Last Mile Health | Dr. Rajesh Panjabi | Skoll Award 2017


Liberia suffered 15 years of war. We have one of the worst doctor shortages in the world. Fifty-one doctors after the conflict to serve four million people. Geographically, it’s a challenge; Liberia is over two and a half million acres of rainforest. If you’re a two-year-old and you come down with a fever, your mom would have to put you on her back, get to the river bed, get in a canoe, paddle across to the other side and walk, sometimes for up to two days, just to get a diagnosis at a clinic. The tyranny of distance is what we talk about; that if you’re too far away, you’re the last to receive health services, but you’re the one that often needs it the most.

Our vision at Last Mile Health is to deploy a health worker for everyone, everywhere, every day. And we work with governments to take those networks of community health professionals and scale that nationally. So how are you doing with her medication? The medicine you gave us, I am giving it to her as you instructed.

In Liberia’s National Community Health Assistant program, which Last Mile Health’s working to support the government on along with a host of other partners; the goals are clear. It’s to train, equip, pay, supervise over 4.000 community health workers, with over 400 supervisors to deliver health care for 1.2 million people. The training that these folks receive covers everything from tracking the next Ebola, the next disease outbreak, to treating children for malaria, diarrhea and pneumonia, and malnutrition; four of the most devastating diseases that contribute to child mortality. That worker then is equipped with a backpack full of the medicines, and the gloves, and the treatments and the diagnostic equipments, even the smartphone that they need to record the data and assess whether they have the right amount of stock. When Last Mile Health started, the first village they worked in, the villagers said they walked 22 hours to the nearest clinic. And during the heavy rains, the roads are impossible. To get to Gboe, you have to cross creeks, walking through the very, very small, small path. We have lot of water, sometime you have to cassava snake, sometime you are sliding, you are falling.

It’s not very easy. The Community Health Assistant is the front-line worker. We are there to arrest the cases right away. With us being in the community, all of my babies now, since last year, every one of them have taken their vaccines and they are on track. So the only time you’re going to give it is in the evening time. Three years of implementing in that district alongside the Ministry of Health, we’ve seen the rate of treatment for malaria, pneumonia, and diarrhea go up to 75% to 85%. We’ve seen the mothers, only half of whom were delivering babies in clinics, now 95% of them are delivering babies in clinics. Sometimes when I call my family at home, they say, “What are you doing, Abush?" Plus, I love taking care of children.

Last Mile Health | Dr. Rajesh Panjabi | Skoll Award 2017

I love my community and my community loves me. We’re starting with Liberia because we think that if we are able to show that it’s possible to deliver a model for remote health care delivery that isn’t conservative, but radical, that goes further than it’s ever gone before, that lifts the standard of care for people in the most remote communities. We think that will generate momentum to help us get to the second and the third country. It’s been true for all of human history, that illness is universal and access to care is not. That doesn’t have to be true in this century and we have a chance to change that.

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