The Against Malaria Foundation was started somewhat by accident in 2005 after a three-person fundraising swim for a two-year-old girl, who suffered 90% burns in a house fire, grew over seven weeks into 150 swims in 73 countries involving 10,000 people. The swim helped to secure the child's financial future, and many participants asked: "What are we doing next year?" My answer was a very big swim for malaria, which led to our first malaria-focused activity, World Swim Against Malaria (in which 250,000 people participated).
AMF's process has remained largely the same over the years: we receive donations from the public that we use to buy long-lasting insecticide-treated anti-malaria nets, ‘LLINs’, and we work with distribution partners, including national Ministries of Health, to distribute them. Independent partners help us monitor all aspects of our programmes, including post-distribution monitoring to help ensure nets are distributed as intended, are hung and used properly, and continue to be used properly in subsequent years. Here's more information on how we choose which distributions we fund.
As we seek to be as efficient and focused in our work as we can, AMF is set up and operates a little differently from many charities. Some of those differences:
- AMF is still run from the back room of my house in London
- We are a registered charity in 12 countries but have no offices
- Our overheads over the last 5 years have averaged 0.85% of revenues
- We are a lean organisation: i.e. for 10 years, two of us ran AMF and grew the organisation to ~$50m of revenue per year, although we are now a team of seven
- I have a ’20 minute rule’ when working out how we go about things at AMF and to help us move quickly.
We focus strongly on data to maximise the impact of our work and to deliver accountability. For example, we gather data from each one of the millions of households to which we then deliver nets so that the right number of nets go to each household. We show transparently to donors where the nets they fund are distributed, linking each individual donation to a specific net distribution. So far we have received 492,500 donations totaling US$235,443,337. Our smallest donation has been $1 and our largest $22.8m, and every $2 matters because every net matters.
We have grown over the last five years and now fund multiple millions of nets at a time. We have recently agreed to fund, for distribution in 2020, 3.5 million nets for Togo, 11.6 million nets for Uganda, and 16.2 million nets for the Democratic Republic of Congo (DRC), one of the two countries in the world worst affected by malaria. This is a US$70 million commitment, and these nets will protect about 56 million people.
We recently completed a significant randomised controlled trail of a new type of LLIN to help in the fight against malaria, and the results so far are positive.
AMF has benefited *hugely* over the last eight years from the support of the EA community for which we are exceptionally grateful. AMF has been a GiveWell top-rated charity since 2012 and has long been similarly ranked by The Life You Can Save.
A recent update on AMF activities can be found here.
I'd be happy to answer any questions you have about AMF: how we started, how we work, the challenges we face, my biggest mistake, the opportunities we have ahead of us, what AMF most needs, etc.
I'll be responding to questions on Monday 27th January, and I'll check the post later in the week in case new questions come up. If you're reading this after early February and have questions, please feel free to email me at rmather@againstmalaria.com.
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.