Advancing Health & Gender Equity in Africa
In 2022 Last Mile Health (LMH) committed to partnering with ministries of health in Liberia, Ethiopia, and Sierra Leone to realize a vision of a resilient health system, powered by trained, equipped, salaried, and supported community health workers (CHWS) . Through designing blended-learning curriculums, introducing training in maternal and child health care, and increasing the number of paid female workers, LMH seeks to advance gender equity and strengthen health systems.
Last Mile Health (LMH) trains CHWs by partnering with governments to design curricula and training to strengthen skills and performance. By upskilling the community health workforce and increasing the number of paid CHWs, LMH strengthens health systems, delivers high-quality care, and advances gender equity.
Building from 15 years of experience, LMH will partner with the governments of Liberia, Ethiopia, and Sierra Leone to train CHWs to strengthen the delivery of primary health services to remote communities and increase the number of paid females CHWs.
In Liberia, as the lead technical partner for the national CHW program, LMH is working towards fully scaling and sustaining the national program, with a focus on increasing the number of female CHWs to strengthen quality of care for mothers and children. Building on a pioneering gender assessment, LMH and the government will evaluate the barriers for women to become paid CHWs, revise the national policy, and recruit more female CHWs.
In Ethiopia, the Ministry of Health (MOH) invited LMH to design an in-service training program for CHWs to increase performance. Leveraging the success of a reproductive, maternal, and child health pilot, LMH will scale blended training (incorporating face-to-face and digital training) to 1,000 additional CHWs over the next year–with the potential to eventually reach all 40,000 CHWs working nationwide, majority of whom are female.
In Sierra Leone, LMH is partnering with the MOH to implement a revised integrated national CHW program in the country. The integrated national program aims to train 8,700 CHWs to deliver a comprehensive service delivery package for mothers and children. LMH is a key technical partner, providing upskilling and monitoring and evaluation support.
This commitment represents a foundational investment in the lead up to Last Mile Health’s next five-year strategy, to be launched in 2023.
The development of an improved, competency-based curriculum for CHWs
165 community and frontline health workers trained in District #1, Grand Bassa County, with 30% identifying as female
Adjust National Community Health Policy and accompanying documents to provide the necessary enabling environment for female community health workers to function equitably to their male peers, including addressing safety, and transportation challenges
30% of newly recruited community health workers nationwide are female
1,000 additional CHWs trained in the reproductive, maternal, and child health module by June 2023, serving as a proof point for eventually scaling this approach to all 40,000 CHWs across the country
Develop and user test high quality blended learning content for non-communicable disease and communicable disease modules for CHW in-service training by June 2023
Design and pilot test interventions (including targeted training and direct service delivery) in four pilot districts to improve management of sick children following the reproductive, maternal, and child health module
Package results of pilot to inform national and global evidence base
Co-development of improved training and curricula materials for CHWs deployed under the revised CHW program policy and strategy
Co-develop monitoring, evaluation, and learning plan for the national CHW program in partnership with the Ministry of Health and Sanitation
Half of the world’s population lacks access to essential primary healthcare (World Health Organization) . This gap is particularly acute in remote communities, where two billion people live outside of the reach of healthcare (World Health Organization) . This has only been exacerbated during the pandemic – for every COVID-19 death, more than two women or children have died as a result of disruptions to health systems (Global Financing Facility) .
Illness is universal, access to healthcare is not. But we can change that when we invest in community health workers (CHWs) , who provide primary health services to their neighbors. Studies show that training and professionalizing CHWs can save more than three million lives annually (Journal of Global Health) . CHWs can maintain primary health services during crises like COVID-19 and contribute to reductions in child and maternal mortality (Exemplars in Global Health) .
However globally, there are not enough paid CHWs to meet demand. There is a massive health worker shortage, with 18 million more health workers needed by 2030 (World Health Organization) . Training this workforce is a crucial component of strengthening health systems, but it can be expensive and unevenly delivered, leading to significant gaps in patient care. Suboptimal training plagues CHW programs and contributes to lower job satisfaction and performance and prevents these programs from reaching their full life-saving potential (World Health Organization) . A focus on training alone isn’t sufficient to build the community health workforce – it’s also about fair pay and recognition of the critical role women play in the existing workforce. 70% of the community health workforce is female worldwide, and at least 6 million women are working unpaid or underpaid (Women in Global Health) .
A healthier, safer, and more gender-equal world is within reach, and it starts with investing in high-quality training for CHWs and pathways to professionalization for women.
In Ethiopia, 388 CHWs were trained in reproductive, maternal, and child health. Phase 1 of developing a training module regarding non-communicable diseases/communicable diseases commenced with a Ministry of Health workshop in November 2022 to produce blended learning curricula. This approach was integrated into national guidelines for Health Extension Program, which is a tremendous milestone to enhance delivery of training for all 40,000 CHWs deployed nationwide.
In Liberia, the Ministry of Health launched a national community health policy, focusing on increasing gender equity. Building on an assessment that examines gender responsiveness of the program, the Ministry is adjusting its recruitment approach/curriculum to increase female employment as CHWs. Last Mile Health, alongside the Ministry of Health, hosted the 3rd International Community Health Workers Symposium in March 2023 in Monrovia; professionalizing the community health workforce included in the Monrovia Call to Action. In Grand Bassa District, 134 CHWs were recruited; 36% identifying as women. In Montserrado County, 32% of the 160 recruited CHAs are female, with the following variation in districts: Commonwealth — 40% female, Careysburg — 33.3% female, Todee — 30% female, and St. Paul — 27.5% female. These outcomes are a success compared to the national gender ratio (less than 20% female) . While more work is needed to improve access to education and social status for women, strong leadership and emphasis on female participation in the National Community Health Program are effective.
In Sierra Leone, LMH continued co-development of training and curricula for CHWs deployed under the revised program policy. They also supported co-developing monitoring, evaluation, and learning plans for the program, alongside the Ministry of Health and Sanitation. Phase 2 of training for the National CHW Program concluded with ~8,000 CHWs trained across the country. LMH supported 15 Quality Assurance Officers to monitor the 23-day training.
Technical expertise in upskilling the community health workforce to deliver high quality primary health care in remote communities.