile clinics that reach communities more than 15 kilometres from health facilities have helped overcome distance barriers, while “husband schools” engage men and religious leaders to address cultural norms that prevent women from seeking care without permission.

Despite ongoing challenges, there is a sense that the field has changed. Implementers are collaborating more closely, competition has given way to coordination, and integrated approaches are yielding unexpected positive outcomes.

In Niger, treating malaria holistically has proven to be more than a health strategy. It is a practical response to real lives, real constraints, and real opportunities. By maximising every community interaction, integrating services, and reducing costs, AHMS Niger’s work is proving that it’s possible to reduce malaria today while building a system capable of sustaining those gains tomorrow.

AHMS Niger is funded by the U.S. U.S. Bureau of Global Health Security and Diplomacy and managed by the Palladium Group and its partners: Medical Care & Development Global Health, Bluesquare, ideas42, ESCAVI and SongES.