Liberia: building a resilient health service on a fragile infrastructure

14 March 2017
George Poe Williams, General secretary of NAHWAL, Liberia
At the end of the Ebola crisis in the Mano River Basin, the Liberian government declared its commitment to building a resilient health care delivery system. However, the Liberian government left the same management in place and, unsurprisingly, working conditions for health workers have not improved.

Doctor Bernice Dahn advanced to win support in her bid to become Minister of Health. But public health workers cited her role as Chief Medical Officer (CMO) of the Health Sector for nine years in the collapse of the public health system, her poor managerial skills, and lack of rapport with health workers.

One would have thought that with the terrible experience of the Ebola outbreak, the Liberian government would have begun to do things differently with an aim to revise and resuscitate what used to be an underfunded and poorly managed health system. However, as the system's management itself was never overhauled, health workers knew for certain that it would be business as usual. Today, the fears of the National Health Workers' Association of Liberia (NAHWAL) have been justified.

According to the Parrot, a local daily in Monrovia (vol. 5 no. 311 Friday January 20, 2017 edition), the ministry of health’s 2016 annual report reveals a depressing list of failures: lack of electricity, unsanitary sources of water, and low scores on the General Service Readiness (GRS) index for diagnostics, together with insufficient essential drugs and basic equipment.

It is reported that these deficits were widespread across the country at all levels of the health care delivery system. In fact, several patients including medical professionals died due to lack of oxygen ventilators in Emergency Rooms (ER) and Intensive Care Units (ICU).

This surprising confirmation by the Ministry of Health validates what workers have been expressing for years through their union, NAHWAL, which led to the victimization of leaders of the union. One can only wonder why these farsighted worker’s leaders, who pointed out these pitfalls long before, are being punished in the first place. Now that the government is admitting to these deficits, is there any justification for the draconian actions taken against them for speaking to these acute shortages?

NAHWAL continues to point out unfavorable working conditions for health workers such as serving long hours on duty (in some cases, 12 hours per shift), and limited staff on the work floor. Other challenges include denial of annual leave for many public health workers, thousands are working without pay as “volunteers”, lack of social security for health workers, huge salary disparities, no occupational health and safety committees at places of work, and the lack of motivational packages for health care workers who serve as the cornerstone for a resilient health system.

If the Parrot’s story is anything to go by, only two things are clear:

  1. Liberia’s objective to build a resilient health system is in jeopardy, and
  2. This means that health care providers will again pay the price of their lives should anything like Ebola resurface in the country.

NAHWAL calls for global attention to this fragile health care delivery system, with the aim of strengthening its infrastructure base.

Also see