Sunday, April 25, 2010

World Malaria Day ... How much has already been wasted?

Dear Colleagues

World Vision has reminded me that today is World Malaria Day. This day is now entrenched as a day when those that are involved with international relief and development make a pitch for more money to fund ongoing malaria control work.

Several years ago an amount of around $100 million was being disbursed annually to support malaria control programs ... now the total is more than $2 billion a year, a not inconsequential amount.

As I cost accountant, I am very concerned that nobody seems to know very much about how much things cost and what impact is being achieved from resources consumed. The organizations engaged in this work seem to have a very weak understanding of the cost of what they are doing and the effectiveness of the initiatives. That is not to say that the people involved are not well educated ... they have PhDs, they are MDs or have the MPH education ... but in the main, they are not cost accountants. From my perspective, they all seem to think that cost accounting is "beneath" them ... but that should not excuse them from knowing absolutely essential management information!

Many organizations like World Vision, MalariaNoMore, NothingbutNets ... not to mention the Presidents Malaria Initiative (PMI) and the Global Fund for Aids Tuberculosis and Malaria (GFATM) have done a lot of their work on the basis that modern insecticide treated bednets are a cost effective way of saving lives ... and now there is a lot of pamphleteering about the success of programs that have used bednets in various malaria endemic countries ... but little of this PR material seems to be based on credible data about the performance of bednets and the cost effectiveness of this intervention.

It is fairly clear that after spending more than $2 billion a year, there is some reduction in the burden of malaria ... but it is far from clear whether we are getting "our money's worth"! Nobody seems to have data that is very satisfying to a cost accountant ... though many of the beneficiary governments around the world and implementing agencies like PSI, RTI and many others have convinced the donors that they are doing effective work. This is accomplished mainly by story telling and tiny bits of data that get major statistical manipulation to show performance. As a cost accountant, this methodology is not credible ... and should be discounted.

I want to see the burden of malaria reduced ... and from what I know of medical science, entomology and cost and management accounting ... the way we are going about it will end up costing a lot more than it should, and quite quickly become unsustainable. This is a development train-wreck waiting to happen ... and one could add "with the engineer in charge texting"! The costing may not be very simple, because the best programs are ones where there are multiple interventions, with variations depending on the physical circumstances of the place ... but the fact of this modest complexity does not excuse the managers from knowing something about how much things have cost and how much impact there has been.

How does one make an impression on the big organizations that are engaged in the international relief and development industry ... but do not want to come into the modern world when it comes to the metrics of socio-economic performance ... and therefore end up funding programs that cost more they should and do less than they should!

The following is the text of the e-mail I received from WorldVision today suggesting I send money for bednets ... I don't think so!

Peter Burgess
---------- Forwarded message ----------
From: World Vision
Date: Sun, Apr 25, 2010 at 2:04 PM
Subject: Give bed nets on World Malaria Day!


Give long-lasting insecticide-treated bed nets to protect children's lives.

Dear Sponsor,

Today is World Malaria Day. This disease kills nearly 1 million people each year; 85 percent are children under the age of 5. Hitting Africa the hardest, malaria is the top killer of children in many of the places where World Vision works. Join us in our efforts to end malaria.

Effective and inexpensive tools make malaria both preventable and treatable. Tragically, simple solutions such as treated bed nets are often inaccessible to the people who need them most. Today, you can help change that.

Through our Operation Safety Net program, World Vision is distributing long-lasting insecticide-treated bed nets in Africa, but we need your help.

Your gift of $18 today will provide 3 long-lasting insecticide-treated bed nets. That's enough to protect an entire family from this deadly disease.

Please send a generous gift to provide bed nets to help end malaria in Africa. And please remember to pray for children and families in communities hit hard by this disease. Your prayers can make a difference.

Every day, malaria kills more than 2,000 children. No one should die from a mosquito bite.

God bless,

Rich Stearns
President, World Vision U.S.

World Vision United States — Building a Better World for Children
World Vision is a Christian humanitarian organization dedicated to working with children, families, and their communities worldwide to reach their full potential by tackling the causes of poverty and injustice.

In 2009, 89 percent of World Vision's total operating expenses were used for programs that benefit children, families, and communities in need.
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