By Dustin Cai
Even though Liberia has been declared Ebola-free since May of 2015 with the last known case to occur in that November, it is no time to relax for Liberia and its healthcare system. In the wake of the Ebola virus that ravaged the country in all sectors, Liberia is left with the remains of a nation that was already in a poor place pre-Ebola. After killing over 11,000 people in West Africa since 2013, 4,800 of which were in Liberia, Ebola also destroyed much of the little healthcare infrastructure that was in place prior to the outbreak.
Prior to the outbreak, Liberia had a limited healthcare system. Armed with only 117 doctors and a handful of other workers such as nurses, Liberia mainly relied on international non profit organizations such as USAID and Doctors Without Borders. But, with much of this international aid withdrawing with the end of the outbreak, Liberia is left vulnerable to other acute diseases and, in the face of another outbreak, possible collapse. After Ebola killed over 8% of Liberia’s healthcare workforce with many other medical workers fleeing the country, the citizens of Liberia are now facing the full frontal force of other medical issues such as Malaria, Tuberculosis, and HIV/AIDS that will be left untreated due to physician shortages. Many regular vaccinations that occurred before Ebola saw significant decreases of nearly 30% for diseases such as tetanus, hepatitis B, and measles. With such devastating effects, the entire healthcare system is faced with the very real threat of collapse.
So how did it get this way?
One of the major problems that Liberia faced was poor governance under President Ellen Sirleaf, the first female president of Liberia. The corruption of the government under Sirleaf led a lot of the Liberian citizens to distrust the government and ignore the warnings that Sirleaf gave. In a report of citizens’ reactions to the news of Ebola, one village chief explained that they believed Sirleaf had created this disease to kill people and to get free international aid, causing many villages and families to ignore the safety recommendations for Ebola. Because of Sirleaf’s many scam projects in the past, it set up a system of distrust between the people and their government, making the Ebola outbreak in Liberia worse than other countries and previous outbreaks. We will have to wait until 2017 to see if the Liberian election cycle is to bring in a better president and an improved system of government and trust. Otherwise, poor governance and distrust of government announcements will allow for the continuation of Liberia’s healthcare issues.
In addition, the lack of resources in Liberia set the system up for failure when the major outbreak of Ebola hit. With only one medical school in all of Liberia and the extremely low compensation for being a doctor of just $85 a month when you start, home grown doctors are hard to come by in Liberia. Because Liberia cannot keep relying on international doctors to help sustain its own health system, more funds will be needed to address this issue.
So what can Liberia do?
Well, more funds are exactly what Liberia needs. Liberia and two other countries impacted the most by Ebola, Guinea and Sierra Leone, have asked for $8 billion combined, $1.5 billion of which is dedicated to revamping their healthcare systems and building more hospitals and medical schools. While Liberia needs international funding to kick start its program, Liberia cannot simply rely on international aid to become a self-sustaining country. Already, 65% of Liberia’s spending budget comes from external donors. To start building independence, Liberia is currently looking at many different options to fund their expenditures, including sin taxes on goods such as alcohol and tobacco and also begin charging citizens for health services.
On top of gathering funds, Liberia might need to rebuild its entire healthcare system from scratch to remove all of the inefficiencies, build a system of medical training, and become self sustaining. For this, we can look to Afghanistan as the model for rebuilding healthcare systems. After their structural systems were wrecked by war and the Taliban regime in 2001, their healthcare system resembled that of modern day Liberia. By focusing on building hospitals, care centers, and a system of primary care, Afghanistan was able to expand its primary care coverage from 9% of the population in 2003 to 85% in 2009.
In order to achieve the similar results that Afghanistan was able to accomplish, there are many pressing issues that Liberia will need to fix. First, unclean water and food insecurity plague the nation with 68% of the nation drinking from contaminated sources. Second, the lack of physical infrastructure such as unpaved roads, lack of modern day technology, and the poor condition of many buildings and facilities threaten the failure of any healthcare system developments. Finally, Liberia as a whole will need to restructure, which encompasses the training of more physicians, the building of better schools, the stabilization of their economy, and improving communications between government agencies and the people of Liberia. While these issues do not cover the entire range of concerns in Liberia, they provide a strong starting place in the rebuilding of a health system.