Year in Review, Looking Back at Liberia’s Health Sector in 2015

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One of the critical and most important sectors in any nation is the health component of that country.

The total wellbeing of the people, including their psychological and physical state, makes a nation strong or weak.

Our Health Desk has decided to look back at Liberia’s health sector in 2015, how it is faring and what we can predict for 2016.

Unlike 2014, which was a very tumultuous year for the nation, Liberians were very hopeful as dawn broke on 2015.

More than 4,000 Liberians became casualties of the deadly Ebola virus disease, which ravaged the land in 2014. As that year came to a close, the virus’ transmission had started to wane, giving hope to Liberians that indeed 2015 would be a year when they would get back on their feet and begin to rebuild their lives, after enduring so much humiliation from some of their fellow Africans and others.

As the situation progressively improved, on Saturday, May 9, 2015, the World Health Organization (WHO) declared Liberia Ebola free. Following this declaration, an elaborate program was held on May 11 at the Centennial Memorial Pavilion, where the declaration was formally made. Several African leaders came to grace the declaration in Monrovia.

The WHO Representative in Liberia, Dr. Alex Gasisira read: “Today, 9 May, 2015, WHO declares Liberia free of Ebola virus transmission. Forty-two days have passed since the last laboratory-confirmed case was buried on 28 March, 2015. The outbreak of Ebola virus disease in Liberia is over.

“Interruption of transmission is a monumental achievement for a country that reported the highest number of deaths in the largest, longest, and most complex outbreak since Ebola first emerged in 1976. At the peak of transmission, which occurred during August and September 2014, the country was reporting from 300 to 400 new cases every week.

“During those 2 months, the capital city, Monrovia, was the setting for some of the most tragic scenes from West Africa’s outbreak: Gates locked at overflowing treatment centers, patients dying on the hospital grounds and bodies that were sometimes not collected for days.

“Flights were cancelled. Fuel and food ran low. Schools, businesses, borders, markets and most health facilities were closed. Fear and uncertainty about the future, for families, communities and the country and its economy dominated the national mood…”

Liberians and others residing within our borders were admonished to continually observe all the health protocols, including constant washing of hands, avoiding bodily contacts, etc.

The Liberian government, through the Ministry of Health and its partners, got to work and began initiatives aimed at building a “resilient health sector.”

The government convened a meeting of health stakeholders and announced an ambitious six-month plan for immediate transition from Ebola virus disease (EVD) response to restoration of basic health services.

It’s no secret the nation’s health sector completely collapsed in 2014 when the deadly EDV tested the “gains” that health stakeholders boasted they had attained before Ebola.

Despite their boasts of the “gains,” they still in their 2,100-word transitional plan admitted that “weaknesses” existed. MOH authorities attributed those weaknesses in the nation’s health system to “multiple factors such as capacity, systemic, financial, contextual issues relative to the prolonged period of instability and structural flaws.” They said those things were left “unaddressed while rebuilding” and “all combined…collapsed the system with the onslaught of the EVD outbreak.”

They also stated that as a consequence of those weaknesses, “massive deaths occurred in the affected communities, including an unprecedented number of healthcare workers.” At least, out of 340 reported EVD cases among health workers, more than 180 deaths were reported.

“Such mass post-conflict casualty and the resulting trauma and strains on the society eroded public confidence [in the health sector],” the Ministry had said.

The Ministry’s transitional plan, which has been earmarked to be realized by June 2015, targets eight thematic areas, some of which were, long before EVD, a part of the blueprint of the Ministry’s health care restoration plan.

Those selected “immediate action areas” towards restoration of basic health services included building a good human resource capacity, laboratory services at health facilities and others, EVD funds realignment, infrastructure/ETUs/community care centers (CCC), logistics and supplies, surveillance, preparedness and response and community engagement and coordination.

As the Ministry drew up this transitional plan, President Ellen Johnson-Sirleaf declared that her government had developed a 10-year plan for the health sector.
It was not absolutely clear if President Sirleaf’s 10-year program to develop the nation’s health care system included the Ministry’s 6-month transitional plan, which some health commentators described then as having “more holes and won’t amount to anything tangible in the six-month timeframe.”

The President said in her April 3, 2015 national address that her administration would embark on this because Ebola had exposed the weaknesses in the sector.

The program’s areas of concentration, according to Madam President, would be to train health care professionals, improve and expand services at primary and secondary health care centers, upgrade county hospitals and establish three regional hospitals in the country.

These objectives are to be achieved in 10 years, not six months. However, President Sirleaf’s administration ends in January 2018.

In the President’s nationwide address, she admitted: “We were invaded by an enemy we did not know and were not prepared to confront and which caused the deaths of many of our fellow citizens and robbed many more of their livelihoods.”

Since the Ministry’s plan was not included in the President’s speech, was it possible for the Ministry to achieve its 6-month plan for immediate transition from Ebola virus disease (EVD) response to restoration of basic health services? Certainly, not!

Under the human resource capacity component of the plan, the Ministry has among others at least six priority areas, including taking stock of foreign medical teams and deploying them, based on expertise and experience, to health training institutions, hospitals and counties; all hazard/risk benefits paid to all health staff and end date for payment communicated to them; and establish a formal in-service training program in infections control, with regular continuing education efforts for all those involved in the delivery of health services in Liberia to ensure quality.

The Health Ministry said, under the laboratory section, it intends to, among others, use current laboratories at regional and county levels to strengthen services; take stock of EVD specimens and establish a bio-bank and a system for accessing the specimens for research; and current staff in the EVD lab will be trained to carry out Ebola, Lassa fever and Yellow fever tests.

It further stated that in order to realign Ebola funds, it intends to pull all extra financial resources for realignment and tracking under the MOH financial management system and conduct financial resource mapping for realignment to EVD and restoration of health services.

Under its plan for infrastructure/ETUs/ and or community care centers (CCC), by June 2015, it should have established permanent infectious disease wards in county hospitals; establish triage in all health facilities to properly screen all patients; and protect health workers, among others.

Looking at logistics and supplies, the Ministry said in this timeframe, it hopes to conduct assets transfer and transition to support restoration of basic services; take stock on EVD and non-EVD supplies including medicines, non-medical supplies, nutritional supplements and food supply and align them towards restoration of health services; and strengthen the delivery and storage of pharmaceutical and medical supplies.

The Ministry said in order to have a good surveillance, to be prepared and be ready to respond, it intends to maintain the current health referral structures (community, health facilities, Ebola units and schools) and transfer surveillance responsibilities (case detection, investigation, contact tracing, etc.) to the county health teams (CHTs). It also wanted to integrate the call center to dispatch center, and transition to the J.F.K. Memorial Hospital.

Under its last component of coordination, the Health Ministry’s authorities said in the event of Liberia being Ebola free, the Incident Management System (IMS) will transition to health sector coordination mechanism and review the terms of reference and structure of the national disaster commission and expand it to include epidemics and disasters.

“This transitional plan is an immediate effort and connective tissue between the effective efforts employed to combat the outbreak and a continuation of pre-Ebola health investment plan towards the national development agenda.”

These are plans the Ministry had hoped to achieve by June 2015.

While the first 6-month plan was yet to be achieved, health stakeholders met Monday, April 6, to discuss another 6-month transitional plan, which was drawn for July to December 2015.

Did they meet the first ambitious plans that they had drawn? You visit health centers, including hospitals, around the country, and decide!
After all of the hard efforts that the government exerted toward building a resilient health sector and fighting to stamp out the disease in 2015, authorities reported two outbreaks in the country. In these outbreaks, the response effort from the government and partners was massive, leading to the outbreaks being arrested in their tracks a few days from their onset.

Looking ahead this year, some of the problems that existed, like alleged Ebola health workers’ constant demonstrations for “benefits” in 2015, would continue, as they were not adequately resolved in 2015.

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