Building Stronger Community Health Systems Together

By Tapiwa Mukwashi and Brittney Varpilah

Even with the pandemic, essential medicine distribution to Community Health Assistants continues in Grand Gedeh County, Liberia. | Photo Credit: James Kologbay

In rural and remote communities around the world, people have to walk for hours or even days to reach the nearest clinic to access services and medicines, which may not even be available when they arrive. A people-centered health system looks beyond health facilities to move vital health products more directly to people, wherever they live. Last Mile Health and VillageReach share a commitment to ensuring every person can access the health care they need — no matter where they live.

Why Community Health Workers

Community health workers are recruited from their own community to serve the daily health needs of their neighbors. However, they often aren’t equipped with appropriate quantities of medicines or supplies. Funding shortages mean health products are often purchased in limited quantities. Additionally, when products are purchased, they are then packaged and distributed in bulk to health facilities based on the quantity available — not based on the facilities’ actual demand. This results in overstocking at certain facilities, leading to waste at some facilities and shortages at others. Community health workers, who are restocked with supplies from the health facilities, can ultimately be left with fewer health products to treat patients at the community-level.

In Liberia, we saw an opportunity to change this reality to ensure community health workers have access to the health products they need to serve their communities. Last Mile Health and VillageReach are working collaboratively in three counties in support of the Government of Liberia’s National Community Health Assistant Program, which launched in 2016 to provide quality primary health care to all Liberians who live more than five kilometers from a health facility. While Last Mile Health collaborates with the County Health Teams to manage direct program implementation and provide technical support, VillageReach brings its supply chain logistics expertise to ensure community health workers are included in national and subnational supply chain planning.

Key Practices for Building a Strong Partnership

Our partnership starts with acknowledging that solving a problem at scale requires a systems-change approach. This means working within the systems that exist and collaborating within and across sectors. We aim to highlight five key principles that are helping us jointly maximize impact.

  • Aligning around a common goal: Any partnership, big or small, will work best when there is a clear, shared goal. We are closely aligned as partners and with the government. In our case, this alignment goes beyond the specific objective of our joint project: at our core, both VillageReach and Last Mile Health believe everyone, everywhere deserves access to quality health care.
  • Impact above organization: Formalizing a partnership on paper is an important step, but to advance our collective mission, we have put a singular focus on programmatic needs as a single team. At the end of the day, what matters is increased access to life-saving medicines, not who receives credit.
  • Flexibility to respond to government needs: Both Last Mile Health and VillageReach have an intentional approach to build relationships with government and work to strengthen government systems. When the COVID-19 pandemic hit, we worked collaboratively with the government to develop a quantification process and tool to determine how much personal protective equipment (PPE) was required for all community health workers to keep safe while providing essential health services. Now, over 3,000 community health workers in Liberia are receiving a three month supply of PPE to safely do their jobs.
  • Transparent and frequent communication: Central to our success to date has been a firm emphasis on clear communication. With any partnership of this nature, challenges and conflicts are bound to arise. We have created a meeting schedule that enables the adoption of adaptive management practices. Through frequent collaboration, we can proactively discuss potential issues as they arise, and realign when needed. We also sit together on the Community Health Impact Coalition, so we are able to highlight opportunities for coordination beyond just one project.
  • Leverage organizational strengths: A critical first step is always to recognize the work that has already been done and the existing assets that can be leveraged. We have leveraged our organizational strengths and have candidly shared weaknesses, so that we’re putting our best talent and strengths forward.

We are nearly two years into our partnership. Though establishing a meaningful partnership between two organizations can be challenging, we have already seen improvements in supply chain coordination mechanisms at the central and county levels as well as improved reporting rates, which are essential to accurately forecasting demand. What may be the most impressive achievement to date was our ability to efficiently and effectively respond to the needs spurred by the COVID-19 pandemic. This work included quickly evaluating the PPE needs of community health workers, which is required for the delivery of primary health services during COVID-19, and coordinating resource mobilization with multilateral and private donors. To date, we were able to procure and deliver PPE (gloves, masks, goggles, etc.) to all community and frontline health workers employed by the National Community Health Assistant Program.

Looking forward, our partnership aims to support the Government of Liberia to put in place the systems, structures, and processes to enable the flow of goods and services from central medical stores and suppliers to community health workers. To do so, we need accurate and strategic information on consumption patterns to inform appropriate procurement and distribution, which is not currently available. However, we look forward to continuing this vital work, fueled by the power of partnership.

We look forward to continuing this work together in Liberia and potentially extending it to new countries. We’re confident that by working together, we’ll achieve far more than any of us would alone.

Tapiwa Mukwashi is Director, Supply Chain for VillageReach. Brittney Varpilah is Deputy Country Director, Programs at Last Mile Health.

VillageReach transforms health care delivery to reach everyone.