Breathing life into ailing healthcare system

Some three million people live in Liberia, but after a decade and a half of warfare there are only 34 government doctors catering for their healthcare needs.

Fighting destroyed 95 percent of Liberia’s healthcare facilities and the number of trained government doctors in the country dropped from 400 to less then 20 at the civil war’s end in 2003, according Liberia's National Human Development Report released last week.

“The brain drain is so deep that hardly any doctor is available to make regular rounds in hospital wards,” said the report.

With the decline in health services has come an increase in illnesses, including diarrhoea, pneumonia and tuberculosis, but coaxing doctors back is proving difficult when wages for the highest paid government doctors are less than US $100 a month.

"How can one work upcountry, where you are not assured of any benefits like housing? All you have is a meagre salary that won't even last you a week," said government doctor Oscar Brown. "Because of this I've seen many of my trained colleagues prefer to work in the private sector rather than for the government."

The shortage of government doctors and facilities has forced many Liberians into the private sector for treatment.

In the capital, Monrovia, residents still feeling the effects of the war can't afford the cost of private hospitals when they fall ill. The lowest private hospital bills are usually upwards of $500 Liberian dollars (US $9). But most people live on less than US $1 per day.

"This is a problem for us. Most of the government clinics do not have sufficient drugs and so we have to find ways ourselves to get the money to go to private clinics, just to survive," said Nimely Saytue, a resident of New Kru Town, one of Monrovia's western slums.

Treatment inaccessible

Even when drugs are available, Liberia’s shattered infrastructure means that doctors are not always able to get life-saving treatment to patients, said Dr. Joel Jones, head of Liberia's Malaria Control Division.

"We have the drugs, but we are unable to transport them to towns and villages that are currently inaccessible by road. Land travel is the only means available to take anti-malarial drugs upcountry," he said.

Jones says malaria is a serious public health threat and accounts for 40 to 45 percent of outpatient hospital visits.
"About 18 percent of deaths reported from health centres are caused by malaria," he said.

The government's Human Development Report says that malaria "remains the primary cause of death amongst children".

Some progress

Working with donors and UN agencies, the government said last week that measures have already been taken to rehabilitate several health facilities in rural areas, where most of the former internally displaced persons and refugees are being resettled.

"UNICEF and UNOPS [United Nations Office for Project Services] have reactivated 27 health clinics and are supporting 10 health centres," said the plan. In addition, the European Commission, the World Health Organisation, the UN Development Programme and the UN Mission in Liberia restored seven health facilities, including the Phebe Hospital, one of the major referral hospitals in densely-populated central Liberia.

The government says that the European Commission also wants to deploy 50 health workers, including nurses, physicians and doctors to rural areas.

The UK-based NGO Merlin, an international medical relief charity, has also reopened the J.J. Dossen Hospital in Harper, in the southern county of Maryland, and is supporting 29 other health facilities in the country by providing medical supplies and training for national health workers.

"We have trained over 1,000 workers, including nurses, physician assistants, certified midwives, nurse's aids and vaccinators, among others," said Craig Sophia, head of Merlin in Liberia.

But the Human Development Report says Liberia is still unlikely to meet most of its Millennium Development Goals regarding health, which include reducing child mortality, improving maternal health and combating HIV/AIDS, malaria and other diseases.

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