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 Health  Liberia Project #5983

Save Lives in the World's Most Remote Villages

by Last Mile Health
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages
Save Lives in the World's Most Remote Villages

Grace works as one of Liberia’s 3,600 community health workers. She provides essential, lifesaving care to her neighbors in a remote community in Rivercess County and is supported by a clinical supervisor who visits regularly to ensure that she has the lifesaving drugs, supplies, and mentorship needed to provide quality care. Approximately 30% of Liberia’s 4.6 million people live farther than five kilometers from a health facility, requiring them to travel long distances, often at great cost and through dense rainforest to reach traditional points of care. Launched in 2016, the National Community Health Assistant (CHA) Program is a government-led initiative that serves those living in the country’s most remote areas.

As the National CHA Program approaches full scale, Last Mile Health is supporting the Ministry of Health to deepen the quality of service delivery in programmatic areas, such as nutrition, to ensure a healthy future for rural communities. Nationally, nearly one-third of children under the age of five suffer from chronic malnutrition and almost half a million are anaemic.

Grace has six children, including her twin girls Mara and Clara. When her twins turned six months old, she started doing routine malnutrition screenings for them every month. One of the twins began to lose weight after introducing complementary foods and Grace immediately used her knowledge as a CHW to provide her child with the healthiest diet possible. When she didn’t improve, Grace notified her nurse supervisor who counseled her to make a few changes to her breastfeeding routine. Within two weeks, her daughter had fully recovered.

To address more widespread nutritional barriers in Rivercess – a site of innovation for the national program – Last Mile Health, along with the county division of the Ministry of Health, conducted surveys in local food markets, focus group discussions, and a barrier analysis to better inform service delivery by community and frontline health workers. It is now working to support CHAs like Grace to augment healthcare service provision with community-based nutrition education, including the promotion of diversified protein sources such as small livestock and home-grown produce, as well as an emphasis on breastfeeding practices. Through these efforts, community and frontline health workers aim to improve nutritional outcomes, particularly for women and children, so that they are more likely to live healthy, productive lives.

 

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Daniel works as one of Liberia’s 3,500 formally employed community health workers. He provides essential, lifesaving care to his neighbors in a remote community in northern Rivercess, supported by Ghanwarkpa, a clinical supervisor who visits him regularly to ensure that he has the lifesaving drugs, supplies, and mentorship needed to provide quality care. Approximately 30% of Liberia’s 4.6 million people live farther than five kilometers from a health facility, requiring them to travel long distances, often at great cost and through dense rainforest to reach traditional points of care. Access has long been a challenge, contributing to significant disparities in service delivery and health outcomes across Liberia. Launched in 2016 – more than two years after the world’s deadliest Ebola outbreak began in a remote West African community not too dissimilar to Daniel’s – the National Community Health Assistant Program is a government-led initiative that serves those living in the country’s most remote areas.

Daniel is not the only healthcare professional in his household; his wife Hannah is a Trained Traditional Midwife serving the women and children of hers and other communities in the Gozohn Clinic catchment area. From her home, Hannah walks an hour to the main road where she takes a motorbike to work to assist Ghanwarkpa and other facility-based colleagues with antenatal check-ups for pregnant woman. Daniel and Hannah are members of their Community Health Committee, which meets twice a month to discuss solutions to self-identified health issues affecting the community. Together, Daniel, Hannah, and Ghanwarkpa work to ensure a complete continuum of care for children and families in their quiet corner of Rivercess County. Globally, their efforts are helping to inform the integration of quality community health interventions at scale, supporting the realization of universal health coverage and the drive towards ending preventable child and maternal deaths.

Hannah recently gave birth to a healthy baby boy named Andrew. Throughout her pregnancy, Hannah used her own experience to connect with mothers in the community and to encourage them to go to at least four antenatal care visits during their gestation period. Hannah herself had nearly twice the recommended number of check-ups, partly as a way to set an example in her community, and partly to help de-stigmatize doctor visits and recast them as a responsible approach to maternal health. Thanks to her work, her community has now instituted a fund for referring pregnant women to the Gozohn clinic – removing a significant barrier to maternal health care in the community. Because of women like Hannah, the number of women in Rivercess county who receive four or more antenatal care visits during their pregnancy has risen from 61% to 80% over the last four years. Together with her husband Daniel, Hannah is truly influencing the health of pregnant women and mothers in her area by ensuring that each one has a healthcare worker within reach when they need it most.

Having partnered with the Liberian Ministry of Health for more than 10 years, Last Mile Health is now expanding its work with governments around the world to design, scale, strengthen, and sustain teams of digitally-empowered community and frontline health workers who bring high-quality primary health care within reach of millions of rural people.

Hannah, Trained Traditional Midwife
Hannah, Trained Traditional Midwife

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William, CHW supervisor
William, CHW supervisor

Despite living in an age of unparalleled medical and technological innovations, one billion people still lack access to health care worldwide. To close this gap, Last Mile Health partners with governments to design, scale, strengthen, and sustain high-quality community health systems that extend care, save lives, and create jobs for underserved populations living in the most rural and remote communities. Founded in rural Liberia in 2007, the organization is now supporting the Ministry of Health to scale a National Community Health Worker Program that will deliver lifesaving services to every last child and family living beyond the reach of physical clinics and hospitals. This groundbreaking program was founded on the belief that a strong, resilient health system must reach every Liberian — no matter where they live.

Since the program’s launch in 2016, over 3,500 community and frontline health workers have been deployed to provide lifesaving care to every rural and remote Liberian. William - one of over 350 clinical supervisors deployed across Liberia – plays an essential role in the provision of quality health care at Liberia’s last mile. A trained midwife, William mentors and coaches community health workers to ensure they deliver the highest-quality of care, serving as a critical link between the community and the health center. He explains, “I’m proud of seeing myself supervising people, helping them to bring health to people. When they make mistakes, I correct them, and make sure that they bring quality services to people.”

1.2 million people in Liberia live more than five kilometers from a health center – many in remote communities in Liberia’s dense rainforest. For those who live hours - or even days - away from the nearest clinic, it used to be all too common for treatable conditions like malaria, a complicated childbirth, or untreated infection to be fatal. However, through the National Community Health Assistant Program, William sees how the health of people living in Liberia’s last mile communities has been transformed: “Before, there were a lot of cases that were killing children under five. But now – due to the Program – these cases have reduced. The workload from the clinic has also reduced, because most of the cases in the community have been addressed by the community health workers.” Through the program, over 790,000 sick child visits for the screening and treatment of malaria, diarrhea, pneumonia, and malnutrition have been carried out by this new workforce at the homes of the people they serve.

Liberia’s National Community Health Assistant Program has demonstrated that health care for all - no matter where people live - is possible. Clinical supervisors like William are playing a vital role in bringing quality primary health care within reach of everyone, everywhere. William’s drive comes from his vision of a world in which everyone can realize their right to health: “It has been my wish to serve humanity, and take health to places that health cannot reach, bringing health to people in need – that alone is my motivation”.

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Founded in Liberia more than a decade ago, Last Mile Health’s mission is to save lives in the world’s most remote communities. Driven by its vision of a health worker within reach of everyone, everywhere, the organization is supporting the Liberian Government to scale a groundbreaking community health workforce initiative that will extend care to all 1.2 million people living more than five kilometers from the nearest health facility by the year 2021. Since its launch in 2016, the National Community Health Assistant Program has trained and deployed over 3,300 community health workers (CHWs), who are now providing basic health care – often for the first time – to over 707,000 people.

Through the Program, CHWs are providing reproductive, maternal, and neonatal health services to women and newborns in their communities, helping to ensure that no mother or child dies simply because they live too far from a health facility. In addition to providing family planning services and counselling to pregnant women and mothers, CHWs support pregnant women to attend antenatal care visits, deliver at the facility, and make referrals to clinics and hospitals in cases where specialized care from a midwife or clinician is required.

Farzee works to strengthen this care across Rivercess County. A midwife by training and now the Reproductive Health Supervisor for the County Health Team, Farzee coaches and mentors midwives based in rural health facilities. A mother of two, she was inspired by a midwife who raised her in Guinea during Liberia’s civil war and developed a passion for supporting mothers to safely bring their children into areas where access to a health professional has, for too long, been limited.

Now, having spent twelve years providing and strengthening reproductive, maternal, and neonatal health services in Rivercess County, Farzee recognizes the impact the National Community Health Assistant Program is having on the health of pregnant women and newborns. Strong linkages between the Program and Liberia’s primary health system have strengthened access to and quality of rural health services by providing a continuum of care between the home, community, and health center. “The National CHA Program has really impacted the entire maternal and child health services in Rivercess,” Farzee says.

The National Community Health Assistant Program seeks to strengthen the rural health workforce, from empowered, professionalized CHWs to the health workers who support the facilities that CHWs refer patients to. Farzee explains, “Since the program, because the CHWs are referring pregnant women to the facility for [birth] delivery and antenatal services, now maternal death has reduced significantly. They are helping to refer people timely, and whenever they see a pregnant woman with danger signs they refer them promptly. It’s really helping.”

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Community Health Worker, Daniel Cassell
Community Health Worker, Daniel Cassell

Last Mile Health saves lives in the world’s most remote communities by partnering with governments to design, scale, strengthen, and sustain networks of community health workers who bring high-quality, lifesaving health care within reach of millions of rural people. In Liberia, maternal and under-five child mortality ratios are amongst the highest in the world and even more dire in remote areas, where hundreds of thousands of Liberians spend hours or even days travelling on motorbike, on foot, or by canoe through dense rainforest to reach basic health care.

Recognizing that health needs are greatest in the most remote communities, the Government of Liberia, in partnership with Last Mile Health, launched a groundbreaking initiative that will extend lifesaving health care to all 1.2 million people in Liberia living more than five kilometers from a clinic or hospital. Through the National Community Health Assistant (CHA) Program, Daniel is one of more than 3,000 community health workers in Liberia who are providing essential primary health services to their communities.

Moved by the all-too-common tragedies that occur simply because people live too far from a health facility, Daniel volunteered at his local clinic when he moved to remote Rivercess County, sharing health promotion messages with remote communities. “When I came here, there was nobody to carry people to the health center, to give pregnant women help, to send them to antenatal care visits, for vaccines – nobody! So I started going to [other] hard-to-reach areas. I forced myself, I sent myself all around the hard-to-reach areas.”

When the Government of Liberia launched the National CHA Program in 2016 – a program which would ensure that all workers like Daniel are trained, paid, supervised and equipped - the Ministry of Health visited Daniel’s community to seek nominations for community health workers. Daniel was chosen by his community, and through eight weeks of training and regular supervision, he has been empowered to provide reproductive, maternal, and neonatal health care services, as well as to diagnose and treat common childhood illnesses, monitor for disease outbreaks, and provide health education and referral for non-communicable diseases directly in his community. “Now, I’m very happy - no more maternal deaths or still births in my community, the children are getting vaccines. Everything is going on fine.”

Last Mile Health is committed to supporting community and frontline health workers like Daniel to bring primary health care within reach of everyone, everywhere. For the first time, children and families living in Daniel's community - in the heart of Liberia's dense rainforest and far from a health center - can now access health care right at their doorstep. Daniel's favorite part of his work is "being with my people. I don’t love sitting – I get to see friends and we can talk when I go around performing routine health visits. I can help my people.”

National Community Health Assistant Program guide
National Community Health Assistant Program guide
Baby Nelson, born in a nearby clinic in Rivercess
Baby Nelson, born in a nearby clinic in Rivercess
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Organization Information

Last Mile Health

Location: Boston, MA - USA
Website:
Project Leader:
Tommy Good
Boston, MA United States
$4,647 raised of $10,000 goal
 
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