Focus on the data and make sure they are as accurate as possible.
That underpins what we do at AMF as it gives us the best chance of understanding well what is needed (e.g. how many nets are needed and where) and reaching our objective as best we can (i.e. all sleeping spaces covered). An example would be structuring our work to: a) maximise the proportion of households that are visited during the registration phase of a distribution during which we establish how many nets are needed by each household (we aim for 100%); and b) ensure the data are accurate. We seek to maximise accuracy via two techniques. First, we carry out ‘105% registration’ which involves visiting a random selection of 5% of the households with the 5% data collectors having no knowledge of the data previously collected for the households and, most importantly, by making sure the 100% data collectors know in advance of doing their work that their work will be checked in this way and the 5% overlap compared.
Keep things simple and design things out.
I think that has helped us at AMF. An example of keeping things simple is to focus just on nets. An example of designing things out is taking our annual accounts preparation and reporting process, that used to require three people working for four weeks, to requiring essentially no one, We did this by building a system that allows us to track all relevant financial numbers on a daily basis (including, last year, more than 112,000 donations in a myriad of currencies) with all reporting material and documents either automatically generated at the end of the financial year or able to be generated within minutes. As a result, we are able to produce all our annual accounts’ materials across 12 countries, including material for three separate audits, within nine hours of the end of our financial year.
1. What do you think are the main positive and negative indirect impacts of the program, both long- and short-term? (E.g. increasing productivity and economic growth, increasing/decreasing total population, strengthening health systems, greenhouse gas emissions, consumption of factory-farmed meat...) Do you have any data on these? Are you planning to gather data on any of them?
The main positive indirect impact of distributing nets is to improve the economy in the areas in which the nets are distributed. If people are sick, they cannot teach, they cannot drive, they cannot farm, they cannot function. They cannot be productive members of the community, and they may in addition draw on the heath service. It has been estimated that there is a 12:1 multiplier i.e. that for every $1m we spend effectively fighting malaria we improve the GDP (Gross Domestic Product, a measure of economic performance) by $12m. A pretty good return, aside the humanitarian benefits of such funding. Similar calculations and analysis can be found in: The economic burden of malaria – Gallup & Sachs, 2001, The American Journal of Tropical Medicine and Hygiene; The economic and social burden of malaria, Sachs & Malaney, Feb 2002, Nature.
The main negative indirect impact of distributing nets is millions of pieces of plastic being brought into the environment. A net is ultimately a piece of plastic. However, this is an OK price to pay for the impact the nets have on health outcomes. FYI, over the last few years we have moved to not providing individual packaging for nets but provide nets loose in bales (typically 40, 50 or 100 nets per bale) and that avoided 4.8 million pieces of plastic going to Guinea in the recent distribution, so we are making progress in this area.
2. What proportion of the long-term benefit from the program is due to short-term direct effects such as saving lives and averting unpleasant episodes of malaria, relative to indirect benefits?
I guess you’d have to say a high proportion of the long-term benefits from our work (people living healthy lives, being productive members of society and reducing the funds spent avoidably on health care) are due to the short-term direct effects (saving lives and avoiding illness) rather than any indirect benefits.
(I may not have fully understand the question as an indirect benefit of our work is improved economic performance but that is also a long-term benefit. If I have not understood correctly, please do feel free to explain further.)
3. Do you hold a particular view of population ethics (totalism, averagism, person-affecting, etc)?
My population ethics could best be summed up by saying that my four children go to sleep at night with the consequence of a mosquito bite being an annoying itch and not severe illness or worse and I wish to do all I can to make sure it is the same for children, and others, in currently malarious areas.
4. What is your response to critics who claim we are ultimately “clueless” about the long-run magnitude or even sign of interventions like this? (I think the basic argument is that e.g. averting deaths has a wide range of knock-on effects, both good and bad, and that we may not be justified in being confident that ultimately – say, over the next few hundred years—the impact will be net positive. See e.g. here, here, and here for a better explanation)
My response would be that the short and medium term consequences of distributing bednets – saving lives, avoiding illness and improving economic circumstances, are very persuasive for me and I could not imagine any unknown long term consequences could persuade me that the actions we take now are not worthwhile.