Deputy Minister of Health for planning, research and development, Tornorlah Varpilah, stayed in Liberia through the decades of conflict, doing humanitarian work. He was often on the run and occasionally terrified. His work included trying to reunite families, because thousands lost touch with each other when they had to flee at a moment's notice from shifting fighting or raids into villages to kidnap children. He worked with donations from international agencies to distribute food to people who were internally displaced.
When the wars ended, he joined the Transitional Justice Working Group, a coalition of 23 Liberian non-governmental organizations. In 2004, he told a seminar at the Woodrow Wilson Center Africa program in Washington DC that the "culture of violence can be replaced by a culture of peace" by implementing measures to bring perpetrators to justice, while ensuring that the process for dealing with these crimes had the full support of the Liberian people.
Now, at the ministry of health, he is happy to be planning for a better future for Liberians, rather than merely trying to help them survive. He discussed with AllAfrica both his own experiences and the work of the ministry.
I spent fourteen years of my professional life working for NGOs. I started in 1990 with the emergency relief program here in Liberia. I was coordinating emergency food distribution, working with internally displaced people, working with refugees, repatriating. I was involved in organizing food convoys across the border and bringing food in.
And then in '95, I gradually moved into the management area. I was much more involved with grassroots organizations, organizing them into networks and providing capacity building training for them so that they could function as organizations in doing planning, organizational planning, and program planning. And then I gravitated to being a trainer; I did some work in development studies and then focused more on training.
I worked here throughout the war years. I survived mainly working for the people. I was really involved in humanitarian work. Once you get yourself involved in that and the lives of many people depend on you, your life becomes useless to yourself. And that is what carried me the most. I didn't feel that my life was more important than the people who were depending on services that I would provide them to keep their lives and to keep the lives of their children. That was for me an inspiration.
I ran many times. There were times I was terrified. There were times I was targeted. There were times that I saw people shot before me. There were times where I fed people and they died. There was a lot of trauma. But the lesson I learned is that when you are deeply involved with something like this, that has to do with your country, and you have the conviction that what you bring forth as a contribution will help generations to come, you no longer think about fear, you no longer think about your own safety. That kept me going a long time.
For the last three or four years, I was involved in the field of peace building. I led a national network of peace organizations that led the first real peace advocacy program in Liberia – working with women to put pressure on the warring parties to end the war. I taught for some time at a university. I taught also in high schools for some time in the '80s. So this is my first major migration into government. I must admit that I am very much impressed with the quality of workers I have seen in government. And I am very much impressed and hopeful.
The health sector's primary strategy is to pursue a reform agenda, geared towards changing the whole system in a way that provides a builds a just and equitable system that makes a maximum impact on the population, to change our health outcomes to a more positive side.
One of the major challenges is human resources. We have experienced a lot of migration of health workers, both nationally and internationally. To pursue our reform agenda, we need to have the right workers with the right skills at this right moment to provide the required services. We have a huge shortfall.
Currently, Liberia's doctor-to-population ratio, is .03. That is unacceptable. We have to change that, because health is linked to skills and education. Health, to a large extent, creates wealth, because when people are healthy, they can work long hours and increase their productivity. Unless we have skilled health workers, our health indicators will continue to be bad – which means we will not fight and win the war against poverty that this government is all about.
We have been faced with the whole challenge of the support system. What do I mean? We need a continuous flow of drugs and medicines for people. We need to have the right logistics. And we need to have the right information process to inform us to make appropriate decisions. We are still processing health information by hand. We want to put some technology into place, some basic computer system, so that the retrieval and processing will be increased.
Our drug supply chain management hasn't been working very well. Drugs are very difficult to access in most areas. We want to strengthen the national drug service, working with international partners like the Clinton Foundation to put in a robust supply chain management system for drug procurement, stocking, distribution, and reporting. There are a lot of fake drugs on the market, and the way to fight fake drugs is to make good drugs available in the quantity that is required by the population.
So, yes we have these challenges. I think the donors that we have are very supportive. The greatest achievement we have had so far was that when we took over the ministry there wasn't any policy, there wasn't a plan. Now we have a plan. The willingness of the partners to support the health sector is a welcome achievement. We have coordination meetings with the partners every quarter to talk about key issues in health and what actions need to be taken. There are discussions around health financing issues for the long-term sustainability of the health sector.
Our financial system was in shambles. Now we have an international financial firm, Price, Waterhouse Cooper, working with us to put in a strong financial management system for tracking budgets, tracking expenditures and controlling accounts. Another big achievement has been in rural health services. When the minister took over, the minister of health, Dr. Gwenigale, over 90% of the medical doctors were in Monrovia. Now the current deputy minister for health services, Dr. Berenice Dahn, has been able to put doctors in all of the counties except for one, even providing some basic logistics to the counties through our partners. Each county at least has a vehicle. That is a major logistical achievement.
We are even beginning county planning, so the counties are now beginning to plan themselves. That is a very big achievement. They planned and implemented the plans, and then we monitored their performance. These are some of these ideas that this management team is pursuing in health.
I am aware that change is not an event; it should be a process. Liberians should be a bit patient, so that they can work with the government to propel the change that we all have been struggling towards for several years.
Liberia has suffered for democracy for a long time. I was a student leader myself, and I know the struggle we went through many years, talking about democracy. We have a good opportunity to make the appropriate change, the transformation that will take this country forward.
This is a welcome opportunity for me to bring to the public domain some of the values that we have long years advocated – the values of governance, the values of transparency and accountability, the values of service to the people. Those values of discipline and integrity needed in every system that has succeeded. So it is a welcome opportunity to see a government in post-war Liberia that is a proponent of these values that we, as student leaders in the past, all supported. I am happy for this.
This is my first time in government, and I'm impressed when I see the caliber of people the president has been able to attract to work in government. It is a welcome development. To put a technical government into operation – not many people have that opportunity.
Liberia has got that opportunity to change things around, and our people have got to be patient-minded. I am very sure that in the next two to three years, something dramatic will happen in this country. I am hopeful that the health sector will make a bold turnaround. We are going to fight and turn things around for the people.