Staff at the Government of Liberia's Central Medical Stores process and distribute personal protective equipment procured by Last Mile Health for the COVID-19 response.
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Impact Narrative

Health For All must be The Legacy Of COVID-19

When I was growing up as a child there was no clinic, there wasn’t even a trained traditional midwife... but now things are changing. With [community health workers] that have a passion for the job, the community can be better.
Jerome Gardiner
Community Health Worker
Davis Town, Grand Bassa County, Liberia
Community health workers are a critical part of the health team. They have direct contact with the community and are the first point of contact for health services. Everytime [ministry staff] go to a community, our first interaction is with the community health worker. They are the ones who will relay every [health] message. So we always work with them, especially when it comes to infection prevention and control.
Comfort King-Gbaie
Quality Assurance Coordinator
Ministry of Health, Monrovia, Liberia
Community health workers are a critical part of the health team. They have direct contact with the community and are the first point of contact for health services. Everytime [ministry staff] go to a community, our first interaction is with the community health worker. They are the ones who will relay every [health] message. So we always work with them, especially when it comes to infection prevention and control.
Comfort King-Gbaie
Quality Assurance Coordinator
Ministry of Health, Monrovia, Liberia
It is important to have access to health for everybody because it's very important to prevent and control diseases, especially pandemics like [COVID-19]. Health extension workers are important because they go house to house and can easily make contact with households and easily gain trust. We have better access to the community through them.
Kidist Hailegiorgis
General Practitioner
Kolfe Health Center, Addis Ababa, Ethiopia

COVID-19 has left us all vulnerable, but the fallout will be most devastating for populations that are too often left behind.

A health worker vaccinates a child at Boegeezay Clinic in Rivercess County, Liberia.

COVID-19 further exacerbates inequities for countries already facing shortages of health workers and medical supplies. Ninety percent of countries are experiencing wide ranging interruptions to essential health services, with low and middle income countries hit hardest. In 2020 alone, health coverage has been set back nearly 25 years in 25 weeks. Experts estimate that deaths from HIV, tuberculosis, and malaria could double in the next year, and vaccine coverage could drop.
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Click on graphic to expand

But crises like COVID-19 also present an opportunity to accelerate progress. Around the globe, teams of community and frontline health workers are playing a critical role in controlling the spread of COVID-19, while ensuring that patients continue to receive life-saving health services. And, long after the virus is contained, this critical workforce will remain to serve the daily health needs of their communities. When strong, community-based primary health systems are in place, they can become a robust first line of defense against everyday health threats and global emergencies. If we are able to meet the urgency of this moment with investment in community health workers as the foundation of a resilient health system, we can not only help control COVID-19, but rebuild for a future where everyone, everywhere is within reach of healthcare. 

Now is our opportunity to double-down on our commitments to health for all by making investments that will shape our world for years to come. We believe the global community can emerge from this crisis stronger.
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We are being given the opportunity to define our collective future. What will our legacy of COVID-19 be?
Community health worker Jerome Gardiner demonstrates proper personal protective equipment use while seeing patients in his community.

THE LEGACY OF COVID-19 CAN BE RESILIENT PRIMARY HEALTH SYSTEMS THAT PRIORITIZE ACCESS FOR ALL

For rural and remote Liberians, community health workers like Jerome Gardiner are the first line of defense against COVID-19.‍
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Though Jerome’s formative years were marked by war, he was determined to complete high school and find ways to serve his community. In 2011, Jerome’s neighbors nominated him as a community health volunteer to promote healthy behaviors in his community. Then, during the 2014-2015 Ebola epidemic, Jerome answered the call to serve when the Government of Liberia asked for support in educating communities, tracing contacts, and rapidly referring patients to care in remote and rural areas. In the wake of the epidemic, Liberia’s Ministry of Health transitioned many community health volunteers like Jerome into paid, professionalized community health workers by training them to prevent, diagnose, and treat common health conditions.
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Jerome Gardiner, a community health worker in Grand Bassa County, Liberia.
Liberia's Community Health Assistant Model
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Liberia's Community Health Assistant Model
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Jerome is now employed as part of Liberia’s National Community Health Assistant Program, where he is a critical part of the country’s primary health system. Over the course of a few weeks, Jerome was trained in basic skills to to diagnose and treat preventable diseases—from treating children for malaria and pneumonia and screening kids for malnutrition, to ensuring mothers have a birth plan to deliver in the clinic, to delivering contraceptives and screening for diabetes and high blood pressure. Upon completing his training, he was equipped with medicine and supplies like a smartphone with video lessons on topics like assessing a child for malnutrition.

Community health workers like Jerome serve the daily health needs of their neighbors. When a parent is worried their child is suffering from an illness like pneumonia, Jerome comes to their home to provide care for the child on the spot. With the nearest clinic more than five kilometers away, Jerome is able to team up with his supervisor and other frontline health workers to create a strong link to the public health system for patients who require additional care. Before the introduction of the national program, Jerome’s community didn’t have a trained midwife and pregnant women rarely visited the health facility. Now, thanks to community health workers like Jerome, women are receiving high-quality antenatal care services and are safely delivering babies in the facility. After growing up watching his community struggle to access healthcare, Jerome is a testament to what’s possible when clinicians, frontline, and community health workers work together to expand access to healthcare. In the future, Jerome hopes to continue serving his community by becoming a clinical supervisor.

When community health workers like Jerome are trained and supported to bring primary health services to the doorsteps of people living far from care, they can improve health outcomes and save lives. In Grand Bassa County, where Jerome is one of the 252 community health workers serving over 45,000* people, coverage of treatment for childhood illness like pneumonia, malaria, and diarrheal disease increased in districts implementing the National Community Health Assistant Program compared to districts that were not. In communities served by the national program in Liberia, community health workers now treat 45 percent of all reported malaria cases for children under five.

When community health workers like Jerome are trained and supported to bring primary health services to the doorsteps of people living far from care, they can improve health outcomes and save lives. In Grand Bassa County, where Jerome is one of the 252 community health workers serving over 45,000* people, coverage of treatment for childhood illness like pneumonia, malaria, and diarrheal disease increased in districts implementing the National Community Health Assistant Program compared to districts that were not. In communities served by the national program in Liberia, community health workers now treat 45 percent of all reported malaria cases for children under five.
The Ebola epidemic propelled Liberia to extend the reach of its health system. As countries respond to COVID-19, investments in expanding access to primary healthcare through community health workers could help them defeat the virus, while also laying the foundation for a robust health system that is prepared to respond to future global health emergencies. 
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I met a guy that I helped before. He had a problem and I encouraged him to go to the health facility to get treatment. So he went to our local clinic and they referred him to Buchannan. When he got well, I met him and he said, 'my brother, I most appreciate what you do. You helped me a lot. I just have to appreciate you and I can’t forget about you.'

Jerome Gardiner
Community Health Worker
Davis Town, Grand Bassa County, Liberia
A health worker conducts a COVID-19 sample collection for a patient at a Ministry of Health enhanced surveillance site in Monrovia, Liberia.

THE BEST EMERGENCY RESPONSE IS A PRIMARY HEALTH SYSTEM THAT CAN BE SURGED IN TIMES OF CRISIS

COVID-19 has reinforced what we have always known to be true: the best emergency response system is a primary health system that can be surged in times of crisis.
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Though the novel coronavirus is unparalleled, past emergencies––from the West African Ebola epidemic to the everyday crises of preventable disease––have taught us to look beyond immediate solutions and to transform systems for the long term. Over the past 13 years, our team at Last Mile Health learned that the following lessons are central to building and sustaining primary health systems that can surge during crises, while protecting the hardest-to-reach communities.

Investing in the people closest to community is the root of a resilient health system.

A frontline health worker walks to a community in Rivercess County, Liberia.

In remote and rural communities where reaching a hospital or clinic can be an arduous journey, community health workers are a crucial part of an everyday health system that reaches the most vulnerable. Recruited directly from the community they serve, community health workers can be among the first to raise the alarm for an outbreak while also ensuring their neighbors have the information and care they deserve to stay safe and healthy.
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Community health workers learn about how to detect and respond to cases of Ebola in their communities in Last Mile Health supported trainings.
During Liberia’s Ebola epidemic, a lack of confidence in the safety of health facilities kept many people from seeking routine care. But expanding the healthcare team proved to play a crucial part in meeting patients where they were: in their homes. Community health workers across Liberia teamed up with doctors and nurses to educate their communities, actively track cases and contacts, and quickly refer sick patients to the health facility. Due to established trust with their neighbors, many were able to keep essential health services going. While Liberia experienced a three-times decrease in facility-based delivery nationally during the Ebola outbreak, in Konobo District, where paid and supervised community health workers were providing services, the facility-based delivery rate remained high, dropping a mere three percent.

This same community-driven strategy remains critical.

Much like they did during the Ebola outbreak, community health workers are now fully engaged in the fight against COVID-19. Earlier this year, Liberia Ministry of Health employees like Comfort King-Gbaie stepped up to rapidly train community and frontline health workers like Jerome to recognize the signs and symptoms of COVID-19, encourage social distancing, hand washing, and mask use, and refer any suspected cases for treatment. Comfort and her colleagues also partnered with community-based clinics to establish infection prevention and control procedures and adapt physical distancing and no-touch protocols so that health workers can stay safe while continuing to administer the package of essential, life-saving health services.
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Comfort King-Gbaie, a Quality Assurance Coordinator for Liberia's Ministry of Health, oversees community infection prevention and control in the COVID-19 response. Read more.
Now, every community health worker deployed as part of Liberia’s national program is trained to respond to COVID-19––and in partnership with doctors, nurses, and frontline health workers, they are critical to containing the virus while keeping essential health services going. Early evidence from Liberia’s National Community Health Assistant Program indicates that community health worker service provision has held steady since the onset of COVID-19, with only marginal decreases in facility-based delivery rates in areas served by the program.
Click to view images of Last Mile Health supported COVID-19 trainings.
Click to view images of Last Mile Health supported COVID-19 trainings.
Now, every community health worker deployed as part of Liberia’s national program is trained to respond to COVID-19––and in partnership with doctors, nurses, and frontline health workers, they are critical to containing the virus while keeping essential health services going. Early evidence from Liberia’s National Community Health Assistant Program indicates that community health worker service provision has held steady since the onset of COVID-19, with only marginal decreases in facility-based delivery rates in areas served by the program.

When we invest in local residents as community health workers trained to identify threats, they can stop outbreaks of disease before they start. But it's not enough to just have health workers in place––they need to be supported.‍

We know that COVID-19 is spread through droplets and through contact. So the community health workers are [trained] on these things. Now, when they get back to the community they... do health education. If someone has respiratory symptoms, tell them to cover their mouth when they cough, cover their nose when they sneeze, and perform hand hygiene… [For example,] we have Victoria telling the community, ‘From the bathroom, you wash your hands.’ We have basic things that are being done in the home that are on posters and when [community health workers] go into a home they show the community and they understand exactly what the community health worker is portraying to them.

Comfort King-Gbaie
Quality Assurance Coordinator
Liberia Ministry of Health

Community health workers need to be recognized as integral to the health system.

Naomi Davis, a community health worker in Grand Bassa County, Liberia.

As part of interdisciplinary teams of midwives, nurses, and doctors, community health workers are an important part of a well-functioning primary health system. When strong community health systems are in place, countries can rapidly deploy community health teams to prevent, detect, and respond to a crisis. But to effectively mobilize this workforce during times of crisis, they need to be supported—and that includes being entitled to the same protections as other health providers.

Click to view images of PPE procurement and distribution in Last Mile Health supported countries.

Appropriately trained and adequately resourced community health workers who are supported with supplies, supervision, and payment are vital to ensuring equitable access to care. With this critical workforce stepping up around the globe to support the COVID-19 response, we need to invest in the systems and support networks that empower community health workers to continue delivering the highest possible quality of healthcare—which includes ensuring they have the personal protective equipment to keep safe and keep serving their communities. 
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Appropriately trained and adequately resourced community health workers who are supported with supplies, supervision, and payment are vital to ensuring equitable access to care. With this critical workforce stepping up around the globe to support the COVID-19 response, we need to invest in the systems and support networks that empower community health workers to continue delivering the highest possible quality of healthcare—which includes ensuring they have the personal protective equipment to keep safe and keep serving their communities. 
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Click to view images of PPE procurement and distribution in Last Mile Health supported countries.
Ndasowa Chitule, Director of Programs at Last Mile Health in Malawi.
In Malawi, our Director of Programs, Ndasowa Chitule, worked with her colleagues to procure and distribute essential supplies and personal protective equipment to help safeguard community and frontline health workers responding to the virus. After our organization contributed over 900,000 pieces of personal protective equipment to Malawi’s Ministry of Health, critical supplies like masks, gloves, and gowns were distributed to community and frontline health workers who work at health facilities in remote communities. Now, these health workers are equipped with the protection to continue health service delivery and safely participate in community COVID-19 contact tracing.
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While a global shortage has made it difficult for all health workers to access personal protective equipment, the brunt has fallen on community health workers in low- and middle-income countries––who are often women. Worldwide more than 7 out of 10 healthcare workers are women, which means they are disproportionately affected by global shortages of personal protective equipment––while they are also increasingly underpaid for their work. Despite being critical members of the primary health team, the unpaid contributions of women in healthcare globally—including women serving as frontline and community health workers—totals $1.5 trillion dollars annually.

We depend on community health workers to put themselves on the frontlines of crises. Now, as this workforce prepares to go as far as it takes to control COVID-19, countries need to go as far as it takes to invest in them.
Click on graphic to expand
While a global shortage has made it difficult for all health workers to access personal protective equipment, the brunt has fallen on community health workers in low- and middle-income countries––who are often women. Worldwide more than 7 out of 10 healthcare workers are women, which means they are disproportionately affected by global shortages of personal protective equipment––while they are also increasingly underpaid for their work. Despite being critical members of the primary health team, the unpaid contributions of women in healthcare globally—including women serving as frontline and community health workers—totals $1.5 trillion dollars annually.
Click on graphic to expand
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We depend on community health workers to put themselves on the frontlines of crises. Now, as this workforce prepares to go as far as it takes to control COVID-19, countries need to go as far as it takes to invest in them.

The way community health services are provided in Malawi, the lowest point of service delivery is in the community, meaning that a community health worker goes to his nearest facilities, collects his supplies or the things that he needs to use, and goes into the community to deliver the services. So, he cannot deliver services without protection. In the context of COVID-19, it is much more important because then the community health worker is exposed to contact with different groups and so he must be protected. For him to be safe, but also if he is infected, he is also protecting his clients. In general though it is a standard, community health services should be provided with quality and having the right and appropriate PPE for the right service is also critical as part of providing quality health services.

Ndasowa Chitule
Director of Programs
Last Mile Health Malawi

Technology is essential to quickly and equitably upskill the health workforce.

A clinician navigates the COVID-19 Ethiopia app.

Investing in the training of community and frontline health workers is critical to creating strong health systems. Digital technology can help enable this workforce to provide better, more timely care by availing health workers with valuable information when and where they need it. Through the use of digital platforms, they can quickly triage and refer patients, access up-to-date information, and collect timely data needed to improve the quality of care. Technology-enabled learning and performance management systems can transform the performance of health workers by increasing their skillset and improving and expanding effective coverage of health services.
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With consistent, reliable information on their smartphone, health workers like Dr. Kidist Hailegiorgis are better equipped to rapidly respond to outbreaks of COVID-19 within their communities. She now has access to the COVID-19 Ethiopia app, which was launched by Ethiopia’s Federal Ministry of Health, the Ethiopian Public Health Institute, and the Community Health Academy to provide high-quality educational and training content on coronavirus.
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Dr. Kidist Hailegiorgis, General Practitioner at Kolfe Health Center inAddis Ababa, uses the Ethiopia COVID-19 App.
As the Federal Ministry of Health’s first smartphone-based digital learning platform for COVID-19, the app is supporting Ethiopia’s health workforce to identify and treat patients with COVID-19. Across the country, more than 2,349 health sector professionals like Dr. Hailegiorgis have viewed modules on risk communication and community engagement, surveillance, case management, and infection prevention and control of COVID-19. With these modules at her fingertips, Dr. Hailegiorgis can reference and relay critical information on the COVID-19 response to her patients and community.
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Dr. Kidist Hailegiorgis, General Practitioner at Kolfe Health Center inAddis Ababa, uses the Ethiopia COVID-19 App.
With consistent, reliable information on their smartphone, health workers like Dr. Kidist Hailegiorgis are better equipped to rapidly respond to outbreaks of COVID-19 within their communities. She now has access to the COVID-19 Ethiopia app, which was launched by Ethiopia’s Federal Ministry of Health, the Ethiopian Public Health Institute, and the Community Health Academy to provide high-quality educational and training content on coronavirus.
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As the Federal Ministry of Health’s first smartphone-based digital learning platform for COVID-19, the app is supporting Ethiopia’s health workforce to identify and treat patients with COVID-19. Across the country, more than 2,349 health sector professionals like Dr. Hailegiorgis have viewed modules on risk communication and community engagement, surveillance, case management, and infection prevention and control of COVID-19. With these modules at her fingertips, Dr. Hailegiorgis can reference and relay critical information on the COVID-19 response to her patients and community.
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Screenshots from the Ethiopia COVID-19 Andriod application.

Community and frontline health workers need access to timely, accurate education and training materials to surge their capacity. By leveraging technology to upskill and sustain this essential workforce, we can build leaders at all levels of the health system.‍

It is a very important tool to have as a nation, as it was prepared for the health professional, it means we can use it when treating our patients. And since it is developed based on the guidelines, we are not worried about missing something. It is also accessible. Once you download it, you can use it offline and refer to it whenever you want. Science can be forgotten, so it is good that people can refer to it anytime they want. That is why I believe it is very useful for the professional. Especially for those working in treatment centers, for those living in the rural areas—it is invaluable.

Dr. Kidist Hailegiorgis
General Practitioner
Kolfe Health Center
Children play in Rivercess County, Liberia.

Defining Our Collective Future‍

The COVID-19 pandemic has reminded us of the urgent need for universal health coverage. 
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The best emergency system is a strong primary health system—powered by well-supported community and frontline health workers. Not only can these health workers respond quickly to crisis, but they can actively prevent the next one by expanding access to essential primary care.

But systems will change only if we make long-term investments to protect the vulnerable, ensure recovery, and prevent the next crisis. Now is the time for us to work together to build health systems that will save lives—for the current pandemic and beyond.

Though the future of COVID-19 is unknown, one thing remains certain: its legacy is ours to shape. We believe resilient primary health systems that include community health workers must be the legacy of COVID-19.

What do you want the world to learn from COVID-19?‍

As an individual, I contribute to make sure people around me and in my community, can access better health services. I believe the most important thing for mankind is knowledge sharing. Not sharing what we know is a selfish act that can bring harm to those close to us. When I teach my family and neighbors, and when those neighbors teach their neighbors—is the way we can reach everyone. By helping my community, I think I am doing my part. One thing I hope the world learns from COVID-19 is that we need to stop saying “I” and start saying “we”. Now we know that it is impossible for one nation to close down its borders and stay safe. Unless the COVID virus is eradicated from everywhere, there is always the chance that it will come back. That is why I wish the world forgets the “I” mentality and starts saying “we”

Sister Saliha Mifta
Clinical Nurse, Health Extension Worker
General Jagama Kello Memorial Health Center, Addis Ababa, Ethiopia

I think the question of why now is like planting a tree. The best day to plant a tree is yesterday. If not, then today. That's the same analogy I would draw to community health workers, knowing that this cadre brings you much needed complementarity to the health system. If thirty to forty percent of the world doesn't have access to this full package of essential health services, and if community health workers allow you to get there, why not invest today?

Niranjan Bose
Managing Director, Health & Life Sciences
Gates Ventures, Washington, USA

COVID-19 taught us that you can prepare all these facilities and still it will not be sufficient to take care of everybody that is infected. So, it was time to take the fight beyond the hospitals, beyond the treatment facilities. That is the moral reason why now it is very  important that we make the community, and the healthcare services within the community, more resilient than before so that they can respond to any kind of shocks and epidemic outbreaks that may occur––concurrently or even after COVID. And that is the lesson I think we should take from here, that we must prepare the community more than before.

Dr. Upenytho George DuGuMm
Commissioner of Health Services for Community Health
Ministry of Health, Kampala, Uganda

It is important now to invest in community health workers, looking at the current outbreak of global pandemic within Liberia and how it affects Liberia. It is also important in terms of training and motivation, so as to strengthen community health workers for current and future health crises.

Patience G. Synyenlentu
Community Health Services Supervisor
Boegeezay Health Center, Rivercess County, Liberia

We all really need to take a step back and look at what COVID-19 is teaching us. Quite frankly, for us in Africa COVID-19 has not shown us what we do not know. It has shown us that our health systems are fragile. It has shown us that we are not investing adequately in health security. It has also shown the impact of fragmented funds flow from our partners on our healthcare systems and delivery. But more importantly, COVID-19 has called us to action on the lessons we have failed to learn. These lessons are the lessons we have failed to learn from vaccines-preventable diseases, we failed to learn them from HIV, we failed to learn them from polio. And that key lesson is that community and citizens matter.

Dr. Lola Dare
President
Centre for Health Sciences Training, Research, and Development - Global

It takes a community to save lives… it takes a community health worker to save lives. As a community health worker you give the message that is very clear that COVID-19 can be defeated if the community joins hands together to fight the virus.

Moses Cowan
Health Specialist
UNICEF, Freetown, Sierra Leone

I believe that the lesson from COVID-19 is that we need to invest in the health system so that when any other emergencies or shocks comes in the system, we are able to address it without any problem. COVID-19 has exposed the weaknesses in investing in health globally, but also nationally. So we are learning that and, also, the capacities of our community health workers and our health workers to manage crises.

Maziko Matemba
National Community Health Ambassador for Malawi
Lilongwe, Malawi

As a researcher I do hope that at the end of the day we are able to conduct research aligned to the government agenda and come up with recommendations on how to address disparities within our healthcare set up. Our main goal should be ensuring that our population gets access to universal health coverage. This entails accessing affordable and quality healthcare anywhere and at any time in a bid to improve on service delivery.

Dr. Judy Mwai
Research Scientist
Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya

financial summary

Our progress over the past year was made possible by the generous support of hundreds of partners like you who have invested in our shared vision of a health worker within reach of everyone, everywhere.
OUR PARTNERS
Fiscal Year 2020: July 1, 2019 to June 30, 2020.
Click here to view our most recent audited financial statements.
*Grand Bassa County, Liberia has an estimated population of 250,000, of this, the population within the districts served by the National Community Health Worker program is approximately 45,000.
Copy Writer 
Rebecca Gifford‍

Designer 
Aimee Edmondo