Liberia: UNMIL Humanitarian Situation Report No. 107

4 - 10 June 2007


- Opportunities and challenges of the health sector in Liberia

- Repatriation of Liberian refugees reaches the 100th person mark


Agriculture sector assessment report launched

The Ministry of Agriculture has released the validated report of the Comprehensive Assessment of the Agriculture Sector in Liberia. This followed a validation workshop of stakeholders held in Monrovia a week ago. The report highlights the key issues affecting the agriculture sector and recommends several measures to revitalize the sector. It is expected that a comprehensive agriculture policy would be developed based on the survey findings.

CHAP 2007 funding update

The total funding to the Liberia 2007 Common Humanitarian Action Plan (CHAP) as of 10 June remained unchanged at US$ 18.6 million, or 15.9% of the total requirements (US$ 117 million). Meanwhile, funding for activities not included in CHAP 2007 reached US$ 9.6 million during the same period. This brings the total funding in 2007 for humanitarian and recovery activities in Liberia to over US$ 28.2 million.


Refugee repatriation tops the 100,000 mark

UNHCR officially marked the repatriation of the 100,000th returnee since the voluntary refugee repatriation programme started in October 2005 with the arrival of a convoy of 232 Liberian refugees from Sierra Leone on 5 June 2007. This convoy brings to 100,150 the total number of Liberian refugees who have returned home under the programme.

UNHCR estimates that 83,000 Liberian refugees are still in West Africa, and are being encouraged to return home. With an approaching deadline of 30 June 2007 for the end of the voluntary repatriation programme, it is not certain that all these refugees would return home by the deadline.


Feature: Opportunities and Challenges of Health Care Delivery in Liberia

A resident of a rural community in Liberia faces no greater a challenge to access adequate health care services than one in most urban communities in the country. Although the number and quality of health care facilities and personnel in urban and peri-urban areas outstrip those in rural areas, the costs incurred by urban residents in accessing these services equally serve as an impediment to the provision of basic health care; as do poor road access, fewer or inexistent health facilities and workers or lack of drugs in rural areas.

The prolonged period of war and instability took a great toll on the country's infrastructure, including the health system. Support to revitalizing the health care system in Liberia has improved since the restoration of normalcy and improvement in security in the country. Many parts of Liberia now have functional health facilities (referral hospitals, clinics, health centres, etc.), and the number of health workers in rural area is increasing. The National Drug Service, the UN Global Fund (for AIDS, TB and Malaria), and bilateral and individual donations of drugs have increased the availability of medicines in the country. The Government of Liberia has drafted a five-year National Health and Social Welfare Plan to address the health needs of the country for the period 2007 - 2011.

Support to the health sector in Liberia is largely provided by NGOs and UN agencies. The Ministry of Health and Social Welfare and its partners estimated that of the 521 health facilities surveyed in 2006, 389 are functioning, albeit at a minimal or substandard level. Of the functioning health facilities, 81% are supported by either UN agencies or NGOs.

At the start of 2007, over 30 international NGOs and UN agencies were supporting various types of health programmes in Liberia. Some of the international NGOs are drawing down their activities in the health sector by pulling out of the country (as in the case of MSF Holland and France). Other organizations are redirecting their activities towards development programmes. This drawdown is expected to continue to the end of 2008.

The eventual drawdown in the health sector could lead to a gap in the transition from humanitarian to recovery and development in Liberia. This transitional gap led the Ministry of Health & Social Welfare to urge donors and NGOs to remain active in the health sector until end of 2008, where it is deemed that the Government could be in a better position to support the sector.

In this vein, the Government of Liberia and partners are working together to improve the health sector and bridge the gap that an NGO-drawdown in the health sector could produce. The National Health and Social Welfare Plan estimated the total needs of the health sector at US$ 54.4 million from July 2007 to June 2008. Allocation for the health sector in the Liberia national budget will increase by 28% in fiscal year 2007/2008 to US$ 13.9 million. The World Bank has provided a US$ 8.5 million grant to help revitalize the health sector. Other international aid organizations, including Irish Aid, have earmarked funding for the health sector in Liberia. USAID and the European Union are the two largest donors to the health sector in Liberia.

In February 2007, the humanitarian community in Liberia launched a Common Humanitarian Action Plan (CHAP 2007) which appealed for US$ 117 million to address remaining humanitarian needs in health, food security, water and sanitation and other areas in 2007. Of this amount, US$ 43.7 million has been identified as the humanitarian requirement in the health sector. The priorities of the health sector in the CHAP 2007 include increasing quality primary healthcare services; rehabilitation and equipping of mid-level health training institutions; providing secondary healthcare and emergency obstetric care; providing physical and psychosocial rehabilitation; and strengthening capacities of local health authorities. So far, only 15.9% of the CHAP 2007 funding requirements have been met, with zero funding to the health sector.

The UN Central Emergency Response Fund provided US$ 4 million for urgent, live-saving interventions in Liberia in 2006. The Health Cluster received US$ 2 million, and used the money to rehabilitate and support health facilities, fund immunization campaigns, and to purchase and distribute reproductive health kits and drugs, among other things.

In spite of the achievements in restoring basic health services in many parts of the country, the country still faces many challenges in addressing urgent health needs. The Ministry of Health & Social Welfare estimates that only 41% of the population of Liberia has access to basic health care, with many of them doing so by walking up to three hours to reach a facility in the rural areas. In 2006, residents of 90% of rural communities surveyed by the Comprehensive Food Security and Nutrition Survey reported that they did not have a health facility in their area. The survey also found that of the communities who reported the presence of a health facility in their communities, 20% said that the facility was non-functional.

Tackling the prevalence of treatable and preventable illnesses has been made difficult by the lack of an adequate health infrastructure and qualified staff. The lack of sufficient and qualified health workers in Liberia poses a challenge to improving health services even where facilities are adequate. Levels of morbidity are linked to poor water and sanitation facilities in most parts of the country, especially during the rainy season, when there is an observed increase in cholera and other water-borne diseases. Less than 32% of the population of Liberia has access to safe drinking water. In urban areas, many people cannot afford the high fees charged at some clinics and hospitals. Many critical illnesses are referred to neighbouring countries and other parts of the world due to the lack of qualified staff and facilities in the country to treat these cases.

Many organizations in the health sector are striving to surmount some of the challenges in the health sector and are helping to save lives in some of the remotest parts of the country through health care service delivery, rehabilitation/construction of health facilities, health education, and training of health workers, among others. The International Rescue Committee, Africare, and many health organizations run innovative health programmes in Liberia, which have helped to make a great difference in the lives of many rural residents. UNICEF has pioneered the funding of programmes to improve primary healthcare in Liberia, and has helped improve maternal-child health through its support to immunization for children and mothers. UNMIL medical outreach teams provide rapid medical services to people in remote communities with no health facilities.

The amount of investment required to improve the Liberia health system is huge and requires partnership between the Government of Liberia and donors. Clearly, the Government of Liberia has little capacity to meet the medium term needs of the health sector. NGOs and faith-based organizations play an important role in providing life-saving health care services to Liberians, and they should be encouraged through continued donor support in partnership with the Government. Such partnership between the Government and NGOs in the health sector should be strengthened through capacity building and be geared towards building or revitalizing a Government-supported health system in the medium to long term.


WFP feeds 90,000; warns of funding shortfalls

Some 90,000 people received 1,242 MT of WFP food support during the week. The beneficiaries included schoolchildren, community people involved in local initiatives to grow food and rehabilitate infrastructure, returnees and refugees, critically ill people, among others. WFP also reminded donors that it needs US$ 7.4 million to cover resource shortfalls for the first six months of its new PRRO 10454.0 project, which starts July 1, 2007.