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.
We know that realizing our vision starts by investing in community health workers who are skilled, salaried, supplied, and supervised as part of national programs operating at scale and backed by strong data and financing systems. This vision has become the reality in many communities where it wasn’t 15 years ago—and it changes health outcomes every day. Just ask Marie Gboto in Liberia, a mother whose son recently recovered from malaria thanks to the treatment provided by community health worker Laura Gbee. Or Workinesh Getachew, a community health worker in Ethiopia recently promoted to district supervisor thanks to her hard work to master the skills and knowledge she gained in her in-person and digital training sessions—and applied each day as she cared for her patients. Frontline health workers like Laura and Workinesh are bringing care within reach for more people each year, supported by national ministries of health, Last Mile Health, and our funding partners—but much remains to be done.
This starts with partnering with governments to prioritize, finance, and implement strong community health programs that can achieve long-term sustainability and impact. These systems support community health workforces that are skilled, supplied, supervised, and salaried, operating at national scale, and integrated into broader public systems via data and financing (we call these the Six Ss).
Today, Last Mile Health partners with ministries of health in Ethiopia, Liberia, Malawi, and Sierra Leone to skill, supply, salary, and supervise 8,308 community and frontline health workers to serve 5.6 million people. In each country, we tailor our work with government to catalyze an exemplar community health system by working across the three levels of our Theory of Change:
Advocate for and advise governments to build and sustain responsive, resilient, and well-financed community health systems that embody the Six Ss and reach all communities.
Train and grow the community health workforce to manage and sustain high-quality community-based primary care.
Demonstrate effective community-based primary care that leads to improved health equity and outcomes in rural and remote communities.
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.
In partnership with governments, we upskill and grow the community health workforce to increase their performance and deliver high-quality primary healthcare. We work to ensure community and frontline health workers acquire and apply new knowledge and skills in primary care delivery, and we support health leaders to acquire and apply expertise to manage community health systems.
This year, our upskilling work has included two exciting initiatives: ensuring the quality of the pre-service training of Sierra Leone’s first fully-integrated national cohort of community health workers and developing an innovative new blended learning training module for community health workers in Ethiopia.
We work in partnership with governments to deliver effective community-based primary healthcare at the last mile. Community health workers supported by Last Mile Health provide high-quality care to their neighbors right at their doorsteps.
In one county served by the Liberia Ministry of Health and Last Mile Health, care for childhood illness by a qualified provider increased by 60.3 percentage points when professional community health workers were deployed—meaning more children are happy and healthy.
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.
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.
But change doesn’t happen overnight, it happens across generations—and to drive lasting, systemic impact in our mission to save lives in the world’s most remote communities, we must continue to invest in community health workers and the systems that enable their success.
Fifteen years is only the beginning. The journey ahead is long—but like the community health workers who walk narrow forest paths and cross dry plains each day to visit their patients and provide lifesaving primary care, we are committed to going the distance. This is about more than Last Mile Health: it’s about a global movement to realize universal health coverage, and it’s worth the work.
