Best charity in the world update

Depressing news from Givewell on the Against Malaria Foundation (AMF).

The good news: Givewell has directed $10m in the last 2 years to AMF. 

The bad news: This is a massive increase in scale for AMF, and they haven't yet managed to spend the money. This seems to be primarily because the transparency and accountability measures that help to make them such an attractive proposition for donors, also makes them a pretty unattractive proposition for implementers such as national governments. 

There's something about a sexy new NGO innovation which then runs into trouble when it tries to scale-up working through national government that sounds somehow familiar.

We shouldn't be too disheartened - this is hopefully just a set-back and the money will still eventually be spent. And it is still useful to model what good practice can look like even it is isn't replicated more widely immediately. But "room for more funding" - the capacity to implement at large scale, is clearly critical here. 

In the short-term this implies finding someone else to give your money to - your two best options seem to be Give Directly (tax deductible in the US) or the Schistosomiasis Control Initiative (tax deductible in both the US and UK, but with some concerns here) - neither of which seem to be entirely satisfactory for me as a UK-taxpayer. I'll wait for further comment from Givewell.

Eradicating Malaria in Rwanda

“In 2008, malaria was the topmost killer disease in Rwanda, but results have shown that now it is the eighth. Our aim is to eradicate it completely from the list of killer diseases in Rwanda,” she said.

The Demographic Health Survey conducted in 2010, indicates that malaria prevalence has decreased from 2.6 per cent in 2008 to 1.4 per cent in 2010 in children under five and from 1.4 per cent in 2008 to 0.7 per cent in 2010 in pregnant women.

Ministry looks to eradicate malaria, New Times

Against Malaria Foundation

As part of my personal evidence-based living regime (ahem) I'm planning a £1,000 donation to the Against Malaria Foundation. It's at least partly selfish - one of the few ways that spending money can actually bring you happiness is by spending it on other people (can you tell how smug I feel writing this?). There has also been a lot of analysis into the effectiveness of buying bednets. Givewell estimate that the marginal cost of a net is $5.15, and that by buying enough of them, you can probably save a child's life for about $1,600 (or £1,000). I had been hesitating over a recent story about behavioural adaptation by mosquitoes to nets, but responses from Givewell and AMF have basically reassured me. Unless anyone has any other good objections?

Givewell:

our positive view on LLINs remains in place. There is strong evidence that LLINs reduce malaria and save lives and only preliminary/suggestive/mixed evidence that insecticide resistance may reduce their impact. In addition, it appears to us that the malaria control community has been devoting at least some attention and investigation to this issue for a long time, has developed a reasonable knowledge base (if one that has plenty of room to grow), and still recommends the use of LLINs regardless of the resistance situation. 

Indeed, the fact that we’re discussing this issue at all speaks to the extraordinarily and unusually strong evidence base (and supply of data) behind ITN distribution. For most aid interventions that donors can fund, the set of “things that could go wrong” is large and broad, and we have little evidence to address most of them, but when looking at LLIN distribution, the salient concerns are few and specific enough that the malaria control community is able to put substantial resources into specifically investigating them.

 And AMF:

Currently both issues - resistance to pyrethroids and changed time of biting - are not widespread. Currently LLINs remain highly effective in reducing the incidence of malaria.

 And why not, here's the Donation Page. 

Good aid meets bad governance: The case of bednets in Masisi

So apparently the donors and the Government of DRC agreed to split 50:50 the cost of providing insecticide treated bednets for every family in the Masisi district. There are now 100,000 donor funded nets sitting in the hospital in Masisi town, waiting there for months to be distributed by government staff, and taking up scarce space in the hospital. And there is no sign of those government funded nets.

Millennium Villages: impact evaluation is almost besides the point

A lot has been said about evaluation and the impact of the Millennium Villages, most of which boils down to:

"What is the impact of the Millennium Village package of interventions on the area in question?"

The really depressing part though is that this is actually the least interesting question. Chances are that throwing in a whole bunch of extra inputs to a community will create some outputs, and some impact. The whole point of the Millennium Villages though is to provide a model for the rest of rural Africa to follow. The really interesting question is whether African governments have the desire and capability to manage a massive and complex scaling up of integrated service delivery across rural Africa.

A point which basically belongs to Bill Easterly.

Mr. Easterly argues that the Millennium approach would not work on a bigger scale because if expanded, “it immediately runs into the problems we’ve all been talking about: corruption, bad leadership, ethnic politics.” 

He said, “Sachs is essentially trying to create an island of success in a sea of failure, and maybe he’s done that, but it doesn’t address the sea of failure.” 

Mr. Easterly and others have criticized Mr. Sachs as not paying enough attention to bigger-picture issues like governance and corruption, which have stymied some of the best-intentioned and best-financed aid projects.

A proper randomised evaluation could give you a good estimate of the cost-effectiveness of the island. A difference-in-difference estimate could give you a slightly worse estimate. Doing a fake difference-in-difference with unreliable recall baselines, arbitrarily selected control villages, misrepresented results, and mathematical errors, will give you a pretty awful estimate. But either way, you are missing the main point, which is about scale and replication, and how that works.

How feasible would it really be to replicate something like this on a national level in Ghana? How exactly would it work? Do the  systems of accountability and capability exist at local levels to manage all of these projects? How would coordination and planning work between national ministries and their sectoral plans, and local level priorities?

The Millennium Village project seems to grasp vaguely at these issues but ultimately brush them under the table. From a MV project report:

Another challenge in some sites is insufficient capacity of local government to take full ownership of MV activities. This is manifested in unfulfilled pledges to perform mandated roles, unsatisfactory maintenance of infrastructure, and insufficient involvement of local elected officials. MV site teams are addressing these challenges by agreeing to jointly implement interventions targeted at improving the performance of sub‐district governments, increasing sensitization and engagement of local government officials, increasing joint monitoring of MV activities in communities, and developing training plans in technical, managerial, and planning skills for local government officials.

 Or : "we have no clue how to fix the systemic implementation challenges"

An anonymous aidworker writes on his blog Bottom-up thinking

I’ve noticed around here, normally sloth-like civil servants who won’t even sit in a meeting without a generous per diem rush around like lauded socialist workers striving manly (or womanly) in the name of their country when a bigwig is due to visit, working into the night and through weekends, all without any per diems...   

I fear all the achievements of the MVP will wash up against the great brick wall that is a change resistant bureaucracy.

None of this is to say that the situation is hopeless. It isn't. In particular there are elements of the Millennium Village package which are proven to be effective, cheap, and don't require complicated systems of governance and accountability. Namely distributing insecticide-treated bednets. Aid money can provide them easily, sustainability is less of a concern than other interventions, and you can buy them right now. Check out Givewell for a rigorous independent assessment (and recommendation) of the Against Malaria Foundation. Probably the single best way you could spend some money today.