| Organization | Against Malaria Foundation (AMF) |
| Location | Democratic Republic of the Congo (DRC) |
| Amount | $276.0 million1 |
| Approval date | May 2026 |
| Funded by | Coefficient Giving, Top Charities Fund |
Summary
This grant will fund the procurement of 92 million2 insecticide-treated nets (ITNs) and provide partial funding for their distribution across the Democratic Republic of the Congo (DRC) between 2027 and 2029, which we expect to avert 67,000 deaths.
An in-depth grant report is being finalized and will be linked from this page once complete.
Published: August 2026
The challenge
We estimate that 8.4% of children in DRC die before their fifth birthday, and malaria contributes to around 56% of those deaths,3 among the highest share of any country.4 For more information, see our intervention report on mass distribution of ITNs.
What this grant will do
This grant to the Against Malaria Foundation (AMF) will provide additional funding for mass ITN campaigns to ensure that almost all households in DRC receive ITNs at least once in the 2027-29 period.5 ITNs prevent transmission of malaria by mosquitos: the netting provides a physical barrier to mosquitos and the insecticides kill or repel them.6
This funding will cover:
- Initial ITN procurement to enable coverage for all provinces of DRC. About $180 million7 of this grant will go towards AMF procuring up to the approximately 80 million nets needed to cover all 26 provinces.8
- ITN distribution management by AMF in some provinces. We expect the country to use its funding from the Global Fund to cover most distribution costs and manage distribution in around 18 provinces;9 a portion of our funding (about $35 million) will allow AMF to manage distribution in the remaining provinces.10
- Monitoring in all provinces. We expect AMF to contract out roughly 124 coverage surveys, four per province, at a cost of $9 million. The surveys are intended to check whether nets reach households, are hung properly, and stay usable.11
- A conditional second campaign in high-burden provinces. Nets in DRC stay in good condition for around 18 months,12 but campaigns currently run 30 to 40 months apart,13 which leaves many children unprotected for a year or more before the next distribution arrives. This grant includes approximately $54 million for a second ITN campaign to take place within the 2027-2029 time period, which will provide 12 million nets14 in five high-burden provinces, conditional on the agreement of DRC's national malaria program and other partners.15
Our reasoning
We made this grant because we believe it is highly cost-effective; our best guess is that it is approximately 16 times as cost-effective as our benchmark. We expect the grant to avert approximately 67,000 deaths. This is GiveWell’s largest grant to date;16 we believe the underlying case for the funding is well-evidenced, and we have high confidence in AMF and its implementation plans.
Our high cost-effectiveness estimate is driven by:
- High under-5 malaria mortality in DRC. We estimate that the annual under-five malaria mortality rate in DRC is 0.88%, among the highest under-5 malaria mortality rates of any geography.17
- ITNs effectively reduce deaths from malaria. ITNs provide substantial protection from malaria, and we are confident that most nets procured by AMF end up in households and used at night.18 We discuss this further in our intervention report on ITNs. Our analysis of 2023–24 data from DRC indicates that previous mass ITN campaigns reduced both malaria prevalence and all-cause child mortality by margins broadly consistent with what we predicted at the time.19
- ITNs are relatively cheap. We estimate that we will pay about $6 for each counterfactually additional net procured and distributed.
- Many children covered by these campaigns would not otherwise use ITNs. Without mass distribution campaigns, we estimate only around 25% of children in DRC would sleep under a net. Without this grant, we estimate that roughly 16 of the country's 26 provinces would go without a mass net distribution campaign between 2027 and 2029.20 This funding gap exists because the Global Fund, historically the primary funder of mass ITN campaigns in DRC,21 caps how much of its malaria funding any single country can receive,22 so there is insufficient funding to provide nets nationwide in DRC with Global Fund funding alone.
Outside of our cost-effectiveness model, a few qualitative considerations influenced our decision to fund this grant:
- AMF has a solid track record. AMF has worked with the DRC malaria program for over a decade23 and we have been told by the national malaria program (PNLP), SANRU,24 and the Global Fund that they are a welcome and constructive partner.25 DRC is a challenging operating environment for net campaigns due to minimal logistics infrastructure, heightened fraud risk, and significant turnover in campaign management staff, among other challenges.26 We believe that AMF has done an effective job mitigating and managing these challenges in past campaigns.
- AMF is broadly aligned with GiveWell on the fundamentals of cost-effectiveness. In general, we think AMF has consistently demonstrated over a long period that it is focused on achieving high cost-effectiveness, including by seeking low net prices, high-quality campaigns, and targeting campaigns to countries and areas with high malaria burden.
- This grant would remain above our funding bar in most plausible cost-effectiveness scenarios.27 Our rough cost-effectiveness estimate stays above our funding bar across a wide range of assumptions.28
How we could be wrong
Our key uncertainties about this grant are:
- We are uncertain of the effect that a grant of this size will have on other funders. This grant is much larger than any we have made before, and is much larger than any other philanthropic donations for specific ITN campaigns we are aware of. This grant would mean that GiveWell will be the largest funder of net campaigns in DRC for this mass distribution cycle, providing roughly two thirds of the funding,29 with the Global Fund covering most of the remainder. Becoming the dominant funder of malaria prevention in a country could change how other funders behave, including by reducing their own commitments to malaria interventions in this cycle or future ones.
- AMF has limited experience managing ITN distribution directly. AMF is highly experienced at procuring nets and working with partners who deliver them, but it has not yet managed campaign delivery on its own.30 This could cause delays or lower-quality campaigns. Nonetheless, we believe our best option is to fund delivery through AMF; this is because of the qualitative strengths listed above, and that we don’t have experience with making and managing grants to the Global Fund or SANRU, potential alternatives. We plan to continue to discuss distribution logistics with AMF during the grant implementation period.
- Shortening the interval between campaigns in some provinces risks lowering the quality of malaria prevention activities by overburdening the PNLP and SANRU. Although AMF will procure nets in all provinces and manage delivery in a subset, the PNLP would coordinate planning for every campaign, and SANRU is likely to be the implementer in the majority of provinces.31
Our funding would support 31 campaigns across 2027 to 2029 (26 provinces + 5 additional interval-shortening campaigns), a significant expansion from the 21 campaigns conducted or planned for the Global Fund’s GC7 funding cycle.32
This additional burden could reduce the quality of ITN campaigns, or reduce the PNLP and SANRU’s ability to successfully conduct other malaria prevention activities.
- We are trying to mitigate this risk by making the portion of this funding that would fund the interval-shortening campaigns contingent on buy-in from the Global Fund, PNLP, and SANRU, allowing them an opportunity to voice feasibility concerns. We are also asking AMF to report on campaign progress and we plan to consider providing technical assistance funding or additional support if needed.
- The Global Fund country team also provides oversight and plans to work with UNDP as a distribution partner in some provinces and AMF will conduct competitive tenders among multiple partners for distributions it funds. AMF also has input into operational elements connected with logistics and net delivery, and funds monitoring activities across all operational stages.33
- Additionally, we expect that making one large, early funding commitment now could substantially reduce planning workload compared to previous funding cycles by allowing DRC to plan nationwide campaigns without needing to re-plan as new funding becomes available.
This page summarizes our research at the time of approval and was reviewed by the grant recipient.
Sources
- 1This includes up to $54.0 million for additional campaigns in up to five provinces, which will be used only if DRC's national malaria program and other implementing partners agree to that plan.
- 2
- Approximately $180 million of this funding will fund procurement of approximately 80 million nets to cover all 26 provinces. An additional $54 million will fund up to 12 million nets for second campaigns in high burden areas, if the conditions for funding are met. (80m + 12m = 92m nets). See the “What this grant will do” section of this page.
- The total number of nets this grant would fund procurement of is distinct from the total number of nets distributed we think our funding will counterfactually cause (i.e., how many nets distributed that would not have been distributed without this grant). In our cost-effectiveness analysis for this grant, we calculate that our funding will counterfactually cause about 46 million nets to be distributed throughout DRC. The difference between nets directly provided by this grant and nets counterfactually distributed is primarily due to the fact that we account for delivery costs even when GiveWell is not the one paying for them. Without this grant, we expect the Global Fund would have spent approximately $115M to both buy ITNs and deliver them. With this grant, we expect it to spend approximately $115M for delivery costs, increasing the total number of counterfactual nets distributed but not by as much as it would in a hypothetical case where the counterfactual was that Global Fund was not procuring any nets.
- 3
- We estimate the all-cause under-five mortality rate in DRC at 8.4%, weighting equally the estimates from the Global Burden of Disease 2023 study (6.8%), the UN Inter-agency Group for Child Mortality Estimation 2024 (9.0%), and the 2024 Demographic and Health Survey (9.3%). Institute for Health Metrics and Evaluation, Global Burden of Disease, GBD Results, DRC probability of death before age 5 (2023) (accessed August 17, 2026); UN Inter-agency Group for Child Mortality Estimation, DRC under-5 mortality rate 2024 (accessed August 17, 2026); DHS, Congo Democratic Republic 2023-24 final report, p. 8
- We estimate malaria contributes to 56% of under-five deaths in DRC: 35.5% caused directly by malaria, plus an estimated 0.569 indirect deaths for every direct death. 35.5% × (1 direct death + 0.569 indirect deaths) = 55.7%. GiveWell, Burden across malaria pods [DRC 2027-2029] (unpublished). For our approach to indirect malaria mortality, see our intervention report on ITN campaigns.
- While we think this estimate could plausibly be off by +/- 30%, conversations with external experts and data from other high burden countries substantiates that malaria is a significant driver of child mortality in DRC. This estimate is corroborated by post-mortem tissue sampling in Sierra Leone, a comparable high-transmission rural setting, which found malaria in the causal chain for 42.9% of 294 under-five deaths: Ogbuanu et al. 2024.
- 4For example, we also estimate that malaria contributes to 56% of under-five deaths in Sierra Leone: 35% caused directly by malaria, plus 0.6 indirect deaths for every direct death (35% x 1.6 = 56%). GiveWell, Burden across malaria pods [DRC 2027-2029] (unpublished). Note that this is based on our current estimates and that we expect to publish this analysis in the future alongside a more detailed page for this grant.
- 5This funding excludes campaigns in 36.5% of Kinshasa and 50% of Nord Kivu. Nord Kivu includes some high-altitude areas with minimal malaria, and Kinshasa is one of Africa’s largest urban centers, which are typically associated with lower malaria prevalence, lower all-cause mortality, and higher access to care.
- “In many countries where malaria spreads, you will not find it in all parts of the country. Even within tropical and subtropical areas, you will not find malaria at very high altitudes,” CDC, “Where malaria occurs,” 2024
- “Le pourcentage d’enfants dont le résultat au test de dépistage du paludisme était positif est deux fois plus élevé dans le milieu rural (39 %) que dans le milieu urbain (17 %). Il varie de manière importante entre les provinces, de 5 % à Kinshasa et de 9 % dans le Nord Kivu à plus de 50 % dans les provinces du Kasaï Central, du Kongo Central, du Lomami, du Maniema et du Bas Uele (Carte 12.3)." DHS, Congo Democratic Republic 2023-24 final report, p. 281
- “Urban populations are on average subject to reduced levels of malaria transmission and severe disease than rural ones. They are also able to access better healthcare facilities and consequently suffer less morbidity and mortality from malaria and several other conditions,” Hay et al 2005, p. 8
- 6See our intervention report for more information.
- 7
- Our base grant includes approximately $180 million to procure around 80 million nets. AMF, DRC Funding Gap, May 2026 (unpublished)
- Note that we previously made a $9 million grant to AMF for ITN procurement in DRC in March 2026, which we also expect to support these campaigns. Of the approximately $180 million total from this grant that will go toward procuring nets, $9 million of it is from this previous grant, so roughly $170 million of the total is new funding (numbers may be off due to rounding).
- 8
- AMF, Comments on a draft of this page, August 14, 2026 (unpublished)
- We think it is likely that 1-2 campaigns will be cancelled due to security challenges – as has recently happened in Nord and Sud Kivu – but as the situation is in flux, we believe it’s appropriate to allocate funds for these distributions in the hope they can occur. AMF, DRC Funding Gap, May 2026 (unpublished)
- 9AMF, Comments on a draft of this page, August 14, 2026 (unpublished)
- 10We expect the Global Fund to provide around $115 million toward distribution costs for these campaigns, and the US government to provide a smaller amount. These are our expectations at the time of the grant, based on AMF's projections following discussions with the national programme and our conversations with the Global Fund's country team; they are not commitments.
- 11AMF, DRC Monitoring Costs Estimate, May 2026 (unpublished)
- 12Using data from AMF and a field durability meta-analysis to calculate the point at which 50% of nets are no longer in good condition, we found that at 18 months roughly 47% of nets are in good condition. GiveWell, Analysis of ITN durability and retention, March 2026 (unpublished)
- 13AMF, DRC Funding Gap, May 2026 (unpublished)
- 14AMF, DRC Funding Gap, May 2026 (unpublished)
- 15AMF has proposed five provinces with among the highest under-five malaria prevalence in DRC. We agreed to these funds only if the Global Fund, the national malaria program, and SANRU support the plan and we agree on the provinces selected.
- 16See GiveWell’s past grants and grant amounts here.
- 17Compare to 0.73% in our recent grant to fund campaigns in several states in Nigeria (grant page not yet published), 0.47% in Chad, and 0.25% in Zambia.
- 18We estimate that, in DRC, 8% of nets are diverted before delivery (from GiveWell, Estimate of AMF cost per net, 2026, unpublished) and that net usage among children under five is 87% following a mass campaign.
- 19GiveWell, “Do bed net campaigns save lives in DRC? Evidence from the 2023-24 Demographic and Health Survey”, 2026 (unpublished)
- 20"Our current best estimate of the counterfactual (no funding contributed from AMF) is that the country receives a combined total of US$137.1m of funding from The Global Fund and PMI, which would mean that 31 million nets protecting 55 million people could be distributed at estimated mass campaign costs. 16 provinces and 74m people would not receive nets." AMF, DRC Opportunity Assessment Document, April 2026, (unpublished)
- 21For example, in the previous campaign (GC7), the Global Fund provided 49% of total funding, the largest share of any funder. For comparison, GiveWell provided 36% of total funding in GC7 and other funders provided the remaining 15%. GiveWell, “DRC grant size calculations,” 2026 (unpublished)
- 22The Global Fund's allocation methodology caps the share of its malaria funding that any single country receives. See The Global Fund, Allocation Methodology for the 2023–2025 Allocation Period.
- 23See Against Malaria Fund, Net distributions - Congo (Dem. Rep.), where AMF’s earliest program in DRC is listed as taking place near Bukavu city between April and October 2007 (accessed August 12, 2026).
- 24SANRU is one of the Global Fund's Principal Recipients for malaria interventions in DRC and the main implementer of ITN campaigns in the country. More about the Global Fund’s partners in DRC can be found here.
- 25Conversations with PNLP, SANRU, and the Global Fund, May 2026 (unpublished)
- 26This is our impression based on multiple conversations with AMF, the Global Fund, the Alliance for Malaria Prevention, and other experts.
- 27Our funding bar at the time of this grant is 6 times as cost-effective as our benchmark.
- 28We conducted a sensitivity analysis which projects an estimated cost-effectiveness range of 5.4 to 20.8 times our benchmark for the 25th and 75th percentiles. While the 25th percentile estimate is lower than our current funding bar, we feel comfortable with this range and think that in most plausible cases this grant will remain above our bar.
- 29We expect the Global Fund to provide around $115 million toward distribution costs for these campaigns, and the US government to provide a smaller amount. These are our expectations at the time of the grant, based on AMF's projections and our conversations with the Global Fund's country team; they are not commitments. We calculate this by dividing this grant amount of $276 million by the total of our contribution and the Global Fund’s (276 + 115) = 71%; additional contributions from other funders would decrease this somewhat so we estimate our contribution in the range of two thirds of the total.
- 30AMF is currently in the planning process of managing distribution for one campaign in DRC (Ituri) and one in Nigeria (Sokoto).
- 31AMF, Comments on a draft of this page, August 14, 2026 (unpublished)
- 32AMF, DRC Funding Gap, 2026 (unpublished)
- 33AMF, Comments on a draft of this page, August 14, 2026 (unpublished)