Mission Liberia

Context

Liberia is currently undergoing a period of transition, of "near peace", after fourteen years of civil war that killed over 300,000 people, resulted in one million internally displaced persons and refugees and destroyed the country's infrastructure and economy. From 1989 to 2003 the population suffered infringements of their civil and political liberties at the hands of successive governments, and brutal war crimes were committed throughout the country.
The ceasefire signed in 2003 between the different factions and the deployment of a civilian and military mission by the United Nations marked the beginning of peace and reconstruction, consolidated by a national programme to demobilize and disarm the former combatants. The elections held in 2005 and the accession of Mrs Ellen Johnson-Sirleaf as the first democratically-elected female head of state in Africa represent an important and encouraging sign of Liberia's progress towards long-term stability.
When Médecins du Monde reopened a mission in 2003, health care in Liberia was almost nonexistent. It was therefore essential to replace the state system, first at three existing clinics, then at four clinics and finally at ten clinics. The accession of Ellen Johnson Sirleaf in January 2006 marked a new stage in the mission of MdM with the start of a joint project with the Ministry of Health and the health authorities in the district where the mission is located. This joint project will make it possible to reorganize the health system, to train health workers and to jointly manage the medical centres. The aim is to enable the Liberian health authorities in this district to become totally autonomous once again. It is therefore essential that the international financial backers continue to provide support for the reconstruction of the Liberian health system.

Liberia : Peace in Progross

The health system

The very high morbidity and death rates are due to the lack of access to primary health care and the poverty of the population. Life expectancy is 41 years which is well below the average for the least developed countries (52 years) . The population is unable to pay for health care. The local health facilities have very limited capabilities and the situation is even more serious in rural areas. Access to primary and secondary health care is a major problem, with over 75% of the population unable to access referral medical centres and therefore deprived of basic treatment such as emergency obstetric care. Consequently Liberia has the highest infant and maternal mortality rates in the world (infant mortality rate: 157/1000 births, maternal mortality rate: 580/100,000 births). Infant malnutrition is widespread with 39% of children aged under 5 suffering from growth retardation. For infants aged between 6 and 23 months, 86% suffer from anaemia and 53% from vitamin A deficiency. In addition, the health workers are neither sufficiently qualified nor sufficiently numerous to meet the demand. HIV/AIDS prevalence is officially estimated at about 8.2%. The level of information available and the guidance and treatment provided for patients must urgently be increased to prevent the epidemic from spreading.
Finally, the population as a whole has been traumatized by fourteen years of civil war. They therefore require urgent psychological care.

Mission activities:

Comté du Bong

Médecins du Monde is training and supporting the government health workers at 10 clinics in Bong County (Gbarnga, Palala, Samay, Zowienta, Gbecohn, Belefanai, Shankpalai, Gbansusuloma, Bah-Ta and Jorwah) through the following activities:

• primary and reproductive health care consultations including STI prevention
• epidemiological (malaria and cholera etc.) and nutrition monitoring, in particular for children aged under 5
• vaccination services
• transfer of emergency cases to referral hospitals
• psychological and psychiatric support for women and young women who have suffered sexual assault, and training of women in caring for psychological problems
• writing of a report on the positive impact of providing psychological care for former child soldiers and of the creation of a psychosocial support network for them
• development of community health through information, education and communication activities

Outlook :
In 2007 Médecins du Monde will introduce a prevention programme for mother-to-child transmission of HIV/AIDS in the 10 clinics it supports.
MdM will also support the medical training provided by the Phebe nursing school to enhance the skills of the teachers and to update programme contents.

January 2007