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What Happened in Areas Where AMF Considered Funding a Distribution, But Did Not?

Published: June 2016

Summary

The purpose of this investigation was to help us answer the question 'when AMF funds a distribution, is it funding nets that would not otherwise have been funded?' Here we've considered cases where AMF considered funding a distribution and did not ultimately provide funding. We then look at whether other funders stepped in and how long of a delay resulted from having to wait for other funders.

We looked at five cases. In short:

  • In two cases, major delays (18 months and ~3 years) occurred.
  • In two cases, other funders filled the gap six to nine months later than AMF would have.
  • In one case, funding was committed soon after AMF's talks fell through.
  • There does not appear to be a single large funder that is able to step in when other funding is not available. Funds for the delayed distributions came from many different sources.

We have not fully investigated whether lack of funding was the only or primary cause of delays in each case, however, we feel that these case studies provide some evidence that nets that AMF buys do not simply displace nets from other funding sources.

Details of each case are below.

Our process

To investigate cases of distributions that AMF considered but didn't fund, we:

  • Identified distributions that AMF considered but ultimately didn't fund by reviewing archived versions of AMF's "future distributions" page and past GiveWell reviews of AMF.
  • Confirmed our list of distributions with AMF, and asked if there were other large distributions AMF had considered but did not fund. AMF did not mention distributions others than the ones we had identified.
  • Asked AMF for details about the largest distributions we identified, focusing on what ended up happening in the areas that would have been covered by the distribution.
  • Asked Melanie Renshaw of the African Leaders Malaria Alliance and Marcy Erskine of the International Federation of the Red Cross about the largest distributions, focusing on what ended up happening in the areas that would have been covered by the distribution.
  • Reviewed Global Fund reports about grants it made in the countries in question, to see if information was available on when distributions occurred. We also attempted to do this for PMI grants, but could not find relevant public information about its grantmaking in the countries in question.


Case studies

Sierra Leone 2013

  • In 2013, AMF was in discussions to fund more than three million nets in Sierra Leone. According to AMF, it was approached by the Alliance for Malaria Prevention (AMP) in March 2013 to provide funding for a distribution, after it became apparent that other funders would not be able to meet the full net need in Sierra Leone.1
  • AMF did not ultimately sign an agreement to fund this distribution.2
  • The net distribution was delayed by about 6-9 months.3 As a result, the distribution occurred during an Ebola outbreak.4
  • The net gap appears to have been filled in the second half of 2014.5 The gap was filled by "reprogrammed" Global Fund funding (funding reallocated from other malaria programs, which might include, for example, diagnostics and treatment) as well as funding contributed by other funders.6

Senegal 2013

  • In 2013, AMF was asked to fund approximately 600,000 nets in Senegal.7
  • Ultimately, AMF did not end up funding this distribution.8
  • As far as we can tell, the distribution was delayed by about six months.9
  • The distribution was funded by the President's Malaria Initiative (PMI), utilizing savings from reduced prices for nets.10

Togo 2012

  • In 2012, AMF was in discussions to fund a distribution of 500,000 nets in Togo.11
  • AMF did not ultimately sign an agreement to fund this distribution.12
  • As far as we can tell, the net distribution was delayed by at least 18 months. Areas with a higher incidence of malaria were prioritized and received nets, while areas with lower incidence went uncovered.13
  • Marcy Erskine told us that the Red Cross and the United Nations Foundation contributed funding to fill the gap.14

Nigeria 2013

  • In 2013, AMF was in discussions to fund a distribution of somewhere between 0.5 to 1.8 million nets in Nigeria.15
  • AMF did not ultimately sign an agreement to fund this distribution.16
  • The gap was filled soon after AMF's talks fell through by a major funder.17

Cameroon 2013

  • In 2013, AMF was asked to fund a distribution of 2 to 12 million nets in Cameroon.18
  • AMF deprioritized this distribution in favor of other candidate distributions for which discussions were further advanced and seemed more promising.19
  • As far as we can tell, this distribution has not yet taken place, and is slated to take place in mid-2016. According to Melanie Renshaw, there was an upsurge in malaria cases in 2015, which she believes was likely a consequence of nets in the region decaying and not being replaced.20
  • Melanie Renshaw told us that the planned mid-2016 campaign has been funded by the Global Fund and the government.21

Sources

Document Source
Rob Mather and Peter Sherratt, conversation with GiveWell, February 28, 2016 Unpublished
Rob Mather, conversation with GiveWell, August 15, 2013 Unpublished
Marcy Erskine, conversation with GiveWell, March 29, 2016 Unpublished
Melanie Renshaw, conversation with GiveWell, March 16, 2016 Unpublished
Melanie Renshaw, email to GiveWell, May 15, 2016 Unpublished
Global Fund report: "Scaling up Malaria Control Interventions Towards Universal Coverage in Sierra Leone", Grant SLE-M-MOHS, Grant Performance Report Source (archive)
Global Fund report: "Improving universal-access prevention and care services for Malaria in Togo", Grant TGO-910-G10-M, Grant Performance Report Source (archive)
Global Fund report: "Improving universal-access prevention and care services for Malaria in Togo", Grant TGO-910-G11-M, Grant Performance Report Source (archive)
Global Fund report: "Scaling up simple malaria treatment with combination of artesunate-amadiaquine", Grant CMR-910-G07-M, Grant Performance Report Source (archive)
Global Fund report: "Scaling up Malaria Control for Impact", Grant CMR-M-MOH, Grant Performance Report Source (archive)