- 07 Nov
Honorable Joseph N. Boakai, Sr. Vice President of the Republic of Liberia Delivered The OFFICIAL OPENING STATEMENT at the 2ndAnnual General Scientific Meeting of the Liberia College of Physicians and Surgeons (LCPS)
Monrovia City Hall, Monrovia, Liberia
Friday, November 4, 2016
Honorable Members of the National Legislature Present;
Minister Bernice Dahn of the Ministry of Health;
Other members of the Cabinet Present;
President Roseda E. Marshall and Officers of the Liberia College of Physicians and Surgeons;
Officials & Representatives of our Health Institutions;
Members of the Diplomatic Corps;
Representatives of our Development Partners;
Our Good Friends of the Press;
Distinguished Ladies and Gentlemen:
I find it a great deal of honor to be back in this fold today, nearly three years since I was with you to launch the Liberia Post Medical Residency Program.
Today we are here to compare notes on the relevant and thoughtful theme, MEDICAL EDUCATION – A Critical Ingredient in Building a Resilient Health System in Liberia.
We all acknowledge that, since then, a lot has unfolded in our health sector, noticeably, the onslaught of the deadly Ebola Virus. The fragility of health systems has never been of greater interest or importance than at this moment, particularly in the aftermath of that scourge that caught our health care delivery systems unaware and unprepared.
The loss of lives, massive social disruption, and near collapse of even the most basic health-care services shows what happens when a crisis hits and health systems are not prepared. Let’s examine what we can safely say constitutes a resilient health system should be.
A resilient health system can be defined as the capacity of health actors, institutions, and populations to provide appropriate health services, prepare for and effectively respond to crises; maintain core functions when a crisis hits; and, be informed by lessons learned during the crisis and reorganize if conditions require it.
In other words health systems are said to be resilient if they protect human life and produce good health outcomes for all in normal conditions and during a crisis and in its aftermath. Resilience is much more than just the absence of vulnerability; it is about whole system capacity.
Response to a crisis, be it a disease outbreak or other disruption resulting in a surge of demand for health care (e.g., a natural disaster or a mass casualty event), needs both a highly proactive and functioning health-care delivery system and a vigorous public health response.
Health-care systems are complex adaptive systems and resilience is an emergent property of the health system as a whole, rather than a single dimension. Building resilience is thus context dependent and iterative, needing advance assessments of system capacities and weaknesses, investments in vulnerable components of the system before a crisis, reinforcements during the emergency, and review of performance after a crisis.
The Rockefeller Foundation has developed substantial data about resilience.
Building on this Foundation’s initiative, we can readily figure that a resilient health system might be characterized by the following five elements:
- Awareness of potential health threats and risks to the population from biological and non-biological sources. It will need an up-to-date map of human, physical, and information assets that highlight areas of strength and
- Endowed with the capacity to address a broad range of health challenges rather than a targeted few. In times of calm, a resilient health system addresses diverse health needs and increase the number and quality of people’s interactions with the
- In this, it enhances public trust, promotes broad-based provision of health services in line with the Universal Health Coverage (UHC), and protects vulnerable families from financial hardship, helping to ensure health-seeking behavior.
- Has the capacity of self-regulating with the ability to contain and isolate health threats while delivering core health services and avoiding propagating instability throughout the system.
- Potential to bring together diverse actors, ideas, and groups to formulate solutions and initiate action. These include private sectors, non-governmental organizations, local community leadership, and civil society to bring crucial complementary capabilities and perspectives. In particular, communities need to be recognized as a central actor in health systems and not simply a recipient of health
- The ability to transform in ways that improve function in the face of highly adverse Adaptability does not manifest only in crisis.
Resilient health systems demonstrate the capacity to adapt in normal times, such as to changing epidemiological and demographic needs of people.
In the context of natural disasters or other mass-casualty events, health systems face the demand to adapt to health needs of refugees, or internally displaced people. Adapting to emergent challenges needs strong and flexible leadership, well-trained medical staff, and organizational structures and management systems that allow pivot.
Distinguished Ladies and Gentlemen;
The history of humankind is replete with evidence of the life-saving intervention of solidly built health care systems and the devastation allowed by fragile ones.
Globally, events such as the Haiti and Nepal earthquakes and West Africa Ebola outbreak, have demonstrated, now more than ever, that a resilient health system is vital to ensuring stability and well-being in society. In Liberia, the Ebola epidemic has shown the fragility of the health system. The most basic health-care services collapsed and demonstrated the lack of resilience, illustrating that several preconditions for a resilient health system are lacking, particularly relevant manpower and healthcare infrastructures.
Consequently, there is a need for a trained, strong and committed health workforce, characterized by specialists in diverse medical fields who can show up for work that might be professionally technical and difficult.
According to World Health Organization (WHO) and UN partners’ Report in 2015; HIV/AIDS, Tuberculosis, Malaria, Acute respiratory infections, maternal and neonatal conditions constitute major causes of death in Liberia. Others include; malnutrition, cardiovascular diseases, diabetes, cancers and other non-communicable diseases.
The under-five mortality rate and maternal mortality ratio are still high according to recent WHO source, notwithstanding gains we have made in this area. Undergirding the problem is the fact that about 44% of WHO member states are reported to have less than 1 physician per 1000 population. This includes Liberia.
According to the Liberia Medical and Dental Council, there are currently 298 medical doctors with the huge burden of catering for the country’s 4.5 million population. This constitutes a woeful doctor–to- patient ratio of 1:15,000. Of the 298 doctors, 203 are Liberians while 95 are foreign doctors.
Though we should be proud toacknowledge a gain represented by an increase of 22.5% from 2015, the number is still a far cry away from the 1:1,000 doctor-to-patient ratio, as recommended by the World Health Organization. A recent report from the Liberia Medical and Dental Council revealed 207 general practitioners out of 298 registered doctors in the country.
Of the specialist doctors, less than 10 percent are Liberians. Consequently, inadequate number of specialists becomes a serious bottle neck in addressing health emergency issues, high child and maternal mortality rates, particularly in the rural areas.
While the limited number of specialist in the country is alarming, the uneven distribution formula across the country constitutes even a greater challenge as most of the specialists are domicile in Monrovia. For instance, one obstetrician each is in Nimba and Bong counties; 8 are in Montserrado. The remaining counties have none according to the Medical Council report.
In view of the above, the Government of Liberia through the Liberia Post Graduate Medical College has recruited 53 medical doctors in various teaching hospitals in the country.
We take this to be a critical ingredient in trying to jump start a resilient health system in Liberia. Indeed, it is a historical land mark in the history of our nation which requires the embrace of all Liberians, giving utmost support with every concern and agility.
It is against this background that you convene here today for this Meeting. Much is expected out of this historic Conference to further expand the scope of efforts at reinforcing our health care system as kicked off at last year’s Meeting.
Our population stands in anticipation for workable and sustainable formulations from this Meeting of such fine collection of the country’s health care practitioners. While we prepare for cure, prevention should be our main goal.
Before I close, let me particularly register my thanks and sincere gratitude to you, our medical practitioners, for all the sacrifices you make to save our lives.
On this note, I now take great pride and excitement to declare this 2nd Annual General Scientific Meeting of the Liberia College of Physicians and Surgeons officially open on this 4th day of November 2016, in the City of Monrovia, Republic of Liberia.
I wish you very incisive, productive, and life-impacting deliberations, to the benefit of our people and their health.