Leo Mbondo has just carried his three-year-old daughter, Charlene, to the Goba Town community clinic. He has walked for two and a half hours in the blazing heat, all the way from Zinc Camp more than five kilometres away.
Charlene looks well cared for and smiles constantly – but her father is worried about the hacking chesty cough that she has had for almost a week now, which seems to be getting worse.
But Goba Town clinic has run out of antibiotics due to delays in the supply of drugs from the government. Leo will have to decide whether to carry Charlene another five kilometres to the closest referral hospital in Kakata.
Managed by the Liberian government, the Goba Town serves a radius of 15km, and women sometimes walk for more than five hours to get there.
Yet despite being a vital health resource for the local population, the clinic is in a deplorable state. There is no electricity, no lighting, and it hasn’t had running water since the pump broke many months ago. The clinic’s drug store is depleted and its lab is no longer functioning – its one microscope having been broken for more than a year.
What should Save the Children do?
At the moment, Save the Children provides minimal support to the clinic, including a solar lamp for the labour room and a cold box for vaccines, powered by a solar battery.
An observer might suggest that the Goba Town clinic would be better staffed, equipped and managed if Save the Children gave it full support. But would this really be the best answer for Liberia? It would mean that Charlene has access to skilled health workers and essential drugs when she needs them, but what about the other clinics in a similar state across Liberia?
There is a less obvious way forward. By strengthening democracy in Liberia, improving health governance and consulting communities, we can improve children’s access to healthcare across the country. We need to include local populations in health planning and budgeting processes, and empower women and children to make decisions around health.
Yet these are all slow, ‘unsexy’ strategies that will not produce immediate results. Their impact will be difficult to measure to donors’ satisfaction, and they will require long term commitment at the community level before any difference can be seen.
Also, there is an argument that most of these strategies might not interest the governments in charge of fragile democracies – getting donors to support health centres is a lot simpler than empowering citizens who may then demand their rights. This poses a major challenge for Save the Children, whose main partner is always the government.
To get the health system working for Charlene, we need to work with the government to strengthen national systems – but also work in a more meaningful way with wider civil society to strengthen the social, economic, cultural, environmental and political fabric of Liberia.