In Liberia, over a decade of civil war decimated the country’s health infrastructure and availability of a qualified workforce,1 leaving the health system in a fragile state, with consequences that have carried over from 1989 into the present day. As a result, Liberia continues to face significant workforce shortages, with an estimated ratio of 0.01 physicians practicing in the public sector per 1,000 of the population in 2014, well below the WHO recommended threshold.2 Access to providers is even worse in remote and rural areas outside the capital Monrovia, with most of the population facing little or no access to health care services.3 Even if the population can access services, power shortages and limited access to safe water in existing health facilities remain present challenges to the provision of high-quality care. The Ebola Outbreak of 2013 - 2016 only further underscored the need for strong and resilient health systems that ensure universal access to services.4

Last Mile Health, a non-profit organization founded in 2013, supports the Liberian Ministry of Health through programmatic work and technical assistance in efforts to strengthen the health system at grassroots and policy levels. Through a five-step innovative community health worker model - recruit, train, equip, manage, and pay - this partnership works to bridge the gap between health facilities and rural or remote communities by bringing a skilled primary care workforce to populations living in rural and remote areas. To promote the delivery of comprehensive services at the frontline, community health workers are trained in four modules: community health and surveillance, child health, maternal and neonatal health, and adult health and equipped to deliver a variety of diagnostic, curative, and point of care services and medications.2 Community health workers undergo a 12-month intensive training supplemented by annual refresher trainings to promote the delivery of quality services. In efforts to strengthen the capacity of the health system to deliver services that are both high-quality and accessible for all, Last Mile Health and the Liberian Ministry of Health are currently working to scale the community health worker model nationwide through the National Community Health Workforce Program. Over the next five years, the Liberian Ministry of Health plans to deploy approximately 4100 community health workers and 230 supervisors to over one million individuals living in remote areas.2 The Liberian Ministry of Health’s partnership with Last Mile Health is an important demonstration of the potential of leveraging public-private partnerships to accelerate and scale innovations that increase access to high-quality services in fragile contexts.2 More information on Last Mile Health can be found here

Learn even more about Community Health Workers in Liberia on the Exemplars in Global Health webpage.

References:

  1. Challoner KR, Forget N. Effect of civil war on medical education in Liberia. Int J Emerg Med. 2011 Feb 16;4:6.
  2. Chater R, van Neikerk L, Lim J. Social Innovation in Health Initiative | Case study: Last Mile Health. World Health Organization; 2016.
  3. Kruk ME, Rockers PC, Williams EH, Varpilah ST, Macauley R, Saydee G, et al. Availability of essential health services in post-conflict Liberia. Bull World Health Organ. 2010 Jul 1;88(7):527–34.
  4. Our Story - Last Mile Health [Internet]. [cited 2019 Jan 31]. Available from: http://lastmilehealth.org/our-story