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Project Title: Zambian Nurses Saving Lives.
Project Saving Children from Rheumatic Heart Disease through Nurses Saving Lives and Building Stronger Communities in the Kanyama Level 1 Hospital catchment area, Lusaka Province, Zambia.
Why is this project important: Strep infections are endemic and when untreated, undertreated, or incorrectly treated the body can respond with an autoimmune response causing irreversible cardiac valve damage resulting in life-long heart failure and early death. The genetics of sub-Saharan Africa includes a faster and bigger autoimmune response in children ages 5 to 15 years.
Purpose and Justification: This project will strengthen early detection, treatment, referral, and community prevention of Streptococcus pyogenes infections, acute rheumatic fever, rheumatic heart disease, and pediatric heart failure in an underserved, high-volume primary care setting. The project responds to documented gaps in provider knowledge, limited access to pediatric cardiology expertise, heavy outpatient demand, and the late presentation of children with preventable rheumatic heart disease.
Disease Prevalence in Zambia: The actual prevalence of Strep infections, and ARF are truly unknown due to lack of clinical diagnostic skills and community awareness. However, in 2018 RHD research completed on school age children in Luska revealed up to 10% of the children had some cardiac valve disease and 1% had severe RHD. That equates to about 1000 children in Kanyama District with severe life-limiting disease and profound heart failure...who are currently undiagnosed.
Project Objectives: The project will train a focused group of nurses, clinical officers to gain the skills, knowledge, and tools to assess, diagnose, and treat the full scope of RHD. Community health workers, teachers, and local pharmacists to recognize potential strep throat, acute rheumatic fever, rheumatic heart disease, and heart failure; use practical clinical and educational tools; improve referral readiness; and deliver consistent prevention messages to families and the wider community.
Scope of Work: The project includes pre-implementation stakeholder coordination; training of a small core Zambian implementation team; delivery of the Nurses Saving Lives conference for selected health center and health post nurses and clinical officers; delivery of the Building Stronger Communities seminar for community health workers, teachers, and pharmacists; distribution and use of stethoscopes, otoscopes, manuals, clinical diagnostic tools, and flip charts; post conference 8-week virtual mentorship for providers; a post-training stakeholder review; and follow-up mentorship or facility visits to assess translation of training into practice.
Project Model: This project uses a novel two-tiered train-the-trainer model that has been validated in the Rwandan Nurses Saving Lives (2024-2026) Global grant. This model decreases the in-country time of the VTT, improves ownership and sustainability, and increases the continued education at the district level. The first tier the VTT trains the selected people (8-10) to become the National Training Team (NTT). The NTT is responsible for the training conference content, data management, stakeholder engagement, and sustainability. The second tier is the training of district hospital nurses as certified conference presenters (CCP). These nurses will assist in conference presentations, skills training, peer-to-peer nurse mentorships, and building referral relationships.
Two unique conferences-
ZNSL: The Nurses and clinical officers are provided knowledge and skills through a 3-day highly interactive educational process to assess, diagnose, and treat Streptococcus pyogenes infections, acute rheumatic fever, rheumatic heart disease, and pediatric heart failure. To increase education retention, this conference is followed by an 8-week unique WhatsApp virtual mentorship.
Building Stronger Communities: Whereas the community training is for teachers, pharmacists, and community health workers to recognize symptoms and encourage evaluation by a ZNSL trained provider.
Primary Beneficiaries: Direct beneficiaries include selected nurses and clinical officers serving health centers and health posts in the Kanyama Level 1 Hospital catchment area, along with community health workers, teachers, and pharmacists who influence family decision-making and community awareness. Indirect beneficiaries include children with sore throat, skin infections, acute rheumatic fever, rheumatic heart disease, or heart failure; their families; local schools; health facilities; and the broader Kanyama community.
Key Deliverables: Project deliverables will include a stakeholder launch meeting, a trained core implementation team, completed Nurses Saving Lives and Building Stronger Communities training sessions, participant manuals and translated educational flip charts, clinical diagnostic tool orientation, basic clinical equipment for participants as budgeted, pre- and post-training knowledge or skills assessments, an after-action stakeholder meeting, and a follow-up plan led locally by Beat RHD Zambia, the host Rotary partners, and clinical stakeholders.
Project Boundaries: This scope is limited to a single-site vocational training team project centered on Kanyama Level 1 Hospital and its catchment health centers, health posts, schools, and community partners. The project does not include cardiac surgery, long-term direct clinical service delivery by Rotary, construction, broad national rollout, or replacement of Ministry of Health responsibilities. Future expansion may be considered after the project is evaluated and local partners determine readiness, resources, and alignment with national RHD priorities.
Timeline: The in-country implementation is expected to occur over approximately 4-6 weeks, including stakeholder engagement, a six-day NTT train-the-trainer component, 4-day CCP training; two 2-day Nurses Saving Lives conferences, and 2-4 half-day Building Stronger Communities seminars, and after-action meetings. Follow-up mentorship, facility visits, newsletter communication, or refresher activities may continue after the training period as determined by local partners. The Zambian team will them independently implement 3 additional cohorts of ZNSL and BSC over the course of 16 months.
Roles and Responsibilities: The vocational training team will provide technical training, instructional materials, facilitation, and implementation support. Beat RHD Zambia, Zambian cardiology leaders, the host Rotary club, and Ministry of Health stakeholders will support local coordination, participant identification, contextual validation, translation needs, follow-up, and sustainability planning. Health facility leaders and community representatives will support participant release, local adoption of tools, and ongoing community education.
Conference Materials: This VTT was required to build all of the training materials as this project is the first of it kind to include strep infections, and ARF in an RHD program. These materials were built for a 3 year period using over 120 peer reviewed journal articles, chapters, and websites. The graphic art was built to support sub-Saharan Africa. All members of the NTT and CCPs will have both printed and electronic versions of the manuals, PowerPoint, posters, educational flip charts, and questionnaires. This expanded access allows further dissemination and sustainability.
Assumptions and Constraints: The project assumes continued support from local health authorities and participating facilities, availability of selected participants for training, acceptance of the clinical and educational tools, and coordination among Rotary, Beat RHD Zambia, National Heart Hospital clinicians, and Ministry of Health stakeholders. Constraints include limited physician availability, high patient volumes, equipment shortages, travel and training costs, need for local validation of some assessment details, and the need to align clinical practice changes with national policies and referral pathways.
Success Measures: Success will be measured by completion of planned trainings, number and type of participants trained, improvement in pre- and post-training knowledge and skills assessments, demonstrated use of the clinical diagnostic tool and educational flip charts, participant confidence in recognizing and referring suspected ARF/RHD/HF cases, evidence of community education activities, and follow-up observations showing sustained use of training content in health facilities and community settings.
Sustainability:
1.Encourage local ownership: Local ownership started with building trust relationships between the two Rotary clubs. The Nkwazi club's technical team with Beat RHD-Zambia and the National Heart Hospital began the work of sharing the manuals, PowerPoints, educational flip charts, and posters for review and modification to fit the Zambian culture. The Nkwazi club has received DDF to support the funding. Together we are developing activities for the Rotaract club to develop to enhance the educational activities in schools and community.
2.Sustainability of the project in Kanyama District is a primary aspect currently with the discussion of stakeholders, future Rotary Global grants for additional cohorts, the continued use of KoBo toolkit for data collections, the future development of an RHD registry and improved paths of referrals. Engagement, inspiration, and communication is being developed through shared project PowerPoints for Rotarians, bimonthly discussions, and email threads brainstorming creative ideas.
3.Start with the community: Kanyama community is an excellent community to launch NSL because it is in Lusaka making travel easy. It is the densely populated (increased TB) with poor infrastructure and high disease prevalence. The geographic area is prone to flooding which created past cholera out breaks. These health issues provide a need for community involvement and work with the MOH. This past history allows a path for another disease prevention project to be accepted. Kanyama District was wisely chosen by the Nkwazi club technical team.
4.Provide training: Build local skills: This project is built to grow community ownership and involvement through the training of nurses in the Nurses Saving Lives conference and post conference mentorship and teachers, pharmacists, and community health workers in the Building Stronger Communities conference. It takes all key community people to work together to recognize children with sore throats, skin infections, the bizarre symptoms of ARF, or the symptoms of heart failure. Teaching in a group decreases silos and opens communications to help refer children in need.
5.Buy local: All printing (manuals, flip charts, conference bags, t-shirts, posters and publicity signs) are purchased locally. Stethoscope are currently anticipated to be purchased in the US and hand carried (per Zambian team request). The otoscope provided will be the ArcLight solar-powered scope. It is will directly shipped to the MOH by St. Andrews of the UK.
6.Find local funding: Nkwazi club has DDF. The development of Stakeholders has started. World Vision-Zambia will be included.
BUDGET: Budget for a 16-18 month project: July 2027 with VTT training of the national training Team, the Certified Conference Presenters, 2 cohorts of Nurses/Clinical Officers (72 total); 2 cohorts of community professionals-the Building Stronger Communities. Plys 3 cohorts each to be completed in the following 16 months with the VTT virtually present. Note: Budget recalculated in Aug 2026 and reflects a 15% increase due to exchange rate.
2027 Project Budget for 2 T-t-T and 5 Cohorts
Expenditures Amount USD
Equipment/Materials = $860 USD
Funds for Zambian Participants travel-food-stay (required by Zambia)
NTT to train CCP = $1052 USD
NTT/CCP to train Nurses = $1105 USD
Nurses to attend x 3 days= $1420 USD
BSC CHW to attend x 1 day= $265 USD
BSC Teachers x1 day = $395
BSC Pharmacists x 1 day= $132
Total = $14,637 USD
Project management/supervision/administration- required by the Zambian MOH. Payment to non VVT facilitators x 25 days (NTT -6 days, CCP -4 days, NSL x15 days) =$2075 USD
NTT training (10 NTT x 6 days)
Conference + training manuals/flip charts/posters + stethoscopes/otoscopes + supplies + backpacks = $4850 USD
CCP training (6-8 District Hospital nurses x 4 days)
Conference + training manuals/flip charts/posters + stethoscopes/otoscopes + supplies + backpacks = $3444 USD
Nurses Cohort (36 nurses x 3 days)
Conference + training manuals/flip charts/posters + stethoscopes/otoscopes + supplies (including T-shirt) = $11,470 USD/ NSL cohort X 5 cohorts= 57,350 USD
Building Stronger Communities: cohort (40 participants) x ½ day
Conference + manual +poster + role specific flip chart + supplies $5300 USD/ BSC cohort X 5 cohorts= 26,500 USD
Zambian Partners Stakeholder's meeting $525 USD/meeting X2 meeting= $1050 USD
Publicity and Signage = $2000 USD
Conference bags, branded with logos (#370 bags)= $5840 USD
Monitor & data
CCP onsite mentorships $475/cohort x 5 cohorts= $2375 USD
CCP data collection $315/cohorts x5 cohorts = $1580 USD
Nurse clinical data collections $947/cohort x 5 = $4735 USD
KoBo Toolbox kit education $49/person x4 = $98 USD
Travel: VTT (3 people) airfare $9000 USD hotel x 45 days 13,500 USD; food x 45 day $4000
Zambian ground transport x 45 days $5400 USD (per Zambian team)
Total VTT=$31,950 USD
PROJECT TOTAL $159,540
Club Member Involvement:
International club- Lander Rotary club, Lander Wyoming USA: This project originated in the Lander Rotary club through the passion and expertise of Dr. Maria Kidner, cardiac nurse practitioner. The materials development is led through the Lander club's VTT members. In addition, project design, building the interactive presentations, outcome management, graphic artwork, fund raising, securing stethoscopes and otoscopes, and building relationships are primary functions of the international club.
Host club- Nkwazi club of Lusaka, Lusaka, Zambia: The host club is responsible for securing a printing requirements (manuals, educational flip charts, posters, T shirts, conference bags), the community assessment, updating MOH, building relationship with the Director of the District hospital, working with the Rotaract club of the University of Zambia,
Together- we built shared objectives, cardiology review of all materials for content, cultural sensitivity and design, building stakeholder relationships, project promotion and publicity, budget development and review, and transitioning from paper questionnaires to electronic.
Timeline:
Topic Timeline
Funding: Started Oct 2025 end December 2026
Project design review: May 2026 and completed Sept 2027
Project material review and revision: Oct 2025 and to be completed Oct 2026
Final Cadre review: Nov 2026
Submission of Grant: Jan 2027
VTT Travel: Late June 2027 through beginning of August 2027
NTT and CCP training: July 2027
Cohorts 1 and 2: July -Aug 2027
Evaluation of outcomes of first 2 cohorts: Nov-December 2027
Cohorts 3-5: Nov 2027- Nov 2028
Evaluation of outcomes for cohorts 3-5: Feb 2028-April 2028
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