Name: Watch Last Mile Health’s CEO at Fortune-Time’s Global Forum
Uploaded: 2016-12-02
Duration: 11 min 42 s
Description: Raj Panjabi explains how everyone could have access to healthcare.

[ MUSIC ] So here's what the World Health Organization said about the recent Ebola epidemic in Liberia. At the peak of transmission in August and September 2014, Liberia reported between 300 and 400 new cases every week. During those two months, the capital city Monrovia was the setting for some of the most tragic scenes from West Africa's outbreak. Gates locked and overflowing treatment centers. Patients dying on the hospital grounds. Bodies that were sometimes left for days. Flights were canceled, schools were closed, food and fuel ran low But public health experts said that it was the 1, 300 Liberians that your organization Last Mile Health trained. Many of whom were rural villagers without any previous healthcare experience. They kept the virus at bay in many parts of the country. How did you do that? Well, thanks, Cliff, and it's good to be here. Well, first I would just reframe it and say there were many, many groups, many of you here in the private sector who helped respond to our epidemic. And NGO partners here as well, I see [ BLANK_AUDIO ] IRC here, our friends Gary Gottley from partners in health. Those were all critical. Treatment units were important. Lab systems were important. One of the most important interventions was actually training people in the communities most affected. To help educate communities about how the virus spreads. To help ensure that people who are burying their loved ones safely if they got sick. Going door to door to find who was sick and get them into healthcare. Those are called community health workers, but many of them were the loved ones and relatives of the very people who were most at risk. So our organization was one of many that contributed. It's said that some 10000 rural Libyans and urban Libyans, some in poor slums went door to door to help stop the transmission of this disease. Definitely a lot of the international community mattered and that partnership with those local communities matter. And Liberia is now taking that lesson and trying to do something about it by investing in those workers. We talk a lot about technology and healthcare and in fact, we just finished a conference, the Fortune Brainstorm Health Conference which was really about technology. But a lot of the stuff that you talk about is simple, it's, as you said, door to door, community work, you actually can talk a little bit about the kinds of work that people can be train to do effortlessly. It is, right now there are a billion people on the planet. Who have no access to healthcare because they live too far from the nearest. They live too far from city centers. The hot spots of inequality correlate very closely with the hot spots of disease, that was true in Ebola, a two year old boy died in a rainforest community hours away from the nearest clinic. It's true of recent elections Diabetes and obesity rates correlated more with the outcome of the US election than even typical political indicators did in rural America. And so in a space of moral uncertainty, one of the places where there are islands of moral clarity is to look where suffering is the greatest. And we have a good way of measuring that. Medicine, mortality and morbidity. So a billion people have no access to health care, while there's been great progress in global health, child mortality has been cut by half in the last 25 years. We have left large portions of those people behind and we have seen mortality rates not improve for those people. How do you solve that? When a two year old gets sick, In a village Mom has to take him to a river bed, get in a canoe, paddle to the other side and then walk for up to two days just to get a diagnosis. How do you solve that? Well what we try to do is to take women like Mosou who I was just working with a few weeks ago and will be back in Liberia in a few days working with. And train her. She was 18- years- old in rural village. Got a high school degree, which is a very hard thing to do in rural Liberia. [ BLANK_AUDIO ] Went 30 years without a job until she was 48- years- old. [ BLANK_AUDIO ] Was seen as a community leader, Last now health, when the ministry of health went in and asked the community members, we want to stop the death rates of children in your communities, who here could be a great health worker? Lucier raised her hand. We trained her, equipped her, you know a lot was made this morning about what the outcomes of technology. Here's a place where technology Has been critical. Lab tests like this, which some of your companies have made, a dollar malaria test. Medicines like this that used to be you could only get at hospitals and now you can put in a medicine chest or a backpack for a women like Moussa to give. Thermometers which have been around for a long time. So technologies have been out for a long time. You give someone like Moussa these types of equipment. You train her for a few weeks or a couple of months. And she's managed to stop child deaths in her own community, but she's also gained a job from that. Uh- huh. She gets paid $ 70 dollars a month to do this health care. And so what we've started to ask ourself is what is the role of these community health workers if we pay them, if we professionalize them, if we formalize their work? There are so many thousands of informal Health providers if we can give them jobs in rural areas, could we help close this inequality gap in healthcare and try to create jobs in rural areas? Now apart from the crisis stage, when you're in the middle of an epidemic like Ebola, you've said that health is misunderstood in Africa, that there are actually Three overlapping, but distinct, public health epidemics, chronic health epidemics, that affecting the urban rich, the urban poor and the rural poor. You talk a little bit about that? And why do we miss that? Yeah. Well I think we are very focused on infectious disease epidemics. HIV- AIDS, Zika, Ebola, those tend to, I think one Thing we worry about is that they are transmissible, right? They could come and strike us. And we saw that with Ebola that reached the soils not just of my country and the ones next to it but United States and other parts of the world. But the chronic disease epidemics, the noncommunicable diseases, high blood pressure, diabetes, Obesity are also epidemics that transmit. They transmit where poverty. They transmit where inequality is. Richard talked this morning about the fault lines of inequality. If you look at the fault lines of these diseases, where is it more likely to happen, they correlate very closely with poverty and inequality. The good news is if while those diseases Or do exist while we have not yet solved them. There are ways to apply techniques we've used for infectious disease, epidemics, controlling it with say, Ebola community health workers, training those same health workers to stay focus on high blood pressure. And mental health. And we have such a short session that I do wanna open it up to at least one or two questions out there. But before I do, Alan mentioned that yesterday you won the TED prize, this million dollar prize. So I assume you're buying lunch for everyone today. [ LAUGH ] And in that, you said that in April you would reveal your bold wish For healthcare. So why wait til April? Why don't you tell us right there? Let's make a little news. Well we're really honored about the price. We've had the chance to work with the Ted community, which I know many of you might be a part of or involved with. And we will be working on developing this price. They will build on the work in Liberia. The government of Liberia with the help of a number of partners here is trying to scale To reach those 1. 2 million people in the country who have no physical access to health care and [ UNKNOWN ] by employing 4, 000 community health workers over the next four years in those very villages. So giving young rural unemployed people jobs to provide healthcare. If every country could do that, and some countries like Rwanda have already done that, Ethiopia has done that. If other countries including America Could do more of that the forty eight thousand community health worker in America if more investment was put there. We can really dramatically scale our collective effort and the tend price will build more network But if you have ideas for how we could use it and wanna collaborate we would be- Well let me ask you, I mean the business community is gathered here and this is an effort to forge this new social compact. What can business do to make your wish easier? [ BLANK_AUDIO ] I think it starts with getting over our bias against rural communities. One of the faults with capitalism as its currently construed is that, we do not see opportunity where there is not a high density of consumers. In rural areas, by the numbers, by definition, there are low densities of consumers. So What I would ask is that you ask your general managers in poor countries to first think about how to overcome that challenge. Hire people from those communities. To be health workers if that's the case but if you're in farm products team up with a group lie One Acre fund. Andrew [ UNKNOWN ] is here to do product delivery for helping local farmers get better. So hiring people from those communities is number one, ask your general managers to do that. For your R & D units, ask them to design products that work in off grid, off road, off network places, things that are hand held. That can be powered by solar, that don't require electricity, can label work to be distributed for them. I mean, look, my profession being physician, is the greatest culprit of a guilt mentality. If we are willing to shift tasks that are usually confined to doctors and nurses into community health workers Imagine what more we could do if the products were available like the ones i just showed for those workers. The third thing to do is around supply chains. Think of these folks as your partners to distribute your products. I mean the frontier markets There is no competition in these places. You can actually succeed if you go out there. So if you're thinking about long term sustainability as a CEO, and accelerate your business. Scale it but let it reach those people. So that's what I would say for those that create products. In terms of those who create infrastructure I cannot over emphasize how critical communication infrastructure is in these places. If you can take cellphone communication and you can take energy infrastructure and bring it to rural areas then that may require New business models, that would lift so many of the people in these places. The Moussas of the world would be able to use their smartphones and not be off the grid. She has one. She uses it for clinical care, but she's not connected to a network. If she was connected to a network, think about how much more she could do and how much more her community would be connected. So, connection is the last piece I would argue for. Well, in our effort to make this as fast and dynamic as possible, we've run out of time for questions, I'm sorry to say. Okay. But thank you so much, Raj Panjabi. Thank you. Uh- huh, thank you. [ APPLAUSE ] [ MUSIC ]

Raj Panjabi explains how everyone could have access to healthcare.