Liberia: “Please leave small-small”

Save the Children has supported the Worhn community clinic in Gibi district, Margibi county, Liberia, since 1997.

With the aid of ECHO and then EU funding, we have financed the expansion of the clinic, built a maternal health centre and maternity waiting home; ensured the supply of drugs; trained staff and members of the community; provided furniture, medical equipment, mobile phones and motorbikes.

The Maternal and Child Health Unit in the Worhn Community Clinic.

Save the Children also offers accommodation to vital health workers and pays the incentives for all 8 staff in the clinic. The Certified Midwife has just been informed that she is now on the government payroll but is yet to receive her first salary from the government.

This may be an early warning of bigger problems to come. The EU’s funding contribution will end in August.  The only remaining funding is from the Capital Appeal, which can only be used to upgrade the building. The Worhn community clinic is yet to be classified as a district health centre but the planned upgrade will certainly ensure this.

Real anxiety

Despite this, with the government taking over its day-to-day running from January 2014, the quality of services is in jeopardy. Among the Worhn community, there is a great deal of anxiety about the government’s capability: government-run health centres continue to remain inadequately staffed and under-resourced.

Anthony Klay-Sie, Margibi Field Manager – Save the Children and Amos Boyer, Commissioner for Gibi District.

Amos Boyer, the Commissioner for Gibi district, was firm in assuring the community that the government will step up to the challenge but pleaded with Save the Children to “please leave small-small” – that is, gradually. Quite a sensible request, really.

But his request poses some real challenges. Will the system become strong if Save the Children continues to support health centres? Government and donor resources have been mobilised at both national and county level, so why is capacity still weak?

Political will needed

Liberia remains one of the most unsafe places to be a mother or new-born child. Government-run health centres remain inadequately staffed and under-resourced.

Political will has contributed to better policies but what is required urgently is a concerted effort: governments, donors and NGOs must harmonise  plans, resources and development intent.

Until plans and resources are better streamlined to  strengthen the health system and improve governance, it is the people of Liberia who will continue to pay the price.

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  • Zaeem Ul Haq

    Great blog Tara! Some real challenges for Liberia, and other fragile/ post-conflict settings across SSA. I think probably no local authority in such an under-resourced setting would ever want an iNGO to leave, as they provide a lifeline for the rundown health services. Yet I know you’ll agree that we can’t be there forever. I think the solution lies in building-in an exit strategy from the outset, and ensuring that we end up strengthening the health system to endure on its own, instead of making it dependent on foreign assistance. The transition could be difficult and take a long time, but it has to start sometime.

  • Beyan, Jenkins

    I affiliated at the Worhn Community Clinic as a Primary Health Care worker/Physician Assistant(PA) with the SCF/UK Liberia, Ministry of Health and the Margibi County Health Team in 1999/2000 and later move to the county hospital as Officer In Charge(OIC) of the hospital out patient department with direct supervision of SCF/UK Liberia.
    However, I’m sad indeed that Liberia remains one of the most unsafe places to be as a mother or under five; also, regrettably Government-run health services remain inadequately staffed, under pay and under resourced. After working for about 13 month, I later got hire with World Vision international Liberia(WVI) and UNICEF joint project as a Emergency Field Supervisor over seeing the Emergency and humanitarian health need of thousands Internally Displace Persons and Sirrraleon Refurgee.
    I’m willing as US citizen to offer 3 to 6 month voluntary services to the Worhn Clinic and the people of Margibi county, Liberia.

  • Simon Wright

    This is a crucial discussion about how to make sure we build capcity and do not undermine it. It is not easy. Donors like to give money through NGOs. We are not as bureaucratic as government so can move a bit faster. And, as Beyan Jenkins shows above, sometimes big iNGOs recruit staff out of the ministry when their proper place should be to be there running services. I agree that we have to plan our departure when we are starting the work, not when it is ending.