TEN YEAR PLAN FOR THE
BASSA COUNTY HEALTH
& SOCIAL WELFARE TEAM
PREPARED IN BUCHANAN, GRAND BASSA COUNTY
BY:
MEMBERS OF THE TECHNICAL TEAM:
Dr. Saygbeh M. Vanyanbah, County Health Officer
Joyce W. Garblah, Community Health Director
Varwo S. Gbessie, Reproductive Health Assistant
Rick Fendrick, Peace Corps Volunteer
Dr. Bilal Saleem, Health Coordinator , Merlin
Christopher Vunni, Capacity Buildiing Officer, Merlin
Mabey Sartie, Project Coordinator, Merlin
Dr. Saye Dahn Baawo, Director, Family Health Division
Justine Korvayan, Director of Planning &Decentralizat’n
DATE: APRIL 4-8, 2011
Executive Summary - Grand Bassa County Health Plan (2011-2021)
Grand Bassa has a population of 231,000 with26 clinics, 1 health center and 3 hospitals. While 51% of the population live within 5km (one hour walk) of a health facility, only 16% of deliveries are facility-based with skilled assistance. OPV3/Penta3 vaccination coverage for children under one year is 64%. The Grand Bassa ten year health plan will improve access to the EPHS by adding 25 facility-based and non-facility based Service Delivery Points. The plan will also reinforce systemic components to support services. Specific objectives, baselines (2010) and targets (2021) include the following[1]:
Increase the population living within 5 km of a health facility from 51% to 85%;
Increase children under 1 year who received OPV3/Penta3 from 64% to 90%;
Increase facility-based deliveries with a skilled birth attendant from 16% to 80%;
Increase pregnant women provided with 2nd dose of IPT for malaria from 34% to 80%;
Increase public facilities with a two star accreditation from 28% to 90%;
Increase timely, accurate and complete HIS reporting from 79% to 90%; and
Increase facilities with no stock-out of tracer drugs to 95%.
Table of Contents
Executive Summary...... ii
Table of Contents...... iii
List of Acronyms...... iv
1. Introduction and Background ...... 1
2. Summary of Previous County Plan and Its Implementation...... 5
3. Mission and Vision...... 5
4. Service Provision...... 7
4.1 Main Existing Preventive Services ...... 7
4.2Main Existing Curative Services...... 11
4.3Main New Services...... 16
4.4Network Of Health Facilities To Provide The Services...... 19
5. System Components...... 23
6. Sector Coordination Issues...... 25
7. Monitoring & Evaluation Framework...... 26
Figures and Tables:
Figure 1: The Administrative Structure of Grand Bassa County
Figure 2: The Grand Bassa County Health Team Organogram
Figure 3: Map of Existing Health Facilities
Figures 4 & 5: Provisional Maps of Proposed SDPs
Table 1: Grand Bassa Health Facilities
Table 2: Investment plan for Rehabilitation and SDP Expansion
Table3: Existing Human Resources
Table 4: Existing Partners and their Contributions
Table 5: Grand Bassa Ten-Year Implementation Plan
Table 6: Grand Bassa Monitoring Framework
List of Acronyms
AIDSAcquired Immune Deficiency Syndrome
ANC Antenatal Care
ARV Anti Retro Virus
BPHSBasic Package of Health Services
CHOCounty Health Officer
CHVsCommunity Health Volunteers
CHWsCommunity Health Workers
CMCertified Midwife
CHTCounty Health Team
CHSWT County Health & Social Welfare Team
CHDC County Health Development Committee
CHSA County Health Service Administrator
CHDD County Health Department Director
DHODistrict Health Officer
DHISDistrict Health Information System
EHTEnvironmental Health Technician
EPHSEssential Package of Health Services
EPIExpanded Program on Immunization
EmONC Emergency Obstetric Neonatal Care
EPR Emergency Preparedness & Response
FBOFaith Based Organization
GoLGovernment of Liberia
HIVHuman Immunodeficiency Virus
HMISHealth Management Information System
HRHuman Resources
HRHHuman Resources for Health
IPTIntermittent Preventive Treatment
PRSPoverty Reduction Strategy
PSI Population Services International
MERCI Medical Emergency & Relief Cooperative International
MCHMaternal and Child Health
M&EMonitoring and Evaluation
MOEMinistry of Education
MOHMinistry of Health
MoH&SWMinistry of Health and Social Welfare
NGONon-Governmental Organization
NHPNational Health Policy
NCD Non Communicable Disease
PAPhysician Assistant
PHCPrimary Health Care
PMTCT Prevention of Mother to Child Transmission
QA Quality Assurance
RBHS Rebuilding Basic Health Services
STIsSexually Transmitted Infection
TBTuberculosis
TTTetanus Toxiod
TTMTrained Traditional Midwife
UN United Nations
UNMIL United Nations Mission in Liberia
WHO World Health Organization
WFP World Food Program
1
1.0 INTRODUCTION AND CONTEXT
1.1Summary of Rationale for the Production of the Ten Year Plan
Since the election of 2005, which instituted a democratically elected government, a lot of changes have occurred in the health sector and the health status of the people in Grand Bassa County is improving as indicated by improved access to the Basic Package of Health Services of 85% (BPHS Assessment Report 2010).In 2007, the Grand Bassa County Health Team developed a five year health plan which did not include any social welfare component. During the development of that plan, there were many shortcomings and lack of information. These included the lack of health and demographic data, information on access to services, information on human resources, information on catchment population for health facilities and information on disease epidemiology and its burden. The development and implementation of the Basic Package of Health Services was based on the assumption that people will use them, coupled with inadequate funding for the plan which presented a lot of challenges.
Following four years of implementation, we have learned a lot of lessons and implementation experience.In addition, there are now data (health, demographics, HR, HF) to inform proper planning, to ensure the development of an evidence-based plan.Besides, the County situation has changed over the years with new partners in the health and non-health sectors.As the health system is being decentralized, the CHSWT will have increased responsibility to oversee the planning, management, implementation, monitoring and evaluation of health and social welfare services in the County.
Based on the above and in order to contribute to the achievement of the overall national health targets set by the MOHSW in its Ten Year Health & Social Welfare Plan, it is expedient for the County Health & Social Welfare Team to properly plan if it is to succeed.A long term plan will assist the CHSWT develop annual operational plans which can be monitored and evaluated to assist to re-strategize andimprove service delivery to the people of this county.Moreover, in the wake of limited resources, a plan of this nature will inform all stakeholders to mobilize additional resources to support the implementation of the plan over time.This plan will be informed by the following guiding principles:equity, efficiency, sustainability, accountability and transparency and the overall issue of health as a universal human right for the people of Grand Bassa.This plan is also important to consider the new changes that have been made by the MOHSW in the area of service delivery with the development of an Essential Package of Health & Social Services with new services added to augment the current Basic Package of Health Services.
1.2County Geo-Demographic Information
Grand Bassa County, established in 1833, is of historical significance and prominence as one of Liberia’s three original counties. The capital city, Buchanan, is the second largest city in which is located the Port of Buchanan, the second major seaport in Liberia. Grand Bassa is situated in south-central Liberia and is bounded on the north by Bong County, the west by Margibi County, the northeastby Nimba County, the southeast by Rivercess County and the Atlantic Ocean on the southern border. Grand Bassa County is linked to Nimba by a railroad network that is being revitalized. Grand Bassa, because of its seaport, is of great economic importance to its neighboring counties, but there are major difficulties with access during the rainy season due to sub-standard roads and bridges. Therefore, there is a need to improve the road network for inter-county trade and movement.
There are three major ethnic groups in Grand Bassa:Bassa, comprising the majority of the county’s population, Kpelle, Kissi and other Liberian tribal groups. Fanti fishermen from Ghana comprise a small community and are located along coastal Grand Bassa.
Grand Bassa County is sub-divided into eight politicaldistricts:Commonwealth;Neekreen;Owensgrove; St. John River; District #1; District #2; District #3; and District #4 (LISGIS 2008 Census Report). The county, however, maintains the original five political districts:Dian; Kpoegbannie;Glarkon; Neekreen; and Wee.
Grand Bassa County has a population of 234,381 with the population distribution as follows: District #3 - 49,744; Commonwealth – 35,763; District #4 – 34,485; Neekreen – 33,490; District #2 – 29,677; District #1 – 26,246; Owensgrove – 14,266; and St. John River City District – 10,710. (LISGIS Census Report 2008). The capital city of Grand Bassa County is Buchanan, located 89.4 miles from Monrovia.The population is expected to reach 275,000 by the year 2021.
There is no municipal electricity in Grand Bassa County.Only the three hospitals, including the referral hospital in Buchanan City and nearby LAC and Mittal Steel, have electricity by generator and pumped water supply.Approximately eight facilities have generators but they all lack the means for running their generators due to absence of wiring and necessary fuel. Most health facilities have hand pumps that are prone to frequent breakdown. Twenty-eight facilities are accessible by primary or secondary roads.Two facilities are not readily accessible by road, Jacob Larteh and Sue Town.However, severe weather conditions may even hamper access to some of the other facilities.
Most of these facilities do not have staff housing and regular mobile phone signals.Many health workers assigned in these facilities feel isolated as they are not originally from these counties. Moreover, the salary structure is not encouraging and most of them, especially the midwives, feel that there is no career ladder.Because of these infrastructure and other challenges, we have not been able to recruit and retain sufficient number of certified midwives and other health professionals. For example, we are presently at only 67% of our goal for certified midwives.
Since the elections of 2005, the county has seen development in terms of renovation and construction of schools, health facilities and road networks.The county hosts a number of companies, among which include the Liberia Agricultural Company (LAC), the second largest rubber plantation in Liberia; Arcelor Mittal, an iron ore mining company; Buchanan Renewable Energy (BRE); BHP Billiton, an oil exploration company; Equatorial Bio Fuels (Palm Bay Plantation) and a local branch of the TOTAL Petroleum Company.There are also banking institutions such as the Liberia Bank for Development & Investment (LBDI), ECOBANK, First International Bank (FIB) and Global Bank. These companies serve as an attraction for the employment of many Liberians and foreign workers.In addition to employment offered by the aforementioned companies and government of Liberia, the majority of the population is involved in petty-trading, farming and fishing.
Merlin is the international NGO that works with the CHSWT as partner and provides direct support to fifteen of the health facilities.The Roman Catholics, the Methodists and World Wide Mission and other FBOs are involved in health care in the County.
1.3Administrative Structure of Grand Bassa County
The County is headed by a Superintendent who is appointed by the President of Liberia.The Superintendent represents the President at the County level and has oversight responsibility for the county along with a corps of officers. There is an advisory body called the Superintendent Council, headed by a representative of one of the civil society organizations, which consists of representatives of the business community, youth and religious organizations. Buchanan is the administrative seat of the county where the Office of the Superintendent and line ministries is located.There also exists District Development Committee (DDCs).The organogram below shows the administrative structure of Grand Bassa County.
Figure 1: The Administrative Structure of Grand Bassa County
1.4 The County Health System
The Ministry of Health & Social Welfare is represented at the county level by the County Health and Social Welfare Team (CHSWT) which is the implementing arm for all health and social welfare services under the decentralization process.The CHSWT (see Figure 2 below) is headed by a County Health Officer who has oversight responsibility for day to day operation of the health and social welfare sector.There exists a County Health & Social Welfare Board which is an advisory arm of the CHSWT headed by the Superintendent or her designee and consists of representatives from line ministries, NGOs, CHSWT, concessions, traditional healers, FBOs and CSOs.
Services are provided through primary and secondary facilities throughout the county.There are currently thirty-two health facilities among which include twenty-eight health clinics, two health center and twohospitals.There are seven District Health Officers (DHOs) who have oversight responsibility for health and social welfare services at the district level.Services are also provided through Community Health Volunteers, including General Community Health Volunteers (gCHVs) and Trained Traditional Midwives (TTMs).Community Health Care is overseen by Community Health & Development Committees or Community Health Committees.
Figure 2: The Grand Bassa County Health Team Organogram
1.5 Grand Bassa County Planning Process
The County planning process was initiated in 2010 at the Central Ministry of Health & Social Welfare.It has four stages and steps:
- Stage 1-Preparation – a Roadmap Workshop was conducted to map the policy and plan development process in September 2010, development of a health sector situation analysis report in October 2010 and the adoption and launching of the Roadmap in November 2010 by the President of Liberia at the Monrovia City Hall
- Stage 2 - Policy Revision – the first draft of the revised National Health Policy was circulated in January 2011, followed by county consultation process on the draft policy in February 2011 with the Grand Bassa CHSWT and its partners to set priorities for their county plan.The County M&E Officer participated in a workshop in February 2011 at central MOHSW to prepare for county-level consultation.
- Stage 3-Plan Development – the CHSWT Technical Working Group, supported by two central MOHSW staff, worked for five days (April 4-8, 2011) to incorporate the ideas generated from the County consultation with stakeholders into a County First Draft Plan.Prior to this, the County Health & Social Welfare Team was sent data collection tools on February 25 to complete for the County Plan Development.The County Health Officer also participated in a capacity building workshop on the data collection tools in March 2011.
- Stage 4 - Finalization – to follow after this process.
2.0 SUMMARY OF PREVIOUS PLAN AND ITS IMPLEMENTATION
The Grand Bassa County Health Plan was developed and a five year plan which was published in September 2007.The components of the plan were as follows:
- Introduction and Background
- County Health Planning Process
- Situation and Gap Analysis
- County Health Facility Plan
- Supervision and Monitoring & Evaluation
- Implementation Challenges and Solutions
- Annexes
2.1 The County Health Facility and Service Delivery Plan included:
- Improvement in the existing network of health facilities in the county.Eighteen new clinics were proposed for construction in underserved communities and construction or upgrading of five clinics to health center level was proposed.
- Rehabilitation (minor and major) of 21 health facilities, including the referral hospital.
- Implementation of BPHS in 70% of functional health facilities in the county.
- Recruitment of staff for the county was proposed as follows: 1 medical doctor, 3 physician assistants, 3 registered nurses, 18 certified midwives, 1 lab technician, 2 environmental health technicians, and 3 social workers.
- Provide scholarships to upgrade skills of non-professional staff
2.2Supervision and Monitoring & Evaluation Plan included:
- A one year M&E Plan was proposed to be developed
- Establishment of an HMIS/M&E Unit to coordinate all reports related to the implementation of the BPHS
- Standardization of check-lists for supervision and reporting forms for monitoring
- Strengthening of community health workers to collect data at the community level using standardized reporting form
- Collect, analyze and report health facility data to central level
- Conduct regular monitoring at all levels on a quarterly basis
- Bi-annual review of implementation of activities to be conducted to evaluate progress of program activities
2.3Implementation Progress
The Grand Bassa County Health Plan developed in September 2007 was an ambitious one. The plan was made based on blueprint initially developed by the Central MOHSW and many indicators were set with unconfirmed county data collected from reports. The plan set targets that were unrealistic and unachievable within the period indicated. For instance, the following targets were set to be accomplished:
Provideskilled health providers at all existing HFs from 25% to 100%;
Ensure that 100% of hospitals and health centers have functioning lighting with only one at the time;
Provide hand pump from 7 health facilities to 100% of existing HFs;
Recruit and train 100% ofCHWs from all functioning HFs with a baseline of 0; and
Increase ANC coverageunder skilled attendant from 39% to 100% for pregnant women
Increase skilled delivery from 5% to 100%.
Of the activities planned to be implemented in the plan only few were done.For example:
Of the eighteen proposed new facilities, only one health facility at Barconie (Commonwealth District) is under construction.