Delays in Achieving Maternal, Newborn, and Child Health Targets for 2021 and 2030 in Liberia

Laaser U, Broniatowski R, Byepu S, Bjegovic-Mikanovic V. Delays in Achieving Maternal, Newborn, and Child Health Targets for 2021 and 2030 in Liberia. Frontiers in Public Health. 2019;7: 386.Objectives: The Government of Liberia has set ambitious national health targets for 2021 to reduce the high maternal, newborn, and child mortality rate and to improve the related health services. Additionally, Sustainable Development Goal 3 provides a long-term target for 2030. The objective of this article is to analyze the gaps between the targets and collected data. Materials and Methods: Relevant national documents were scrutinized to identify targets and related indicators which can serve as benchmarks for future achievements in Liberia's maternal, newborn, and child health. For each indicator, progress observed will be compared with that needed to meet the target, based on the indicator value in a baseline year, a later observed value, and the expected value in 2021 and 2030, respectively. Results: The Gap Analysis reveals achievements and serious delays for 21 health and health system indicators. Based on national data the reduction of the maternal mortality ratio will take an additional -8.2 years for the 2021 target and -12.5 years for the 2030 target. The Neonatal Mortality rate is experiencing similar delays of -7.9 years for 2021 and -12.9 for 2030 whereas the targets for the Under-5-Mortality rate can be achieved with small delays of -1.8 and -1.7 years. Conclusions: The Government of Liberia requires persistent efforts and international support to achieve its national targets and the Sustainable Development Goal 3 for health

Maternal and new-born health policy indicators for low-resourced countries: The example of Liberia

Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health. Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases. Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities. Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets

Maternal and new-born health policy indicators for low-resourced countries: The example of Liberia

Abstract Aim: Over the past two decades, two catastrophic events caused a steep decline in health services in Liberia: the long-lasting civil war (1989-2003) and the weak response of the health system to the Ebola Viral Disease (EVD) outbreak (2013-2015). In early 2015 The Liberian Government reacted and developed a strategic health policy framework. This paper reviews that framework with a focus on maternal and newborn health.Methods: The study is designed as a narrative review executed during the second half of 2017 in Monrovia. It takes advantage of triangulation, derived from recent international and national documents, relevant literature, and available information from primary and secondary sources and databases.Results: In 2015 the severely compromised health system infrastructure included lack of functional refrigerators, low availability of vaccines and child immunization guidelines, high stock-out rates, and an absence of the cold chain minimum requirements in 46% of health facilities. The public health workforce on payroll during 2014/15 included only 117 physicians. Skilled birth attendance as an indicator of maternal health services performance was 61%. Presently, approximately 4.5 women die each day in Liberia due to complications of pregnancy, delivery, and during the post-partum period, equalling about 1,100 women per 100,000 live births. Of particular note is the adolescent birth rate of 147 per 1000 women aged 15-19 years, three times higher than the world average of 44. Additionally, with a neonatal mortality rate of 19.2 neonatal deaths per 1,000 live births, Liberia stands higher than the world average as well. The high mortality rates are caused by multiple factors, including a delay in recognition of complications and the need for medical care, the time it takes to reach a health facility due to a lack of suitable roads and transportation, and a delay in receiving competent care in the health facilities.Conclusions: The fact that performance is above average for some indicators and far below for other points to unexplained discrepancies and a mismatch of international and national definitions or validity of data. Therefore, it is recommended to concentrate on the core of tracer indicators adopted at the global level for Universal Health Coverage and the Sustainable Development Goals to enable a permanent update of relevant information for policymaking and adjustment. At present all health policy documents miss a thorough application of the SMART objectives (Specific, Measurable, Attainable, Relevant and Timely), notably missing in most documents are realistic and detailed budgeting and obligatory timelines for set targets

The status of health services in the 15 counties of Liberia

Aim: Liberia, situated at the West African coast, is composed of 15 counties with an economic gradient steeply decreasing from the Northwest to the Southeast. Health-related activities by government action in the 15 counties concentrate on the areas of family planning, antenatal and delivery care, as well as immunization, health workforce and infrastructure. The differences in this regard between the 15 Liberian counties will be reviewed. Methods: A narrative review is employed, making use of the recent international and national documents, relevant literature and available information from the following primary and secondary sources and databases. Results: The results point to gross differences between the 15 counties of Liberia in terms of health service provision. The overall readiness based on defined indicators for all 701 facilities was 59% with a range between facilities at the level of counties of 50% to 65%; for family planning services 88% (range 65% – 100%); for antenatal care 62% (range 55% – 100%); for immunization coverage 76% (range 66% – 86%). The health workforce of Liberia comprises 11.8 health workers per 10.000 population, WHO target is 23, the counties range from 8.0 to 15.7. Similarly, according to WHO standards, there should be 2 health facilities per 10.000 inhabitants, Liberia comes up to 1.9 however the counties range from 1.1 – 3.0 per 10.000. Conclusions: It is obvious that across almost all areas of women and child health and health services in general there exist large differences between counties, which points to considerable health inequities in this country. The government of Liberia should consider reallocating the available resources per number of population instead of accepting historical developments, however with a correction factor in favou of disadvantaged regions and population groups

The status of health services in the 15 counties of Liberia

Aim: Liberia, situated at the West African coast, is composed of 15 counties with an economic gradient steeply decreasing from the Northwest to the Southeast. Health-related activities by government action in the 15 counties concentrate on the areas of family planning, antenatal and delivery care, as well as immunization, health workforce and infrastructure. The differences in this regard between the 15 Liberian counties will be reviewed.Methods: A narrative review is employed, making use of the recent international and national documents, relevant literature and available information from the following primary and secondary sources and databases.Results: The results point to gross differences between the 15 counties of Liberia in terms of health service provision. The overall readiness based on defined indicators for all 701 facilities was 59% with a range between facilities at the level of counties of 50% to 65%; for family planning services 88% (range 65% – 100%); for antenatal care 62% (range 55% – 100%); for immunization coverage 76% (range 66% – 86%). The health workforce of Liberia comprises 11.8 health workers per 10.000 population, WHO target is 23, the counties range from 8.0 to 15.7. Similarly, according to WHO standards, there should be 2 health facilities per 10.000 inhabitants, Liberia comes up to 1.9 however the counties range from 1.1 – 3.0 per 10.000.Conclusions: It is obvious that across almost all areas of women and child health and health services in general there exist large differences between counties, which points to considerable health inequities in this country. The government of Liberia should consider reallocating the available resources per number of population instead of accepting historical developments, however with a correction factor in favour of disadvantaged regions and population groups.  

A Gap Analysis of Mother, New-born, and Child Health in West Africa with Reference to the Sustainable Development Goals 2030

The Economic Community of West African States (ECOWAS) comprises 15-member states with an estimated population of 350 million. This account relates the present status of maternal, neonatal, and under-five-mortality to the Sustainable Development Goals (SDG) targets set for 2030. For each SDG indicator, progress observed was compared with that needed to meet the target (assuming linear progression). The time gap was calculated as the difference between the time remaining to the target year (2030) and the estimated time needed to achieve the target. The highest maternal mortality ratio is found in Sierra Leone (1360 in 2015), followed by Nigeria (814) and Liberia (725). Whereas Sierra Leone and Nigeria keep high positions also for the neonatal and under-five mortality rate, Liberia ranks clearly better than the ECOWAS average. Globally skilled health  professionals‘ density is 25 per 10,000 population and in Nigeria close to it with 20.1 whereas Guinea takes the last position with 1.4. The gap analysisshows that ECOWAS countries have a realistic chance to likely reach the SDG targets in 2030 with a delay of less than 4 years regarding maternal, neonatal, and under-five-mortality although their skilled health  professionals‘ density is considerably lower than for the entire African region. (Afr J Reprod Health 2018; 22[4]: 123-134).Keywords: West Africa, Mother, New-born and Child Health, Sustainable Development Goals, Gap Analysis, Health Worker Densit