The Against Malaria Foundation provides insecticide-treated nets (for protection against malaria) in bulk to nonprofits which then distribute them in Africa.

Unlike other net distribution organizations, AMF is extremely transparent, publishing the status of each distribution on its website along with post-distribution photos. We have questions about whether nets continue to be used appropriately over the long run, but net distributions have had repeated success in the past, at a cost of under $1000 per infant death averted. We believe that AMF has a significant funding gap.

What do they do?

The Against Malaria Foundation (AMF) purchases insecticide-treated nets (ITNs) for individuals in the developing world.

AMF (a) reviews proposals (through its Malaria Advisory Group (MAG)) from non-profits seeking bednets,1 (b) purchases and ships nets for approved proposals,2 and (c) posts pre-distribution reports, post-distribution reports, and photos of the distribution taking place on its website.3

Does it work?

Distributing ITNs has, in the past, been shown rigorously to prevent deaths from (and other cases of) malaria. (For more, see our full report on distributing ITNs.) The conditions under which success have been achieved are relatively unclear; we feel it is reasonable to expect impact when ITNs are used consistently and appropriately by people at risk from malaria.

When evaluating the effectiveness of an ITN distribution organization, we therefore seek to answer the following questions:

• Do the nets reach the intended destination? Yes. AMF posts approximately 10-40 photos for each distribution. These photos mainly show nets arriving in the village, a speech or presentation before nets are handed out, people receiving nets, and sometimes, a net or two hanging in a house.4
• Do high-risk populations (i.e., pregnant women and children under 5, living in areas with high rates of malaria) receive them? We believe that nets reach areas with high rates of malaria, as this is one of AMF's criteria for approving proposals (and it provided us with proposals that it declined to fund because of unanswered questions about rates of malaria in the area)5 but we are unclear on the extent to which nets specifically reach children under 5 and pregnant women, who face the highest risks from malaria.6
• Do those who receive the nets install them in their homes properly? Our best guess is that approximately 75% of those who receive the nets install them properly.7
• Do those who receive the nets utilize them consistently over the long term? We would guess that many do and many do not. There are clear examples of ITN-distribution projects where many individuals who received nets used them such that malaria rates fell dramatically (for more, see our report on large-scale net distributions). Nevertheless, we would guess that many nets fall into disrepair or that people choose to stop using them. Unfortunately, we don't know whether this applies to very few people, a moderate number of people, or most people.

Possible negative or offsetting impact

We see relatively small risk of negative or offsetting impact from ITN distributions. It is possible that donor-funded ITN distributions end up substituting for government projects (or private, for-profit provision of ITNs) or temporarily divert local labor, but intuitively speaking, these risks do not strike us as major.

What do you get for your dollar?

We estimate that when ITN distributions are effective, $182-$1126 prevents a death from malaria and prevents 320 less severe malaria episodes. Note that cost-effectiveness could vary significantly depending on the extent to which people use ITNs and the overall effectiveness of a given distribution program. (For more on cost-effectiveness, see our full report on distributing ITNs.)

AMF's approval process adds some additional (though relatively small) cost to the program.8

Room for more funds?

We believe that additional donations to AMF would likely result in an increase in ITNs distributed. AMF provided us with several proposals that would have been approved,9 but were partially funded or unfunded due to limited funds. Two were as recent as March 2009.10

In a phone conversation, AMF's founder told us that he estimates AMF could reasonably allocate three times as much capital, given the applications they must currently reject due to lack of funds.

Financials/other

Financial documents are available on the United Kingdom's Charity Commission website.11 Since AMF is a British charity, all figures are presented in British pounds.

Revenue and expense growth (about this metric): AMF is relatively young and relatively small. Its revenues have been somewhat unsteady after first year in existence (2005). It's expenses have risen very slightly over the past few years.

Assets-to-expenses ratio (about this metric): AMF assets-to-expenses ratio is around .5, at the lower end of what we consider reasonable.

Expenses by program area (about this metric): AMF only runs one program, so all expenses support ITN distributions.

Expenses by IRS-reported category (about this metric): These are within the range we believe is reasonable.

Note: AMF is a British charity, and we therefore use the terms that equate to IRS-reported categories. We believe that the "charitable activities" item refers to "program expenses" and "governance costs" refer to "administration". We did not see a line item for fundraising costs on AMF's financials.

Unanswered questions

• We have several unanswered questions about AMF's impact. We do not have a strong position on the characteristics most likely to predict whether an ITN distribution program succeeds. Do AMF's ITNs reach children and pregnant women (who are most at-risk) or adult men (who are not)? Are AMF's nets properly installed in homes? Do AMF's nets remain in use and in good condition over time?
• We may do a formal tabulation of how many of AMF's projects have been completed and have posted completion reports and photos, although our sense at this point is that most projects that have had time to do so, have done so.

Sources

• Against Malaria Foundation. Accepted (quality) proposals and rejected (inadequate) proposals. 2009. Available online. (This includes notes as to why the proposals were rejected.)
• AMF Underfunded/Rejected Proposals due to funding constraints:
  • Against Malaria Foundation. Proposals that could only be partially funded due to funding constraints. 2009. Available online.
  • Against Malaria Foundation. MAG notes on proposals that could only be partially funded due to funding constraints. 2009. Available online.
  • Against Malaria Foundation. Proposals that were rejected due to funding constraints. 2009. Available online.
• Against Malaria Foundation. Organization website. Online at http://www.againstmalaria.com, accessed 7/1/09.
• Lawson, Todd. Field report. 2008. Available online at http://www.againstmalaria.com/images/00/07/7811.pdf, accessed 6/29/09.
• Phone conversation with Rob Mather, AMF's founder, 4/28/09

1. 1.

   http://www.againstmalaria.com/Distribution_strategy.aspx, accessed 6/29/09.

2. 2.

   Phone conversation with Rob Mather, AMF's founder, 4/28/09

3. 3.

   These are available on each distribution's page. Distributions are listed at http://www.againstmalaria.com/distributions.aspx, accessed 6/29/09.

4. 4.

   You can view all completed distributions via http://www.againstmalaria.com/Distributions.aspx?MapID=1&StatusID=7, accessed 6/30/09. An example of a completed distribution with photos is at http://www.againstmalaria.com/Distribution.aspx?DistributionID=265, accessed 6/30/09.

5. 5.

   AMF provided us with 6 examples of rejected proposals. At least 2 (Proposal 47, in India, and Proposal 58, in Rwanda) were due to concerns about the area's rate of malaria. Information from "Accepted (quality) proposals and rejected (inadequate) proposals" document.

6. 6.

   See our discussion of malaria.

7. 7.

   AMF does not usually perform follow-up surveys to determine net installation. One informal survey performed by Todd Lawson, an AMF donor, found that roughly 25% of nets were uninstalled or not installed properly. Lawson 2008, Pg 2.

8. 8.

   We spoke with a representative from a charity that applied to AMF for ITNs. She said that the AMF proposal took several days to complete. However, she also noted that AMF-provided nets arrived extremely quickly, and she was happy with the cost/benefit trade-off for her organization. Phone conversation 6/25/09.

9. 9.

   See MAG notes on proposals that could only be partially funded due to funding constraints 2009

10. 10.

    See MAG notes on proposals that could only be partially funded due to funding constraints 2009, distribution proposals 127 and 128.

11. 11.

    http://www.charity-commission.gov.uk/, accessed 7/10/09. For AMF's recrods, go to http://www.charity-commission.gov.uk/ShowCharity/RegisterOfCharities/Doc..., accessed 7/10/09