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STRENGTHENING HEALTHCARE SYSTEM IN LIBERIA

By Melvin B. Moore

We are living in a world of uncertainties. The world has experienced unforeseen pandemics that have left many countries with the polarized economy and healthcare systems. For example, today, the world is in the race against the Covid-19 outbreak. The virus has affected millions of people around the globe. Besides, it has resulted in the deaths of thousands of people around the world. Currently, there are about 6.1 million people who have been infected with the coronavirus.

Moreover, the number of people who have died from coronavirus infection worldwide has hit around 388,000 persons. However, the number of infections and deaths are rising every day. Generally, the USA is the most affected nation. Approximately 1.8 million cases have been reported and still climbing.

In Liberia, during the Ebola epidemic of 2014-2015, approximately 375 healthcare workers in the country were infected. Moreover, about 189 of them lost their lives. Apart from the Ebola pandemic, the country today is also battling the coronavirus pandemic. The COVID-19 virus was reported in the country in March 2020. However, as per today, about 321 persons in the country have been infected. The coronavirus epidemic has taken the lives of approximately 28 people within Liberia.

Furthermore, the cases of infections and deaths are rising as times go. Now, the coronavirus is equally affecting rich countries, and it isn’t easy to expect the same level of support as was received during Ebola. However, what can the government of Liberia do to strengthen the healthcare system so that to fight any future pandemics?

Healthcare financing

The Ebola outbreak in Liberia between 2014 and 2016 uncovered the country’s healthcare challenges. Among the challenges, there was inadequate funding.  While the country aims to promote universal and affordable healthcare, low investment, and the unsustainable dependency on aid for many essential primary healthcare interventions are two of the paramount contributors to weak healthcare services in Liberia. Many healthcare facilities are run by the government, donors, or through non-governmental organizations (NGOs), including faith-based organizations. Generally, there is minimal private sector involvement in the health sector. In the national budgets for the fiscal years 2017-18 and 2018-19, the government appropriated 14% and 13%, respectively, to the health sector. Though we appreciate GoL’s commitment towards the Abuja declaration signed in 2001 to increase their health budget to at least 15% of the annual country budget, there is a need for more funds to increase the number of hospitals and equipping those facilities.

Improving healthcare workforce and capacity

Health care workers are the backbone of any health system, making their wellbeing and emotional resilience vital to maintaining essential health services. A health workforce of adequate size and skills is critical to the attainment of any population health goal. Liberia needs sufficient skilled doctors, nurses, physicians, as well as the healthcare support staff. Furthermore, the number of healthcare should be proportionate to the population. Therefore, this promotes quality healthcare to the people. According to the WHO, Africa needs 63% more health workers to meet the staffing requirements of universal coverage.

According to Liberia Medical and Dental Council report revealed that by the year 2016, the number of doctors was about 298 among the 4.5 million population of Liberia. This, therefore, means that one doctor serves about 15 thousand people. However, this contrasts the World Health Organization that recommends that one doctor should at least help one thousand people. Before the outbreak of Ebola, the ratio of healthcare workers to the population was 3: 10,000. It means that three healthcare workers were serving ten thousand persons. Therefore, the number of the healthcare workforce in Liberia is minimal compared to the World Health Organization recommendation of 22 healthcare workers per 10,000 persons. However, the International Labor Organization recommends that 41 healthcare workers against 10,000 people need to enhance an adequate healthcare system. It implies that the healthcare workers in Liberia are not enough, and those that are available are being overworked.

The physician assistants, midwives, and registered nurses account for seventy percent of the healthcare workforce. Besides, they are the backbone of the health sector working for underserved communities in rural areas where there is physician scarcity. The multi-factorial reasons for the shortage of Liberian doctors include the civil wars, the 2014-2016 Ebola outbreak, and the exit of doctors trained in Liberia who relocate to wealthier countries, the private sector, and other non-governmental organizations present in the country.

There have been efforts from the Liberian government; for instance, in 2018, 15 Liberian doctors were selected to do their specialized training in several African countries. Besides, the World Bank has been at the forefront of supporting medical education programs in the country. Graduate medical programs in family medicine, surgery, gynecology and obstetrics, pediatrics, and internal medicine are among the areas that World Bank has supported people to undergo training. While the government has tried to increase the workforce and their capacity in collaboration with other partners, there is still a need for a more skilled workforce in preparation for future pandemic uncertainty.

Establishment of integrated disease surveillance framework

An excellent public health surveillance framework is very significant in detecting any unusual disease trend. However, it needs staff who are skilled. Besides, it also requires reliable laboratory capacities for testing and confirming the cases. In Liberia, for example, the integrated disease surveillance framework has been implemented. Strengthening the surveillance system also forms part of the investment plan. The surveillance system was adopted as a way of implementing international health regulation.

Also, the surveillance can help in the early detection of pandemic and inform the nation on the best approaches to avert the health situation from worsening. Furthermore, since the country’s implementation, some progress has been achieved over the years. However, weak healthcare facility reporting, as well as inadequate responses, remains as challenges. Therefore, there is a need to do more training on surveillance, research, health communication, epidemic preparedness, and control. An operational laboratory network is another critical component of a highly-functioning health system. It helps to enhance result confirmation and assist in future detection toward uncertain pandemic.

Building better healthcare infrastructure

Robust healthcare infrastructure is essential to support outbreak and diagnostic reporting. From the 2014/15 health facility assessment, 13% of all facilities did not have access to safe water; good clinical care needs access to water supplies to maintain sanitary standards. Moreover, 45% did not have a primary power source for emergency lighting. This significantly limits the readiness of facilities to provide health services. Also, according to the National health policy plan 2011-2021, 71% of the population lived within 5 kilometers of a health facility. We must make sensible investments in infrastructure and services so that political leaders, as well as ordinary citizens, can confidently expect and receive quality services as opposed to seeking treatment abroad.

Recommendations

If we were to prepare for future pandemics, the government of Liberia must act on the following:

1. Increase budgetary allocation on healthcare

2. Invest in local disposable gowns, masks, PPEs for healthcare workers.

3. Restore and strengthen regional laboratories.

4. Focus on research and epidemic preparedness and control.

Conclusion

A sound healthcare system is essential for the success of any country. The government of Liberia is working in collaboration with other partners to promote the healthcare system. However, more funding is needed to help strengthen Liberia’s healthcare system in readiness for future pandemics.

About the Author

Melvin Moore

Melvin B Moore is a Liberian and currently a Graduate Research Assistant at the Department of Epidemiology & Biostatistics (Mount Kenya University) Nairobi, Kenya. He’s the CEO/Founder of Liberian Data Research Group. It is a Non-profit Organization composed of young, energetic professionals who saw the need to provide quality research; hence, using data, evidence, and insight. He has written several articles on Liberia and Kenya. Here are some of his articles:

You can reach him on the following numbers: +254789355173, +254799869764 or via email: mooremelvinb@gmail.com

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