Liberia’s roots as a country stem from a settlement of freed slaves from the United States in 1822. Situated in West Africa along the North Atlantic Ocean, Liberia is slightly larger than Tennessee. It is home to 4.7 million people, more than half of whom live in urban areas – one-third of those within an 80-km radius of the capital of Monrovia.
Over the last 30 years, Liberia has been both a source of – and a destination for – refugees. During the country’s 14-year civil war from 1989 to 2003, more than 250,000 people became refugees and another 500,000 were internally displaced. Following the 2010-11 post-election violence in Côte d’Ivoire, Liberia hosted some 125,000 Ivoirian refugees, with about 12,000 still living in the country at the end of 2017.
Since 2003, Liberia has struggled to rebuild its health system, which lost some 90 percent of its health workers who fled the country during the years of conflict. The 2014-2015 Ebola outbreak – one of the worst Ebola epidemics ever recorded – reduced the health workforce even more and further destabilized the country’s fragile health system. Liberia currently has just 0.02 physicians per every 1,000 people. As part of its post-Ebola recovery, Liberia is developing comprehensive human resources for health strategies to health address severe health worker shortages and improve access to quality care for its citizens – particularly the large number of people who live in remote rural areas with little or no access to even the most basic healthcare services.
Despite these health sector challenges, since 1990, Liberia has made significant progress toward preventing child deaths, decreasing infant and child mortality by nearly 70 percent. The country’s maternal mortality rate, however, remains among the highest in the world at 725 deaths per 100,000 live births, according to estimates from 2015. Key factors contributing to this include high adolescent fertility, frequency of early childbearing, lack of access to family planning services and quality obstetric care, and a low proportion of births attended by a medical professional.
Prior to the Ebola outbreak, noncommunicable diseases (NCDs) and injuries accounted for a large number of hospital visits. The risk of infectious diseases is very high. This includes food or water-borne diseases, such as bacterial and protozoal diarrhea, hepatitis A, and typhoid fever, and vector-borne diseases, including malaria, dengue fever, and yellow fever. Schistosomiasis (caused by contact with contaminated water), Lassa fever (caused by contact with contaminated aerosolized dust or soil), and rabies are other public health threats. In 2017, Liberia’s adult HIV prevalence rate was 1.4 percent with an estimated 40,000 people living with HIV/AIDS and 2,500 lost to the virus.
Liberia Hospital-based Residency Training Program Accreditation Assessment
(2016 – 2017)
Under AIHA’s HIV/AIDS Twinning Center Program and in collaboration with the Liberia College of Physicians and Surgeons and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, AIHA conducted a comprehensive assessment to inform development of a hospital-based residency training program, including specific investigation into biomedical engineering capacity. This project was implemented from November 2016 to January 2017.
Major observations made during the assessment included:
- an acute shortage of faculty in the various clinical disciplines needed to teach and supervise residents
- a severe lack of laboratory services to support clinical diagnosis and care, including the complete absence of a pathologist and radiologist at the main training site
- a need for more robust restructuring and upgrading of both basic and more advanced equipment to enhance quality of care, as well as training of care providers
- a severe shortage of functioning medical equipment across all sites, which greatly hampers clinical training for medical specialists and results in sub‐optimal care for patients
To read the final clsoeout report on AIHA’s Twinning Center Program, click here.