In a nutshell
In April 2025, GiveWell recommended a $200,154 grant to Population Services International (PSI) to fund the third and final round of a 36-month streamlined survey of the physical and chemical durability of dual-active ingredient (dual AI) insecticide-treated nets (ITNs) distributed in Cameroon in 2022.
GiveWell recommended this grant because:
- ITN durability is a major driver of cost-effectiveness of ITN campaigns, but we have limited information about the durability of nets.
- We are not aware of any dual AI ITN durability data from Cameroon, and a brief search suggests this might be true for central Africa more generally.
- We expect funding cuts to substantially reduce the funds available for this kind of survey in the future, so us funding this grant may be a highly leveraged opportunity.
Our main reservations about this grant are:
- In order to take advantage of a time-limited opportunity, we conducted a light-touch investigation that did not explicitly model value of information (VOI), extensively interrogate the proposed budget, or consider funging in-depth, meaning we may have missed something.
- It is possible that most of the value of the surveys is in the data from the first two years, which has already been collected.
The previous survey rounds (conducted 12 and 24 months after ITN distribution) were funded by the President’s Malaria Initiative (PMI), which is experiencing significant funding cuts as part of broader funding cuts to the US Agency for International Development (USAID). Our best guess is that in the absence of GiveWell funding, this survey would not be completed. For more on our response to the US government’s funding cuts, see our overview page here.
Published: June 2025
Background
Insecticide-treated nets (ITNs) are nets that have been treated with insecticide to deter and kill the mosquitoes that transmit malaria, a major driver of under-5 mortality in sub-Saharan African countries like Cameroon. The nets are typically hung over beds to provide protection during sleep.1 GiveWell believes that distributing insecticide-treated nets (ITNs) is one of the most cost-effective programs that donors can support; we estimate that it costs approximately $3,000 to $8,000 to avert a death in locations where GiveWell supports campaigns.2
Population Services International (PSI) is a global non-profit organization working across multiple public health areas including HIV/AIDS, women’s health, and malaria.3 We recently recommended a grant to PSI and five other organizations to fill short-terms gaps in funding for seasonal malaria chemoprevention (SMC).
What we think this grant will do
This grant will fund PSI to carry out the final round of streamlined4 durability testing, at the 36-month mark, for the two types of ITNs distributed during Cameroon’s 2022 mass ITN campaign. These ITNs, DuraNet Plus (PBO nets, or nets incorporating piperonyl butoxide to combat insecticide resistance alongside a pyrethroid insecticide) and Interceptor G2 (a type of new dual-active ingredient [dual AI] net), will be tested for physical and chemical durability.5 This grant will also fund the preparation of a manuscript of the survey findings and other publication costs.6
The previous survey rounds (conducted 12 and 24 months after the campaign) were funded by the President’s Malaria Initiative (PMI), which is experiencing significant funding cuts.7 Our best guess after consultation with PSI is that in the absence of GiveWell funding, this survey would not be completed.8
PSI will partner with the Centre for Research in Infectious Diseases (CRID) for in-country data collection and bioassay lab work and Walloon Agricultural Research Centre (CRA-W) for chemical analysis.9
The case for the grant
Our key reasons for recommending this grant include:
- We believe that ITN durability is a major driver of the cost-effectiveness of ITN campaigns, but we have limited information about the durability of nets. This is particularly true for the new dual-AI nets, which we expect to form the bulk of campaign nets in the future.10 This funding will enable the collection and publication of survey data on the physical and chemical durability of both dual AI and PBO nets.
- ITN durability data from Cameroon might be especially valuable. We are not aware of any dual AI ITN durability data from Cameroon, and shallow desk research suggests that this data might be lacking for central Africa more generally.11 We have observed significant variation in ITN durability across geographies, and having more data for central Africa, where we have funded numerous ITN campaigns,12 could lead to better decision-making by GiveWell and other stakeholders.13 That said, we have not tried to explicitly model the value of information (VOI) of this grant.
- More broadly, we expect funding cuts to PMI and Global Fund to lead to a substantial decrease in the funds available for this type of monitoring going forward.14 GiveWell’s malaria team may consider funding more ITN monitoring in the future, making this opportunity both a leveraged way to explore this type of work (since the first two rounds were already funded) and a useful point of comparison to similar monitoring we have funded Malaria Consortium to conduct in Nigeria.15
Risks and reservations
Our key reservations about making this grant include:
- As noted above, we have not explicitly modeled the value of the information that these activities would generate. However, we believe the qualitative case for the grant (described above) is strong.
- It is possible that most of the value of the surveys is in the data from the first two years, which has already been collected. Nevertheless, since the WHO recommends a three-year cadence for ITN distributions, we think having three years’ worth of data would be useful.16 It also seems plausible that previously-collected data will not get published or disseminated without the endline data that is being funded by this grant, even if the first two rounds are the most informative.
- We haven’t closely analyzed the budget17 for this project, and it's possible that the costs exceed what we might consider optimal for the scope and outputs. That being said, we have requested that PSI look for cost savings (some of which have already been made) and this is a relatively small grant for GiveWell.
- We have not deeply investigated the question of whether we are displacing another funder by recommending this grant (i.e., that we are “funging” other funds),18 as PSI told us that we are running up against the latest possible time to conduct this survey (the next ITN campaign in the survey area is expected in June 2025).19 It did not seem likely that PSI would secure funds from another funder prior to June.
Plans for follow up
- In June 2025, we will ask PSI to report on how the data collection went, and to provide a timeline for publication and data sharing.
- Based on this timeline, we will ask PSI for the data from the survey and to share the final output when it has been submitted for publication (~late 2025-early 2026).
Our process
In addition to our own research, we consulted with both internal and external experts on the subject and based the case for the grant largely on their recommendations rather than a quantitative model or a concrete cost-effectiveness estimate.
This was a very light-touch investigation process, as PSI told us that time was running out to conduct the final round of this survey given that the next ITN campaign in the survey area is expected to be conducted in June 2025. In the context of the US government’s funding cuts, GiveWell is focused on filling time-sensitive gaps in high-impact program areas we’re familiar with, such as ITNs.20
Internal forecasts
For this grant, we are recording the following forecasts:
| Confidence | Prediction | By time | Resolution |
|---|---|---|---|
| 70% | Data gathering activities in the field are complete. | By June 1, 2025 | - |
| 80% | Data gathering activities in the field are complete. | By July 1, 2025 | - |
| 50% | Results from this survey are incorporated in some way into our cost-effectiveness analysis of ITNs. | By Jan 1, 2026 | - |
| 70% | The results of this survey are published in a journal. | By June 30, 2026 | - |
| 85% | The results of this survey are published in a journal. | By September 30, 2026 | - |
Sources
- 1
- “Insecticide-treated nets (ITNs) are nets that have been treated with insecticide to deter and kill the mosquitoes that transmit malaria. They are typically hung over beds to provide protection during sleep.”
- “[M]alaria is widely seen as one of the main causes of child mortality in sub-Saharan Africa.”
GiveWell, “Mass Distribution of Insecticide-Treated Nets (ITNs).” Note, as of the time of publication, we are in the process of updating our ITN intervention report to reflect our latest methodology, and the details in our public intervention report from April 2024 may no longer accurately describe the methodology used in recent grant investigations, although our overall impression of ITNs has not changed.
- 2
More information on GiveWell’s assessment of ITNs as an intervention and the past ITN campaigns we have funded can be found at GiveWell, “Mass Distribution of Insecticide-Treated Nets (ITNs).”
- 3
- 4
“PMI supports two approaches to durability monitoring (DM):
- Standard DM approach can be implemented where there is no or limited country data available on ITN durability, or if an issue has been noted.
- Streamlined DM approach should be considered in countries that have previously collected DM data and are primarily interested in evaluating bioefficacy, particularly for new types of nets.
Both approaches include pre-distribution testing of ITNs…The streamlined approach requires less time for fieldwork and will cost less than the standard approach for the same set of ITN brands being monitored.” PMI, “Summary of the Differences between Streamlined and Standard Durability Monitoring”
With this grant, PSI will carry out streamlined durability testing. - 5
Correspondence from PSI to GiveWell, April 8, 2025. (unpublished)
- 6
Correspondence from PSI to GiveWell, April 7, 2025. (unpublished)
- 7
Correspondence from PSI to GiveWell, April 30, 2025. (unpublished)
- 8
Correspondence from PSI to GiveWell, April 21, 2025. (unpublished)
- 9
Correspondence from PSI to GiveWell, June 11, 2025. (unpublished)
- 10
According to the Alliance for Malaria Prevention Net Mapping Project, in 2024, 47% of ITNs shipped were dual-AI nets and 30% were PBO nets, compared to just 2% dual AI and 7% PBO in 2019.
- 11
GiveWell, shallow desk research on ITN durability data in central Africa, April 2025. (unpublished)
- 12
In central Africa, we have funded ITN campaigns in the Democratic Republic of Congo (DRC), Chad, and South Sudan. Roughly 85% of the funds we have directed to central Africa for ITN campaigns have been directed to DRC. See the database of GiveWell grants.
- 13
- See “Fig. 5: Long-lasting insecticide-treated net (LLIN) median retention times” in Nature Communications, “Maps and metrics of insecticide-treated net access, use, and nets-per-capita in Africa from 2000-2020,” 11 June 2021.
- We model the decay of ITNs over time in various geographies as part of our ITNs CEA.
- 14
- Correspondence from Global Fund to GiveWell, April 25, 2025. (unpublished)
- “A State Department spokesperson said Thursday the agency spared critical USAID awards, including for food assistance, and life-saving medical treatments for diseases such as HIV, malaria and tuberculosis.” CBS News, “State Dept. claims it's sparing life-saving efforts from USAID cuts, but some groups say it's "not true",” February 27, 2025. Our understanding (from conversations with credible sources) is that durability surveys are not considered “life-saving” and hence defunded.
- 15
We have previously funded Malaria Consortium to conduct ITN durability monitoring in Ondo and Anambra states in Nigeria.
- 16
“Campaigns should also normally be repeated every three years, unless available empirical evidence justifies the use of a longer or shorter interval between campaigns.” WHO, Guidelines for Malaria Vector Control, 2019, pp. 39-40.
- 17
Publication costs are included in “Indirect Costs” in this budget.
- 18
For more on how GiveWell thinks about funging, see this blog post.
- 19
Correspondence from PSI to GiveWell, April 21, 2025. (unpublished)
- 20
For more information about how GiveWell is responding to USAID funding cuts, see this page.