Strengthening community-based care: Last Mile Health’s frontline health worker program

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Andy Sechler / Last Mile Health
Clinical Mentor Tarnue Jallah uses a Masimo Rad-57 Pronto device to detect anemia during antenatal care outreach in Tempo, Liberia, in December, 2013.

“While illness has always been universal, today, in Konobo, access to care is too.”
Madeleine Ballard, former Frontline Health Worker Manager & Scale-Up Advisor
Last Mile Health

Access to health care is an urgent issue across Liberia, but especially for so called ‘last mile’ communities far from the capital city Monrovia. In Konobo, one of the most poor and remote districts in Liberia, the average age of death was 28 years old in 2012 as many villagers live inaccessibly far from the nearest health clinic.

Through a groundbreaking Frontline Health Worker (FHW) program, Last Mile Health has inspired the global health community by achieving 100% access to a health worker in Konobo district, including a pilot program of frontline health workers providing hypertension screening and referral services in 11 villages. Last Mile Health (or Tiyatien Health as it’s known in Liberia) has also committed to supporting national noncommunicable disease policy in Liberia and, through a formal partnership with the Liberia Ministry of Health and Social Welfare and the NCD Synergies project, they plan to continue this work in expanding NCD care in poor and remote populations throughout Liberia.

The bottom line

Last Mile Health’s partnership in Liberia has achieved impressive success in providing access to health care in the Konobo region. Throughout its history, Last Mile staff have been repeatedly told that Konobo is “too far,” “too difficult,” “too dangerous,” and “too expensive” to deliver care there. Last Mile Health’s hypertension screening programs demonstrate that it is possible to provide quality NCD services to those living in poor and remote regions worldwide.

Lessons learned

  • The first critical step for NCDs in Liberia is better understanding the disease burden for NCDs like cardiovascular disease, especially in rural and very poor regions. This can be done through clinical service that is paired with strong data systems. Last Mile Health’s data systems, which ensure quality and scalability of its treatment programs, has been applied to their work in NCDs.
Last Mile Health's five step model to deploy Frontline Health Workers.

Last Mile Health’s five step model to deploy Frontline Health Workers.

  • Last Mile Health’s proven model for training and deploying frontline health workers can continue to be expanded to support NCD care. Last Mile Health’s five-step model (recruit – train – equip – manage – pay) has improved access to care across remote villages in the Konobo region, allowing communities to receive services like hypertension screening for the first time.

Local barriers to care

As one of the poorest countries in the world, Liberia faces limited financial resources and health system capacity. Trained health workers and community-based health services to treat NCDs and other diseases are needed in Liberia, given the geographic and financial hurdles to travel. The recent Ebola outbreak has stretched the health system in Liberia, demonstrating the importance of well-equipped health facilities at the community level.

Models like Last Mile Health’s, that give remote communities access to clinical services while collecting data on disease prevalence and quality and efficiency of treatment, may be applicable in other similar settings worldwide. The data collected while delivering care, in turn, may make it more possible to mobilize much-needed resources to build the right systems to treat NCDs from the community level up to the hospital level.

Program successes

  • Last Mile Health has achieved 100 percent access to a trained health worker in the remote district of Konobo region by training and deploying 42 Liberian frontline health workers in 41 hard-to-reach villages. These health workers are able to directly provide care to the majority of patients in villages where it can take up to two days to get to the nearest clinic.
  • Last Mile Health frontline staff currently provide hypertension screening to 11 villages in Konobo, which represents the first rural, community-based NCD screening and referral program in the region. In coming years, Last Mile Health will expand their model of counseling, early detection, and follow up to reach more patients and address more NCDs in Konobo.
  • Last Mile Health will continue to partner with the Liberia Ministry of Health and Social Welfare to build a community-based health delivery model that integrates maternal and child health, infectious disease, and NCD services in the poorest and most remote communities in Liberia. Through a complementary partnership with the Ministry of Health and Social Welfare and NCD Synergies, Last Mile Health will support the national strategic planning process for NCDs.

Biography of key leaders

Raj Panjabi is an Associate Physician in the Division of Global Health Equity at Brigham and Women’s Hospital, Instructor in Medicine at Harvard Medical School, and Co-Founder and CEO of Last Mile Health. At age 9, Panjabi narrowly escaped a civil war in his home country of Liberia. He returned to serve the people he had left behind, co-founding Last Mile Health (LMH), which works with the Liberian government to save lives in the world’s most remote villages by giving village health workers the training, equipment, and support they need to perform as professionals. LMH’s work has been recognized by President Bill Clinton, Liberian President Ellen Johnson Sirleaf, and Big Bang Philanthropy. Named a “Social Disruptor” by the Forbes 400 Summit on Philanthropy, Panjabi is a fellow of the Draper Richards Kaplan Foundation, Mulago Foundation, and Echoing Green as well as an Advisor in Global Health to the Clinton Global Initiative. He is a recipient of the Global Citizen Movement Award, the Segal Family Foundation Rising Star Award and the Johns Hopkins University Outstanding Recent Alumni Award.

Location

  • Grand Gedeh County, Liberia (offices in Zwedru and Konobo)
  • Konobo region, Liberia (clinical work)
  • Monrovia (planning work and NCD Synergies consultant)