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Rethinking Liberia’s healthcare delivery system

Francis W. Nyepon


The Ebola outbreak showed how vulnerable Liberia’s healthcare delivery system is.
It also proved how the health of the vast majority of Liberians remains in jeopardy, with  many still suffering from diseases that are relatively simple to prevent or treat.
The virus also proved the urgent need for a modern healthcare delivery system. It
confirmed the challenges face by the Healthcare System,which makes it near
impossible to impact the lives of ordinary Liberians in a meaningful way.

The aim of this author is to begin a serious conversation about repairing; revamping
and overhauling Liberia’s healthcare system in the wake of the Ebola virus outbreak.
In spite of this failing, the outbreak can and should provide an outstanding
opportunity to improve the system in order to acquire better health outcome for
Liberia. Furthermore, the virus’ outbreak can provide the Sirleaf administration with
the ideal platform from which to spring into action and develop strategies to put
measures in place to avoid another epidemic.

By now, every Liberian recognizes that the challenges affecting Liberia’s healthcare
system are gigantic and bountiful. Most will also agree that stringent and sweeping
reform measures need to be put in place to fix the system. Liberia’s healthcare
system needs vision, direction and a roadmap to bring it in line with 21st century
practices and thinking, in order to achieve results. Liberia’s healthcare sector has
been neglected, mismanaged and disorganized in the face of substantial contributions
from donors and partners. Policies to combat serious health challenges have on the
one hand not rendered noticeable improvements in the lives of ordinary Liberians.
While on the other hand, barriers dealing with management and organization prevent
progress in meeting basic standards of care by lowering living standards, and in the
process fermenting inequality.

What is needed in Liberia at this critical junction, when so many Liberians have lost
their lives to this virus, is a comprehensive approach to delivering healthcare. It
is mandatory that Liberia overcome barriers to accessing affordable, standardized and
sustainable quality care for all 4.3 million Liberians. First, there is the need to
prioritize access to affordable care, and bring to bear tolerable resource management
upon the system with adequate policy formulation and strategic thinking to realize
and attain verifiable results. Second, the system needs to be endowed with skilled
caregivers, along with equipment and supplies so as to not hold development hostage.

Overall, the system needs to be modernized, using our limited resources, so that it
doesn’t prevent those with health issues from moving up the social ladder, and
prevent them from participating in making Liberia a dynamic and transformative
society. For example, impartial access to healthcare in Liberia has not been attained
by many because of class, social status and geography. Many times, Liberians have to
travel long distances or pay huge amounts of money to receive the most
basic healthcare. In the absence of accessibility, Liberians use pharmacies as clinics,
and many times they have to forego treatment because of cost, quality and location.

Additionally, there are several other challenges that need to be mentioned. First,
over the past 10 years, Liberia has not produced sufficient health workers at the
rate that the country requires. These challenges can be surmounted by maximizing
our resources at our medical and nursing schools. According to the World
Health Organization (WHO), Liberia has one physician for every 71,000 people
compare to one physician for every 10,000 persons in the sub-region. Second, the
majority of healthcare workers in Liberia are located in the Monrovia Metropolitan
Area where one half of the population resides; thereby, leaving the rest of the
country unattended to and vulnerable. This author believes that Liberia will not
develop technically, economically and socially without substantial improvements in
its healthcare sector.

At this point in time, the Sirleaf administration needs to initiate a number
of reforms to address the pressing problem of modernizing the country’s
health care delivery system. First and foremost, the administration should focus
on upgrading the entire healthcare infrastructure. This includes a thoughtful
and unbiased look at the Ministry of Health, local medical and nursing schools,
and County Hospitals and regional clinics, where the rubber meets the road. Who is to
say, as Liberians, we will not see improvements in our healthcare system if modest
investments were made by the Sirleaf administration in the institutions mentioned
above in two years? The aim here is the fact the the Sirleaf administration needs to
alleviate the health burden on the Liberian people. This can be done in two years.
And so, this author will urge the government of President Sirleaf to begin thinking
about providing all Liberians with universal healthcare coverage. This national
health coverage can be paid for by imposing a 1% tax on income or on high-end
consumer goods. In addition, this author is of the opinion that intensive training
for additional healthcare workers in nursing and ambulatory care and hospital
administration is needed in the next two years to insure all Liberians get access to
quality care, affordable service and improved health outcome.

A moral argument needs to be made by President Sirleaf calling upon all healthcare
workers who are currently underemployed or unemployed to return to the profession to
help develop Liberia. The President can also promise and insist that our national
health policy will tackle emerging and re-emerging priorities in the sector with the
primary aim of improving health outcomes and wellness for all. To make it attractive,
the President must maintain that such a policy will be accomplished first and
foremost by prioritizing safe drinking water, adequate sanitation and proper hygiene
to impact rural, peri-urban and urban communities. She must insist that a realistic
strategy be developed to deal with communicable disease transmission among all
segments of the population. And finally, she must demand specific strategies from the
Ministry of Health to strengthen national research systems in order to shape the
national health agenda, while asking health workers to make sacrifice in the national

As a final point, our educational system must join the fight. We must begin teaching
health again at elementary school level where children learned about personal health
and hygiene. Parents too can play a role. They can help their children learn about
wellness, and do the simple things like personal hygiene that we are currently being
forced to practice today because of the Ebola virus (like hand washing and proper
hygiene practices).

Liberia’s healthcare delivery system needs to be drastically improved if health
outcomes are to be improved to impact the daily lives of all Liberians. To
significantly reform Liberia’s Healthcare Delivery System, this author believes that
an office of standards and compliance be created. Such an office should be
100% independent, and should include an inspectorate, an ombudsman and early
warning systems. This office should set standards for Liberia’s healthcare sector.
It should be a regulator with legal status, and should report directly to
the President and not the Minister of Health. The Minister of Health should not
be able to intervene with this office on any level, because, potentially, he or she
could protect or insulate people that are a problem; and that would indeed be
tantamount to conflict of interest. This office will not have any impact on our
healthcare delivery system if it becomes politically compromised.

Our Healthcare Delivery System functions badly because of poor service, mismanagement,
lack of adequate supplies and equipment, and the discouraging supervision of staff.
Another important area is public health expenditure, which almost always result in
bad outcomes due to the lack of accountabilityand mismanagement of funds and
facilities. Another important area which must be highlighted is the lack of autonomy
in Liberia’s Healthcare Delivery System, especially with regard to requesting needed
equipment, supplies and staff. If Liberia’s Healthcare Delivery System is to run
efficiently and become modernized, than authorities at facilities should have the
ultimate power to make real decisions over critical management issues such as hiring
and firing of staff or the purchasing of equipment and supplies, and not the
centralized system, which is the foundation of the current system.

Above all, the office of standards and compliance needs to be established with
international best practice regime to deal with health outcomes of Liberians
vis-à-vis geography, gender and age. Independent boards needs to be established to
have oversight responsibilities over facilities and institutions instead of the
Ministry of Health. Politically connected individuals need to be excluded from the
sector, because they would comprise the autonomy of such a board by paying
lip-service to critical issue in exchange for favor and remuneration. Today, all over
the world, Healthcare Delivery Systems are created with board of directors
that consists of members of the public. And these boards hold institutions and
their administrators accountable for effective service delivery. It makes a
huge difference in the efficiency of facilities management. Therefore, Liberia can be
no exception to such international best practice if reform is to come. The Sirleaf
administration should commit itself to addressing incompetence, mismanagement and
lackadaisical behavior in our healthcare delivery system.  Liberia can do better and
develop a first-rate 21st century Healthcare Delivery System to improve the lives of
every Liberian so that each person gets equal opportunity to move up the national
social ladder and actively participate and contribute to making Liberia a
vibrant, transformed and modern society.
Francis Nyeponcan be reached at:

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