Liberia: “Is This the Best Liberia Can Do?”
— US Ambassador Laments Liberia's misplaced priorities
Imagine this scenario: a public health facility that serves thousands of rural poor who depend on its struggling workers for the compassion, diligence, and dedication required of those working in the healthcare profession.
The situation is the reality of Tellewoyan Memorial Hospital, a 135-bed hospital that, like many public hospitals in rural Liberia, has been neglected and left to survive on the shoulders of “dedicated health workers” — scraping together whatever they can.
“Tellewoyan Memorial Hospital in Lofa County currently survives on the backs of incredibly dedicated health professionals, making do with whatever they can scrape together,” says US Ambassador, Michael McCarthy, in a strongly worded statement yesterday as he laments the neglect of public hospitals and other government-run facilities across the country.
“I [am] startled and deeply troubled to encounter multiple county hospitals that received not one penny of what they were promised in the 2022 budget. Hospitals on which lives depend, where outbreaks are prevented and suffering is alleviated, did not receive any portion of the US$100,000 or more appropriated by the legislature for them to operate.”
McCarthy's reflection came the day President George Weah was kicking off a three-day Cabinet retreat in Grand Bassa to assess his administration's achievements as he seeks reelection in a few months' time.
But the administration, given its mixed achievement record with poverty and unemployment at an all-time high, downplayed the US envoy's concern, saying the President has done extremely well in providing needed services to the people of Liberia.
“We have done much in our first term, and we are capable of doing more,” Weah said, in a release a few hours after the Ambassador statement. “The achievements of the last five years under his administration speak for the Liberian people.”
The President's response, if it is anything to go by, attempts to downplay McCarthy's statement which, among other things, accused the Weah administration of misusing resources meant for public health in rural areas.
According to McCarthy, the blocking of resources "is so complete that it is institutional but the scary part is that no alarm has been raised on the issues, which indicates a syndicate involving players at the legislature, the Ministry of Health, and the Ministry of Internal Affairs.
"In one town, administrators look with anticipation mixed with fear at the brand-new, modern hospital that sits vacant, knowing that they can barely keep the existing makeshift facility going, and running the new one will require ten times the resources."
The new hospital that McCarthy is indirectly referring to is the state-of-the-art Emirates Hospital in Gbarpolu County, one of the poorest counties in Liberia.
Constructed with funding from the UAE government, a 100-bed capacity hospital comprises several operating theaters, a modern laboratory, an intensive care unit (ICU), and various specialized departments and would need more than a million dollars to run.
It was built to replace the makeshift Chief Jallah Lone Hospital, which is currently struggling with funding and drug supply problems, according to its administration. The situation with Chief Jallah Lone, Tellewoyan, and other hospitals has made McCarthy question whether the government would be able to fully fund the ruling of a US-funded National Reference Laboratory after its completion.
The Laboratory is being constructed at a cost of over US$40 million and, when completed, according to the US Envoy, will require US$3 million to US$4 million a year from the government of Liberia to operate.
According to McCarthy, If the Government is failing to deliver statutory appropriations of only US$100,000 to existing hospitals, the US would find it hard to ever trust its annual pledges of US$3 million to run the laboratory.
“As for me, should the U.S. Congress ask how the elite in Monrovia are treating destitute citizens in the leeward counties, my honest response would have to be, those citizens are treated with a neglect that borders on contempt. Is this the best that Liberia can do?
“It was striking that the further I went from Monrovia, the more elaborate and explicit the reasons given for the lack of funding from the central government. 'Oh, it is challenging for the government these days. Oh, Putin’s war has made everything more difficult. Prices have dried up the budgets. I wonder if these people are aware that, much to their credit, the Liberia Revenue Authority has surpassed projections and increased revenues for the past four years, climbing from US$435,682 million in 2019 to US$605,005 million in 2022. I suspect the country folk don’t know that the Liberian economy grew by 3.7% in 2022.”
“And I am quite sure they have not been told that the legislature has spent more every year for the past three years buttering their own bread, allocating over US$65 million in 2022 for salaries and operations. That’s correct – while hospitals went without, and service centers withered on the vine, the 30 senators and the 73 representatives spent sixty-five million US dollars feathering their own nests.
Meanwhile, McCarthy has lamented that the lack of funding for many County Service Centers across the country is a mockery of decentralization efforts as the center is no longer a one-stop-shop that addresses the challenges by bringing government services closer to the people. The centers were established to address the challenge rural Liberians face in accessing documents such as birth certificates, business registration, and land deeds, among others.
However, McCarthy noted that none of the country's 15 county service centers has now received the budgetary allocation of a little over US$13k for the 2022 budget year. The US envoy cited the case of one center, which he says has not printed marriage certificates for four years as a result of a broken printer broke to illustrate how bad the neglect has been;
“Virtually all of them, beautifully electrified over the past two years with UNDP-supplied solar power systems (costing around $35,000 - $40,000 each), and amply staffed by (mostly) salaried employees in tidy buildings, are reduced to the job of middlemen.”
“Limited to forwarding paperwork to Monrovia periodically for time-consuming processing, their plight makes a mockery of decentralization efforts. The one functioning office in every center, the Liberia Revenue Authority, has representatives who collect duties and regularly forward funds to Monrovia – apparently a one-way street.”
McCarthy noted it is sad that members of the legislature would be spending US$65 million on themselves as captured in the 2022 budget but appropriated around US$7.1 million for grants and subsidies to county health facilities and US$2.76 million for operations at basic and secondary education …. “although, as we saw, that doesn’t mean the funds reached their intended destinations.”
US taxpayers, McCarthy said, spend around US$60 million a year on health care in Liberia, and another US$23 million on education but members of the Liberian legislature are unable to just appropriate an additional US$10 million a year to primary education (for a country that is tied in last place for average days of school attendance), and an additional US$10 million a year for county hospitals, even the greatest cynics concede that it would make a big difference.
“We withhold 25% of the salaries of our Liberian employees at the Residence and at the Embassy to pay their legally mandated income tax to the Liberia Revenue Authority. Why are the much better-paid representatives and senators not paying a full 25% of their salaries? McCarthy wondered.
“Why are legislators and ministers, those living on the top of the heap, given annual duty-free imports that deny the LRA much-needed additional revenue? Is there any reason other than the perverted version of the Golden Rule - ‘those that have the gold, make the rules?’
According to McCarthy, just US$500,000 each per year of actual maintenance (not make-believe budgeted funds) on four unpaved roads (Zorzor - Voinjama; Zwedru – Fishtown; Greenville – Barclayville City; and Greenville – Buchanan) would dramatically improve the lives of more than a million of poor citizens, lowering food costs, and revolutionizing farm to market access.