Today is a historic day in the fight to advance universal health coverage in Liberia, starting with the most remote and vulnerable communities. On July 24th, President Ellen Johnson Sirleaf launched the country’s first national community health worker initiative, called the National Community Health Assistant (CHA) program. This program will deploy over 4,000 health workers across Liberia to serve the 1.2 million Liberians who live more than 5km from the nearest health center. This program will advance access to care for the most vulnerable, build a resilient health workforce, and strengthen the primary health system for the long-term.
At Last Mile Health, we know that there are hundreds of millions of people around the world who go prematurely to their graves without ever seeing a health worker because they live in isolated, remote, hard-to-reach communities – too far from the nearest clinic. In Liberia, 29% of the population (roughly 1.2 million people) lives more than 5km from the nearest public health facility. In the majority of last mile communities, the distance to the clinic must be traversed on foot through dense rainforest, by motorbike over bumpy, unpaved roads, or by canoe across rivers. This journey can take hours or even days just to reach the health center and thus, health outcomes are substantially worse than national averages. As a result of this shortage and the gaps in health access, Liberia has some of the worst health indicators in the world.
Community health professionals have the power to reach the most vulnerable and save lives by delivering health interventions in last mile communities. We believe that it is possible to transform health outcomes at the last mile through the deployment of a well-equipped, well-supported, and well-trained health workforce. Liberia is following in the footsteps of other progressive nations, including Brazil, Bangladesh, Ethiopia, Thailand, Pakistan and Zambia, which have instituted effective, integrated national community health programs from fragmented and isolated programs. Until now, Liberia’s most remote communities have been primarily served by a fragmented system of health volunteers. These volunteers receive varying levels of support and training, while tasked with serving1 as the primary points of entry to the health system. Liberia’s CHA program recognizes the labor of these volunteers, and aims to professionalize and incentivize a new cadre of health workers who perform the hard work of serving Liberia’s most remote communities.
Through this new, integrated program, Liberia has the opportunity to transform the health system to advance access to care and better adapt to future epidemics. The best defense to prevent epidemics tomorrow is a resilient health system today. Health workers are the frontlines of disease surveillance systems, as they can identify, respond, and contain outbreaks before they become epidemics. This is particularly important following the devastating Ebola crisis of 2014-2015, which killed approximately 11,300 people and resulted in an estimated US$2.2 billion in lost economic growth in the region. The Ebola outbreak exposed the weakness of the health system, which faced a severe shortage of health professionals. Prior to the epidemic, a mere 117 physicians served the entire country. In addition to bolstering the country’s health workforce, this program has the opportunity to resume previous hard-won gains made in healthcare that were tragically erased by the epidemic. The UN Population Fund projected that maternal mortality rates would double in Liberia. It’s essential to restore access to primary care and ensure all Liberians – no matter where they live – can access care.
Last Mile Health applauds the work of the Government of Liberia and Ministry of Health to launch this historic plan. Raj Panjabi, CEO of Last Mile Health, said, “The Government of Liberia’s groundbreaking National Community Health Assistant Program will create thousands of rural Liberian jobs, extend health care to over 1 million people in the most remote communities and be a frontline defense that can help stop the next local outbreak from becoming the next global epidemic.” It is due to the leadership of the Liberia Ministry of Health and other leading community health partners, including IRC, PLAN, UNICEF, USAID, Partners In Health, and WHO, as well as many others, that a plan was initiated to rebuild Liberia’s health system that could provide more inclusive and equitable health services, respond to the possibility of future outbreaks, and remain resilient to public health shocks. Panjabi continued, saying, “Last Mile Health is proud to support the Government of Liberia in this historic initiative and shares in its vision of a health worker for everyone, everywhere, every day.” The launch of the CHA Program today calls for a moment of celebration to mark the achievements to date, and look forward to the work ahead to ensure access to care for all Liberians. Last Mile Health is tremendously grateful for the leadership of the Government of Liberia as well as the support of public and private partners in making this work possible.