When talking about effective charities, it never seems to take too long for the Against Malaria Foundation to come up. It has consistently been rated one of the top charities recommended by GiveWell, a non-profit that evaluates charities according to evidence of their cost-effectiveness, transparency and ability to use more funding, so that well-meaning donors can maximise their impact. As such, the Against Malaria Foundation (AMF) is hugely popular with effective altruists around the world who want their donations to do as much good possible.
So what is this star organisation of the effective altruism world? As the name suggests, AMF works to combat malaria. It does this by buying mosquito nets and distributing them in areas where there is a heavy malaria burden. This parasitic disease, which is spread via mosquito bites, continues to be one of the most devastating diseases in humanity’s history. In 2015 there were an estimated 212 million new cases of malaria, 90% of which occurred in Africa. The severity of the illness varies but all of these cases have an impact on the health, growth, study or work of the people affected. Many of these cases do result in death with 429,000 estimated deaths due to malaria in 2015. Those most vulnerable to malaria are children under the age of five. It is estimated that one child under the age of five dies of malaria every 2 minutes.
Given the scale of malaria’s global health impact this problem has, unsurprisingly, gathered a lot of support around the world. The Global Fund to Fight HIV, TB and Malaria has provided US $8.3 billion to malaria control programs. The Bill and Melinda Gates Foundation has made malaria one of its top priorities, with the ambitious goal of achieving complete eradication of malaria. The United Nations’ sustainable development goals (the UN’s blueprint for improving the world) list ending the malaria epidemic by 2030 as one of their targets.
With the complexity of the response required to overcome malaria, and the involvement of big philanthropists like the Gates Foundation, you might wonder what the role individual donors like you and me could play. The answer is that all this giving by philanthropic foundations is still not enough to end the problem. Improved global collaboration, scaling up programs to diagnose and treat malaria, and new technologies will all have a role to play. But that old saying that prevention is better than a cure might still be relevant. The World Health Organization recommends ensuring universal access to prevention as part of its 15 year strategy for action against malaria. Thankfully there is a cheap, easy way to prevent malaria: long-lasting insecticidal nets. Distributing these nets is the strategy AMF focuses on.
There are new technologies being developed to help to prevent malaria, such as vaccine development, mosquito engineering, and preventive medications.All of these may have a role to play in the global fight against malaria, but the reason AMF chooses to focus entirely on bed nets is that it is one of the most cost-effective ways of reducing the harm inflicted by malaria. Each net can last for three to four years and protects an average of two people, and costs about US $2.50. This direct, quantifiable benefit explains AMF’s focus on nets over the other options.
Nevertheless, ensuring that the nets are distributed and used properly is not a simple matter. For this AMF works through partner organisations to make distributions, educate people on how to use their nets, and monitor their usage in the longer term. This cooperation with local partners not only assist with the sustainability and local ownership of the operations but also enables AMF to commit all of its public donations exclusively to buying more nets for distribution.
However, when GiveWell measures the effectiveness of AMF as a charity, it looks beyond the upfront price AMF pays per net. As a result of their partnership with local organizations, there are many further costs in the process not covered by AMF itself, such as costs of education, distribution and monitoring. Although AMF does not pay for this, they are still important factors for a donor to consider when deciding which organisation to support.
When GiveWell factors these other costs in, the total cost per net distributed comes out to just under US $5. If this price is combined with information on the prevalence of malaria in distribution areas, and the known effects of the use of nets on malaria risk, GiveWell can produce an estimate on the cost per life saved. The best guess estimate comes out to about US $3000 (or around AUD $4000) per equivalent life saved, using the total cost per net in the countries we expect AMF to work in over the next few years. Now compare this figure to the price of a car or an overseas holiday. The fact that the cost is so low shows what an incredible opportunity this is to help others through our donations.
So, tackling malaria is a great cause and AMF is a great charity, but what makes it GiveWell’s number one recommendation? Partly this is due to the impressive cost-effectiveness of AMF’s approach, but another reason is AMF’s continued evaluation of its own performance. It does this by collecting data on each of its distributions and making this available to the public for scrutiny. It is particularly important to ensure that the nets are reaching their intended destination, are used as intended, and continued to be used. Although AMF provides nets through various distribution partners, it obliges them to gather and report detailed data to ensure the nets are serving their intended purpose of preventing malaria. The monitoring process is ongoing and detailed. It is achieved partly through unannounced visits to communities to see if nets are being used as intended, and through monitoring of health data to assess the program’s impact on malaria morbidity and mortality. This commitment to evaluating its own performance and transparency is what allows GiveWell to confidently assess AMF’s effectiveness.
Another reason for its top ranking is that AMF has enough ‘room for more funding’; in that it has the required capability and infrastructure to turn lots of extra dollars into nets instead of letting them sit idle in a bank account. This gives donors confidence that their money will be put to work quickly and usefully. Unfortunately there is an ongoing need for the scale up of net distribution programs. In 2015 the WHO estimated that almost half of all people at risk of malaria were not sleeping under nets, meaning that there is an ongoing need for net distribution.
It is the combination of these factors – the scope and seriousness of the problem, the capability of AMF, and the evidence that the nets are working and are a necessary part of the global malaria response – that has made AMF a consistently top-ranked charity in GiveWell’s list of recommendations, and a partner charity of Effective Altruism Australia. It is a great example of an organisation that is highly effective, but which also has the humility and sense to monitor its own programs and evaluate its impact. I personally find it very rewarding to donate my hard-earned money to a charity which I can confidently say is one of the most effective in the world.