#HealthSystems, Prevention & Preparing for Epidemics - Part 4: Maternal Health in Liberia

#HealthSystems, Prevention & Preparing for Epidemics - Part 4: Maternal Health in Liberia

 {Photo credit: Cindy Shiner/MSH}A mother waits for the nurse to vaccinate her baby during an immunization clinic at Phebe Hospital in central Liberia.Photo credit: Cindy Shiner/MSH

Stronger health systems are critical to preventing outbreaks from becoming epidemics. In fragile states, systems already weakened by conflict, disaster, or instability can crumble under the weight of an outbreak -- devastating access, availability, and quality of basic health for women and their families.

This message is part of a new blog and email series on improving the health of the poorest and most vulnerable women, children, and communities by prioritizing prevention and preparing health systems for epidemics (see also: Part 1: Preparing for Epidemics, Part 2: Health security, and Part 3: Antimicrobial resistance). Join the conversation online with hashtag .

Continued Stability, Focus on Health Systems Critical for Controlling Outbreaks in Liberia

Last week, Liberia quietly marked a critical milestone. On June 30, the country assumed full responsibility for its own security for the first time since peacekeepers arrived in 1990 at the start of what turned out to be a 13-year civil war. Peacekeeping troops are continuing their drawdown ahead of elections in October 2017. With painful memories of the war, Liberians are wary as the political rhetoric heats up ahead of the change in administrations–President Ellen Johnson Sirleaf is completing her second term.

The country’s continued stability is critical, not only for the security of the subregion, but also for ongoing efforts to shore up the health system to be able to deliver quality health care to all Liberians and effectively respond to potential new outbreaks of Ebola.

[Video: The Ebola epidemic claimed the lives of more than 5,000 Liberians, including at least 157 health workers. The health worker deaths led to skyrocketing maternal mortality, with an increase of more than 100 percent, according to The Lancet. Liberia's maternal mortality ratio was already one of the highest in the world. Watch this video about efforts to strengthen the health system and improve maternal health]

When I traveled to Liberia as a journalist during the war in the 1990s, organized health care barely existed in the country. Most medical assistance was implemented by international aid agencies and missionaries. Any hospitals or clinics that did manage to operate did so under constant threat of armed groups. At Phebe Hospital in Central Liberia, rebel forces massacred health workers and patients.

After the war ended in 2003, Phebe hospital, like most health facilities, required complete rehabilitation: bullet holes scarred their facades, windows were shattered, ceilings had collapsed, and medicine and equipment had been looted. Staff needed to be trained and recruited because so many health workers had left the country.

Indeed, half of Liberia’s 2.8 million people had fled their homes. Educational institutions required teachers, textbooks, and new curricula. The Ministry of Health had to be rebuilt from scratch, literally, with construction of a new facility.

Then Ebola struck in 2013.

Many people in the capital, Monrovia, talk about the epidemic in the same hushed tones as they did the war. “In a way it was worse than the war,” one Liberian man told me when I recently visited the country.

At least with a war you can hear it and see it. This was invisible.

People stayed home for months at the height of the epidemic, venturing out only if absolutely necessary. They avoided shaking hands; some wiped down furniture with alcohol when the occasional visitor left.

The epidemic, which started in a remote corner of Guinea near the borders with Liberia and Sierra Leone, claimed more than 11,300 lives in the three countries. Among them were about 500 health care workers.

The epidemic created deep mistrust of the health system as people came to consider hospitals and clinics as veritable Ebola transmission centers. Child and maternal mortality shot up. People died of treatable illnesses, such as malaria, and immunizations came to a stand-still.

The disease’s rapid spread was, in fact, a symptom of a vulnerable health system. That weakness enabled Ebola to rage.

Trust in the health system has slowly returned, but post-war, post-Ebola Liberia still requires an enormous amount of work for many years to come to be able to respond effectively to epidemics.

[ A health worker fills in a child’s immunization booklet during an immunization clinic at Phebe Hospital in central Bong County, Liberia. The Ebola epidemic disrupted routine immunizations. The USAID Collaborative Support for Health program, led by MSH, is supporting Liberia’s Ministry of Health to strengthen the country’s health system, including making it more resilient to deal with outbreaks like Ebola.] {Photo credit: Cindy Shiner/MSH} A health worker fills in a child’s immunization booklet during an immunization clinic at Phebe Hospital in central Bong County, Liberia. The Ebola epidemic disrupted routine immunizations. The USAID Collaborative Support for Health program, led by MSH, is supporting Liberia’s Ministry of Health to strengthen the country’s health system, including making it more resilient to deal with outbreaks like Ebola.Photo credit: Cindy Shiner/MSH

Expanding access to electricity and water and improving the country’s roads—necessary  for getting people to health facilities and transporting medicine—are critical. Power is necessary for efficient electronic data collection and use, and water is needed for sanitation and preventing infection. Reliable communications are also vital—for advocacy, capacity-building, and getting information to Liberians in times of crisis, whether by text message, Internet, social media, or community blackboards. In addition, health workers need protective clothing—a major gap in infection prevention that led to many deaths during the Ebola epidemic.

Continued stability and stronger health systems in Liberia are critical to preventing any future outbreaks from becoming epidemics. As during the Ebola outbreak, the front line in stemming the spread of any infectious disease will be health centers like Phebe Hospital.

Watch video: "Maternal health in Liberia"

Management Sciences for Health and its partners are working to improve the health of Liberians by strengthening the health ministry’s capacity to consistently and effectively deliver high-quality health services by focusing on the WHO’s six building blocks of a health system, with improved water and sanitation as an added component.

Comments

Samuel
Wish them well and Gods favour in providing the basic and necessary health care to the citizens of Liberia

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