Situation analysis of health care in Liberia

The following analysis uses the most recently available data from the World Health
organization. Some of this data is dated, but the conflict in Liberia has prevented the
collection of up-to-date information pertaining to the health status of the population.

Fourteen years of civil war has adversely affected all sectors of Liberia's national life.
In the health sector, there has been the destruction of health infrastructure, dislocation
of health personnel, the massive looting of equipment, drugs and medical supply inventories.
The destruction of the country's limited housing stock, educational infrastructure, as well
as the disruption of farming activities have all impacted the health status of the people.
With many houses destroyed, a greater portion of the population has been forced to reside in
makeshift shelters, thus exposing them to the outbreaks of various diseases. The massive
displacement of especially the rural population (which constitutes about 80% of the
subsistence farmers), has resulted in a new problem of malnutrition in the country's
morbidity spectrum.

The destruction of an already ailing national economy has exacerbated the problems of
poverty and ill health. Prior to 1990, the traditional sector of the economy sustained more
than seventy percent (70%) of the population. Since 1990, the country has come to rely
significantly on relief and humanitarian assistance.

As a result of the conflict, poverty has become very pervasive with more than three-quarters
(76.2%) of the population living on less then US $2-3.00 a day, and over half (52%) living
in abject poverty on less then US$1.00 a day. Within the current estimated population of
around 3m, about 2.06m people are below the poverty line, whilst 1.4m live in abject
poverty.

The war disruption in the Liberian economy compounded the problems of financing the
country's health sector. The total health budget as a proportion of GDP fell significantly
below the WHO stipulated minimum of 5%. The current expenditure level is less then US$1.00
per capita and has affected the level and quality of health services.

The current situation in the health sector is very poor. Access to basic health services is
extremely low, which in turn accounts for the major causes of the country's high infant and
child mortality rates. At present, infant and under-five mortalities stand at 157 per 1000
live births and 194 per 1000 live births respectively. With an under-five mortality rate of
194 per 1000 live births, Liberia is far above the Sub-Saharan Africa average of 175 per
1000 live births, and ranks 43 out of 46 countries.

Malaria, diarrhea, acute respiratory infections, neonatal tetanus, measles, and malnutrition
are the major causes of morbidity. The country's crude death rate has historically been
high. The average crude death rate between 1982 -1986 was 13.7 per 1000 population per
annum. During the war years, the crude death was put at 30 per 1000, accounting for the
approximately 150,000 estimated deaths. Average hospital deaths between 1993 - 1996 were
60.3 per 1000 population.

On account of the prolonged conflict, life expectancy has reduced. In 2002, the life
expectancy of a male was 40.1 years and that of a female was 43.7. Malnutrition continues
to be widespread with 39% of children under five years of age stunted, 26% underweight and
widespread micronutrient deficiencies among children and women. Infant feeding is far from
optimal with less then 20% of children exclusively breastfed at six months. The situation of
maternal health is very poor as a result of inadequate access to health and reproductive
care and poor nutrition. As a consequence, maternal mortality has increased to around 560
per 100,000 by 2002, putting Liberia in the very high category of maternal mortality rate
countries in the world.

The prevalence of communicable diseases such as HIV/AIDS, TB and River Blindness continues
to escalate. HIV/AIDS is estimated to affect 8.2% of the population between the ages of
15-49 years. The lack of knowledge, exacerbated by poverty, and multi-sexual behavioral
practices, continue to pose great challenges for the survival of young adolescents
especially females who have been the main victims of rape and sexual abuse through out the
crisis.

As regards health infrastructure, 30% of all major hospitals in the public sector since 1996
have been reduced to health centers, while 70% remain out of commission. These facilities
were all badly looted and vandalized. Services at the Primary Health Care level have run
down throughout the country.

There is a shortage of critical health manpower. In 1989, there were an estimated 5,056
health workers within the sector; with 3,526 in the public sector and 1,855 in the private
sector. These included 237 physicians/specialists, 656 nurses and nurse midwives, 2,782
trained traditional midwives, and 1,381 other supporting personnel. By 1998, the number of
health workers had reduced drastically by 28% to 1,396.