The past twelve months have been deeply challenging. The COVID-19 pandemic has claimed the lives of more than 4.5 million people and emerging data suggests that for every COVID-19 death, more than two women or children have died as a result of disruptions to health systems.1 Health systems are struggling under the weight of the pandemic. The health workforce shortage, already estimated at nearly 18 million people, has grown.
Further, where you live has continued to determine your access to care, leaving half of the world’s population behind. COVID-19 vaccines have been distributed along lines of power and privilege, with only 6% of people in low-income countries having received at least one dose. 2
In Liberia, community health workers, when adequately supported and equipped, were able to maintain routine visits during the pandemic. And it’s not just in Liberia. Research by the Community Health Impact Coalition indicates that community health workers who were supported to respond to the pandemic were able to maintain speed and coverage of care across four countries.
This moment of global crisis presents an opportunity to reimagine a world where everyone is able to access the dignified healthcare they deserve, regardless of where they live.
Ruth David was recruited to become a community health worker in 2018, when Liberia’s national program expanded to Grand Bassa County with the support of Last Mile Health. Before the program, Ruth and her neighbors could not access essential health services due to distance. Pregnant women often went without prenatal care and parents had inconsistent access to medication for their sick children. Now, Ruth says, “The way of living in the community has changed because of my work.”
Ruth David was recruited to become a community health worker in 2018, when Liberia’s national program expanded to Grand Bassa County with the support of Last Mile Health. Before the program, Ruth and her neighbors could not access essential health services due to distance. Pregnant women often went without prenatal care and parents had inconsistent access to medication for their sick children. Now, Ruth says, “The way of living in the community has changed because of my work.”
To serve her neighbors and conduct active disease surveillance, Ruth is paid a salary, trained on topics like malaria treatment and contraceptives, supplied with essential medicines and a smartphone to collect and track her patients’ health information, and supervised by a nurse.
She also has access to training and education resources while on the job. When COVID-19 began to spread across the country, Ruth needed to know how to keep herself and her community safe. She is able to access the latest information through in-person training and digital tools.
Importantly, she is also integrated into the health system. To enable last-mile health workers like Ruth, we need to start at the first mile: the health system in which Ruth works requires strong governance, long-term financing, and tools and processes to assess and drive high-quality performance and delivery.
Lisha McCormick
CEO, Last Mile Health
Ruth David was recruited to become a community health worker in 2018, when Liberia’s national program expanded to Grand Bassa County with the support of Last Mile Health. Before the program, Ruth and her neighbors could not access essential health services due to distance. Pregnant women often went without prenatal care and parents had inconsistent access to medication for their sick children. Now, Ruth says, “The way of living in the community has changed because of my work.”
To serve her neighbors and conduct active disease surveillance, Ruth needs to be paid a salary, trained on topics like malaria treatment and contraceptives, supplied with essential medicines and a smartphone to collect and track her patients’ health information, and supervised by a nurse.
She needs access to training and education resources while on the job. When COVID-19 began to spread across the country, Ruth needed to know how to keep herself and her community safe. She is able to access the latest information through in-person training and digital tools.
Importantly, she also needs to be integrated into the health system. To enable last-mile health workers like Ruth, we need to start at the first mile: the health system in which Ruth works requires strong governance, long-term financing, and tools and processes to assess and drive high-quality performance and delivery.
At Last Mile Health, we are partnering with governments in five countries in Africa to work across three pillars – strengthening community health systems, upskilling the community health workforce, and delivering effective community-based care – to build exemplary community health worker programs that can meet the everyday needs of patients, during moments of crisis and calm.
We have seen first-hand the incredible impact of community health worker programs on patients’ lives. To succeed, these programs need to be nationally prioritized, financed, and actively managed.
We work with governments to design and strengthen high-quality, data-driven community health systems. Together, we develop the programs and policies that guide teams of health workers and health leaders to deliver high-quality care in remote communities.
Armed with the evidence from nearly 15 years of delivering community-based primary healthcare in Liberia, we know that professionalized community health workers are the first line of defense against future threats and are foundational to resilient health systems that leave no patient out of reach. In 2020, we partnered with Africa CDC, a specialized technical institution that provides guidance and support to countries in Africa, to strengthen national community health workforces across the African continent, during the pandemic and beyond.
Together, we are working to guide governments, implementing partners, and aid organisations to build stronger health systems with community health workers. We are doing this through:
For many people living in rural and remote communities, community health workers like Ruth David are their primary point of contact with the health system. Continuous training is needed at every level of the health system to ensure Ruth is able to provide high-quality care in her community and effectively respond to new challenges like COVID-19.
We partner with governments to train and grow the community health workforce and to build the community health expertise of national health leaders by leveraging innovation, like digital tools, to increase knowledge gain, cost-effectiveness, and scale.
Ethiopia's Health Extension Program - the country’s flagship community health worker program - has contributed to remarkable improvements in health outcomes since its launch in 2003. However, challenges like equitable access to high-quality care in rural areas remain, so the government is now investing in education and training to strengthen community health worker performance.
As part of these efforts, we've developed an innovative in-service training on reproductive, maternal, neonatal, and child health in partnership with the Ethiopia Ministry of Health. We are piloting the training with an estimated 1,170 community health workers serving 2.9 million people. Utilizing blended learning, the training includes both digital tools and in-person facilitated learning and contains innovative multimedia content in three languages. The training has the potential to be scaled nationally in the future -- reaching all 40,000 community health workers in the national program who serve close to 100 million people.
Professionalized community health workers deliver an integrated package of lifesaving health services in communities previously outside the reach of the health system. When properly equipped, they save lives through disease surveillance, and the delivery of maternal and child health-care, malnutrition screenings, malaria treatment, and more.
At Last Mile Health, we partner with communities to equitably select, train, pay, supervise, and supply the community health workers who bring primary healthcare to their remote communities.
Emerging data estimates that for every COVID-19 death, more than two women or children have died as a result of disruptions to health systems since the start of the pandemic. This is often the reality during a crisis; during the 2014-2016 Ebola epidemic, Liberia experienced a three-fold decrease in facility-based care.
Despite this, there is hope to be found in professionalized community health workers. Data from Liberia’s National Community Health Assistant Program suggests that in places where funding remained consistent, routine visits by community health workers held steady during COVID-19. And it’s not just in Liberia. Research by the Community Health Impact Coalition indicates that community health workers who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period.
