It’s early morning as you set off down the path. Already, the sun is warm on your shoulders, and you have a busy day ahead. As the only community health worker for miles around, your entire community depends on you. There’s the young couple eager to welcome their first child: the expectant mother relies on you to conduct her antenatal checkups, and when the time comes, you’ll help coordinate her transport to the nearest clinic for her delivery.
There’s the little boy from the home next to hers—last month his mother noticed he had a fever, and you used a rapid diagnostic test to diagnose him with malaria and then provided treatment right in his own home.
And there’s your closest neighbor, a mother of three whose youngest child was born just three months ago at the health facility. Today, she and her baby girl will be the first patients you visit.
When you arrive, your neighbor welcomes you in. She answers your questions about her health and the health of her baby, and she wants to know—Is my daughter growing the way she should be? Is she getting enough to eat? To check for malnutrition, you use a measuring tape to perform a middle-upper arm circumference screening, a skill you learned when you first trained to become a community health worker.
To help your neighbor understand the test, you take out your tablet and find a video that shows a mother like her with her own baby. Last month, when you completed your regular refresher training, the facilitator shared this resource with you. Today, when you share it with your neighbor, she’s reassured: like the baby in the video, her daughter’s arm measurement falls within the green section of the tape. She’s growing just the way she should be.
Before you leave your neighbor’s house, you switch to the case management portal on your tablet. When you first started working, you had to fill out paper forms for every visit to every patient—a time-consuming process. But now, you easily manage each case on a digital health system. When you meet with your supervisor next week, she will help you look at any tricky cases where you want support, and she’ll make sure you’ve submitted your patient reports.
If there is an outbreak of TB, malaria, or even a new sickness, the Ministry of Health will notice it, your supervisor explains, emphasizing that you’re part of a well-connected system that covers communities in every district of the country. Through thousands of community health workers’ reports, the Ministry tracks healthcare coverage, identifies potential health threats, and gets a bigger picture of the changes that have happened in communities like yours. They’ll use the data to refine the systems, trainings, and practices that support you, ensuring you can provide even better care. They’ll also make certain you get the supplies you need to care for your patients.
As you leave your neighbor’s house, you are happy to know her baby is thriving—and you’re proud that the family trusts your advice. They know you have been trained to give them the care they need—and that you are their link to the health system. You are proud of the work you do and the changes you’ve seen. The salary you earn helps pay for your own children’s school fees, and your oldest child tells you she wants to be a health worker like you someday. She tells you, I want to help people, like you do.
There’s a long day ahead. Already, you’re thinking of your next patient. There is more work to be done, today and every day. But seeing your neighbors healthy and happy drives you—and makes your journey worthwhile.
You walk on.
by Last Mile Health and Ministries of Health
by community health workers in Liberia
Our work in the world’s most remote communities has taught us what’s needed to bring primary care to all. We partner with ministries of health to ensure that community health workers are skilled, salaried, supplied, and supervised as part of a well-functioning community health system operating at national scale. We call these the Six Ss.
We have evidence that this approach works. This year, we’ve marked important milestones—and this is exactly why we must stay the course.
Where we are today isn’t the destination:
it’s evidence that drives us on our journey ahead.
We work with governments to build community health programs that are durable, high-quality, and data-driven. Through global advocacy and direct partnership with ministries of health, we work to ensure community health workers are skilled, salaried, supervised, and supplied as part of programs operating at national scale and integrated into national data and financing systems.
This year, our work to strengthen health systems has centered on two key efforts: digitizing Malawi’s national community health system to improve the quality, accessibility, and monitoring and evaluation of primary care delivery; and building from our country-level financing work to launch the Africa Frontline First initiative to increase the community health workforce in up to ten countries across Africa.
Each day, we are working to answer Ruth’s call: equipping community health workers with the supplies and support they need to deliver high quality care, upskilling new and experienced health workers to grow and sustain the community health workforce, and strengthening health systems to scale and sustain exemplar community health programs. We’re proud of the work we have helped make possible–and inspired by the partnership of the health workers, health systems leaders, financing partners, and peer organizations we stand alongside each day in our fight to bring healthcare within reach for all. Much work remains to be done–and we’ve made it our mission to close the distance to care for those living in the world’s most remote communities.
Our impact demonstrates that our approach works. We can see this in the growing numbers of health workers we’ve trained and patients they’ve reached, in new policies and financing streams we’ve developed together with ministries of health and funding partners, and in the lived experience and shared perspectives of community health workers and their patients. But these numbers, milestones, and stories also highlight the distance that remains on the path toward healthcare access for all. Alongside our ministry and funding partners, we must stay the course as we work to drive meaningful systemic change. We owe this unwavering commitment to community health workers and the patients they serve.
We must ensure that a community health worker is within reach of everyone, everywhere. We must ensure those community health workers are equipped with the conditions they need to succeed. And we must ensure the systems that support them are sustainable. Community health workers work: they change health outcomes in their communities, they are cost-effective, and they represent a real and powerful chance at achieving universal health coverage. Community health workers are the future we need—and at Last Mile Health, they’re the future we’re invested in.
There is a growing evidence base underscoring the vital role community health workers play in improving maternal health services, reducing infant mortality, and maintaining access to care during crises like COVID-19. There is growing demand for health services from patients living in last mile communities, and public sector partners are increasingly adopting community health policies. But there is also growing urgency, as the pandemic continues to exacerbate inequities that result in two billion people living outside the reach of the health system.
We can close that distance when we invest in community health workers and the systems that support them—and that’s exactly what we’re committing to do in our new strategic plan, Closing the Distance. Over the next five years, we will deepen our impact in four to six national community health systems to bring essential primary care to last mile communities, and we will influence community health financing across Africa to improve how $2 billion in sustainable funding is invested for the greatest impact at the last mile.
At the country level, we will accompany governments to build and sustain responsive, resilient, and well-financed community health systems that reach all communities. We will tailor our efforts in partnership with governments to strengthen one or more of the Six Ss as aligned with the country’s community health program, policy, and priorities, resulting in higher-quality care for patients.
At the global level, we will continue our work as a founding member of the Africa Frontline First initiative to catalyze $2 billion in new investments for community health by 2030, enabling 200,000 new professionalized community health workers to expand healthcare access for 100 million people across 10 countries.
We will partner with four governments to design curricula and blended learning training modules; facilitate engaging and effective training for community health workers; and measure improvements in skills, knowledge, and cost-effectiveness. For example, in Ethiopia, we’ll continue to expand our innovative blended learning training, with the potential to reach up to 44,000 community health workers. In Sierra Leone, we’ll partner with the Ministry of Health and Sanitation to train over 8,000 community health workers to deliver an integrated service package to rural and remote communities.
We were founded to bring care within reach of patients living in remote communities, and we will build on 15 years of direct service delivery work in Liberia to continue to expand access to care, measure impact, and deepen quality of services. We will evaluate the impact of service delivery innovations on quality of healthcare delivery and equitable access to health services, and we will grow community-led monitoring efforts.
