Improving Immunization and Fighting Polio in Pakistan

Polio remains endemic in only two countries: Afghanistan and Pakistan. Apart from polio campaigns, broader support for immunization is essential to eradicate polio. Two weeks ago (on April 21, 2016), the World Bank approved an International Development Association (IDA) credit of $50 million to increase the availability of vaccines for infectious diseases, including polio, for children under two years of age in Pakistan.  Additional funding to the amount of $80 million is provided by a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation also participates through a buy-down mechanism (on what a buy-down amounts to, click here). Below is information on the project reproduced from the World Bank’s website (the original link for the information is here).

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The National Immunization Support Project (NISP) is supporting the country’s Expanded Program on Immunization (EPI) that aims to immunize all children against eight vaccine preventable diseases:  tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type b (Hib), and measles. Strengthening EPI will also support Pakistan’s access to newer vaccines which are either in the process of roll out (pneumococcal vaccine) or under planning (rotavirus vaccine).

The Project is also receiving additional support of $80 million grant from a World Bank administered multi-donor trust fund, Gavi – the Vaccine Alliance, and the United States Agency for International Development. The Bill and Melinda Gates Foundation is also supporting the project through an innovative partial conversion of the IDA credit into a grant upon successful achievement of project objectives.

“Pakistan is grappling with the public health emergency of polio virus transmission. Ensuring strong routine immunization services is the first essential pillar in polio eradication”, says Illango Patchamuthu, World Bank Country Director for Pakistan. “The World Bank and other development partners are working with the Government of Pakistan to strengthen routine immunization services at the critical endgame stage of polio eradication, particularly as Pakistan introduces injectable polio vaccine into its routine schedule”.

The project will incentivize provincial government capacity for rigorous monitoring and effective implementation of its program, including strengthened vaccine logistics, and deploying and expanding qualified technical and managerial personnel.

“Pakistan’s performance in maternal and child health remains weak and inadequate immunization coverage is a major challenge. Childhood immunization against vaccine preventable diseases can help in significant reductions in disability and death”, says Robert Oelrichs, World Bank Task Team Leader of the Project. “The project will establish linkages of the federal and provincial EPI cells with private sector health providers and health-related civil society organizations (CSOs) working in low coverage catchment areas – especially urban slums.”

Children under two years of age in Pakistan are the main beneficiaries of NISP – particularly children belonging to the poorest households in which immunization coverage is lowest. In addition, all children will benefit from strengthened polio and measles interventions.

The credit is financed by IDA, the World Bank’s fund for the poor, with a maturity of 25 years, including a grace period of 5 years.

Evaluation is essential to assess what works and share stronger stories

Readers of this blog know that I have emphasized for some time the need to strengthen a culture of evaluation in Rotary. Evaluations should be undertaken not only for our service projects, but also to assess how our clubs meet, work, and grow – or wither away. This post is about a recent evaluation of an education project supported by my club, and how the evaluation is proving to be useful not only for the local nonprofit we worked with, but also for our club and more generally for practitioners and policy makers working in the field of education.

OWED celebration
Photo of OWEd scholarship winners with Brian Pick, Chief of Teaching and Learning for the District of Columbia Public Schools, and Dave Paris, member of the Board of OWEd.

For several years my club has supported One World Education (OWEd), a great nonprofit based in Washington, DC. OWEd runs the largest argumentative writing program in public and charter schools in the city. The nonprofit reached 5,800 middle and high school students this past school year. The aim of the program, which runs for 4-5 weeks in the schools, is to improve the research, writing, and presentation skills of the students, many of whom are from disadvantaged backgrounds and do not do very well in school.

In previous years, our support to OWEd consisted in providing a bit of funding and volunteering at some of their events. This year, we provided college scholarships for some of the high school students (seniors) who participated in the program and worked especially hard. But we also did more. Together with a team at American University, we designed an evaluation of the program to better measure its impact. For more than 550 students, teachers collected essays written in class before and after the program. The essays were graded by professors and instructors in the Department of Literature at American University. This enabled us to assess whether the program made a difference in the writing skills of middle and high school students.

The evaluation demonstrated that the program has a positive impact. The program generates statistically significant gains in writing quality, especially for students who performed worst on the initial pre-program assignment.  The positive impact of the program was confirmed through data on the perceptions of teachers and students about the program. Two summary briefs about those evaluation results have been written and are now available for public schools and for charter schools separately.

It is clear that this type of evaluation is beneficial for the nonprofits whose programs are evaluated, as the evaluations enable the nonprofits to measure their impact, and take corrective action when needed.  The evaluations are also beneficial for our club in reassuring members that we are investing in worthwhile initiatives.

But there is more. Many others are interested in such evaluations and may learn from them, possibly generating larger impacts beyond the specific programs being evaluated. And these evaluations provide for great stories to be featured in local newspapers or magazines as well as social media, giving more visibility not only to the nonprofits and programs being evaluated, but also to the Rotary clubs that supported those evaluations.

This is what we are focusing on now – making sure that the positive results obtained by OWEd through its program are better known in Washington, DC, and beyond. We are writing short articles that document those results, and some of the stories of the students who benefited from the program.  We have secured already two placements for stories in the local media and we hope to write additional articles for national publications about the results of the evaluation. In addition, we will also prepare technical papers for academic journals. It remains to be seen whether we will be successful, but we now have a stronger story to tell thanks to the evaluation.

Finally, as mentioned, the evaluation has been summarized in two easy-to-read briefs. The two briefs, together with briefs about the work of other nonprofits operating in the field of education and skills for youth in the city, will be included in a small brief series on innovations in education in Washington, DC to be published by the World Bank. We hope that this simple brief series will help attract attention to the nonprofits doing great work in the city, while also helping practitioners and policy makers learn from the experience of successful programs.

In summary, evaluation is essential not only to help improve service projects, whether implemented by Rotary clubs or nonprofits, but also to tell stronger stories about ways to improve the lives of the less fortunate. Investing more in evaluation seems to be a win-win for nonprofits as well as service clubs.  And for Rotary as a whole, as I mentioned it in a previous series of posts on this blog, focusing more on partnerships, innovation, and evaluation seems key to achieve larger impacts.

Rotary’s Family Health Days Featured at the World Bank

Today, in celebration of International Women’s Day, Marion Bunch, the founder of Family Health Days, participated in a well-attended event at the World Bank about inspiring women who made a difference in the world through innovative programs in the areas of education and health. The event was streamed online through World Bank Live, and a recording will soon be available if you missed it. What are family health days? Do these days make sense from a policy point of view? And who is Marion Bunch? This blog post answers these three questions.

Family Health days

What are family health days?

Imagine hundreds of thousands of families and individuals getting free health care for two or three days. Family Health Days makes this feasible. Individuals and families can be tested for HIV/AIDs as well as receive counseling. Testing and/or screening for tuberculosis, diabetes, high blood pressure, and other conditions such as cervical and breast cancer is provided. Children receive immunizations as well as Vitamin A supplements. Some sites also include dental clinic and hygiene education as well as eye examinations. Health counseling is also provided.

The program was launched in 2011 and is now active in a half dozen countries in sub-Saharan Africa and South Asia. The program is led by Rotary in partnership with the Coca-Cola Africa Foundation, the U.S. Mission – including the Centers for Disease Control, USAID and the health service delivery expertise of their implementing partners – and Ministries of Health that provide services and supplies at the sites. Media partners promote the days in each of the countries. Thousands of volunteers in each country, including many Rotarians, help in various ways.

Do family or child health days make sense from a policy point of view?

Intrigued by the concept of family health days, I conducted a rapid search of the literature and found that for purposes such as screening for illnesses and child immunization, holding such days appears to make a lot of sense. This type of programs appear to be beneficial and cost effective if implemented well.

For example, Fiedler and Chuko looked at the reach and cost of child health days in Ethiopia in 2008. They found that the program reached more than 10 million children at an average cost of half a dollar per child (one dollar when including measles). This made the program cost-effective, with potential additional benefits to be reaped through economies of scope in increasing coverage at delivery sites.

Palmer and others note in a 2010 article that child health days are becoming increasingly popular, implemented in more than 50 countries at the time of the study. They conclude that the days are helping countries achieve high and equitable coverage of essential health and nutrition services. Child health days were also recognized as beneficial in a 2013 World Health Organization report on essential nutrition actions for improving maternal, newborn, infant, and young child health and nutrition.

Improvements could be made, however. In a 2012 review of experiences integrating the delivery of maternal and child health services with childhood immunization programs, Wallace, Ryman, and Dietz emphasize the importance of proper planning and awareness when implementing these interventions, among other actions to reduce the risks of logistical difficulties, time-intensive interventions ill-suited for campaign delivery, concerns about harming existing services, and overlap of target age groups with other service delivery mechanisms. The review also revealed gaps in information about costs and impacts.

On costs, a 2014 paper by Fiedler and Semakula suggests that part of the reason why costs may appear so low in some countries (US$0.22 per child in their analysis for Uganda) is because of underpayment for Ministry of Health staff and volunteer allowances. Still, the authors find that child health days are successful in saving lives, making them highly cost-effective. Vijayaraghavan and others in a case study for Somalia also find child health days to be cost-effective in addressing leading causes of child mortality in a conflict settings. They rate child health days as one of health sector’s best buys in sub-Saharan Africa.

Who is Marion Bunch?

What is also interesting – especially as we celebrate International Women’s Day and the power of women to make a difference in the life of the less fortunate, is the personal story of Marion Bunch. Marion is the Chief Executive Officer of the Rotarian Action Group Rotarians for Family Health & AIDS Prevention. She has received numerous awards on behalf of her work for AIDS. But first and foremost, she simply considers herself a mother who helps in representing the human face of AIDS. She started her work after losing her son to the disease in 1994. As she explained it in an interview. “I never thought I’d do anything about it until one day, three years after his death, I felt a tap on the shoulder, and a voice in my ear said, ‘Mom, get up and get going; you haven’t done anything, and it’s been three years.’” Since then, the reach of Family Health days has expanded every year, in close partnership with Ministries of Health in the countries where the program is running. Marion’s story has been told in a documentary film that won two 2015 Telly Awards.

What can be learned from Marion’s project?

On the occasion of International Women’s Day, at least two important lessons emerge her project. The first lesson is that we can expand access to health care for children and families through Child and Family health Days, and we should invest in the expansion of these programs. But the second and most important lesson is that beyond the important role of the state that we often emphasize in development work, committed individuals can truly make a difference in the life of the less fortunate. The theme of the event at the World Bank was “Inspiring Women of Action”. There is no doubt that Marion is such a woman.

If you were not able to watch the event live, a recording will soon be made available here.

This post is adapted from a post published today on the World Bank’s Investing in Health blog.

World Bank Live To Feature Rotarian Women of Action

 

On March 8, in celebration of International Women’s Day, World Bank Live will feature a discussion with inspiring Rotarians who have made a difference in the world. Hosted and sponsored by the World Bank Group Staff Association, the session will illustrate the power of women to change the world and improve the lives of the less fortunate through innovative and impactful projects in the areas of education and health.

The event will take place from 2 PM to 3 PM in the World Bank Preston Auditorium in Washington DC. The event will also be streamed online, so you can watch from wherever you are. Please do not hesitate to share this blog post with friends and other Rotarians who might be interested in this event, and maybe even ask you Club or District leaders to spread the word. This promises to be a great event.

iwd

What Is World Bank Live and How Do I Connect?

The World Bank Group aims to eradicate extreme poverty within a generation by 2030. It consists of five organizations: (1) the International Bank for Reconstruction and Development which lends to governments of middle-income and creditworthy low-income countries; (2) the International Development Association which provides interest-free loans and grants to governments of the poorest countries; (3) the International Finance Corporation which finances investment, mobilizes capital in international financial markets, and provides advisory services to businesses and governments; (4) the Multilateral Investment Guarantee Agency which offers political risk insurance (guarantees) to investors and lenders; and finally (5) the International Centre for Settlement of Investment Disputes which provides international facilities for conciliation and arbitration of investment disputes.

World Bank Live is the web streaming platform used by the World Bank Group to enable citizens worldwide to participate in high level events online. The platform enables viewers not only to follow the event, but also to post comments online as part of an interactive discussion. In order to connect to the March 8 event “Inspiring Women of Action: A Celebration of International Women’s Day”, simply click here.

Who Will Be the Speakers?

Three speakers will be featured.

Marion jennifer deepa

 

 

 

Marion Bunch is the Chief Executive Officer of the Rotarian Action Group Rotarians for Family Health & AIDS Prevention. Marion has received numerous awards on behalf of her work for AIDS, and considers herself a mother who represents the face of AIDS because she started her work after losing her son to the disease in 1994. One of her signature programs has been the organization of Family Health Days in several developing countries where families receive free consultations and health care.

Jennifer Jones is the President and CEO of Media Street Productions Inc., a television production company. She is also a Director on Rotary International’s global board. Through Rotary, she has successfully transferred her professional skills into her volunteer life including several Rotary missions where she has created documentaries and taught journalism and ethics classes in Brazil, Tanzania and Haiti. She has also participated in Rotaplast medical missions in Venezuela and Peru.

Deepa Willingham is also a Rotarian and the Founder and Chair of Promise of Assurance to Children Everywhere (PACE). Born and raised in India, Deepa worked in the United States, and then returned to India. PACE Universal is an organization dedicated nurturing the educational, health, nutritional, social and cultural development of girls in impoverished areas of India and other parts of the world.

The panelists will be introduced by Daniel Sellen, the Chair of the World Bank Group Staff Association. Daniel has been in the World Bank for twenty years, the last twelve of which based in Delhi, Abidjan, and Bogotá. He is the proud father of two daughters, who give him extra reason to celebrate International Women’s Day.

The event is organized by a team led by Eva Ruby de Leon, Christian Bergara, and Clara Montanez.

May I Attend the Event in Person if I Live near Washington, DC?

If you are watching the event online, no registration is needed.

If you would like to attend in person, limited seating is available. To attend in person, unless you are a World Bank staff, spouse, or retiree, you need to register ahead of time so that a security pass can be prepared for you. To register for the event in person, please click here.

We hope many of you will be able to attend in person if you are in the area, or watch the event online. Please don’t hesitate to send me an email through the Contact Me page of this blog if you have any question.

Evaluation of Rotary’s 2016 World Peace Conference

Promoting peace is one of six areas of focus of the Rotary Foundation. In January 2016 Rotary International held a “World Peace Conference” in Ontario, California. This post summarizes the main results of an evaluation of the conference from the point of view of participants (a paper with more detailed results is available here). The conference appears to have been successful, in terms of both the satisfaction of participants and the promotion of work on peace and conflict prevention/resolution in Rotary.

Peace conference

The World Peace Conference was one of five flagship conferences organized by Rotary in 2015-16. The other conferences are on disease prevention and treatment in Cannes, economic development in Cape Town, literacy and WASH (water, sanitation, hygiene) in schools in Kolkata, and WASH in schools near Manila.

The evaluation is based on a survey administered shortly after the conference. A single email was sent to participants to invite them to provide feedback on the conference. The web link was kept open for a week. Some 211 participants provide feedback. Nine in ten participants at the conference were members of the Rotary family, and most were Rotarians as opposed to Rotaractors and Interactors. The quality of the conference tracks and plenary sessions was deemed high. The conference was considered better than previous Rotary conference attended by participants.

Most respondents rated the various aspects of the conference highly. Slightly lower marks were however reported for the quality of the food, the cost of the conference (often an issue for district conferences as well), publicity prior to the conference, and entertainment.

Open ended questions were asked about what participants liked best and least. The quality of speakers came up as the best feature of the conference, with especially high marks for Fr. Boyle, Dr. Wollschlaeger, and Claes Nobel. The possibility for participants to choose among many different tracks and sessions was also mentioned.

As to areas for improvement, a few plenary speakers were rated poorly, as is often the case with multiple plenaries. The House of Friendship did not get high marks. Some thought that the conference was too packed. A few respondents suggested that the Peace concert was too long, and that the quality of the food could have been higher. Technical difficulties, such as a late start for some sessions, were also mentioned.

Questions were also asked about the types of speakers and sessions that participants would like to see more of, or less of in future conferences. Participants would like to see more sessions on the specific topic of the conference, whether this relates to information and debates on peace/conflict in general, information and debates on Rotary’s role in peace/conflict, or sessions on successful Rotary projects. In terms of the types of speakers to invite, there is a desire in such conferences to have more academic/research speakers, motivational speakers, and government/public sector speakers especially at the international level.

Finally, questions were asked about whether participants are engaged in peace related work currently and whether attending the conference is likely to lead them to be more engaged in such work in the future. About half of participants stated being engaged in Rotary or other volunteer work related to peace, and for one in five peace or conflict prevention/resolution are topics on which they are engaged at work and in a volunteer capacity. For a third of participants, peace/conflict work is not something they are currently working on.

Almost one in two participants stated that due in part to the conference they would be likely to be working much more on those topics in the future, and for a third, they would be likely to work a little more on those issues. Many participants are also considering in part thanks to the conference implementing Rotary peace projects or incorporating peace in their Rotary work in the future. A third stated they would definitely do so. Finally about two thirds of participants did not donate to Rotary in the past for peace related work, but half would now consider doing so, some definitely.

Responses suggest however that some of the projects participants would like to work on may not be specifically focused on peace or conflict as traditionally defined (the approach at the conference in terms of what constitutes peace/conflict related work was also fairly broad). It may also be the case that after a conference enthusiasm is high to be active in the area, while the ability to actually do so in the future may be more limited.

Still, overall the conference seems to have had a positive impact on the desire of participants to be more engaged in peace and conflict related work in the future.

To access the paper with the more detailed results of the evaluation, please click here.

Open Access World Bank Publications on Education (Resources Series No. 5)

Getting a good education is one of the best ways to escape poverty in the developing world. This post, the fifth in a series on open access World Bank publications, provides easy access to a selection of 50 books and reports published since 2010 by the World Bank on education and (to a lower extent) on WASH in schools. The publications were compiled as a resource for participants at the 2016 Rotary International Presidential Conferences on literacy and WASH in schools in Kolkata, India, and on WASH in schools in Pasay near Manila, Philippines. The list of publications is available here.

KolkataManilla

Rotary International has long recognized the importance of basic literacy and education, as well as WASH (water, sanitation, and hygiene). These areas have been recognized as two of the six areas of focus of the Rotary Foundation. Many clubs and districts around the world are implementing projects in those areas.

How can clubs and districts contribute to efforts towards literacy and education, including through WASH in schools? These are the questions that will be discussed at the Kolkata and Pasay Conferences. The conferences are part of five flagship conferences organized by Rotary International in 2015-16. The other conferences are on peace and conflict resolution in Ontario (California), disease prevention and treatment in Cannes, and economic development in Cape Town.

The compilation of recent World Bank publications on education made available here is provided as a service to Rotarians and others working on those areas without any endorsement of the World Bank as to which publications should be featured. Access is provided through the World Bank’s Open Knowledge Repository. In order to keep the list manageable, the focus is on books and reports published since 2010 as opposed to other publications. Only publications from the World Bank are listed simply because covering (many) other organizations would be a rather complex task. At the same time, focusing on World Bank has the advantage of being able to go global with a single organization.

The hope is that the publications listed, and more generally the World Bank’s open access knowledge resources, will be useful to conference participants and others working on education and WASH in schools.

 

Open Access World Bank Publications on Entrepreneurship, Jobs, and Skills (Resources Series No. 4)

Entrepreneurship, jobs, and skills are fundamental for poverty reduction and development. This post, the fourth in a series on open access World Bank publications, provides easy access to a selection of 50 books and reports published since 2010 by the World Bank on entrepreneurship, jobs, and skills. The publications were compiled as a resource for participants at the 2016 Rotary Presidential Conference on Economic Development in Cape Town, South Africa. The list of publications is available here.

Cape Town

Rotary International has long recognized the importance of growing local economies and more generally economic development. This area has been recognized as one of six areas of focus of the Rotary Foundation. Many clubs and districts around the world are implementing projects promoting economic development, and these projects often focus on skills, jobs, and entrepreneurship.

How can clubs and districts contribute to efforts to grow local economies? These are some of the questions that will be discussed at the Cape Town Conference. The conference is one of five flagship conferences organized by Rotary International in 2015-16. The other conferences are on peace and conflict resolution in Ontario (California), disease prevention and treatment in Cannes, literacy and WASH (water, sanitation, hygiene) in schools in Kolkata, and WASH in schools in Manila.

The compilation of recent World Bank publications on entrepreneurship, jobs, and skills made available here is provided as a service to Rotarians and others working on those areas without any endorsement of the World Bank as to which publications should be featured. Access is provided through the World Bank’s Open Knowledge Repository. In order to keep the list manageable, the focus is on books and reports published since 2010 as opposed to other publications. Only publications from the World Bank are listed simply because covering (many) other organizations would be a rather complex task. At the same time, focusing on World Bank has the advantage of being able to go global with a single organization.

The hope is that the publications listed, and more generally the World Bank’s open access knowledge resources, will be useful to conference participants and others working on economic development and jobs.

Open Access World Bank Publications on Health, Nutrition, and Population (Resources Series No. 3)

Good health is fundamental for development. This post, the third in a series on open access World Bank publications, provides easy access to a selection of more than 50 books and reports published since 2010 by the World Bank on health, nutrition, and population. The publications were compiled as a resource for participants at the 2016 Rotary Presidential Conference on Disease Prevention and Treatment in Cannes, France. The list of publications is available here.

Cannes

Rotary International has long recognized the importance of health. PolioPlus, the first global campaign aiming to eradicate polio through mass vaccination of children, was launched in 1985 by Rotary. In 1988 Rotary became a spearheading partner in the Global Polio Eradication Initiative (GPEI), a public-private partnership in which the Bill and Melinda Gates Foundation, UNICEF, the U.S. Centers for Disease Control and Prevention, the World Health Organization, and a number of national governments are also engaged and contributing.

In addition, disease prevention and treatment, and saving the lives of mothers and children, are two of the six areas of focus of the Rotary Foundation with large funding commitments, and many Rotary clubs and districts around the world implementing projects.

How can clubs and districts contribute to efforts to improve health, nutrition, and population outcomes worldwide? These are some of the questions that will be discussed at the Cannes conference, one of five flagship conferences organized by Rotary International in 2015-16. The other conferences are on peace and conflict resolution in California, economic development in Cape Town, literacy and WASH (water, sanitation, hygiene) in schools in Kolkata, and WASH in schools in Manila.

The compilation of recent World Bank publications on health, nutrition, and population made available here is provided as a service to Rotarians and others working on those areas without any endorsement of the World Bank as to which publications should be featured. Access is provided through the World Bank’s Open Knowledge Repository. In order to keep the list manageable, the focus is on books and reports published since 2010 as opposed to other publications.  Only publications from the World Bank are listed simply because covering (many) other organizations would be a rather complex task. At the same time, focusing on World Bank has the advantage of being able to go global with a single organization.

The hope is that the publications listed, and more generally the World Bank’s open access knowledge resources, will be useful to conference participants and others working on health, nutrition, and population.

 

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.

Trying a Different Type of District Conference: Does It Work?

by Quentin Wodon

For the past four years, I have conducted evaluations of our district 7620 conferences using surveys administered through the web. This year our conference was different. It was shorter than previous conferences and cheaper to attend. It included on the first day several opportunities to participate in community service projects with local NGOs. It had substantially higher attendance (425 registrations) than previous conferences. It focused largely on fun and fellowship, with only a few sessions on Rotary matters. And it involved multiple locations with transportation provided from one location to the other. Because the conference was located in an area with several Rotary clubs nearby, many participants were also able to attend without having to book a hotel night.

Did the new format of the conference work? A total of 155 participants responded to the evaluation survey, which makes the results reliable. Overall, the conference was clearly a success. As shown in Figure 1, almost half of participants rated the conference as better than previous conferences. This is slightly below the result for last year at 60 percent, but still impressive given that for the previous two years (2012 and 2013) most respondents rated the conferences on par with previous conferences. We are getting better at organizing these events!

One Pager District Conference 2015_Page_1

Figure 2 provides data on satisfaction rates with the facilities and various aspects of the conference. The number of respondents for each question and ratings are provided. The ratings look good with most respondents rating most aspects of the conference as very good or good. Fewer responses are provided for hotel rooms because as mentioned many participants did not need to book a room, which is a good thing to keep costs down. The organization of the conference and the opportunities for fellowship were well rated. The categories on learning about Rotary and meeting with the district leadership were less well rated, probably in part because few sessions at the conference focused on Rotary business and training, but even in past conferences, these ratings have not been high either. Importantly, the cost of the conference was much better rated than in previous years – the conference was affordable!

One Pager District Conference 2015_Page_2

Some 25 different sessions were individually rated with at least nine respondents per session (this is a minimum number of respondents to ensure some reliability in the assessment). Six of the 25 sessions got 75 percent or more “very good” ratings: two of the service project sessions, the high school 4-way speech contest, the Interact session, the Saturday evening dinner with Dean Rohrs as speaker, and the subsequent Rock Tenor music performance. In other words, service projects, interactions with youth, and the Saturday capstone events stole the show in terms of approval ratings. Another nine sessions got between 60 percent and 75 percent “very good” ratings.

What could still be improved in future years? When asked what types of sessions they would like to see more off, sessions on successful projects and debates/discussions on Rotary and its future were mentioned the most. There were few of these sessions this year, and we should probably have more next year. In terms of speakers, participants would like more motivational and entertaining speakers. Participants would like the conference to remain short at two days. As to whether it is better to have one or more districts present at the conference, the feedback was split between the two options. All of those results were similar in previous years.

To sum up, attendance at the conference was high and most participants were highly satisfied with the event. The conference was affordable and fun to attend. At the same time, a number of areas for improvements were identified. Many of these recommendations are not new: they had already emerged from the evaluation of the past three conferences. The good news is that we seem to be getting better at organizing these events, and now at making sure that they are affordable for more Rotarians to participate.