Note: This page summarizes the rationale behind a GiveWell grant to Malaria Consortium. Malaria Consortium staff reviewed this page prior to publication.
In a nutshell
In June 2025, GiveWell recommended a $10.4 million grant to Malaria Consortium to expand its seasonal malaria chemoprevention (SMC) program in Chad. This grant will enable Malaria Consortium to expand SMC delivery to 31 additional health districts for the 2026-2027 malaria seasons and maintain support across 12 existing districts in 2027, with a target reach per year of approximately 1 million children aged 3-59 months.
We are making this grant because we think:
- SMC is highly cost-effective in Chad. We estimate high cost-effectiveness due to high malaria burden and seasonal transmission patterns. (more)
- Malaria Consortium has a strong track record. The program achieved 87-94% coverage from 2018-2024 and demonstrated ability to navigate implementation challenges. (more)
- There is low risk of crowding out other funders. We believe other funders are unlikely to fund expansion districts. (more)
Our main reservations are:
- More cost-effective funding gaps could arise. Global health funding cuts could create higher-impact opportunities, potentially raising our funding threshold above this program's cost-effectiveness. (more)
- Malaria burden data in Chad is highly uncertain. We have unusually low confidence in child malaria mortality rates in Chad compared to other countries with SMC programs we've investigated. (more)
- Country-level technical capacity in Chad may be lower than in many other countries where we support SMC. We have some concern this might complicate successful expansion to new districts. (more)
Published: September 2025
1. The organization and the intervention
Malaria Consortium's seasonal malaria chemoprevention (SMC) program is one of GiveWell's top charities. GiveWell has recommended many previous grants to Malaria Consortium's SMC programs, including its program in Chad. We made an exit grant in 2023, but then renewed funding in 2024 at a smaller scale after re-evaluating our cost-effectiveness analysis (see more here). See this page for all of our content on Malaria Consortium’s SMC program.
Seasonal malaria chemoprevention involves giving children monthly courses of antimalarial medicines, usually for four or five months per year, in locations where malaria is highly seasonal (i.e., a high proportion of cases occur in a relatively short period each year). SMC is described in further detail in our intervention report.
2. The grant
Malaria Consortium uses funding for their SMC program to, among other things, buy the medicines used in SMC, train community distributors to deliver the medicines door-to-door, and conduct monitoring to understand what proportion of children are reached.1
Chad has 135 health districts eligible for SMC, according to the national malaria program's 2022 stratification exercise.2 Currently, 51 districts are funded for SMC campaigns in 2025 and 2026, which leaves 84 SMC-eligible districts unfunded.3 This grant of $10.4 million will enable Malaria Consortium to deliver SMC during the 2026 and 2027 malaria seasons in 31 districts that have not previously received SMC,4 while continuing support through 2027 in the 12 districts we previously provided funding for through 2026.5
The expansion will increase Malaria Consortium's geographic scope in Chad from 12 to 43 districts across five regions:6
- All 4 SMC-eligible districts in Bahr el Gazal (~100,000 target population)
- All 15 SMC-eligible districts in Mayo-Kebbi Est (~320,000)
- All 7 SMC-eligible districts in Logone Occidental (~220,000)
- All 8 SMC-eligible districts in Mayo-Kebbi Ouest (~160,000)
- All 9 SMC-eligible districts in Tandjile (~190,000)
Malaria Consortium selected the 31 expansion districts based on malaria incidence rates, input from the national malaria program, and geographic proximity to facilitate coordination and travel.7
2.1 Budget for grant activities
The total amount for this grant is $10,427,075.8 This will fund Malaria Consortium’s SMC programming in the 31 expansion districts in 2026, and both the 31 expansion districts and 12 pre-existing districts in 2027.9 Including the 2026 costs for the 12 districts with a preexisting Malaria Consortium SMC program, the total budget for SMC campaigns in Chad for 2026-2027 is $12.1 million. Malaria Consortium's budget breakdown for the two-year period is approximately:
- 56% intervention delivery costs
- 27% medicines, other commodities & freight
- 10% staff costs
- 4% digitalization and external relations costs
- 3% operational costs
This excludes Malaria Consortium's 12% management fee on all direct costs.10 Note that Malaria Consortium expects costs may increase due to higher per-diem rates for community distributors but decrease due to cost-cutting initiatives and program maturity over time, and believes these two factors are likely to offset each other.11
3. The case for the grant
High cost-effectiveness
We estimate this program is approximately 16 times as cost-effective as unconditional cash transfers ('x cash').12 See our cost-effectiveness analysis (CEA) here.13 SMC is highly effective at reducing malaria cases, relatively cheap to deliver, and targeted during a time-limited window when a high proportion of malaria cases occur. The general determinants of high cost-effectiveness in the part of West and Central Africa where this grant would support SMC (the Sahel) are described in our intervention report.
Our cost-effectiveness estimate has increased to 16x, up from our estimate of 13x the previous time we made a grant to support Malaria Consortium's SMC program in Chad. Key updates from our previous model include:
- Marginally higher child malaria mortality rate. We originally estimated an under-five malaria mortality rate of 0.25% in the 12 districts we'd previously funded. We estimate a slightly higher malaria mortality rate of 0.31% across the full 43 districts. Though this represents our best guess, we do have a high degree of uncertainty in malaria burden data for Chad (see details below).
- Higher cost per round of SMC ($8.80 vs $7.77 previously). Though Malaria Consortium's cost per child targeted for each SMC cycle is lower,14
the cost we estimate for fully delivering a round of SMC is higher, primarily due to:
- Number of cycles delivered per round. Malaria Consortium currently delivers four monthly cycles of SMC in the 12 supported districts of Bahr El Gazal and Mayo-Kebbi Est.15 In all of the 31 expansion districts, five cycles of SMC will be delivered instead of four.16
- Coverage. We expect that coverage will be lower in the 31 expansion districts due to our general assumption that newer programs face more obstacles (e.g., community acceptance) during the early years of the program.17 We assume that coverage in the 12 existing districts will be the same as what Malaria Consortium achieved in 2024 (87%) but estimate that coverage will be notably lower in the expansion districts in 2026 (77%) and in 2027 (82%). Malaria Consortium agreed it would be reasonable to expect lower coverage in expansion districts.18
- Lower risk of crowding out other funders. We assume a 10% risk of crowding out other funders (compared to our previous estimate of 30%) because we don't expect other funders will be prioritizing expansion of SMC programs in Chad. See a detailed explanation below.
- Larger adjustment for malaria vaccine rollout. We'd previously estimated that the rollout of malaria vaccines would result in a 2% reduction in the malaria mortality rate of the target population for Malaria Consortium's SMC program in Chad. We've increased that to 6% because we see some indication that vaccine rollout is being prioritized in Chad.19
Simple cost-effectiveness analysis
Below is an intuitive illustration of the key drivers of cost-effectiveness.
| What we are estimating | Best guess (rounded) | Confidence intervals (25th - 75th percentile) | Implied cost-effectiveness |
|---|---|---|---|
| Grant to Malaria Consortium | $10,427,075 | ||
| Cost per child reached with SMC | $8 | $7 - $10 | 12x - 18x |
| Number of children receiving SMC | 1,300,00 | ||
| Percent of children who would have received SMC without mass distribution | 0% | ||
| Annual mortality rate from malaria and associated causes among children who do not receive SMC | 0.48% | 0.1% - 0.8% | 5x - 28x |
| Proportion of malaria mortality occurring in SMC season | 70% | 63% - 77% | 15x - 18x |
| Reduction in malaria mortality from receiving SMC | 79% | 71% - 87% | 15x - 18x |
| Initial cost-effectiveness estimate | |||
| Cost per death averted (child mortality only) | ~$3,000 | ||
| Moral weight for each death averted | 116 | ||
| Initial cost-effectiveness estimate | 11x | ||
| Summary of primary benefits (% of modeled benefits) | |||
| Reduced child mortality | 79% | ||
| Reduced mortality among older children and adults | 4% | ||
| Income increases in later life | 17% | ||
| Additional adjustments | |||
| Adjustment for additional program benefits and downsides | 34% | 15% - 53% | 14x - 19x |
| Adjustment for grantee-level factors | -8% | -14% - -2% | 15x - 17x |
| Adjustment for diverting other actors’ spending into SMC (“leverage”) | -1% | ||
| Adjustment for diverting other actors’ spending away from SMC (“funging”) | -7% | -11% - -4% | 16x - 17x |
| Overall cost-effectiveness (multiples of cash transfers) | 16x |
For our simple cost-effectiveness analysis, see here, and for our full analysis, see here.
Strong track record
We have a positive impression of Malaria Consortium's track record in Chad. According to randomized household surveys, the program achieved average coverage of 87-94% from 2018-2024, with the exception of 2019 when coverage was 69%.20
Malaria Consortium has also shown an ability to navigate implementation challenges in Chad, namely extensive flooding that required deployment of alternative methods of transportation and new approaches to registering and tracking children.21 Cost efficiency has also improved over time, with cost per SMC cycle decreasing from $2.35 in 2020 to $1.36 in 2023. Our understanding is that this was driven both by increased scale and through an effort by Malaria Consortium to find programmatic efficiencies that would reduce costs.22
Low risk of crowding out other funders
We estimate only a 10% risk that our funding crowds out other funders, compared to 30% in our previous model. Several factors support this assessment:
- The Global Fund is likely prioritizing other programming. The Global Fund is a major funder of SMC in Chad, having provided funding for SMC campaigns in 40 of the 77 districts that received SMC in 2023.23 However, in response to health service disruptions and funding uncertainty, the Global Fund is working to reprioritize funding allocations, with initial guidance suggesting they may prioritize treatment interventions over preventative interventions.24 Given this, we expect it's unlikely the Global Fund would be able to support SMC expansion from 2026-2027 and plausible that even the existing budget for SMC during this period is reduced.
- Other funders have limited expansion plans. The President's Malaria Initiative does not support malaria activities in Chad.25 UNICEF and Médecins Sans Frontières (MSF) support SMC in only 7 and 4 districts in Chad respectively,26 with no known expansion plans, though we have not confirmed this with either organization.
- Expansion districts are particularly unlikely to receive alternative funding. The districts we are funding Malaria Consortium to expand into have not previously received SMC campaigns.27 We think it is more likely that other funders will prioritize continuation of existing campaigns over expansion to new areas.28
Given the above, we think there is a very low risk that our support crowds out other spending on SMC in Chad. We quantify this roughly in our CEA with a 10% risk of crowding out other funders (down from 30%) and a 0% adjustment for marginal funding going to lower-priority areas (up from -10%).
Other considerations
Our primary case for this grant is that it supports a highly cost-effective program with a strong track record, and that there is a low chance this grant is crowding out other funders. Additional minor considerations supporting this grant include:
- Substantial room for more funding: There are still many SMC-eligible districts in Chad, some of which exhibit high malaria burden, that remain unfunded even after accounting for the 31 expansion districts.29 This grant would enable Malaria Consortium to increase its footprint in Chad, which may make it easier to expand SMC programming in Chad even further.
- Opportunities for integration of other interventions: Malaria Consortium has conducted a small-scale pilot of integrating malnutrition screening with SMC in Chad, and is working with Clear Solutions on a small-scale pilot to integrate ORS+zinc delivery with SMC in Chad.30 There may be other integrations worth trialing as well. While small-scale piloting could occur without this grant since Malaria Consortium's SMC program in Chad is already funded through 2026 in 12 districts, this expansion grant could enable Malaria Consortium to more easily move forward with larger-scale deployment if the ongoing pilots indicate that the integration is promising.
4. Risks and reservations
Uncertainty about the funding landscape
Global health funding likely faces significant reductions over the next few years. Funding from the US government is highly uncertain, but ~60% budget cuts for 2026 have been proposed.31 The Global Fund, one of the major supporters of SMC, has concerns about major cuts to malaria fundraising for its next grant cycle.32
While the future funding landscape remains highly uncertain, these funding cuts could create large, highly cost-effective funding gaps, which we may decide should be high-priority to fill.
Given that uncertainty, we could wait until we have more clarity before funding SMC expansion in Chad. However, we have decided to recommend this grant because: (a) we believe that this grant's cost-effectiveness is likely competitive with other funding opportunities we would find, and (b) we don't expect this grant to represent a large portion of our total expected 2025-2027 grantmaking.
High degree of uncertainty in malaria burden data in Chad
We have unusually high uncertainty in child malaria mortality rates in Chad compared to other countries where we support SMC. National data from UN IGME suggests malaria mortality more than double that reported by IHME GBD, our primary data source. While both estimate a similar all-cause child mortality rate in Chad, IGME attributes a much higher share of that mortality rate to malaria than the GBD model does. Our best guess is that the differences between the models stem from our understanding that neither use any direct data on cause-attributed mortality in Chad (e.g., verbal autopsies, vital registration systems) and so need to make uncertain modeling choices to generate malaria mortality estimates.33 The most recent "ground truth" survey data on all-cause mortality and malaria burden in Chad that we have been able to identify are from 2014-15 and 2017. We expect subnational mortality data to be even poorer due to smaller sample size.
Though we understand these two data sources' methodology at a relatively shallow level, our current impression is that neither source is clearly more accurate, so we place equal weight on IGME and GBD estimates. As a sense-check, we compared our final estimates of subnational burden with administrative data on malaria incidence from Chad's 2022 SMC eligibility report, and found that the administrative data generally agreed with our model in terms of the relative differences in burden between subnational areas.34
Country-level technical capacity in Chad
Our impression is that Malaria Consortium's SMC program in Chad requires more oversight than many SMC programs we support, due to somewhat lower technical capacity at the country level. We believe this results from a combination of factors, including the fact that SMC has been operating at relatively smaller scale in Chad (compared to the much larger programs in Nigeria, for example)35 and because GiveWell's prior exit grant caused Malaria Consortium to begin downsizing its local team.36 We have some concern that this might complicate successful program expansion, which we would expect to involve activities that require relatively more technical capacity at the country level than program maintenance would (e.g., sensitizing new communities on the benefits of SMC, building effective relationships with local government officials).
However, Malaria Consortium has told us they feel confident in their ability to successfully implement SMC and that global-level staff and government leadership at the national level will help facilitate a smooth transition to reaching this larger target population. They also do not believe this expansion will require major hiring efforts.37 Moreover, we have seen that Malaria Consortium's Chad SMC program has been able to achieve strong outcomes in the past despite these challenges (see above), and our CEA already accounts for an expectation of lower initial coverage in expansion districts (see above).
Other considerations
- Low malaria burden in Barh El Ghazal: We believe that malaria burden in Barh El Ghazal is likely lower than in the other areas this grant would support. However, after speaking with Malaria Consortium, we do not believe we should discontinue support in those districts because:
- They represent only a small fraction of the total target population (~100,000 of ~1 million) and so do not have a major effect on the overall cost per child reached.
- They are located in the central region of Chad separate from the southwestern region where the other districts this grant would support are located. It could be beneficial for Malaria Consortium to have an ongoing presence in the central region of Chad in the case that we decide to support further expansion there.
- We continue to have major uncertainty in subnational malaria mortality data.
- Uncertainty in other model parameters: In addition to our specific uncertainty in malaria burden estimates for Chad, we are generally uncertain about a number of other CEA parameters for all grants we make to support SMC in the Sahel: adjustment for non-malaria deaths indirectly averted by SMC, impact of malaria reduction on long-run income, proportion of malaria mortality in the high transmission season, impact of receiving SMC, cost per cycle of SMC, impact of SMC on drug resistance, and counterfactual value of Global Fund spending. These are detailed on this page.
5. Plans for follow up
- We will continue monthly calls with Malaria Consortium and request standard spending reports and coverage surveys for 2025, 2026, and 2027 campaigns.
- We will engage with the Global Fund to understand their SMC prioritization and allocation processes for future grant cycles.
- We will conduct biannual calls with Malaria Consortium focused on SMC implementation progress and receive annual written reports from them.
- We will further develop a learning and research agenda for our chemoprevention work, including items specific to Chad.
- We will scope possibilities for further expansion of SMC in Chad to additional districts.
- We will schedule calls with Chad's national malaria program to build relationships and understand their priorities.
6. Internal forecasts
For this grant, we are recording the following forecasts:
| Confidence | Prediction | By time | Resolution |
|---|---|---|---|
| 60% | We will renew (not exit) this grant in all districts for at least one year, by December 31, 2027. | December 31, 2027 | - |
| 30% | We will recommend further expansion of Malaria Consortium's SMC program in Chad, by December 31, 2027. | December 31, 2027 | - |
| 60% | We will retrospectively assess the cost per child reached per cycle for Malaria Consortium's SMC program in Chad in 2027 to be < $1.89, by December 31, 2028. | December 31, 2028 | - |
| 25% | Global Fund will reduce its SMC investment in Chad in 2025 compared to 2024, in terms of the number of districts in which it supports any SMC costs and/or the proportion of costs it supports for any given district (e.g., reducing number of cycles covered, covering only drug procurement and not implementation), by December 31, 2025. | December 31, 2025 | - |
| 70% | Global Fund will reduce its SMC investment in Chad in 2026 compared to 2024, in terms of the number of districts in which it supports any SMC costs and/or the proportion of costs it supports for any given district (e.g., reducing number of cycles covered, covering only drug procurement and not implementation), by December 31, 2026. | December 31, 2026 | - |
| 65% | Global Fund will reduce its SMC investment in Chad in 2027 compared to 2024, in terms of the number of districts in which it supports any SMC costs and/or the proportion of costs it supports for any given district (e.g., reducing number of cycles covered, covering only drug procurement and not implementation), by December 31, 2027. | December 31, 2027 | - |
| 40% | Our bar for grants to top charities will have increased to 10x or more, by December 31, 2026. | December 31, 2026 | - |
7. Our process
- We updated our cost-effectiveness analysis, malaria burden model, and funging risk parameters based on new data.
- We conducted calls with Malaria Consortium to discuss expansion plans and operational questions.
- We spoke with Global Fund to understand their SMC investment plans and budget constraints in Chad.
- We reviewed Malaria Consortium's funding proposal and detailed budget for the expansion.
Sources
- 1
"In the locations where GiveWell funds Malaria Consortium to support SMC, it provides the funding to deliver SMC campaigns,trains distributors to deliver the campaigns, and provides technical and operational support to governments on all aspects of campaign delivery. It also conducts monitoring after campaigns to understand what proportion of children were reached." GiveWell, Malaria Consortium.
- 2
"Based on a stratification of malaria interventions carried out by the national malaria programme with support from academic partners, a summary report prepared by the national malaria programme in 2022 listed 98 health districts as eligible for SMC (Annex 2). …Many of the health districts listed as SMC eligible in the eligibility report have since been subdivided and the total number of eligible health districts as of early 2025 is now 135." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025, p. 1-2
- 3
"Including the 12 health districts covered by the grant GiveWell approved in October 2024, 51 health districts have funding confirmed for 2025 and 2026." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025 p. 2
135-51 = 84. - 4
The list of districts Malaria Consortium plans to support is available here. New districts are the ones marked "N" in the column "Supported by MC in 2025." Compare to this spreadsheet of the history of SMC funding across districts in Chad.
- 5
See our previous grant here. Note: "Two of the 10 health districts included in the grant request have since been subdivided into four health districts. The total number of health districts supported by Malaria Consortium in 2025 is therefore 12." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025 p. 1
- 6
See Malaria Consortium's list of supported districts and estimated target populations here. See this spreadsheet for details on SMC eligibility of districts in Chad.
- 7
"The additional 31 health districts were selected based on the following considerations:
- Malaria Consortium already supports eight out of the 15 SMC-eligible health districts in Mayo Kebbi Est region. We now propose to expand our support to the remaining seven health districts in this region, as we already have a strong relationship with the provincial health authority.
- We also propose to expand our support to 24 health districts in three regions that have not so far benefitted from SMC: Logone Occidental, Mayo Kebbi Ouest and Tandjile.
- The majority of health districts in those three regions are located in areas of high transmission according to the national malaria programme’s eligibility report, with adjusted annual incidence of >450 per 1,000 population.
- The national malaria programme has expressed strong interest in expanding SMC to those regions.
- Mayo Kebbi Est, Mayo Kebbi Ouest, Logone Occidental and Tandjile would form a contiguous area of operation, which facilitates coordination between regions, for example with regard to the transport of commodities."
Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025, p. 3
- 8
See the budget for this expansion here, and an overall budget for SMC in Chad 2025-2027 here.
- 9
"Malaria Consortium requests approval for the use of philanthropic funding to support SMC
implementation in 31 additional health districts in 2026, increasing Malaria Consortium’s
area of operation to a total of 43 health districts in five regions (Figure 1). We also request
approval for the continuation of SMC implementation support in the same 43 health districts
in 2027." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025, p. 2
See our previous grant to 12 health districts in Chad through 2026 here. Note: "Two of the 10 health districts included in the grant request have since been subdivided into four health districts. The total number of health districts supported by Malaria Consortium in 2025 is therefore 12." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025, p. 1 - 10
See here for management fee calculations.
- 11
Malaria Consortium, conversation with GiveWell, May 22 2025 (unpublished)
- 12
This estimate of the value of direct cash transfers is out of date as of 2024. We are continuing to use this outdated estimate for now to preserve our ability to compare across programs, while we reevaluate the benchmark we want to use to measure and communicate cost-effectiveness.
- 13
Note that our cost-effectiveness analyses are simplified models that are highly uncertain, and our cost-effectiveness threshold for directing funding to particular programs changes periodically. See GiveWell's Cost-Effectiveness Analyses for more information about how we use cost-effectiveness estimates in our grantmaking.
- 14
The cost per child targeted across the 43 districts is $6.64, compared to our prior estimate of $6.50 for the 12 currently supported districts.
- $6.64 / 5 cycles = $1.33
- $6.50 / 4 cycles = $1.63
- 15
Note that in two of the districts of Bahr el Gazal the delivery schedule will be reduced to three cycles. "There are two health districts in Bahr el Gazal which are among the 12 health districts Malaria Consortium is supporting in 2025 and which, according to the eligibility report, only require three annual SMC cycles. We plan to reduce the number of annual SMC cycles accordingly in those health districts as of 2026." Malaria Consortium, Grant request: Supporting SMC in Chad, 2026-2027, March 2025, p. 3
- 16
See Annex 4 of Malaria Consortium's funding request for the number of cycles recommended in each of the targeted districts.
- 17
See our coverage estimates here.
- 18
Malaria Consortium, conversation with GiveWell, June 9 2025 (unpublished)
- 19
In October 2024, Chad announced an ambitious triple-vaccine rollout (malaria, PCV13, and rotavirus), potentially signaling a more concerted effort around increasing vaccine coverage.
- 20
Average coverage across cycles according to post-round surveys:
- 2018: 89%
- 2019: 69%
- 2020: 94%
- 2021: 91%
- 2022: 89%
- 2023: 94%
- 2024: 87% (See Table 25. (86.7+86.5+82.9+90.5)/4 = 86.7)
We have not deeply investigated the reason for lower coverage in 2019.
- 21
"The widespread displacement and destruction of roads created immense logistical challenges for SMC delivery…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…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…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." Malaria Consortium, Reaching the hardest to reach: Maintaining seasonal malaria chemoprevention in flood-affected areas, May 2025
- 22
Malaria Consortium, conversation with GiveWell, June 9 2025 (unpublished)
- 23
Malaria Consortium, SMC in Chad 2013-2025. Note that some 2023 districts have been split into multiple districts as of 2025.
- 24
"To preserve lifesaving services, HIV, TB and malaria programs need to cover core priorities, considering all sources of funds. This includes domestic resources and Global Fund investments as well as other sources, such as partners and development banks. Priority services will differ by disease program, though arguably the most essential element is treatment: treatment continuity and care for HIV; diagnosis and treatment for TB; and case management for malaria. Countries should continue to follow WHO disease specific normative guidance." The Global Fund, Operational Update, May 2025, p. 2-3
- 25
See current funding sources for SMC in Chad here.
- 26
See current funding sources for SMC in Chad here. Note that Doctors Without Borders is abbreviated to MSF (Médecins Sans Frontières).
- 27
The list of districts Malaria Consortium plans to expand support into is available here. New districts are the ones marked "N" in the column "Supported by MC in 2025." Compare to this spreadsheet of the history of SMC funding across districts in Chad.
- 28
For example, in its reduction of SMC funding in Chad from 2024 to 2025, the Global Fund seems to have prioritized continuation of SMC in districts that had previously been receiving SMC over expansion to new districts. All 28 districts receiving 2025 SMC funding from the Global Fund had received SMC campaigns in 2024. See historical funding sources for SMC in Chad here.
- 29
According to Malaria Consortium's report, there are 135 SMC-eligible districts, and after accounting for the investments of UNICEF (7), MSF (4), Global Fund (26), and Malaria Consortium (43 including expansion), there are still 55 remaining. Moreover a number of these are in parts of Chad that exhibit moderate to high malaria burden both according to GiveWell's modeled estimate and government data on malaria caseload.
- 30
- "Building on the model used in Burkina Faso, Malaria Consortium tested the integration of malnutrition screening into SMC delivery. Community distributors in one health district screened children 6–59 months for malnutrition during household visits and referred them to malnutrition treatment services." Malaria Consortium, 2024 Philanthropy Report, p. 28
- "We are excited to be partnering with Clear Solutions to test a community-based model for delivering co-packaged oral rehydration solution and zinc (ORSZ) alongside routine #SMC delivery in Moulkou health district in Chad, starting next week." Malaria Consortium, LinkedIn post, July 2025
- 31
"Global Health Programs (GHP) Account: The main account that supports global health programs totals $3.8 billion in the request, $6.2 billion below the FY 2025 amount ($10.0 billion)." KFF, "Administration Releases Additional Details of Fiscal Year 2026 Budget Request," June 2025.
See more on our response to foreign aid funding cuts here.
- 32
"For more than twenty years, the highly successful financing structure of the Global Fund to Fight AIDS, Tuberculosis and Malaria has been defined by a provision in U.S. law that limits U.S. contributions to one dollar for every two dollars that other donors contribute…Changing the match requirement from 1:2 to 1:4 would reduce the leverage power of the U.S. contribution to the Global Fund, lower overall funding to fight AIDS, TB and malaria, slow down progress on transition to country self-reliance and limit the influence of the U.S. in Global Fund decision-making." The Global Fund, The enduring impact of the 1:2 match requirement, May 2025
- 33
For sources used by IHME GBD, see the GBD Sources Tool. For a list of sources used by IGME, see CA CODE, Causes of death in Africa in 2021, 2024, p. 9-14
- 34
GiveWell, Malaria burden triangulation in Chad (internal), 2025 (unpublished)
- 35
In 2024, approximately 30 million children in Nigeria were covered for SMC delivery. In comparison, approximately 3 million children were covered in Chad in 2 024.
- 36
Malaria Consortium, conversation with GiveWell, June 2025 (unpublished)
- 37
Malaria Consortium, conversation with GiveWell, June 2025 (unpublished)