Inaugural Programs of Scale Grant Honors Those Leading Malaria Treatment Efforts in Zambia

By building on a proven concept — such as efforts to stamp out malaria in Zambia — Rotary’s new multimillion-dollar Programs of Scale grants help make good better

by Diana Schoberg and Vanessa Glavinskas Illustrations by Gwen Keraval

As part of the polio eradication campaign, Rotary and its partners have trained millions of health care workers and volunteers and vaccinated nearly 3 billion children. Polio cases have dropped 99.9 percent since Rotary took up the cause in 1985, and the number of countries with endemic wild polio has dropped to two: Afghanistan and Pakistan.

“What you’ve done with polio is remarkable,” says Larry Cooley, a well-known international development consultant. “But it shouldn’t be a study of one.”

Rotary is stepping up to that challenge 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.

The concept of Programs of Scale dates back to 2013, when global grants, introduced through The Rotary Foundation’s updated grant model, expanded the scope and size of Rotary projects with the aim of increasing their impact. After a 2016 evaluation of the grant model, the Foundation Trustees requested that a new grant type be developed that would fund “scalable” grant projects in the areas of focus — meaning projects that were planned in a way that allowed them to be expanded, built upon, and further developed.

The Programs of Scale grants are the result: a way to fund large-scale, high-impact projects that can attract partners while tapping into Rotary members’ capacity and enthusiasm. “While global grants and district grants have been very successful, we want to give opportunities for projects with even more impact,” says Foundation Trustee Sangkoo Yun, who was on the Programs of Scale selection committee. “We want to better quantify that impact and share what we learn with all Rotarians engaged in international service.”

So what, in this context, does “scale” mean?

“It’s a simple question with a complicated answer,” says Cooley, who is an expert on the topic. One way to think about it, he says, is that you are looking for a solution that matches the scale of the problem. If you define the problem in local terms, then the scale of the solution is local. If you define it as international, as with polio, then the scale of the solution is international.

“Problems have denominators,” he says. “If somebody said, we helped distribute blankets to 10,000 villagers, I’d say, congratulations, but how many villagers needed blankets? If the answer is that it was 10,000 out of 15,000, I’d say, holy mackerel, that’s great. If it’s 10,000 out of 10 million, I’d say that’s still great, but that’s not the right strategy.”

Clubs can think about scale when-ever they’re developing a project, not only when they are aiming to apply for a Programs of Scale grant. Cooley suggests that rather than focusing on projects, Rotarians focus on problems. “Take on a problem and [don’t] let go until it’s solved, or materially improved, whether at the community or national level,” he says.

When thinking about scaling up, Tusubira notes, you can take a successful project and add new aspects to it to deepen the impact. Or you can expand the project to reach more people, as is the case in Zambia, where Rotarians are building on successful global grants and other programs that funded training for community health workers in other parts of the country. The challenge, he says, is figuring out which are the unique environmental factors that are responsible for the success of a project in order to be sure you are scaling up the right things.

The Foundation received more than 70 proposals from around the world for the first Programs of Scale grant in March 2020. After a rigorous review process, including proposal evaluations, three finalists were recommended.

“I was bowled over by the quality and strength of the applications, and by the expertise and experience of Rotarians on the ground and the connections they have,” says selection committee member Judith Diment. “What I really liked about [the malaria project in Zambia] was the partnerships and the collaboration they had established,” adds Diment, who is also the dean of the Rotary Representative Network and a longtime polio advocacy adviser. “It had many parallels with the polio program.”

Rotary’s success in the polio eradication program provides valuable lessons for clubs — not only those interested in applying for a Programs of Scale grant, but those planning any project.

One lesson, as Diment notes, is about the power of partnerships. The Global Polio Eradication Initiative is one of the most ambitious public-private health partnerships in history. “Collaborating with partners gives you a much bigger opportunity for large-scale change,” she says.

A second lesson is the need for large-scale programs to grow out of Rotarians’ interests. Before polio was adopted by Rotary on a global scale, individual clubs were already tackling the disease through Rotary-funded projects, including a 1979 project to administer oral polio vaccine in the Philippines. Programs of Scale, Tusubira notes, will give Rotary members the chance to come up with ideas they can demonstrate will have a sustainable impact and bring partners to the table.

Another lesson is about deploying Rotary’s power of networks. Rotarians around the world have used their connections — local, national, and international — to draw attention to and garner support for polio eradication.

Cooley, the development consultant, says he’s fascinated by Rotary’s potential to scale up projects. “These are the most prominently placed people in a community, all of whom are trying to do something good,” he says. “Look at Rotary as an asset. There are lots of problems Rotary could make a big difference on.”

The new Programs of Scale grants will give Rotarians a way to do it.

Rotary members expand on a proven concept in Zambia

Bill 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.

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.

Ready to scale up?

If your club is interested in applying for the next Programs of Scale grant, start by asking the following questions:

1. Is your club or district project successful — and is that assessment based on strong evidence?

2. Does it solve a problem for the target population?

3. Is there a clear and logical implementation plan that can be scaled up?

4. Does the implementing partner have the ability and leadership to deliver a larger program over several years?

5. Are all stakeholders committed?

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Have a question?

Send it to programsofscale@rotary.org. Apply or learn more about Programs of Scale grants at rotary.org/programsofscale.

• This story originally appeared in the May 2021 issue of Rotary magazine.

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