The last mile to global health

The last mile to global health

‘The backpack is a key part of Last Mile Health’s effort to deliver basic health care to people who live beyond the reach of the health system. Raj was born in Liberia and fled the civil war there with his family when he was 9. When he returned as a medical student years later, he was shocked to learn that there were only 51 doctors for a country of 4 million people. So he and his co-founders set out to recruit, train, and equip a cadre of community health workers who would provide a range of 30 basic services in remote areas of Liberia.’

Some of the most extraordinary advances in global health come from the simplest innovations. In nations where little health infrastructure exists, the most remote remain the most vulnerable. But with small interventions which empower local communities to become their own infrastructure,  radical change is possible.

Many of the most effective solutions are shockingly low-tech. Kangaroo mother care, for example – where pre-term or low birth weight babies are given continuous skin-to-skin contact and breastfed – has been proven to act as an incubator, accelerating weight gain and regulating body temperature. Rwanda, Gates writes, ‘cut its newborn mortality rate by 30 percent between 2008 and 2015, largely due to the spread of kangaroo mother care along with encouraging exclusive breastfeeding and cutting the umbilical cord in a hygienic way.’

In 1990’s Ethiopia, one in five children died before their fifth birthday. Now, thanks to 38,000 newly equipped health workers (mostly local women, armed with basic but effective training on childbirth, immunisation  and family planning) who walk from door to door in their communities providing care, deaths in under-five have fallen by 66%.

Last Mile Health in Liberia, funded by the Gates Foundation, is showing us what happens when community innovation meets mass technology.  ‘Their staff’, writes  Gates, ‘use smartphones to collect data about their work with patients, which helps identify health trends and improve the program. They’re also developing a training platform where you could watch video lessons on, say, how to vaccinate children, or hear a podcast on how to distribute bednets, and then take a quiz to test your understanding.’

Over 500 health workers now reach 280,000 of Liberia’s hardest-to-reach counties. They’re training is fast, impact-focused and accessible to anyone with a middle school education. Hear Gates in conversation with Dr Raj Panjabi and learn more about his work here.