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Going the last mile

September 2, 2020

reading time: 8 minutes

by Laura Gianesi, LGT

Last Mile Health

At the nonprofit Last Mile Health, Amy Walburn helps to bring basic healthcare to the most remote communities. How the American ended up in Liberia.

As a teenager back home in the USA, I tried to find the reason for the blatant injustice in the world by studying religion. However, when I had my first job at a microfinance organization in Haiti, I quickly realized that my degree wouldn't get me very far. I learnt how important and underestimated basic business skills are for nonprofit organizations. When talking about nonprofits, most people think about their visions, their goals, their philosophy. But I realized that the place where I could add the most value within the industry was in areas that usually get forgotten, like improving efficiency, defining a strategy and improving HR practices. 

This is why I decided to get a Master of Business Administration – in Beirut, Lebanon. While living and working there, my husband at the time took a job in Liberia and as the situation in Lebanon became increasingly unstable during the Arab Spring, I decided to join him there. I planned to only stay for a month, but I loved the country so much, I ended up living there for nearly four years.

Last Mile Health
Hospitals are often miles away. Image: © Last Mile Health

I really wanted to work in public health. This was the sector that particularly needed support. The civil war in Liberia had ended in 2003 and the country's health infrastructure remained devastated. Most doctors had fled and didn't return. What added to the health crisis was the large number of people living in remote areas. Even today, more than one third of Liberia’s 4.7 million citizens live in rural communities with limited or no access to basic healthcare services. Even though I wasn't a doctor, I knew I could add value thanks to my business skills – but back office positions in health organizations with realistic and inspiring visions were hard to find.  

This was when I first heard about Last Mile Health. The organization had demonstrated an innovative way to tackle Liberia's health crisis: training community health workers, who help bring healthcare services within reach of everyone, everywhere. Community health workers are recruited directly from their own communities and trained to provide primary healthcare to combat preventable diseases such as malaria and diarrhea. They expand access to care for those living in rural and remote communities who may be too far from the nearest health center – especially young mothers and children. And crucially, they are paid for their work, which allows them to support themselves and their families. 

Last Mile Health
The community health workers of Last Mile Health provide help on-site. Image: © Last Mile Health

As Last Mile Health was growing at an incredible speed, they started hiring for more roles to help build organizational capacity. The impact they had already achieved amazed me, but I also knew that they needed the internal infrastructure to successfully scale the work to reach more patients, including a strong fund development team. I applied straightaway for a position in Monrovia – and got the job. I became the Director of National Partnerships to support our overall fund development, and served in that position for two years. Today, as Chief Development Officer, I cultivate and lead our fundraising activities and partnerships that help us advance and elevate impact.

Overseen complexities

During my early years at Last Mile Health, we experienced unbelievable financial growth. When Last Mile Health was founded in 2007, it had an annual budget of under 100 000 USD. Eight years later, this number had risen to 9 million USD – primarily from financial institutions like LGT, foundations and private sector partners. We were growing at such a rapid pace that our administrative functions in areas such as finance and HR slipped into the background. 

Last Mile Health
Amy Walburn, Chief Development Officer at Last Mile Health

This is where LGT Venture Philanthropy (VP) has been a great partner. From my perspective, funding partners are often most passionate about our results– like the numbers of patients whose lives were saved. While this is critical, it’s also essential to understand the internal infrastructure that allows an organization to achieve impact. We must dedicate the time and resources required to develop our IT infrastructure, revenue strategy, and HR systems. Tom Kagerer, one of LGT VP's investment directors who has worked closely with our team, understands this element of our work, which is often invisible to other funding partners. He has helped us to define new processes, recruit for management positions and build long-term strategies and goals. 

Last Mile Health
Last Mile Health supports the government of Malawi, too. Image: © Last Mile Health

What is important in our organization’s growth at this point is that we want to stay lean. We don't want to grow for growth's sake. Instead, we're driven by questions of how we can scale our impact globally. For example, we've just started working together with the Government of Malawi. However, we're not trying to enter the market with the goal to become the largest NGO in the country. Instead, we're asking ourselves how to leverage our skills and expertise to support the government build a national program of health care in a sustainable manner. 

As we help the Liberian and Malawian governments design, scale, strengthen and sustain its community health worker programs, we move from a direct implementer to an advisor. The idea is that the governments will employ the health workers directly, while we offer our experience, expertise and knowledge in how to build and sustain these programs. In Liberia, our goal is to support the government to train 4000 health workers by 2021. LGT VP supports us actively to reach our targets, by helping us to set milestones, monitor progress and course-correct when something isn’t working well. Also, LGT VP has a portfolio of NGOs that LMH can learn from, including mothers2mothers, a NGO that is also present in Malawi and supports HIV-infected mothers and their children. Thanks to LGT VP, we have the opportunity to learn from others with experience operating within the Malawian health system. 

As we continue to grow, I am excited and proud but also grapple with a certain anxiety about the unknown. As we advance our work in new countries like Malawi, we have so much to learn. But at the same time, we are thrilled about the potential for impact.

Philanthropic commitment

Last Mile Health was founded in Liberia in 2007 to save lives in the world’s most remote communities. It partners with governments to design, scale, strengthen, and sustain high-quality community health systems, which empower teams of health workers to bring life-saving primary healthcare to all people. LMH has been a LGT Venture Philanthropy portfolio organization since 2018. Additionally to grants, the organization receives access to LGT VP's network and professional support.

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