Liberia’s National
Community Health Program
In partnership with Liberia’s Ministry of Health and peer organizations, we designed and launched the country’s first-ever national community health worker program in 2016. Today, the program is making primary healthcare access universal for Liberians in rural and remote communities. Across all 15 of Liberia’s counties, paid, professional community health workers deliver primary care, increase referrals to health facilities, rapidly respond to disease outbreaks, and educate their communities. Named a global exemplar, the country’s community health workforce now diagnoses and treats 50% of malaria cases in the country for children under five.
The origins of Liberia’s national program
In 2016, Liberia emerged from a two-year-long Ebola epidemic that claimed nearly 5,000 lives. The epidemic devastated the health system, already weakened by two civil wars. About 100 doctors remained to serve a population of more than four million, and an estimated 1.2 million Liberians lived more than 5 kilometers from the nearest health facility. Primary healthcare was inaccessible for the majority of rural Liberians.
However, a bright spot of the Ebola response was the engagement of communities across the country. Community members 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.
The government of Liberia recognized the urgent need to strengthen the health system and the opportunity to leverage the power of the community. In July 2016, six months after West Africa was declared Ebola-free, the Ministry of Health assembled a coalition of NGOs (including Last Mile Health) and funding partners to launch a national community health program. They aimed to deploy a professional community health worker to every rural and remote community in the country—and in June 2024 the National Community Health Program reached full scale. Today, more than 5,000 community and frontline health workers have been recruited, trained, supervised, equipped, and deployed.
An enduring partnership: the Ministry of Health and Last Mile Health
Last Mile Health is the lead partner to the Ministry of Health on the national program. We partner with the Ministry to assess its implementation, impact, and sustainability to ensure community health workers are supported to deliver quality care. In 2021, we conducted a gender assessment that examined the factors contributing to the low percentage of women in Liberia’s community health workforce and determined only 17% of paid, professional community health workers were women. Together, Last Mile Health and the Ministry made a commitment to change this, developing recommendations to increase gender parity. These recommendations were formalized in the new community health policy.
Last Mile Health directly implements the national program in Rivercess County, an innovation site where we pilot solutions to identified gaps. For example, community health workers were trained to administer the injectable contraceptive Sayana Press in 2019, and this training is being scaled nationally based on the success of the pilot. Beyond Rivercess, we provide technical assistance to the national program as a whole, offering guidance in areas including policy, curriculum, implementation, fidelity, and financing.
Community health workers have become a crucial component of Liberia’s broader health strategy, key to community education, service delivery, and patient referral. When Liberia launched its first malaria vaccine in 2024, community health workers were integral to the Ministry of Health’s strategy, and today, they play a central role in community outreach and patient tracking for this lifesaving intervention.
A new national policy
In 2023, the Ministry of Health launched its second national community health policy. Building on a comprehensive review with Last Mile Health and other partners, the new policy includes:
Rolling out a revised, competency-based curriculum and training to equip community health workers with the knowledge and skills they need to make the greatest impact in their communities.
Expanding the essential package of services provided by community and frontline community workers, including immunizations and more family planning options.
Introducing a nationwide electronic community-based information system.
Strengthening the commitment to increasing gender equity in the national program.
IMPACT
5,200 community and frontline health workers have been deployed
More than one million Liberians are served by community health workers.
Community and frontline health workers have treated more than one million childhood cases of pneumonia, malaria, and diarrhea
By 2020, community health workers diagnosed and treated 50% of confirmed malaria cases for children under the age of five
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