By Astrid Zweynert
OXFORD, England, April 5 (Thomson Reuters Foundation) - When Ebola ravaged Guinea, Liberia and Sierra Leone, health experts were puzzled how the disease had been able to spread so quickly, killing more than 11,000 people and crippling the region's health systems.
Ebola started in the forests of Guinea in December 2013 but spread undiagnosed for nearly three months through dozens of villages, eventually affecting other countries in the largest outbreak of the viral disease in history.
Physician Raj Panjabi had no doubt that to prevent the next epidemic, more community health workers were needed to reach patients quickly in remote areas, the "blind spots of healthcare", where it can take up to two days to reach a clinic.
"It's what we call the tyranny of distance," said Panjabi, who received the $1.25 million Skoll Award for Social Entrepreneurship at a conference on Wednesday.
"If you're too far away, you're the last to receive healthcare but you're the one who often needs it the most."
It is a potentially deadly dilemma for an estimated one billion people who lack access to healthcare because they live too far from a doctor or clinic, most of them in sub-Saharan Africa.
Having fled his native Liberia as a nine-year-old when civil war ravaged the West African country, Panjabi returned after the conflict had ended in 2003 to find around 50 doctors were left to treat four million people.
The experience prompted him to co-found what would later become Last Mile Health in 2007 with a group of civil war survivors and American health workers.
Last Mile Health's mission: to recruit, train and provide resources to healthcare workers in far-flung Liberia so that "everyone, everywhere, every day" can have medical treatment.
"In this century no one should die because they are too far away from a clinic," said Panjabi, who is also the winner of the $1 million TED Prize 2017.
Last Mile Health has conducted more than 100,000 patient visits in remote Liberia, one of the world's poorest countries.
During the Ebola outbreak, it helped the government of Liberia to train 1,300 health workers and community members.
It is also working closely with the government to train, equip and employ more than 4,000 community health workers by 2021 for the 1.2 million Liberians living in the remotest parts.
The health workers are equipped with a backpack full of medicine, treatments and diagnostic equipment as well as smartphones to record data and keep track of stock of drugs. They are also essential in providing surveillance to help stop a local outbreak becoming a pandemic, said Panjabi.
"What we learned from the Ebola outbreak was we can't separate emergency response systems from everyday response systems," said Panjabi, a doctor at Harvard Medical School in the United States.
"What we need in an emergency (such as Ebola) is an everyday system that is in place and can adapt and respond," he added.
A 2015 report showed community health workers are crucial in improving healthcare in developing countries.
But despite efforts to boost recruitment there is still an estimated shortage of about 700,000 community health workers across sub-Saharan Africa and it will take at least $3 billion each year to address the gap, Panjabi said.
"It's an investment in the future to recruit more community health workers - not just for healthcare but also because it creates jobs in areas where there are very few available." (Reporting by Astrid Zweynert @azweynert, Editing by Belinda Goldsmith; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights, climate change and resilience. Visit http://news.trust.org)