2018

ANNUAL REPORT

Collective investment
in
rural community health
brings
primary healthcare
to
ALL
Collective investment
in
rural community health
brings
primary healthcare
to
ALL

Reflections

from Last Mile Health Leadership

Dear Friends,

A few years ago, during a period of growth, a teammate said, “as we scale our work, so too must we scale our values.” This inspired a months-long process of interviewing team members across our sites in Liberia and the US, culminating in the creation of our culture code, which begins with 'we go as far as it takes for our patients.' This value has remained at the heart of our work since 2007, when we were supporting 30 community and frontline health workers, to 2018, as we support the Liberian government to scale and strengthen a workforce of over 3,000 community and frontline health workers. Every day, this value reminds us of our commitment to stay proximal to our patients, no matter how much we grow and scale.

For 11 years, we have done this proximal work in partnership with many—from governments and multilateral funding agencies, to peer organizations, the private sector, foundations, and philanthropists. Together, we know that it’s possible to strengthen the community healthcare team so that families have access to healthcare right at their doorsteps. The data shows that this work not only saves lives, but also creates meaningful employment opportunities for people who are passionate about serving their communities. Working in partnership, we know that we can extend the reach of the health system so that everyone, everywhere has access to healthcare.

Despite incredible progress in countries like Liberia, the world still faces ongoing challenges in ensuring that health workers are providing high-quality health services. Our commitment to staying proximal to the experience of our patients pushes us to reflect on where we are still falling short—such as in cases like Precious. When Precious was six years old, she developed a fever, sore throat, and aching joints. With no access to a health worker, her symptoms went undiagnosed. Years later, with the support of her community health worker and nurse, she was finally referred to the nearest clinic to treat her advanced symptoms. There, they realized she had developed rheumatic heart disease—likely due to an untreated strep throat infection that had damaged her heart valves. With the support of her community health team, Precious is now receiving treatment, but still requires surgery, and her case underscores the vital work still left to do to ensure access to high quality care in rural and remote areas of the world.

At Last Mile Health, the word ‘ALL’ is etched into our logo as a testament to our belief that all people, no matter where they live, deserve high quality healthcare. It also serves as a reminder that the solution to universal health coverage requires ALL—the challenges we aim to solve are so much bigger than one organization alone can tackle. As the African proverb says, if you want to go fast, go alone. If you want to go far, go together. We know that when we go as far as it takes for our patients collectively as a movement, anything is possible.

In solidarity,

Raj Panjabi
Chief Executive Officer

Lisha McCormick
Chief Operating Officer

Katherine Collins
Board Chair

Reflections

from Last Mile Health Leadership

Dear Friends,

A few years ago, during a period of growth, a teammate said, “as we scale our work, so too must we scale our values.” This inspired a months-long process of interviewing team members across our sites in Liberia and the US, culminating in the creation of our culture code, which begins with 'we go as far as it takes for our patients.' This value has remained at the heart of our work since 2007, when we were supporting 30 community and frontline health workers, to 2018, as we support the Liberian government to scale and strengthen a workforce of over 3,000 community and frontline health workers. Every day, this value reminds us of our commitment to stay proximal to our patients, no matter how much we grow and scale.

For 11 years, we have done this proximal work in partnership with many—from governments and multilateral funding agencies, to peer organizations, the private sector, foundations, and philanthropists. Together, we know that it’s possible to strengthen the community healthcare team so that families have access to healthcare right at their doorsteps. The data shows that this work not only saves lives, but also creates meaningful employment opportunities for people who are passionate about serving their communities. Working in partnership, we know that we can extend the reach of the health system so that everyone, everywhere has access to healthcare.

Despite incredible progress in countries like Liberia, the world still faces ongoing challenges in ensuring that health workers are providing high-quality health services. Our commitment to staying proximal to the experience of our patients pushes us to reflect on where we are still falling short—such as in cases like Precious. When Precious was six years old, she developed a fever, sore throat, and aching joints. With no access to a health worker, her symptoms went undiagnosed. Years later, with the support of her community health worker and nurse, she was finally referred to the nearest clinic to treat her advanced symptoms. There, they realized she had developed rheumatic heart disease—likely due to an untreated strep throat infection that had damaged her heart valves. With the support of her community health team, Precious is now receiving treatment, but still requires surgery, and her case underscores the vital work still left to do to ensure access to high quality care in rural and remote areas of the world.

At Last Mile Health, the word ‘ALL’ is etched into our logo as a testament to our belief that all people, no matter where they live, deserve high quality healthcare. It also serves as a reminder that the solution to universal health coverage requires ALL—the challenges we aim to solve are so much bigger than one organization alone can tackle. As the African proverb says, if you want to go fast, go alone. If you want to go far, go together. We know that when we go as far as it takes for our patients collectively as a movement, anything is possible.

In solidarity,

Raj
Panjabi

Chief Executive Officer

Lisha McCormick
Chief Operating Officer

Katherine Collins
Board Chair

A note on acronym use

Under Liberia’s National Community Health Assistant Program, professional community health workers (CHWs) are called community health assistants (CHAs). Every CHA reports to a trained nurse, physician’s assistant, or midwife called a Community Health Services Supervisor, who is based at the nearest clinic. For the purpose of this report, we will refer to CHAs using the universal term CHW and to Community Health Services Supervisors as clinical supervisors.

Collaboration at every level of
the health system fuels the
community health movement

Collaboration at the Community level

The Power of the Community Health Team

Clinical supervisor Nelson Kerneah reviews data collection forms from CHW Marie Gbordoe in Gboe, Doedain District, Rivercess County.

There is growing recognition worldwide of the role that community health workers can play in advancing the right to health, saving lives, and strengthening disease surveillance.

Recruited directly from their own communities, CHWs in Liberia are talented women and men who are nominated by their neighbors. After a rigorous recruitment and selection process, they are then trained in infectious disease prevention and surveillance; reproductive, maternal, and neonatal health; child health with a focus on preventing the top drivers of child mortality, including pneumonia, malaria, and diarrhea; and adult health with a focus on diagnosing and treating HIV/AIDs, tuberculosis, and neglected tropical diseases. They are equipped with the supplies they need to diagnose and treat their neighbors, including a smartphone, and paid for their work as professionals.

READ MORE

Collaboration at the National Level

Advancing Universal Health Coverage in Liberia

A CHW reviews his participant handbook for Liberia's National Community Health Assistant Program.

Liberia is advancing universal health coverage due to the tremendous leadership of the Government of Liberia’s Ministry of Health. During the devastating Ebola outbreak from 2014-2016, the Ministry of Health committed to not only respond to the crisis—but to rebuild the health system stronger, more resilient, and more inclusive than ever before.

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Collaboration Drives Impact

Now operational in 14 out of 15 counties, the Government of Liberia's National Community Health Assistant Program, supported by Last Mile Health and other partners, is transforming access to primary care for rural and remote Liberians who have historically lived beyond the reach of the health system.

Impact of the National Community Health Assistant Program as of December 31, 2018
Hover to view images of activities

CHWs Make an Impact
in Children's Lives

A recent study, titled A Community Health Worker Intervention to Increase Childhood Disease Treatment Coverage in Rural Liberia: A Controlled Before-and-After Evaluation, was published in the American Journal of Public Health by Liberia’s Ministry of Health, Last Mile Health, and researchers from Harvard and Georgetown Universities. They found that, in just one year, the deployment of CHWs through the National Community Health Assistant Program in Rivercess County—one of Liberia’s poorest and most rural regions—equipped with supplies, clinical supervision, and a monthly stipend was associated with statistically significant improvement in children receiving treatment from a qualified provider. Specifically, CHWs increased the percent of children treated for diarrhea, malaria, and pneumonia from one quarter (28.5%) to over two thirds (69.3%).


The results not only highlight the role CHWs play in ensuring access to lifesaving treatment for children in Rivercess County, but also underscore the potential of the National Community Health Assistant Program to rapidly improve access to primary healthcare in remote communities across the country. Liberia is demonstrating what’s possible when governments invest in a community health workforce as the foundation of a strong primary healthcare system to accelerate universal health coverage.

read the study

Global Collaboration

Collaboration fuels the community health movement

There is growing momentum for governments to invest in integrated community health systems that extend primary healthcare to hard-to-reach communities. Last Mile Health is working with a global network of partners to identify and elevate best practices from exemplar countries like Liberia, generate evidence for advocacy to shape global policy and practice, and support other countries to build and strengthen high-quality community health systems.

Integrating Community Health Program

Integrating Community Health Program partners working in Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Liberia, Mali, and Uganda.

A global consortium of partners, including the United States Agency for International Development, UNICEF, Population Council, PAI, Last Mile Health, and many other implementers have joined forces to advance integrated community health programs across seven countries across the globe—including Bangladesh, Democratic Republic of Congo, Haiti, Kenya, Liberia, Mali, and Uganda. Last Mile Health is the lead policy and advocacy partner for the Integrating Community Health Program, which is supported by the Bill & Melinda Gates Foundation. In this role, we work with these seven countries to share lessons from successful frontline delivery models, advocate for investment in CHWs, and provide targeted technical support to several of the countries’ ongoing efforts to strengthen community health systems.

sharing Community health best practices

CHWs provide reproductive health education to young women in rural Bangladesh.

Last Mile Health is part of a global research effort committed to harnessing rigorous data and evidence to better understand and replicate large-scale health successes around the world. This project convened a global advisory panel and local partners in four selected countries (including Liberia) to better understand how these countries developed high-performing national community health systems. To develop these case studies, Last Mile Health has partnered with leading institutions in the primary and community health sector, and the findings will be disseminated in major global health conferences and forums to contribute to the global CHW movement. Ultimately this research aims to inform the scale and strengthening of community health programs globally by identifying best practices for implementers, policymakers, and funders.

the audacious project

Rivercess County CHW Musu Johnson uses the timer application on her mHealth data collection tool to monitor a child's respiration rate as part of the patient screening process for diagnosing pneumonia.

The Audacious Project, publicly launched in 2018 and convened by TED, brings together philanthropists who believe large-scale social change is possible through collaborative philanthropy. The project brought together Last Mile Health and Living Goods as implementation partners to scale and deploy 50,000 digitally-empowered CHWs by 2021 to provide lifesaving primary care to 34 million people across six countries in East and West Africa. Currently, more than 8,500 CHWs across Liberia, Uganda, and Kenya are supported through the project to serve more than 7 million people.  

Community health impact coalition

The Community Health Impact Coalition (CHIC) is a five-year quality initiative led by some of the field’s most innovative implementers to catalyze the design and adoption of high-impact community health systems. Led by Dr. Madeleine Ballard, the group includes Integrate Health, Living Goods, Lwala Community Alliance, MedicMobile, Muso, Partners in Health, Pivot, Possible, VillageReach, and Last Mile Health. The mission of the coalition is to leverage practitioner experience in order to design global guidelines and advocacy tools that can enable community health systems leaders to design and operationalize quality programs for impact. CHIC published a groundbreaking report in 2017 titled Practitioner Expertise to Optimize Community Health Systems to highlight eight design principles that drive quality: effective CHWs are accredited, accessible, proactive, continuously trained, supported by a dedicated supervisor, paid, part of a strong health system, and part of data feedback loops.

Convening the Community Health Academy

The Community Health Academy was created as a collaborative initiative for the community health space, convened by Last Mile Health. The Academy aims to partner with Ministries of Health to strengthen the clinical skills of community health workers and the capacity of health systems leaders to build higher quality systems by leveraging the power of digital training tools.

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Collaboration Matters

ruth's
Journey

Ruth Tarr has always been passionate about community health. Previously serving as a community health volunteer, she was recruited and trained to be a member of Liberia’s professional community health workforce in 2016. She is coached by a clinical supervisor, who visits her in her community twice per month to replenish her medical supplies, mentor her on key clinical skills, and ensure she is delivering high-quality care and referring advanced cases to the local health center as needed. In this role, she ensures her neighbors can access life-saving primary healthcare. She is paid for her work, and her salary empowers her to dream of a bright future for her and her family.

READ MORE

Our Team

Our team makes this work possible. We are grateful for the tireless work and leadership of our over 150-person staff in Liberia and the US, as well as our Board of Directors and Advisory Council.

Board of directors

Katherine Collins, MTS Board Chair
Kim Keller, MSc Governance Chair
Lynn Black, MD, MPH
Andy Bryant, MPA
Peggy Clark, MA
Kevin Fleming, MPP

Pooja Kumar, MD, MSc
Brad Mak, MBA
Moses Massaquoi, MD
Robtel Neajai Pailey, PhD, MSc
Wendy Taylor, MPP

advisory council

Randall Lane, Advisory Council Chair, Forbes
Bridgitt Arnold, Gates Ventures
Suprotik Basu, Blue like an Orange Sustainable Capital
Paurvi Bhatt, Medtronic Foundation
Niranjan Bose, Gates Ventures
Nancee Oku Bright, United Nations Organization Stabilization Mission in the DR Congo
Marine Buissonniere, Non-Profit Consultant and Researcher
Robyn Calder, ELMA Philanthropies
Bill Doyle, Novocure
Peter Ehrenkranz, Bill & Melinda Gates Foundation
Tim Evans, World Bank
Paul Farmer, Partners In Health
Paul Garrett, BetterWorld Trust
Jacob Hughes, Hughes Development
Krishna Jafa, Bill & Melinda Gates Foundation
Ashish Jha, Harvard Initiative on Global Health Quality

Kim Jonker, King Philanthropies
Jennifer Carolyn King,
Rugged Elegance Foundation
Ambassador Jimmy Kolker, Former Secretary for Global Affairs, US Department of Health & Human Services
Robert Lawrence, Johns Hopkins Bloomberg School of Public Health
K. Riva Levinson, KRL International
James Nardella, Skoll Foundation
Ryan Rippel, Bill & Melinda Gates Foundation
Kevin Starr, Mulago Foundation
Tony Tjan, Cue Ball
Drew von Glahn, World Bank
Jeff Walker, UN Secretary General’s Special Envoy for Health in Agenda 2030 & Malaria
Andrew Weiss, Child Relief International & Weiss Asset Management
Rob Yates, Chatham House

Our Team

Our team makes this work possible. We are grateful for the tireless work and leadership of our over 150-person staff in Liberia and the US, as well as our Board of Directors and Advisory Council.

Board of directors

Katherine Collins, MTS Board Chair
Kim Keller, MSc Governance Chair
Lynn Black, MD, MPH
Andy Bryant, MPA
Peggy Clark, MA
Kevin Fleming, MPP

Pooja Kumar, MD, MSc
Brad Mak, MBA
Moses Massaquoi, MD
Robtel Neajai Pailey, PhD, MSc
Wendy Taylor, MPP

advisory council

Randall Lane, Advisory Council Chair, Forbes
Bridgitt Arnold, Gates Ventures
Suprotik Basu, Blue like an Orange Sustainable Capital
Paurvi Bhatt, Medtronic Foundation
Niranjan Bose, Gates Ventures
Nancee Oku Bright, United Nations Organization Stabilization Mission in the DR Congo
Marine Buissonniere, Non-Profit Consultant and Researcher
Robyn Calder, ELMA Philanthropies
Bill Doyle, Novocure
Peter Ehrenkranz, Bill & Melinda Gates Foundation
Tim Evans, World Bank
Paul Farmer, Partners In Health
Paul Garrett, BetterWorld Trust
Jacob Hughes, Hughes Development
Krishna Jafa, Bill & Melinda Gates Foundation

Ashish Jha, Harvard Initiative on Global Health Quality
Kim Jonker,
King Philanthropies
Jennifer Carolyn King,
Rugged Elegance Foundation
Ambassador Jimmy Kolker, Former Secretary for Global Affairs, US Department of Health & Human Services
Robert Lawrence, Johns Hopkins Bloomberg School of Public Health
K. Riva Levinson, KRL International
James Nardella, Skoll Foundation
Ryan Rippel, Bill & Melinda Gates Foundation
Kevin Starr, Mulago Foundation
Tony Tjan, Cue Ball
Drew von Glahn, World Bank
Jeff Walker, UN Secretary General’s Special Envoy for Health in Agenda 2030 & Malaria
Andrew Weiss, Child Relief International & Weiss Asset Management
Rob Yates, Chatham House

We need more passionate
innovators like them.
Bill Gates on Last Mile Health
see our job openings

financial summary

Our progress over the past year was made possible by the generous support of hundreds of partners like you who have invested in our shared vision of health for all. Click here to view our most recent Audited Financial Statements.

Fiscal Year 2018: July 1, 2017 to June 30, 2018
*Stated revenue includes $10,793,858 in multiyear grants and other commitments that will be implemented between fiscal year 2019 and fiscal year 2021. Please see Last Mile Health's forthcoming Fiscal Year 2020 to 2023 Strategic Plan, which outlines program expansion activities and total related resources required.

View The amazing partners who make our work possible

Together, we can work towards a world where
everyone, everywhere has access to a health worker.No one has to be left behind, if we're willing to
go as far as it takes.

Together, we can work towards a world where
everyone, everywhere
has access to a health worker.
No one has to be left behind, if we're willing to
go as far as it takes.

We are deeply grateful to Gabriel Diamond of the Skoll Foundation for the video footage featured in this report.