How Last Mile Health and LGT Venture Philanthropy are driving equitable access to health.
On the occasion of the 77th World Health Assembly in Geneva, Lisha McCormick, CEO of Last Mile Health, and Tom Kagerer, Partner and Global Health Lead at LGT Venture Philanthropy, sat down to explore what it takes to create lasting change in health care systems, and how the two organisations are helping secure life-saving care for millions of people in remote communities in Africa.
Lisha, who joined LGT Bank colleagues for our Learning Lunch and Impact Espresso Events in Geneva during her visit, has devoted her life to serving those most in need, and Last Mile Health is a vital partner in LGT Venture Philanthropy’s mission to build resilient communities and transform public health services. Together, we have made significant strides towards a healthier, more equitable world.
LMcC: As a young child, I went to a Montessori school where children engage in free play and choose how to spend their time. One of my earliest memories from there is of one day 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 realize 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 wasn’t any particular clinical intervention but the experience of being prioritized for care. Being included wasn’t something to which they were accustomed. That lit a fire in me for designing health care systems that prioritize the needs of vulnerable and under-served communities. A mentor of mine framed it perfectly – once you know what you stand for, you can look at things from any angle.
LMcC: Our mission is saving lives in the world's most remote communities. We believe that where people live should not determine if they live. That’s why 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 neighbours.
Half of the world's population, including two billion people living in remote rural areas, lack access to care due to distance. 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 4,000 community health workers. The national community health program is now fully scaled, reaching every remote community in the country. And despite being consistently ranked among the ten poorest countries in the world, Liberia is on track to achieve universal health coverage by the end of 2025. It’s a beacon of light amidst the many crises we face as a global community. Community health workers save lives.
LMcC: Meaningful change comes from working as a movement rather than as an individual organisation which means collaboration and partnership are critical.
When we first met LGT Venture Philanthropy, 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. We realized we can use our experience as an implementer not only to professionalise community health workers but also to influence policies and strengthen health care systems on a national scale.
In 2014, just as we’d started to replicate some of our programs in Liberia, the Ebola crisis hit. A small child fell ill with Ebola in the rainforest across the border in Guinea, and before long, the disease was rampant across West Africa. That was a critical moment for us. We helped trained more than 1,000 community health workers and community members in Liberia to detect the virus, provide care, and contain local outbreaks. While the World Health Organisation forecast two million cases and hundreds of thousands of deaths, we saw global recognition for what community health workers could do. That opened a door for us to scale our work and help create more resilient health systems in Liberia and beyond.
Before the Ebola crisis, health coverage in remote rural areas of Liberia was a rarity. Today, having professional community health care workers delivering primary care is the norm.
LMcC: 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 all have made political commitments to professionalizing 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 $100 million in multilateral funding, supporting strong community health programs across 20 countries in Sub-Saharan Africa.
Historically, funding for primary care in low- and middle-income countries has been very disease-specific – funding for malaria in one place, HIV in another, and immunization somewhere else. This siloed approach has often been more an obstacle than an enabler of inclusive and effective health care services. To counter that, Africa Frontline First will leverage integrated financing to scale community health care that strengthens health care systems and directly saves more lives.
LMcC: To us, LGT Venture Philanthropy has been a trusted partner that brings business acumen and strategic insight about how to deliver impact, and you’ve provided multi-year unrestricted funding. When we first started talking, Last Mile Health was a modest-sized organisation with big ambitions, and you’ve played a critical role in helping us think through how we can be most effective. When I've had a critical strategic question or challenge, you've often been one of my first calls. And your inputs on ‘critical path’ thinking have helped us ensure that all our staff, whether they’re administering a motorbike fleet or working in a health care system, understand our priorities and how each team member contributes to them.
LMcC: 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. Strong public health systems are vital, regardless of where we live in the world.
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. And we need to ensure that women from communities are able to participate in policymaking and funding decisions, and influence which health needs are prioritized.
LMcC: As human beings, our memories are all too short. 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. I hope policymakers honour commitments to support and invest in primary health care.
And, while it’s fantastic that we have generated strong public sector commitments for community health, organisations like Last Mile Health still 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.
LMcC: A health worker within reach of everyone, everywhere.