Q&A: Making Last Mile Health's community training academy sustainable

BRUSSELS — Last Mile Health’s Community Health Academy works on two fronts: offering health ministry officials training materials on how to lead community health worker programs and equipping the workers with mobile phone technology to help them register, refer, and diagnose patients. Both, it is hoped, will help enhance community health workers role in health systems, which could save more than 2.5 million lives each year.

In a 2017 TED talk, Last Mile Health CEO Dr. Raj Panjabi expressed the wish that no one should die because they live too far from a doctor. His idea for a community health academy to train and connect community health workers won $1 million in funding, with other philanthropists soon joining in.

The academy so far has six full-time staff and four consultants. It is in discussions with the health ministries of Liberia, Ethiopia, Uganda, and Malawi on how to digitize their national curriculum for community health workers. And on May 9, it will release its first online training for policymakers. More than 1,200 people from more than 120 countries have registered for the course, which is free to access, though a certificate costs $79.

Devex caught up with the academy’s executive director, Magnus Conteh, to get the latest on the academy and its plan to move to a hybrid model, sustained 60% by donations and 40% by income generated through premium content.

This conversation has been edited for length and clarity.

Who is the typical community health worker?

A lot of them are ordinary local community members who take responsibility, initially by volunteering, to say “I am concerned enough about the well-being of my own family and my community to provide my services to support the health and well-being of my local community.”

There is a group who would do this whether you paid them or not, but by paying them you are recognizing that they are making a significant contribution to the health and well-being of their community. The age ranges from teenagers to a 70-year-old community health worker I saw in East Africa who was retired from being a school teacher but still committed to providing support to his community.    

What is the Community Health Academy?

It aims to revolutionize the training of community health workers by leveraging digital technology. The penetration of mobile technology in African countries is huge — more people own mobile phones than have access to water or electricity.

Community health workers in a lot of places already have mobile phones that they use to do registrations, referrals, and diagnostics. We want to leverage that by embedding a digital platform that allows us to deliver high-quality educational content that the community health workers can access to learn more advanced ways of identifying signs and symptoms, be able to at least make some preliminary diagnosis, and in some cases, use the phones to make referrals.

On the other side, we know that community health worker programs are designed, led, and managed by health ministry officials. A lot of countries are still struggling with community health work programs.

As a result, we want to strengthen the knowledge base and the experience of ministry of health leaders that lead community health worker programs by making sure that we use case studies from other countries that have been very successful in designing and managing community health worker programs. Examples include Rwanda, Ethiopia, Brazil, Bangladesh. We want to build in content using a global faculty network to deliver training on an e-learning platform to government officials. These are free courses they can access.

What is the funding model?

Currently we are housed within Last Mile Health, but further down the road in a few years’ time, we are hoping that the academy will be its own legal entity and operate as its own multistakeholder collaborative. With that in mind, we have developed a business model that will allow us to continue to receive philanthropic donations, but we will also develop an income-generating offering in terms of providing content globally.

Currently, we are fully funded by philanthropic donations and other global donors. All the content we are providing now is free to access, for governments, other implementing partners, and for frontline health workers. That will be our global public good model.

In a couple of years time, we are moving to a situation where we will start to develop premium content. That premium content will be made available online to global institutions like United Nations agencies, but also bilateral agencies like USAID and even the Gates Foundation, wherein they will pay for the content, with a view to providing it for their staff who they are sending to developing countries as technical advisors where they will require specialized training. We will provide that content, either on a cost-recovery basis, or at least we will try and get a bit of profit margin in order to keep the initiative alive.

That does not mean we will abandon our global public good model. We will run a hybrid model, where we will still have about 60% of our funding expected to come from donations or funders, but as a minimum 40% of our income will be generated through this type of premium course production.

We will not just be targeting organizations. The private sector or other high net worth individuals that want to use our content and could also pay for it. We’ve already developed this model. We have the documentation ready to run, but of course, we will take a gradual approach towards implementing it.

Are there any precedents for this hybrid model?

There are precedents for this kind of model, either a hybrid model or maybe taking a hybrid model as an initial stage and then becoming an entirely for-profit initiative. We are not necessarily signaling that that is what we want to do.

Our intention is to support capacity building for improving clinical care provision, saving lives at the last mile and contributing to the achievement of universal health coverage. If that is our goal, it’s going to be very difficult for us to be entirely for-profit because most of the frontline health workers cannot afford to pay for this kind of training. Even some health ministries will not be able to pay entirely for our content.

For now, our approach is that there is always going to be a significant element of our offering that will be a global public good and free to access. But our intention in moving into a hybrid model is to ensure our sustainability and that we are not entirely dependent on donations and philanthropic funding.

Currently, we are registered under Last Mile Health so we are operating as a nonprofit. But once we start to migrate into our hybrid model it will probably coincide with when the Community Health Academy is registered as a legal entity of its own. It’s during that process that we will probably be looking at ensuring that we are meeting the right registration that will allow us to operate our hybrid model and be tax compliant at the same time.

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