APPROACH
In conjunction with the Government of Liberia, Last Mile Health (LMH) will bring high quality health care - for the first time - to 150,000 rural Liberians, with the goal of accelerating national progress toward MDGs 4, 5 and 6. Last Mile Heath will do this by scaling its innovative, high-impact Frontline Health Worker (FHW) model, that was developed and deployed as part of its 2011 CGI commitment, to an additional ten Liberian health districts by June 2017. Additionally, LMH will work in conjunction with the Government of Liberia to leverage lessons learned from the LMH FHW model, and build a partnership mechanism with government centers and affiliate organizations throughout the country to ensure access to care for an additional 1.35 million Liberians in the future.
In collaboration with the Government of Liberia, LMH will serve as the primary implementing partner for this commitment. With primary goals of reducing under five child mortality by at least 33%, increasing access to prenatal and skilled maternal care by 50%, and secondary goals of increasing access to HIV, TB, malaria and NCD diagnosis and treatment by 50%, LMH will provide the following resources:
Training and Curriculum: An evidence-based curricula has been systematically developed based on local quantitative and qualitative data, to permit LMH FHWs to bring life-saving treatment, prevention and care to fight the five leading causes of child, maternal and adult mortality and morbidity, including childbirth complications, pneumonia, malaria, HIV, and mental illness, in remote villages lacking doctors.
Support and Supervision: By applying recent advances in telemedicine and mobile health, FHWs will be supervised and supported by a network of mid-level clinicians based in public health centers. (Note: Communications between FHWs and clinicians are enabled by key advances in access to telemedicine in Konobo - a direct result of the 2012 LMH/Medic Mobile CGI commitment.) With training, support and supervision, LMH will recruit, train and manage FHWs to respond to 85% of health problems typically handled by a primary care doctor, delivering access to a quality primary health care system for all villages, including those without doctors, for the first time.
Monitoring, Evaluation and Dissemination: LMH and its partners will demonstrate not only the health impact but also the economic value of the model. These outcome, systems, and economic data will be shared via scientific literature and through an open-access portal, allowing this work to be shared with and receive critique from others working in rural settings. Having demonstrated the heath and economic value of the frontline health corps, LMH will build, in collaboration with the Liberian Ministry of Health, an adaptable mechanism to certify, hire, and sustain this new village-grown workforce within the African public health sector.
ACTION PLAN
Phase I (October 2013 - June 2014): LMH will expand the Konobo FHW model to a second district in Konobo. LMH will recruit, train and deploy a second cohort of 30 FHWs (thereby doubling the number of FHWs currently operating in Konobo district) to bring primary health services to an additional 15,000 people that currently lack access to care. Through this expansion, LMH will demonstrate that the outcomes of its FHW pilot model (i.e. reduction in child mortality and improved access to maternal health services) are replicable and will strengthen systems to support role out of additional cross-site programming.
Phase II (July 2014-June 2017): LMH will hire a total of 300 FHWs to bring primary health services to 150,000 people currently without access to care across 10 health districts. In Phase II, LMH will also create a partnership mechanism to replicate our FHW model through alliances with government centers and affiliate organizations throughout the country.
LMH currently partners with two health districts and by July of 2015 it will partner with four, by July 2016 six, and by July 2017 ten. Given LMH's existing base of operations in Grand Gedeh, and given that the majority of districts that are >10km from a health facility are in the Southeast, LMH will conduct a district health assessment in the five Southeastern counties (Grand Gedeh, Sinoe, Grand Kru, Maryland, and River Gee) in the summer of 2014. Similar to the health district assessment conducted by LMH in Grand-Gedeh in winter of 2012, the summer 2014 assessment will gather necessary information about each district in order for LMH to make an informed decision about where to best devote resources and in what sequence.
According to the World Health Organization, one billion rural people around the world, including 400 million rural Africans, go their whole lives without seeing a health worker. It is becoming increasingly clear that villages that are remote and hard-to-reach are the final frontier of global health; these so-called 'last mile' villages are precisely where the fight to improve child and maternal health, and control HIV/AIDS, tuberculosis, malaria and malnutrition, is most likely to fail. This crisis is accentuated in Liberia's last mile communities where, according to the Liberian Demographic and Health Survey, 1.5 million people currently lack access to care because they live too far from a doctor and/or healthcare facility.
It has never been clearer that new solutions to village health delivery are desperately needed. Village health workers - community health workers and primary care providers in rural clinics - are the first and often the only point of contact to the health care system for millions of people in remote villages.
Unfortunately, while village health workers have been recognized as potential high-impact solutions, they remain undervalued by most health systems. A combination of insufficient investment and reliance on an outdated model has prevented community health workers and rural primary care providers from reaching their full potential to save lives in remote villages. There is a critical need for a new 21st century model that reinvests in and leverages innovation to bring modern primary care to last mile villages.
