Liberia: Health Ministry Unable To Report All Deaths; Cites Limitations

Monrovia, Liberia – February 7, 2019: In the West African nation of Liberia, the reporting of deaths is woefully inadequate, in spite of the country’s Public Health Law which requires the registration of all deaths within 24 hours of occurrence. Severe under-development coupled with various factors have limited the ability of Liberia’s Ministry of Health to fulfill its mandate.

Ministry of Health Building
Ministry of Health Building

According to the Government Health Agency its Mandate include:

◾Formulation, Implementation, Monitoring and Evaluation of Health Policies, Plan, and Standards.

◾Deliver and Coordinate the Delivery of Decentralized Medical Care in Public Facilities.

◾Develop Health Manpower.

◾Undertake Preventive Services and Health Services, including Specific Health Interventions.

However, in a statement posted to its website, the Ministry, in trying to explain its inability to register all deaths in the country, stated that, “…This regulation has not been implemented to its fullest by the Ministry due to limited access to death registration services and information on the importance and need for death certification. As a result of inadequate access, the coverage of registration has always been below 5% annually. Apart from the mentioned plausible reasons for low registration of deaths, traditional and religious practices contribute to lower registration in Liberia. Death certificates are usually processed in Liberia with the intent to obtain insurance benefits, to settle inheritance issues and not as a requirement for burial and documentation of cause of death. The registration of deaths continues to fluctuate over the past seven years. In 2007, 548 deaths were registered compared to 624 in 2011 and 549 in 2012. In 2013, 659 deaths were registered compare to 600 in 2014.”

Vital Statistics require the accurate, complete and standardized reporting of births and deaths. The data collected from birth and death certificates and forms by the Liberian government is to be utilized for the identification, monitoring, informing and allocation of adequate budgetary resources to address public health issues. Data is also utilized in planning for the implementation and achievement of the Ministry’s vision of “A healthy population and social protection for all”.

Liberia Health Minister Dr. Wilhemina Jallah
Liberia Health Minister Dr. Wilhemina Jallah

With 14,916 Full Time Employees, the Health sector 2018/2019 budget is $81.7 million USD.

About $51.7 million USD account for employee compensation. In its budget narrative, the Health Ministry noted the following achievements for the past fiscal year and objectives for the current one.

Achievements (FY2017-18):

  1. Built adequate capacity for management of required medicines and supplies.
  2. Restored and enhanced service delivery systems to ensure a safe working environment and quality of care for clients to improve health outcomes.
  3. Established a functional emergency medical service including referral system between primary, secondary and tertiary care.
  4. Ensured adequate supply chain of medicines, Equipment and laboratory facilities in county hospitals, and
  5. Improved childhood preventable disease vaccination coverage.

 Objectives (FY2018-19):

  1. Build a fit for purpose productive and motivated health workforce that equitably and optimally delivers quality services

2. Expand capacity for leadership and governance to ensure that effective guidance of health actions is provided, and

  1. Support health professionals’ in-service training and career advances with an appropriate scheme of remuneration and benefits payment for healthcare workers based on performance and places of assignment.
Phebe Hospital - Bong County Liberia
Phebe Hospital – Bong County Liberia

In contradiction of these achievements listed in the 2017-2018 budget narrative, just three weeks ago, reliable reports surfaced that insufficient budgetary allotment for the smooth operation of the Phebe Hospital in Suakoko District, Bong County in central Liberia was causing problems.

Administrators at another government hospital in the southeastern political district of Grand Bassa County say the hospital is experiencing severe lack of essential drugs and fuel to operate. Major health centers operated by the Ministry of Health in Liberia continue to operate with meager budgetary resources and untrained personnel.

Liberia’s Health Minister Dr. Wilhelmina Jallah has admitted the shortage of essential drugs and resources for the smooth operation of medical facilities across the country but says her administration is seeking assistance from donors to address the deteriorating situation. She recently returned from assessment visits to medical centers in three political districts in western Liberia.

The 2014-106 Ebola pandemic laid bare the inadequate health system of the poor West African country. By April, 2016, when the pandemic was declared over by the World Health Organization (WHO), the U.S. based Centers for Disease Control (CDC) reported that Liberia accumulated 10,678 total Ebola cases and estimated 4,810 deaths.

Meantime, a signature project of Liberian President George M. Weah, the construction of a military hospital is ongoing.

Geographical Map of Liberia
Geographical Map of Liberia

The estimated cost of the facility is $3 million USD with an estimated completion date of late 2019. The cost is, however, expected to jump based on an increase in the price of materials. The project is in addition to the construction and relocation of the new Redemption Hospital in the western suburb of Caldwell, outside Monrovia. Unlike the Redemption Hospital for which an Environmental and Social Management Plan (ESMP) was generated and is posted on the website of the Ministry of Health, the 14 Military Hospital has no such plan.

The main objective of an ESMP is to provide measures to minimize adverse effects on the biophysical and socio-economic environment during construction and operation of such facilities.

Military 14 Hospital has no ESMP which would undertake the following:

1. field assessment of the construction site fto appreciate the magnitude of the project activities and determine their environmental and social footprint.

  1. review on the policies, regulations and environmental standards in order to develop a comprehensive and guided policy, legal and institutional framework so that the ESMP is responsive and aligned with government’s and financiers’ policies;
  2. discussion with major stakeholders including the Ministry of Health;

4. discussion with key informants from the surrounding communities, affected directly by the project;

  1. assessment of the socio-economic and the health-care systems data and prevailing national regulations, policies and standards; and
  2. verification that the project meets international standards.

By Our Health Reporter in Monrovia

West African Journal Magazine

 

New Ebola Virus Found In Bats In Sierra Leone.

A new Ebola virus has been found in bats in Sierra Leone, two years after the end of an outbreak that killed over 11 000 across West Africa, the government said on Thursday.

It is not yet known whether the new Bombali species of the virus – which researchers say could be transmitted to humans – can develop into the deadly Ebola disease.

The AFP quotes a Sierra Leonen Health ministry official Amara Jambai as saying, “At this time, it is not yet known if the Bombali Ebola virus has been transmitted to people or if it causes disease in people but it has the potential to infect human cells.”

“This is early stages of the findings,” Jambai added, calling on the public to remain calm while awaiting further research.

A health ministry spokesperson and a researcher who worked on the discovery confirmed the findings to AFP.

Researchers who found the new virus in the northern Bombali region are now working with the Sierra Leone government to determine whether any humans were infected.

“As precautionary measures, people should refrain from eating bats,” Harold Thomas, health ministry spokesperson told AFP.

CDC -Ebola workers
Ebola Workers

The worst-ever Ebola outbreak started in December 2013 in southern Guinea before spreading to two neighbouring west African countries, Liberia and Sierra Leone.

The West African outbreak was caused by the Zaire species, which has historically been the most deadly in humans since it was first identified in 1976.

That outbreak killed more than 11 300 people out of nearly 29 000 registered cases, according to World Health Organisation estimates.

The WHO declared the epidemic over in January this year, but this was followed by flare-ups in all three countries.

AFP 

 

Liberia’s Health Minister Designate Faces Setback At Confirmation Hearing

The new Weah Administration in the West African nation of  Liberia is still in its formative stage with the President making appointments to fill top government positions.

Senator George Weah of CDC
President George Weah of  Liberia

One of those is for the position of Health Minister. But The confirmation of controversial Health Minister-designate, Dr. Wilhelmina Jallah suffered another setback Monday when members of the Liberian Senate abruptly cut off her confirmation hearing.

 

The decision of the lawmakers to cut off Dr. Jallah’s confirmation hearing is the result of her failure to give the true story over the death of late Pastor Desiree Fahnbulleh who mysteriously died at the Women of Hope Health Center in Paynesville.

During Monday’s confirmation hearing, one of the Senators quizzed Dr. Jallah as to whether the matter relating to the death of Madam Fahnbulleh was still in court but the Health Minister-designate initially denied that as far as she was concerned, the case was not in court.

When pressed by Senator Nyonblee Karnga-Lawrence of Grand Bassa County on the status of the case, Dr. Jallah later confessed that the case was still in court and that no determination has been made by the court.

The conflicting statement from Dr. Jallah infuriated the Senators with some accusing her (Dr. Jallah) of lying under oath. Some of the Senators decided to leave the Chamber of the Senate but were calmed down by their colleagues.

Dr. Wilhelmina Jallah
Dr. Wilhelmina Jallah

Following consultation amongst the lawmakers, they decided to postpone the confirmation of Dr. Jallah to a later date which was not stated. This was the first appearance of Dr. Jallah before the Liberian Senate for her confirmation hearing since she was nominated by President George M. Weah a month ago.

At the same time, report gathered from sources at the  legislative seat of government  – the Capitol Building revealed that President Weah is heavily lobbying with the Senate for the confirmation of Dr. Jallah. The  President’s motive  is unclear but several individuals and groups including the Liberia Medical Dental Council of Liberia are calling on the Liberian Senate to place a hold on the confirmation of Dr. Jallah until the legal matter is settled.

Family of the late Pastor Desiree Fahnbulleh are also appealing to the Liberian Senate not to confirm Dr. Jallah until “justice” can be served over the death of their family member.

Following the appointment of Dr. Wilhelmina Jallah as Health Minister-designate a month ago, her family has been claiming that the Health Minister appointee is culpable for the death of their relative and continues to protest her nomination. Larry Fahnbulleh, widower of the late Pastor Desiree Fahnbulleh, who is leading the family protest,  urging President George Weah to withdraw Dr. Jallah’s appointment.

Recently, Mr. Fahnbulleh tearfully said, “We are hurt, deeply frustrated over the nomination of Dr. Wilhelmina Jallah as Minister of Health of the Republic of Liberia,” said Mr. Fahnbulleh at a press conference on Wednesday, February 7 in Monrovia.

Members of Liberia Senate
Members of Liberia Senate

Dr. Jallah is an experienced practicing general physician in obstetrics and Gynecology. The Health Minister-designate is currently facing a lawsuit for the ‘wrongful death’ of the late Pastor Desiree Fahnbulleh, who died at her private hospital – Hope for Women International Incorporated Hospital – during childbirth on December 8, 2016.

The Fahnbulleh family filed a US$6 million action of damages for wrongful death lawsuit against the hospital with 6th Judicial Circuit Civil Law Court at the Temple of Justice in Monrovia.

The Fahnbullehs are now furious and disheartened that while the case is not yet adjudicated the accused has been nominated as Minister of Health by President George Weah.

Liberia-Guinea Map
Liberia

Many are becoming to the belief that that Dr. Jallah will be second minister appointed by President George M. Weah that will be withdrawn because of the accusation levied.

Reporting by Lincoln Barcon in Monrovia

West African Journal

 

Lassa Fever Disease Kills 1 In Northern Liberia

The World Health Organization (WHO) reports that a little over a year ago, 91 suspected cases of Lassa Fever were reported in the small West Africa state of Liberia.

Political Map of Liberia
Political Map of Liberia

Terming the prevalence of the disease as “endemic” in the country, the WHO says the cases were reported in six sub-political sub-divisions of Liberia including Grand Kru, Lofa, Margibi, Nimba Grand Bassa and Bong Counties between January, 2017 and January, 2018.

Lassa Fever is also endemic in Guinea and Nigeria.

Citing a recent fatality due to the disease, WHO says, “On 9 January 2018, a patient from Guinea with fever, neck pain, body pain and vomiting was admitted to a hospital in Ganta in Nimba County, Liberia. The patient was treated with Ribavirin until her death on 11 January 2018. The patient first experienced symptoms on 29 December 2017. Prior to hospitalization in Liberia, she sought medical care at a health facility in Diécké in N’Zérékore Region, Guinea where she was treated for typhoid and malaria. On 10 January 2018, a specimen was collected and tested positive for Lassa fever by a reverse transcription polymerase chain reaction (RT-PCR) at the National Reference Laboratory in Liberia. On 11 January, a safe and dignified burial was conducted for the patient in Ganta.”

In its risk assessment, the Geneva based UN agency dedicated to international public health defined Lassa Fever as, “…an acute viral haemorrhagic fever illness that is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces. Person-to-person infections and laboratory transmission can also occur. Overall, the case fatality rate is approximately 1%; however, it can be 15% or more among patients hospitalized with severe symptoms. Early treatment and rehydration improves the chance of survival. Lassa fever causes outbreaks almost every year in different parts of Liberia and West Africa…”

More cases of the haemorrhagic and potentially deadly disease were reported in January of this year, the WHO says.

Anatomy of Lassa Fever Virus
Anatomy of Lassa Fever Virus

28 contacts including 16 from the regional Ganta Hospital and 12 family members were identified. From the northern neighbor Guinea, 28 contacts, including 22 health care workers, were identified. And as of January 18, 2018, “two of the patient’s contacts in Liberia were symptomatic, but both tested negative for Lassa fever,” according to the WHO.

More follow ups are being made with the contacts identified. Meantime, Liberia and Guinea have triggered a public health responses:

In Liberia, the Nimba County Surveillance Officer was responsible for coordinating the response to this event.

A rapid response team was deployed to Ganta, Liberia and an investigation mission took place in Diécké, Guinea. A cross-border epidemiological investigation also took place.

In Guinea, an in-depth investigation has been conducted by an epidemiologist, infectious disease doctor and laboratory technicians.

Surveillance has been enhanced at the district and county levels. Contact tracing and active case finding has been conducted in both countries.

A total of 27 blood samples from 24 contacts and three febrile patients in Diecké Primary Healthcare Center, Guinea were collected.

Infection control measures were reinforced in Diécké’s public and private health care facilities.

Infographics on Lassa fever have been made available in Diécké public and private health care facilities and at points of entry.

Community engagement and sensitization activities have taken place in Nimba County, Liberia and Diécké, Guinea to increase awareness about the risks and prevention of Lassa fever.

According to the WHO, due to potential cross-border disease transmission, the WHO country offices of Liberia and Guinea have been collaborating to share information with each other about this event. The WHO has described the pathogen as an “urgent threat”.

Although the trend of the disease in Liberia has remained stable in the last year, the WHO says prevention methods are key and recommends the promotion of “hygienic conditions” such as preventing rodents like mice, rats, gerbils, Guinea Pigs, hamsters and squirrels from entering homes.

“In health care settings, staff should consistently implement standard infection prevention and control measures when caring for patients to prevent nosocomial infections. Travellers from areas where Lassa fever is endemic can export the disease to other countries, although this rarely occurs. The diagnosis of Lassa fever should be considered in febrile patients returning from West Africa, especially if they have been in rural areas or hospitals in countries where Lassa fever is endemic. Health care workers seeing a patient suspected to have Lassa fever should immediately contact local and national experts for guidance and to arrange for laboratory testing,” the WHO advises.

Lassa Feveral Poster
CDC Lassa Fever Poster

In another West African country, 73 persons have died from a Lassa Fever outbreak. Health authorities in Nigeria have disclosed that the disease has ticked up by 50% in a week.

The Lassa Fever virus was first identified by scientists in 1969.

Liberia, Sierra Leone and Guinea in West African were devastated n 2014 by another deadly pathogen Ebola. The already fragile and relatively non-existent health systems of these West African countries were laid bare at the height of the pandemic.

The Centers for Disease Control (CDC) in the United States reports that out of laboratory confirmed Ebola cases of 15,227 in the sub-region, the disease killed about 11,310 with the bulk of the fatality in Liberia – 4,810 persons.

By Emmanuel Abalo

West African Journal Magazine

 

 

Nigeria: UK Court Deals A Blow To Oil Spill Victims And Corporate Accountability

Amnesty International (AI) says, responding to a Court of Appeals judgment that two Niger Delta communities cannot have their case against oil giant Shell heard in the UK because the parent company cannot be held liable for the actions of its Nigerian subsidiary.

Shell_logoAccording to a statement quoting  Joe Westby, Amnesty International’s Campaigner on Business and Human Rights, “With this ruling the court has struck a blow not only to the Ogale and Bille communities, who live everyday with the devastating consequences of Shell oil spills, but with victims of corporate human rights abuses all over the world. This ruling sets a dangerous precedent and will make it more difficult to hold UK companies to account.

“The idea that powerful multinationals are not responsible for the conduct of their subsidiaries overseas has allowed Shell to evade accountability for a raft of shocking human rights abuses spanning decades. This is a textbook example of the almost insurmountable obstacles to justice faced by people who take on powerful multinationals.

Map of Nigeria
Map of Nigeria

“Internal Shell documents show that the company’s headquarters have known full well for decades about the massive oil pollution caused by their operations in Nigeria, and have chosen not to stop it. If Shell cannot be held to account for such well-documented abuses, what hope is there of bringing other companies to justice?

“The communities will now be taking their fight for justice to the Supreme Court – this could be their last chance to see their environment restored.”

Background

Shell Protests - NigeriaThe Ogale and Bille communities brought two separate legal claims against both Royal Dutch Shell plc (RDS) and its 100% owned Nigerian subsidiary, the Shell Petroleum Development Company of Nigeria (SPDC) in 2016.

Today’s decision rejected the communities’ appeal against a January 2017 ruling that RDS could not be held liable for the actions of SPDC. In a split decision, a panel of three judges ruled that the claim could not proceed.

Amnesty International

AU Commission To Deploy Election Observers To Sierra Leone

Addis Ababa, 5 February 2018: The Chairperson of the African Union Commission, H.E. Moussa Faki Mahamat, will deploy an African Union Election Observation Mission (AUEOM) in the Republic of Sierra Leone as the country prepares to hold General Elections on 7 March 2018.

The African Union Commision Logo
The African Union Commision Logo

A press statement issued on Monday in Addis Ababa, Ethiopia, copied to West African Journal Magazine and quoted the AU Commission as saying the deployment of the AUEOM will take place in two phases. The first phase will comprise of the deployment of 10 long-term election experts and will take place from 10 February to 21 March 2018.

The AU Commission says this move is to ensure that its observer mission conducts a comprehensive observation and analysis of all relevant aspects of the electoral process, the statement disclosed.

 In the second phase of the Mission, the AU Commission says the long term experts will be joined by 40 Short Term observers from the 26 February to 11 March 2018.

 The objectives of the AU Observer Mission, the continental body says are: (a) to provide an accurate and impartial reporting or assessment of the quality of 7 March General Elections, including the degree to which the conduct of the elections meets regional, continental and international standards for democratic elections; (b) to offer recommendations for improvement of future elections based on the findings; and (c) to demonstrate AU’s interest to support Sierra Leone’s elections and democratisation process to ensure that the conduct of genuine elections contributes to the consolidation of democratic governance, peace and stability.

SLPP Candidate Julius Maada Bio
SLPP Candidate Julius Maada Bio

Political campaigning is in full swing in the West African nation. Reports from the capital Freetown say the opposition Sierra Leone’s People’s Party (SLPP) over the weekend launched its platform. Its candidate, a retired military officer Julius Maada Bio told partisans during the launch that, “…So for these 2018 Elections let there be no mistake. The SLPP will not accept results of elections that are not credible and transparent and are not a true reflection of the will of the electorate…”

Meantime, the government of  Sierra Leone has announced the banning of the common and horrendous practice of Female Genital Mutiliation (FGM) until the conclusion of the Presidential and General elections on March 7 in an effort to discourage candidates from “buying votes” by paying for the cutting ceremony for families who cannot afford the price of the practice.

WHO Logo
WHO Logo

According to the World Health Organization (WHO), “Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. Procedures can cause severe bleeding and problems urinating, and later cysts, infections, as well as complications in childbirth and increased risk of newborn deaths. More than 200 million girls and women alive today have been cut in 30 countries in Africa, the Middle East and Asia where FGM is concentrated. FGM is mostly carried out on young girls between infancy and age 15. FGM is a violation of the human rights of girls and women…”

Complications from the procedure can include, severe pain, excessive bleeding, infections, urinary issues, genital tissue swelling and sometimes death in victims.

Map of Guinea-Liberia-Sierra Leone in West Africa
Map of Guinea-Liberia-Sierra Leone in West Africa

With international outcry and campaign against the practice worldwide, over 300 communities in West Africa have declared an end to the practice. In January, the outgoing President of Liberia Ellen Johnson Sirleaf signed an Executive Order banning FGM in the country for a year.

Activists are calling on the new Weah Administration to make the ban permanent.

Emmanuel Abalo 

West African Journal Magazine 

 

Meningococcal Disease Kills 4 in North-western Liberia

A Joint Situational Report issued on Wednesday by the World Health Organization (WHO) and the National Public Health Institute of Liberia (NPHIL) says that a total of nine cases of Meningococcal Disease has been reported in the northwest of the West African country of Liberia.

Map of Guinea-Liberia-Sierra Leone in West Africa
Map of Guinea-Liberia-Sierra Leone in West Africa

The report say there have been 4 deaths as of January 23, 2018 but no new cases have been reported since January 24th. The report says Neisseria Meningitides sero-group W had been found in samples in two of three cases in Foya District, Lofa County Liberia.

According to the report, “…Fourteen new contacts were identified on January 23, 2018. In total, 239 contacts have been identified and listed and are under follow-up. 213, which is about 89% of the contacts have received chemoprophylaxis (ciprofloxacin 500mg, single dose)…”

This an antibiotic which is administered to treat the disease.

The report further disclosed that a total of 5 case patients have been admitted for treatment and 2 have been treated and discharged while 3 others are still undergoing medical treatment.

28 health care workers have undergone refresher training in case management of the Meningococcol infection in the area and community members in Foya have been given orientation on the simple identification of the disease while community surveillance has been increased.

The U.S based Centers for Disease Control and Prevention (CDC) says, the bacteria called Neisseria Meningitidis cause meningococcal disease. About 1 in 10 people have these bacteria in the back of their nose and throat with no signs or symptoms of disease; this is called being ‘a carrier’. But sometimes the bacteria invade the body and cause certain illnesses, which are known as meningococcal disease, the CDC says.

Spread of the Disease: 

The CDC notes that in the spread of the meningococcal disease …”People spread meningococcal bacteria to other people by sharing respiratory and throat secretions (saliva or spit). Generally, it takes close (for example, coughing or kissing) or lengthy contact to spread these bacteria. Fortunately, they are not as contagious as germs that cause the common cold or the flu.

People do not catch them through casual contact or by breathing air where someone with meningococcal disease has been. Sometimes the bacteria spread to people who have had close or lengthy contact with a patient with meningococcal disease. Those at increased risk of getting sick include:

  1. People who live with the patient

2. Anyone with direct contact with the patient’s oral secretions, such as a boyfriend or girlfriend

According to the report, Ebola (RT-PCR), Lassa Fever (RT-PCR), yellow fever (serology-IgM) and typhoid (WIDAL) have been ruled out in specimens collected from some of the human cases.

CDC -Ebola workers
Ebola Workers

An Ebola outbreak in the West African sub-region in 2014-2015 killed over 11,300 in Liberia, Sierra Leone and Guinea and there are about 10,000 Ebola survivors in the region, according to WHO data.

The  Ebola outbreak laid bare the glaring inadequacy of health facilities and personnel in the three countries.

Medical observers say no major programs have been implemented to address the woeful lack of national health programs in the three countries and there are fears that another pandemic outbreak will devastate the poverty stricken populations.

By Emmanuel Abalo

West African Journal Magazine