This is our 10th Annual Letter, and we’re marking the occasion by answering 10 tough questions that people ask us.
It is amazing how many lifesaving tools you can carry on your back.
I was meeting with Dr. Raj Panjabi, and he was showing me one of the backpacks created by Last Mile Health, the nonprofit he co-founded in Liberia. Raj reached into the bag and took out a vial of medicine to treat pneumonia. Next he pulled out rapid test kits for malaria and HIV. Then, rehydration salts for children with diarrhea. A measuring tape to screen kids for malnutrition. A thermometer to check for fevers. A blood pressure cuff. And so on. It was like watching a magician pull rabbits out of a hat.
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.
Thanks to Last Mile Health, more than 500 trained workers now serve 280,000 people in two of Liberia’s most far-flung counties. “These are community members,” Raj told me, “who may have a middle-school to a high-school education and can be trained and equipped to provide high-impact medical care just within a matter of weeks.” (Our foundation helps fund some of their work.)
Other countries use community health workers too—I’ve written before about Ethiopia’s success with them and will be posting soon about Rwanda’s—but Last Mile Health is putting some clever twists on the idea. For example, they’re on the cutting edge when it comes to using digital tools. Their staff 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.
Ultimately, there’s no getting around the need for a primary health care system with well-stocked clinics and staff. Community health workers are a good complement to a functional primary health care system, and a step in the right direction for places that don’t yet have one (like Liberia). As Raj says, no one should die simply because they live too far from a doctor. It’s great to see him and his colleagues trying to make that idea a reality. We need more passionate innovators like them.