In Liberia, the rates of maternal and child mortality are among the highest in the world. Underlying this problem are two key factors. First, primary health care is geographically inaccessible to many Liberians: More than 1.2 million of them live at least a one-hour walk away from the nearest health facility. Second, the country faces a serious deficit of doctors and nurses.
Last Mile Health trains and deploys community health workers who operate in hard-to-reach rural areas. These workers can diagnose and treat preventable diseases (such as diarrhea, malaria, and pneumonia), as well as micronutrient deficiencies. To improve community health programs, Last Mile Health also provides technical advising and engages in policy and research work.
Why We Invest
Last Mile Health excels at developing close partnerships with government agencies. In Liberia, the site of its flagship program, Last Mile Health collaborated with the Ministry of Health to reform the country’s National Community Health Services Policy. Through this reform effort, the ministry transformed a fragmented and ineffective system into a unified network of professionally trained community health workers. This network—part of the country’s National Community Health Assistant Program—is operational in 14 of Liberia’s 15 counties. To date, the program has deployed more than 3,800 community health workers.
“A health worker within reach of everyone, everywhere.” That vision guides the work of Last Mile Health. The deployment of community health workers is not unique; other organizations follow variations of that model. What distinguishes Last Mile Health is its focus on building a community health workforce that can serve the hardest-to-reach parts of a given country. In the Liberian county of Rivercess, for example, community health workers often travel many hours by foot and by boat to deliver primary care services to patients. Despite the challenge of reaching such areas, the National Community Health Assistant Program—with support from Last Mile Health—has been able to achieve 70% coverage of the rural population in Liberia. Even more impressive is the quality of the health care that this program delivers: According to a rigorous study, the deployment of community health workers in Rivercess led to a year-over-year increase from 28% to 69% in the portion of children who had received treatment for diarrhea, malaria, and pneumonia.
As Last Mile Health expands into new countries, it retains a focus on working with governments to build and maintain high-quality community health systems. By empowering public officials to take ownership of those systems, Last Mile Health is charting a path toward sustainable, large-scale impact—and toward improved health care for those who need it most.
How We Partner
King Philanthropies is funding direct implementation of the community health worker program in target counties across Liberia. Support from King Philanthropies also funds technical advising work that Last Mile Health offers to the Liberian government. In particular, because malnutrition and stunting are highly prevalent in rural Liberia, King Philanthropies is working with Last Mile Health to strengthen nutrition programming within the suite of services that community health workers provide.
In addition, King Philanthropies is providing support for the Community Health Academy, a digital platform created by Last Mile Health to train community health workers and health system leaders.
Using a tape that measures middle upper-arm circumference, a community health worker assesses a child for malnutrition in Grand Gedeh County, Liberia. Photo: Last Mile Health/Rachel Larson
Community health workers in Rivercess County, Liberia, attend training session on reproductive, maternal, and neonatal health. Photo: Last Mile Health/Rachel Larson
Grace Dahn, a community health worker, conducts a home visit with an expectant mother in Rivercess County, Liberia. Photo: Last Mile Health/Rachel Larson
A community health worker in Rivercess County, Liberia, checks a child's respiration rate as part of a process for diagnosing pneumonia. Photo: Last Mile Health/Rachel Larson
Members of the HEAL Initiative, a global health fellowship, conduct supervision visits with community health workers in Grand Gedeh County, Liberia. Photo: Last Mile Health/Rachel Larson
A network of care—and a healthy, happy baby
In February 2019, a baby named Nelson was safely delivered by Baryou Cadard, a clinically trained midwife at Boegeezay Health Center in Liberia. Before Nelson’s birth, Baryou worked with Mama Boe, a community health worker, to identify and follow all of the pregnant women in Mama Boe’s catchment area and to encourage facility-based deliveries. The catchment area includes Zeegar’s Town, the home village of Nelson’s mother, a woman named Naomi.
Thanks to the efforts of community health workers like Mama Boe, women in Liberia can now receive pre- and postnatal care services directly in their homes. Mama Boe works for the National Community Health Assistant (CHA) Program, an initiative run by the Liberian Ministry of Health with support from Last Mile Health.
Previously, to receive high-quality care, expectant mothers in many parts of Liberia had to travel for hours or even days to visit the nearest health facility. Under the National CHA Program, teams of providers—including community health workers, nurses, and midwives—extend the reach of the Liberian health system to the most remote communities in the country.
In the months leading up to her delivery, Naomi received support and guidance from Mama Boe in a wide range of areas. Mama Boe spoke with her about birth planning, prenatal nutrition, breastfeeding, and newborn care, among other topics. Then, during the final days of Naomi’s pregnancy, Mama Boe referred the expectant mother to Boegeezay Health Center, which provided pre- and postnatal care, as well as delivery services.
Nelson’s birth is a testament to the power of community-based primary health care. Today, as a result of the high-quality care that Naomi received from providers like Mama Boe, Nelson is a happy, healthy toddler. Mama Boe continues to visit Naomi’s village to ensure that Nelson remains up-to-date on his vaccinations and that he can access the care that he needs to fulfill his potential.
And Nelson is not alone. Since the National CHA Program was implemented in 2016, the portion of children in Liberia who receive medical care has increased by more than 40%. Nationwide, community and frontline health workers have screened or treated more than 1 million cases of malaria, pneumonia, malnutrition, and diarrhea in children under the age of 5.
As stories like Nelson’s (and Naomi’s) become more common, they form a powerful blueprint for delivering primary care in even the most out-of-the-way places