Health in Liberia


Liberia is one of the poorest countries in the world. Civil wars have killed around 250,000 people and displaced many more. The wars ended in 2003 but destroyed most of the country's healthcare facilities. Recovery proceeds but the majority of the population still live below the international poverty line. Life expectancy in Liberia is much lower than the world average. Communicable diseases are widespread, including tuberculosis, diarrhea, malaria, HIV, and Dengue. Female genital mutilation is widely practiced. Nearly a quarter of children under the age of five are malnourished and few people have access to adequate sanitation facilities. In 2009, government expenditure on health care per-capita was US$22, accounting for 10.6% of total GDP. In 2008, Liberia had only one doctor and 27 nurses per 100,000 people. It was ill-equipped to handle the outbreak of Ebola in 2014 and 2015.

Health infrastructure

Liberia has 5,000 full-time or part-time health workers and 51 Liberian doctors to cater to a population of 3.8 million, according to the 2006 health survey. That is equivalent to about 76,000 civilians being attended to by 1 doctor. Most of the hospitals, clinics and equipment were destroyed due to its 14 years of civil conflict from 1989 all the way until 2003. The strengthening of the health sector faced financial problems. The government used only 16.8% of the total health expenditure in the country.
Liberia has heavily relied on the international community for health infrastructure and aid. International relief organizations assisted the government to rebuild health facilities and provide essential health care for its citizens. The World Health Organization donated equipment and helped provide and assist in vaccinating the population to prevent the spreading of many communicable disease.
The Global Alliance for Vaccines and Immunisation funded 160 million US dollars to improve the health care system and increase the quality of immunization services in Liberia. Médecins Sans Frontières, an international medical humanitarian organization, helped Liberia by operating free hospitals right after the civil war and treated more than 20,000 women and children per year.

Health status

Ebola

Ebola virus is an extremely contagious and severely fatal illness among humans. The disease is transmitted from animals to humans and then spread throughout populations due to human interaction.
As part of a wider regional Ebola outbreak in 2014, Ebola was first reported in Liberia in Lofa and Nimba counties in late March. Not even a month later there were already six recorded deaths related to Ebola. Liberia had suffered 1,779 deaths from Ebola as of September 22, 2014. The Ebola crisis in Liberia continued in 2015 only this time the disease had been narrowed down to only two of its counties Grand Cape Mount County and Montserrado County. The ELWA-3 treatment centre for Ebola in Liberia opened in August was so swamped with patients affected by the disease that some were even having to be turned away. There were several deaths and positive tests in Liberia until in September the WHO declared Liberia free of the virus. However, in April 2016 it was reported that there was a fatality that tested positively to the Ebola virus and by 4 April, 84 people were under observation after two confirmed cases in their region.

Malaria

In Liberia, malaria is the leading cause of attendance in outpatient departments and the number one cause of inpatient deaths. Hospital records suggest that at least 33 percent of all inpatient deaths, and 41 percent of inpatient deaths among children under five years of age, are attributable to malaria. The Plasmodium falciparum parasite is the major source of infection, and malaria transmission occurs year-round within all geographic areas.
The 2016 Malaria Indicator Survey showed 45 percent of malaria rapid diagnostic test positivity rate among children age 6-59 months, with regional variations from 12 percent in Greater Monrovia to 69 percent in South Eastern B; and 62 percent of households had at least one insecticide-treated net. National achievements from the 2009 MIS to the 2016 MIS included: increases in artemisinin combination therapy coverage in children under five years of age from 45 percent to 81 percent; intermittent preventive treatment for pregnant women uptake from 45 percent to 55 percent; households with at least one ITN from 47 percent to 62 percent; and children under five years of age with fever who had a finger or heel stick from 23 percent to 50 percent.
The Liberian Ministry of Health's Joint Annual Health Sector Review Report of 2016 indicated that malaria services were mostly available and provided by 97 percent of the health facilities across the country.

Mental health

A considerable amount of the population suffers from mental illnesses or were mentally or physically traumatized, due to 14 years of intense civil conflict. A study by the American Medical Association in 2008 had showed that a staggering 40% of adults had shown symptoms of major depressive disorders. 44% of adults also had symptoms of PTSD, or post-traumatic stress disorder.
E. S. Grant Mental Health Hospital is the only inpatient psychiatric facility in Liberia.

HIV/AIDS

is one of the biggest diseases that has affected and is affecting Liberia to date. At any given time 33,000 people are living with HIV in Liberia of whom nearly 60% are female. Due to Liberia's incapability to treat this disease only about 1.2% of those affected survives the disease. The youth in Liberia is one of the biggest contributors to the extensive post-conflict HIV/AIDS problem. This is due to risky unprotected sex among adolescents without any form of contraception. A new social marketing condom program is being introduced to adolescents in vulnerable areas of the country in order to stop the spread of the disease and to minimize many preventable deaths throughout the country. In a 2012 study conducted by the African Health Sciences organisation over 20,400 condoms were provided to males and 316 to females in over 87 sites throughout Liberia. Communities were informed how to provide awareness of the dangers of HIV AIDS and how easily it can be prevented through the method of safe sex. Through the help of Population Services International in 2012 alone, the provision of contraception is estimated to have prevented 4.7 million unintended pregnancies and 13,600 maternal deaths, and to have provided 19 million couples with protection.

Malnutrition and starvation

Liberia is one of the most poverty-stricken countries in the world. The national human development organisation has stated that 75% of Liberia's people live of less than a dollar a day. Malnutrition is widespread: 40% of children have unnatural stunted growth and 7% of Liberia's population have highly acute malnutrition. This high level of starvation and malnutrition is linked to a major lack of food and the high level of early teenager mothers who have little knowledge of how to look after or treat their babies. The teenage mothers are usually single, sometimes due to rape. These unprivileged teenage mothers are too embarrassed to even breastfeed their babies to supply the nutrients they need to survive. They feel completely robbed of their freedom. One of the most major contributors to a dire lack of food in Liberia is Ebola. Ebola is heavily attacking Liberia's food supply leaving 4.1 million people to try and survive the epidemic on their own accord, with many families or even kids on their own having to travel long distances to try access clean water or bags of wheat or flour for their families in order to even try survive. 85% of families in Liberia have been forced to eat fewer meals, even as low as just one meal a day.
UNICEF and non-governmental organizations, or NGOs, are working with the Ministry of Health to increase the awareness malnutrition, and make it a top priority of the country. Providing nutrition services is a major priority for the government, and it forms an important part of the National Health Policy. In 2008, the health ministry developed a nutrition policy, which became a good start from the service’s promise. With this new policy, the health ministry aims to reduce the 39% chronic malnutrition rate by one-third by 2011, and fix one of the greatest issues of Liberia.

Water and sanitation

After the thirteen year long civil war, populations in the slums of Liberia skyrocketed. At this point around 60% of the population, or 2.5 million people, do not meet the poverty line. The people were left with little choice of where to obtain water or sanitation. To date Liberia still lives with bad sanitation conditions, with up to 10 people sharing the same toilet without disinfectant and an extreme lack of clean consumable water. For every four people living in Liberia, there is one living without access to any clean drinking water or substantial sanitation. Every five deaths that occur in Liberia is due to people drinking contaminated drinking water. Due to extreme public defecation, the World Health Organisation discovered that 58% of Liberia's water was contaminated with E coli. The E coli present in the water cause many illnesses such as diarrhea and vomiting throughout the population. The water crisis in Liberia has reached catastrophic levels. Action has been taken by many non-profit organizations, one of which is called Waves for Water who are providing water filters for clean drinking water to over 60,000 Liberian people.

Dengue fever

Africa accounts for 16% of all dengue fever infections in the world. Dengue fever has very limited attention in Liberia. There is a lack of laboratory research and the disease frequently goes undiagnosed, which is critical as without early detection dengue fever can be fatal. It is the Aedes type of mosquito that transmits four different types of fatal dengue fevers in Liberia.

Female genital mutilation

It is estimated that around half of all girls in Liberia have been subject to female genital mutilation, which is culturally ingrained in their society. It is seen as an important precursor to marriage, to ensure a girl’s purity. It causes numerous health problems and can sometimes be fatal. Reuters reported on July 28, 2016, that Liberia’s parliament removed a ban on female genital mutilation from a new domestic violence law. The law listed it as a criminal offense, when it was first submitted to lawmakers in September 2015. Opposition from several politicians in April led to the FGM provision being removed from the bill.

General references