I was interested and pleased to hear from GiveWell when they first contacted us (in 2009⁄10 I think) as it was obvious straight away that we shared a similar attitude to impact, transparency and accountability. I remember in particular reading at the time that they had two recommendations (and I paraphrase): ‘Do give money to these 3 charities. Don’t give money to these 132.’ I liked those numbers. It said to me that they really valued data and evidence and not stories. I didn’t think it was weird at all that they were evaluating charities. On the contrary, I thought ‘Hallelujah!’ as in many ways I am quite cynical when it comes to charity and feel it is very important that charities are held to account.
RobM
Karma: 447
AMF – Reflecting on 2023 and looking ahead to 2024
AMA: Rob Mather, founder and CEO of the Against Malaria Foundation
Yes, based on a) if AMF no longer adds value, we’ll stop (I think of that as Plan B for the charity, and I’d love for AMF to close if its work is no longer needed. Sadly, it looks as though malaria will be here for the next 10 years at least and within that time frame, currently, the distribution of nets is the most effective thing we can do to prevent malaria); and b) those of us involved in AMF care very much about what we do and I suspect others might also like to focus on another area where we can make a difference.
Perhaps I should have written 20 minute ‘approach’ rather than rule.
Sometimes when I wish to achieve an objective, I think about how I might do so with 20 minutes of effort.
It doesn’t apply to all circumstances, but the idea is to focus thinking on how best to go about getting something done and come up with suitable actions.
Actions compatible with the objective.
For me, the 20 minutes begins once you start ‘doing’ something i.e. picking up the phone or writing an email to someone. You can have as much thinking time before that as you like.
There has to be some poetic licence here as many ‘big things’ are unlikely to be achieved in 20 minutes but I don’t let that get in the way of the thinking.
An example might help.
When I was considering trying to get a million people to swim ‘against malaria’ back in 2004⁄05, my answer to the 20 minute question was ‘I am going to call 20 people, spend a minute on the phone with each, and ask them to each give me 5,000 people to swim. If I achieve that, we’ll be on the way to having 100,000 committed to swim and that is a credible platform from which to launch World Swim Against Malaria and to see if we can achieve a million swimming.’
And, pretty much, that’s what I did.
I phoned 20 people and they all agreed to commit to ‘contributing’ 5,000 people to swim. Admittedly some phone calls were longer than a minute and I went to meet about half of those I spoke with, but the ’20 minute limit’ allowed me to focus on actions that were at the right scale. It meant I didn’t start by going to the local swimming club and gaining 50 participants and then the local school and gaining 100 etc which would never have got us to a very large number of people swimming.
I’d be interested to read more about that.
If other projects, including projects to promote economic growth, can be demonstrated to be very or more-cost effective at saving lives (than funding and distributing long-lasting insecticidal nets) I would be interested in supporting them.
The problem we have today is people falling ill with, and dying from, malaria. Currently, the bednet is the most effective way of preventing that so it seems good and sensible to put funds into distributing nets.
My over-riding thought is that protecting people from malaria is a humanitarian issue first, and then an economic one, and whilst I would be interested in actions that drive economic growth, I would also want to support actions and interventions that improve health outcomes (saves lives, reduce illness) in the near and medium-term.
Yes, I try and respond quickly (meetings, calls, other commitments etc notwithstanding) out of courtesy and a desire to allow others to keep going with their projects and work, without me holding them up. The speed with which I am able to respond to an email will also depend on whether the response is clear and simple, meaning a quick response is possible, or requires more thought, data collection, liaising with others etc, which leads to a longer response time.
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.
There is more malaria prevention happening now. When AMF started in 2004⁄05, 5 million LLINs were distributed globally by all contributors. It is now around 200 million nets per year.
There is a greater focus on data I am pleased to say with funders ever more focused on ensuring nationwide campaigns are well targeted and not wasteful.
More money has come into malaria prevention through a combination of greater awareness of the disease, its impact and what can be done about it, as well as, in our experience, donors having greater confidence that funds being given to a charity focused on a problem in Africa will be well directed and used with significant impact. There is still a very significant gap in funding each year for basic malaria control (covering people with nets) so there is still much work to do and support to gain.
There has been some progress on developing a vaccine but we do not yet have a highly effective vaccine that could make the sort of impact on reducing malaria that we would all like to see. My understanding is we are at least 5 and probably 10 years away, at the earliest, of having a vaccine that is ‘really interesting’ (but others will have a more informed and up to date opinion here than mine).
There has been significant progress with gene drive technology and there is growing hope that it may make a significant contribution to malaria control in the coming years. But we are not there yet. My understanding is we are at least five, and maybe more, years away from developments that could be, similarly, ‘really interesting’ (similar disclaimer as above).
Nothing particularly insightful, I’m afraid. I have always been a fan of the portfolio approach to supporting charities given there are many good charities doing important work so if there are a variety of views and interests within the EA movement, that seems like a good thing to me. At AMF, we have a significant gap in funding and of course we would like as many as possible to support what we do so that means we have to continue to make the case that we are worthy of support whilst understanding donors will wish to put their support, financial or otherwise, in many different areas.
Hi Aaron
I’m pleased to say it’s what happened—and across 10 languages. I don’t think there is any particular secret here—and I’m certainly not the best copywriter in the world—but a combination of: a good cause; a modest time commitment requested (a few hours); asking people with the right skills and with some time to allocate; giving enough time to do the work (several weeks) so as not to create any pressure, led to this large number of experts offering to help.
Warm regards, Rob
Not close. Money. There are significant gaps in funding for nets and our current information is that for the period 2021-2023 that gap will be around US$500m to US$750m.
I am pleased to say that I was able to introduce a number of the translators we worked with to companies that supported AMF pro bono and they secured new paid for translation work. Perhaps a nice example of what often happens - ‘what goes around, comes around’.
We have certainly improved monitoring practices since 2016 and it’s important that we continue to look to improve them.
The observations and criticisms made in 2014 were valid and it is one of the benefits of independent organisations reviewing our work in detail that we receive feedback and suggestions that can help us do a better job.
An example of a recent improvement is the change in the frequency and scale of our post-distribution monitoring. For many years, PDMs were 6 monthly and involved visiting 5% of the households that received nets. As a result of an 18 month trial in Uganda, where we carried out PDMs in 124 health sub-districts split into five randomised groups (Arm 1: 6-monthly, 5% of households; Arm 2: 9-monthly, 5% of HHs; Arm 3; 6-monthly, 1.5% of HHs; Arm 4: 9-monthly, 1.5% of HHs; Arm 5: A PDM at 18 months as a control), we generated the data to support a move to 9-monthly PDMs visiting 1.5% of HHs. This has reduced cost without any loss in the benefit of carrying out the PDMs or value of the data generated.
Another example that took place earlier, as a result of feedback from GiveWell, was for AMF itself to make the randomised selections of households to visit rather than leaving this to in-country partners. It is not clear if this changed the outcome and reliability of the PDMs, but the separation of who does the selecting and who does the visiting increased confidence in the results of the PDMs.
The increased use of electronic device data collection is another way in which monitoring is being improved with benefits including: lower cost, improved accuracy, earlier detection of problems and faster access to results.
Improving monitoring practices is a priority and we continually reflect on how we can do better.
We are looking to hire a technology developer and I haven’t come up with a 20 minute solution to that.
That’s not really failing to produce a good outcome, more an example of how the 20 minute approach doesn’t apply to every task or challenge, but I find it usually helps in some way when thinking through how to approach bigger tasks or projects.
Another example is how we have approached managing the post-distribution monitoring reports that come in from Uganda following our 2017 distribution of 12.8 million nets.
130 PDM reports are received every 6 months and we thought about how we could manage the whole process of receiving 130 reports, analysing them all and deciding on required actions in just 20 minutes i.e. 20 minutes of effort required every six months.
At the time, PDM reports from other countries, involving fewer PDMs, came in via email in Word docs or pdfs and they required a lot of time to sort, file and review.
Our ‘20 minute approach’ led to us developing a system that allowed online reporting from the field.
This took the number of reporting emails received to zero and eliminated any need to process documents. It meant data could be aggregated and presented instantly for review and analysis.
A second phase of development took any text entries entered by each of the 130 reportees in the field (responses to questions like ‘What went well?’ and ‘What went less well?’) and distilled the myriad answers into drop down menu choices. This made the next round of reporting easier and quicker for those submitting reports. It also meant we could instantly see qualitative results in quantitative form and better and more quickly analyse them.
The result is we have dramatically reduced the time taken to manage this reporting and improved the speed with which we can make decisions and act if needed.
Climate change is not materially affecting AMF’s work at the moment as there is a lot of malaria to bring under control. I’d like to think that with the right support we can bring malaria under control in the next 10 to 15 years before the impacts of climate change make things worse. There are some sensible comments being made about climate change increasing the risk that malaria will appear in new areas and new countries and that would not be good at all.
I am not clear on the water and temperature question. Can you clarify?
I guess the probability I would have ended up doing something like [founding and running AMF] before I did is zero, given I didn’t! 😊 Would I have ended up doing something like I am now had the ‘chance event’ (me being useless with a remote control and not succeeding in turning off the tv news one evening and instead switching to a channel showing a programme about a burns victim that led me to organise a swim for the little girl that then led to World Swim Against Malaria…), yes I think I would have. That is based on me feeling (through my 20s and 30s and beyond) that I have been fortunate in many ways in my life (education opportunities, work experiences, family, friends, health etc) and that I wished helping others in some way to be an important part of my life.
Why not, assuming it can be agreed what is the definition of high impact for animal charities. For human-focused charities, measures include deaths averted and health outcomes improved and I don’t see why the same should not be achievable for animal charities. It is then a case of charities focused on these causes providing data and other information to allow independent assessment of their level of impact.
I don’t feel I know enough to suggest what may be missing in current animal charities’ activities, including advocacy.
Our technology (databases etc) are bespoke – all built in-house. We follow a simple process: we decide what functionality we need, and we build it. A key element is thinking through what we need and how that needs to be structured (content, layout, user interface, analysis functionality etc) so there are two stages – establishing clearly what we need; building it.
Unfortunately, I don’t think we will run out of areas in which to distribute nets. We don’t just distribute nets in easily accessible areas but also in hard and very hard to get to areas as it is important to protect everybody and achieve ‘universal coverage’ i.e. all sleeping spaces covered. Often the hardest to reach areas are those that most need nets as they have more challenging access to health care. There are many examples of hard to reach areas in DRC, one of the two countries in the world most affected by malaria, and in Papua New Guinea where geography is particularly challenging, but most countries, regions and districts have areas that are tough to get to and require extra effort.
The insecticide lasts for more than three years, the typical mechanical lifetime of the net. BTW, the long-lasting in ‘long-lasting insecticidal net’ (LLIN) refers to the insecticide. In some of the next generation nets we are looking at and working with, that typically have a second (safe for humans) chemical on them to enable the net to be more effective at dealing those mosquitoes species that may be developing a resistance to the (pyrethroid) insecticide on the net, we are monitoring carefully how long the ‘active ingredients’ as they called, last.
You may be interested to know that a net remains effective not just because of the longevity of the insecticide, but also because the insecticide is ‘bio-available’ i.e. it is on the surface of the nets and is available for the mosquitoes to pick it up via their feet. The insecticide is held on the net by a binding agent and the agent has to achieve the balance of keeping the insecticide from evaporating (too quickly) but also allowing it to be released. In some net manufacturing processes, the insecticide actually ‘sweats out’ of the filaments that make up the net. As a result, the humble $2 bednet is in fact quite an amazingly well engineered and chemically engineered product.
We do already go back to the same areas and distribute nets because of the three year lifetime of the net. The global approach to bednet distributions is that they take place in an area every three years. In fact, we would suggest the lifetime (on average, for a large cohort of nets) is closer to two and a half years and we are looking at repeat distributions with this frequency in some areas in order to ensure the populations in these malarious areas are continually covered. How long a net lasts depends on its environment (a net in a thatched dwelling is not likely to last as long as one in a brick house) and how it is treated.