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 Health  Liberia Project #19463

Last Mile Health - Urgent Ebola Response Campaign

by Last Mile Health
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign
Last Mile Health - Urgent Ebola Response Campaign

As the restoration of health services across Liberia continues, Last Mile Health remains committed to improving access to essential, quality healthcare for children and adults living in the most remote parts of the country. In Rivercess County, a total of 226 Community Health Workers (CHWs) have been recruited and trained over the last three months, expanding the provision of primary health care to almost 250 remote communities. They join 57 existing CHWs in Grand Gedeh County in ensuring that people do not forget about the threat of Ebola and continue to take precautions and recognize the danger signs associated with this highly infectious disease.

Reflecting on the weeks before her training in Ebola response, CHW Musu from Nimba Junction explains just how crucial a role this was and continues to be.

According to Musu, it was common belief in her village that Ebola was not real. Furthermore, people were horrified by the prospect that they would be cremated rather than buried by their families in the traditional way if they should contact the virus. It was a harrowing time and people were afraid.

As a general Community Health Volunteer (gCHV) and member of the Community Health Committee (CHC), Musu was summoned to the nearby town of Bodowhea to attend Last Mile Health’s Ebola response training. There, she learnt about the clinical nature of the virus and was given the knowledge and tools she needed to prevent its spread and, if required, contain an outbreak in her community. This included relevant talking points for community education on the cause of Ebola and training on simple but effective infection prevention and control protocols.

Musu held a respected role as a gCHV, through which she was able to convince those in her community that the threat from Ebola is real. Just as she had learned, Musu went from house-to-house educating her neighbors on the importance of raising the alarm if anyone became seriously ill or showed signs of the virus. She showed them how to adapt plastic buckets to make hand-washing stations and succeeded in making this a routine practice.

Today, Musu is no longer a gCHV. Having been selected by her local CHC to undergo a rigorous interview, literacy testing and training process, Musu joined Last Mile Health’s first cohort of CHWs in Rivercess County last year. With the ongoing support that she receives, she has been able to reinforce her knowledge and skills, and continue to build the trust of her community. Even though Ebola has gone from Liberia, Musu’s neighbors know that it is real and are mindful that it could return at any time.

This is the message that new CHWs in Rivercess have been taught and are carrying to each and every remote village in the county. In addition to knowing how to identify, isolate, and refer Ebola cases, they are able to establish the foundation for continued service provision through community mapping and household registration. In this way, they are helping to fulfill Last Mile Health’s vision to see a health work for everyone, everywhere.

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Zacharino (right) undertakes the riding test
Zacharino (right) undertakes the riding test

Over the last three months, Last Mile Health has driven forward the expansion of a Community Health Worker (CHW) program in Rivercess County – a remote area of Liberia where the organization first started working in late 2014. In partnership with the government health authority, the County Health Team, last mile communities were protected from the Ebola crisis and are now gaining access to primary health services within their own communities through CHWs. The story below introduces you to someone who line manages a group of these CHWs, a dedicated and skillful member of our frontline team: Zacharino.

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In early 2015, Zacharino Garsaynee starting working with Last Mile Health to provide Ebola response trainings to community leaders in Rivercess County, Southeast Liberia. Zacharino’s role in the training required dedication and flexibility, as the challenges of rapid implementation during a time of crisis were compounded by the lack of transport and communication infrastructure.

As Last Mile Health looked to transition from their response to Ebola to their pre-existing model of using professionalized CHW’s to provide high-quality primary health services in all of Rivercess County’s remote communities, Zacharino was encouraged to apply for the full-time role of Community Health Worker (CHW) Leader.

The role of CHW Leader was one that Zacharino was already enthusiastic about, as he had lived in Zwedru, where Last Mile Health was founded, for six months. There, he had learned about a CHW program in the remote district of Konobo, where CHW leaders would travel by motorbike and foot to conduct weekly supervision visits among 10-12 CHWs all serving villages that were several hours from the nearest health facility. Particularly due to poor road and weather conditions, the role would demand the same dedication and flexibility that had been required of Zacharino during his earlier Ebola response work.

Zacharino applied for the role, was hired, and is now fully immersed in his work as a CHW Leader, playing a crucial role in transforming health service provision in the remote county through expanding community-based services. The Community Health Workers he supervises together serve over 2,500 Liberian’s living at the last mile, protecting them from disease outbreaks, and providing preventative and curative services for malaria, diarrhea, and acute respiratory illnesses among children less than five years of age.

Zacharino’s enthusiasm remains undimmed: while Liberia’s long rainy season has made his work consistently more difficult and time-consuming, he has expressed that overall he enjoys it and feels it’s very impactful.

Zacharino takes notes during a training workshop
Zacharino takes notes during a training workshop

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Meet Felecia Boe: Young mother, Outstanding Student, and Community Health Worker

As of September 3, 2015, Liberia was again declared Ebola free, after passing 42 days with no cases reported. As a result, Last Mile Health has shifted its Ebola response strategy into a long-term plan to train Community Health Workers (CHWs) to provide essential health services to their own communities. Ebola response services as part of the first training modules CHWs study, in recognition that CHWs are uniquely positioned to help prevent future outbreaks.

Last Mile Health recently completed recruitment and basic training of 120 CHWs in Rivercess County. The account below introduces you to one of the new CHWs Last Mile Health has recently trained, Felecia Boe.

 

In 2003, with Liberia’s second civil war coming to a close, Felecia Boe’s first pregnancy forced her to drop out of school in the third grade. After moving to live in the city with her uncle, she graduated high school and returned to her home village, Yolo, where she started a family and became a respected member of the 500-person community, which subsequently nominated her to become a Community Health Worker with Last Mile Health.

During her training, she was introduced to Last Mile Health’s vision to see a health worker for everyone, everywhere. She was trained to identify, isolate, and refer Ebola cases, and to establish the foundation for later service provision through community mapping and household registration. She will soon be trained in Integrated Community Case Management (iCCM) to treat malaria, diarrhea, and acute respiratory infections in children under five.

Felicia will fulfill our collective aim to establish access to health services in remote places like Yolo, more than six hours’ walk from the nearest health facility. Felicia is a core representative in the Government of Liberia and Last Mile Health’s plan to expand health care access to all 1.2 million Liberian’s living in remote communities.

 

The Last Mile Health team is grateful for your support, which enables us to be part of an effective Ebola response, and to realize our vision for every Liberian - especially those living in the most remote places - to have access to quality healthcare.

We believe that the most effective way to have widespread impact is through supporting the Liberian government, which shares the same vision. We’re interested to hear from you about other organizations who have combined implementing programs and supporting the local and national government, as an opportunity for possible learning exchanges.

Links:

Solomon Kangar, CHW Leader in Rivercess
Solomon Kangar, CHW Leader in Rivercess

In partnership with the Ministry of Health's county-level authorities - the Rivercess and Grand Gedeh County Health Teams - Last Mile Health (LMH) has trained a total of 1,382 health workers to respond to the Ebola outbreak in Liberia. Replication of this coordination between governmental and non-governmental partners across Liberia contributed towards an effective response, and Liberia was declared Ebola-free on May 9th, 2015, following two consecutive twenty-one-day incubation periods without a confirmed case.

On June 29th, Liberia's post-Ebola relief was broken as a post-mortem test on a seventeen year old boy confirmed a new case of Ebola Virus Disease (EVD) in Margibi County, close to the capital, Monrovia. Two people who were in contact with the boy before his death have since tested positive for EVD. This cluster of new cases has again demonstrated the need for community-based health workers, such as those of LMH, to swiftly respond to outbreaks, both through identifying, isolating, and referring cases in affected communities, and preparing unaffected communities to prevent infection spread through maintaining good hygiene, avoiding contact with the sick, and alerting health workers to assess suspected cases.

As part of Last Mile Health's commitment to ensure quality healthcare is accessible to all, LMH is currently serving in the role of technical advisor as part of a government-led coalition to advance a national workforce of professional Community Health Workers (CHWs). The National Health Workforce Plan specifically focuses on the role of professionalized CHWs in providing access to healthcare by serving remote communities. 

National level plans will be realized through the recruitment and training of CHWs, supervised by CHW Leaders like Solomon Kangar, (pictured, above), who are key to ensuring that the programs are implemented as designed at the community level.

Solomon Kangar is a CHW Leader who graduated from the Last Mile Academy (an LMH training program specifically for CHW Leaders & Community Clinical Supervisors) in May 2015. He will supervise between ten and twelve CHWs in Jowien district, a particularly remote area of Rivercess County.

Solomon stood out during the Last Mile Academy training as an enthusiastic and encouraging participant. During a twenty-two kilometer hike, he chose to stay towards the back of the group to support his colleagues who were finding the walking more difficult. He is a skilled motorbike rider, who has expressed his excitement about the opportunity to serve communities in Rivercess - his home County - through supervising CHWs. 

The Last Mile Health team is grateful for your support, which enables us to be part of an effective Ebola response, and to realize our vision for every Liberian - especially those living in the most remote places - to have access to quality healthcare. 

We believe that the most effective way to have widespread impact is through supporting the Liberian government, which shares the same vision. We're interested to hear from you about other organizations who have combined implementing programs and supporting the local and national government, as an opportunity for possible learning exchanges.

Links:

Training facility staff to prevent infection.
Training facility staff to prevent infection.

Summary

Last Mile Health (LMH) has leveraged its experience gained in piloting a professionalized community health worker project in Konobo district to directly respond to Ebola on the community and facility levels in Rivercess and Grand Gedeh counties, also providing support to the Ministry of Health to galvanize an effective national response.

LMH recognizes that an effective Ebola response must be followed by comprehensive health system strengthening work, ensuring that Liberians swiftly gain greater access to health services and are protected from future outbreaks.

The Community Level

Last Mile Health has trained 801 health workers and promoters to respond to Ebola in Rivercess County, focusing its Ebola response efforts at the community level, in recognition of its importance in swiftly identifying cases, transferring patients to care, and preventing infection spread.

The majority (573) of those trained are Community Health Committee (CHC) members. CHC members are chosen based on  their position of influence in communities, and include town chiefs, elders, religious leaders, and leaders of women and youth groups. CHC members are trained to communicate Ebola awareness and prevention messages to community members, as well as to establish procedures that would facilitate a safe response, should a suspected case emerge. As Liberia shifts from urgent Ebola response to health systems strengthening, CHCs will act as additional support and accountability mechanisms for community health workers.

The second largest group (113) trained are general Community Health Volunteers (gCHVs). Prior to the Ebola outbreak, these workers had received some basic healthcare training, and were supplying some medicines to their communities, to varying degrees, on a voluntary basis. Last Mile Health trained these gCHVs to conduct Ebola awareness training, contact tracing, and screening for symptoms as part of active case finding, providing a monthly incentive of $60 for the completion of this work.

It is expected that some of these gCHVs will be recruited by LMH to provide ongoing provision of primary health care to their communities. Over the coming eighteen months, LMH will recruit community members across Rivercess to become professionalized community health workers, absorbing those gCHVs that meet basic recruitment criteria. Trainings will be delivered that equip them to provide life-saving interventions that focus on combating the greatest threats to the lives of rural Liberians, and they will be supported by a network of supervisors who meet with them weekly, providing drug re-stocks, ongoing coaching, collecting data, and delivering their monthly incentive.

The Facility Level

Across the nineteen facilities in Rivercess, Last Mile Health has established infection prevention and control (IPC) procedures, to equip facilities to safely receive suspected Ebola patients. These trainings have been succeeded by monitoring and enhanced supervision (MESH), to troubleshoot problems, and ensure that standards are being maintained.

Dr. Ami Waters, LMH’s IPC coordinator in Rivercess, reported that facility staff had been afraid to come to work because of the real risks of becoming infected. She says after having received training on IPC standards, they feel confident returning to work to care for patients. In total, 222 facility-based staff have been trained.

Last Mile Health has distributed facility IPC kits across Rivercess, delivering trainings to staff on how to best use these. The contents of each kit includes personal protective equipment for the protection of health workers, temporary fencing that can be used to triage patients, and equipment to ensure safe waste management.

The National Level

At the national level, Last Mile Health has provided immediate support during the Ebola crisis, and has also been working with the Ministry of Health and two other partners to develop the Health Workforce Plan, setting the agenda for health system strengthening.

For the duration of the crisis, LMH seconded a full-time technical advisor to the national Incident Management System (IMS), who has helped to coordinate response at the national level over the past year. IPC standards developed by LMH’s medical team have been adopted by organizations responding to Ebola across the country.

As Liberia transitions out of response mode, it is hoped that the Health Workforce Plan will set the agenda for the establishment of an accessible and high quality health system across Liberia, over the next ten years. This plan is based on the training of thousands of professionalized community health workers, nationwide. Pending the receipt of funding approval, LMH is currently navigating the role it will play in the implementation of this plan.

Patience (center) screens her neighbor for Ebola.
Patience (center) screens her neighbor for Ebola.

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Organization Information

Last Mile Health

Location: Boston, MA - USA
Website:
Project Leader:
Tommy Good
Boston, MA United States

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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.
   

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