Saving lives in remote communities

Lisha McCormick, CEO of the NGO Last Mile Health, and Tom Kagerer, Partner and Global Health Lead at LGT Venture Philanthropy (LGT VP), talk about what it takes to create lasting change in health care systems, and how their two organisations are helping secure life-saving care for millions of people in remote communities in Africa.

Tom Kagerer: Lisha, you've dedicated your life to designing and implementing health care systems that support excluded and difficult-to-reach communities. How did you get started in health care?

Lisha McCormick: One of my earliest memories from school is of playing with a group of girls, and for whatever reason, deciding to exclude another girl from our play circle. I can still remember the look on her face. I didn't realise the significance of that moment at the time, but so much of my motivation today comes from the belief that people should not be left out, especially when it comes to matters as critical as health and well-being.

Later, when I worked as a door-to-door community health worker in the poorest districts in New York City, I realised that what made the biggest difference to people was the experience of being prioritised for care. Being included wasn't something they were accustomed to. That lit a fire in me to design health care systems that prioritise the needs of vulnerable and under-served communities.

What's Last Mile Health's mission and why is it important?

Our mission is saving lives in the world's most remote communities. We believe that where people live should not determine if they live. So we work with governments and a wide range of partners to train, equip and pay community health workers to provide life-saving care to their neighbors.

This is important because half of the world's population, including two billion people living in remote rural areas, lack access to care due to distance. And fixing this could prevent nine million unnecessary deaths every year. In Liberia, for example, where Last Mile Health started out, we've helped deploy over 4000 community health workers. The national community health programme is now fully scaled, and reaches every remote community in the country.

Last Mile Health partners with governments and NGOs to reach around 16 million people every year. Can you share some insights into how you've been able to scale impact to this level?

When we first met LGT VP, Last Mile Health supported about 40 community health workers serving a population of 15,000 people. That's miniscule compared to the actual scale of social injustice and lack of access to care. But then we realised we can use our experience not only to professionalise community health workers but also to influence policies and strengthen health care systems on a national scale.

The Ebola crisis in 2014 was a critical moment for us. We had just started to replicate some of our programmes in Liberia, and helped train more than 1000 community health workers and community members there to detect the virus, provide care and contain local outbreaks. So while the World Health Organisation was forecasting two million cases and hundreds of thousands of deaths, we also started seeing increasing global recognition for the positive impact of community health workers. That opened a door for us to scale our work and help create more resilient health systems in Liberia and beyond.

So what's next for Last Mile Health?

In Ethiopia, Liberia, Malawi and Sierra Leone, we're on track to support 20 000 community health workers serving upwards of 25 million people by 2028, and to generate insights and exemplars for setting up primary health care systems around the world. The countries where we work are very different from one another, but they’ve all made political commitments to professionalise their community health care.

We're also very excited about Africa Frontline First, a joint venture we co-founded with Financing Alliance for Health and Community Health Impact Coalition. Through Africa Frontline First, we've worked closely with funding partners to leverage more than USD 100 million in multilateral funding, supporting strong community health programmes across 20 countries in Sub-Saharan Africa.

As you know, LGT VP aims to be more than just a funder - we want to add value in other ways too. Can you tell us what it's been like for Last Mile Health to partner with us?

To us, LGT VP has been a trusted partner that shares its business acumen and strategic insights about how to deliver impact, and has provided multi-year unrestricted funding. When we first started talking, Last Mile Health was a modest-sized organisation with big ambitions. You've played a critical role in helping us think through how we can be most effective. And when I've had a critical strategic question or challenge, you've often been one of my first calls.

What else needs to happen to deliver a step change in health care?

It's estimated that 84 % of community health workers in Africa are currently unpaid. This needs to change. We need to scale professional public sector community health workforces that have the skills, salaries, supervision and supplies they need to be successful.

We also need the philanthropic sector to work closely with governments and implementers like Last Mile Health, shifting from supporting reactive crisis response to building sustained partnerships with communities and social enterprises.

Lastly, we need organisations engaged in community health to address the social determinants of health and put community health workers at the centre of planning and development.

Lisha, what keeps you up at night?

We've just emerged from a global pandemic but I'm not sure we've learnt the right lessons or will be in a better position when the next one strikes. So I hope policymakers will honour their commitments to support and invest in primary health care. Also, organisations like Last Mile Health need philanthropic and private capital that allows us to retain some autonomy, continue to innovate, and encourage governments to increase their ambition and support what works.

And what are your hopes for the future?

That there will be a health worker within reach of everyone, everywhere.