The following is a conversation between Rob Mather, the Founder and CEO of the Against Malaria Foundation, and Denver Frederick, the Host of The Business of Giving.
Denver: The Against Malaria Foundation, AMF, provides long-lasting insecticidal nets to populations at high risk for malaria, primarily in Africa. It has been rated as the most effective charity in the world and is the epitome of a movement called “effective altruism.” And here to tell us more about what they do and how they do it, it’s a pleasure to have with us the founder and CEO of the Against Malaria Foundation, Rob Mather.
Welcome to The Business of Giving, Rob!
Rob: Thank you very much.
Denver: AMF started, I guess you could say, somewhat by accident. Tell us how you came into being.
Rob: Yes. It was by accident really. I guess I’m doing what I do now with my colleagues because I’m not very good with the remote control of a television.
Short story is that I was trying to turn off the BBC News one evening and switched to another channel, and saw an image of a melted child — somebody who’d been caught in a house fire. And the one-hour program that I then watched was extremely moving. It led to three of us agreeing to swim to raise some money for her, and that led to 150 swims involving 10,000 people in 75 countries around the world… It led to World Swim Against Malaria that led to the Against Malaria Foundation.
So, I’m not very good with the remote control of a television.
It’s been very important to me that it is this grassroots feel so that we can engage as many people as we can around the world who can give modest amounts of money, but when you put it all together, it can make a really big difference.
Denver: Isn’t it funny how it changed the trajectory of your life? Thank God that you are not very gifted with the remote control! And it’s interesting that the way you started, it was really a grassroots-y type of start, and I guess it would be fair to say you’re still pretty much that kind of an organization today, right?
Rob: Yes, very much so. We receive donations from people like you and me, so people all over the world; I think people in 189 countries have donated to AMF. We don’t receive money from governments. We’re very simple in our objectives. The money that is donated to us, we turn that into long-lasting insecticidal nets. We work with partners. We distribute them.
And it’s been very important to me that it is this grassroots feel so that we can engage as many people as we can around the world who can give modest amounts of money, but when you put it all together, it can make a really big difference.
One of the things that really stood out to me was that the most effective thing we can do to protect people from contracting malaria is have them sleep under what I would refer to as the “humble bed net.”
Denver: And why malaria? We had the girl that you saw who had been caught in the fire, but this obviously switched over to malaria. Why was that your focus?
Rob: Well, when I had a conversation with a nice man called Walter in Australia who said, “What are we doing next year?” when Swim for Terri was still to take place some five months later, I said, “Well, I wonder if we could get a million people to swim.” And I remember his line back to me, which was, “That’s terrific because it would mean that we only need 999,998 more people because I’m in.” And it sent me thinking of: Could we get a million people to do something largely on the same day? And if we were to do that, what would we do it for?
And I guess my thinking was: I want to have impact. I traveled quite a bit in Africa and in Asia in my youth, and I guess I thought not heart disease, not cancer, not things that are relatively well-funded. And that took me to think about, and I guess I probably went through HIV/AIDS, TB, malaria, landmines, freshwater, diarrhea– big problems that don’t get the attention they need and can have a terrific impact in developing countries.
And when you scratch the surface of all of the lists that I just mentioned, one of the things that really stood out to me was that the most effective thing we can do to protect people from contracting malaria is have them sleep under what I would refer to as the “humble bed net,” that at the time costs $5, but now it costs $2 because the prices have come down. And it seemed to me that the malaria control sector, if you like, was crying out for funds for more nets. And so a little bit more research, and that’s what led me to malaria.
And particularly, if I might add, that when I looked at the impact of malaria, we were talking about seven 747s full of children under five dying from malaria every day. And you add to that that malaria was and is, if not “the,” certainly one of the largest killers of pregnant women in the world. Under-fives – their immune system is developing. Pregnant women – their immune system is somewhat compromised when they’re pregnant. And so, that’s why those two groups are particularly vulnerable. And I felt very strongly that malaria needed some additional support.
Denver: Makes a lot of sense. How do you get malaria, and what happens to a person when they contract it?
Rob: So you contract malaria if you’re bitten by an infected mosquito. An infected mosquito or a mosquito carrying malaria, when it bites you, it’s actually the pregnant female that’s after a blood meal in order to be able to reproduce. And so these pesky mosquitoes will land on you if they can get to you, typically between 10 o’clock at night and two o’clock in the morning. And in biting you or putting its proboscis in through your skin– you almost don’t feel it, and in fact, most people don’t feel it– it can then inject the malaria parasite, which then runs around your body through a series of phases, and it can make you very, very sick or worse.
Denver: And how many people die of it annually? I know it’s a very hard thing to count.
Rob: Yes. That’s a good secondary point there in terms of– these are estimates, but it’s at least 400,000 people a year die of malaria. As I said, 70% are children under five, and about 200 million people are infected with malaria each year. And when they’re infected and they’re ill for one- to three weeks, they feel not very well at all. In fact, a lot of people will say that they want to die when they have malaria. You really feel very, very unwell. So, the numbers are significant.
Denver: Let me ask you a few things about the nets. What’s the lifetime of a net? And when you distribute them, how can you be sure they’re being used, and if that’s a problem?
Rob: So the lifetime of a net is three years. That’s what it’s billed as. We would probably argue that the additional relevant number is probably two-and-a-half years because when you distribute nets, you have a very high rate of sleeping space coverage initially. And we’re talking about mass distribution campaigns, nationwide, every sleeping space covered. And so, you can achieve 95%, 96%, 97% plus sleeping rate coverage.
But these nets do degrade over time. They’re distributed in pretty challenging environments, and so they have holes and rips and tears, which doesn’t mean that they are not viable. In fact, they’re still 99.9% viable because mosquitoes, by the way, don’t do an aerobatics maneuver through a hole in the net. They land on the net and migrate to the hole. So that’s one thing about these long-lasting insecticidal nets [unintelligible] because the insecticide on them is long-lasting. So you find that the “decline curve,” as we would call it in coverage, in year three becomes steeper, so you probably want to redistribute nets 30 months in.
So let’s have in our heads two-and-a-half to three years. How do we make sure that nets get to the people who need them? Well, that, in essence, is at the heart of what AMF does, and the answer is data. So we make sure that we understand that all of the nets, all of the households that are going to receive nets are visited prior to the distribution of nets so that we can make sure that the right number of nets go to each household. It’s not always distributing two nets to each household because some households are bigger than others– two people under each net. And so, that’s the start of the process, and then we monitor that over time to make sure the nets are being used.
Denver: Is insecticide resistance a challenge that you’re concerned with?
Rob: Yes. And it started about 10 years ago, perhaps a little bit more, when we started to see– as Darwin predicted, “survival of the fittest”– that there will be mosquitoes that would become resistant to the insecticide on the nets. And we see that occur in many parts of Africa now and towards [unintell.
Chloroquine used to be a fantastic anti-malarial that you would take when you suffered from malaria, and it would knock malaria out and you’d be fine. And then certain malaria parasites became resistant, if you like, to chloroquine, so it had almost zero effect. So, we had to switch in a new type of drug known as artemisinin combination therapy, catchily named, known better as ACT.
And so, this process of the dance with the malaria parasite, the dance with the mosquito goes on. And so, what we do know is there are some new types of net — “types,” plural of net — that typically include a different chemical on the net, which switches off the resistance mechanism in the mosquito and then the underlying insecticide works again. And so, it is something we’re concerned about and there’s a lot of work going on, and time will tell whether we win that particular battle.
Let’s call it a skirmish. The major battle is against malaria. There are skirmishes that occur all the time. And it looks as though we might be doing quite well against insecticide resistance over the coming years, but that verdict isn’t in yet. So there’s a lot of work going on, a lot of research, a lot of money going into establishing new tools.
At the heart of what we do is making sure that all of the nets that we fund get to the people who need them and they are used…and that is absolutely fundamental to what we do.
Denver: That’s really interesting. It’s sort of like a game of checkers with the mosquito where you’re jumping at each other, and they’re figuring it out; then you’re figuring it out, and you just keep on going until you finally, hopefully, come up with a solution, which will be more permanent.
Well, you have some tough decisions to make. And I would imagine one of them, Rob, is that: With demand being as great as it is for these nets, how do you go about allocating the resources that you have?
Rob: So we start by looking at where malaria burden is the highest, and so usually the high- and medium- burden countries are the ones that we focus our efforts on. And I say “we” – that’s not only us at the Against Malaria Foundation, but it’s also all the partners that we work with– co-funding partners. In particular, when we’re looking at allocating resources, we look at where there are funding gaps because it may well be that in a particular country with a very high malaria burden, enough funds are being brought to bear. Sadly, that’s rarely the case. In fact, I should probably correct myself in that that is not the case in any of the high-burden countries, and unfortunately, there is a need for funding – an immediate gap as we would call it.
What you then look at on a practical level is we work with governments, and we ask a very simple question, if you like: Are you happy to work with us in a highly accountable way? And again, to keep things simple, if the answer is yes, then full steam ahead. If the answer is maybe – well, maybe we’ve got a little bit of patient work to do. But at the heart of what we do is making sure that all of the nets that we fund get to the people who need them and they are used, as you asked in an earlier question, and that is absolutely fundamental to what we do. So it’s a very important part of our work and working out where we work.
I’m pleased to say we’ve not had to, apart from one situation many years ago… We’ve been around for 15 years now. There’s only– it rarely ever happens that a government now that we work with, where we ask to share, confidentially, if you like, a lot of data that is at the heart of accountability. That happened. So, we continue with our work in many countries.
Denver: And I may be wrong about this, but it would seem to me that if you focus on a particular country at a time and really concentrate, you’re going to have that much more leverage with the government, as opposed to spreading it evenly across 36 countries or wherever you’ve been. Would that be a correct assumption, or am I missing the point?
Rob: No, you’re spot on. I think the literal and metaphorical seat at the table is more effective if you’re bringing a larger proportion of funding to bear. In fact, in the seven or eight countries in which we work at the moment, we fund 30% to 60%, 70% of the nets that a country needs. We work with an organization called the Global Fund, with whom we have quite a close partnership. In essence, we fund the nets and the Global Fund funds the non-net costs– the shipping and the costs in-country– because we’re a small organization, and they are well set up and equipped. And so they sort of bring that element to the partnership and it works very well.
And it is important… it has been important for us, and we’ve had greater success, by which I mean it’s been an easier, swifter process to bring the governments that we work with to a point where they’ve said, “We’re very happy to share this data,” and adjust perhaps some of their operational procedures so that accountability can be delivered. Because that is something that is extremely important to me and to us at AMF.
The impact that we aim to have at AMF is very simple: We want to reduce the number of people that die from malaria, and we want to reduce the number of cases of malaria.
Denver: And we’re going to get to that because I have been so impressed, Rob, by the way you go about your work. And it is informed by four guiding principles, which in turn, as you alluded to, is also informed by data. So let’s touch on each of them, starting with impact. How are some of the ways you go about measuring that?
Rob: So the impact that we aim to have at AMF is very simple: We want to reduce the number of people that die from malaria, and we want to reduce the number of cases of malaria. So that’s in, a sense, the statement of the impact we aim to have, and those are both quantifiable. It’s not easy sometimes to quantify them. Sometimes you have to have a proxy because it’s difficult to measure the actual thing, but we can measure something else that is directly correlated and gives us a pretty good idea of what impact we’re having.
So, how we measure the impact of our work in terms of mortality is that you can generally follow mortality numbers that are reported. It’s not perfect by any stretch of the imagination because data can be quite challenging to be reliable reporting. It can be challenging in some of the areas we work in. Similarly, case rate data as it’s referred to– in other words, how many cases of malaria have been reported at particular health centers each month– you can look at that sort of data and work out how you’re doing.
I mentioned the proxy and malaria case rate data can be very noisy. We probably don’t have enough time to talk about how many ways it can be noisy. But if you imagine you didn’t have a qualified nurse available in those particular two weeks at the health center, you might only report two weeks’ worth of data rather than four weeks’ worth of data, so you’ll think you’re doing twice as well as you really are. So that’s just one small example.
But what we can do is we can look at net hang-up rate because there is a terrific correlation between sleeping space coverage, which is delivered by nets being hung, or what we call hang-up rates, and levels of malaria. So we follow the latter, a net hang-up rate, and that gives us a very good guide as to how we’re doing in terms of reducing levels of malaria.
Denver: Got you. I know since you started, you’ve saved over 100,000 lives, or at least we can estimate it’s been over 100,000 lives. Have you been able to look at how much it costs to save a life and put it in terms of that sort?
Rob: We haven’t, but others have. And there are some very talented organizations that are incredibly focused, are very analytical at paring back all the layers of… in a sense, asking us and other organizations “Prove to us that you do what you say you do,” and really want to get the costs and the proportions and how many nets go out and how many cases of malaria are averted and so on.
And so, that work has been done by a number of organizations, particularly an organization called GiveWell. They’ve been around for 10 years now. And the number that they would focus on– and they admit it is an estimate because one can’t be precise– but it ranges from $3,000 to $4,000, to $5,000 per life. So I think if we were to take a look at that, we’re looking at roughly $4,000 will save a life. And it’s interesting to compare that with what in many developing countries– a health system would probably spend between $35,000 and $50,000 on extending our lives by one year…here we think about relatively low sums of money to prevent a death.
There is work that’s been done over the last couple of decades that has estimated that what you’re looking at is: For every million dollars you put into fighting malaria effectively in Sub-Saharan Africa, you’re increasing the GDP of the local economies and the continent by $12 million.
Denver: People have also looked at the economic return because sometimes there is such a focus on the deaths caused by malaria, but there’s such a loss of productivity as well. And I guess when you look at dollars invested, at least some folks have looked at return on GDP.
Rob: Yes. It’s one of the things that the humanitarian aspect of the fight against malaria is easy to grasp. We’re now down to two 747s of children under five each day. I’d still like to suggest that that is slaughter, and we still need to work really hard to bring that down. And we’re looking at, for every death from malaria, we’re looking at about a thousand cases of malaria. So that there’s still a lot of malaria out there that we can bring down, and we can have a humanitarian impact because we don’t want people to be sick. We want them to be healthier.
But as you point out, there is this economic impact, which we could probably imagine fairly logically that if you’re preventing people from falling sick– now those individuals who used to be in a position where they couldn’t teach, they couldn’t farm, they couldn’t drive, they couldn’t be productive members of society– you’re boosting your local economy significantly.
And in fact, there is work that’s been done over the last couple of decades that has estimated that what you’re looking at is: For every million dollars you put into fighting malaria effectively in Sub-Saharan Africa, you’re increasing the GDP of the local economies and the continent by $12 million. So it’s a 12-to-1 return. And if I offered you a 12-to-1 return, you may well jump at it.
Rob: It’s not some second fiddle to humanitarian impact. So, the two go hand in hand.
Denver: Well, these are really hard things to get your arms around. You’ve done a real good job in really trying to give some numbers and really measure that impact.
The second guiding principle is accountability, which does mean structuring your partnerships so you can see the data. Walk us through that, Rob.
Rob: So when we agree to fund nets for a particular country, we will put in place a legal agreement. So we have to have a legal agreement in place, given we’re talking about millions and tens of millions of dollars that we’re putting to work. And we, I guess, simply say to those partners, governments, and others we work with, that we will all gather certain data at every single household that will receive nets. And that information will be shared with us, often in real time, so that we’re working hand in hand and we can all look at that data, verify it, error-check it, work out whether there are some sillies and funnies, and correct those, such that we all know that the nets when they’re distributed are going out in the right numbers to each household.
And indeed, as you will imagine, nets being distributed is a significant logistical exercise, so one of the other things we want to do is make sure that the movements of these nets through the chain is understood and permissioned and tracked, and so on. So, there’s a lot of work we do to make sure that the transit of the nets and where they eventually end up is completely surrounded by data that we get to see and check in a sense, and quite close to real time, and certainly after… sort of within days typically. And that’s an important part of operational accountability that is, again, what sits at the heart of what we do.
Denver: The third guiding principle is transparency, and that is both real-time data on the work you’re doing, as well as complete transparency with your donors. What are some of the ways you go about doing that?
Rob: So we publish all of the distribution data that we receive, so that sort of delivers transparency when it comes to our operations and what actually happens to the nets. But yes, so I asked myself the question when I set up AMF: What information do we want to share with donors? And my simple answer to that question was: everything. Or at least everything we can share.
So in fact, when we receive a donation, we allocate it to a specific net distribution. Every donation we receive is allocated to a specific net distribution. If you like, think of it as: we have a bucket that requires $2 million to be put into it because that’s going to fund a million nets. And so, we pour a whole series of donations as they come in into the relevant bucket so that the donor… because we send them a receipt and a link in that receipt… it shows them where your money has been allocated.
Or rather, because we know the specific cost of a net for that particular distribution– because it can change, there are different types of net and sizes of net– we can show the donor exactly how many nets you’ve funded. We can estimate the number of people that those nets will cover because you multiply that number by 1.8, because at scale… in common parlance, you and I would say that each net protects two people, but at scale it turns out to be 1.8, whether it’s mom and baby, or mom and dad, or three small children, et cetera.
We can show the donor exactly where those nets are going to be distributed, in which health zone, and in which country, and also because we track the nets through their manufacture and shipping, the donor can see for that individual donation exactly where their nets are. And so, that’s our way of delivering transparency. You can actually see what happens to 100% of your money.
Denver: There’s no black hole there where your money goes into. You can really, in a very tangible way, see it. And would it be right to say that that’s essentially your solicitation of your donors? You really never ask them for money. You just provide them with the information of what they’ve done, and maybe they’ll want to do more.
Rob: Yes. I suppose you could put it that way. I’ve been asked over the years about fundraising and how we go about it. And it is accurate to say that I’ve never actually asked anybody for any money. What we do is we just get on with our job of distributing nets and working with the many partners we work with, and then we report back. And the two ways we communicate with donors is we thank them, and we provide information.
And so, we never ask for money because I just feel there are a lot of very intelligent people out there, and if they feel they want to give money to a particular cause or to us, then they’ll make that decision and they’ll give us money. So yes, our marketing budget has been very, very defined each year for 15 years, and it’s zero.
Denver: Zero. There you go. Which gets us to that fourth guiding principle, which is efficiency. And we can start with that marketing budget, but also you have a remarkably lean team in operation. Tell us how you’ve been able to achieve unheard-of rates of efficiency for the organization.
Rob: We’ve achieved the efficiency that we have because we’ve had lots of help. When I first started AMF, I approached a number of organizations, and I was a little bit more polite than I’m about to put it, but I basically 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 children in Africa need a bed net.”
And I’m pleased to say that many organizations — we list them on one of the pages of our website, the pro bono section — agreed. And we, in essence, don’t pay for anything. So we don’t pay for accounting, banking, legal, translation, websites, you name it. We don’t pay for it. Why? Because I guess our model of AMF is really simple. People give us money. We buy nets. We make sure they get distributed–boy, do we focus on that–and we report back. There are some other things we do in terms of insecticide resistance research we’ve helped to fund in a very targeted way, but broadly that’s what we do.
And so, that has meant that the design and the simplicity of our strategy, our operations means that we don’t need much. But those things that we do need, like most organizations, we’ve been fortunate to find people that have agreed to help us, and I think I’m particularly proud that none of the supporters, more than a hundred now — there are six principal supporters, but more than a hundred organizations over the years — have never stepped away. So that’s one of the ways we do it.
So right now, our central costs are six salaries. Two of us ran AMF for 10 years, and we grew it to $50 million a year. I still run it out of the back room of my house in London, so we don’t have any offices even though we’re registered in 12 countries. So, I guess the mantra is: Do we need it? No, so we don’t have it, and therefore, we don’t need to pay any money for it. So that means that our overheads are about a half a percent of revenue.
Denver: It’s incredible.
Rob: And that will keep going. That’s pretty scalable.
Denver: Let me ask you a little bit about your capacity to be a salesman and your persuasive skills. Because two things here: Pro bono support is not that easy to get for a lot of organizations — you managed to do that, but the thread I have is going back to how you are able to get that many people into the water to go swimming. So there has to be something in how you go about asking people to get them to say yes. Have you ever thought about that? Do you have any insights as to why you’ve been able to achieve what you’ve been able to achieve?
Rob: Well, I guess it’s what we’ve been able to achieve has been through the work of many people. It was just Andrew and myself. Andrew and I worked at a former company. If you like, he was my head of technology at a former company, and then I asked him to come and join me because he’s extremely good at what he does. I would describe him as the world’s best. And it was just the two of us. But as I mentioned, we went to a series of organizations, and we had some terrific people who said, “We’ll help you.” And they brought to bear teams in those organizations who delivered that particular task or that particular piece of support. And so, it’s always been a lot of people that have made this happen.
I guess the marketing people would say that if you’ve got a good product, that helps. And I suppose you could say that when I was thinking about trying to contribute to the fight against malaria, the product I had was: We have so many people dying from malaria each year. If you will, as we started with the swim, as you mentioned, if you swim, we’ll save lives. And I guess that resonated.
And when I go back to the little girl called Terri, when we did Swim for Terri, that was my escapade when I was not very good with a remote control… I guess my appeal to people was: There was a child who suffered 90% burns in a house fire. I would like to try and help her. Will you help me? And I tend to find that when I ask people for support and help–because I absolutely couldn’t do something against malaria at the scale that we’re doing now without an awful lot of help–I’ve often found that I picked up the phone to people. I’m very happy to pick up the phone to people and say, “I don’t know how to do this. I don’t know who to talk to. Can you give me some advice and guidance?”
And I think I’ve certainly been told by people, over the years that that line can be quite a good one. When you’re not going to somebody directly and saying, “Hey, can you give me this amount of money? Or, “Can you do this for me?” If that person might be the person you’re hoping can do that for you, you start the conversation by saying, “I’ve got an idea, and I’m pretty committed to doing something about it, but I think I need some help; and have you got some advice and guidance?” I guess what I would reflect on is: very few people don’t like to be asked for advice and guidance.
Denver: That’s exactly right. The other thing that I’ve noticed from what you just said, too, is you keep it very simple. This is not complex. This is pretty much the clarity is there and not too many bells and whistles. You go right at it.
Let me go back to Andrew for a minute. What would you have to say about leveraging technology? Because to do all that you do and the places that you do it with eight people, or whatever it is, is extraordinary. How do Andrew and you and the rest of the team leverage technology to manage this far-flung operation?
Rob: It’s really important. Again, it’s at the heart of what we do, along with household-level data being gathered. There are eight of us at AMF now. So compared with two of us for 10 years, we’re a massive organization of eight people. And we all work from home. We get together, of course, every now and again, but in effect, we work from home. We’re always talking to each other on the phone, of course, in the last 18 months, way more by video call, which is much more fun.
We use technology in, I guess, I could give you two examples. One is in the field. We’re using smartphones to gather data from households. And in some ways, it’s a rather marvelous juxtaposition of an incredibly challenging set of environments, often war-torn and very limited infrastructure, et cetera, yet some of the most modern technology on the planet turning up at a household to tap in how many people are there and their ages and so on, so we can establish how many nets people need, whizzed off a satellite onto a database so we can examine it. So we use technology to keep costs down, to improve the accuracy of data, et cetera, so that plays a very important role.
And then we use technology behind our website. Our website is well in need of a refresh, and so no emails please on how seriously that needs to be rectified. That’s happening this year. But the database behind it, which has millions of household records very securely held and has donor data on the process of allocating donations to individual distributions. A lot of that is automated. And in fact, a mantra we have internally is we design things out. So that things that used to take perhaps a few hours a week a year ago, they literally take no time now because we’ve automated it, and that has been a very strong theme across AMF over our years. We design stuff.
Denver: That’s good advice for any organization. You said, Rob, that you’re pretty cynical about charity. What aspects of how a lot of it is conducted has bred that cynicism?
Rob: Yes. I have been quoted saying that I am the world’s greatest cynic when it comes to charity, and I don’t want to withdraw that. I think I am. And I often add fuel to the fire when I say that, “If I thought I was cynical 15 years ago, boy, am I cynical now, given what I’ve seen in the last 15 years in international aid.” Listen, there are fantastic organizations and people doing incredibly important work, and I’ve met many people I have huge admiration for who work in this sector.
I think there are occasions– I have to be quite tactful when I say this– but there are occasions when there is less of a focus on accountability, efficiency, effectiveness, lack of removing wastage than there needs to be. And all I would– I guess what we’ve tried to do at AMF is to focus on those elements of efficiency and accountability because ultimately, I treat every donation that’s being given to us as though it was my money, and I’m really careful about if I put some money into a donation, I really want it to have impact or know what’s going to happen to it.
So, we don’t have all the answers at AMF. We learn all the time and do things better, but I think the guiding principles, if you like, that you’ve, in essence, gone through, if we stick to those, then we’re going to do a better job… or get close to doing the best job we can.
Denver: I also observed that you have a different set of assumptions than a lot of people do. A lot of people think, for instance, they have to pay for stuff. That’s pretty much the way they operate. And you kind of start from a completely different assumption… is that I don’t want to pay for anything. I want to be able to get somebody who can contribute it. And I don’t think a lot of organizations think that way. They’re not thinking – let’s get somebody in here to volunteer. They put it into the budget.
Rob: Yes. And I think that when we work in Africa and we work with partners– and we do pay for extensive monitoring at every phase of our distribution, and we pay for it so that we can manage that process– I wouldn’t dream of going and asking for people to do things pro bono because I think those are people’s livelihoods, and they need to be paid a fair remuneration for the work they do.
Where, however, we’re talking about, and clearly what you’re referring to is, the sort of banking, accounting, legal support. I think there is a nice drawing together of the fact that we absolutely need help in those areas. There are people that can give us a few hours of their time– sometimes it’s as small as that– and it makes such a difference. And it’s not necessarily about the money. I could go and raise another half a million or a million dollars a year for those costs, but with a million dollars, I can buy half a million nets, and I can protect a million people. And so, that’s a huge number of people for me to, if I needed any motivation, to go to organizations and say, “Would you be willing to help in a way that’s not going to move the dial in your organization? You’re not going to become unprofitable.”
And in fact, the interesting dynamic that’s been fascinating for me to see over the years is that we have many, many volunteers that help us, be it translators or people assisting with IT and web design and so on. And it is very clear– there’s overwhelming anecdotal evidence now– that people got a huge amount from offering that support and help. We get very humbling emails and people saying, “Dear Rob, I’m so grateful to you for giving me the opportunity to help in this way. And so da-da-da-da-da…” And they’ve done a sort of what could have been a fee-paying service for us for free. And in a sense, they’re then part of the AMF family as I like to think of it.
So yes, there is an attitude and it comes, I guess, from I and my colleagues cannot do this on our own. We need help from people. We obviously need money, but we need other stuff as well. And it’s been a really humbling experience for 15 years, which is why I have the same energy and enthusiasm when I get up in the morning now as I did 15 years ago.
Denver: You certainly sound like you do. And yes, it’s absolutely a great point about the AMF family because a lot of people sometimes get the service. That’s the only part of it. They’re in the stable now. They’re a partner, and they can do so many other things; they can lead you to so many other places, and that’s how things begin to just grow. You get to 10X.
What’s the impact of the COVID on malaria, I guess, and on AMF as well… your fundraising? Sometimes there’s been such a focus on COVID. I had somebody on the show the other day who heads up a breast cancer organization, and she was a little concerned that everybody’s put off their screenings and that when we finally come out the other end, we’re going to get a lot of Stage 3s instead of Stage 1s. I’m just wondering the impact that COVID has had across Africa and in terms of doing the malaria work that you’re dedicated to.
Rob: So, it’s so far limited. Almost limited or none. Not quite none, but almost way down there. And the reason for that is that ministers of health in Africa took the decision a number of months ago, I guess, probably about a year ago now, when they had to consider: Do we allow mass distribution of nets to occur across our country and continue, for which there is inevitable movements of some people across the country and certainly people within counties and districts?
And the decision they took, we contributed our thoughts to that discussion, the World Health Organization also were very vocal in effectively saying, “Please, you must continue with these campaigns because we do not want to provide space for malaria to resurge.” And I’m pleased to say that within a period of about 10 days to two weeks, the unilateral decision was, or the universal decision I should say, was: Yes, let’s keep going with malaria distribution campaigns.
And then if you add onto that another two to six weeks for PPE to arrive, all of the impacts on malaria control has been a two-month hiatus or delay in carrying out distributions. But pretty much, they’ve gone ahead as normal with a few operational tweaks to take into account, reducing contact, and so on.
So from the operational perspective, I’m very pleased to say limited impact. Really important that that’s the case because you do not want malaria to resurge. You give it a number of months’ worth of space, and it will start to head North again. And we’ve seen how with COVID, how a few infections in a particular area can clearly lead to hundreds and then thousands, and you don’t want that happening. And we know that the impact of COVID is more pronounced when you have co-morbidities, when you have other illnesses. And so, you just don’t want a lot of people with malaria contracting COVID because the results could be fatal, whereas they would be otherwise a disease you could get over. So, from that perspective, so far, unaffected.
Denver: That’s great. Boy, Africa certainly has its set of problems, but I have always been so impressed how the continent comes together around issues like this and handles them in such an intelligent fashion.
The 20-minute rule. What’s that?
Rob: A few people have asked about that. So I often challenge myself in thinking: If I want to do this thing that I’m trying to do, how would I do it in 20 minutes? So if I literally only had 20 minutes. And you can do as much thinking as you like, you can do as much research as you like, but when you pick up that phone or you send that first email, and I guess we’re probably talking about a phone call, or a series of phone calls maybe, or a series of actions, because who knows when somebody will respond to your email — you’ve got 20 minutes.
And so, I found it’s been really helpful in certain ways. I found it focuses me on coming up with a course of action that is matched to the solution or the problem I’m trying to solve. So I guess I first used it when I decided that I would try and get a million people to swim as part of World Swim Against Malaria in 2005. And so, my application of the 20-minute rule there was: If I’ve got 20 minutes to get a million people to swim, how would I do that? And what’s rattling around my head was well, I could go run to my local school, and I might persuade them to get involved. And they’ve got a thousand children, so that would give me a thousand people. But of course, it’s going to take a lot of work and a lot of schools to visit, et cetera, to get to a million. You’ve got to multiply–
Denver: In 20 minutes, for sure.
Rob: Yes. So my answer to my 20-minute rule was I’m going to phone 20 organizations, and I’m going to spend one minute on the phone with each of them, and I’m going to ask them for 5,000 people swimming. And if I achieve that, that would give me a thousand people to swim; that will be the world’s largest participatory swim in the world, and that will be a credible platform from which to launch this. And maybe then, we effectively are close to a tipping point, and we get to a million.
And in essence, that’s what I did. I spent slightly more than a minute on the phone, but that’s what I–
Denver: That’s polite of you.
Rob: –2005, and I was very polite. And in essence, 20 good people, only 20 people in a sense, answered that call and said, “We’re in.” And that led to 100,000 people. We then launched it, and we didn’t quite get to a million, so I failed. But we got to a quarter of a million.
Denver: You succeeded.
Rob: I’m not going to beat myself up too much about that, but–
Denver: No, no, no.
Rob: So that’s the 20-minute rule.
We’re working hard to find donors at all levels, again, not by asking for money as I mentioned, but by people being aware of what we do and hopefully, they’ll look a bit further and decide to help us with those plates.
Denver: I like it a lot because I think what it does is it forces you to only think of highly leveraged activities and all those things that are labor-intensive at the bottom of the food chain, you skip and say, “My goodness, I had to do it,” and it gets you to really say, “Well, this is where the multipliers are,” and you spend your time there and not on things which are not really going to have a return on investment.
What has been the toughest challenge or the most difficult decision you’ve had to make since the start of the pandemic, Rob, and how did you go about doing it?
Rob: I guess one of the very difficult decisions we have to make often is that we have to turn countries down. We have to say, “The request for funding far outstrips the funding that we have.” So we have something called an immediate funding gap. And if that immediate funding gap is not filled within a certain period of time, given that distributions need to take place, and decisions need to be made of scaling back or focusing on certain vulnerable groups in a distribution and not giving everybody a net, that’s really tough.
Because you have to call, often, not just email somebody who is working within a country who is trying really, really hard. They don’t have enough money in the country and that is the truth of the matter. It’s just not a question of: Well, surely that country could find some money for something as important as this. It just doesn’t work like that. There are so many competing problems. That’s really difficult.
So one of the ways, as to the second part of your question, that we’ve dealt with that recently is that we’re trying to… I suppose, what is the picture I would want to paint? We have got four or five plates spinning at the moment, and I don’t want to let any of them crash. And I certainly don’t want to have to reach up and remove one of those plates and put it gently on the table and say, “We can’t help.”
So we’re working hard at keeping a number of plates spinning, and that means reallocating money from one country to the other in the interim because we think we can take a little bit longer to find or buy ourselves some more time to find money for one country. So, we’re working hard to find donors at all levels, again, not by asking for money as I mentioned, but by people being aware of what we do and hopefully, they’ll look a bit further and decide to help us with those plates.
Denver: So I guess a lot of it is you don’t foreclose one of those opportunities. If you can keep it spinning, maybe some answer will come to it. But once, as you say, it comes down, it’s hard to reopen it again, and you have to start from scratch, and very often you’d never get to reopen it again.
Final question, what do you think the upheavals of this past year, between the pandemic, racial issues and racial justice, every aspect of our lives– particularly here in America, have been changed– What do you think will be the lasting impacts of all that on society, but particularly on the philanthropic sector?
Rob: Well, it’s clearly been a horrific time for many people who’ve lost loved ones, who’ve suffered in intensive care in hospitals, and that’s just COVID, let alone all the other things that are going on on a daily basis like malaria that have… the mosquito has not gone into lockdown in our neck of the woods, so that’s continuing.
I guess, one of the things that I do feel that many people have experienced, who have not been so badly affected by COVID, for example, if I just focus on that, and losing loved ones, is that we’re not going to take for granted some of those things that previously we have taken for granted: going out for a walk; seeing our friends; going to a restaurant. And I wonder whether that will actually make people happier going forward because people will be just a little bit happier at things they… saw as mundane before, but now they realize is that’s actually something that we can be thankful for being able to do.
I have a very positive, forward-looking, optimistic spirit about how we as a whole set of people around the world are going to respond, and maybe that will seep into generosity of charitable giving for all organizations as well as the philanthropic effort in which I generally feel is the larger sums of money. I’m keeping my fingers crossed.
Denver: Rob, for listeners who want to learn more about the Against Malaria Foundation or financially support this work– notice I’m asking, not you– tell us about your website, which will soon be updated, and what they can expect to find there.
Rob: Well, I’d invite people to go to www.againstmalaria.com and have a look.
Denver: There you go. Well, thanks Rob, for being here today. It was such a delight to have you on the program.
Rob: My pleasure.
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