After months of development with staff, partners, board members, and advisors, we are excited to share our new five-year strategic plan, Closing the Distance. Launching on July 1, 2023, Closing the Distance will deepen our impact in community health systems and influence community health financing—all in service of ensuring that more people can equitably access quality healthcare. We will deepen our work with the governments of Ethiopia, Liberia, Malawi, and Sierra Leone (with the potential to scale to one or two additional countries in Africa) to improve community health systems. In parallel, we will influence community health funding, practice, and policy across Africa to improve how $2 billion in sustainable funding is invested in community health.
We know paid, professionalized community health workers reduce maternal and child mortality, offer crucial pandemic surveillance and response, and have a return on investment as high as 10:1–and we know that working alongside ministries of health to develop and sustain strong community health policies and practices is key to building exemplar health systems. For 15 years, we’ve been working to build strong community health programs and ensure community health workers are skilled, supervised, salaried, and supplied by a well-functioning community health system operating at national scale and integrated into broader public systems via data and financing (we call these the Six Ss). The time is now to build on this foundation.
1: Accompany ministries of health in a focused portfolio of countries in Africa
Community health worker Workinesh Getachew with a community member outside her health post in Oromia Region, Ethiopia.
Advancing our government partnerships in Ethiopia, Liberia, Malawi, and Sierra Leone will be critical to improving community health systems and outcomes. We will continue to train community health workers and health systems leaders to improve their knowledge, skills, and capacity; work with ministries of health to develop sustainable country-based community health financing; and strengthen community-led monitoring and evaluation while keeping gender equity at the forefront.
At the core of our new strategic plan are our four country strategies. Developed under the leadership of our country directors and their teams, the strategies identify the challenges and opportunities unique to each country’s health system–and set measurable goals, concrete tactics for achieving these goals, and detailed explanations of the resources needed to implement these tactics. Critically, country-led programs ensure each country’s needs are effectively identified and efficiently addressed–and will help us deliver on our commitment to placing decision-making and strategic leadership in the hands of our country teams.
2: Evaluate the impact of Last Mile Health’s accompaniment on community health outcomes, systems, and costs
We will continuously assess improvements in community health systems and the institutional capacity of our government partners to ensure our programs are effectively strengthening health systems and positively impacting the quality and accessibility of care for patients in remote communities. We’ll measure improvements in the knowledge, skills, data utilization, and behavior of community health workers and health leaders; evaluate the impact of service delivery innovations; and analyze cost effectiveness.
Community health workers in Malawi participate in training.
We will demonstrate the impact of our work on community health outcomes in hard-to-reach communities, as well as the cost-effectiveness of this work. We will also generate evidence aimed at persuading governments and donors to facilitate inclusive community-based primary care, including insights on driving government adoption of systems change at national scale.
3: Influence community health system funding and practice across Africa
We are committed to sharing our lessons learned with peer organizations and health systems leaders–and to working collaboratively to improve policy and practice. Building on our experience in co-founding coalitions like Community Health Impact Coalition and advancing national advocacy strategies, we will build political will and shape standards for quality community health systems. As a founding member of Africa Frontline First, we will work to secure at least $500 million in sustainable funding for community health systems in Africa and ensure these resources are invested effectively. Through these efforts, we will continue to elevate the perspectives of rural and remote communities: those closest to the work.
4: Mature the Last Mile Health organization
To succeed, we must continue to invest in our own capacity and efficacy. We will center our commitment to localizing decision-making, ensuring our African leaders drive program design and execution, complemented by effective support from our global teams. We will strengthen our team’s technical expertise, emphasizing health financing, digital health and technology, and community engagement. To optimize these investments, we will reinforce operational support, primarily in our growing office in Accra, Ghana. Throughout, we will grow and sustain our revenue, and we will maintain a dedicated focus on diversity, equity, and inclusion, guided by our DEI roadmap.
Stronger health systems, skilled health workers, better care
A community health worker shares an animated video on breast feeding to a young mother in Sodo Region, Ethiopia.
Closing the Distance represents the next chapter in our commitment to ensure that quality community-based care is the rule, not the exception. The strategy guides how we will advance our work via our Theory of Change and our proven ability to connect exemplar national community health systems to demonstrable improvements in community health outcomes and advance funding reform, all in service of patients at the last mile. We know what we must do to bring care within reach–and the time is now to close the distance.
