This article presents a practical approach to fixing Liberia’s broken healthcare delivery system. It offers realistic approaches to deal with the meltdown of the system during the Ebola crisis by offering alternatives to rebuild the system. Since the advent of Ebola, the attention of Liberians and the world has dramatically increase regarding the harrowing and appalling state of Liberia’s healthcare delivery system. So, let’s cut right to the chase: The ensuing debate over how weak our healthcare delivery system is isn't going to go away anytime soon. It may sound daunting, but the reality is that these challenges are surmountable – if, that is, our leaders totally commit themselves to tackling these challenges sincerely and with the right people leading the charge to properly manage the change. Liberia already has the needed people, know-how, experience, and financing to make its healthcare delivery system one of the best on the continent. However, with strong political will from the President, sustained encouragement from the legislature, pressure from an informed public, and a ‘can do’ attitude from policymakers to make real change happen, Liberia’s healthcare delivery system can be fixed. We too can make our voices heard by offering alternatives in a constructive manner and presenting structural reform measures, which can realistically fix our healthcare delivery system.
It has already been well established that Liberia’s healthcare delivery system is totally broken and desperately in need of urgent repair. Every Liberian knows that our healthcare delivery system is awfully dysfunctional, and doesn’t deliver effective and adequate care to the vast majority of our people. And, because of its horrific condition, it impacts families miserably and impoverishes the vast majority of our people unnecessarily. Our healthcare delivery system is unevenly weighted toward the privileged and urban centers and contributes to poverty and inequity. Despite considerable increase in spending over the past decade, our healthcare system continues to undermine socioeconomic development by not ensuring equity or adequately addressing the substantial increase in our disease burden. This author believes that this is the primary reason why Liberians who are in poor health less often move up and more frequently move down the social ladder than those who are privileged, connected and in good health.
Because equitable and sustainable access to healthcare delivery has not been attained in Liberia, the biggest causes of morbidity remain malaria, respiratory infections, diarrhea, typhoid, intestinal worms, anemia and malnutrition. In addition, life expectancy is lower, infant deaths are higher, and there are fewer doctors and hospital beds available on average to Liberians. In addition, it is near impossible for a woman to give birth in Liberia without complications due in part to treatment, medication, location of facilities and transportation to facilities. As a result, there is high child and maternal mortality, recurrent epidemics and health crisis, which chronically aggravates the system, according to WHO, the World Health Organization. As such, over 37% of children who are less than five years of age suffer from chronic malnutrition with 7% of them suffering from acute malnutrition, causing stunting in nearly one-third, and leaving 2 in 5 underweight, this is according to UNICEF, the UN Children agency. Furthermore, many Liberians, particularly those in peri-urban and rural areas, often have to travel long distances to receive basic healthcare. And, once they reach a hospital or a clinic, they can only receive care when they pay the exorbitant cost for treatment and medication. Inevitably, many ends up foregoing treatment, while those who can afford to pay, find cost ruinous and quality of service limited. Worst of all, medicines are loosely and cavalierly sold on the street by peddlers hawking counterfeit drugs because the country’s healthcare system does not have regulatory enforcement powers and systems for dispensing drugs safely across the board.
Liberia is not a healthy country by any stretch of one’s imagination, and it has not been healthy for the past decade when numerous opportunities and massive goodwill existed to make a real difference in the lives of the vast majority of our people after years of terrible wars and socioeconomic dislocation. During this period, our healthcare delivery system was neglected and underserved, consistently relying on bilateral organizations and international institutions to upgrade and provide the most basic of resources, treatment, medication, supplies, equipment and technical assistance. Today, the state of our healthcare delivery system is one of poor population, subjected to abject poverty and burden by diseases that have been eradicated or brought under control in most of the world. The challenge for our country is to implement basic sanitation, water, hygiene and medical techniques to address our very heavy diseases burden.
According to the World Health Organization (WHO), Liberia lags far behind the rest of the world, in almost all indicators of health, and forth from the bottom behind most other countries on the continent. Since the beginning of multiparty democratic rule in the country in 2006, our government has continuously focused on the purchase healthcare through direct payment by individuals, instead of facilitating some sort of health insurance scheme to cover all Liberians regardless of social status, income or region. In addition, widespread corruption in the sector has cut a large slice out of our healthcare budget, thus accounting for miserable provision of care. Furthermore, the lack of adequate accessible health infrastructure has made it difficult to provide services to the vast majority of our people especially those in remote areas or in leeward counties. Imagine being seriously ill in Lofa, Bong, Bomi or Maryland county and have to travel on bad roads in dilapidated public transportation or motorbike taxi to a clinic or hospital 10 miles away. In many of these cases, patients expire before reaching their destination.
Now, let’s face the facts about Ebola, which terrorize our country for seven months. The spread of the virus put a terrible spotlight on our country’s extremely weak healthcare delivery system. The crisis caused our healthcare delivery system to collapse at its core. Many Liberians who suffered from other curable diseases during this period die and still continue to die simply because they could not and cannot access proper and adequate healthcare. Ebola proved that fighting disease from a prevention perspective will always be difficult because the necessary tools, such as sanitation, clean water and nutrition are still not in place in homes, clinics, hospitals and community settings throughout the country to deal with the most basic necessities of sustaining life, let alone illness at a distressed period of infirmity. Ebola placed Liberian healthcare at a critically defining moment despite the huge level of international attention, which has had no tangible impact on primary and secondary healthcare of our people. The lack of trust in government was a major handicap in tackling the spread of Ebola; notwithstanding, the virus has presented our country with a golden opportunity to rebuild our healthcare system.
Rebuilding Liberia’s healthcare delivery system needs to begin by embracing longer-term structural changes. By so doing, the strategy should begin with an honest examination of the relationship between the people and the government. This means the government should launch community-based healthcare initiatives and facilities, which should critically engage and empower local communities in the rebuilding of our healthcare delivery system. The next two years will determine whether or not our country’s healthcare delivery system is structurally reformed or just tinkled with around the edges. The kind of structural reforms, which needs to be undertaking, is crucial to improving general health outcomes, reducing disease burdens and cutting the mortality rates of Liberians by more than eighty percent. Structural reforms than, needs to first deal with political leadership, which is required from the highest levels of government to fix the system.
Fixing the system means, bringing together policymakers, regulators, health care practitioners, donors, businesses, NGOs, and civil society groups to discuss key issues in a critical but constructive format, which in the end, must yield tangible realistic results and outcomes. Of course, these innovations are not a panacea and would need to be adjusted on a county-by-county basis, taking into account, needs, lifestyle, and geographic constraints of Liberians. But, by improving our healthcare delivery system in this manner, it will eventually lead to increased productivity, educational performance, life expectancy, savings and investments. Indeed, it will decrease debts and expenditure on our national budget and realign already weak healthcare system by building a foundation for success. Ultimately, this will lead to greater equity, economic return, improved manpower development and social and political stability in the country, not to mention, efficiency in the system.
Reforming Liberia’s healthcare delivery system will require:
- Providing alternative ways of delivering care efficiently throughout Liberia;
- Decentralizing healthcare decision making to regional and county authorities;
- Establishing and providing universal health insurance coverage to all Liberians;
- Building, staffing and equipping regional healthcare colleges and training centers;
- Reconstituting, restructuring, strengthening and professionalizing county hospitals;
- Providing successful, innovative, scalable and cost-effective solutions to fixing county hospitals;
- Improving access to healthcare via mobile technologies to deliver healthcare advice and treatment;
- Building full service district health centers to directly impact the lives of the vast majority of Liberians;
- Shifting the focus of Liberia’s healthcare delivery from curing to preventive care to keep people healthy;
- Laying the foundation for building a system that offers efficient solutions to fit the needs of all Liberians;
- Delegating budgetary responsibilities to regional and county administrative and institutional oversight boards;
- Removing limitations that make survival difficult for the sick or those who live at the bottom of the social ladder;
- Providing a strategy to enhance and clarify the roles of the private and informal sectors in our healthcare system;
- Recognizing that the lack of nutrition, clean water, sanitation and hygiene cause persistent problems for wellness;
- Training of 100 doctors, 100 pharmacists, 100 nutritionists, 100 hygienists, and 100 facility administrators annually;
- Training 300 nurses, 1,000 community-base healthcare practitioners nationwide to provide adequate care annually;
- Avoiding constraints, which hamstring delivery of efficient care, such as, shortage of doctors, lack of appropriate infrastructure, equipment, supplies, resources, staff housing, transportation, and adequate pay;
Francis W. Nyepon: Author, Policy Analyst, Environmentalist & Entrepreneur <> [email protected]