1. How are you actually tracking progress?

Answer:  The logical framework that we designed has a set of outputs that is expected to be undertaken and these activities will help us achieve our outcome. We are benchmarking our planned activities against the outputs. I can confidently state that we have achieved over 80% of target to date, despite the inconveniences we faced due to the covid-19 pandemic. We have employed a Malaria surveillance specialist who is closely monitoring and interpreting the data from the District Health Information System (DHIS2).

2. Why is the level of measurement and tracking results so important to Rotary and the Foundation?

Answer:

• Stewardship of the funds invested: A promise is made to every donor that every $ spent will go where it is intended, will be spent where intended and will produce a full result.  All donors receive a full report on how the funding was used.
• Sustainability: no program or project happens without a full plan of the effect and results for the future.  The impact and effect of the project must be measured and recorded as it happens but also what impact it has on those involved over future years.  We need to be able to go back in 10 years and see the program or project still working and making a difference.
• Program/Grant/Fund development: Program development is based on the data that comes out of previous programs.  The same applies for decisions made on the grant systems/needs and any associated fund development.  Rotary and the Rotary Foundation providers for members and community needs which are based on the data provided by tracking and measuring the results of its programs and projects.

3. And how are you sharing data with your partners who are also committed to the fight to eliminate malaria in Zambia?

Answer: The CHWs have been provided with smartphones that are linked to the MOH DHIS2. This is the information system that all other partners feed into. So, when our CHWs are reporting this information can be accessed by our other partners. But of course, we have our Rotary partners who have no access to this system. We will share this information through our website, the District Magazine and we are available to make presentations to clubs when called upon.

4. One of the goals of Programs of Scale is to lift up lessons learned and advice. For those who are interested in malaria programming in particular, what are you learning through this program that you’d like to share with others?  

Answer: One important learning is how critical it is to have in-country Rotarian experience in combatting malaria along with competent implementing partners and collaborators. Zambian Rotarians have been active in fighting malaria for over a decade, with deep experience in the last three years in training, equipping and sustaining Community Health Workers (CHWs).  World Vision Zambia has been combatting malaria for decades. The Zambian Ministry of Health, led by the National Malaria Elimination Centre (NMEC), has been training CHWs in integrated Community Case Management (iCCM) for nearly a decade. PATH, a Seattle-based Global Health Organization, provided the NMEC with counsel and leadership in developing a state-of-the-art malaria tracking system. While the tasks of training and equipping 2,500 CHWs are well defined (over 17,000 trained in Zambia), successful implementation in the time of Covid requires close coordination of all partners. Our funding partners, led by The Rotary Foundation and the Bill and Melinda Gates Foundation, have guided the development of a rigorous Monitoring, Evaluation and Learning Agenda which has us focused on key outcomes, including the dramatic reduction of severe cases of malaria and deaths. We have also learned how eager Zambian Rotarians are to volunteer and participate in the training, community outreach and results tracking and follow-up.

5. There are also likely participants today who care deeply about disease prevention and treatment and maternal and child health—what are some of the larger lessons that you are learning that are relevant to last mile or last kilometer health delivery and health system strengthening?   

Answer: While the Ministry of Health has developed a relatively strong rural health system, with a focus on malaria prevention, detection and treatment, the training and resources available to the district and rural health facilities is not always adequate. Thus this Program of Scale has built-in programs and funding for health system strengthening including staff training and feedback from the malaria tracking system. The Ministry of Health assured the Partners for a Malaria-Free Zambia (PMFZ) that they would provide adequate supplies of medicines and Rapid Diagnostic Test kits to the CHWs we have trained.  Due to funding shortfalls in 2021 that has not always been the case. Working with the NMEC, the President’s Malaria Initiative and PATH, PMFZ is pushing to rectify this situation.

6. And you have convened an amazing set of partners for this program. That brings so many benefits but multi-stakeholder partnerships are also very complex—what does Rotary bring to the partnership that others cannot? And what are you learning about partnership through this program?  

Answer: Rotary brings in diversity, ideas and as you know Rotarians are people of action and that pulls people to want to be part of this family. The Rotary ideal of service fascinates our partners and obviously, they become interested in experiencing that.

Our Partners have well-established systems that as Rotarians we are tapping from their expertise and experiences.

7. Why are these lessons so important to Rotary? 

Answer:

• Much applies as to what has been answered in the above question.
• Development of partnerships: For Rotary to develop strong funding and active partnerships in what it does, it needs to be able to share the data that proves how it has succeeded in its efforts.  Having the records and data on all its initiatives proves the strength that Rotary has in delivering to the needs of its members and the communities it serves and, authenticates the advantage of partnering with Rotary.
• Reporting back to its Partners and Members: It is critical that Rotary keeps communicating with all players and sharing the story and data with all involved.

8. And, as the name notes, Programs of Scale is for programs that are ready to grow and present an opportunity for future scaling. How is the team thinking about scaling and preparing for future scale through this program?  

Answer:  If Partners for a Malaria-Free Zambia achieves its Program of Scale objectives, there is a strong likelihood that the Bill and Melinda Gates Foundation and World Vision will commit to another large CHW program in Zambia. Given the key role that Rotarians have played in implementing PMFZ, these two funding partners will want the Rotary Foundation to join them. Although on a smaller scale, Malaria Partners International and Malaria Partners Uganda are already collaborating with World Vision and the Bill and Melinda Gates Foundation on Rotary Global Grant application to train Uganda’s equivalent of CHWs. Malaria Partners International continues to have a dialogue with the Bill and Melinda Gates Foundation and World Vision about conducting malaria elimination programs in other Sub-Saharan African countries.

9. In August 2021, there was an amazing announcement that the WHO approved the first vaccine for malaria—what does this mean for your program?

Answer: The news means a lot to us as Partners who are working in collaboration with others to ensure Malaria is eliminated in Zambia. We await guidance from NMEC who offers oversight and technical supervision as well as policy guidance.

They have not yet commenced the use of this vaccine in Zambia, I think from my last interaction was that the matter is with the technical team who are still working on issues of viability and scheduling. But like I said this will be a welcome move as you know 2/3 of deaths due to malaria are of children under the age of 5 and to know that these children can receive a level of protection brings joy to us. What it means for our program is that once implemented, most children will be protected from Malaria, and this will relieve CHWs to now handle cases from over 5. With the CHWs already stationed are a good resource to use for vaccinating these children. Remember we are tracking malaria cases so if the number of people getting sick is reduced, we all win.

10. Is there any negative impact on the project by the deteriorating financial situation of the Zambian Government?

Answer: Yes, we have experienced a negative impact due to the deteriorating financial situation. Prices of commodities went up, and this has affected our budget. We have tried to keep the expenditure within budget by identifying and utilizing cost-effective mechanisms.

11. Do you plan to integrate the concept of effective malaria vaccination, which will probably be available within the near future, into the project?

Answer: Our concentration has been on ICCM at the community level and if this component of vaccination is added to the ICCM agenda we would be happy to take it up.

12. Explain ICCM.

Answer:  Integrated Community Case Management, (ICCM) Integrated Community Case Management (iCCM) is an equity-focused strategy that complements and extends the reach of public health services by providing timely and effective treatment of malaria, pneumonia and diarrhea to populations with limited access to facility-based health care providers, and especially to children under 5. This intervention brings primary health care close to the Community.

13. How much do the CHWs get paid for their work?

Answer: CHWs are volunteers and only get a small allowance during training. They are supported with talk time monthly to enable them to report their monthly activities. They are equipped with Bicycles, Raincoats, gumboots, T-shirts, Caps, Bags, and other enablers to make it easy for them to work in their communities.

14. What happens when there is great need in the community, but the local Rotary is weak?

Answer: The answer is the Community will suffer, but in our case, we have great support from Rotary clubs supporting the programs. In Communities where we have no Rotary club presence, we are supported by a Rotary club nearer to the Community.

15. Martha brings out good points on aspects of Malaria. How do you intend to work with local companies that have biodegradable nets? Do you have plans for future possible partnerships for distribution before the vaccine is implemented? For instance, in Northwestern one cannot even be outside around 17:00 pm due to mosquitos.

Answer: It is an opportunity that we can explore, we need to identify these companies and engage them.

16. Are the CHW trained to screen people with G6PD?

Answer: Community Health workers are trained to test, diagnose and treat, Malaria, diarrhea and simple pneumonia.