Save Lives in the World's Most Remote Villages

Last Mile Health was founded on the belief that all people deserve access to health care, no matter where they live. In pursuit of this vision, the organization focuses specifically on the hardest to reach areas by supporting networks of community health professionals who deliver health care at the doorsteps of the people who need it the most. Since 2007, Last Mile Health has partnered with the Liberian government to test and refine a community health workforce model that now serves as the basis for the National Community Health Assistant Program, a groundbreaking healthcare delivery system that will extend care to 1.2 million people living in the country’s most remote communities by the year 2021.

Helping to bridge the gap between remote communities and Liberia’s existing health infrastructure, nurses like Nohn are at the center of the community health program. Originally from Nimba County, Nohn earned her nursing degree at the United Methodist University in Monrovia before traveling to Rivercess County to serve as a nurse supervisor two years ago. Today, she fulfills the position of CHW clinical supervisor at Neezuin Clinic, supporting eight CHWs who provide lifesaving care to remote populations within the facility’s catchment area. Nohn spends the majority of her time in the field providing supervision, mentorship, and supplies to CHWs so that they can remain in their communities and be on hand to provide lifesaving care to their neighbors. “I chose to become a [supervisor] because people in the city have a lot of hospitals that they can go [to], but for those that are in the villages, they have distances. I feel I can train somebody to be residing in their own community while providing care for their own people.” 

Because Nohn travels frequently between remote communities and the clinic, she is uniquely positioned to aid in referrals for patients who are too sick to benefit from the essential medicines provided by CHWs and in need of more specialized care. At the same time, routine supervision visits enable her to track and help prevent disease outbreaks over time via the provision of preventative health education to and collection of key health data from CHWs to pass onto community members and county health representatives, respectively. Through this multi-faceted approach to health care that includes prevention, education, and treatment, Nohn and her CHWs help to ensure that no child dies because of distance: “Children who used to die of common sicknesses, like diarrhea, malaria, and pneumonia… instead of dying they are surviving and making the community a better one. So that’s what keeps me doing this job.”

Not long ago, many believed that providing high-quality health services to Liberia’s remote communities was simply too difficult. In collaboration with the Liberian government, Last Mile Health has proven that by working together, it is possible to drive towards the vision of a health worker within reach of everyone, everywhere. For Nohn – and for the community members she serves – continued support means the provision of care and supervision where it is needed most. “We are waiting to see how best we can make Liberia [be free from] health problems, because sacrificing to live in this bush, it is not easy, but we have to do it for the sake of our country.”

Midwife Olivia is from a remote community along the Atlantic Coast in Rivercess County, southeastern Liberia. To reach the place she was born, she has to travel many hours through dense rainforest by foot, on dirt road by motorbike, and across two rivers by canoe. The journey is long, treacherous, and costly; common across Rivercess County, which is home to some of the worst health outcomes in Liberia, including the lowest rates of full-vaccination coverage and the highest rates of acute-respiratory infection and diarrhea in children under five. For Olivia, this reality was all too apparent, with profound effect: “One year, we had four women die from child birth… there is no way to transport the people and they die from bleeding hemorrhage. In a year’s time, I saw four orphans… It went deep down in my heart. I felt sorry and I decided to go and attend the midwifery school to come and help my people. This is why I chose the work.” Olivia attended school for three years in the neighboring county of Grand Gedeh and now works at the Charlie Town Clinic in Rivercess, which serves remote communities similar to the one where she grew up.

Like Olivia, Last Mile Health is motivated by the belief that women and children living in the world’s most remote areas should not be denied access to lifesaving health care due to distance. In Liberia, Last Mile Health is supporting the 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 (CHA) Program has trained and deployed 3,000 of the 4,000 estimated community health workers needed to achieve universal health coverage across Liberia’s remote communities. These CHAs provide basic reproductive, maternal, and neonatal health care services, diagnose and treat common childhood illnesses, and support patients living with HIV/AIDS, TB, and other conditions. They can’t do this alone, but rely on support from passionate and committed, clinically trained caregivers like Olivia.

Speaking about her favorite part of the work, Olivia shares with pride examples of trust building with health workers and patients alike. “What I enjoy most about the job (is) the women. The Traditional Trained Midwives, they listen to me and don’t do home delivery. I am encouraged and I’m too happy for that. Each time they come for a meeting we talk about danger signs. Because of this, they don’t do delivery at home again. And some of the women… they are very happy now to take in the family planning. When they come, I tell them the importance of their life and to let the uterus rest. I tell them the risks and the benefits, and they listen to me…I enjoy that part.”