Liberia was one of the countries in West Africa that was badly hit by the Ebola virus. Between 2014 and 2015, the nation lost over 11,000 citizens.
Its healthcare system was already in a dire state due to the civil war, which began in 1999 and lasted until 2003. By the end of the war, Liberians were left with only 50 doctors for a population of 4.3 million people, as the war saw the destruction of over 95% of the nation’s healthcare facilities.
In 2007, 20.4% of children under the age of five were malnourished, the following year only 17% of the population had access to adequate sanitation facilities, which contributed to the easy spread of diseases such as tuberculosis, diarrheal diseases, and malaria.
The challenges facing the healthcare system are evident to both the government and health officials, and as such, they are both working to resolve them.
Liberia’s Executive Director of Health Initiatives, Joyce K. Jarwolo, has suggested that the government craft health policies that enable all Liberians access to affordable healthcare services.
“We need a national universal health coverage reform that is a critical enabler to social justice and equity and must be part of a wider effort to realise our right to health. While we agree that UHC will be achieved progressively, we call on governments, global health stakeholders, and donors to commit to progressive universal health care to ensure that those who are currently left behind and the most in need are prioritised without discrimination,”
As one can imagine, Liberia’s ruling class and those financially well-off are not having to deal with a failing health system, this is why a change in the current healthcare system will ensure citizens who fall within those marginalised groups like the poor, young, and disabled, are not denied affordable and good health care.
Health Strengthening Specialist, Shelly Ada Wright of USAID-Liberia said: “While some gains have been made in the health sector over the years, more needs to be done, especially in healthcare financing.”
The government are welcoming support and advice, and they have been working tirelessly to improve and strengthen the system.
Developing global health strategies over the years, part of their focus has been on ensuring adequate preventative and rehabilitative measures are developed. One project
In 2008, the government, in partnership with the JSI Research & Training Institute, John Hopkins University Centre for Communication Programs, and the Liberian Ministry of Health and Social Welfare (MOHSW), established a USAID funded project called Rebuilding Basic Health Services (RBHS). The RBHS’ focus is to rebuild basic health systems and services affected by the civil war in Liberia. Working with local organisations through a system of targeted performance-based financing for health services, and with national-level health training institutes, the program seeks to transform the relief-dependent health system into a fully functional service guided and managed by the Ministry of Health. It provides health workers with the adequate tools and training to improve care and use a performance-based financing system to set targets and ultimately improve results.
The government are also learning from neighbouring countries, such as Ghana, who have developed successful health systems.
Liberian government officials are working with and learning from the Ghanaian health system in order to emulate their universal health insurance and find out how to adapt a similar system in Liberia.
Some of the lessons learned from their time with the Ghanaians are:
- Payroll taxes, value-added and sales taxes appeared critical to enlarging the health financing pool to support the Liberian Health Equity Fund (LHEF–the title of the national health insurance system in Liberia).
- Donor funding is likely needed in the short term.
- Health financing can be harmonised with a proposal to incorporate performance-based financing into the purchasing mechanism to incentivise providers to seek more patients.
- It is better to start with a smaller benefits package and add-on services over time.
Before leaving office, former President, Ellen Johnson Sirleaf, was fully committed to improving the health system and to ensuring its longevity, with strong financial backing to avoid future system failure. In December 2017 she launched the construction of facilities for a National Public Health Institute, National Reference and Regional Reference Laboratory in Congo Town, Liberia, during the event the President said “Today we celebrate the partnership. The National Public Health Institute and Liberia’s doctors and nurses who paid the ultimate price during the Ebola crisis. The initiative was worth celebrating because it will not only go beyond a public disease control centre that will be built, but will also bring the people to consciousness to continue the individual practices such as hand washing and other measures that enable us to keep safe.”
Liberia still has a lot of work to do and still faces many challenges, but the country has come a long way, and with continuous, strong direction, and focus, the nation will continue to improve its healthcare system for all its citizens.