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 SITUATION REPORT

01 - 31 May 2002

SITREP #4

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I.Introduction

The month of May 2002 witnessed the exacerbation of the health needs of large segment of the population. The displacement was due to continued and intensified rebel attacks which spread to 2 additional counties, Grand Cape Mount and Montserrado.

The WHO/Liberia emergency and humanitarian response to the situation included intervention in reproductive health, essential drugs and medical supplies, and disease prevention and control. The goal, to reduce avoidable loss of life and burden of disease to which displaced populations are predisposed.

II. Social-economic and Political Development with Health Implication

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A. The rebel group, LURD attacked the central Liberia city of Gbanga on 7 May. The hostilities resulted into the closure of the Phebe Hospital, the major referral hospital in central Liberia and caused the displacement of some 20,000 IDPs, the IDPs, basically from Lofa County, settled in the Gbarnga area in May 2001. LURD also attacked the settlement of Arthington, the home town of President Taylor. Some, into Totota, Bong County and others into Nimba County. It has also been reported that new Liberian refugees have begun to appear in neighbouring countries.

A. Two (2) joint UN agencies missions were undertaken to Phebe ( ) and Ganta (22 May) to access the humanitarian needs of IDPs created from the Gbarnga attack. The IDPs formerly located in CARI near Phebe relocated to Totota (southward) in the direction of Monrovia. The need for food, health service and shelter is grave in the population of IDPs. IDPs who relocated to Ganta were found to be temporarily housed in school buildings thus resulting into the closure of schools. A site for the creation of an IDP camp had however been identified by 27 May. Health services were found to be well coordinated by the county health office. Food needs remain grave in all IDP camps.

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A. Anti-UN sentiment continued in the wake of the extension of UN Security Council Sanctions on Liberia. This development perhaps reached the climax with the issuance of a press statement by the “Consortium of Interest and Pressure Groups of Liberia” Inc. In the press statement, the group threatened to among others, take the following actions against the United Nations in Liberia - “our member organizations - 25 in total will carry sit-ins at United Nations Offices and will not allow any UN personnel to be evacuated, if there is any other upsurge in the dissident attack. This threat could have resulted into the closure of UN offices in Liberia, but for the intervention of senior government officials.

A. The UN System launched its public awareness problem on the work of the United Nations in Liberia. The goal of these programs is to improve the image of the UN in Liberia. The first set of programs are radio programs which will run for an initial period of 6 months.

Programs will also be produced for publication in the leading local journals. The work of WHO in Liberia has been featured among the first set of programs. These public awareness programs are being coordinated by UNIC/Liberia.

III. WHO Collaborative Programs

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A. Communicable Disease Surveillance and Response

With WHO support, an epidemiological reporting form has been developed and printed to provide uniform reporting of epidemiological data which until now had several reporting forms. The form will be further reviewed at a meeting on the introduction of the Integrated Disease Surveillance and Research (IDSR) scheduled for June 2002. It is hoped one reporting form will be developed to meet the reporting needs of all partners, during the IDSP meeting.

A. Leprosy/TB Control

In an effort to expand DOTS in Liberia, a monitoring and supervisory mission is currently in the southeastern region of Liberia. The team is looking at the availability in the counties of health workers previously trained for TB control. The attrition rate of health workers is very high in the southeastern region, perhaps the most hard-to-reach region of Liberia.

A. HIV/AIDS Prevention and Control

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1. The NACP held a 5-day TOT Workshop for Military and paramilitary organizations in Monrovia. The workshop which was held from 6 to 10 May brought together 40 participants from 8 institutions. The major recommendations of the participants are:

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i. that budgetary allocation be made per security/military/paramilitary/apparatus for HIV/AIDS intervention by each institution,

i. that HIV testing among military/paramilitary personnel be undertaken,

i. that HIV/AIDS desks be established at each participating institution to afford its personnel easy access to HIV/AIDS information.

The workshop was held in Monrovia, Montserrado County.

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A similar workshop was also held for traditional zoes in Liberia by NACP and the Talking Drum Studio.

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2. Liberia participated in a UNDP sponsored regional meeting on: “Capacity Building and Information Exchange for Anglophone West African Countries, held in Accra, Ghana from 6-10 May. The meeting was organized by the UNDP Regional Project on HIV/AIDS and brought together 20 participants from the 5 Anglophone West African Countries - Ghana, Liberia, Gambia, Sierra Leone and Nigeria. Participants included WHO, representative of a CBO, the National AIDS Conrol Program and UNDP. The end result was the development of a one-year country program with each country identifying areas of support from the Regional Project. The Liberia Country Plan focused on  HIV sero-prevalence survey,  Development of a directory of partners in HIV/AIDS Prevention and Control and  development of UNDP country program to include an HIV/AIDS component. The UNDP Regional Project on HIV/AIDS was established by UNDP and UNOPS to look at the support of the UNDP country offices to HIV/AIDS prevention and control. The meeting will be rotated between the member countries, with a follow-up meeting scheduled for September in Gambia.

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D. Reproductive Health

With WHO support, the Ministry of Health and Social Welfare conducted a training in the concept of reproductive health and modern contraceptive technology. The purpose of the workshop was to provide orientation for health workers to deliver service with an emphasis on post partum care and not sorely within the context of MCH which has in the past focused on the child/baby. Post abortion care also received major emphasis along with the use of contraceptives. The workshop was held in Rivercess County over a 10-day period and brought together 20 OICs of health facilities. It was held in collaboration with the Family Planning Association of Liberia (FPAL).

E. Women in Health and Development

WHO is supporting the Ministry of Health and Social Welfare in conducting training for 25 women and 25 youths of the West Point Community in Monrovia, in functional literacy. The introductory session which lasted for 5 days was held from ...... to ...... May. During the introductory session, issues such as decision making in reproductive health (ie family size, visitation to health facility during pregnancy, etc.), HIV/AIDS and teen pregnancy were discussed with participants. The functional literacy training program takes 4 months. The training has an income generation component which is designed to give participants skills they can use to strengthen their economic base. The current skills program includes soap making, local food preservation and tye and dye.

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This functional literacy program for youths and women started in 2001. It has already been introduced in 5 of the 15 counties of Liberia. Each group of trainees selects the income generation activity to perfect. Women groups have succeeded in establishing small community banks from which community members can get loans. The on-going civil war is a major obstacle to sustaining the efforts of the various women groups.

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F. Nutrition

WHO is collaborating with UNICEF, FAO and the Government of Liberia (through the Ministry of Health and Social Welfare and Agriculture) in the development of a national plan of action for nutrition NPAN. The exercise started in 2001 with WHO hosting 2 preparatory meetings. Currently, WHO is providing technical support for the preparation of the document. A draft of the NPAN has been completed and copy forwarded to AFRO for review.

F. Expanded Program of Immunization

As a follow-up to the recommendation of the Data Quality Audit (DQA) conducted by GAVI in 2001, teams of health workers from the Central MOH are currently in 7 of the 15 counties to undertake the following activities:

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1. Training of county health teams in the introduction of yellow fever vaccine in routine EPI services.

1. Implement the DQA recommendation in Record Keeping. This includes record generation, the storage of records and the use of record generated for the reporting of EPI information.

1. Training of county health teams in skills for monitoring their own performance, at all levels of the county health system.

The training will be followed by an intensified Multi-antigen Catch-up Campaign.

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H. Health Economic Planning

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1. A situation analysis on the health sector commenced in early May. A preliminary draft has been developed and circulated among all stakeholders for their review.

1. The Ministry of Health and A.M. Dogliotti College of Medicine and School of Pharmacy were during the reporting period, provided with office supplies including stationery to strengthen their administrative capacity.

3.Liberia has finalized its fellowship plan for 2002/2003. The focus is on the provision of basic training of mid level health workers in Liberia as well as graduate training in area with severely limited manpower in the county.

I. Emergency and Humanitarian Assistant

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1. With the support of WHO, the Ministry of Health commenced the provision of RH services in 6 IDP camps in and around the Monrovia area. The exercise began with an assessment of the RH situation, looking at NGO partners who are providing services and the type of services they provide. The purpose is to bridge the gap in service delivery. All but one camp was found to have some form of RH service in place. This camp with no RH service has been given contraceptives for distribution through NGO already providing health service for its residents.

A meeting of all RH service providers including trained traditional midwives (TTM), has been held. The TTMs were given refresher training and their kit materials replenished. At the end of the entire exercise, it is hoped that the RH service in all IDP camp will be at the minimum level/standard required in the RH protocol.

1. WHO formed part of two joint UN agencies assessment mission to IDP centers created from recent fighting between LURD rebels and the Liberia Government. The first mission was to Phebe Hospital which has had to close down. IDPs originally in the Gbarnga area where Phebe is located have relocated to the Totota area. At the health post in Gbarnga, first aid and dressing materials were delivered. During the second mission which took the team to Ganta, a basic kit was given to the Ganta United Methodist Hospital for IDPs while ORS sachets were given to the International Rescue Committee (an NGO), which is the major provider of health service in Ganta.

H. Health Promotion

Liberia commenced activities in observance of World No-Tobacco Day 2002 on 27 May with public awareness. The other activities for World No-Tobacco include....

IV. Staff Movement/WHO Mission/Consultancies

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A. In-Country

NamePurposeDate

Dr. Fatorma BolayTo assess the health needs of IDPs15 May

in parts of Bong County

Dr. Fatorma BolayTo assess the health needs of IDPs22 May

Dr. Sei-M. Parwonin Ganta, Nimba County

Dr. Benjamin Vonhm

A. International Travel

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1. Dr. Fatorma BolayTo attend consultative meeting on7-11 May

Mr. Franci KanuEnvironmental Health Policy

Formulation, Younde, Cameroon

1. Dr. Eugene DolopeiHELP Course in Geneva, Switzerland6-16 May

1. Mr. Kamau ThuoRest and Relaxation Break to the 17-28 May

AO/LiberiaUnited Kingdom

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