Supporting recovery, rebuilding, and a national health workforce in Liberia: World Health Day, 2016

Almost exactly two years ago, West Africa came face to face with a dangerous and deadly Ebola outbreak lasting well over one year and killing thousands of people, including the health workers trying to save them.

Liberia, a small West African nation situated on the coast is a lively, beautiful, yet poor nation of nearly 4.5 million people. In the early 2000s, civil war ravaged the nation destroying buildings, homes, roads and livelihoods. Over the past decade Liberia has been recovering and rebuilding and in 2013 the economy was growing rapidly at eight percent GDP increase per year.

Unfortunately, Ebola halted then reversed this progress.

Rubber tree fields were left empty, rice paddies vacant, businesses locked, hospitals and health facilities closed; the nation’s future seemed uncertain. For a country that had never dealt with a health emergency of this size and scope, the future seemed dark. However, the Government of Liberia mounted an unprecedented response to the outbreak with the support of various ministries, partners, and communities.

In May 2015, Liberia was the first West African nation to declare itself Ebola free. But just days before World Health Day 2016, new cases of Ebola have been confirmed. Flare ups are expected in the region and Liberia needs to rebuild its health system in order to preempt future outbreaks and deliver care to the millions of people in need.

“Ebola has weakened already fragile systems, and it should be the catalyst to strengthen the systems far beyond their pre-Ebola levels… our estimates suggest that substantial investment in health systems—and specifically in the health workforce—is urgently required not only to improve future epidemic preparedness and meet basic needs, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce.”
-David K. Evans, The World Bank Group

From: Health-care worker mortality and the legacy of the Ebola epidemic. The Lancet Global Health, Volume 3, Issue 8 , e439 – e440. July 2015

Since Liberia’s civil strife, the availability of skilled health workers remained critically low.

Today there are just two Liberian pediatricians caring for the nation’s children. Liberia’s only medical school graduates less than 50 physicians per year under hard conditions. There are just a handful of full-time faculty at the medical school and the students live in dilapidated dormitories without running water.

For a nation with the second highest maternal mortality in the world, Liberia does not have enough well-trained, qualified midwives to staff facilities. There is just one bachelors level midwifery program in the country and it has an inadequate skills laboratory and an insufficient number of faculty.

“The post war priorities were many and the economic situation of the country couldn’t allow the Government of Liberia to invest in building a strong vibrant fit-for-purpose health workforce. The need for bilateral and multilateral donor support is pivotal if we truly want to support Liberia’s Post-Ebola Recovery and Resiliency Plan.” 
-Dr. Moses Massaquoi, CHAI Liberia Country Director

Prior to the Ebola outbreak, Liberia’s Minister of Health, then Chief Medical Officer, requested assistance from the Clinton Health Access Initiative, Inc. (CHAI) to help the government develop a national-level intervention to address the health workforce shortage.

Dr. Roseda Marshall (one of two Liberian pediatricians) and Dr. Rose Macauley, June 2014.

With support from the ELMA Foundation and Vitol Charitable Foundation, CHAI supported the government to establish planning committees comprised of national leadership and conduct assessments of Liberia’s 22 health professional training institutions. Analyses found that at current production rates, Liberia would never reach the targeted number of health professionals in the national health plan (which are far below WHO-recommended minimum health worker-to-population ratio standards). Based on this information, various interventions were designed to increase production of physicians and midwives, improve diversity of the nursing specialization, and introduce two new health worker cadres.

Planning continued throughout the Ebola outbreak and was completed in early 2015. Led by the government with support from CHAI and other partners, a national health workforce program strategy was laid out and then integrated into Liberia’s Post-Ebola Recovery and Resiliency Plan, identifying a “fit-for-purpose health workforce” as the top priority moving forward.

“A Comprehensive Health Workforce Program that focuses on the development of Physicians, Nurses, Midwives, Health Managers, and Community Health Workers and is addressing health workforce gaps across Liberia is bound to dramatically improve access to safe and quality health care services which will contribute to improve the clinical outcomes.”
– Dr. Moses Massaquoi, CHAI Liberia Country Director


CHAI Liberia Country Director Dr. Moses Massaquoi receives the first vials of experimental drug, zMapp, on behalf of the government.

Over the course of the next seven years Liberia intends to increase its health workforce by 7,000 health workers, 4,000 of whom will be community health assistants who will deliver life-saving care in the most rural parts of the country. Management systems at the Ministry of Health and county-levels will be established and strengthened, new facilities including regional hospitals will be completed, and a generation of Liberian faculty will be developed as part of the national initiative.

In support of the Liberian Government, CHAI is working closely with partners such as MASS Design Group and Partners in Health, as well as academic partners, thought leaders, and implementers in community health.

In addition to today’s celebration of World Health Day, this week (April 3rd- 9th) also marks World Health Worker Week. Please join us at CHAI to thank health workers in Liberia and across the world for their service to the public and for keeping us healthy.

“A lasting legacy of this terrifying health crisis must be a new architecture for global health delivery, with a strong focus on building local capacity to respond effectively to such crises. Equity must be an indispensable goal in protecting from threats like Ebola, and in the quality of care delivered when prevention fails. Only then can we leave behind the rubber plantation model of international health and draw on the science that must inform these endeavors.”
– Dr. Bernice Dahn, Minister of Health, Republic of Liberia

From New York Times article, ‘Yes, We Were Warned About Ebola’