We began working in Sierra Leone in 2021, equipping health leaders with high-quality training during the COVID-19 pandemic. The success of this initial partnership opened the door to deeper accompaniment to the Ministry of Health after they revised the national community health policy to prioritize reaching hard-to-reach communities, improve performance and gender equity, and integrate training and service delivery across a full package of essential health services. The Ministry needed help translating policy into practice and addressing gaps in implementation—and Last Mile Health launched a formal partnership to meet this need. Now, we work to leverage data to drive quality improvements to the community health worker program at the national and district level, ensuring the program can effectively serve patients in rural and remote communities.

We accompany the government to do this work in three ways: building tools for data and governance at national level; using those tools to identify gaps in program design and designing interventions to address them; and implementing those quality improvement interventions in our learning lab districts. Our flagship activity in Sierra Leone, Exemplars in Global Health, works to strengthen how data is gathered, analyzed, and leveraged, bridging a critical gap to help the Ministry understand how the community health program is being implemented—and drive impactful quality improvements. The research reviewed recruitment, training, and community health system performance, all with the aim of creating a replicable monitoring and evaluating system that can be used by the Ministry. Our systems strengthening work at the national level closes foundational gaps in the community health program through stronger program design, leadership, and governance—and we leverage this work to advocate for adequate, sustainable financing.