Liberia: Malaria, Other Drugs Donated by U.S. Not For Sale

A coalition of nine civil society organizations is creating awareness and promoting accountability and transparency in the public health drug supply chain system, to ensure that essential drugs donated by USAID and other international partners are free.

The coalition, which was created under the USAID funded Liberia Civil Society Activity (CSA), seeks to  address why public health facilities around the country run out of essential drugs such as malaria pills, family planning and medicines for HIV-AIDS and tuberculosis.

Since its formation in June, the coalition has met with  key stakeholders in the health sector, citizens, and the private sector to address the root causes of the stock-out of essential health commodities at service delivery points in the country.

Participants at  inception meetings, focus group discussions  and one-on-one engagements complained about the lack of vehicles to transport drugs from  county drug depots to  rural areas; health facilities gave patients prescriptions to buy malaria medicines at local pharmacies or charge them for contraception; and drugs expire because they are stuck in warehouses. 

Some participants alleged that the drugs are stolen from health facilities and sold on the streets. The donated drugs are distributed quarterly, but some citizens and health care providers say the drugs often run out before the end of the quarter.

In addition to engaging stakeholders, the coalition will develop messages through jingles, drama, flyers, billboards, and radio talk shows to educate the public that the drugs are free of charge, not for sale. They also want to enlist the public’s help in reporting sale of donated drugs.

“We want citizens to be aware that the donor drugs that come to health facilities are free,’’ said Siah Sam, community engagement and research coordinator for Community Health Education and Social Services (CHESS-Liberia), one of the coalition members. “Many citizens are not aware that some of the drugs are free. Our advocacy is to find out how long the drugs will last when they come to the facility.’’

The coalition’s advocacy is centered around three projects: Integration of Citizen Charters for Health Facility Development Committees; Drug Stock-out Mapping and Supply-Chain Management Advocacy; and Civil Society Advocacy and Monitoring of Revolving Drug Funds (RDFs). The projects are implemented in six counties: Montserrado, Margibi, Grand Bassa, Bong, Nimba and Lofa.

In addition to CHESS-Liberia, the other coalition members include Public Health Initiative Liberia (PHIL); Youth Network for Positive Change (YOUNETPO);  Efficient Research and Development Institute (ERDI);   Humanity Above One-Self Foundation (HAOSF); Volunteers United for Development (VUD); Institute for Policy Evaluation and Research (IPER); Institute for Research and Democratic Development (IREDD); and Rural Human Rights Activists Programme (RHRAP).

Jocee M. Tuazama, project manager for Efficient Research and Development Institute (ERDI), said her organization will train  the citizen-led Health Facilities Development Committees (HFDCs) about their roles and  responsibilities, so they can  monitor the drugs supply system, tracking the drugs when they arrive and its distribution in the community.   The HFDCs were created under the National Community Health Policy to empower citizens to ensure health facilities are meeting the needs of the community.  Under the National Community Health Policy, HFDCs are charged with providing feedback from citizens to the health centers. However,  HFDCs are inactive in most communities because of the lack of support from  county health teams, Tuazama said.  HFDCs are required to have monthly meetings, but  they hardly meet because members say they receive no money for transportation. HFDCs, she said, are more active in the quarterly meetings that are supported by partners such as Last Mile Health.

“The HFDCs can play a major role in educating citizens that the donated drugs are free,’’ she said.

Coalition members said health facilities in some communities are closed because of the lack of drugs. In Foya, Lofa County,  the Worsonga Clinic has been closed for six months because of the lack of drugs, said Edward Saah Chofullah, of VUD. “The officer-in-charge told me the clinic basically shut down because they do not have drugs,’’ he said. 

In Grand Bassa, some citizens said they were refused family planning medication because they did not pay staff at the health facilities, said Mariyata A. Jarbateh, project manager at IREDD. Most times, it is not paying for drugs, but paying health facilities’ staff to give the drugs, she said. “The problem is, people do not complain,’ she said. “We need to set up a committee for citizens to seek redress for the problems they experience in health facilities.’’

To address  the drug shortage problem, citizens and some stakeholders  in the health sector have been advocating for the Revolving Drug Funds (RDFs), a scheme that will enable health facilities to reserve fees collected from patients and put in a fund to stock-up on drugs to serve communities when the donated drugs run out or cover drugs that are not provided by donors.  The coalition will be raising awareness, so that citizens can buy into it. But the first step is to provide some accountability for the donated drugs, coalition members said.

The health coalition talked about the challenges facing the drug supply system  last week (September 4-8) during five-day training where they  learned tips on research and communication strategy to support advocacy campaigns for health sector reforms and advocate for peaceful elections.   USAID CSA facilitated the training in collaboration with Naymote Partners for Democratic Development, one of its main partners.   Coalition members  thanked USAID CSA and NAYMOTE for the capacity support and promised to use the skills and knowledge learned to run robust campaigns to improve Liberia’s health sector. 

Siah Sam, of CHESS-Liberia, said she learned some communication and research skills that will enable her to strengthen the advocacy for policy reform in the drug supply system. “I will do my best to make sure my advocacy brings good results which will be useful for my organization in terms of sustainability of the project,’’ she said. 

Eddie Jarwolo, executive director of NAYMOTE Partners for Democratic Development, thanked USAID for the opportunity to  strengthen the coalition’s capacity to expand their knowledge in advocacy and team building to ensure health care services are available and affordable to citizens.