WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ

REGIONAL OFFICE FOR AFRICA BUREAU REGIONAL DE L’AFRIQUE

OFFICE OF THE WHO REPRESENTATIVE FOR LIBERIA

WHO STITUATION REPORT

Period: 01 June to 15 July 2002

SITREP #5

I.Introduction

Liberia is still fighting a civil war with untold humanitarian consequences. There is an urgent need for food, health services and shelter for displaced persons victimized by the civil war.

The country remains in UN Security Phase #4, thus limiting program implementation in rural Liberia. Deteriorating security conditions resulted into the relocation of UN international staff from their residence in River View, Virginia in the suburb of Monrovia, to Mamba Point.

A “state of emergency” declared by the government in February for 3 months, remains in place after being extended for an additional 6 months.

The WHO Country Office’s major engagement during the period included the preparation of the first Semi-Annual Monitoring Report (SAM-1) for the 2002/2003 biennium, outbreak investigation of severe diarrhea in the Southeastern Region of Liberia and preparation for intensification of routine EPI activities nationwide.

II.WHO Collaborative Program
A.EPI

1. A training workshop to introduce yellow fever vaccine into routine EPI services, data management and record keeping was held for Montserrado County in June. The 110 participants included EPI service providers from 55 of 58 health facilities in Montserrado County. The Montserrado training brought to 7 (out of 15 counties) the number of counties in which yellow fever vaccine has been introduced into the routine EPI program. Until now, Liberia’s EPI program has been limited to BCG, Polio, DPT, Measles and Tetanus Toxiod for women of childbearing age.

  1. A one-week multi-antigen catch-up campaign began in 6 counties (Nimba, Grand Gedeh, River Gee, Rivercess, Margibi and Montserrado) on 8 July. The activity will continue for 2 additional months (August and September) in an effort to increase EPI coverage in Liberia. Additional to the vaccination, Vitamin-A is being given to under-fives who qualify.

Vitamin-A for under-fives was introduced in Liberia in 2000 during polio eradication NIDs. It has become appended to the EPI program.

  1. From 8-12 July, four counties (Grand Bassa, Sinoe, Bong and Grand Kru) received training for the introduction of yellow fever vaccine into their EPI activities. The training will also cover EPI data management and record keeping. Eleven of the 15 counties in Liberia would have been covered by these training activities by the end of July. The remaining 4 counties (Lofa, Gbarpolu, Bomi and Grand Cape Mount) are inaccessible due to ongoing civil war in these areas.
  1. The national laboratory for yellow fever and measles was furnished with office equipment in June. Its utilization depends on the receipt of remaining supplies and reagents from HQ. Meanwhile, Liberia continues to send all suspected yellow fever and measles specimens/samples to the Pasteur Institute in Abidjan, Ivory Coast. WHO supported the training of 2 laboratory technicians to man the facility.
  1. During the reporting period, WHO distributed stool collection kits to 11 of the 15 counties, in support of AFP surveillance. For the first half of 2002 (January to June), 21 suspected AFP samples were collected and sent to the Pasteur Institute in Abidjan for analysis. Eleven of the samples have been tested and all found negative for wild polio virus. Since 2000, no wild polio virus has been isolated from Liberia.

To further strengthen AFP surveillance, 7 counties (Grand Gedeh, River Gee, Maryland, Sinoe, Grand Bassa, Grand Kru and Rivercess) were supplied with bicycles for use by district surveillance officers.

B.Malaria Control

1.In June, WHO sponsored a national level TOT workshop on Malaria. The focus was on the management of severe and complicated malaria in the context of the integrated management of childhood illnesses (IMCI). The 16 central/national level trainers came from the Ministry of Health and Social Welfare and two NGOs, namely: Catholic Health Services and Save the Children/UK-Liberia.

  1. The Ministry of Health and Social Welfare began to operate its “Sustainable Mosquito Net” project in June. The project is being run in collaboration with 2 NGOs: the National Drug Service and MERLIN. Under the program, insecticide treated mosquito nets (ITN) are sold to the public at a price which is lower than the current market price ($6.00 vs $15.00).

The Ministry of Health launched its sustainable mosquito net project in April during programs in observance of Africa Malaria Day 2002. The rationale behind the program is to reduce the country’s dependency on donated mosquito nets and ensure the availability of ITNs in Liberia at all times and at a price that is affordable to the average citizen and residents.

  1. Dr. Benjamin Vonhm joined the WHO Liberia office as Malariologist/NPO on 10 July. Dr. Vonhm comes to WHO from the Ministry of Health and Social Welfare where he was Director of the National Malaria Control Program.
  1. Disease Prevention and Control – Epidemics

The Ministry of Health and Social Welfare and WHO collaborated in conducting a diarrhea outbreak investigation in Maryland County. The activity was implemented from 2 – 6 June, in response to an alarm raised by the MOH.

The investigation discovered that the problem of severe diarrhea started in June and had already victimized 264 persons with 5 deaths (0.38%CFR). To support the Maryland County Health Team in case management, WHO provided them with 40 boxes of ringers lactate (480 liters), 4,000 tablets of nalidixic acid, 4,000 tablets of paracetamol, 4,000 sachets of ORS, 8 tubes of transport media for patients’ specimen and a box of gloves. In addition to the supplies, the team provided technical advice on environmental/sanitation activities to

facilitate the containment of the outbreak. The team returned to Monrovia with specimens from 3 patients, all of which have proven positive for cholera.

The team visited Maryland, Grand Kru and River Gee counties during the investigation.

  1. National Health Systems

1.A situation analysis of the Liberia Health Sector is being conducted. During the reporting period, a consultative meeting was held to review the draft document. Thirty (30) participants from the public and private sectors took part in the exercise. A technical review committee is incorporating inputs from the meeting to come up with the final document. The situation analysis of the health sector is among others, looking at health manpower, infrastructure, management, external cooperation, health financing and general health situation/trends.

  1. The Tubman National Institute of Medical Arts (TNIMA) graduated 179 health workers upon the completion of basic training in various discipline as follows:
  • Nursing - 68
  • Physician Assistantship - 45
  • Midwifery - 51
  • Environmental Health - 15
  1. WHO continues to provide technical and financial support to TNIMA and the A.M. Dogliotti College of Medicine and School of Pharmacy in the area of medical education. In June, WHO disbursed a total of thirteen thousand dollars (US$13,000.00) as salary subsidy for TNIMA (US$6,250.00) and A.M. Dogliotti College of Medicine and School of Pharmacy (US$6,750.00).
  2. In June, an orientation workshop on the Liberia National Health Account (NHA) was held. The purpose was to present the framework of the NHA to all stakeholders of the health sector. There were 30 participants. A proposal is being developed for the establishment of a National Health Account in Liberia.

The National Health Account is an information gathering system on health financing. It shows the inflow and outflow (level of funding, origin/source of funding, the utilization, etc.) of resources for health financing.

E.Mental Health

The Government of Liberia has taken over the operations of a private Mental Health Hospital. The Government mental health hospital in Liberia was destroyed in the early 1990s during the civil war. Mental health services are currently provided by NGOs and private institutions, some of which are community-based service providers. About 80% of mental health cases that require institutional care have been roaming the streets. About 10% of mental health patients in Monrovia are being treated by a “spiritual healer” while another 10% receive treatment from private services, all of which are quite expensive for the average person.

P.O.Box 316, 1000 Monrovia 10, Liberia, Tel: (231-226-208; +871 762 545 625; +31 594 55 21 22 Ext. 5500; Fax: (231) 226 –747; +871 762 545 626

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