DAVOS, Switzerland — Musu, a community health worker in Liberia, lives in a village that is four hours from the nearest clinic. Only 25 percent of Liberian women make it through primary school, but Musu finished high school. But when she returned to her community, she found children were dying from diseases, including malaria and pneumonia. Musu became determined to help her community and so — with the help of Last Mile Health — she became a community health worker, armed with point of care diagnostic tests, a backpack full of medicines, a smartphone, and — importantly — a wage.
Now more people like Musu are going to get a boost. Raj Panjabi, the founder of Last Mile Health, has joined Chuck Slaughter, the founder of Living Goods, a nonprofit organization that has built a distribution platform for lifesaving products, for an announcement on Wednesday at the World Economic Forum Annual Meeting in Davos, Switzerland.
A coalition of partners from philanthropy and business are committing $50 million to support these two social entrepreneurs to deploy 50,000 community health workers to provide digitally enabled, door-to-door care to 34 million people. And as Panjabi and Slaughter continue to fundraise in Davos and beyond, and prepare to scale their work to three other African countries, they hope to demonstrate how technology can reinvent community health care at scale.
“This disruption is very similar to the disruptions we’re seeing in so many sectors,” Slaughter said, explaining that virtually every other sector has been reinvented by mobile technology, and it is time for health to go through a similar reinvention. “Where mobile is coming in, it’s shifting power from institutions to individuals.”
According to a report from the World Bank and World Health Organization released last month, at least half of the world’s population cannot access essential health services, and there is a shortage of health care workers. While medical training is costly, community health workers, however, require less training and pay, and are able to provide basic health services, particularly in hard-to-reach areas.
Additionally, Panjabi is building the Community Health Academy, a mobile platform providing video and audio instruction to community health workers around the world, so community health care workers do not have to travel hours for training sessions.
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Virgin’s Richard Branson, Jeff Skoll, the first president of eBay and founder and chair of the Skoll Foundation, and Christopher Hohn, the investor who set up the Children’s Investment Fund in London, and the ELMA Foundation, are pledging $50 million in a challenge grant to kick off a shared campaign to deploy 50,000 of these community health care workers to reach 34 million people across 6 countries. To unlock this commitment, Panjabi and Slaughter have to raise another $50 million from new sources over the next four years, making the pitch that new backers can double the impact of their investments. UBS, the wealth manager based in Switzerland, jump started the process when it announced the first major commitment toward this match: for every two dollars their clients give, the UBS Optimus Foundation will match that with a dollar, up to $10 million, meaning this could amount to $30 million total.
Hubertus Kuelps, head of communications and branding for UBS, told Devex there are four reasons his clients are so interested in supporting this work: there is evidence of impact; there is scale; they activate additional money with every dollar they give; and through the UBS Optimus Foundation, they get reporting.
“Ninety percent of UBS’s clients are involved in philanthropy in some way, shape, or form, but only 20 percent of them think it’s being done effectively or they're doing it effectively,” he said.
Living Goods and Last Mile Health are looking to expand to three more countries where the partners plan to invest $170 million over the next four years. They will evaluate which governments have leaders who are most likely to become champions of this work, as well as which geographies could benefit most from extending the reach of doctors and nurses. As they pursue additional funding, they will also look into partnerships with NGOs, who share their approach of strengthening and scaling up national community health worker programming.
“Part of what Raj and I see is a real intersection between innovation in technology and innovation in finance. Impact bonds and pay-for-results structures are powerful ideas, but they have a hard time gaining traction for two reasons: they are too complicated and verifying the results investors are paying for can be prohibitive. Typically you have to verify outcomes on foot, but mobile allows you to verify electronically and that cuts costs,” Slaughter told Devex.
Davos is a place where a large number of health initiatives have launched, from Gavi, the Vaccine Alliance, to the Coalition for Epidemics Preparedness Innovations. “The emergence of disruptive digital technologies has created unprecedented opportunities for the public, private, and social sectors to work together to develop and deliver social innovations that can improve people’s lives at great scale,” Steve Davis, president and CEO of PATH, told Devex.
Each of the community workers in the new scheme gets an Android phone with an app that automates the diagnoses of three of the deadliest diseases in Africa: malaria, diarrhea, and pneumonia. They can also register and triage pregnancies. Then the app provides instructions on prescriptions, whether the patient should be referred, and it sends reminders and follow-ups. This helps community health care workers push back against the skepticism that they cannot do what doctors can do, enables the organizations that recruit and train and pay them to better track their work, and provides performance feedback for the entire health system.
As Devex reported previously, mobile technology not only allows community health workers to provide better care at a lower cost, but also allows organizations that build networks of community health workers to lower the risk for prospective funders. This real-time data, together with randomized control trials to demonstrate impact, allows them to provide transparency and accountability to donors and investors. It is just one example of how technology can attract new kinds of capital to health care systems work, drawing in new actors from the private sector, at a time when funding for global health from bilaterals and multilaterals is on the decline.
When Slaughter talks about the power of the community health care worker model, he mentions its low cost, scalability, ability to halt outbreaks before they can become pandemics, and its potential to create jobs and livelihoods, particularly for women.
“So many industries are worried about automation stealing jobs. This is a place where automation is creating jobs,” Panjabi said.
In Liberia, Panjabi works with groups including Partners in Health, the International Rescue Committee, and Plan International, all under one government plan to reach the last mile. “We’re seeing more and more of this kind of large-scale population change, what we would call systems change, that social entrepreneurs as the innovators are able to drive not in isolation but in partnership with other key stakeholders,” Katherine Milligan, head of the Schwab Foundation for Social Entrepreneurship, a network both Panjabi and Slaughter are part of, said.
She added that while much Davos conversation focuses on how technological changes could exacerbate differences between haves and have nots, these emerging and disruptive tools can be constructively applied in a low-income, low-resource setting. “I think it’s going to be absolutely fundamental for people looking to solve social challenges that they’re incorporating technology into the business models from the outset,” she said.
But technology is not the only thing that needs incorporating. Some health experts warn such initiatives need to fit into a wider ecosystem of health development, including government. Rudiger Krech, director of Universal Health Coverage and Health Systems at the World Health Organization, pointed to the One Million Community Health Workers initiative, which aims to scale up community health workers with an emphasis on health systems strengthening.
“If these good intentions and innovations are not well integrated into the wider health system of a country, then you see a plethora of pilots and raised expectations and promises that cannot be met,” he said.
Krech did say he sees the use of digital health as a promising tool for universal health coverage and said it will be an area of increased emphasis for WHO. But the focus should be on the nuts and bolts of health systems, he said, adding that sometimes disconnected initiatives end up counteracting one another. Health systems strengthening will be required in order to optimize the impact of digital health, rather than the other way around.
“For a system to work, we need health workers, we need sustainable financing, we need governance, we need information, we need research, and we need services that are people centered and not disease specific,” he said. “If we’re addressing one or the other item without focusing on the interconnectedness of the other elements, then we’re losing out.”
Slaughter and Panjabi say their approach focuses on health systems. They want to put more data into the hands of health care systems decisionmakers, demonstrate how community health care workers are undervalued, and professionalize them.
“We’re not going to solve the whole world’s health problems,” Slaughter said. “But when we pick a country, we want to build the national solution both from managerial and technology point of view, but also from a financing point of view — which is why, while $170 million is a lot, that has to be catalytic in influencing other bigger pots of money.”
Read more Devex coverage on global health.