Author: Delia Akosua Bandoh
Site of the publication: JIEPH
Type of publication: Report
Date of the publication: November 2022
Introduction
West Africa continues to experience recurrent epidemics of infectious diseases and other public health emergencies over the years which have resulted in deaths, disabilities and loss of property due to the weak public health system including low capacity to respond, a lack of a preparedness plan or inadequate execution where it exits. One major epidemic is the Ebola Virus Diseases (EVD) epidemic that devastated the region between 2014 and 2016; resulting in high morbidity and mortality, especially in Liberia, Sierra Leone, and Guinea with its subsequent adverse impact on the health systems of these countries. This epidemic revealed weak regional response capacities to outbreaks in terms of disease surveillance, early warning, preparedness and response.
Liberia ́s health services have been severely disrupted by years of conflict and the EVD outbreak in 2014. While revitalization of the health services has begun, it is still far from satisfactory. Communicable and infectious diseases like malaria, TB and HIV; outbreaks from epidemic prone diseases like Lassa Fever, Yellow Fever and EVD are increasingly presenting threats to the already vulnerable and weak health system. However, the country has taken several steps to improve its preparedness and response to public health emergencies, especially after the Ebola Outbreak. We therefore conducted this study to determine Liberia ́s status of public health emergencies preparedness and response and to identify gaps which could prevent her from effectively responding according to IHR core capacities.
Ethical considerations
Approval was obtained from Ministries of Health of all West African countries in ECOWAS through WAHO. In Liberia, permission was sought from the head of the National Coordinating Institute, NPHIL. The purpose of the assessment was explained to participants who were interviewed, and their approval was obtained before interviews were conducted. Participants and countries were free to opt out of the assessment at any point they liked, and they were assured it would not affect them in any way as a nation.
The situation
The National Public Health Institute of Liberia was established by an Act of the Legislature in 2016. A public health law passed in 1976 is currently undergoing revision. The country also has a National Disaster Management Agency (NDMA) newly established by law. There are disease specific protocols that are used to manage outbreaks. These diseases include Ebola Virus Disease (EVD), Cholera, Lassa Fever, Dengue Fever, Monkey pox. A one health coordination platform has been established with five technical working groups.
There are legally backed functional coordinating mechanisms that ensure they work together from planning, implementation, monitoring, and evaluation of preparedness and response projects that mostly cut across mandates of state institutions and the commitments of donor partners.
There is also a good political will and direct involvement of the executive arm of government in matters of health emergency preparedness and response. With the coordinated support of multiple donor partners, Liberia plays a key role in cross border surveillance among her immediate neighbors. Documented plans are in place for almost every aspect of health emergency preparedness and response. Some are undergoing revision to increase their scope and relevance to contemporary public health threats.
Discussion
Policies and regulations form integral pillars for effective coordination. The effectiveness in responding to various outbreaks depends on well-structured form of coordination. With experiences from the 2014 Ebola Outbreak, Liberia has developed a strong public health system with a number of policies and structures in place to handle any such emergency which may come up. The establishment of NPHIL, availability of strategic plans and operational guidelines and the enhancement of infrastructure are signs of an improved public health system poised for emergencies that may hit the county.
From the 2014 EVD outbreak, the need for a strong cross-border collaboration was evident. This is because people cannot be restricted with geographical boundaries. Similarly, diseases and emergencies can cut across all boundaries. Liberia ́s ability to develop a point of entry contingency plan and development of an MoU for cross border coordination with Cote d ́Ivoire, Guinea and Sierra Leone are steps in the right direction to handle cross-border emergencies. This shows collaboration between Liberia and its neighboring countries. Cross border collaborations have been found to be strengthened by long standing bilateral agreements which exist between countries.
Human resource and workforce are a major component of a good public health system. Structures without the requisite workforce and the needed capacity would lead to failure of the system. Thus, a workforce development plan for public health emergency preparedness and response is embedded in the Liberian six-year health sector plan. Currently, the required health workforce capacity of the country has still not been achieved. To help in building the required capacity, the country has training structures.