Increasing the Impact of Rotary (Partnerships Series No. 9)

This post is the last in a series of nine posts on partnerships, innovation, and evaluation in Rotary. The rationale for the series was my conviction that if Rotary is to have a larger impact globally, it must rely more than has been the case so far on partnerships, innovation, and evaluation (and in some areas advocacy, as has been the case with polio). Seven different projects or investments that have relied on partnerships, were innovative, and were evaluated at least in some way, were showcased. A compilation of the case studies together with a brief introduction is available here. Separate briefs are also available for each of the projects here.

TRF_Centennial_logo_lockup

As I mentioned it in the introduction to the series, partnerships help to implement larger projects and benefit from the expertise of organizations that are among the best in their field. Rotary’s Foundation was created almost 100 years ago (the Centennial is next year) and it has about $1 billion in assets. This is respectable, but in the world of development projects, which is in practice where Rotary is investing most of its funds, this remains small. Without innovation, the contribution of Rotary is an important drop, but still a drop in the development assistance bucket.

By contrast, if Rotary clubs and district innovate, successful pilots can then be scaled up by other organizations with deeper pockets, thereby potentially achieving much larger impact. However, for innovative projects to be recognized as such, proper evaluations are needed. We must be able to demonstrate the impact of pilot projects. Innovation and evaluation are like twins: they work best in pairs. Together, partnerships, innovation, and evaluation are the key to larger impact.

To encourage clubs and districts to think bigger and more strategically, stories of great projects were shared: an innovative financing mechanism for polio eradication; an award winning project fighting malaria and Ebola in Mali; a teacher training program that is transforming teaching and learning in Nepali classrooms; a project on obstetric fistula saving the lives of mothers and children in Nigeria; a program to invest in the writing skills of disadvantaged youth in the United States; a project to improve access to water and sanitation in Uganda; and a global network of Peace Centers and Peace Fellows to help promote peace.

Some of these programs and projects are large. Others are small. Most were implemented through global grants, but one was implemented through a district grant. All these projects have been in one way or another innovative. They have all leveraged partnerships not only to crowd in financial resources, but also – and even more importantly – to build on great expertise. And they have all relied on monitoring and evaluation mechanisms to assess their impact, at least partially.

Putting together great projects requires work. Fundraising is often time consuming in Rotary given the funding model of the Rotary Foundation that requires raising funds from many clubs and districts first before getting a match from the Foundation. Planning, implementing, and in addition evaluating projects also takes time, especially when one tries to do this in a professional way. Finally, in order to be innovative, Rotarians leading projects need to be aware of where the frontier is in their field, and what could be innovative. This also takes some time.

There is nothing wrong with clubs and districts funding and implementing traditional Rotary projects. Most projects will continue to be fairly simple, with funds provided to worthy charitable causes. These projects, as well as the volunteer time often contributed by Rotarians when implementing them, serve an important purpose. The beneficiaries of these projects are better off thanks to them. These projects help communities, and they also benefit Rotary through the goodwill that the projects create.

But if we want to raise the bar and achieve larger impact, we also need to do more innovative projects. Rotary needs to be bolder, more ambitious. It needs to better learn from its projects, both the great and not so great ones, and make sure that lessons learned are shared broadly, well beyond the Rotary family. The launch of the Future Vision model, despite some challenges, was a step in the right direction. As we celebrate the Centennial of the Rotary Foundation next year, let’s make sure that we have the right vision for what Rotary and its Foundation could accomplish in the next 100 years.

Fighting Malaria and Ebola in Mali (Partnerships Series No. 7)

As part of this series of posts on increasing Rotary’s impact through partnerships, innovation, and evaluation, I had to include Muso, a nonprofit that has successfully fought malaria and Ebola in Mali, in part with support from Rotary. As some readers may remember it, I talked about Muso in this blog previously, and this post is based in large part on previous posts. But at the risk of repetition, it is worth emphasizing again that Muso is a great example of an innovative approach that has been evaluated and has the potential of being replicated at scale thanks to partnerships.

Muso2

A Successful Pilot

Muso started in Mali as a project to provide basic care to communities, focusing initially in part on malaria. Two years ago a Harvard/University of California San Francisco study documented a tenfold difference in child mortality rates after the rollout of the Muso model in the program’s catchment area. Muso relies on professionalized community health workers to diagnose illnesses quickly in its catchment area, refer patients to clinics and hospitals as needed, and reduce financial barriers to care for families.

One needs to be careful in inferring causality between the intervention and the reduction in child mortality since the evaluation was based on repeated cross-sectional data as opposed to a randomized control trial. Still, the impact appears to have been major and obtained at relatively low cost. The Muso model was recently recognized as a finalist for two major prizes – the GSK Global Healthcare Innovation Award and the Caplow Children’s Prize.

Support to the Ministry of Health

Some successful pilot interventions in health are implemented without ever being scaled up, so that their benefits for a country’s population as a whole may be limited. This is not the case for Muso. In addition to implementing and evaluating an innovative model, Muso worked closely from the start with the Malian Ministry of Health as well as other partners to explore opportunities to expand the model nationally.

In November last year, based in part on the Muso model, Mali’s Ministry of Health Division of Community Health Systems announced a strategic plan to scale up professionalized community health workers throughout the country. How did this transformation happen? As just mentioned, Muso and other partners have been actively working with the Ministry of Health for seven years. The partnership was launched in 2008. The collaboration has been not only operational, but also scientific, with support from university researchers. Though this partnership, Muso has been able to provide technical assistance to help the Ministry develop a national plan for scaling-up the community health worker model.

Factors contributed to the success of this partnership and to the scaling-up announcement according to Dr. Ari Johnson, the co-founder of Muso, who was interviewed last year. “First, we started the partnership early on. By setting an operational research partnership at the design phase of the project, we were able to ensure that the pilot would focus on the priorities of the Ministry of Health, which meant a focus on child survival and disease-specific targets, including early effective treatment for malaria.”

A second factor for success was the ability to work with other NGOs to test the robustness of the community health worker model in different parts of the country. “The Malian Ministry of Health worked simultaneously with several NGOs on operational research to test community health workers models. This included, but was not limited to Muso with the operational research study in Yirimadjo and Doctors without Borders (Médecins sans Frontières) with another study in Kanbaga. These experiences with multiple partners in several locations provided the Ministry of Health with converging evidence for scaling up paid, professionalized community health workers,” explains Dr. Johnson.

The third factor for success was the support of international organizations. Multilateral and bilateral global health institutions are all trying to strengthen health systems in Africa. In Mali, Dr. Johnson explains that UNICEF and the Global Fund provided important support for the adoption and expansion of the community health workers model by the Ministry of Health.

Finally Dr. Johnson insists that operational research partnerships must be long-term to succeed. “Longitudinal operational research partnerships take time to implement, but over time, they help build relationships between public sector policy makers and hubs of research. These relationships become avenues for translating research into evidence-based policy change at scale.” Dr. Johnson adds that “the long view is critical, and often neglected in global health work. Short-term funding cycles push organizations to move on after a few years and abandon the foundations of a strong partnership. A long term partnership for iterative and ongoing research is crucial to support Ministries in their strategic plans and thereby achieve scale.”

Many questions remain. What should be the health care financing system for community health workers? How can those workers be deployed across both urban and rural areas? How is the supervision of the workers to be worked out? These and other questions will need to be answered. But progress is being made.

Relevance for Ebola

How does all this relate to the Ebola crisis that recently hit West African countries? Apart from their role in preventing and treating malaria as well as other common illnesses, community health workers can be essential in the fight against Ebola. Ebola arrived in Mali through a two-year-old girl who had traveled with her grandmother from Guinea died.  Mali became the sixth West African country with a confirmed Ebola case.

Why are community health workers so important for the fight against Ebola? They are crucial in part because they tend to be trusted members of their communities. They can not only help in providing information about Ebola and promoting appropriate behaviors, but they can also help to trace and monitor those who have been in contact with the virus. This must be done for at least 21 days – the period during which symptoms do not yet emerge, and it must be continued after that period if individuals become sick. In the other countries affected by the virus – including Guinea, Liberia, and Sierra Leone, community health workers already play that vital role.

As Dr, Johnson explained it, “there is huge potential for community health workers to accelerate the effort to stop Ebola across West Africa, by supporting epidemiologic surveillance, contact monitoring, returning traveler monitoring, community engagement, and prevention counseling.”

Conclusion

Muso has piloted an innovative new model of health care delivery that appears to have contributed to reducing child mortality in its area of intervention. The model has also proved valuable in fighting the Ebola epidemics. Rotary provided crucial support to Muso when the NGO was still small and not as well-known as it is today, with fewer resources. Rotarians and Rotaractors have volunteered with Muso in Mali, and others have contributed to making the project better known internationally.

Today, Muso is scaling up, aiming to raise substantial funds to expand its program. It is also launching a rigorous impact evaluation through a randomized controlled trial to measure its effectiveness. While many organizations and individuals have contributed to Muso’s success, especially the Muso team working on the ground, at times taking substantial risks to help the population as was the case during the Ebola epidemics, Rotary and Rotarians have played a small supporting role as well.

Rotary Foundation Basics, Part 3: What’s Great, What Could Be Improved?

by Quentin Wodon

This last post in a series of three on The Rotary Foundation (TRF) looks at what is great about the foundation, and what could probably be improved. TRF support for Rotary projects is first discussed, based on my own perceptions and those of a few fellow Rotarians to whom I talked before writing this post. Ratings received by the foundation as a charity are then briefly reviewed.

TRF Support for Rotary Projects

On the plus side, TRF support for polio has been instrumental in the near eradication of the disease, as mentioned in the previous post in this series. The focus on polio has also helped Rotary in getting a seat at the table with major partners such as the World Health Organization and the Bill and Melinda Gates Foundation. Even more importantly for Rotarians involved in service projects, the matching system whereby TRF co-funds grants is well appreciated. Both district and global grants benefit from TRF support, but I will focus in this post on global grants.

TRF provides up to $200,000 in matching funds for global grants, with the minimum match being $15,000. This is for projects that reach a minimum size of $30,000 in overall cost/funding. The system for global grants has been fundamentally revised in recent years in order to have fewer but larger grants, which should help in ensuring that projects have a bigger impact on the ground and are well managed. Six areas of focus have been selected for the grants, which is also positive to narrow down a bit the scope of what is funded (even if this scope remains fairly broad). The rules of the game for putting together global grants are clear, which also helps.

In terms of potential areas for improvement, the Grants Online System may not be as friendly as it could be, given today’s technology. Several Rotarians mentioned to me that there may also be at times issues with the grant review process. Hopefully reviewers are as objective and qualified as they should be, but this is something that could be assessed. In addition, despite efforts to help Rotarians put together great global grants, more could be done in terms of e-learning resources and other tools to help the membership develop impactful projects beyond the management and processing aspects of grants.

Many global grants are complex and require substantial expertise. It is not always clear that project teams have enough expertise. The system relies largely on volunteer hours to prepare and implement grants. This helps not only for cost savings but also for getting Rotarians’ hands dirty. Personal experiences gained through hands-on work are invaluable, especially when working directly with project beneficiaries. But it may be useful in some cases to rely more on external paid expertise, especially for large grants. In principle Rotarians can get help from Rotarian Action Groups (RAGs) for the design and implementation of projects. These are great resources, but it is not fully clear how active and effective some of the RAGs are.

One area of concern is the ability of TRF to respond to crises, with the most recent case being Ebola in West Africa. There are two issues here. One issue is fundraising. TRF does not seem to have a good system to provide incentives (read matching funds) for individual Rotarians to donate in times of crisis. Many Rotarians donate when a major crisis hits, but they often do so through other organizations because TRF does not have a good system to attract these donations. If TRF could set aside funds to match individual donations by Rotarians for major crises, this could help the foundation raise more funds. It would also help TRF gain in visibility as a humanitarian organization. The other issue is about the allocation of the funds that could be raised. Part of the funds could be allocated to Rotary clubs in affected countries for their projects to respond to crises with some type of fast track approval. Part of the funds could also be transferred to well established national and international NGOs active on the ground in responding to crises. Overall, setting up a stronger crisis response mechanism within TRF could strengthen the Rotary brand while providing much needed rapid support to vulnerable groups in countries affected by major crises.

Finally, more expertise and commitment from TRF is needed for proper monitoring and evaluation of global grants, and for disseminating the results of such evaluations. My perception is that few projects are evaluated in-depth with baseline and endline data collection to assess impact. Impact evaluation can be expensive, so not all projects should be evaluated in that way. But more should be done in this area, including in partnership with some of the NGOs implementing TRF projects. If TRF could fund more innovative projects that would be evaluated seriously, it could have a larger impact because other organizations with more resources could then bring successful TRF pilots to scale.

Ratings for TRF as a Charity

The comments above point to some great features of TRF, but also some potential areas for improvement. One should not forget however that overall TRF is very well rated as a charity. Given that many of the followers of this blog are new, let me repeat here what I mentioned on TRF ratings a few months ago on this blog as well as in another post for Rotary Voices.

In the US, Charity Navigator provides ratings for charities. Three ratings are available for financial performance, accountability and transparency, and a combination of both. Charities can get one to four stars overall. TRF has the highest possible rating (four stars). The yellow dot in the Figure below shows exactly how the foundation is rated – it has a rating of 89.8 out of a maximum of 100 for financial performance, and 97.0 on accountability and transparency, which yields a four stars rating overall.

RI Foundation Graph

For financial performance, Charity Navigator considers seven main indicators: the share of the charity’s budget spent on programs and services, the share spent on administrative expenses, the share spent on fundraising expenses, the fundraising efficiency ratio, the primary revenue growth, the program expenses growth, and the working capital ratio. Details are available on the Charity Navigator website. For accountability and transparency, a total of 17 indicators are used. TRF could have scored even higher except for the fact that its donor privacy policy requires donors to opt out for their basic information not to be (potentially) shared with other charities.

Conclusion

Overall, TRF helps fund great projects on the ground, and it is also well rated as a charity. The reform of the global grants model of the last few years to define areas of focus and implement fewer but larger grants was smart. But as for any other organization, there are also areas where TRF could probably do better, especially in terms of the friendliness of the Grants Online System, the need to ensure that project teams have the expertise they need, the ability to respond to humanitarian crises, and the need to better evaluate the impact of projects that appear especially innovative. What do you think?

Note: This post is part of a series of three on TRF: Part 1, Part 2, Part 3.

Malaria, Ebola, and Saving Lives: Part 3 – Funding and Emergency Response

by Quentin Wodon

The first two posts in this series documented how Muso’s community health workers pilot in Mali helped reduce child mortality and the factors that made it feasible for the Malian Ministry of Health to adopt the model nationally. The relevance of the community health worker model for Ebola was also briefly discussed. This last post explains how Rotary supported Muso and, more importantly right now, how Rotarians and others can help those affected by the Ebola epidemic.

Supplies for the Ebola Response from the Monrovia Rotary Club
Supplies for the Ebola Response from the Monrovia Rotary Club

Two Grants for Muso

While Rotary has not been the only supporter of the Muso pilot, it has played an important role in funding it. Rotary has supported Muso through two so-called global grants thanks to Maria Nelly Pavisich from the Rotary Club of Washington, DC and other Rotarians from many clubs. A first grant of $60,000 was approved when Maria Nelly was with the Rotary Club of Capitol Hill. The focus of that grant was on malaria prevention and treatment. The funds were used to buy high quality insecticide bed nets, and provide diagnosis and treatment for more than 3,500 patients. During the course of this first grant, Muso grew tenfold. With new partnerships among others with the Against Malaria Foundation and CHF Muso achieved universal coverage of its interventions in Yirimadjo.

In March 2014 the Rotary Foundation awarded Muso an additional $151,500 grant to expand its work. The new initiative is called Thrive for Five: Improving Child Health and Survival in Mali. It will benefit 13,500 children over two years. Putting the grant together was not easy, because the Rotary Foundation requires clubs and districts to contribute before matching those contributions. As Maria Nelly explained: “We had to create a global coalition of more than 50 Rotarians from Africa, North America, Europe, and Asia. We all worked together to raise funds and provide expertise. Eight clubs and seven Districts agreed to contribute. It took hundreds of emails, multiple reports, conversations, and presentations to get there. You’ve got to have a firm commitment to reach the goal! I guess it is the humanitarian adrenaline that keeps me going.”

The donations for the $151,500 grant by clubs as well as the district (DDF) and Rotary Foundation (TRF) matching funds are visualized in the Figure below. So far, for the two global grants as well as in other ways, a total of 15 Rotary Clubs in 11 Districts, seven countries, and four continents have supported Muso. While putting these grants together was substantial work, it was all worth it according to Maria Nelly: “When you reach the goal, it feels so good! It is extremely motivating to do this work with a reputable, focused and reliable organization such as Muso. And to hear Yirimadjo survival stories from community health workers… Muso does the hard work on the ground, but as Rotarians we contribute as we can, in this case with funding.”

Funding for Second Muso Grant
Funding for Second Muso Grant

Ebola Response

Today, many Rotarians and others are asking how they can help those affected by the Ebola epidemic, especially in Guinea, Liberia, and Sierra Leone. Funding by individuals and clubs may seem small in comparison to contributions by organizations such as the World Bank ($500 million) or the United States Government (e.g., building hospitals). But while small, these contributions still make a major difference in the life of those who benefit from them.

Many Rotary districts are trying to raise funds. In my district (D-7620), the Disaster Relief Committee will fund personal protection equipment for 18 hospitals and health centers in Liberia in partnership with IMA World Health and the Christian Health Association of Liberia. The fundraising is coordinated by Disaster Aid USA and the Rotary Club of Bonds Meadow Foundation. Beyond support right away, given that the needs for assistance in Ebola-affected countries will be there for quite some time, clubs and districts could also consider global grants, as was done for Muso in Mali.  These grants take a bit of time to prepare, but they can be quite powerful.

Rotarians in affected countries are also engaged, as are many other citizens. For example, the Rotary Club of Monrovia in Liberia has established an Ebola Response Committee. The club initially purchased locally a wide range of items including examination and other gloves, mattresses for patients in treatment facilities, infra-red thermometers, boots for health care workers, and so on. The club also carried out awareness campaigns with the Liberian Nurses Association, and it is has been supporting reintegration of patients into the community. With the Ministry of Health and the NGO ChildFund, it launched the first Interim Care Center for children whose parents were in isolation in treatment centers or had been orphaned by Ebola. Right now, the Monrovia Rotary Club is raising funds to attend to the urgent needs of Ebola victims, their families, and caregivers.

When members of our club spoke to members of the Monrovia club, more than three dozen clubs worldwide had already contacted the Monrovia club to provide assistance. But much more is needed. If you, as a Rotarian or otherwise, can support those responding to the Ebola crisis on the ground in the affected countries, please do.

 

Malaria, Ebola, and Saving Lives: Part 2 – Scaling Up

by Quentin Wodon

Some successful pilot interventions in health are implemented without ever being scaled up, so that their benefits for a country’s population as a whole may be limited. This is not the case for the Muso pilot. In addition to implementing and evaluating an innovative model, Muso worked closely from the start with the Malian Ministry of Health as well as other partners to explore opportunities to expand its model nationally. This second post explains how this was achieved.

Muso2

A Successful Pilot

Recall from the first post in this series that a Harvard/University of California San Francisco study documented a tenfold difference in child mortality rates after the rollout of the Muso model in the program’s catchment area. Muso relied on paid and professionalized community health workers to diagnose illnesses quickly in its catchment area, refer patients to clinics and hospitals as needed, and reduce financial barriers to care for families. One needs to be careful in assigning causality since the evaluation is based on repeated cross-sectional data as opposed to a randomized control trial. Still, the impact appears to have been major and obtained at relatively low cost. The Muso model was recently recognized as a finalist for two major prizes – the GSK Global Healthcare Innovation Award and the Caplow Children’s Prize.

National Expansion: Four Enabling Factors

Last week Mali’s Ministry of Health Division of Community Health Systems announced a five-year strategic plan to scale up professionalized community health workers throughout the country. Just a few years ago Mali’s public health sector had no paid community health workers. Soon, they may be present in every region.

How did this transformation happen? Muso and other partners have been actively working with the Ministry of Health for seven years. The partnership was launched in 2008. The collaboration has been not only operational, but also scientific, with support from university researchers. Though this partnership, Muso has been able to provide technical assistance to help the Ministry develop a national plan for scaling-up the community health worker model.

Four factors contributed to the success of this partnership and to last week’s scaling-up announcement according to Dr. Ari Johnson, the co-founder of Muso. “First, we started the partnership early on. By setting an operational research partnership at the design phase of the project, we were able to ensure that the pilot would focus on the priorities of the Ministry of Health, which meant a focus on child survival and disease-specific targets, including early effective treatment for malaria.”

A second factor for success was the ability to work with other NGOs to test the robustness of the community health worker model in different parts of the country. “The Malian Ministry of Health worked simultaneously with several NGOs on operational research to test community health workers models. This included, but was not limited to Muso with the operational research study in Yirimadjo and Doctors without Borders (Médecins sans Frontières) with another study in Kanbaga. These experiences with multiple partners in several locations provided the Ministry of Health with converging evidence for scaling up paid, professionalized community health workers,” explains Dr. Johnson.

The third factor for success was the support of international organizations. Multilateral and bilateral global health institutions are all trying to strengthen health systems in Africa. In Mali, Dr. Johnson explains that UNICEF and the Global Fund provided important support for the adoption and expansion of the community health workers model by the Ministry of Health.

Finally Dr. Johnson insists that operational research partnerships must be long-term to succeed. “Longitudinal operational research partnerships take time to implement, but over time, they help build relationships between public sector policy makers and hubs of research. These relationships become avenues for translating research into evidence-based policy change at scale.” Dr. Johnson adds that “the long view is critical, and often neglected in global health work. Short-term funding cycles push organizations to move on after a few years and abandon the foundations of a strong partnership. A long term partnership for iterative and ongoing research is crucial to support Ministries in their strategic plans and thereby achieve scale.”

Many questions remain. What should be the health care financing system for community health workers? How can those workers be deployed across both urban and rural areas? How is the supervision of the workers to be worked out? These and other questions will need to be answered. But on the occasion of the launch of the national plan last week, Dr. George Dakono, the National Director of Community Health Systems, noted that “Muso is at the vanguard.” In recognition of the role played by the Muso team, Dr. Dakono invited Muso’s Health Systems Director, Dr. Djoumé Diakité, to present the plan at the Ministry of Health.

Relevance for Ebola

How does all this relate to the Ebola crisis in West Africa? Apart from their role in preventing and treating malaria as well as other common illnesses, community health workers are essential in the fight against Ebola. Last week witnessed the first confirmed case of Ebola in Mali. A two-year-old girl who had traveled with her grandmother from Guinea died. While no other cases of Ebola have been reported to date, many people have been in contact with the girl and more than 40 of those individuals are being monitored. Mali is now the sixth West African country with a confirmed Ebola case.

Why are community health workers so important for the fight against Ebola? They are crucial in part because they tend to be trusted members of their communities. They can not only help in providing information about Ebola and promoting appropriate behaviors, but they can also help to trace and monitor those who have been in contact with the virus. This must be done for at least 21 days – the period during which symptoms do not yet emerge, and it must be continued after that period if individuals become sick. In the other countries affected by the virus – including Guinea, Liberia, and Sierra Leone, community health workers already play that vital role.

As Dr, Johnson explains, “there is huge potential for community health workers to accelerate the effort to stop Ebola across West Africa, by supporting epidemiologic surveillance, contact monitoring, returning traveler monitoring, community engagement, and prevention counseling.”

Malaria, Ebola, and Saving Lives: Part 1 – The Muso Pilot

by Quentin Wodon

Two days ago, Mali launched a national strategic plan to scale up Community Health Workers in every region of the country. This initiative has the potential to save tens of thousands of lives. It could also significantly reduce risks related to Ebola.

This post is part of series of three that tells the remarkable story of how this happened, thanks in part to Rotary-funded Muso, a NGO that has been working closely with the Malian Ministry of Health for several years.

Muso baby

Roll back a few years and meet Djeneba, a young girl living in Yirimadjo in Mali (West Africa), one of the poorest countries in the world. Today she goes to school but her life was once threatened. At the time her family was living on less than a dollar a day. Djeneba started getting high fevers but her parents did not have enough money to pay for care. They tried to break the fever by bathing her in herbal remedies and buying unregulated pharmaceuticals but the fevers persisted and became increasingly severe.

Fortunately Djeneba lived in a community were Muso was being implemented. Families could receive healthcare for free or at very low cost. Sira, one of the community health workers trained by Muso became aware of Djeneba’s situation after one particularly nasty fever, and wrapped Djeneba in wet towels to stabilize her fever. She sent Djeneba by ambulance to a large hospital in the capital city of Bamako where she received comprehensive treatment. During the ambulance ride Djeneba lost consciousness and she was diagnosed with advanced cerebral malaria. During the first 10 days of her stay in the hospital she was in a coma. But after three weeks in the hospital and lifesaving medication she was released happy and healthy.

When Djeneba returned home Sira taught her parents how and when Djeneba should take her medication at home. Everyday Sira visited Djeneba to care for her. Two weeks after her recovery, Sira saw Djeneba with a school backpack entering her house. Sira’s diligence and attention towards Djeneba saved her life and got her back on track in school.

Djeneba’s story is not unique. Half of the world’s population is vulnerable to malaria. Every year, 665,000 people die from malaria episodes. Many are children under five. Muso is on the frontlines of providing timely, proactive health care to poor communities and hard-to-reach populations so that the lives of children like Djeneba can be saved.

“Most children killed from malaria die within 48 hours of the moment they say ‘Mommy I’m sick.’ We already have the tools to avert nearly all deaths from malaria, but they are not reaching the children who need them early enough. Our idea is simple but powerful: if we reach every child early, we could avert nearly all child deaths from malaria. But to reach every child early in the world’s poorest communities is a big challenge. To make this happen, we had to challenge the conventions of traditional health systems. Traditional health systems are reactive. Medical providers like me are expected to wait for patients to come to us. Muso’s health system takes a proactive approach, deploying Community Health Workers to search actively for patients door to door”, says Dr. Ari Johnson, co-founder of Muso.

As explained in a previous post on this blog, Muso works in communities through a four-step approach. The first step consists of mobilizing the existing health care delivery system. This includes selecting, training, employing and supervising local individuals who go door-to-door and identify children sick with malaria and other illnesses. These community health workers diagnose malaria in the household and treat simple cases. The second step consists of removing barriers that prevent people from accessing care when needed. By eliminating point-of-care user fees, Muso ensures that even the poorest can benefit from life-saving comprehensive and universal care, whether at home, in community health centers, or in referral hospitals. The third step consists of creating rapid referral networks by training communities in identifying health risks, prioritizing rapid treatment, and navigating the health system. The final step consists of clinical capacity building. As Muso systematically removes access barriers to achieve universal health coverage, it reinforces the ability of the public sector to provide quality care to its patients.

How do we know that Muso has been successful? A recent study published in the peer- reviewed journal PLoS ONE is very encouraging. The study documents a ten-fold difference in the rate of child mortality in the three years after the launch of Muso. At baseline the rate of child mortality was 15.5 percent. After three years, it dropped to 1.7 percent. During the same period, there was a ten-fold increase in the number of patient home and clinic visits in the catchment area, a doubling of the rate of rapid access to malaria treatment for children in need, and a reduction by one third in the share of children becoming sick with fever.

The Muso team has been interviewed among others by the BBC, ABC News, Reuters, and the New York Times and the project recently received two global awards. First, the 2013 GSK Global Healthcare Innovation Award recognized the project as one of five effective new models for better chances of child survival. In addition the Caplow Children’s Prize named the project one of eight finalists for its global award that also identifies some of the world’s high-impact new models for saving children’s lives.

Part of this story was already told on this blog. But the announcement two days ago of the adoption of a national strategic plan in Mali to scale up Community Health Workers is a major new development that warrants telling this story again in more details. The story continues to have relevance for malaria and child mortality, but it also now has relevance in the context of the Ebola epidemic. The relevance of the Muso model for Ebola and the role that Rotary played in supporting Muso will be discussed next.

Are Youth Less Involved in Community Service Today?

Broadneck

Photo: An Interact Club raises $2,000 for Doctor without Borders with a 5K race

by Quentin Wodon

Twenty years ago Putnam suggested in his Bowling Alone paper that in contrast with earlier times in American history, social capital was eroding in the United States. Putnam suggested several explanations for this perceived decline (which has been much debated since). The movement of women into the labor force may reduce the time they have for investing in social capital and community life. A higher labor mobility may be preventing workers from planting deep enough roots in their communities to nurture civic engagement (the “repotting” hypothesis). Demographic and other transformations may also play a role, including through the rise of supermarkets as opposed to neighborhood stores. And perhaps most importantly, the technological transformation of leisure – at the time Putnam wrote his article, the irruption of television, the VCR, and other technologies, may lead to a privatization and individualization of leisure time and a concurrent drop in civic engagement.

In today’s world, at least in wealthy countries such as the US, many teenagers often carry their cellphone, iPad, or other electronic device almost everywhere they go. The irruption of technology – and the apparent privatization of leisure time, may seem to be stronger than ever, potentially eroding further various forms of social capital, including in terms of service work for communities and the less fortunate.

But is this actually the case? The Bureau of Labor Statistics (BLS) publishes annual statistics on volunteering in the US. In 2013 the overall volunteer rate declined by 1.1 percentage points to 25.4% for the year ending in September – this was the lowest rate since the BLS started to collect the data in 2002 (see the press release here). The rate for teens (16- to 19-year-olds) was slightly higher, at 26.2%, but it was also in decline from 27.4% in 2012. However, the volunteering rate in 2012 was also the highest recorded in the previous six years – for teens, the volunteering rate in 2007 was at 25.5%. More importantly, beyond variations over short periods of time, if one looks at longer term trends, as the Corporation for National and Community Service has done, volunteering rates appear higher today than 30 or 40 years ago.

Volunteering among teens seems to be alive and well, not only in the United States, but also abroad. For example, the youth report of the European Union suggests that the proportion of youth working for civil society organizations and associations has increased slightly over the last decade, mostly thanks to large gains in four countries (Denmark, Germany, Finland and Sweden). One of the potential explanations suggested is that lack of satisfaction with political structures would lead youth to get more involved with community activities and small-scale organizations where they feel they can make more of a difference.

In Rotary, the available data also points to substantial, and possibly more volunteering over time among youth. Interact is the branch of Rotary International for children and youth between 12 and 18 years of age. The first Interact Club was chartered with 23 students from Melbourne High School in Florida in 1962. Today Interact worldwide has more members than Rotaract (the Rotary branch for young professionals).

Exactly how many Interactors (the members of Interact clubs) are involved in clubs is difficult to tell very precisely because Rotary International does not maintain a database of Interactors like it does for members of Rotary clubs. But estimates suggest that there are close to 400,000 Interactors worldwide. This is based on a total of 16,742 clubs (April 2014 data) and an assumption (based on the data available) of an average of 23 members per club. Interact Clubs operate in 151 countries and geographic areas. The estimates – based on club growth – also suggest that the year-on-year growth rate in membership is positive (it was 1.7% from 2013 to 2014).

What do Interactors do in terms of service work? They are involved in all kinds of projects, some of which are featured annually through the Interact video contest. This blog will feature Interact projects – as well as other great service initiatives by youth whether they are involved in Interact or not. Some of those stories will also be published as part of the Interact Today newsletter that you can find on the Interact page of this blog. The first issue of the newsletter featured an interview with then-Rotary International President Ron Burton. But it also featured a nice story about the Broadneck High School Interact Club in Maryland. The club held its first Broadneck without Borders 5 kilometer race a few months ago and raised $2,000 for Doctors without Borders. This is the non-profit organization leading the fight against Ebola in West Africa.

Youth – including Interactors – are doing great service work all around the world. Congratulations to you if you are one of them.