2025 Annual Letter

Dear partners,

On a visit to Sierra Leone this fall, meeting with Last Mile Health’s team and health leaders including Minister of Health Dr. Austin Demby, I was struck by the familiar themes in our conversations. Once again, we used words like crisis, uncertain, unprecedented, and challenge, this time to describe the tumultuous shifts in financing that have rocked the global health landscape. For leaders and community health workers in Sierra Leone, the funding crisis follows in the well-worn footsteps of past crises including the Ebola epidemic and the COVID-19 pandemic. And once again, people in rural, remote, and vulnerable communities face the largest share of the burden. Already, lives have been lost with the closure of programs funded through international aid, with women and children most at risk. Crisis is a term that is all too familiar, and all too apt.

It’s easy to be discouraged in times like these—but among colleagues and partners, and particularly when speaking with community health workers, I hear another familiar refrain: one of clarity, resilience, and purpose. In this moment of crisis, cynicism and inaction are privileges we can’t afford. We must see the drastic changes in global health funding as an opportunity to shift norms and invest in solutions that work. Together, we can meet this moment to drive health for all through community-led primary care, owned by governments and sustained by durable, resilient financing.

Last Mile Health was built for times like these. Here is our vision of the path ahead.

The way we save lives in rural and remote communities is by increasing access to primary care. This conviction has always been the foundation of Last Mile Health’s approach: bringing quality care within reach through paid, professional community health workers. Nearly 20 years of applied experience have shown us that when we center rural and remote communities, entire systems benefit. We’ve also seen how integrated care—with the same community health worker delivering a full range of primary health services, rather than focusing narrowly on one disease—is more efficient and more affordable. To make the greatest impact with limited resources, we must invest in these strategies proven to save lives.

Prioritizing community-led primary care also means prioritizing care for those whose lives depend on it most: mothers and children. Pregnant women and young children—particularly in rural and remote areas—face the greatest risk of death from preventable causes. When community health workers are supported to deliver care, promote healthy behaviors, and link families to the health system, these deaths can be averted. Reproductive, maternal, newborn, and child health services are our “guiding star,” addressing the most urgent and inequitable health needs and saving the lives of those at the greatest risk.

Living and working in underserved, under-resourced contexts where the impact of disease outbreaks, climate-driven events, and conflict is most acutely felt, community health workers and their patients regularly face crises—yet what we consistently hear from them is that they want to continue providing care. In a New York Times article investigating the human impact of the shuttering of USAID, journalist Nick Kristof amplifies the voice of community health worker John Flomo of Bong County, Liberia. Despite losing his salary as a result of foreign aid cuts, John continued to provide care for his neighbors, saying, “I will continue to save my people.”

To ensure community health workers like John can continue delivering care, we must build the capacity of the health systems that support them, and we must equip governments to finance these systems sustainably. We know how to deliver what patients need now and in the long-term—but to do so, both increased domestic financing and right-sized, bold philanthropic investment are crucial. 

We know community-led primary care is the path toward health for all: already, in the countries where we work, this approach has changed individual lives, and it’s changing systems that impact millions. As massive disruptions to international aid put those changes at risk, we’re doubling down on the solutions that save lives. To support community health workers in the long-term as they deliver essential care, governments need resilient, durable financing—and they must be firmly in the driver’s seat.

As a trusted implementing partner for nearly 20 years, Last Mile Health brings deep expertise in program design, cost-saving interventions and digital tools, and the agility to secure and manage complex funding streams—both domestic and philanthropic. Our vision for the future of community health couples high-impact interventions with financing reform that maps increased domestic funding while leveraging bold philanthropic investment. We’re already working with governments and through Africa Frontline First to secure increased domestic financing. Strategic philanthropic investment will ensure this funding delivers at its full potential, facilitates critically needed innovations, and allows us to influence how hundreds of millions of dollars in financing are applied for community health across the continent. 

Hiring and supporting more community health workers and reaching more patients is a crucial step toward sustainable primary care for all. But we’re doing more than this: we are catalyzing a continent-wide shift in how healthcare is delivered and financed, ushering in a sea change for hundreds of millions of people. Healthcare in Africa is changing one way or another. Together, we can ensure it changes for the better.

Amid this crisis, I feel a profound sense of purpose: Last Mile Health’s experience and expertise can offer valuable direction as the global health field works to set a course that will save lives now and ensure progress toward universal health coverage.

We know community health workers save lives in the communities most at risk. At this critical juncture, we must ensure the systems that support them are resilient and durable. Government-owned, community-led primary care backed by sustainable, strategic financing—both domestic and philanthropic—is the path toward health for all.

Last Mile Health has long championed community-led primary care as a locally sustained, cost-effective approach that bolsters resilience during health and financial shocks. We are primed and ready to realize this sustainable, domestically led solution. The time is now to invest where the need is greatest—and the impact is most powerful. This is how we can save lives together, now and for years to come.

In partnership,
Lisha McCormick