Rob Mather: Against Malaria Foundation — what we do, how we do it, and the challenges

By EA Global @ 2019-02-12T15:59 (+8)

This is a linkpost to https://www.youtube.com/watch?v=E5wr3u8Gjwg&list=PLwp9xeoX5p8OpYjWpNDQnjyTpoelQmy4P&index=18

This transcript of an EA Global talk, which CEA has lightly edited for clarity, is crossposted from effectivealtruism.org. You can also watch the talk on YouTube here.

The Against Malaria Foundation is one of the most effective global health charities in the world, and the single most common donation target for EA Survey respondents (as of 2018). What makes this organization so special? How do they approach their work, and what challenges do they face? CEO Rob Mather answers these questions in this talk from EA Global 2018: London.

The Talk

I'm going to try and cover what we do and how we do it, but I use the words impact and accountability a lot in what we do. They're themes that you will see that run through what we talk about, because every charity really, our focus is to have impact. And particularly delivering that for us means focusing on accountability, because the devil is in the detail. It's not easy to raise money, but it's not where you mess up. You mess up on delivery, on operations. So that's really where our focus lies.

You guys can read the numbers. I hope you can see the numbers at the back more quickly than I can say them. But I think we all understand that malaria is a humanitarian issue. The numbers are pretty frightening. When I first came across malaria it was because I heard that seven jumbo jets full of children under five died from malaria every day. And that really struck me. Not only does it particularly affect children under five, but pregnant women who have a compromised immune system when they're pregnant are also particularly vulnerable.

We focus on Sub-Saharan Africa, because that's where 90% of the cases of malaria and where most of the deaths occur. But it's not just a humanitarian issue. If you're sick with malaria then you can't teach, you can't farm, you can't function. And that means you're not a constructive or productive member of society. And so malaria is a drain on the economies of all of these countries that are affected. So if the humanitarian doesn't get you like it got me, then I hope the economic component would get you instead. If we put $1 million into fighting malaria effectively and efficiently, then we will improve the GDP of the country or the continent, I should say, by $12 million. A 12 to 1 return is a pretty good offer, even if you're not persuaded by the humanitarian element.

Unfortunately, there's no silver bullet. There is no vaccine. Lots of research going on, and we all keep our fingers crossed that they'll find something. Vaccination research and gene drives are a big hope, and we all hope fervently that something comes of them, but for now it doesn't exist. So to pick up on the under fives, if I invited you all down to Heathrow Airport and you saw this, we'd all say, "Hang on a minute. This is slaughter." And this is daily, remember, so it is a big issue that we absolutely need to do something about.

And a big part of the solution, not the only solution, but a big part of the solution is nets. They cost $2. They protect two people each. And, therefore, given that the female mosquito that is pregnant and wants to reproduce needs a blood meal to reproduce bites between 10:00 at night and 2:00 in the morning, that is something terrific we have on our side. It means that we can cover people when they sleep, and we can protect them mechanically. We also cover these nets with insecticide. We're putting nets in very challenging environments: they're households but they're not houses. So inevitably, these nets become ripped, they become torn, they have holes in them. But fortunately, the mosquitoes don't do a red arrows maneuver through a hole. They land on the net and migrate to the hole, and when they pick up insecticide it kills them. The fact that mosquitos typically feed between 10:00 at night and 2:00 in the morning is a really good characteristic that we can exploit here.

And the impact is dramatic. We're talking about whether it's 600 nets or 1,000 nets or 400 nets, it depends on the malaria burden, but we're talking about low thousands of dollars equals one death averted, and broadly it's 1,000 cases of malaria prevented for every person that dies, the mortality to morbidity ratio. This is an extraordinary impact. And graphically that's what we see.

We see prior to putting nets in place you have the top graph, the seasonality, rainy seasons and dry seasons, happens more or less immediately, so within weeks. It's not as easy as just handing out nets and saying, "Right, we're done." Education is involved and there's sustained effort, but broadly speaking any major health initiative where you'd have a 10% decline nationwide is dramatic. So if we can introduce 40% or 50% decline, you can see this is in the sensational category of what we can achieve.

How AMF Got Started

So just a minute or so on how I started. I shamelessly called 250,000 of my best friends and said, "Would you like to swim?" And they all said yes. In fact, the truth is that I failed because I was trying to get a million people to swim, but I'm not going to count that as true failure really. And very much the spirit behind this was, as I said to Michael Phelps, "What I'd like you to do in front of the camera is just say, 'I would like you to swim. It doesn't matter how fast I swim. When I swim I count as one person. And if you swim you count as one person as well.'"

Very much the spirit behind what we do at AMF is that we're ordinary folks, so very grassrootsy in that I don't think this is about celebrity. It's about all of us, because it's almost the power of all the ordinary folk that can get things done. And that was very much the spirit, and it is today behind what we do at AMF. And so there were some wonderfully nutty people swimming as part of World Swim Against Malaria in 2005 in Serpentine, not far from where we are now. A whole bunch of people at PWC decided to go into the channel. And then some very sensible people in Australia and America where it was warmer.

And it was particularly important to me that there were lots of children involved, given the death toll is particularly affecting children. This was my first experience, if you like, of... actually it was the second experience after a swim for a burns victim. But I learned a lot from this experience of how people reacted to certain sorts of communication. It was a seminal period, if you like.

I was intending to go back and get a proper job because I had taken two years off to launch World Swim. And when we went to see the Global Fund, an organization based in Geneva, a big funder, they said, "Do you realize with 130,000 people swimming (which is what we had at the time), you are the largest malaria advocacy group in the world?" And I said, "Are you telling me that 20 phone calls out of the back room of my home in London has created the world's single largest advocacy group for the world's single largest killer of children." And they said, "Yes." And I said, "Well, that's shame on all of us if that's the case." I guess that meant that I didn't want to go back into a proper job. I wanted to do an improper job.

What AMF Does

What we do at AMF is we provide nets. We distribute them. We make sure they don't get stolen. That's potentially a very big issue, back to operations. We certainly want to ensure they're used. And when we get involved in funding nets we go to governments and we talk to them about data. In fact we put it a lot more politely than I'm going to put it now, but we basically say to governments, "Please don't ask us to trust you, because we won't. But we won't ask you to trust us either. Let's just focus on the data." And that is really important to making sure that we do the best job we possibly can. We don't always get it right. We're not perfect, and things do happen we have to dive in and try and solve. But in essence this is all about data for us operationally.

When we started, again more politely than I'm about to put it, but I went to a whole bunch of people and organizations and said, "Please will you help me, but I'm not going to pay you because you don't need $5 more than a couple of kiddies in Africa need a bed net." And I'm delighted to say that everybody I spoke to, I can't think of anybody who didn't hear the question, "Who do I talk to in your industry that would be able to help me do X, Y, and Z?" and reply, "Me." And it's incredibly humbling getting a lot of people in big companies. I run this with six other people out of the back room of my house in London, and everybody works from their own homes, so we don't have any offices. But there are a lot of blue chip companies that said, "We get it. We'll support you." Because fundamentally the chief executive of big company X and big company Y, he or she have got kids, and they know kids, and they're human beings. So I guess I appeal to that sense: how do we do this together, as a lot of people coming together?

We have five full time staff. We pay four of them. So one of the things that was a little bit different about what we do is I don't have to really go out and raise money to fund admin costs. I could, and I could certainly use the money we have to do that, but as you can imagine, we want to spend the money on nets. So I have four costs globally, centrally, and no other costs than those four people we say a commercial salary to. We have no banking, accounting, legal, website, translation. You name it, we don't have it.

When we wanted to translate the website into German, the thinking was we could go to a professional company and they'd charge us five grand to do it, or we could go to a lot of other human beings and say, "You're a professional translator. Who do we talk to in your industry such that we could get four people who would translate two and a half thousand words each?" That's 10,000 words. We can now put our website in a language and show people the courtesy in Germany of being able to read the website in their own language. So I sent out 48 e-mails, not dear all because that doesn't work, but Dear Claudia and Dear Claus and Dear Matthew and so on. And in 24 hours I had 44 positive responses out of 48. So I could've translated the website 11 times over for free. And the same thing happened in every other language. So you sort of want to jump up and kiss people when that happens because it's terrific that everybody said, "We'll help." And that in a sense is really behind what we've all built at AMF.

We have very low overheads as a result, as you'll be unsurprised to hear since we're only paying four salaries. Our overhead last year, or FY 2017 rather, was 0.6% of the money we receive, so 99.4% of what comes in goes to the front line. And that's because I am incredibly cynical about charity, which is why people say people like me set them up. And I want to keep those costs really low down, and I want to show people exactly what happens with their money because I think that's the right thing to do.

We work with co-funding partners because we can't fund everything ourselves. And in fact we often fill gaps, so somebody will say to us, "We need $11 million here. Have you got any money?" And then we can cooperate with another organization. And we work with distribution partners because I don't want to set up some massive logistical operation in a whole series of countries. That would be daft. So this is very much us contributing as one of a number of organizations because this is a big team effort. It has to be. So impact and accountability are important. Transparency and efficiency are very important to us. I guess transparency is different from, but it goes hand-in-hand with, accountability. Efficiency covers not just the money we receive but how we actually get nets out to people in the right quantities to protect them.

I think a charity should be able to define in a sentence, or in a few words, what it is they're trying to achieve. It surprises me when some can't. In our situation, it's very simple. We want to stop people dying and stop people falling sick. So that in essence is the metric we must be judged by, although I'm going to throw something out there that we actually don't publish malaria case rate data, and there might be some questions on that later on as to why, if AMF is focusing on these metrics, aren't they publishing the metrics as to what they're achieving? It's a source of frustration, but it's something that I think is important.

So accountability for us means holding people to account in country, so saying to our partners, "We want to see data," so we structure our relationships so that it focuses on data. And we think fundamentally what that does is it means that fewer people die and fewer people fall sick. We want to hold ourselves accountable to our donors and show, as I mentioned, where every donation goes so people can be engaged rather than, I've given them some money, it's gone into a black box, don't know what's happened to it. That, for me, would be frustrating. And we believe that leads to this virtual circle of driving donations because we cannot do anything without donations. Awareness is terrific, but awareness funds nothing. Awareness has to have an endpoint of moving on to driving donations.

Each donor has their own individual page, as long as we have their e-mail address, and we list all their donations. I say as long as we have their e-mail address not as a cute way of saying, "Goodie, then we can market to them" because we as an organization do no marketing. We may be making mistakes in not doing marketing. In a sense other people market for us. The effective altruism community has been sensational in marketing us, and is a fundamental board member of AMF in terms of what it has helped us to achieve. We never send soliciting e-mails. We only send informational e-mails. It's really, really important to us because I think what we do should drive our support, not our ability to persuade because we write good copy.

When we go out into the field we take enough nets to cover everybody in a particular area, and the ratio is broadly two people sleep under a net. In fact its scale is 1.8. And what we focus on is making sure that our partners have visited every household, so we understand whether this household needs three, two, four, one. Whatever the number of nets they need, that's the number of nets we get to them. We make sure at the moment of distribution... and I should say there are a number of things we do to verify and ensure that that data is accurate. It's not perfect, but we can send five data collectors out after the first hundred and get them to visit 5% of the households these guys visited, and tell them beforehand, so we're putting psychology to play, to make sure they're really focusing on getting accurate data. And there are other things we do to make sure that data is good because obviously, garbage in, garbage out. And people, I'm afraid, a very small number, do want to subvert what we're trying to do and misappropriate nets.

It's important to have independent supervision at the moment of distribution so that, again, you make sure the right things happen. We follow nets and their presence and use and condition after roughly six months. And we track malaria case rate data, albeit there are issues with the purity or reliability of that data. So when we go back in and gather data we're doing it not just because it makes us feel good, but because we do want to understand what the decline curve is, because if we're up at 95% here on day one, and we come down like this over three years, that's okay, but also that's not okay. And if we don't know, we can't do anything about it, and we do not want to bury our heads in the sand.

So I have no problem in saying after 18 months, the coverage with our nets is down to 40%, because I'd rather know and be able to say to everybody, so we need to do something about it, because for the next 18 months we've got a significant number of people that we're telling everybody we're protecting from malaria and they're not actually protected. So let's find the data.

That bad trend is not one we see often, but we need to know whether it is there or not. And we can say to the district health officer, "You've got 37 health center catchment areas, and you've got limited resources, and we've got this data of whether sleeping spaces are covered or not, so you can focus on these 10 areas rather than the 37 and actually be more impactful, more effective with your work." So we're not just collecting data for data's sake.

We're very happy to be held to account by others, so we release all of our material. There's almost nothing we won't release, apart from people's personal salaries and things like that. And that's obviously been a terrific benefit to us, as we've been reviewed well. That has been a major driver of the donations we've received. I don't know what the current percentage is, but it's something like 70% of the donations or 60% of the donations we can tie to GiveWell and other organizations' reviews of us. So that's massive. So take 60% of $178 million, we're looking at about $100 million that has been driven by the EA community. So AMF is an EA community thing, really.

Last year we received about 90,000 donations from 190 countries, so we're getting to lots of people. And every donation matters because every $2 buys a net. And it means that when we talk to countries that say, "Hi Rob, if you've got $11 million," we say, "We've got 8." But then the next week we've got 8.2 and 8.4. So we can literally, through the discussions come back and up the number nets we can fund. So we put money to work, in essence, as soon as it comes in, because I can't commit to nets unless I've got the money. So the three key numbers we often, if people are sort of benchmarking, what does it cost to do something in the world of malaria: it's $2 buys a net, $500 protects a village, and roughly $3,000 prevents a death, or $4,000 or $5,000. I don't know what the latest number is from GiveWell, which is where that comes from.

On top of that we have a small number of large donors that build on top of what, in essence, is the likes of most of us or all of us in the room, the many individual donors that are our life blood. These are very lumpy donations. We've had some very significant ones. When you get a $23 million donation, that's amazing because it just means we can say to a country, we can fund 12 million nets for you. And when we're funding larger quantities of nets we can hope to achieve great success in some of the things we're aspiring to.

So some fantastic big donations, but I guess if there's one thing I want to leave somebody with hearing me and looking at this slide, it's that if ever somebody were to ask, "Somebody's given $2 million. What does my $2 matter?", well, the answer is your $2 buys a net, and that matters. It just so happens that $1 million buys 500,000, but we need both. And if we didn't have all of us contributing small amounts, we wouldn't be here, because no big donations would come in on the back of a few people giving a few dollars, so these are inextricably linked.

Over the last few years we've started to hit the tens of millions of dollars, and that means we can fund millions of nets. Everybody who's involved, all the donors, all the supporters, everybody that is involved together, we can say that we're putting ourselves in the position to stop something like 60,000 people dying, preventing 660 million cases of malaria through the number of nets funded. And while we have operated in 36 countries we focus typically on about seven in any one year. So this means that we can fund millions of nets at a time. Rather than turning up at the table and saying, "Yes, we can fund 100,000 nets," where the country would say, "Terrific-ish" because they need 10 million, we turn up and say we can fund 5 of your 10 million. That makes us get listened to, and I think rightly so.

We don't turn up and say, "This is how you're gonna do it" because that would be insensitive, crass, and just not a good way of going about things. So we come forward and say, "Here's our draft agreement. Here's the focus on data. You let us know what's difficult, and let's work with you as to how we adjust it, but some things we're gonna be pretty difficult to move on because it's all about accountability, and we think there's sense behind them." So we're involved in a partnership in persuading. And the more money we have, the more we can do that. So things have radically changed in the last four years, really, with what we can achieve.

But we have challenges, and most of those challenges... I'm not expecting you to read the bottom bullet point. The point is that they are many, and I could go on forever, because the devil is in the detail. But the big ones are ensuring effective planning where you've got limited resources and your span of control is limited, classic stuff. So we're improving all the time. We don't get everything right, but we think we get things more right as each day, each week, each month goes by. And we're in the business of persuading people to do things, because that's what partnerships are all about. We're also in the business of sometimes managing or doing a two step tango around the politics that suddenly can appear in certain situations in the countries we operate in.

Managing millions of household records, which is what we do, is the relatively easy bit. We put 150 lovely people in the room. We say, "Here's a laptop. Here's some data." And we provide them with our data entry system, and we get the data so we can see it, so there's no filter. Really, really important. But I won't bang on about that.

Insecticide resistance is a second challenge. Charles Darwin told us that that would happen, and certainly it has, as it happens with all of these things. So what we have done is we've played our part in saying, "We need to put these new PBO nets"... you'll remember from your chemistry class of course that PBO stands for piperonyl butoxide. Yes, everybody knows that. It's a synergist that goes on the top of a net or on a net, and it switches off the resistance mechanism in the mosquito, which means that the pyrethroid kills it. We've stepped forward and funded six million of those, distributed in 2017, lots and lots of clusters for the statisticians in the room, so that we can actually have a very powerful study, a randomized control trial, the gold standard if you like, so that for the rest of the malaria community, the funding community, we can say, "Here's the data that tells us whether PBO nets are good, and if they are in what way and in what circumstances." And we'll have those results in about six months' time. We don't know them.

We are the funder, we are the sole funder of the study, and in a sense we were a bit surprised that others weren't going to step forward, but nobody did so we said, "We'll do it because this is important." Insecticide resistance is a challenge to be met.

The next challenge is funding. We're allocating about $50 million at the moment, and we have $200 million worth of requests, so we have to make some nasty, nasty decisions in the next three months where we will have to say to countries, "We don't have the money." But we will do our best to try and make sure that the money we do deploy goes to optimize the impact we can have. But that challenge is also an opportunity because there are lots of countries that need help. We don't turn up in the morning and think all these challenges are weighing us down. These are opportunities for us to help. And we tend now to look at anything between 2 and 20 million nets of requests a time, so some of the numbers are quite chunky. We have to really make sure that the partnerships and the agreements we put in place are gonna deliver what we expect it to deliver. We tend to look three years out now because that matches with other funders. It means we can really plan operationally much better.

We also have an opportunity with technology. And this is one of my favorite pictures. It shows in one of the poorest countries in the world, the Democratic Republic of Congo, the use of technology, smart phones, to demonstrate to within six meters where 250 odd thousand households are located that received nets. And when you do stuff like this you've got real time data, you've got a better accountability, you've got lower costs, etcetera. The list goes on. So, fantastic opportunity to do better, but there are challenges with deploying it because you can't just put thousands of phones into the DRC and expect it all to go well, so we have to be very careful how we do this.

I'm going to leave you, last slide, on the note of optimism, which is if we reflect on what we've been doing in the last 15 years within the malaria community, all of us together, it's pretty dramatic in bringing down over 15 years the number of deaths and cases of malaria by about 60%. And there are countries that have moved into elimination, malaria is gone now. Sri Lanka, a very challenged country, the turmoils, war, all sorts of challenging things going on, but they are now malaria free, three years of no native cases of malaria. That's terrific. And there are now eight other countries, I think, on the cusp of that. So elimination is possible, eradication is possible. But a child still dies from malaria every minute, so while I've been talking, depending on how long I've been talking, 22 kiddiwinks have not made it, and that's pretty shocking.

As we know what we need to do, which is nets, we don't have a silver bullet with a vaccine. We don't have a silver bullet with gene drive technology yet. Nets is a big part of what we do. So certainly from our part and with others' help, we're going to continue to do as much as we can.

Questions

Question: Can you explain a bit more of the detail about how your operations work? Do you distribute nets that are manufactured in the countries they'll be used?

Rob: The nets are manufactured broadly in Asia, so the three dominant countries of manufacture are China, Thailand, and Vietnam. There's also a factory in Tanzania, and there may be other factories sort of coming online in several other countries. And there might be one that's come online in, I think, Ethiopia and Nigeria were looking at it. Effectively nets are a textile, so economies of scale are key, and therefore there are relatively few plants that produce 80,000 nets a day or more, because it's just not economic to put small manufacturing facilities, one in each country, which would be great for transport and logistics and local economies and employment if you could do that, but it just doesn't work.

The fiduciary duty I have, if you like, is if I'm looking to spend a million dollars do I spend a million dollars on funding nets from a facility in Africa — there is one — that is gonna charge me because of reasons of economy of scale 20% more, or do I buy 20% more nets and protect 20% more people? And the latter has to be my responsibility. I'm not here to employ people. I'm here to protect people from malaria. However, when there's a very narrow gap, then we can make judgment calls. But broadly those are the locations of the nets. They're brought in, and it costs roughly $2 a net and about 20 cents a net to ship a net, so it's about 10% of the cost. It used to be $5 a net, so that shipping cost has become a larger proportion, but that's still the way the production works.

Question: Do you try and measure or think about the impact beyond just immediately saving people's lives? So for example like the knock-on effects that has to their economy and to the other lives that they then affect in the next 10, 20 years. Is that something that you think about at all?

Rob: No and yes. No in terms of the decision we make each day is where can we protect the most people over the next three years with these nets. We're cognizant of the fact that if you've got people that are not sick, as I mentioned they can function and they can lead healthier lives, and you can transform fundamentally the health of a community, because if you protect people with nets you're reducing the people in the blood pool who are infected, so when a non-malaria carrying mosquito bites the person who is now not infected, it's annoying and they'll bite somebody else, but they're not transmitting. They're not acting as a vector. So we're aware of the impact it has at the micro level within a community, the macro level within a country. But really our day-to-day focus is more pragmatic and prosaic.

Question: If organizations like GiveWell started to look at those longer term impacts, do you think they might be able to start measuring some of those longer term things even if they're not your immediate focus?

Rob: Whether they can start measuring them I don't know. That's probably more for experts within their organization, but it would probably be of benefit in terms of our own statistics, because there is a dramatic economic impact, not just the health impact.

Question: If people are interested in donating do you have a preference around people donating little and often out of their pay packets, or groups of people getting together and pooling donations, or saving now and donating more later? Do you have a particular preference around any of that kind of thing?

Rob: So in reverse order donate now rather than later because we've got massive gaps. I suppose we would prefer people to... we have no method preference per se because we don't want to frighten anybody off by saying, "They want me to give online, and I don't really want to do that. I'd rather give by bank transfer." So we're agnostic when it comes to that perspective. We do like recurring donations. It's something that I look at really closely because I think it acts as a bellwether. It acts as... there's an element of, are we seeing recurring donations falling away? Is that saying something about people thinking, "I think I've done my bit. I'm going to do something elsewhere." So if somebody was thinking of giving 12 pounds, would I prefer 12 pounds now or a pound a month I'd probably prefer a pound a month because this also is the long game.

This is not something where we're after money now, despite my prior comment. If somebody's thinking about whether they're recurring or not, recurring sort of shows, I think it also shows a more considered view that I'm not just going to give 50 bucks. I'm actually going to give 20 bucks a month because I'm probably not going to cancel it in three months' time. And there was one other part of that question I missed, I think.

Question: One of the things that people do in the community is pool money together into EA funds and things like that. Is that preferred to people donating individually?

Rob: Individually much better, simply because, going back to the point I made about trying to connect individual donations to a distribution, so if somebody's given us $50 we can say, "Your $50 have bought 25 nets that have gone to this area of Uganda." I think this is, we hope, more energizing and engaging than if collectively we raise $1,000 from 50 people and we fund something there. We can only attach one e-mail to a donation, so therefore I'm only engaging one person whereas I'd like to engage all 50. But again we'd prefer the donation of funds rather than not.

So yeah, whatever comes to us. It's opportunities like this and people ask us questions and we put them on our blog and so on in terms of how do you prefer. I think in some ways it's probably a refined level of thought because at the top level we need to persuade people why should I give to this charity. And if you've got energetic people that are going to group people together and say, "Hey, why don't we do a fundraiser or do something" then that's terrific. That's also another pebble in the pond in the sense because people getting involved will... it'll spread to their friend groups and networks and so on.

Question: What relations do you have with the Bill Gates Foundation, who are also involved in fighting malaria?

Rob: Effectively none in the sense that we don't have active connections. I chose not to go either to friends and family or big organizations when I started AMF, because I didn't want people saying, "Oh, what's he doing now? We'll give him 50 quid." And I didn't want to tap into money that already existed. I really wanted to get a whole set of people like me who really didn't know anything as much as I felt could be known about malaria. So we've not gone to the Gates Foundation and said, "Hi, would you give us tens of millions?" I think they know of us. I'm aware of that. I was in a room with Mr. Gates recently, but one of 500 people, so there's nothing special there.

However, there have been connections along the way. The chair of my malaria advisory group was a guy called Professor Sir Brian Greenwood, and Brian was also the director of the Gates Malaria Partnership in London, and three of our malaria advisor group members also were chairpersons of Gates Malaria Centers in Africa. And one of our trustees advised Bill Gates Sr. when they were setting up the Gates Foundation. So we have connections, but we've not exploited them because what we're about is new money.

Question: So I suppose that's the money side of it. Is there also the expertise and the knowledge side of things that could be beneficial to work together?

Rob: They tend to work in research rather than product, which is what we are. And there have been connections and I have spoken with senior people at the Gates Foundation over the years, and it's been swapping ideas and notes on things, so that does happen.

Question: You say that you've worked with the Department for International Development in the UK Government as a collaborator. Again around sort of the funding point, is there ever a possibility or are you interested in the government actually funding your work?

Rob: Yes, in the sense that pragmatically I could use $150 million now that I don't have. So if somebody came forward and said, "We'd like to talk to you seriously about that," we'd be straight there. And even though that's not new money, that's just a sort of pragmatic response to... it is also an objective. I think we feel that we are a good funder of nets. I think there are some less good funders of nets. I could get myself into dodgy territory here, so I'll be careful what I say, but I think that we bring an attention to data, an accountability that sometimes other organizations don't have as their specific focus.

So I think that we back ourselves. If somebody said, "We'd give you this much money. Can you spend it on nets?" We'd say, "Yes, but I'll tell you what. Hold onto the money. We'll put that program in place, knowing that you're committed, right?" And they'll go, "Yes." And we'll say, "Right, okay. Don't give us the money. We'll go and put it in place and get it all ready to go, and then we'll come back and say now there's no risk to you. Here you go. Evaluate that. Now give us the money." And at the moment I think my focus is increasingly on how do we increase the volume and the constancy of donations, and also some of the really big donations because I think if I'm going to try and do my best, we're all going to try and do our best to fill that $150 million gap. If I can phrase it that way then I have to have some really, really big donations come in, so that's something I'm thinking a lot about at the moment.

Question: Do you think there is an actual responsibility for governments to be actually doing some of this work, or are you happy for it to be kind of a third sector kind of thing?

Rob: Agnostic. At the end of the day, as fast as we can, we need to make sure that $5 billion a year is made available to malaria, and it's only $5 billion a year. Financial crisis and billions talked about here, there, and everywhere. It's a tiny amount of money for the number of people that die and the lack of productivity. So I don't care where it comes from. Our plan B, we in AMF have a plan B, and it's to close. And I want to do that as fast as I can, not just to see more of my four kids but because then I'd be an unbelievable hypocrite if I wanted AMF to keep going. Because I want to see malaria gone. There are plenty of other things to work on.

So, yes, we want to see money coming from wherever it comes. The reality is, it's not coming from government. Or rather, all of the money at the moment is coming from governments, and in 2017 the four biggest funders of nets were the Global Fund, about $500 million, the British government and the American government in one order or another, and then AMF, which is ridiculous. We need to try and tap into that wall of money that I passionately believe exists within our communities. And I think the greatest barrier to it, frankly, is accountability. I think there's massive cynicism of, "If I give money to a charity operating in Africa where's it going to go?" And I think that's a valid concern, hence my cynicism. And boy if I was cynical when I started AMF 14 years ago, boy am I cynical now given what I've seen, which is why we do what we do the way we do it.

Question: So, tell me what's the cynicism that you've developed over the last 14 years?

Rob: I've seen many, many cases of benign incompetence all the way through to malign corruption at staggering levels.

Question: Apart from donations, how else can people contribute to AMF's mission?

Rob: That's a good question. Julian has been with us for a year as operations manager, and he runs the volunteer program. We need to work out how we can do even better at taking the fantastic offers we get from people saying, "How can we help with our time?" So that's one answer to your question, and expertise. I suppose there are specific ways in which we approach volunteering and say... because that's in a sense where I'm headed, is that if you've got expertise or connections with people I'm shameless.

My favorite dinner party would be three of the 170, I think it's 170, people in the world that have assets of $10 billion or more, and I'd like to sit down with three of them at dinner and say, "Just give me the interest on the money. That's all I want." That's leverage. Three of you could save God knows how many people and et cetera, et cetera.

But apart from that we need to redesign our website. Although there's a huge amount of talent that's gone into it, it's way out of date. It's not responsive. We sort of cringe at it. So what I would like is a really big website designing company to come forward and say, "Great, here's your team, Rob, all for free," because we do things for free, right. And then we redesign it. And we get another group of people who say, "You've got expertise, we don't. How do we keep this, this, this, this, and this, but generate a fantastic website that's responsive so that... how do we..." Another thing I'd throw out there is where we need help, but it's very pragmatic to AMF's needs if you like, because we have to be focused on what we're trying to deliver and then fold in volunteers so they can do things that excite them and they're good at, so we have to marry those two things up.

I would like to try and get a million people to give me one net each, and only one net each. They're not allowed to give us more. Well, if you want to you can go over here, but this bit of the project is a million people giving me a net, in a way that so when Julian gives a net he can come back 10 days later and see, "Wow, five other people gave a net." It's pyramid selling, but it's sophisticated. And then there's more down here. And he can see that, "Wow, there are 42,000 nets that are being given as the result of the net I gave and the five e-mails I sent or the three or the two or the one." Now, I don't know who to talk to about that, so if there's anybody who knows the senior people at Google and Facebook and wherever we get those two guys and say, "How do you guys make that happen? You must be able to do that in about three weeks." And that would be a million nets and two million people protected.

So the help we get is we're always really interested in getting people writing to us and saying, "How can I help?" And we've now got a series of questions where we say, "What are you good at? What do you want to do? How much time do you got, et cetera?" We have a database running, so we can then work out how do we not gets lots of time sucked into volunteer management, because that can be a real danger, but we can focus people on helping.

Question: So it sounds like it says partly individuals who have those skills can get in touch and ask to help, but is it also that people who work at big corporations can try and get in touch with you and leverage the expertise in their organization?

Rob: Yeah. And we might say to somebody, is there a consulting team that over the next three months... not that it's the time thing because people have got jobs, they're earning money, they're paying the rent, so most people can't just say, "I can do something for three weeks." But in the next three months could you guys take on, and we would liase with them, a study to work out what are the top new types of net on the market that we might have missed and so on, and do a research project and come back with us. And what we try and do is identify people who are totally self driven. So our management time doesn't get sucked into it, because there are only seven of us. They then go away, say, "Got it. We'll be back to you in ..." and every four weeks we have a conversation, and they deliver something that we go, "That's terrific. We can now use that." And there are lots of examples of that, where we try and involve people as best as we can in helping with the mission.

Question: I saw an article a couple of months ago about new nets with a combined approach of combined chemical and something to do with growth regulation that effects the growth of mosquitoes, and I was wondering if there had been developments with that since, and whether the nets have changed, or that's something that you focus on?

Rob: I don't know is the answer. The PBO net is a combined net in terms of two chemicals trying to have a particular impact. There are a number of different types of nets that are now being tested. They're not on the market because they have to go through something called WHOPES, the WHO Pesticide Evaluation Scheme, a bit like the FDA in America where it's got to be tested. You can't put a baby underneath a net with insecticide on it unless it's been fully tested. And by the way, a baby could lick two square meters of net and get a mild tummy ache, so obviously these things are tested. There are different things that are being brought to bear, to try and solve the problem of resistance rather than greater efficacy. They're fantastically effective as long as resistance isn't an issue, so I don't have... back to my volunteering thing. We need somebody to go and help the team by working at briefing us.

Question: You said you spend zero pounds on marketing, is that right? A lot of advertising agencies can demonstrate the effectiveness of their campaigns. Quite similarly you said that 1 million US dollars spent can save about 12 million for a country's local economy. That's about the same ratio as the John Lewis Christmas Advertising Campaign. So is there not a bit of an ethical dilemma in not spending money on marketing and advertising, given that you could get more money if you did it?

Rob: I think it's not an ethical dilemma. It's a sort of commercial one. If I put my commercial hat on as to how do I spend the million dollars that somebody gives me: do I buy a million dollars worth of net? I think the way we've come out at AMF is that I think we're getting into some tricky territory. If we were to announce to you that we were spending $5 million over Christmas on a marketing campaign I think there would be some people that would go, "Really?" And the problem with advertising is that 50% is effective. The problem is which 50%.

The way we prefer to look at marketing and the most general thing is that let's put in front of people what we do and how we do it and the results we have, and hopefully that will encourage people to support what we do. If somebody from an advertising firm said, "We're prepared to put together a marketing campaign for you all for free. Here's a case team. And we've got a million dollar budget. Are you interested?" I'd say maybe rather than yes because it depends on the nature of the marketing. Because I think one of the things that we value at AMF is, if somebody gave me a billion dollars tomorrow I couldn't spend it all. It's a capacity issue. So our growth has been managed in a way. Boy, it took eight years to here, but now we're at the stage where we could scale, and we could take $150 million easily.

I would be interested in an advertising campaign, but we're not about celebrities. This is back to this grassroots thing. I think celebrities, they're interested for a while and then they go. And I think that can often be disempowering. It can obviously be empowering because it gets the message out. If Oprah Winfrey said, "Look, I'm interested in supporting you all. What can I do?" I think we'd be really interested in having a conversation. But there's an element of, maybe I'm mistaken and I'm not a marketer, but I feel there's a sort of... I don't like the word brand, associated with AMF.

At AMF we're sort of quite family, we're quite grassrootsy. We want to try and engage as many people as we have, but we just want to get on with the job and do it as well as we can. And I think that's hopefully the best way that will allow us to expand and maybe DFID will come to us and say, "Look, you've got a track record now operationally. We'd like to talk to you about big dollars. Make the case to us. Maybe we should give you some money." I think that's more the way we put our limited hours than thinking about getting... I'm being pejorative... getting sucked into the marketing side of it. But we're not completely closed to it, and we're actually dealing with something at the moment with, do we AB test something, and we've got free stuff given to us. And we're even sort of sitting here going, "Ooh, do we want to do this?" So we probably need somebody to advise us because we're not very good in this area. Sorry, that's a rather inadequate response.

Question: I'm quite interested in AMF's monitoring and evaluation. It's so exceptional. Why do you think that most NGOs actually don't do monitoring and evaluation, and do you think that you can advise other NGOs with different types of programs in low income countries to do monitoring and evaluation better?

Rob: I think there are three things. Firstly, it can be expensive. Secondly, it can be difficult and time consuming. And I think there's attitude as well. I think that many start with the attitude that they don't want to do no monitoring and evaluation, but they don't want to do much because it requires effort and time. So surely the best thing is just get 10 million nets out to the country. And even if some of them get stolen and so on, "Hey, look, like seeds being cast they'll cover most people, right." And my answer to that, is that I've heard of, on very good authority, tens of thousands and in one case 1.4 million nets being stolen and sold to another country, which means that the two million people that were going to be protected with those 1.4 million nets, they didn't get any nets. And nobody was coming in afterwards. None of these were AMF nets, to be clear. So I think monitoring is really important to stop these sorts of things happening.

But a lot of organizations think there are so many challenges we have already. If we're going to do monitoring in this way then we're gonna have to have a team of people doing it. There's money involved. So I think generally things focus on the statistical. So let's do a survey and see how many households are covered or not covered rather than what I would almost call proactive monitoring where you're trying to influence behavior upstream by letting people know you're actually gonna monitor after the fact what goes on.