The GiveWell Blog

Update on the Against Malaria Foundation: Our current #1-ranked charity

Highlights from our update of AMF follow. For those who want more information, please see our full AMF update.


Historically, AMF had distributed bednets in the following way: on-the-ground organizations applied to AMF for nets; after AMF reviewed and approved proposals, it would ship nets to the charity; finally, AMF would check in to see whether the nets had been distributed and were being used.

In early 2011, AMF changed its model. It received significant funding, which allowed it to proactively identify opportunities for net distributions rather than reacting to charities’ requests. In mid-2011, it decided to provide about 250,000 nets (at a cost of a little over $1 million to AMF) to the Ntcheu district in Malawi as part of a national net distribution.

Note: In addition to the costs incurred by AMF, Concern Universal, AMF’s distribution partner in Malawi also incurred costs. We estimated these costs in our review, but are currently working to update our estimate of Concern’s costs because we believe that we underestimated Concern Universal’s costs in our original AMF review. We don’t believe our estimate of total costs per net will change significantly.

The Malawi distribution

In October 2011, three GiveWell staff members visited the Ntcheu district while pre-distribution activities were taking place (such as surveying local households to determine who needed nets and how many each household needed). Concern Universal, the organization distributing AMF-provided nets in Ntcheu, started the distribution in mid-December and now (as of mid-March) Concern Universal has reported that it had distributed 242,745 nets to households in the district, out of the 251,720 nets provided by AMF. For its final distribution location in late March/early April, Concern Universal requires another 16,574 nets, which AMF is sending. (More information in our full, detailed update.)

Concern has posted weekly reports on its progress on AMF’s website, which not only share data on weekly nets distributed but also share problems identified during distributions. Concern reports highlight a number of instances of attempted theft and fraud by the health workers (HSAs) Concern has employed to distribute nets. In one case, Concern believes that an HSA fabricated the existence of two villages in order to steal the nets. Neither we nor AMF are surprised by attempted fraud, and we are glad that Concern’s process has identified such instances.

We cannot be sure whether Concern has identified all instances of malfeasance. That said, we believe that Concern’s process for identifying attempted fraud (along with AMF’s oversight of Concern and our monitoring of the entire process) is robust and therefore, we would be aware of significant problems. (More information in our full, detailed update.)

AMF’s 2012 plans

  • AMF currently has access to approximately $3.5 million in received (or committed and soon to be received) funding. Approximately $2.3 million of this comes from GiveWell-directed donors.
  • Malawi is currently in the midst of a national net distribution, which has been delayed. (AMF-funded distributions are not delayed; the rest of the national distribution is.) Rob Mather told us that Malawi estimates it needs 5.8 million nets, of which it has access to 5.2 million (4.7 million from the Global Fund and approximately 500,000 from the President’s Malaria Initiative). It therefore has a gap of 600,000 nets, and AMF is in discussions with the NMCP to see if AMF will provide these nets.
  • Rob Mather has told us that he is not yet ready to provide these nets. He (a) has not yet seen sufficient data to convince him that there is, indeed, a gap of 600,000 nets, and (b) he is not yet convinced that AMF funding, as opposed to funding from other partners (e.g., Global Fund), is needed. In the event that Malawi does provide this information, AMF would provide additional nets for the Malawi distribution. AMF has therefore reserved $2.5 million of its funding while it assesses the need for nets in Malawi.
  • AMF will likely reach a decision about Malawi in either the next few weeks – if the decision is not to provide further nets for Malawi – or in the next 3-4 months if it looks like funding further nets is possible. Three to four months is the timeframe required to collect data from the National Malaria Control Program and from the field to determine the net gap. Coordination with the Global Fund and President’s Malaria Initiative is also required. In the event of a positive outcome, Mr. Mather expects that the nets would be distributed before the rainy season in November. In the event that AMF decides not to contribute further to the Malawi effort, it believes that there are strong needs for nets exist in campaigns in Ghana, Mali, Togo and several other countries.
  • One of AMF’s broad goals in its interactions with the Global Fund and the National Malaria Control Program in Malawi is improving the way that net distributions are conducted. Mr. Mather believes the AMF/Concern Universal approach in the Ntcheu district distribution follows best practice for pre-distribution data collection, distribution oversight, and post-distribution monitoring (described in our AMF review). As AMF’s influence increases (due to increased funding ability), it hopes to influence other players involved in bednet distribution to adopt the Ntcheu distribution as a model.

Expected future revenue

AMF told us that it has no current commitments for significant future revenue, but is in discussions with donors who could potentially make 7-figure donations. We are currently comfortable with AMF receiving up to ~$15 million over the next year. This figure would be about half of what would be needed to close the net gaps for Malawi, Mali and Ghana (according to our most conservative estimates published in our coverage analysis), and would constitute a significant “step up” for AMF’s size – a somewhat risky but overall strong opportunity for donors. We would have to revisit the question of AMF’s room for more funding if it were to raise more than $15 million.