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THE NATION, SATURDAY, APRIL 28, 2012
•Salome
•Mothers wait with their sick kids at a primary healthcare clinic
•Continued from Page 13 shown in a household where the husband and the head wife were involved in a major domestic conflict which resulted in his refusal to provide her with any financial support. This husband, however, unwillingly paid for his wife’s hospital bills when she contracted cholera. Maternal and newborn care Liberia, according to the country’s Ministry of Health and Social Welfare, has very high maternal and neonatal mortality. The maternal mortality ratio is estimated at 578/100,000 live births, meaning that each year almost 1000 women die from pregnancy related causes. The neonatal mortality rate is estimated at 66 per thousand live births. Therefore, about 11,000 newborns are dying within the first month of life, and most of them are dead within the first week. Access to skilled maternal care is very low. About 75 percent of births occur outside the health facilities and unskilled birth attendants perform about 80 percent of all deliveries. Also contributing to those high mortality rates is the dearth of qualified health personnel. There are just 122 doctors attending to 3.5million Liberians. High fertility rates continue to be supported by traditional cultural values, and contraceptive use is low, at 12.6 percent. Teenage pregnancies continue to escalate and unsafe abortions are prevalent as well as Female Genital Mutilation (FGM). Complaints of misdiagnosis, misconduct, failures by physicians to examine charts, the dispensing of medications deadly to those suffering from particular health conditions, pharmacy personnel dispensing the wrong prescriptions to patients are all too common in Liberia. I have been told stories of doctors refusing to see patients when immediate care was needed in life-threatening circumstances,
and even stories of patients waiting for hours before anyone would respond. Often the response was to simply send them home. In some cases, just a few hours later they would have to return for emergency care. Now that the country is no longer officially in the post-conflict humanitarian crisis phase, the emergency relief funds are pulling out, along with their medical personnel. This transition, from acute crisis to development, is problematic because the country itself is not yet ready to take over the systems now run by the big relief agencies. Fifty per cent of health facilities are run by non-governmental organisations (NGOs). A recent audit of all healthcare givers from tertiary hospitals down to unmanned rural medical posts, conducted by the country’s Ministry of Health and Social Welfare revealed that most of the facilities were under-staffed and lacked reliable water and electricity supply, adequate drugs, and the most basic equipments any clinic should have. Achieving adequate staffing levels is particularly difficult—most skilled health workers left during the war years and those left behind missed out on even a basic education, making it hard to find suitable candidates for fast-track training courses. John Snow International has estimated that the country needs to increase their total health-care workforce by close to 10, 000 people, including finding 4223 nurses, 842 doctors, 1143 midwives, 249 medical assistants, and 249 pharmacists;
skilled staff that cannot be created overnight. The government of Liberia also recognises the need to provide free health care, and in 2005 suspended the “user fee” system. But there is a big difference between policy goals and practice, and even though the government has taken important measures to improve access, free care is still simply not a reality for far too many Liberians. As the health care debate in Liberia continues, the issue of introducing “user fees” is once again being considered. MSF strongly believes that the burden of financing Liberia’s health care system should not fall on those least able to bear it. If Liberia is to even have a chance of serving the population’s health needs, health care must be subsidized. The cost of medicines, diagnostics, staff salaries, and clinics and hospitals can only be shouldered by the national government and international donors like USAID and the European Union. There are no easy solutions, and the government of Liberia faces daunting challenges as it tries to rebuild the country after decades of war. But ensuring that financial barriers do not prevent Liberians from getting essential health care deserves sustained support. Despite the challenges, the ministry of health has set about upgrading not only its clinic walls but also the quality of the health services being provided within them. The NGOs have been informed they must all submit performance-based contracts for the facilities they are currently running and prove
•Alphonso: lost a sister to cholera outbreak they are meeting the standards set by the ministry. This move has ruffled quite a few feathers in organisations not used to being asked to prove their worthiness. But doing things differently is what building a health system out of the rubble of a protracted conflict is all about, said Nestor Ndayimirije, WHO’s representative in Liberia. “Post-conflict countries are very different from other countries…Here in Liberia, sometimes you have to rebuild or re-engineer what was there.” Revivifying Liberia’s health system is a huge task no doubt, notwithstanding, it is yielding interesting solutions to daunting problems even with very few available resources. As Rozanne Chorlton, UNICEF’s representative in Liberia put it: “People like to say that working in Liberia is like flying in a plane while still building it. But I prefer to say it’s like having the scaffolding around the building while you are working in it.”