58 Time November 4, 2019
HEALTH CARE • VIEWPOINTS
illness is universal, healTh care is noT. over half of
the world’s 7.3 billion people, including 1 billion in rural com-
munities, lack access to health care. Approximately 13 million
children still go without a single dose of any vaccine. Nearly
9 million newborns, children and mothers still die each year
from preventable or treatable conditions.
Compounding this crisis is a massive health- worker shortage,
forecast to grow to 18 million by 2030. Training more doctors is
necessary, but because doctors are concentrated in cities, they
alone are insufficient to close this gap. What if the residents of
rural communities—even those without a high school degree —
could become a vital part of our health care team?
I recently visited Ruth Tarr in an isolated community in Li-
beria, the country where I was born and have worked with my
team at Last Mile Health for 12 years. In sixth grade, Ruth was
forced to drop out of school because her parents could no longer
afford it. As an adult, she could not find work—until 2016, when
she was hired as a community health worker. Over a few weeks, a
nurse trained Ruth, equipped her with medicine and supplies—
like a handheld test for malaria,
antibiotics to treat pneumonia,
and contraceptives—and gave
her a smartphone with video
lessons on topics like assessing a
child for malnutrition. Ruth now
serves the daily health needs of
her neighbors. When a patient
has a condition Ruth can’t care
for—like a patient we diagnosed
with a damaged heart valve from
rheumatic heart disease—she
works with outreach nurses to
refer her to a network of clinics
and hospitals.
Community health workers save lives. A
few years ago, when Ebola was spreading like
wildfire across West Africa, community health
workers teamed up with nurses to go door-to-
door to bring patients into care. Later, Libe-
ria’s government created a national program to
put a community health worker in every rural
community. Those workers have now identi-
fied over 4,000 potential epidemic events, im-
proved vaccination coverage and increased the
rate of children receiving medical care by over
50%. Community health workers also lower
health care costs. One of every three children
with malaria is now diagnosed and treated at
home, avoiding expensive hospitalization. For
every $1 a country invests in community health
workers, $10 is returned to society.Liberia is not aLone. In September,
15 countries made commitments to invest in
community health workers. If this were scaled
globally, 3 million deaths could be prevented
each year. We’ve built an online academy
through which anyone, anywhere, can learn to
create similar programs in their own regions.
Americans enrolled in the academy are shar-
ing lessons from places like rural Alaska, where
community health workers are caring for pa-
tients with diabetes, opioid addiction and den-
tal cavities, who were previously out of reach.
But to realize this future of health for all, we
must confront an injustice. Though Ruth is an
exception, most community health workers re-
main unpaid. A recent World Health Organiza-
tion report found that the poorest women in the
world subsidize health care with their unpaid
work to the tune of $1 trillion—a figure that’s
larger than the economies of over 150 coun-
tries. As a doctor, I’m not expected to go with-
out fair pay for my work, so why aren’t com-
munity health workers paid fairly for theirs?
Now is the time to join arms with people
like Ruth and demand our governments invest
in community health workers. In her speech
at last year’s Global Conference on Primary
Health Care, Ruth recast her childhood dream:
“Because I am paid, I feel proud. I am saving for
my daughter’s education... I have a dream that
one day I will finish my high school education
and become a professional nurse.” It is possi-
ble to realize Ruth’s dream and bring modern
medical care within reach of every last family.
No person has to be left behind if we’re willing
to go as far as it takes.Panjabi is the CEO of Last Mile Health and an
assistant professor at Harvard Medical School.
He is a 2016 TIME 100 honoreeIf we scaledthis globally,3 milliondeaths couldbe preventedeach yearWhere neighbors
provide health
care, pay them
By Dr. Raj Panjabi