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Jeff Sebo's Fundraiser:

UNC Chapel Hill, Philosophers Against Malaria

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BENEFITING:

Jeff Sebo

THE STORY:

AMF (againstmalaria.org) provides funding for long-lasting insecticide-treated net (LLIN) distributions (for protection against malaria) in developing countries. Does it work? There is strong evidence that distributing nets reduces child mortality and malaria cases. AMF has relatively strong reporting requirements for its distribution partners and provides a level of public disclosure and tracking of distributions that we have not seen from any other net distribution charity. AMF's post-distribution surveys have generally found positive results, but have some methodological limitations. What do you get for your dollar? We estimate that the cost to purchase and distribute an AMF-funded net is $4.35 in Malawi, $5.92 in the Democratic Republic of the Congo (DRC), and $5.14 in Ghana (the three countries that AMF has completed large-distributions in). We also very roughly estimate, based on past and planned distributions, that the cost per net in distributions AMF may fund with additional donations is $4.85. The numbers of malaria cases prevented and lives saved are a function of a number of difficult to estimate factors, which we discuss in detail below. Is there room for more funding? We estimate that AMF could productively use or commit a maximum of between $78 million (50% confidence) and $191 million (5% confidence) in additional unrestricted funding in its next budget year. We are most confident in the value of the funds for the first $11 million it receives, but we expect funds to continue to be valuable, though possibly somewhat less cost-effective, above that level. AMF is recommended because of its: Focus on a program with excellent evidence of effectiveness and cost-effectiveness. Processes for ensuring that nets reach their intended recipients and monitoring whether they are used over the long-term. Room for more funding – we believe AMF will be able to use additional funds to deliver additional nets. Transparency – AMF shares significant information about its work with us and we are able to closely follow and understand its work. Major open questions: We have seen detailed data from before and during distributions. AMF also seeks to collect follow-up data after distributions, but its track record of collecting the data it seeks from distributions is limited outside of Malawi. In particular, we have seen only two follow-up surveys from distributions outside of Malawi, and these surveys are of lower quality than previous surveys from Malawi. The surveys we have seen from Malawi also have methodological limitations. The best evidence for nets was collected before they were widely used and there is some evidence that mosquitoes have since adapted to the insecticide used in nets, possibly making them less effective. It seems that insecticide resistance is a growing concern, but it remains difficult to quantify the impact of resistance. There are several studies in progress that may help shed light on this within the next year. We discuss this issue in more detail in our page on this topic. We are considerably uncertain about the size of AMF's room for more funding. There are several major funders of nets, which provide most of the funding needed to distribute nets to all at risk populations. The Global Fund to fight AIDS, Tuberculosis, and Malaria is by far the largest and has not yet determined how much it will allocate to nets over the next few years. We believe there is a significant remaining gap (one rough estimate was $125 million per year) but do not have high confidence in the size of the gap.

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