Liberia: Ellen Johnson Sirleaf's Vision for Global Health

Nobel laureate, former President of Liberia, and Goodwill Ambassador for the Health Workforce, Ellen Johnson Sirleaf, shares her thoughts on women in healthcare, the transformative power of technology, and the need for optimism

Dear Madam President...

You were appointed Goodwill Ambassador for the Health Workforce in March, what would you like to bring to that role? The first thing I wish to bring to my role as a Goodwill Ambassador is a focus on women in the health workforce. Over 70 percent of care givers are women, but only 25 percent of leadership positions in healthcare are held by women. According to the World Economic Forum, women contribute €2.6 trillion euros annually to global healthcare, half of which comes in the form of unpaid care work. Clearly, women need to be given greater recognition and voice in the health workforce. I hope that as a Goodwill Ambassador I can give women healthcare workers a greater voice and advocate for them.

I also wish to advocate for all healthcare workers, particularly those in rural areas and high population communities who are on the front lines of global health crises. During the West Africa Ebola crisis, healthcare workers bore the greatest risk when caring for the sick. They put their lives on the line to help others. With an ongoing Ebola crisis in the DRC - which is also in a conflict zone - healthcare workers are again in the front lines of combatting the disease. I wish to bring immediate attention to them and to advocate for them so that they receive the training, compensation and security required.

The world has had some major progress, in combatting malaria, tuberculosis and HIV/AIDS - although some of these gains have since slowed, does it still give you room for optimism?

I believe we must always remain optimistic when confronting these global challenges. Just because the number of new cases of these has not dropped in the last few years does not mean that global leaders, experts in health or scientists have slowed in the fight to eradicate these diseases. In fact, I am highly encouraged by recent innovations which have the potential to save millions of lives in the coming years. For example, new malaria vaccines have entered major testing phases in several African countries, notably Malawi and Kenya. If successful, these new drugs could reduce severe cases of malaria by over one third of cases and are a major step forward in eradicating malaria once and for all. As you know, I sit on the End Malaria Council, which is a committed group of global public sector and business leaders who see malaria eradication as a critical health and development priority. The Council is working to eradicate malaria for good, by focusing on three key areas:

- Leadership: Ensure that malaria eradication remains high on global and regional agendas with strong political commitment from leaders at all levels.

- Financing: Advocate at the global and country levels to ensure sufficient funding to protect our remarkable progress and end malaria for good.

- Technology: Support the introduction of new technologies that can accelerate the path to eradication.

While there are still challenges to overcome and more can be done, I have full confidence in world experts, scientists and healthcare workers to find new and innovative solutions to world health problems.

One of the most pressing issues in the developing world is the shortage of millions of health workers. They do a vital job, but many of those who do that work are in dangerous conditions with little training, low pay, and little prospect of advancement. How can the world go about addressing this deficit?

Any position in health care - whether it be a surgeon, general practitioner or nurse, requires a high degree of skill, years of training and most importantly an education. Unfortunately, many who desire to become healthcare professionals are unable to access the education necessary to fulfil these roles. The first step in remedying the problem of a lack of healthcare professionals is for governments and the global community to prioritize providing quality education for all citizens, with incentive programs for those seeking to become health workers.

Related to an access to education is an increase in training programs and facilities. After obtaining the required education, healthcare workers need to receive intensive training to perform the duties they will face in their profession. Governments can and must do more to provide better training programs that will enable health care professionals to give the care their patients need. Lack of adequate pay is another obstacle that keeps many potential healthcare professionals away from the field. Governments should place a priority on increasing funding for the healthcare systems so that qualified workers can receive reasonable wages. While many healthcare workers are motivated by a sense of duty and a desire to help the sick, one cannot feed his or her family on good intentions alone. More attention needs to be paid on the positive results and cost effectiveness of prevention - better sanitation, better nutrition and better information to enhance self-effort.

As someone with an overview of Global Goal 3: Good Health and Wellbeing, what do you view as the greatest challenges the world faces before 2030?

Because of my experiencing guiding Liberia through the terrifying Ebola crisis and my current work on combatting malaria, I believe eradicating communicable disease, such as AIDS, Ebola and tuberculosis is one of the greatest challenges we face. Each year these diseases take millions of lives, often from the most vulnerable populations such as children. These diseases also cost billions to fight. Over $12 billion is lost annually in the global GDP due to malaria alone. The benefits of eradication these diseases are obvious, but there are many challenges and hurdles that remain.

A major challenge to overcome is on-going conflicts which pose serious global health challenges. A notable example is that conflict in the eastern regions of the DRC, which is making it difficult to put an end to the Ebola crisis in the area. Healthcare workers are unable to treat infected regions and many of the sick are fleeing violence, further spreading the disease. This is only one example. In other regions of the world, conflict prevents people from getting adequate medical care. Displacement camps, lack of clean water and poor hygienic facilities further aggravate health situations for those affected by conflict.

What role will technology have in providing and communicating solutions over the next decade?

New and emergent technologies are an exciting aspect of global health. As the world becomes increasingly connected, it will be easier to people to become connected to healthcare providers, for healthcare professionals to share information, and it will become easier to inform and educate the public on health matters. For example, in the last two years, the use of smartphones in Africa has doubled. By 2020, over 750 million Africans are projected to have access to a mobile device. This means that more and more Africans will be able to access information about diseases, preventative care, or contact a doctor who might be hundreds of miles away. Connectivity can help medical professionals learn more about the people who they care for or be connected to other experts in ways not possible in the last decade.

I also believe that artificial intelligence will play a larger role in global health in the next decade. As technology continues to improve and computers become more powerful, we can use these new technologies to help solve medical problems, find new solutions in curing diseases, or assist medical professionals care for patients.

Madam President, you have been described as a 'health for all' champion. What does that mean to you?

As a leader, I strive as others to motivate and inspire others toward share values and the achievement of common goals. As a woman leader, I recognize the value of life and have a stronger sensitivity to respond to humankind. To enhance the ownership, value participation and contribution in the society. This calls for stronger advocacy and action to promote universal healthcare which will ensure that the marginalized and physically challenged will have access to healthcare.

You were the first female elected head of state in Africa in 2005. Did you bring a different leadership perspective from other leaders?

Every leader of a nation brings a unique perspective to his or her post. Yet, on a continent with over fifty nations that had only seen leaders who were men, being the first woman head of state did give me a different perspective. At the time, Liberia was emerging for a long and protracted conflict, of which women bore the brunt of the violence. Being a woman allowed me to take new approaches and better engage with the women of Liberia to help navigate the complex post-conflict situation. I believe that my perspective also helped my administration focus more on women's empowerment, providing women better vocational opportunities and increasing access to healthcare, of which women were the target beneficiaries.

Perhaps one of the greatest health challenges of modern times was the Ebola crisis that began in 2014 and tragically killed 11,000 Liberians, but it was a response for which you received a lot of international respect for. What did you learn from the experience about the way the world reacts to international health challenges?

In 2013, when the deadly Ebola plague hit our nation and killed over 4,000 persons my administration was able to revert back to the successful, integrated community approaches used in our early malaria fight. When I first took office in 2005, Liberian women and children were dying of malaria. We had no data or statistics on the disease and little to no diagnostic capacity at the local level to differentiate a patient with a fever from a patient with malaria. My administration had to make informed decisions and meaningful interventions while being in the dark. We took a holistic approach. My health and finance ministers partnered with civil society and non-governmental organizations to launch community education campaigns, with a focus on women as primary care givers. We reached out to world leaders and the international community and joined forces with all those working to fight against malaria looked to the international community and joined forces with all those working to fight against malaria.

When Ebola hit, we were forced to adapt to this unknown disease. I assumed personal responsibility visiting and taking supplies to clinics and hospitals around the country; This addressed fears and gave hope. I reached out to world leaders and brought my people together, shifting our initial militant approach to a community health education agenda. With support from UNICEF and our local partner, Last Mile Health, the government of Liberia will scale the national community health worker program used during Ebola by recruiting, training, and deploying approximately 4,100 community health workers and 230 clinical supervisors over the next 7 years.

As a mother, what is your view of the challenges for improving maternal health?

Giving the number of years of conflict, the Liberian healthcare systems suffered major deterioration. Women, the majority of whom reside in rural areas and are in the informal sector bore the brunt of this condition. As a result, Liberia registered one of the highest rates of child and maternal mortality. In reconstruction of the health care system, the government prioritized the training of midwives who have traditionally provided the service most times at great risk to women and themselves.

Giving Liberia's high population rate, the huge infrastructure deficit which exist, it is likely that the number of women and children who reside in rural areas will continue to have limited access to health facilities. This will remain a challenge into the future.

Often there is a separation between how health is perceived in different parts of the world. What is your view of the rapid emergence of traditional Western lifestyle diseases, like diabetes and heart disease, in developing nations?

More can be done in national policy to maintain as much as possible the culture, lifestyle and originality of communities and countries. There is great value in diversity.

Madam President, you have a background in economics and studied Public Administration at Harvard, what is your personal message to the world leaders, the business leaders, the activists and the public about the importance of the Global Goals and the need for funding?

In the year 2000, Millennium Development Goals launched as the world development agenda.

Whilst subservient progress was made in several countries, the goals were full achieved in many countries. In 2015, on exploration of the MDGs, the world launched the Global Goals and Africa launched 2063. For the Global Goals to be achieved, world leaders must take immediate and timely action. The goals need to be domestic and aligned to national agendas. The international partnership communities need to provide more financial technical and advisory support to countries, particularly to those with limited endowment and count fragility. The monitoring system envisioned in the agenda requires stronger and faster action. World leaders could engage in more action and less talking.

Ellen Johnson Sirleaf is the former President of Liberia.

A Nobel Laureate, she is a leading promoter of freedom, peace, justice, and democratic rule. Africa's first democratically-elected female head of state, she led Liberia through reconciliation and recovery following the nation's decade-long civil war, and the Ebola Crisis, winning international acclaim for achieving economic, social, and political change. President Sirleaf was awarded the prestigious Nobel Prize for Peace in 2011. She is the recipient of The Presidential Medal of Freedom--the United States' highest civilian award--for her personal courage and unwavering commitment to freedom for Africans.

In 2017, former President Sirleaf was awarded the Mo Ibrahim Prize for Achievement in African Leadership, which celebrates excellence in African leadership. Sirleaf was the first female recipient.

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