In Liberia, the healthcare system is grappling with a severe crisis that is costing the lives of thousands of women and newborns each year. According to recent reports, approximately 1,100 women - equivalent to about three women every day - and 8,100 newborns die annually in Liberia due to complications related to childbirth. This alarming situation underscores the urgent need for systemic reforms and international support to address the dire state of maternal and newborn health in the country.
In a detailed analysis by Dr. Tolbert G. Nyenswah, a renowned global public health expert, and Dr. Samuel Wai Johnson, Jr., an academic specializing in global security and economic development, the authors describe the current state of healthcare in Liberia as nothing short of a "collapsing health system." They argue that the staggering maternal mortality ratio (MMR) of 742 deaths per 100,000 live births - far exceeding the sub-Saharan Africa average of 542 - reflects profound deficiencies in the nation's healthcare infrastructure.
"The gravity of the situation - 1,100 women die every year in Liberia while giving birth - should be a wake-up call to health authorities and the government of Liberia," stated Dr. Anshu Banerjee, Director of the Department of Maternal, Newborn, Child, and Adolescent Health and Ageing at the World Health Organization, during a recent high-level meeting in Monrovia. This statement echoes the concerns raised by Dr. Nyenswah and Dr. Johnson, who emphasize that these deaths are not just statistics but represent a failure of the system to provide adequate and equitable care.
"If the 1,100 MMR figure mentioned by the UN H6 Joint Mission report is accurate, it indicates a significant increase, highlighting Liberia's deficiencies in healthcare infrastructure, including inadequate access to skilled birth attendants and essential medical supplies", the two Liberian global health experts argue.
The 2019/2020 Liberia Demographic and Health Survey (LDHS) paints a grim picture, with newborn mortality rates standing at 36 deaths per 1,000 live births - alarmingly higher than the regional average of 27. The leading causes of maternal deaths include post-partum hemorrhage (PPH), which accounts for 38% of all maternal deaths, along with eclampsia, sepsis, and obstructed labor. These conditions, largely preventable with timely and appropriate medical care, continue to claim lives due to the inadequacies of the healthcare system.
A Systemic Issue Rooted in Poverty
The analysis by Dr. Nyenswah and Dr. Johnson goes beyond the immediate causes of death to highlight broader systemic issues. They point out that Liberia's health system is not just failing at the point of care but is also hampered by socio-economic determinants such as extreme poverty, lack of education, inadequate access to clean water, and poor sanitation. These factors contribute to the high rates of maternal and newborn deaths, making the crisis a multifaceted problem that requires comprehensive solutions.
"Nearly two decades after the introduction of free healthcare, it remains unclear whether this policy will continue under President Joseph N. Boakai's administration. Is healthcare truly free? It appears not," the authors note, highlighting the persistent high out-of-pocket expenditures that many Liberians face. These costs, according to the Liberian experts, often driven by the need to purchase non-prescribed medicines and medical supplies, push many families further into poverty and deter them from seeking necessary healthcare.
Learning from Other Nations
The path forward, according to Dr. Nyenswah and Dr. Johnson, involves learning from successful interventions in other low- and middle-income countries. For example, Kenya's expansion of family planning services has empowered women to make informed reproductive choices, while Bangladesh's focus on ensuring skilled birth attendants at every delivery has significantly reduced maternal complications.
Ethiopia's deployment of community health workers to provide care in rural areas and Rwanda's investment in emergency obstetric care are other models that Liberia could emulate. These initiatives, according to Dr. Nyenswah and Dr. Johnson, demonstrate that even in resource-constrained settings, targeted investments and strategic planning can yield significant improvements in maternal and newborn health outcomes.
A Call for Increased Funding and International Support
However, the success of such interventions in Liberia hinges on adequate funding - a critical area where the country currently falls short. Despite a recent increase in the health sector budget to $80.1 million for Fiscal Year 2024, this amount is still far below the 15% target set by the Abuja Declaration for health sector spending. Dr. Nyenswah and Dr. Johnson warn that without sufficient financial resources, the goal of reducing maternal and newborn deaths by half by 2030, as outlined in the Sustainable Development Goals (SDGs), will remain out of reach.
The Liberian experts underscore the importance of international aid, noting that the United States Government (USG), through agencies like the United States Agency for International Development (USAID), has been a significant contributor, providing nearly 35% of Liberia's health expenditure through direct budget support and other initiatives. Additional funding from bilateral donors, such as the European Union, Chinese Aid, Irish Aid, and multilateral organizations like the World Bank, the World Health Organization (WHO), and the Global Fund, also plays a crucial role in sustaining the healthcare system.
To close this gap, the authors recommend revamping the Health Sector Coordinating Platform to better align donor resources with national priorities. They also call for engaging new players and donors to invest in healthcare innovations and research, particularly in developing a national insurance scheme that reduces out-of-pocket expenses for Liberians.
Recommendations for Immediate Action
In their analysis, Dr. Nyenswah and Dr. Johnson offer several key recommendations to address the maternal and newborn health crisis in Liberia:
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- Increase Health Sector Funding: The Liberian government must allocate a larger portion of its budget to health, aiming to meet or surpass the Abuja Declaration target, with a specific focus on maternal and newborn health initiatives.
- Strengthen Human Resources: Comprehensive training programs are needed to enhance the skills of healthcare workers, particularly in maternal and neonatal care, with strategies to retain professionals in rural areas.
- Upgrade Health Infrastructure: Investment in the development and renovation of health facilities, especially in rural communities, is essential to ensure they are equipped with the necessary medical supplies and emergency care capabilities.
- Enhance Community Health Programs: Community health initiatives should promote awareness of maternal and newborn health, supported by educational campaigns and local civil society organizations.
- Establish Monitoring Systems: Effective data collection and monitoring systems are crucial to track health outcomes and inform policy decisions, ensuring that interventions are targeted where they are needed most.
A National Imperative
The maternal and newborn health crisis in Liberia is not just a health issue - it is a national imperative that demands immediate and sustained action. As Dr. Nyenswah and Dr. Johnson rightly argue, the future of Liberia's women and children, and indeed the future of the nation, depends on the decisions made today. The time to act is now, and the world is watching.
