Partners for a Malaria-Free Zambia Annual Impact Report

This is the 2025 annual impact report on The Rotary Foundation’s first recipient of the Programs of Scale award, Partners for a Malaria-Free Zambia.

The Rotary Foundation created Programs of Scale to support member-led, evidence-based programs that have already demonstrated success and are ready to expand or be implemented in new places. Scaling proven programs will benefit more people, lead to sustainable programs, and support policy development.

Another goal is to share what we learned through these programs with members who want to develop and implement similar programs in their own communities.

By integrating existing local, regional, and national health care systems, the program was designed to improve health systems for the long term. It contributed directly to a nationwide strategy put forth by the Zambian government’s National Malaria Elimination Centre.

This grant was sponsored by the Rotary Club of Federal Way, Washington, USA, and the program was implemented in partnership with the Gates Foundation, World Vision, Malaria Partners International, Malaria Partners Zambia, PATH Malaria Control and Elimination Partnership in Africa, the National Malaria Elimination Centre, provincial health leaders, and Zambian Rotarians.

To determine if a program is working, Rotary International uses indicators — measurable data points that provide evidence of progress and change related to a specific outcome or goal.

For this program, we developed six indicators. Some are easily measurable, while others won’t show change for some time yet. The Rotarians in Zambia will continue to report on these indicators annually until April 2029 so that The Rotary Foundation and members globally can learn from the program and find out if and how its outcomes are sustained.

1: Number of active community health workers

Because community health workers often share the same background, language, and culture as the people they serve, they are uniquely positioned to connect people to health services and provide support and guidance.

The program trained 2,500 community health workers, with most of them learning to provide services related to malaria, diarrhea, and pneumonia in an area of 500 people. Thanks to these workers, 1.25 million people have improved access to malaria testing and treatment in their communities. The retention rate is 94%, and the workers still conduct the majority of testing and treatment in each area.

Through this program, we found that the community health workers were able to expand the overall capacity of the local health care system, beyond just addressing malaria.

2: Number of people tested for malaria

Having the workers trained, equipped, and out in the community has substantially increased people’s access to malaria testing and treatment services in rural communities. The workers used bicycles issued to them through the program to reach people for testing, treatment, and referral, so that care didn’t depend on people traveling to health facilities.

In 2024, more than 747,000 malaria tests were performed. In most areas served by the program, the workers are identifying at least as many cases of malaria as health facilities do, highlighting their effectiveness.

This data shows that the program provides people with reliable and immediate health care resources, significantly contributing to the national goal of eliminating malaria and improving overall community health.

3: Percentage of people tested by community health workers compared with those tested at health facilities

In the 10 districts where the program was active, nearly 3.3 million malaria cases were detected over the past four years. Last year, 60% of the cases detected were identified by the community health workers. These were cases that would likely have been missed or found later if the person needed to travel to a clinic.

During the course of the program, the number of cases detected overall rose because of the increase in the number of community health workers involved in the program. And because more people were tested near their homes and those who needed treatment received it more quickly, the program also reduced the burden on health facilities and allowed them to allocate resources to severe cases.

Community health workers are identifying more malaria cases than facilities are in both provinces, highlighting their effectiveness.

4: Percentage of malaria cases detected by community health workers that are referred to a health facility

Community health workers treated people who tested positive for malaria except children under two months old, pregnant women, and people with severe symptoms. This aligns with Zambia’s national protocols. The workers referred all cases that they couldn’t treat to health facilities. During the course of the program, community health workers treated 99% of the more than 1.3 million cases they detected and referred the rest to health facilities.

5: Number of people admitted to health facilities with severe cases

Health facility discharge data is used as a proxy to track the number of people admitted with malaria. Tracking this information allows the program sponsors to understand whether severe malaria has been reduced over time.

In 2024, about 6,500 people were discharged from inpatient facilities after receiving treatment for severe malaria. Muchinga Province has more people who require inpatient care, a result that may be linked to higher community transmission or people seeking treatment later.

6: Number of deaths from malaria
The rationale for this program was that if community health workers test and treat malaria closer to people's homes, fewer severe cases will develop and deaths due to malaria will fall over time.

In 2024, the 10 target districts recorded 75 deaths from malaria. Despite the challenges, Ministry of Health data shows that malaria cases and deaths have dropped in most districts. It’s important to note that there are seasonal differences in case numbers, which rise during the rainy season.

Since the grant funding ended, the structures, capacities, and relationships built during the program have endured. The 10 target districts have continued to support the activities begun by the program and have helped solve local challenges, adapted their systems, and sustained the program’s momentum. The activities have transitioned from donor-led implementation to locally led action reinforced by local Rotary clubs, highlighting an evolving model of community-based health care in which government agencies, other groups, and Rotary work in tandem.

Communities have also shown widespread appreciation for the program and the efforts of the health workers. Residents consistently cited as key benefits of the program the ability to get care closer to home and more quickly. Community participation remains strong, especially in areas where the health workers are engaged in outreach and behavior change campaigns.

As we noted, 94% of trained community health workers remain active. They are committed to serving their communities and do so as volunteers, often motivated by knowing they are a critical source of health support in their areas. They are also very respected and valued because of the service they provide. It is, however, essential that they continue to have supplies for testing and treatment and the other equipment they need to do their work. This equipment, which includes backpacks, bicycles, and cell phone access, facilitates their travel and sharing of data. The program collaborated with district health officials to institute data quality audits, which led to the health workers submitting better data. This meant more accurate information about the incidence of malaria was available to determine how to allocate tests and treatment.

This program also strongly engaged Rotary club members. Clubs have had a large role in activities such as continuing the education of community health workers and supporting data reviews.

In addition:
-A new club formed with a focus on malaria elimination.
-This program has been replicated in other places. A similar program model is taking place in Uganda.
-The Rotary Healthy Communities Challenge developed out of this program.

Although most program outcomes have been positive, the sponsors did encounter some challenges.

Most districts reported receiving supplies consistently, but some areas experienced supply chain disruptions. To mitigate these disruptions, local Rotary club members are working with the Ministry of Health to better predict and monitor the inventory of tests and other supplies. They are also working with that ministry and the Ministry of Finance to advocate for greater financial support for the necessary supplies. And members are connecting with other organizations, such as the Global Fund, to promote the equitable distribution of supplies.

Mobile network coverage generally was good, but some districts also had poor mobile coverage, which created challenges for reporting data and planning logistics.

Although the overall retention rate for the program is 94%, some districts experienced significantly higher attrition than others. That may be due to challenges with the selection process, less motivation for workers, and limited Rotary engagement in the district.

Some districts also reported lower involvement from the neighborhood health committees, likely due to limited support or motivation.

Despite these challenges, the program's legacy persists in the Central and Muchinga provinces — not merely in data, but in the people, practices, and partnerships that continue to make progress toward a malaria-free Zambia.

As the program sponsors addressed the challenges they encountered, they learned several important lessons:

The effort to eliminate malaria is not a linear process. Increases early on in the number of cases reported are common and often reflect better access to testing and more reliable data. These increases indicate that health workers are reaching people who previously would not have been tested or treated.

Thorough recruitment processes help identify health workers who are well-aligned with the role and community needs, leading to greater job satisfaction, stronger performances, and higher retention rates.

Fostering community involvement and leadership builds trust, ensures that programs are culturally relevant, and encourages more local participation — important factors for the long-term success and sustainability of community health initiatives.

A well-functioning supply chain is critical. Some districts maintained steady deliveries of testing and treatment supplies to the community health workers by using redistribution facilities and prioritizing community-level care. Rotary clubs should advocate for processes that allocate most of these supplies to community systems and let local program leaders manage the inventory.

Clubs that are interested in launching similar programs need to have patience. Build strong partnerships, remain active in the community, and invest in systems that sustain people’s overall health, not just the short-term outputs. Maintaining our impact requires a long-term view and consistent community engagement.

Rotarians and Rotaractors have had significant roles in sustaining and expanding the impact of Partners for a Malaria-Free Zambia well beyond the grant period. Several clubs have received grants — from Rotary and from outside organizations — to continue training and supporting community health workers.

The program’s success also led to an opportunity to capitalize on Rotary’s strategic partnership with the Gates Foundation and World Vision to create the Rotary Healthy Communities Challenge, a new program aimed at preventing and treating disease. It is being implemented from 2024 to 2027 in the Democratic Republic of Congo, Mozambique, Nigeria, and Zambia. The four countries were selected based on their disease levels and health needs, the presence and engagement of Rotary club members, the potential for partnerships, and alignment with national health strategies.

The Rotary Healthy Communities Challenge was designed using what we learned from Partners for a Malaria-Free Zambia, including the importance of government support, community engagement, and strong Rotary leadership. The first Programs of Scale grant recipient not only has achieved positive results in Zambia but also is fostering healthier futures in even more communities.

If you want to learn more about the Rotary Healthy Communities Challenge, write to rhcc@rotary.org.

Although the Programs of Scale grant funding for Partners for a Malaria-Free Zambia has ended, the systems it built remain largely intact. With continued investment in community health workers, support for neighborhood health committees, and expanded engagement within Rotary, communities in Zambia will benefit from the positive outcomes of this program for many years to come.

You can learn more about Programs of Scale grants and the other award recipients at rotary.org/programsofscalegrants. If you have questions, write to programsofscale@rotary.org.