COUNTDOWN Liberia Partners

Capital City: Monrovia (Montserrado County)

Liberia is located on the West coast of Africa. It is bordered by Sierra Leone on the west, Ivory Coast on the east, on the north by Guinea and the south by the Atlantic Ocean. Liberia is divided into 15 political subdivisions called counties. According to the 2008 Liberia Population and Housing Census the country  has a population of 3.9 million and a growth rate of 2.1 percent per annum. 

The country has over 563 kilometres of Atlantic front, with three district topographical areas: 

(1) a flat coastal plain of some 16 to 80 kilometres, with creeks, lagoons and mangrove swamp

(2) an area of broken forested hills with altitudes from 600 to 1200 feet, which covers most of the Country;

(3) an area of mountains in the northern highlands, with elevations reaching 4,540 feet in the Nimba Mountains and 4,528 feet in Wutivi Mountains.

There are many rivers and lakes with the major ones being St John, St Paul, Mano, Cestos, Farmington and Lofa rivers and Lakes Piso and Shepherd. 

Out of the over 3.8 million population in Liberia;  over 1.1 million of those live in Montserrado County, the most populous county in the country and home to the capital of Monrovia. Nimba County is the next most populous county, with about 462,026 residents.

There are slightly above 41 hospitals in Liberia servicing the 3.8 million population, with 11 in the capital City - Monrovia, followed by Nimba Country with 6, Bong Country 4, Grand Bassa County with 3 and other counties have an average of 1.5 hospitals.            

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 a 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 the 14 years of civil conflict which started in 1989 all the way until 2003. The strengthening of the health sector has faced financial problems since then. 

Liberia has relied heavily on the international community for health infrastructure and aid. International relief organizations continue to assist the government to rebuild health facilities and provide essential health care for its citizens. The World Health Organization (WHO) 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 (GAVI) funded 160 million US dollars to improve the health care system and increase the quality of immunization services in Liberia. Médecins Sans Frontières (MSF), an international medical humanitarian organization, helped Liberia by operating free hospitals right after the civil war (2003) and treated more than 20,000 women and children per year. MSF were also the first respondents in the country when Ebola struck in 2014. Liberia suffered the greatest casualties during the Ebola crisis. 

But Liberia has woken up to the realisation that collaborating with neighbouring countries as seen with the Mano River Union meeting which is fostering cross-border health system planning and integrations. Three member countries can testify to how Ebola affected their health systems as the virus left from Guinea to Liberia and Sierra Leone, leaving many dead in its wake. 

Liberia launched its Strategic Plan for Integrated Management of Neglected Tropical Diseases on the 21st October 2016. It was thought necessary to develop one when the country realised that the country handled different diseases in different ways. Some were through vertical integration such as Lymphatic Filariasis and others through horizontal programmes. But in a bid to maximise resources and target all NTDs, it was agreed that will be good to have a case management plan that incorporates all diseases. This integrated plan would be the first of its kind rolled out in West Africa to manage NTDs. All health actors under the auspices of the Liberia MoH came together to work on this

The COUNTDOWN programme has partnered with the Liberia Ministry of Health and the University of Liberia - Pacific Institute of Reseach & Evaluation (UL-PIRE) to address issues relating to integrating NTD solutions to the general health system. To enable us focus our operational research, COUNTDOWN conducted stakeholder consultations in Buchanan-Grand Bassa County and Monrovia on 28th October 2015 & 11th November 2015 respectively;  to capture the views of a variety of stakeholders: education and training institutes, implementing and funding partners; key ministries involved in the delivery of health interventions; country health officers; community health department directors; general community health volunteers; community drug distributors; community leaders; and women's and youth group leaders. Discussions revealed a host of priority information needs of NTD policy makers and practitioners to support the following:    

- Understanding how to achieve inter-sectoral working from the perspective of all parties

- Improving financial planning within county health team budgets and work plans for activities associated with vertical programmes

- Implementing best practices for supervision, motivation and management of health staff at all levels of the health system

- Establishing transparent drug procurement, storage and monitoring processes

- Improving health facility catchment area information regarding the population and disease profile

- Supporting increased health service uptake by adapting service delivery for different contexts and by establishing and evaluating strategies that were successful prior to the Ebola outbreak.    

In Liberia, the NTDs Programme was included in the National Health Plan (2011 to 2021) as one of the Essential Health Packages for intervention. The program’s strategy relies on an integrated program with onchocerciasis, Lymphatic Filariasis, STH and schistosomiasis. The program is led by a single Director and a motivated young team. MDA for LF and STH are being added to the onchocerciasis communitydirected treatment of Ivermectin (CDTI) platform, which covers the entire country. The programme has successfully completed two rounds of MDA in endemic counties with not less than 80% treatment coverage for LF and Oncho and Schistosomiasis 75%. Success is enhanced by the relatively small size of
the country of about 3.4 million people, and a decentralized health system that enables counties to plan and implement their own NTD interventions.

Commitment from the government of Liberia and donors such as ESPEN (The Expanded Special Project for Elimination of NTDs) formerly APOC (The African Programme for Onchocerciasis Control), the United Kingdom Department for International Development (DFID) and SightSavers are added advantages.

NTDs interventions in Liberia are based on multi-year plan which focus is to continue micro-planning and coordination of various interventions, supervision, monitoring and evaluation. Additionally, researches to guide the implementation that will lead us to successful 2020 goal of elimination are priority of the Ministry of Health & Social Welfare (MOH/SW).

Currently, the NTDs programme consists of one Program Director, one National coordinator of each or two NTDs diseases (5 coordinators) and two support staff at central MOH/SW. Because of the decentralized nature of the health system, there are NTD focal points in each of the 15 counties working with others; making up the county health team (CHT)

In COUNTDOWN the Ministry of Health and Social Welfare expects to:
• Carry out the Project and all its associated activities as will be set forth in the Work Plan,
• Under take regular meetings on planning, supervision and evaluation at central and county levels
• Train Monitoring & Evaluation (M&E) local field works staff including lab technicians, and paramedical personnel as maybe required, based on the nature of the project.
• MOH/SW shall implement recommended strategies based on findings from the research (project) and use them for the NTDs intervention in accordance with WHO advice and what is feasible and realistic in the Liberian context.

University of Liberia - Pacific Institute for Research & Evaluation (UL-PIRE)

UL-PIRE was established in 2005 by Dr Stephen Kennedy. Dr Kennedy had worked with an institute in Kentucky called the Pacific Institute of Evaluation and Liberia adopted the name of his former Alma Mater.

UL-PIRE was birthed thanks to an NRH grant to conduct HIV studies on Liberia youth and build capacity of local research staff. It was a five-year programme and through it UL-PIRE staff got relevant training. UL-PIRE then leveraged the newly-gained expertise to acquire contracts. The institute has worked on various operational research contracts with USAID among others and did a European-funded programme in Bong County and tested for Schisto where about 90% of kids tested in that programme were positive. 

UL-PIRE has worked on handled research contracts with the government of the United States on issues relating to agriculture, forestry and HIV studies and you can find more UL-PIRE research work here.

The research centre was very instrumental during the Ebola outbreak and participated in a Unicef-sponsored study on Knowledge, Attitude & Practices towards the Ebola virus disease in Liberia

UL-PIRE's vision which is  "Committed to making positive impact on the health, safety and well-being of the nation and the world with whom we interact", marries that of COUNTDOWN which seeks to integrate health system solutions.

Over the years UL-PIRE has done a lot of collaboration with the MoH and that is how it came to work with the COUNTDOWN programme.

This institute's foundations are based on hard work and integrity. The institute seeks to change how research is conducted within Liberia.