Our Recommendation
Last Mile Health is a strong candidate for outcomes‑oriented funding if you are willing to pair modeled and observational evidence with clear system‑change gains. It has a rigorous Theory of Change centered on professional community health workers, major scale through government partnerships, and credible signals of improved access and child survival, but its child‑lives‑saved headline is modelled rather than experimental.
Last Mile Health's Fierce Certification score is 100/100 based on our criteria:
✔ Has Ultimate Outcome Goals (50 pts)
✔ Measures Intermediate Outcomes (10 pts)
✔ Measures Ultimate Outcomes (10 pts)
✔ Shows Continual Learning & Adaptation (25 pts)
✔ Measures Intermediate Counterfactual (5 pts)
✔ Measures Ultimate Counterfactual (0 pts)
The Social Problem
LMH targets the persistent exclusion of remote, rural “last mile” communities from effective primary healthcare, resulting in preventable deaths and suffering. In these areas, long distances, weak infrastructure, and understaffed facilities mean children and mothers often lack timely care for common, treatable conditions. Health systems have historically relied on unpaid volunteer CHWs with limited training and support, and national policies and financing have not fully integrated community health into the primary‑care backbone, leaving millions without reliable, high‑quality services.
The Solution
LMH’s solution is to professionalize and scale community health workers (CHW) as an integral part of national primary‑care systems, guided by a clear Theory of Change. They partner with governments to design and implement national CHW programs where workers are skilled, salaried, supervised, and supplied, and to embed those programs in policy, financing, and data systems. Alongside direct implementation in places like Liberia, LMH runs the Community Health Academy and other training initiatives to equip CHWs and health leaders through in‑person and digital learning, and engages in systems‑change work (e.g., Africa Frontline First) to shift global funding and governance toward sustainable, high‑quality community health.
Key Outputs
Key outputs that give context to LMH’s model:
- Scale of workforce and reach: LMH supports more than 30,000 community and frontline health workers who extend primary healthcare to almost 52 million people across Ethiopia, Liberia, Malawi, and Sierra Leone. A recent six‑month report cites 16,425 community and frontline health workers and 19+ million people with improved access to primary healthcare in that period.
- National‑level exemplars: LMH helped establish Liberia’s National Community Health Program and is working to create three exemplar national programs (starting in Liberia and Malawi) that can inform global practice.
- Training and Academy outputs: the Community Health Academy and blended learning initiatives deliver training to CHWs and health leaders, with evidence that blended learners achieve knowledge gains comparable to in‑person training at 39% lower cost.
- Systems‑change initiatives: through Africa Frontline First and other partnerships, LMH has helped mobilize and coordinate financing, policies, and evidence to support professional community health systems as a core part of UHC strategies.
These outputs demonstrate both direct delivery capacity and influence at national and global system levels.
Key Intermediate Outcomes
LMH’s intermediate outcomes map closely to our framework:
- Improved utilization and care‑seeking: in one Liberia county served by the national program supported by LMH, care for childhood illness by a qualified provider increased by 60.3 percentage points after CHWs were deployed, indicating more timely, appropriate care.
- Expanded service coverage and access: LMH‑supported CHWs now provide primary health services to millions, with 19+ million people recently reported as having improved access to primary healthcare; more than 2.46 million women have improved access to modern family planning services since July 2023.
- Quality and trust in community‑based care: LMH research found that their health system strengthening interventions were associated with better patient‑reported outcomes, including satisfaction, trust, and confidence in community health assistants, suggesting improved quality and acceptability of care.
Key Ultimate Outcomes
On ultimate outcomes, LMH presents promising but mostly model‑based evidence:
- Child survival: LMH estimates that interventions delivered by LMH‑supported CHWs have saved 8,851 lives of children under five since July 2023, based on coverage and effect‑size models. This is a direct statement about mortality, though it relies on modeling rather than an experimental or quasi‑experimental design.
- Maternal health: LMH and partners state that professional CHWs improve maternal health outcomes, and 2.46 million women are reported as having improved access to modern family planning, which is linked to better maternal health, but specific maternal mortality or morbidity reductions are not yet presented as causal estimates.
LMH clearly aims at and reports on ultimate outcomes (child survival, maternal health), but the strongest public evidence for impact is modeled rather than counterfactually tested at population scale.
Continual Learning & Adaptation
LMH exhibits many features of a learning organisation aligned with our four‑part cycle:
- Formal Theory of Change and KPIs: LMH has a published Theory of Change and key performance indicators that connect activities (training CHWs, systems change) to intermediate and ultimate outcomes, and this ToC is explicitly used to steer strategy and exemplars.
- Institutionalized learning agenda: a dedicated Learning Agenda, developed through inter‑departmental workshops and country listening tours, identifies key questions, synthesizes evidence, and guides evaluation priorities to strengthen impact and influence of community health systems.
- Adaptive program design: LMH has adjusted its training model (e.g., adopting blended learning after finding equal knowledge gains at 39% lower cost), expanded from direct service to systems‑change work, and leveraged lessons from Liberia to inform programs and policy across countries and globally.
Relative to our cycle, LMH is strong on problem‑grounded Theory of Change, intervention fidelity at scale, and structured learning systems, with a growing but still maturing portfolio of counterfactual evidence on ultimate health outcomes.
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