Against Malaria Foundation

This funding opportunity was recommended by GiveWell, our research partner focused on global health and development. For more information please see GiveWell’s write-up on Against Malaria Foundation.

Against Malaria Foundation funds the distribution of long-lasting insecticide-treated nets (LLIN) in low income countries. These nets protect against malaria transmission.

If you are interested in co-funding a portfolio of organisations like this one, please see our Global Health and Development Fund.

What problem are they trying to solve?

Against Malaria Foundation is trying to save lives and reduce ill health caused by malaria. Malaria is a life-threatening disease that is transmitted to people via the bites of infected mosquitoes. Even when not fatal, malaria is unpleasant, causing flu-like symptoms and in more severe cases, seizures, comas, multiple organ failure and, in pregnant women, stillbirths and low birth weight babies.¹

Malaria can be deadly, particularly for children. There were 229 million cases of malaria in 2019 and it was responsible for 409,000 deaths. Of these deaths, 67% were of children under 5 years old. Pregnant women and those with HIV/Aids are also at a higher risk both of contracting malaria but also of it making them seriously unwell.² This is a shocking loss of life.

While we tend to think primarily of the physical symptoms of malaria, its indirect effects can also be extremely damaging. Because malaria is common and even milder cases can incapacitate people, it has significant opportunity and economic costs on individuals, households and national economies. Malaria is a leading cause of school absenteeism in Africa.³ It’s estimated that in 2000, 4-10 million school days were lost due to malaria in Kenya alone.⁴ In one study in Mozambique, even when treatment was free, an uncomplicated case of malaria cost between 10 and 21% of a family’s monthly expenditure while severe cases could cost a family more than 300%.⁵ Because of this, malaria can contribute to poverty traps where family savings are wiped out and work and education opportunities are limited by unnecessary periods of illness. It also costs governments a great deal. As well as lost productivity from workers, malaria spending makes up on average 5% of all government health spending in low-income countries, although this ranges as high as 14% (Burkina Faso) and even 25% (Liberia).⁶

Most of the burden of this disease falls on low income countries in Africa, with around half of all malaria deaths occurring in just 6 countries: Nigeria, the Democratic Republic of the Congo, Tanzania, Burkina Faso, Mozambique and Niger.⁷ This means the burden of this disease falls on some of the world’s poorest and most vulnerable people.

Despite all of this, between 2010 and 2018, aid spending on malaria has been decreasing by on average 1.9% per year and global spending on this issue is $2.3 billion annually below the estimated sum needed for eradication.⁸

What do they do?

Malaria continues to be a menace to much of the world, despite the fact that there are cheap and effective ways to prevent it. One of the easiest ways to prevent malaria is to sleep under a long-lasting insecticide treated net (LLIN). This protects against bites when mosquitoes are most active and while it doesn’t prevent 100% of infections, it can vastly reduce malaria cases and so save lives and prevent unnecessary suffering simply and easily.

Against Malaria Foundation funds the distribution of these nets in countries where the need is greatest. They identify those countries where there is a funding gap for this kind of project, identify in-country partners, such as non-profits who can distribute the nets and provide them with the most suitable type of nets, depending on local conditions, such as malaria prevalence and insecticide resistance. They also work with the partners to ensure the distributions are implemented as planned.

Against Malaria Foundation also independently funds monitors who monitor the process and conduct follow up surveys.

Why do we recommend them?

GiveWell, our research partner in global health and development, has evaluated Against Malaria Foundation and found them to be one of the most cost-effective global health organisations in the world. A net costs around $2 and GiveWell estimates that Against Malaria Foundation’s programme can avert the death of a child for around $4000.⁹ This estimate takes into account the fact that not every child given a net would have otherwise died of malaria and, while not to be taken completely literally, is a detailed estimate of the impact of the programme. When compared against other healthcare interventions, it’s clear just how cost-effective this is. For instance, the UK National Health Service generally considers it be cost-effective to pay up to £30,000 for treatment that can provide a single additional year of healthy life to a patient,¹⁰ while Against Malaria Foundation can prevent an unnecessary death for a fraction of that.

Key pieces of evidence for Against Malaria Foundation’s effectiveness are:

LLINs effectively prevent malaria and save lives

There have been a range of studies looking into the effectiveness of insecticide treated nets at preventing malaria. GiveWell’s analysis relied largely on a meta-analysis from the Cochrane Collaboration.¹¹ This included 23 high quality trials on the subject, although many were of ITNs, standard insecticide treated nets, rather than the longer lasting LLINs. The authors concluded with high certainty that 5.6 lives are saved each year for every 1000 children protected with ITNs.

The evidence for improving productivity is weaker but even without this, simply on the strength of LLINs’ life-saving potential, this is one of the most effective ways to make a difference in the world.

Against Malaria Foundation gets nets to those who need them

GiveWell found that Against Malaria Foundation explicitly target countries with high malaria prevalence, focusing much of their funding on the Democratic Republic of the Congo, where malaria is the second biggest cause of death and disability.¹²

As well as targeting countries where malaria is a particular threat, Against Malaria Foundation provides nets to people who wouldn’t otherwise have access to them, ensuring that each net is used and makes a difference in protecting people against malaria. They do this by doing pre-distribution surveys to assess how many are needed in each household and by ensuring re-distribution at the point that the average net wears out.

Against Malaria Foundation’s monitoring have shown that this approach is effective and the nets are used as intended. They found that in the households they target, in all but one project, “coverage” (the proportion of household members who slept under a net the previous night) was between 75% and 90%.

Why do we trust this organization?

This charity was recommended by GiveWell, our research partner for global health and development issues. GiveWell is a nonprofit dedicated to finding outstanding giving opportunities and publishing the full details of their analysis to help donors decide where to give.

Unlike charity evaluators that focus solely on assessing administrative or fundraising costs, GiveWell conducts in-depth research aiming to determine how much good a given program accomplishes, per dollar spent, in terms of lives saved or lives improved. Rather than try to rate as many charities as possible, they focus on the few charities that stand out according to a specific set of criteria, in order to find and confidently recommend high-impact giving opportunities. Against Malaria Foundation has been on GiveWell’s list of top charities for several years.

What would they do with more funding?

GiveWell believes that Against Malaria Foundation could productively spend more money on buying and arranging distribution of LLINs in the coming years than they have available. As of June 2020 they had $4.2 million in funds that were not already committed to projects. In addition to their planned projects, they had identified opportunities to spend up to $131.8 million more between mid 2020 and late 2023. Based on predicted income streams, GiveWell predicts that they could spend $37.8 million more than they are likely to receive by early 2022.¹³

What are the major open questions?

There are concerns that mosquitoes could be developing resistance to the insecticide used in LLIN. It is difficult to assess exactly how big an effect this will create but GiveWell have attempted to account for this in their model, assuming some reduction in effectiveness in LLINs compared to the studies mentioned earlier.¹⁴

More Resources

GiveWell write up on Against Malaria Foundation GiveWell review of the evidence for LLINs Against Malaria Foundation’s website

Disclaimer: We do not have a reciprocal relationship with any charity, and recommendations are subject to change based on our ongoing research.

Notes

1. WHO | Regional Office for Africa, “Malaria,” WHO | Regional Office for Africa, accessed January 6, 2021, https://www.afro.who.int/health-topics/malaria. ↩

2. World Health Organization, “Fact Sheet about Malaria,” accessed January 5, 2021, https://www.who.int/news-room/fact-sheets/detail/malaria. ↩

3. Joaniter Nankabirwa et al., “Malaria in School-Age Children in Africa: An Increasingly Important Challenge,” Tropical Medicine & International Health 19, no. 11 (November 2014): 1294–1309, https://doi.org/10.1111/tmi.12374. ↩

4. S. Brooker et al., “Situation Analysis of Malaria in School-Aged Children in Kenya - What Can Be Done?,” Parasitology Today (Personal Ed.) 16, no. 5 (May 2000): 183–86, https://doi.org/10.1016/s0169-4758(00)01663-x. ↩

5. Sergi Alonso et al., “The Economic Burden of Malaria on Households and the Health System in a High Transmission District of Mozambique,” Malaria Journal 18, no. 1 (November 11, 2019): 360, https://doi.org/10.1186/s12936-019-2995-4. ↩

6. Annie Haakenstad et al., “Tracking Spending on Malaria by Source in 106 Countries, 2000–16: An Economic Modelling Study,” The Lancet Infectious Diseases 19, no. 7 (July 1, 2019): 703–16, https://doi.org/10.1016/S1473-3099(19)30165-3. ↩

7. World Health Organization, “Fact Sheet about Malaria.” ↩

8. Haakenstad et al., “Tracking Spending on Malaria by Source in 106 Countries, 2000–16.” ↩

9. “Against Malaria Foundation,” GiveWell, accessed January 14, 2021, https://www.givewell.org/charities/amf. ↩

10. Sir Andrew Dillon, “Carrying NICE over the Threshold | Blog | News,” BlogPost, NICE (NICE), accessed January 14, 2021, https://www.nice.org.uk/news/blog/carrying-nice-over-the-threshold. ↩

11. Joseph Pryce, Marty Richardson, and Christian Lengeler, “Insecticide‐treated Nets for Preventing Malaria,” Cochrane Library, accessed January 8, 2021, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000363.pub3/full?cookiesEnabled. ↩

12. “Democratic Republic of the Congo | Institute for Health Metrics and Evaluation,” November 5, 2020, http://web.archive.org/web/20201105205336/http://www.healthdata.org/democratic-republic-congo.e ↩

13. “Against Malaria Foundation,” GiveWell, accessed January 14, 2021, https://www.givewell.org/charities/amf. ↩

14. “Against Malaria Foundation.” ↩