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Further information about AMF
AMF distribution in Ntcheu, Malawi
268,420 nets were distributed in Ntcheu District, one of Malawi's 28 districts, between December 2011 and February 2012, to achieve coverage of all sleeping spaces (‘universal coverage’) across a population of 550,000.
The results have been very strong:
- Malaria rates in March to June 2012 were 50%, 45%, 40% and 40% lower than in the corresponding months in 2011.
- A six months post-distribution survey of 7,600 households and 15,700 nets showed a hang-up (usage) level of 90% and the percentage of nets in very good condition was 99%.
AMF continues to monitor malaria rates and net use in Ntcheu.
How does AMF work?
- AMF has a clear focus on a specific intervention, anti-malaria bednets, and particularly long-lasting insecticidal nets (LLINs). This means the potential impact on lives saved and health improved per dollar donated is high.
- AMF has an operating model that has proved highly effective: a lean organisational structure, significant leveraging of technology, and a pro bono partnership and distribution partner model. This means their costs are exceptionally low.
- AMF places great emphasis on the preparation, carrying out and follow up of distributions to ensure the potential impact of distributing nets is realised. They report on this transparently and in detail.
AMF’s guiding principles
These are efficiency, transparency and impact.
This because of the way AMF is structured and is run, and through a broad base of pro bono support from organisations and individuals. AMF has very few administrative costs. Those they do have are covered by a small group of private donors. Distribution partners pay for the costs of distributing the nets.
Transparency: You can see where your money is going
AMF lists on their website all donations received and links each donation to a specific distribution so donors see where the nets they fund are distributed. If you donate to AMF, your name (anonymous if you chose) and donation will be linked in this way so you can follow the distribution for which you fund nets.
Impact: The nets reduce illness and prevent deaths.
By donating to AMF you will be helping prevent many from falling ill with malaria or worse. AMF track monthly malaria case rate data and publish this information so you can follow the impact of the net distributions.
Key elements of an AMF net distribution
Pre-Distribution Registration Survey (PDRS) to establish net need.
This involves visiting every household in a distribution area to establish the number of sleeping spaces and the number of perfectly usable LLINs already in place. The resulting data underpins the entire distribution and ensures it can be carried out efficiently and without wastage.
In Ntcheu, 120,000 households were visited with the number of nets needed in every household established. This was inexpensive, a cash cost of $40,000, and was carried out by the 450 government Health Surveillance Assistants (HSAs) under the supervision of AMF’s local distribution partner, Concern Universal.
Malaria education programmes to ensure communities are aware of how malaria is contracted, prevented and treated.
Significant malaria education occurs in the pre-distribution period. Programmes are run by local health leaders and cover how malaria is contracted, how to prevent it, including the effective use of nets and removing stagnant water where mosquitoes breed, and how to identify malaria and what to do in such cases. A bednet demonstration illustrates how to install and use a net correctly.
Independent supervision at the ‘moment of distribution’ to ensure all nets go to those for whom they are intended.
It is important to avoid nets being misappropriated. Otherwise, the consequences include not achieving universal coverage which compromises the ability to break malaria transmission. Independent supervisors, with authority over community leaders and local health workers, however senior, ensures the ‘no show, no net’ rule is followed. This helps avoid others misappropriating nets through ghost names on lists for example. Those unable to be at a distribution can collect their nets later. This approach imparts a strong sense of ‘fairness’ (nets will not be taken by others) and ‘equity’ (if I need 3 nets I will get three nets) throughout a distribution.
In Ntcheu, a team of 20 individuals, from Concern Universal’s staff and senior individuals within the district’s health structure, supervised.
Tracking monthly malaria case rate data so the impact of the nets can be quantified and reported.
This involves maintaining contact with all health centres and clinics in the distribution area and ensuring reliable malaria case rate data is recorded. The data is published.
In Ntcheu, nets were distributed between December 2011 and February 2012. The total number of malaria cases has fallen dramatically in the subsequent months, compared to the year before: malaria incidence, compared to the same month in the prior year, was 50% lower in Mar 2012, 50% lower in Apr 2012, 45% lower in May 2012, and 45% lower in June 2012.
Post-Distribution Surveys (PDSs) to monitor net use and net condition.
Continued use of nets is very important. A post-distribution survey takes place at six-month intervals with approximately 5% of households visited to collect data on net use and net condition. This data is published and triggers additional malaria education and net hang-up interventions where necessary.
In Ntcheu, the first PDS carried out six months after the distribution showed, across all of the 37 health centre catchment areas, 90% of the nets were hung and in use. For 27 of the areas the average was 95% (range 91-98%). For 10 of the areas the average was 84% (range 78- 88%). Additional, structured malaria education and hang-up activities took place (23-27 Sep 2012) in the 10 health areas, with the aim of raising the hang-up level in these areas by 10 percentage points (from an average of 84%).
AMF also keeps tabs on the quality of the nets.
In Ntcheu, 99% of the nets were found to be in 'very good' condition (fewer than 2 holes of up to 2cms in size).
This attention to detail ensures AMF is highly effective at saving lives and preventing illness and explains why AMF is one of our top-rated charities.
AMF was originally identified by GiveWell, one of the key sources in our research. This case study was investigated by us, but if you aren't already fully convinced, you can get much more information on their projects from GiveWell's report on AMF which covers almost every aspect of their work.
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