Published: September 2012

Summary Plans for future distributions AMF currently has $4.6 million in funds, which would allow it to purchase approximately 1.1 million nets for distribution. AMF is currently evaluating potential distributions in Togo and Mali. Were it to decide to move forward with these distributions, they would require all of AMF's current funding. AMF is distributing funds at a slower pace than it anticipated. We will continue to monitor this and provide updates on AMF's progress in purchasing nets.

Past distributions AMF completed a distribution of approximately 268,000 nets in Ntcheu, Malawi in April 2012. It has followed through on its plans to carefully monitor and share data from this distribution, having now posted (a) a final distribution report, (b) malaria case rate data for Ntcheu, and (c) post-distribution surveys of net receipt and use. All data is consistent with the notion that this was a successful distribution.

Bottom line: We remain confident in the effectiveness of AMF's activities. It remains our #1-ranked organization.

Plans for future distributions

In early April 2012, AMF’s distribution partner in Malawi, Concern Universal, completed its distribution of about 268,000 LLINs. AMF is now in the process of searching for future distribution partners.

Progress in the search

AMF has located potential distribution partners in two countries: Plan Togo and Plan Mali. AMF’s discussions with these potential partners are at advanced and intermediate stages, respectively. As of August 2012, AMF had not made any agreements with new distribution partners for large-scale distributions.

Plan Togo

AMF understands that there is a current need for about 500,000 nets in Togo in order to achieve universal coverage. Based on conversations with other funders and the Togo National Malaria Control Programme (NMCP), AMF has concluded that funding to cover this gap is not currently available.

Plan Togo previously was involved in an LLIN distribution campaign in 2011, and AMF believes that this campaign was well-conducted.

Plan Togo and the NMCP have been responsive in providing AMF with information. Discussion on elements of the distribution, including some pre-distribution and post-distribution information and activities, is not yet complete, so AMF has not been able to reach a final decision and conclude an agreement. For example: Plan Togo has told AMF that it has a pre-distribution registration survey (PDRS) for the relevant distribution areas, but AMF has not yet seen this data, nor knows how recent and therefore reliable it is. Consequently, AMF does not know whether a new PDRS will be requested and, if it were, what Plan Togo and the NMCP’s response would be.

AMF has spoken with Plan Canada, which has agreed to cover the full non-net costs of the distribution (including shipping, the distribution and monitoring, pre-distribution registration survey and post-distribution follow-up required by AMF) if AMF decides to partner with Plan Togo.

Plan Mali

AMF understands that approximately 4 million additional nets are needed in Mali in order to achieve universal coverage.

AMF is mid-way through the process of evaluating a potential partnership with Plan Mali, and has not yet reached agreement on its requirements or received the information it needs about Plan Mali’s capacity in the country.

Based on the funds it had available as of early August and assuming a 500,000 net distribution in Togo, AMF could fund approximately 600,000 nets for Mali.

AMF may consider increasing the scale of the Mali net distribution up to 4 million nets if it has successful progress with the Mali NMCP and Plan Mali (or other distribution partners), and if the need for 4 million nets can be justified with reliable data, and if there are no other sources of funds. Should it scale up this distribution, AMF would need to raise additional funds.

AMF has spoken with Plan Canada, which has indicated that it would fund the non-net distribution costs if AMF decides to partner with Plan Mali (though AMF has not discussed with Plan Canada the non-net funding for a larger-scale distribution of 4 million nets).

Next steps

AMF is hoping to reach agreement with distribution partners in Togo and Mali by the end of September, if possible.

If partnership agreements are not reached with partners in Togo and Mali, AMF has a list of other countries with significant net gaps it plans to explore, including Cameroon, Ivory Coast, Guinea, Chad, Nigeria and Malawi.

Room for more funding

In September 2011, AMF told us that if it were to receive $3 million or more from GiveWell, it would use those funds for a distribution with an expected completion date of June-September 2012. As of August 2012, AMF had received that level of funding from GiveWell, but had not made sufficient progress to meet its expected completion date for future distributions.

We discussed this slower-than-expected progress with Rob Mather, AMF's founder. He told us that during March and April 2012, AMF had discussions with the National Malaria Control Program (NMCP) in Malawi regarding the country’s upcoming universal coverage distribution. AMF was considering funding the 600,000 nets this campaign required to close the gap in Malawi. However, AMF withdrew from this potential distribution because it could neither obtain the data to fully evaluate the potential distribution nor receive assurances on how the distribution would be carried out. AMF is considering publishing detailed information on its experiences with this distribution.

AMF currently believes that the earliest date its funds could be spent is October 2012. In this scenario, nets would be disbursed in early 2013.

AMF is conscious of not converting funds to nets as quickly as it expected to and has learned it is necessary to consider more potential distributions in parallel to avoid delays it considers suboptimal. Going forward, AMF plans to build a “pipeline” of potential future distributions, so that money can be moved more quickly into buying nets. AMF feels that it was a mistake to place too much stock in a few potential distributions (including the one in Malawi, discussed above), rather than aggressively pursue more potential distribution opportunities back in April. AMF has recently provided an explanation and update to donors whose donations are currently unallocated to a distribution. (http://www.againstmalaria.com/futuredistributions.aspx)

Results of the past distribution in Malawi

The distribution in Ntcheu, Malawi was completed in early April 2012; we describe details of the distribution in our previous update.

Final distribution report

Concern Universal, AMF's distribution partner in Malawi, published a final report on the Ntcheu distribution that includes a detailed description of each stage of the distribution process (orientation, registration, data entry, verifications, distribution) with photographs. This report also lists challenges met throughout the process and recommendations for future distributions.

In addition to the problems Concern Universal identified that we mentioned in our previous update, the report mentions an anecdote of an identified misuse of 10 nets.

Malaria case rate data from Ntcheu

AMF requires its distribution partners to collect monthly malaria case rate data from all health centers in the distribution zone for 12 months preceding and 4 years following the distribution. AMF has followed through on its plans to collect and share this data and has published data on malaria cases from each of the 37 health facilities in Ntcheu for the months of July 2010 through June 2012. This includes data for nearly four months of full net coverage in Ntcheu.

Based on independent evidence, we believe that net distributions reduce deaths from malaria. (For more, see our page on mass distributions of insecticide-treated nets.) The data AMF collected are consistent with the notion that AMF's net distribution had a significant impact on malaria rates in Ntcheu. However, we do not currently feel that we are able to draw strong conclusions from this data, so it does not significantly increase our confidence in net distributions in general, or AMF's in particular.



Post-distribution survey data from Ntcheu

AMF requires its distribution partners to administer 4 post-distribution surveys (PDSs) to gather data on net usage and condition. In Ntcheu, the first of these surveys was administered six months following the distribution in 200-250 households in each of the 37 health centre areas.

6-month PDS data is now available for some areas of Ntcheu, covering 7,646 households and 15,735 nets (5.9% of the total distributed). The results report a 90% usage rate and 99% of nets still in very good condition (fewer than two holes of 2 cms or smaller). District by district data is available on AMF's website on its survey summary page at http://www.againstmalaria.com/SurveyForms_JobsSummary.aspx (archived).

AMF told us that Concern Universal used several measures to increase the reliability of PDS data.

We are glad that AMF is collecting this data because it demonstrates that AMF is following through on its plans post-distribution and because the survey data might identify a serious problem, were one to exist. Concern's methodology for conducting these surveys appears reasonable, but we have not yet seen the full technical details of these surveys or results from Concern Universal's data quality auditing procedures. Thus, after only a limited examination of the data, these survey results are consistent with the notion that those who receive AMF's nets use them.

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