It’s mind-blowing to me that AMF’s immediate funding gap is $462M for 2027-29. That’s 56-154,000 lives (mostly under-5 children) at $3-8k per life saved, maybe fewer going forward due to evolving resistance to insecticides, but it wouldn’t change the bottomline that this seems to be a gargantuan ball dropped. Last time AMF’s immediate funding gap was over $300M for 2024-26, so it’s grown 50%(!) this time round. Both times the main culprit was the same, the Global Fund’s funding replenishment shortfall vs target, which affects programmatic planning in countries. I’d like to think we’re collectively doing our part (e.g. last year GiveWell directed $150M to AMF, more than to any other charity, which by their reckoning is expected to save ~27k lives over the next 1-2 years), but it’s still nuts to me that such a longstanding high-profile “shovel-ready” giving opportunity as AMF can still have such a big and growing gap!
this doesn’t surprise me so much—they’ve got a huge amount of experience and expertise and have fantastic in country distribution networks organized to distribute a lot of nets. there’s a strong element of rinse and repeat when it comes even to nationwide net distribution.
Personally I’m probably not in favor of increasing AMF’s funding too much more than it is currently at, because I think that countries need to start integrating net buying into their national health budgets in a much bigger scale—the norm of donations buying nets needs to slowly shift to governments, so i think the role of AMF should probably be slowly reducing rather than increasing. i think we should really have reached “peak donor net funding” by now and there should be even more of a push than there already is for governments to pay for their own nets. Nets need to be a normal part of government health spending, given that it’s a regular intervention that needs to happen every few years and one of the most cost-effective interventions governments can do for their people.
The systems of paying big extra allowances to government workers that are an unfortunate part of many vertical-ish programs like these also need to be wound down. Net distribution needs to be normalized.
We’ve seen what happens with USAID HIV and malaria stockouts fall apart and the scramble to cover the funding gap. There was endless talk of countries increasingly funding their own HIV systems but I’m most countries little action was taken and the US didn’t withdraw much funding to force their hand. Part of this funding gap as AMF said is even related to US not funding the global fund. I think there’s a risk of this kind of scramble happening with net distribution funding, for example if GiveWell decided that other options might be more cost effective, or more likely if their open Phil funding dried up quickly for some reason.
It does seem necessary to get governments to spend more of their own money on health, indeed. Do you think it would make sense to fund charities to try to convince governments to invest more in health (perhaps by also helping them increase their tax revenues, via increasing tax collection efficiency)?
I think the solution in this case is make clear plans with government then slowly defund the activity. Poor governments that weren’t going to find something of their own accord anyway, usually won’t front up until the external funding actually reduces.
“working with government” has been the vogue thing for charities, and especially national government aid orgs (like USAID) for decades. There have been endless attempts in the vein you suggest both to support governments to spend more on health, and to allocate money better within the health budget—with no clear evidence that it works. Although shifting government spending from low impact to high impact areas seems attractive, i don’t see any reason that it would work well in future when so many have failed in the past.
GiveWell recently gave a big grant along the lines you are thinking, which i largely disagree with (although I’ve softened a little on it)
On the taxes front it’s a big debate. Personally i think there’s very little correlation between increased tax take persay and increased spending on health. if you look at African countries that are spending more and doing better in health like Liberia and Rwanda, they are spending higher percentages of their GDP on health and smarter, not taking more tax than other similar countries.
Then there are cases like Botswana where they spent their diamond money well on healthcare, but that’s not from taxes.
Obviously when a country develops, then health care gets better but that’s another story. The ” growth people” will tell us to focus on growth and not sweat things like tax take and health allocation, but the jury is out as to how much charities / external actors can influence that either.
It’s mind-blowing to me that AMF’s immediate funding gap is $462M for 2027-29. That’s 56-154,000 lives (mostly under-5 children) at $3-8k per life saved, maybe fewer going forward due to evolving resistance to insecticides, but it wouldn’t change the bottomline that this seems to be a gargantuan ball dropped. Last time AMF’s immediate funding gap was over $300M for 2024-26, so it’s grown 50%(!) this time round. Both times the main culprit was the same, the Global Fund’s funding replenishment shortfall vs target, which affects programmatic planning in countries. I’d like to think we’re collectively doing our part (e.g. last year GiveWell directed $150M to AMF, more than to any other charity, which by their reckoning is expected to save ~27k lives over the next 1-2 years), but it’s still nuts to me that such a longstanding high-profile “shovel-ready” giving opportunity as AMF can still have such a big and growing gap!
this doesn’t surprise me so much—they’ve got a huge amount of experience and expertise and have fantastic in country distribution networks organized to distribute a lot of nets. there’s a strong element of rinse and repeat when it comes even to nationwide net distribution.
Personally I’m probably not in favor of increasing AMF’s funding too much more than it is currently at, because I think that countries need to start integrating net buying into their national health budgets in a much bigger scale—the norm of donations buying nets needs to slowly shift to governments, so i think the role of AMF should probably be slowly reducing rather than increasing. i think we should really have reached “peak donor net funding” by now and there should be even more of a push than there already is for governments to pay for their own nets. Nets need to be a normal part of government health spending, given that it’s a regular intervention that needs to happen every few years and one of the most cost-effective interventions governments can do for their people.
The systems of paying big extra allowances to government workers that are an unfortunate part of many vertical-ish programs like these also need to be wound down. Net distribution needs to be normalized.
We’ve seen what happens with USAID HIV and malaria stockouts fall apart and the scramble to cover the funding gap. There was endless talk of countries increasingly funding their own HIV systems but I’m most countries little action was taken and the US didn’t withdraw much funding to force their hand. Part of this funding gap as AMF said is even related to US not funding the global fund. I think there’s a risk of this kind of scramble happening with net distribution funding, for example if GiveWell decided that other options might be more cost effective, or more likely if their open Phil funding dried up quickly for some reason.
It does seem necessary to get governments to spend more of their own money on health, indeed. Do you think it would make sense to fund charities to try to convince governments to invest more in health (perhaps by also helping them increase their tax revenues, via increasing tax collection efficiency)?
I think the solution in this case is make clear plans with government then slowly defund the activity. Poor governments that weren’t going to find something of their own accord anyway, usually won’t front up until the external funding actually reduces.
“working with government” has been the vogue thing for charities, and especially national government aid orgs (like USAID) for decades. There have been endless attempts in the vein you suggest both to support governments to spend more on health, and to allocate money better within the health budget—with no clear evidence that it works. Although shifting government spending from low impact to high impact areas seems attractive, i don’t see any reason that it would work well in future when so many have failed in the past.
GiveWell recently gave a big grant along the lines you are thinking, which i largely disagree with (although I’ve softened a little on it)
https://forum.effectivealtruism.org/posts/t8QRuMfetCbeAkyFu/technical-support-units-a-dubious-givewell-grant
On the taxes front it’s a big debate. Personally i think there’s very little correlation between increased tax take persay and increased spending on health. if you look at African countries that are spending more and doing better in health like Liberia and Rwanda, they are spending higher percentages of their GDP on health and smarter, not taking more tax than other similar countries.
Then there are cases like Botswana where they spent their diamond money well on healthcare, but that’s not from taxes.
Obviously when a country develops, then health care gets better but that’s another story. The ” growth people” will tell us to focus on growth and not sweat things like tax take and health allocation, but the jury is out as to how much charities / external actors can influence that either.