Fight by Focusing: As Coronavirus Spreads, Lessons from Last Mile Health

High-performance nonprofits like Last Mile Health thrive by adhering to a clear, focused mission — and by resisting the temptation to be all things to all stakeholders.

Despite valiant and unprecedented efforts to contain the novel coronavirus that causes Covid-19, the virus has now spread around the world. Evidence of sustained transmission of the virus has been found on six continents and the World Health Organization has officially declared it a global pandemic. Experience has shown that epidemics such as this tend to disproportionately impact the 736 million people who live in extreme poverty, most in sub-Saharan Africa and South Asia. National public health systems, multilateral organizations, and nonprofits around the world are laying plans to fight the virus in areas where the world’s poorest live — a battle that is certain to be severe as even rich nation’s struggle to contain it.

Raj Panjabi, CEO of Last Mile Health, delivers his TED talk in Vancouver, Canada

Photo: Bret Hartman/TED

Even as I laud the many organizations working to defeat this terrible illness, it also seems a timely moment to remind nonprofit leaders of the importance of staying focused during times of crisis. Mission creep can happen at any stage of an organization’s growth, but as the organization Last Mile Health (LMH) learned during the Ebola outbreak in 2014, the challenge can be most acute during times of crisis. LMH is an excellent nonprofit organization founded in 2007 to bring health-care services to the world’s most remote communities, starting in Liberia.

The trap of mission creep

A fundamental axiom of corporate strategy is that more focused strategies outperform less focused ones. This applies equally to nonprofit organizations and private sector companies, as Bill Meehan and I argued in our recent book, Engine of Impact. Yet well-meaning social sector organizations routinely fall into a trap: their leaders divert attention and resources to activities unrelated to their mission. Mission creep is a prevailing management problem that affects countless organizations in the social sector. Sometimes the cause is internal, as when staff or board members are drawn to a non-mission-aligned opportunity and push their organization to embrace it. Very often, though, funders are the main culprit: by imposing their own specific criteria for awarding grants, they create a powerful incentive for nonprofits to lose focus. It was a well-intentioned version of this latter situation that Last Mile Health, its cofounder and CEO Dr. Raj Panjabi, and his colleagues found themselves facing back in 2014 when the dreaded Ebola virus broke out in Liberia.

A patient and his mother travel alongside community health workers to reach a health clinic in rural Liberia

Photo: Last Mile Health

LMH’s quandary

Liberia is a small, resource-poor country and the spread of the deadly Ebola virus quickly became the most urgent public health problem faced by its government agencies and social sector organizations. For LMH, the crisis posed medical, moral, and strategic challenges that tested its organizational identity. Indeed, the situation raised existential questions that required LMH’s leaders to determine how to respond meaningfully to the Ebola crisis while also remaining true to their mission — “to save lives in the world’s most remote communities”— and long-term strategy of improving government health systems by training and equipping frontline community health workers. 

Health workers in Liberia during the West African Ebola epidemic

Photo: Last Mile Health

LMH’s moment of truth came when a leading funder in the Ebola response effort offered it the opportunity to pursue a multi-million dollar grant to implement a plan for building patient treatment centers intended to help halt the outbreak. The offer represented a welcome vote of confidence in the young organization, and funding at that level would go a long way in Liberia. “Building treatment centers to fight Ebola is vital during an epidemic,” Panjabi later explained. He continued:

Saying “yes” to this opportunity might have felt like the right and moral thing to do, but had we said yes we could have hurt instead of helped, because building treatment centers for Ebola was not a core competency of our organization. If we had taken this on, we would have been managing projects that others could have done much better. Instead, we stayed disciplined and committed to our core competencies.

Community health workers in Liberia are trained to assess and respond to signs and symptoms of Ebola in their communities

Photo: Last Mile Health

The solution

LMH rejected the undoubtedly tempting offer because building Ebola treatment centers in rural Liberia would have led it far afield of its core mission — and of the core competencies it was developing to achieve that mission. Instead, Panjabi and his colleagues decided to focus on continuing to create a network of community health workers (CHWs) who would go door-to-door to help treatment centers, and doctors, identify patients at risk for Ebola. In this way, LMH could remain true to its mission and continue to build its core competencies even as it helped stop the spread of the disease and worked to sustain primary health care systems (which were collapsing across the country) so they could deliver health care for every-day epidemics like malaria; severe acute malnutrition; prenatal health; and other conditions.

Ultimately, LMH also enlisted the support of a larger partner organization that did possess core competencies in building treatment centers; this organization then pursued the grant and allocated a smaller, more circumspect portion of it to LMH to integrate CHWs into the countrywide response to the crisis. By taking this approach, the LMH team refined a strategy that involves cultivating partnerships with the Liberian government and with organizations that have complementary missions and capabilities. As a result, LMH has been able to focus on what it does best. Panjabi explained:

We found that staying disciplined, even during what seemed like an existential crisis, was critical. Because we stayed disciplined during the Ebola outbreak, we had the opportunity to continue work with the Government to hone and refine the CHW approach we were testing and even during outbreak, demonstrate the transformative impact that paid, professionalized teams of community health workers and nurse supervisors could have in extending the reach of the health system to the most remote communities. Now, the Government of Liberia and a coalition supporting it has used this approach to build a national program to provide primary health services and prevent the next epidemic through infectious disease surveillance.

A community health worker in Liberia conducts a diagnostic test on a young patient

Photo: Last Mile Health

The benefits of focus

By resisting the temptation of diversification in programmatic activities — knowing when to say no — and maintaining a laser-like focus on its mission, LMH is making steady progress toward achieving real impact. It has supported the Government of Liberia to create a national program to train and deploy over 3,600 CHWs and nurse supervisors who have conducted 2.6 million patient visits in ‘last mile’ communities. They also launched a global training platform called the Community Health Academy, which is training leaders around the world to build stronger CHW programs in their own countries and providing CHWs with continuing clinical education tools on smartphones. Panjabi and the organization have received a breathtaking array of honors and awards: the Skoll Award for Social Entrepreneurship, the Schwab Social Entrepreneur of the Year award from the World Economic Forum, and the TED Prize.

Given how strong the temptation to expand into new program areas can be, perhaps it is not surprising that many people have come to accept mission creep as a fact of nonprofit life. There are certainly a host of exceptions that prove the rule (as is discussed in Engine of Impact’s chapter on mission). But the example of LMH demonstrates the value of rigorously maintaining one’s focus on a clearly defined mission in order to achieve outsized impact — a lesson we must all take to heart.

Originally published in Forbes

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