Physical Health Liberia Project #19463

Last Mile Health - Urgent Ebola Response Campaign

by Last Mile Health

Last Mile Health - Urgent Ebola Response Campaign

Project Report | Jul 14, 2015
Stop Ebola, Start Providing Access to Health Care

By Peter Harrison | External Communications Coordinator

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.

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Apr 15, 2015
Last Mile Health: Ebola Response in Liberia

By Peter Harrison | External Communications Coordinator

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.

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Feb 5, 2015
Last Mile Health Quarterly Report Oct-Dec 2104

By Lisha McCormick | Director, Partnerships & Development

Last Mile Health

Quarterly Report October - December 2014

Ebola Response Update

Working with the Rivercess and Grand Gedeh County Health Teams, Last Mile Health (LMH) has executed a coordinated Ebola response effort and laid the foundation for rebuilding a resilient health system covering all eight administrative districts in Rivercess County, and three districts in Grand Gedeh, with a total population of close to 93,000 people. Teams in both counties and in Monrovia are ensuring that the response reaches across the community, facility and national levels.

Facility Level: By January, LMH medical teams visited all 33 health facilities in Grand Gedeh and Rivercess Counties, training staff in effective infection prevention and control (IPC). Through the establishment of a MESH (Monitoring & Enhanced Supervision of Health facilities) network, LMH will follow-up monthly to troubleshoot problems and ensure that standards are being maintained. LMH-developed IPC measures for health facilities have been shared and are being used by organizations across the country.

Community: By the end of December, LMH trained 132 community health workers (CHW), 23 CHW supervisors and 133 community health committee members in Ebola response and social mobilization. CHWs were also trained in case identification and contact tracing.

National: LMH provides ongoing support to the Ministry of Health (MOH) in developing and implementing a cohesive national Ebola response strategy, through embedding LMH staff in the Incident Management System, and participation in the MOH’s restoration of health services initiative.

Impact in Konobo: Key Performance Indicators

While Liberia has grappled with this monumental public health crisis, its already fragile progress on key health indicators has stagnated, and in many areas, regressed. The MOH estimates that almost 50% of health services are not functioning at full capacity. Both Grand Gedeh and Rivercess have experienced major reductions in immunization rates and maternal health services. Rates of women receiving the WHO-recommended four or more antenatal care (ANC) visits in Grand Gedeh have dropped from 81.5% to 62.2% and vaccination rates have plummeted by 50%. In Rivercess, the percentage of women who receive four ANC visits has fallen from 65% to 41.3%. While community health services have halted in many regions, in Konobo, LMH’s 55 FHWs have preserved and restored health services. FHWs have treated over 4,000 cases of childhood pneumonia, malaria and diarrhea since the outbreak began and maintained high levels of facility-based delivery (79%) and prenatal care (95%).

Recent data collected by our Monitoring and Evaluation team show progress in Maternal and Neonatal Health (MNH) in particular. As displayed in the graph below (reflecting five year averages), over the last two years, there has been an 18.4% jump in the number mothers receiving the WHO-recommended four antenatal care (ANC) visits, and the number of pregnant women who received zero ANC visits dropped 50%. LMH remains committed to Konobo and will work with its FHWs to restore the upward trend as Liberia recovers from Ebola.

Mapping Our Growth

Konobo: In 2012, LMH piloted its FHW model in Konobo—the lightly shaded region on the right of the map. Now its innovation site for testing new features of the model, LMH rolled out a new ‘near-facility’ cohort of FHWs in Konobo. Near-facility FHWs fill a gap in the referral link between remote FHWs and the facility. For example, these 13 new near-facility FHWs will be able to monitor pregnant women who have relocated closer to the facility during the month prior to their due date. Combined with the original cadre of 42 FHWs, LMH now supports a total of 55 FHWs and 6 FHW Leaders in Konobo.

Gboe-Ploe, the central shaded area on the map, is one of the most isolated regions in Liberia, with some villages located a 23 hours’ walk from the nearest health facility. In December, LMH sent a small team to assess the area and reconfirmed its commitment to replicate the program and recruit 26 FHWs to serve an area of 6,300 people.

Rivercess County represents the largest portion of LMH’s work to scale-up the FHW model in 2015. Relationships built with the County Health Team through collaborative Ebola response work have paved the way for future growth, with LMH committed to serving the county and its residents on a more permanent basis. It is hoped that by September, the first two FHW modules will have been delivered to roughly 297 FHWs. These include provision of integrated Community Case Management (iCCM) services for malaria, diarrhea, and acute respiratory infection, and signify the commencement of essential health care provision for an estimated 72,000 people.

Vision for National Scale – the Health Workforce Program

At the government level, LMH’s Health Systems Policy & Planning team have been working with the Ministry of Health (MOH) and the Clinton Health Access Initiative (CHAI) to develop a 10-year Health Workforce Program (HWP). The plan seeks to train and deploy over 11,000 professional community health workers (CHWs) across Liberia as part of health systems strengthening founded on community-based healthcare provision.

Her Excellency, President Ellen Johnson Sirleaf has voiced strong support for the plan, saying ‘I could not agree more about building local capacity. Our 10-year health workforce plan is about building that capacity at all levels – particularly at the bottom.’

LMH is committed to partnering with MOH and CHAI to deliver a comprehensive, universally accessible health system through the HWP that serves rural Liberians, ending the inequality of access to services based on living too far from a health facility. In 2015, LMH will work with the Rivercess County Health Team to recruit and deploy close to 300 CHWs for 100% coverage of the county. Combined with facility support, this network of CHWs will restore and improve the quality of essential health services and create a countywide model for rebuilding a resilient health workforce that can be replicated nationwide as part of the National Health Workforce Program.

Serving the Last Mile: Going to Gboe

On December 31st, Steve Selinsky checked in for LMH’s assessment team: “Crashing for the night in Zammie Town. Happy New Year all.” Meaning? Last Mile Health is back in Gboe, for good.

Gboe is the southern region of Gboe-Ploe, a geographically remote and neglected district in the southwest corner of Grand Gedeh County. The dense jungle and sprawling rivers and creeks leave all but one community in Gboe inaccessible by road. Most trails between communities are too narrow even for motorbikes, and can only be reached on foot. There is no cell service (Steve’s message was sent via an InReach Satellite Communicator), no electricity, safe water supply or latrines, no policing or health facility, and no external organizations working in region. Last year, an international health partner trained a cadre of general Community Health Volunteers, but only one of these has ever requested more medical supplies, signifying a serious lack of service provision.

In October 2013, Team ‘Not For Fun’ – affectionately named because of the torrid travel required to reach Gboe – trekked out to the remote region to scope the area as a potential LMH site and to welcome a group of valued partners and friends who visited to gain a first hand view of the settings in which LMH operates. The need, even for the most basic of services, was confirmed—two thirds of children under-five were found to have at least one of the most pressing childhood illnesses: malaria, pneumonia or diarrhea. Half had all three. With the nearest facility a 23-hour walk away, community members are likely be considered not ill enough to make the trip worth the effort, or too ill to be capable of making it.

Just over one year later, in December 2014, Steve Selinsky (LMH Project Officer) led a team back into Gboe to conduct a further assessment and begin community engagement with six villages. Patrick, LMH mechanic, ensured that the team’s motorbikes bore them safely to and from the area, while Theo, a long-serving member of LMH and FHW Leader, explained to community members what LMH does, how we work, and what our impact is on the health of communities.

Plans are now being made for how the FHW program will be successfully translated into, and sustained in, Gboe. Compared with Konobo, Steve describes Gboe as ‘an entirely different game’. Gboe’s isolation, its absence of available health services, and indeed any other services, places it firmly under the definition of ‘last mile’. Motivated rather than daunted, LMH will work to fulfil our commitment to Gboe and bring life-saving essential health care provision to the region in 2015.

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