2019
Annual
Report

A global movement for community-based primary healthcare is bringing us within reach of a world where everyone, everywhere can access life-saving health services.

Thanks to the work of community health workers like Mama Boe, who are employed by the Government of Liberia’s National Community Health Assistant Program, women can now receive pre and antenatal care services directly in their homes.
Mama Boe, the community health worker serving Naomi's community of Zeegar's Town.
Naomi waits with Nelson to receive his childhood vaccines at Boegeezay Health Center.
Nelson is a testament to the power of community-based primary healthcare: today, he is a happy, healthy toddler as a result of the high quality pre and antenatal care his mother Naomi received from Mama Boe. Now, Nelson is accompanied by Mama Boe to ensure that he remains up-to-date on his vaccinations and can access the care he deserves to grow into an adult and fulfill his potential.

And he’s not alone: In Liberia, teams of community and frontline health workers have increased the rate of children receiving medical care by over 50%, and one out of every three children with malaria is now diagnosed and treated at home. Nationwide, community and frontline health workers have conducted 2.3 million patient visits—and counting. 

‍As more and more community health workers are integrated into the continuum of care, success stories like Naomi’s and Nelson’s are becoming increasingly common—forming a powerful blueprint for accelerating universal health coverage worldwide.
But it doesn’t stop there. With the support of Mama Boe, women are now safely giving birth in health facilities with clinically-trained midwives like Baryou Cadard.
Naomi waits with Nelson to receive his childhood vaccines at Boegeezay Health Center.
In Liberia, where expectant mothers can spend hours or even days traveling to reach the nearest health facility, community health workers, nurses, and midwives have teamed up to extend the reach of the health system to the most rural and remote communities—like Zeegar’s Town.
A community health worker conducts a home visit with an expectant mother.
A community health worker conducts a home visit with an expectant mother.
In Liberia, where expectant mothers can spend hours or even days traveling to reach the nearest health facility, community health workers, nurses, and midwives have teamed up to extend the reach of the health system to the most rural and remote communities—like Zeegar’s Town.

Thanks to the work of community health workers like Mama Boe, who are employed by the Government of Liberia’s National Community Health Assistant Program, women can now receive pre and antenatal care services directly in their homes.
Mama Boe, the community health worker serving Naomi's community of Zeegar's Town.
Baryou Cadard, a clinically-trained midwife holds a newborn she recently delivered Boegeezay Health Center.
But it doesn’t stop there. With the support of Mama Boe, women are now safely giving birth in health facilities with clinically-trained midwives like Baryou Cadard.
Naomi waits with Nelson to receive his childhood vaccines at Boegeezay Health Center.
Nelson is a testament to the power of community-based primary healthcare: today, he is a happy, healthy toddler as a result of the high quality pre and antenatal care his mother Naomi received from Mama Boe. Now, Nelson is accompanied by Mama Boe to ensure that he remains up-to-date on his vaccinations and can access the care he deserves to grow into an adult and fulfill his potential.

And he’s not alone: In Liberia, teams of community and frontline health workers have increased the rate of children receiving medical care by over 50%, and one out of every five children with malaria is now diagnosed at home. Nationwide, community and frontline health workers have conducted 2.3 million patient visits—and counting. 

‍As more and more community health workers are integrated into the continuum of care, success stories like Naomi’s and Nelson’s are becoming increasingly common—forming a powerful blueprint for accelerating universal health coverage worldwide.
Community and frontline health workers in Doedain District Rivercess County, Liberia. From left to right: Daniel Cassel, Mama Boe, Gahnwarkpa Sarwah, Jacob Sweet, Grace Bonwin, Amelia Doegar, Mamie Wheajue, Isaac Sanwaye, and Nelson Kerneah.

Reflections from Last Mile Health Leadership

Baby Nelson on the day of his birth.
Dear friends, 
‍
Earlier this year we bore witness to the birth of Nelson, a seven pound baby boy from Zeegar’s Town, Liberia. Nelson’s birth was uncomplicated; his mother, Naomi, delivered without incident and returned home with her new bundle of joy shortly thereafter. When teams of community and frontline health workers are integrated within primary healthcare systems, success stories like Naomi’s become the norm.
 
And not just for pregnant women. Community health workers are effective in increasing access to care worldwide. In Ethiopia, community health workers are expanding coverage of immunizations and family planning. And in Liberia, where you’ve worked beside us for 12 years, the Ministry of Health’s National Community Health Assistant Program has deployed a community health workforce that has now conducted over 2.3 million home visits to rural families—providing not only life-saving health services, but also detecting, reporting, and responding to incidents of infectious disease.
‍
Despite this incredible progress, over half of the world’s 7.3 billion people, including one billion in rural communities, still lack access to healthcare. Approximately 13 million children still go without a single dose of any vaccine. Nearly 9 million newborns, children, and mothers still die each year from preventable or treatable conditions. Even exemplar countries like Ethiopia and Liberia face health worker shortages and gaps in quality of care.
‍
But, it is possible to bring healthcare to every last person.
‍
To realize universal health coverage, we must invest in the growing movement of leaders across the health system who are tirelessly working to deliver on the promise to bring quality health services within reach of everyone. This movement includes community health workers that team up with nurses, doctors, and midwives to safely link with clinics and effectively administer lifesaving health services; advocates and policy makers who are holding governments accountable to the health and well-being of their citizens; and philanthropists and partners—like you—that provide the strategic insight and resources to realize a shared vision.
‍
We believe that, with this coalition of movement builders at the helm, a world where everyone, everywhere has access to high-quality healthcare is not only possible, but it is within our reach.
‍
In solidarity,
‍

Raj Panjabi
‍Chief Executive Officer

Lisha McCormick
‍President & Chief Operating Officer

Katherine Collins
Board Chair

Community health worker Abraham Browne conducts a rapid diagnostic test for malaria on a young patient in Grand Bassa County, Liberia.

Revolutionizing a New Standard of Care

Over the last two years, we have partnered with academics, funders, and leading institutions in the community health sector, including BRAC, BRAC University, Fundação Oswaldo Cruz and Sergio Arouca National School of Public Health, the International Institute for Primary Healthcare in Ethiopia, and the University of Liberia, to conduct a global study to identify the drivers of high-performing national community health worker systems. Together, we found that Liberia, Ethiopia, and Bangladesh are outperforming their peers in the design and scale of national community health worker programs.
 
Each of these programs has demonstrated remarkable impact while underscoring important lessons that contribute to their success, such as investing in the systems that support community health workers, supporting government-led coalitions, and leveraging NGO partner expertise.
‍
While these countries are not alone, the learnings that follow provide vital evidence to strengthen and inform national community health worker programs—lessons that we are disseminating to health systems leaders across the globe as part of the Community Health Academy’s first leadership course.
‍
These leaders will turn evidence into impact as they harness this information to replicate large-scale health successes and bring the world even closer to achieving universal health coverage. 

LIBERIA

Konobo District: The percentage of women  who delivered in a health facility*
Gboe-Ploe Districts: The percentage of children  who received care from a skilled healthcare provider*
Rivercess County: The percentage of women who attended four or more antenatal care visits*
National: The percentage of reported malaria cases in children under five diagnosed by community health workers in 2018*

Invest in the Systems that Support Community Health Workers

The 2014-2015 Ebola epidemic exposed the weaknesses of Liberia’s health system, which left nearly one-third of Liberia’s population living in remote communities virtually out of reach of healthcare. In response to this, Liberia’s Ministry of Health and a coalition of non-governmental actors and funders—including Last Mile Health—launched the National Community Health Assistant Program in 2016 to deploy teams of community and frontline health workers to rural communities across the country. Every community health worker receives training and supplies, is connected to a clinical supervisor at the closest facility, and most importantly, is paid for the lifesaving services they provide to their neighbors.

The launch of the program marked the first time a formalized, paid cadre of community health workers was integrated within Liberia’s health system. Now operational in 14 out of the 15 counties, Liberia’s national community health workforce has carried out disease surveillance, reduced preventable deaths, improved vaccination coverage, and, most importantly, transformed access to primary care.
‍
The success of Liberia’s national program is proof that investing in the systems that support community health workers to deliver the highest possible quality of care drastically improves the health outcomes of communities. Thanks to the Government of Liberia, over 80% of Liberia’s community health workforce has been deployed nationwide.
‍ 
As the Ministry of Health looks beyond full-scale of the program to long-term sustainability, the Government is focused on strengthening the quality of programming to enhance supervisor performance, community health worker knowledge, and supply chain management.
Konobo District: The percentage of women  who delivered in a health facility*
Gboe-Ploe Districts: The percentage of children  who received care from a skilled healthcare provider*
Rivercess County: The percentage of women who attended four or more antenatal care visits*
National: The percentage of reported malaria cases in children under five diagnosed by community health workers in 2018*
Proportion of digitally empowered community and frontline health workers
Number of potential epidemic events reported
Number of home visits conducted with pregnant women
Cases of pneumonia, malaria, and diarrhea treated and malnutrition screenings conducted in children under-five
This is some text inside of a div block.
Community and frontline health workers deployed
Number of community clinics staffed by frontline health workers
Number of home visits conducted
Number of women with access to family planning
Number of potential epidemic events reported
Proportion of digitally empowered community and frontline health workers
Number of home visits conducted with pregnant women
Number of home visits conducted
Community and frontline health workers deployed
Cases of pneumonia, malaria, and diarrhea treated and malnutrition screenings conducted in children under-five
Number of women with access to family planning
Number of community clinics staffed by frontline health workers
Data is cumulative from July 1, 2016 to October 31, 2019.

ETHIOPIA

Reduction in
under-five mortality
Reduction in
maternal mortality
Decline in
new HIV infections
Decrease in
malaria-related deaths

Support Government-led Coalitions

In 1990, four out of every ten Ethiopians lacked access to healthcare and maternal mortality was among the highest in the world. After nearly two decades of political instability and war, a new government pledged to improve the country’s health outcomes by introducing a large-scale community health worker program—a robust, coordinated, government-led program integrated into the formal health system and designed to address the most pressing health challenges in rural Ethiopia.
 
From the onset, high-level political leadership aligned a coalition of support across ministries, geographies, donors, and NGOs.This concerted effort encouraged a multi-sectoral strategy, ensured financial backing, and allowed for rapid implementation that brought 35,000 community health workers and built 17,000 health posts in rural communities that had previously been unreachable. The government asked all NGOs to work with the government on this program under what they referred to as the ‘one plan, one budget, and one report’ model.
‍
By 2010, five years after the introduction of the program, 94% of Ethiopia’s population had access to health services. The national program shifted the wider health system’s focus from treatment to prevention, improved coverage of prenatal care, contraceptives, and antibiotics for acute respiratory infections, and dramatically reduced under-five mortality.
‍
Thanks to strong political will and national consensus, Ethiopia has succeeded in achieving most of the health-related Millennium Development Goals and cemented itself as one of the largest community health worker programs in the world.

While Ethiopia has dramatically improved health outcomes, challenges still remain around access to and quality of care, as well as low job satisfaction among community health workers. In line with Ethiopia’s commitment to monitor and refine the program to improve impact, the government is now focusing on strengthening community health worker performance by investing in their education, training, and management capacity.

Reduction in
under-five mortality
Reduction in
maternal mortality
Decline in
new HIV infections
Decrease in
malaria-related deaths

BANGLADESH

Reduction in
under-five mortality
Reduction in
infant mortality
Reduction in
neonatal mortality
Reduction in
maternal mortality

Leverage Partner Resources

Upon gaining independence in 1971, Bangladesh was one of the poorest and most densely populated countries in the world. It had among the lowest number of doctors and nurses per capita and its rural population had little access to healthcare. Bangladesh has made remarkable progress by investing in and refining their national community health worker program. The government has built community clinics and staffed them with community health workers, institutionalizing the role of community health workers and formally connecting thousands of rural villages with the national health system for the first time.
‍
Critical to Bangladesh’s success has been the government’s decision to leverage NGOs to evaluate, innovate, adapt, expand, and improve programming to strengthen access to healthcare across the country. This partnership proved to be effective in helping the government subsidize the human and financial resources needed to deliver primary healthcare services to more than 100 million rural residents. Today, over 130,000 community health workers employed by both the government and NGOs work in a symbiotic partnership to deliver health education, preventive, promotive, and limited curative care across Bangladesh’s hard-to-reach regions. Together, the government and NGOs have expanded community health worker programming beyond its initial focus on family planning to address child health, maternal health, and universal healthcare.
‍
This model, alongside significant investments in education, infrastructure and economic development, has enabled Bangladesh to achieve enormous advances in healthcare including some of the longest life expectancies, lowest total fertility rates, and lowest under-five mortality rates in South Asia. Though implementation challenges related to governance, human resources, and financing remain, Bangladesh has been able to dramatically improve access to health services for rural populations.

Reduction in
under-five mortality
Reduction in
infant mortality
Reduction in
neonatal mortality
Reduction in
maternal mortality
Community-based nurse supervisor Theresa Mah conducts a supervision visit with community health worker Janjay Teedoe.

Partnering with Governments to Design, Scale, Strengthen, and Sustain National Community Health Systems

Building on over a decade of experience, we’re expanding our impact beyond Liberia by partnering with governments to strengthen the quality of community health systems through technical advising, training, policy, and research. We’re also open-sourcing lessons on how to build and sustain high-performing community health worker programs with the belief that, when adopted widely, we can improve the efficacy of health systems worldwide.
LIBERIA
Strengthen and Sustain the National Community Health Assistant Program
VIEW MORE
MALAWI
Strengthen and Scale the National Community Health Strategy
VIEW MORE
UGANDA
Innovations in Performance Management
VIEW MORE
ETHIOPIA
Health Workforce Development
VIEW MORE

Last Mile Health Country Programming

Building on our flagship program in Liberia, we have expanded programming into Ethiopia, Malawi, and Uganda. We are supporting governments alongside a coalition of partners to design, scale, strengthen, and sustain their community health programs.
AMERICAS
38% of Total Learners Enrolled
EUROPE
10% of Total
Learners Enrolled
AFRICA
24% of Total Learners Enrolled
OCEANIA
2% of Total Learners Enrolled
ASIA
26% of Total Learners Enrolled

Community Health Academy

Launched with the TED Prize in 2017, the Community Health Academy partners with Ministries of Health, academic institutions, and other partners to strengthen the clinical skills of community health workers and the capacity of health systems leaders to build systems that deliver quality care. Over 11,600 frontline health workers and health systems leaders across 180 countries are currently enrolled in the Academy’s first leadership course, Strengthening Community Health Worker Programs to Deliver Primary Health Care, which is co-produced with edX and HarvardX.
BANGLADESH
UGANDA
KENYA
DRC
HAITI
MALI
LIBERIA

Integrating Community Health Program

Each of the seven countries in the Integrating Community Health Program is at a critical inflection point in institutionalizing their community health systems through a coalition effort of in-country implementers and collaborative partnerships including USAID, UNICEF, Last Mile Health, Population Council and the Bill & Melinda Gates Foundation. We are collectively working to improve health coverage by building consensus and political will around the effectiveness of integrated, government-led community health programs in partnership with Ministries of Health and local leadership of Integrating Community Health partners.
Logistics Officer Bartue Saylee pushes his motorbike across a log bridge in a Liberian rainforest.

Mobilizing a Movement of
Frontline and Health System Leaders

Exemplary programs in Liberia, Ethiopia, and Bangladesh have shown us that it is possible to bring quality primary healthcare to the hardest-to-reach communities. We’ve seen teams of community and frontline health workers improve healthcare delivery and save lives around the world. They have shown us that equity in access to care is not only possible, but it is within our reach.
‍
To scale this progress, we must continue to invest in the systems and support networks needed for community-based healthcare to flourish. But to accelerate a movement, we must also invest in the leaders—the heroes—who drive its success.
‍
Meet the heroes working with courage and conviction, day in and day out, to bring the world closer to universal health coverage.

Madeleine
Ballard

Advocating for high-impact community health systems design

Robyn Calder

Driving impact through collaborative philanthropy
read more

Baryou Cadard

Reducing maternal mortality through facility-based delivery
read more

Albertha Freeman

Empowering community health workers to reach their full potential
read more

Angela Gichaga

Narrowing the funding gap for health systems across Africa
read more

Richard Kintu

Building
consensus through evidence-based design
read more

Rosaline Moenga

Bringing healthcare to remote communities in Kenya
read more

S. Olasford Wiah

Integrating community health into the national policy
read more

Asok P. Sharma

‍Navigating community-based primary healthcare in rural Asia
read more

S. Olasford Wiah

Integrating community health into the national policy
read more

Rosaline Moenga

Bringing healthcare to remote communities in Kenya
read more

Asok P. Sharma

‍Navigating community-based primary healthcare in rural Asia
read more

Richard Kintu

Building
consensus through evidence-based design
read more

Angela Gichaga

Narrowing the funding gap for health systems across Africa
read more

Baryou Cadard

Reducing maternal mortality through facility-based delivery
read more

Albertha Freeman

Empowering community health workers to reach their full potential
read more

Madeleine
Ballard

Advocating for high-impact community health systems design

Robyn Calder

Driving impact through collaborative philanthropy
A community health worker conducts a screening for malnutrition on a young patient in Rivercess County, Liberia.

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 a health worker within reach of everyone, everywhere.

CLICK HERE TO View OUR PARTNERS

Fiscal Year 2019: July 1, 2018 to June 30, 2019.
‍Click here to view our most recent audited financial statements.

Community Health Worker Harriet Kaimue of Bohn Town, Grand Bassa County, Liberia with her daughter.

Join Us in Bringing Quality Healthcare #WithinReach

To achieve a future in which quality health services are within reach of everyone, everywhere, we need to continue investing in the people and systems working to extend healthcare to women like Naomi and children like Nelson.
‍
We all have a role to play in improving access to and quality of health services that leave no one behind. Together, we can achieve universal health coverage.

Join us:
  • Nominate a leader from your community who makes you optimistic that universal health coverage is within reach. Tag @LastMileHealth and use #WithinReach to give your nominee a chance to be featured in an upcoming story.
  • Join the community of health systems leaders who are learning how to build, optimize, and advocate for national community health worker programs. Register today for the Academy’s first leadership course.
  • Empower teams of community and frontline health workers to transform health outcomes and save lives in the world’s most remote communities. Donate today.
  • Share the video below to show how health workers like Rosaline are bringing care to remote communities.
Copy Writer 
Rebecca Gifford
‍
Designer 
Aimee Edmondo
‍
Opening image caption: A patient and his mother travel alongside community health workers to reach a health clinic in Grand Bassa County, Liberia
‍
*Liberia IMPACT DETAILS:‍