World Health Organization



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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

16 MARCH - 30 APRIL 2002

SITREP #3

I. Introduction

The period under review presented major challenges to health development in Liberia. Dissident attacks continued in various locations within 75 miles radius of Monrovia, the capital. Consequently, the influx of internally displaced persons into the immediate environs of Monrovia intensified. The influx of IDPs resulted in a humanitarian crisis especially in health and food shortages.

I. Socio-economic and Political Developments with Health Implications

1. Dr. Omar Juma Khatib arrived in Liberia on 6 April to head the WHO Country Office as the WHO Representative. Dr. Khatib, a Tanzanian national, comes to Liberia from the Seychelles, his last place of assignment. He replaces Dr. Andre Ndikuyeze who had been WHO Representative in Liberia since October 1999.

On Tuesday, 16 April, Dr. Khatib presented his Letter of Credence to the Government of Liberia. The ceremony was held at the Ministry of Foreign Affairs where the Foreign Minister, H.E. Monie R. Captan, received him on behalf of the Government. In welcoming Dr. Khatib to Liberia, Minister Captan expressed the Government’s appreciation of the work of WHO and the entire UN System in Liberia. The Foreign Minister used the opportunity to educate the Liberian public on the difference between the UN Specialized agencies and the UN Security Council. He said that the role of the UN Specialized agencies in Liberia has been positive. Minister Captan thanked WHO for its support to the formulation of the Liberia National Health Policy, a major instrument for health reform in post-war Liberia.

In his remarks, Dr. Khatib reaffirmed WHO’s commitment to support the Government of Liberia in its health development efforts.

2. Dr. Andre Ndikuyeze completed his tenure of service in Liberia as WHO Representative and departed the country on 7 April 2002. At a farewell program held by the Ministry of Health and Social Welfare, Dr. Ndikuyeze was presented a Citation from the Government of Liberia, for dedicated and committed services rendered to the Government and People of Liberia, during his two and a half-year stay in the country.

2. Liberia remains in UN Security Phase 4, a condition that limits program implementation to Monrovia. Additionally, a “State of Emergency” declared by the Government in February remains in place. During the reporting period, the Government banned public gatherings and political party activities.

2. Sanction (borrow from ONCHO SITREP)

III. WHO Collaborative Program

A. EPI

1. WHO has collaborated with the Ministry of Health and Social Welfare in conducting an active surveillance workshop for internally displaced persons from 4 major IDP camps in Montserrado County. The IDP camps were created or their population increased in February due to re-newed attack by the dissident group “Liberians United for Reconciliation and Democracy”. The workshop was held from 16 to 17 April.

The eighty (80) participants included leaders of the IDP camps and leaders of refugees as well as health workers whose NGOs provide services in the camps. The focus of the training was surveillance of 8 priority diseases, namely: yellow fever, neonatal tetanus, measles, bloody diarrhea, cholera, meningitis, Lassa Fever/hemorrhagic fevers and AFP. The workshop also used planned to mobilize the participants for a pending multi-antigen EPI campaign for under-fives of IDP centers. As leaders of their communities, the participants were challenged to continue to mobilize their people for EPI even upon their return to their original homes.

1. A multi-antigen EPI campaign was conducted from 10 to 27 April 2002 in IDP camps near Monrovia, Montserrado County. The campaign which included yellow fever vaccines targeted a population of 3,575 under-fives. A coverage of 89% was obtained.

1. A review meeting on the performance of routine EPI, surveillance and NIDs took place from 27 to 28 April. The meeting brought together all stakeholders including the donor community, UN agencies, health workers and community leaders. The meeting ended with the recognition and presentation of awards to the best performing county in routine EPI, Surveillance and NIDs. Additionally, a copy of the TFI-2001 Meritorious Award won by EPI Liberia was given to all counties, donors and UN agencies supporting EPI in Liberia.

WHO/Liberia was certificated for having “excellently collaborated and supported the Ministry of Health and Social Welfare in the provision of Immunization Services for the year 2001".

B. Protection of the Human Environment

1. A consignment of chlorine worth seven thousand United States dollars (US$7,000.00) has been provided for the Ministry of Health and Social Welfare (MOH&SW) to strengthen its cholera control program in 18 high risk communities (slum communities) in and around Monrovia. Monrovia has been out of piped water system since June 1990 (12 years), a condition that resulted from the destruction of the water treatment plant during the civil war. Several handpump wells and deep wells have been sunk in Monrovia, by the UN and other partners to provide safe water supply for the citizenry. However, the ever increasing population of Monrovia continues to overwhelm the services available. Thus the dwellers of slum communities continue to drink from unprotected water sources.

The chlorine will also be used for chlorination of water wells in counties (Maryland and Rivercess) where there have been recent reports of cholera.

1. The Monrovia City Corporation has benefitted from health and sanitation tools from WHO, to support its “healthy city” program. The tools include wheelborrows, rakes, shovels, boots, gloves and brooms, among others and cost about US$3,000.00.

A. Onchocerciasis Control

The ONCHO program has received furniture and office supplies worth two thousand seven hundred dollars, ($2,700.00) to strength its administrative capability.

D. Communities Disease Surveillance and Research

Preparations have been finalized for the holding of a consensus workshop on the launching/implementation of the Integrated Disease Surveillance and Research (IDSR) program in Liberia. The workshop will center on advocacy for IDSR, development of a list of diseases for Liberia and development of case definitions for the selected diseases.

E. National Health Systems (OSD)

1. The Government of Liberia has initiated the process for establishment of a National Health Account - the NHA. The account will provide a framework for determining the type and origin of resources invested and consumed in the provision of services by the health sector and its partners. It will enable the national authorities address critical health issues.

Already, the NHA Task Force has been established. The Task Force is currently conducting a review of health financing in Liberia in order to develop a comprehensive package for use in developing the National Health Account.

1. In support of the WHO Poverty Alleviation Program, the MOH&SW and WHO are working with NGOs to develop proposals for possible funding. The proposals must address health and poverty issues.

1. The World Health Organization (WHO) on Friday, 22 March donated a consignment of medical supplies and equipment valued at US$212,451.00 to the Ministry of Health and Social Welfare.

The medical supplies and equipment include essential drugs, a generator, 2 vehicles, motorcycles and helmets, Laptop computers, HP LaserJet Printer and Refrigerators.

Other items are: incubator oven, auto-destruct syringes, impregnated mosquito nets, air conditioners, high frequency codan radios for the vehicles, assorted laboratory equipment and Yellow Fever vaccines, etc.

These supplies and equipment will be used by various divisions of the Ministry of Health and Social Welfare including the National AIDS and STI Control Program (NACP), the National TB/Leprosy Control Program, the Expanded Program on Immunization (EPI) and the Malaria Control Program, among others.

F. NGO Coordination

1. The health sector NGOs continue to provide Emergency and Humanitarian Assistance to the internally displaced and refugees. The operational strategy has been modified from the strengthening of fixed health facilities to provision of health services via mobile clinics. This adjustment is due to the fluidity of the security situation and looting of health facilities in combat zones. It is estimated the 60,000 IDPs are in the Monrovia area.

1. A mass evacuation of IDPs has occurred from Belefani in Bong County to CARI in the Gbarnga area (Bong County). This mass movement is due to renewed fighting between LURD and the Government. This development has intensified humanitarian needs. The CARI displaced center currently holds 15,000 IDPs.

1. Humanitarian needs have also intensified in Kakata, Margibi County due to the movement of IDPs from Bong Mines since early February 2002.

G. Essential Medicine: Access, Quality & Rational Use

Liberia inaugurated its first drug quality assurance laboratory on 22 March 2002. The drug quality assurance laboratory is a special donation of the WHO Regional Director for Africa, Dr. Ebrahim Malick Samba, to the Ministry of Health and Social Welfare. The request for the laboratory was made to Dr. Samba in August 2000 during an official visit to Liberia. The laboratory equipment and supplies arrived in Liberia in early 2001.

To ensure its proper usage, WHO sponsored the training of 2 laboratory technicians who have since returned to Liberia and are manning the laboratory. The problem of counterfeit drugs has increased in Liberia since the civil war.

G. Health Promotion

1. Liberia launched its programs for World TB Day on 22 March 2002 with a radio program on the disease. The Liberia program for this year-long WHO campaign under the theme: Stop TB - Fight Poverty includes; the production of a Fact Sheet on TB and the holding of focus group discussions for selected segments of the society. The Fact Sheet will be distributed during the focus group discussions and inserted in the daily newspapers for the general public. Additionally, the Talking Drum Studio is conducting a quick survey on the public’s knowledge of TB. The material collected will be used for radio programs on TB, to focus on dispelling the myths and misconceptions associated with the disease.

1. Activities in observance of World Health Day 2002 in Liberia took place from 5 to 13 April 2002. These activities included a mini-high school basketball tournament, a female kickball and football tournament and “Walk for Health”. The official/formal World Health Day program was held on Saturday, 13 April. It was preceded by a 2-mile walk. During the program, the various speakers admonished the public to increase their physical activity through various exercises and promote their health and well-being. A demonstration of aerobics and martial arts presented during the programs portrayed some simple types of physical activities that protect and promote health. The theme for World Health Day 2002 is Physical Activities with the slogan “Move for Health”. Winners of the sports tournament were certificated and awarded a trophy, a basketball or a table tennis set.

1. Liberia joined her sister African countries in observing Thursday, 25 April 2002 as Africa Malaria Day under the theme, “Mobilizing Communities to Roll Back Malaria”. The Liberia program had the following high points:

a. The launching of the insecticide treated nets (ITN) program for pregnant women and under-fives. This program was made possible from a ten thousand dollars donation to Liberia in 2001 by the Regional Director for WHO Africa, Dr. Ebrahim M. Samba for high implementation of the WHO/GOL technical cooperation program. An initial consignment of 5,000 nets and chemical for impregnating the nets has already been received in country. At the end of the formal Africa Malaria Day program, 50 nets were given to post partum mothers (42) and labor patients of the obstetrics ward on the Redemption Hospital in Monrovia.

a. The launch of the ITN program for the general public. These nets will be made available to the public through the Ministry of Health and Social Welfare’s cost-sharing scheme coordinated by the National Drug Service and implemented by county health teams.

a. The recognition and awarding of “certificates of merit” to RBM/Liberia partners with outstanding performance. Those recognized were:

• International Rescue Committee (an NGO)

• MERLIN (NGO)

• Talking Drum Studio (Media Institution)

• County Health Officer - Grand Gedeh County

• Dr. Walter Gwenigale (County Health Officer - Bong County)

On her keynote address, Hon. (Mrs.) Marie MacIntosh called on the Ministry of Health and Social Welfare to provide an aggressive technical leadership for Roll Back Malaria in Liberia. She also admonished all cadres of community members to support the Roll Back Malaria Program because their health and survival as a community depend on their level of contribution to the efforts of heath development partners.

IV. Staff Movement/WHO Missions/Consultancies

A. In-Country

Name Purpose Date

Dr. Omar Khatib To participate in EPI/Liberia 27, 27 April

Dr. Sei-M Parwon Review Meeting in Charlesville,

Margibi

A. Missions

1. Dr. Harrison Freeman Intergovernmental Negotiation 17-18 March

Program Director, Body Meeting FCTC in Geneva,

Leprosy/TB Switzerland

2. Mrs. A. Nadu Cooper New Imprest Software Training 18-22 March

Mrs. Wannie Guezo in Accra, Ghana

2. Dr. Fatorma Bolay EPI Manager Meeting in Abidjan, 18-29 March

Dr. Alex Gasasira Cote D’Ivoire

Mr. Jimmi Kingsley

Mrs. Juli Endee-Tarpeh

Mr. J. Wilson

Mr. Sonpon Sieh

Mr. J. Daboi

Dr. Sei-M Parwon

2. Dr. Benjamin Vonhm Intercountry IMCI Case Management 17-29 March

Dr. Paps Ganon in Nigeria

Dr. Eugene Dolopei

Mr. Wuo Gartei

Dr. S. Dahn Baawo

2. Dr. Harrison Freeman Workshop on Updating of Leprosy 26-28 March

Leprosy/TB Program Registers in Bamako, Mali

Manager

2. Mr. Wuo Gartei TOT Workshop on Drug Use 22-26 April

Epidemiology

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