The Last Mile

Despite tremendous advances in medicine, many communities still lack access to essential health care. This disproportionally affects the world’s most rural and remote places, home to about a billion people. Such areas also often lack electricity and the crucial infrastructure of telecommunications and road networks, which keeps the people who live there out of reach of the health-care system. How do we overcome the “last-mile” problem and bring quality health care to places that conventional approaches don’t reach?

The physicians and experts Prabhjot Singh and Raj Panjabi outline a transformative approach to delivering services in remote areas and show how it can revolutionize access to care. The targets of these efforts include the United States, where rural and remote communities across the country struggle to stay healthy. Building on years of experience working in last-mile settings, Singh and Panjabi explain how rural communities are taking the lead in designing a new generation of technology-enabled and people-powered health-care systems. Complementing the conventional hospital-centric system, remote areas can implement a “microgrid”: providing care in clinics and homes, with locals as staff, using portable off-grid materials, backed by an integrated system that helps all these pieces work together. The microgrid model can transform rural health, and it also offers a way to address growing health inequality in urban areas. Giving vivid firsthand examples from places as diverse as Liberia and Alaska, Rwanda and New Mexico, Mali and Brazil, The Last Mile is a powerful portrait of the innovations that will challenge—and change—how primary health care is designed and delivered everywhere.