Rotary is stepping up (…) through Programs of Scale, a new Foundation program awarding grants to Rotary clubs or districts with evidence-based interventions that are ready to scale. The first such grant, announced in February, will provide $2 million to Partners for a Malaria-Free Zambia, a member-led program focused on fighting malaria. Co-funders World Vision U.S. and the Bill & Melinda Gates Foundation are also involved in malaria mitigation efforts and will each contribute $2 million to the program. This $6 million program will train and equip 2,500 community health workers in Zambia to support the government’s work to eradicate malaria in that country.Now Muyendekwa’s vision is coming to fruition in a big way as the work, which has continued since then, expands. With this first $2 million Programs of Scale grant, Partners for a Malaria-Free Zambia (as the initiative is now known) is seeking to help reduce the incidence of malaria over time by 90 percent in 10 heavily affected districts in the Central and Muchinga provinces. They’ll do this by training 2,500 community health workers, as well as other health facility staff and officials who will work with them. The community health workers, equipped with the necessary medicine and supplies, will respond to malaria cases, work to prevent transmission, and provide other needed health care interventions — which will in turn reduce the burden on clinics. Malaria, a preventable disease caused by parasites spread through the bites of infected mosquitoes, continues to be one of Zambia’s leading causes of illness and death, contributing significantly to infant and maternal mortality. The grant proposal included pledges from the Bill & Melinda Gates Foundation and World Vision U.S. to match Rotary’s $2 million grant, for a total of $6 million for the initiative. “Rotary’s credibility is so amazing,” Feldt says. “We’ve got a lot to offer. Let’s demonstrate that.” We asked Feldt for his insights about the application process and about the project. What makes this project a program of scale? It’s expanding on a proven concept, which I think is really important and was compelling to Rotary in awarding this grant. We’ll be impacting about 1.3 million Zambians who will have health care in their communities for the first time. That means testing for, treating, and preventing malaria, and that also means treating diarrhea and pneumonia as well as providing information about COVID-19. We think that’s a program of scale. We’re very excited about that. How does this grow out of previous work Rotarians have done? We’ve written three global grants in the past two years. When the third grant project is complete, we will have trained more than 1,500 community health workers in the Copperbelt province. That gave us credibility with The Rotary Foundation. We think we’re pretty good at it. What we’re really doing is supporting the government in Zambia, which has a superb six-day training curriculum. There are about 12,000 community health workers trained under the auspices of the Ministry of Health. With the global grants and Programs of Scale grant, we are adding about 33 percent more. How did you adapt what you learned in previous projects? We’re going into areas where there are no community health workers. Once the new workers are trained, doctors and nurses need to learn how to interact with them. We’re paying for some of those strengthening activities in the global grants and now even more with the Programs of Scale grant because we’ve learned that’s such a vital component of sustainability. Another thing we’ve learned is that the best community health workers are people who are established in their communities. They aren’t getting paid. It’s really about prestige. A study concluded that people do this because it’s a good thing to do, and it makes them a leader. Why is this the right program to tackle malaria in Zambia? Not just Zambia. Sub-Saharan Africa too. One key success factor is that there is a supportive, committed government in Zambia. If the government isn’t committed, it’s going to go nowhere. One of our project partners, an organization called PATH — which is based in Seattle and receives funding from the Gates Foundation — supported the Zambian Ministry of Health and the National Malaria Elimination Centre in the launch of the government’s community health worker initiative. This is a concept that UNICEF and the World Health Organization have been defining and encouraging. Between 2012 and 2015, the Ministry of Health and the National Malaria Elimination Centre, with support from PATH, did its first real project in the Southern province of Zambia, and they drove malaria rates down to near zero using community health workers. That’s really the proof of concept. The model seems to work, the government is committed, and obviously the Gates Foundation thinks it’s a good model because it’s been supporting the PATH program in Zambia for nearly a decade. What advice do you have for Rotarians looking for partners? Make organizations aware of what you’re doing. Connecting is the whole game. I think that’s what Rotary wants to do through Programs of Scale. In Africa, and all over the world, local Rotarians can open doors through their connections. My view is that we have a leg up on a lot of people looking for money because of what Rotary has done with polio. It is central to our credibility. If we visit the project in 2026, what should we see? I would hope we would see a dramatic reduction in malaria incidence. We’d want to see a self-sustaining health system that is fully utilizing community health workers, where they are diagnosing 60 to 70 per-cent of whatever small number of cases of malaria there are. They will probably be working on pneumonia and diarrheal diseases more than they had been. Hopefully, they’ll be doing telemedicine. We’ll see that turnover for community health workers is low and that there’s retraining. They’ll have been retrained twice by that time, and they’ll be a core part of the health system. They will represent the last kilometer of a health system that’s very successful.
Rotary members expand on a proven concept in ZambiaBill Feldt recalls the first conversation he had about solving Zambia’s malaria problem at scale. It was in 2012, after he worked on his first matching grant for malaria with Mwangala Muyendekwa, a physician and a member of the Rotary Club of Kalulushi, Zambia. It was a $57,000 project distributing 6,500 bed nets in Zambia’s Copperbelt province. “By the time they were distributing those nets, Mwangala emailed me and said, ‘This is good, but not sufficient. We’ve got to go to scale,’” recalls Feldt, a member of the Rotary Club of Federal Way in Washington state.