Liberia: still struggling with broken health care
–but access increasing
By Frank Sainworla, Jr, fsainworla@yahoo.com & William Selmah, wselmah@gmail.com
Liberia’s health care delivery system is still not in good shape and faced with grave challenges. But health authorities say access to better health services is on an upward trend.
One of Liberia’s national Agenda for Transformation goals is to improve the quality of life by investing in more accessible and higher quality healthcare, as well as expanded access to healthy and environmentally-friendly water and sanitation services.
But the government of President Ellen Johnson Sirleaf is still struggling to revamp the broken health care delivery system in the aftermath of the deadly Ebola crisis. It has a master plan called, the Agenda for Transformation (AFT). It puts human development central in line with the Economic Community of West African States (ECOWAS) Protocol on Democracy and Good Governance. The protocol of the 15-nation sub-regional body seeks to provide basic human needs and fight poverty in countries in the sub-region.
How has the Ebola Virus outbreak and the ongoing economic crisis undermined efforts to provide accessible and affordable health services to the people of Liberia?
“Getting access to hospital when one gets sick in this community is often very difficult….especially when an emergency occurs at night,” explains John Togba, a resident of the God’s Gift Community in Bensonville. This town is just 26km from the Liberian capital, Monrovia.
Togba tells www.newspublictrus.com that he even lost his daughter in labor pain. He and his family explored every avenue to help save his daughter but to no avail. He says they hired a vehicle to take her to the Bensonsonville Hospital, the only health center in the area, only to be referred to Monrovia because she needed Caesarean section.
Access to health care services is not the only health-related problem facing most communities. There’s also lack of safe drinking water, as Jefferson Dennis of nearby Gbokolleh Town explains.
“We at times drink from open creeks/streams. We have hand pumps here but they are all not functioning now. I can tell you, it’s by the grace of God but it (creek water) is not really safe. Just look at the water…other parts of the creek… other people go there to use it to wash and latrine. So when the rain falls, it becomes difficult to drink. So it’s not easy for us here. When there is no safe drinking water, it causes a lot of problem for us,” says Dennis.
Despite commitment of resources and trained personnel, two-thirds of rural households still travel more than an hour to reach a health facility. Liberia’s international partners and donors are helping to improve the system,
This is compared with 85% of most urban households that are within one hour’s walk, according to current official statistics. For childbirth, 63% of deliveries in urban areas are facility-based, compared with 25% in rural areas.
One might even be tempted to believe that the reality on the ground is far worse than the figures indicate, considering that some communities just about 15km from Monrovia have grave challenges accessing health centers.
Citizens access increasing
But Liberia’s Ministry of Health says citizens’ access to health is increasing, though the country is yet to reach ECOWAS 15% GDP target for investment in the health sector.
Some US$77 million has been allocated in the national budget of well under US$600m dollars for the 2016/2017 fiscal year, which ended last May.
“We’ve been fighting between 10-12%. We haven’t met the 15% ECOWAS target of national GDP budget of supporting health care. ECOWAS heads of state met and apportioned 15% of their budget but we’re very close to it. Liberia has been able to reach between 12-13% on that so that’s also good. What we need to improve on is the quality of the kind of health care we need to improve on is the quality of health care we provide to our people…,” says Nyenwsah.
Although Liberia is yet to meet the ECOWAS 15% GDP target, the head of the Public Health Institute says the government is doing everything to ensure health care delivery services are more accessible nationwide, emphasizing quality and equality.
“I think Liberia has made significant progress in access to health but more needs to be done… More services especially quality. Quality and equitable health services need to be provided but access to health care has increased from 40% or lower in 2006 to now over 77% in 2016.That’s how fast progress has made in increasing access to health care—Primary health care, secondary health care and tertiary…there’s progress being made in those areas but more needs to be done,” Nyenwsah says.
Way to reduce grim statistics
Despite the relative gains Liberia has made in the health sector, it is still rated among countries with the toughest challenges for childbearing mothers. Infant mortality stands at 71 out of every 1,000 live births and neonatal deaths at 994 out of every 100-thousand women seeking delivery services.
One way to reduce these grim statistics is to step up awareness on prenatal care in both urban and rural areas. This is by giving the people access to health facilities.
The story of the people of God’s gift community and Gbokolleh Town near Monrovia is just a tip of the iceberg. The situation worsens the deeper one penetrates remote rural communities in this country.
“There are lots of health problems…there are lots of health issues, especially in post Ebola, post conflict Liberia; for example prenatal care in Liberia,” says Sunday Mulbah, an experienced Liberian health practitioner.
In the past, he worked in several rural communities in the northwestern Lofa County on the border with Guinea Conakry.
“Awareness is part of preventive health care but in Liberia we are so glued to curative. For example, we treat malaria in one person three times a month. The person comes…we treat malaria…They go back home they’re infected. They come again, we treat…They go back home they are infected. This is a cycle that will never be broken if we continue to do medicine this way in Liberia,” said Mulbah who currently runs the Omega Community Clinic Monrovia’s Paynesville suburb.
This Liberian health worker recalls one specific human interest event, whilst dealing with child bearing mothers during the 2014-2015 Ebola outbreak.
“A pregnant teenage girl could not go to any hospital because everybody was afraid of Ebola, but they trusted us… so when she got in pain they rushed her (to his home), but before we could open the door, she’d already passed the baby on the porch—in this city (Liberia’s capital, Monrovia), not in the rural area. So that experience alone can speak volumes,” Mulbah reflects.
Boost infection prevention control
The National Public Health Institute has been set up to help “heighten infection prevention and control” and beef up health care delivery in the country.
Liberia was one of three countries in the ECOWAS sub-regional grouping worst hit recently by the deadly Ebola virus, with over 4,000 lives being lost.
Even the government admitted that the Ebola outbreak exposed the country’s deplorable health sector. When the disease struck, Liberia had just a few ambulances, while hospitals lacked basic things like gloves.
According to Nyenswah, that devastating outbreak has taught the government many lessons.
Now, he says the Ellen Johnson-Sirleaf’s government boasts of building a resilient health system, where emphasis is being put on prevention rather than cure in this West African nation of some 4 million people.
The head of Liberia Public Health Institute is rather optimistic about the future of Liberia’s ailing health system saying that the Liberian government was prepared to invest more in the health sector. Access is said to be increasing with the quality of services.
“It collapsed our health care system and this is why our concentration now is building a system that is resilient. The resiliency comes in so many forms. Number one the health care workforce is built up, one that is critical. Today, some of the things that we put in our resilience plan are being fast achieved,” says Nyenswah .