Liberia’s 14 year civil war ended in 2003 with the loss of at least 250,000 lives and the displacement of hundreds of thousands of people. Six years on, the country is still trying to rebuild much of its destroyed infrastructure. While this fragile peace has proved lasting, living conditions remain extremely poor, with 68 percent of Liberians living below the poverty line—less than $1 a day.
Due to a chronic shortage of qualified health workers, a dilapidated health infrastructure and insufficient government funds, Liberia’s health care system is only beginning to make the transition from an emergency to development phase.
HOW MERLIN IS HELPING:
We are reaching over 1 million people through hospitals and clinics
Merlin currently supports 156,000 people out of a total population of approximately 1.2 million people. Our program here exemplifies our commitment to work beyond an emergency crisis situation, staying on to rebuild health care systems for the long-term.
We’ve been working in Liberia since 1997 and are now a key partner of the Ministry of Health and Social Welfare (MoHSW) in renovating health facilities, supplying medicines and equipment, and training and supervising health workers to build the capacity of County Health and Social Welfare Teams.
Merlin is currently supporting 52 primary health care clinics and five hospitals in five counties throughout Liberia. We have 26 international staff, 181 Liberian staff and are giving paid incentives to 800 Ministry of Health and Social Welfare staff members.
Training health workers
A key focus of our work in Liberia has been to train community health workers and health teams at county level by working in partnership with the MoHSW. We have been building the capacity of staff in management, administration, and technical skills so that national staff will eventually be able to assume full responsibility for the facilities we currently support. We are also helping the Ministry to maintain staffing levels in remote areas by providing health workers with payment supplements and incentives.
Improving reproductive health services
There are just 297 certified midwives in Liberia and maternal mortality rates have risen by 74 per cent since the civil war ended. To tackle this crisis, Merlin and the MoHSW opened a midwifery training school in the country's remote south-east region in December 2008.
The students are trained for 18 months, before returning to their communities where they've committed to work for at least three years.
We are also improving reproductive health services for over 400,000 women through a program in Grand Bassa, Montserrado, Grand Gedeh and Maryland counties, which provides support to three hospitals and 30 primary care clinics. Services include promoting women’s sexual and reproductive rights in communities, setting up outreach program to women in very remote communities and providing traditional birth attendants with training and delivery kits. In 2008, 430 health personnel received reproductive health training by Merlin, consisting of information on reproductive health, sexual violence and family planning.
Improving access to health care
Diseases such as malaria, acute respiratory infections as well as skin infections and worms represent the most common causes of morbidity and mortality in Liberia. To combat this, Merlin is providing essential preventive, curative and surgical services as well as improving the quality of primary care and community health services. We are also training community health volunteers and hospital/clinic staff to manage and operate sustainable primary and secondary care services. By engaging with community networks Merlin has also been able to boost community-level health education, promote local health services and increase health-seeking behavior.
Controlling HIV
In response to insufficient access to sexual health education and HIV prevention, Merlin staff offer health education in clinics, schools and communities, distributing condoms and working to reduce stigma and discrimination. Together with our local partners, we are also supporting three local youth drop-in centers in Montserrado and Buchanan. These provide youth-friendly services to prevent sexually transmitted infections (STIs) and promote HIV awareness and prevention, as well as reproductive health outreach services, through peer education and life skills.
We also provide HIV testing and counselling services for pregnant women, and operate a referral service for HIV-positive mothers for safe delivery practices and to access anti-retroviral therapy.
Strengthening health information systems (HIS)
Health information in Liberia is unreliable, but it is essential for planning effective health care interventions and policies. As a key partner of the MoHSW, Merlin was instrumental in establishing a resource center for HIS at the MoHSW headquarters in Monrovia, and this is now to be rolled out to the 15 counties in Liberia.
The aim of the project is to standardise the health data collected and increase the capability of staff to analyse and exchange data.
Key achievements
• In December 2008, we opened the first midwife training school in the remote town of Zwedru, in south-east Liberia. This school will train approximately 30 midwives every two years, helping to tackle Liberia’s maternal death rates, which have doubled since the 1980s
• Establishing a resource and information center in the MoHSW to improve the collection, analysis and dissemination of health information in Liberia
• More than 430 health workers and traditional midwives trained in issues relating to sexual and gender-based violence
• Continued support to remote communities and isolated health facilities through providing medicines, financial incentives, technical assistance and trained health workers
Donors supporting Merlin's work
DFID, ECHO, Irish Aid, the McCall-McBain Foundation, Stitching Vluchteling, Medicor and other private donors
Read more about Liberia
Meet George: One of Liberia's first male midwives
Aug 19 2009: Meet George Seakor, 34 years old, from River Gee County, Liberia. George is one of eight men at the Midwifery Training Program for the South Eastern Region (MTPSER). They are the first male midwives in Liberia’s history.
Liberia: “Turning so little into so much for so many”
Aug 17 2009: “So it's started,” writes Helen Sole, as her family leaves the comfort of Connecticut for Liberia on a journey to the front line of global health. In the company of her husband Peter, who is a trustee of Merlin USA, and two of their children, Helen is visiting the post-conflict nation where Merlin is helping the government provide basic health care to over one million people.
Blog From the Field: A Midnight Wake-Up Call in Liberia
Jul 20 2009: Amy Waddell is Merlin's Communications Intern. Having spent six months working with the team at headquarters in London she's now based in Zwedru, Liberia and blogging her experiences in the field.
Field diary from Liberia: One week in Grand Walking County
Jun 29 2009: Pam Gordon is a Merlin intern working in Liberia. She joined a week-long assessment to the rural heart of the country – the remote Grand Kru county, close to the border with Ivory Coast.
FIELD BLOG: Liberians lack clinics, education to tackle malaria
Apr 24 2009: Merlin's Communication Intern Amy Waddell reports from the field.
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