/ 14 January 2009

Liberia battles crippling shortage in health workers

Liberia has just 122 doctors to treat its 3,5 million people, who desperately need at least 1 000 physicians, or almost 10 times that number.

Just how much dirt-poor, war-scarred Liberia needs medical staff can be summed up with an anecdote about the country’s health minister: he moonlights as a provincial surgeon.

”At the weekend I sometimes go back to help out in surgery at Phebe hospital where I used to work before I was appointed minister,” Health Minister Walter Gweningale said, referring to a facility in Gbarnga, 170km from the capital Monrovia.

”Because we are suffering in Liberia from an acute lack of personnel, in particular doctors,” he said.

Liberia has just 122 doctors to treat its 3,5 million people, who desperately need at least 1 000 physicians, or almost 10 times that number.

The shortage mirrors the larger challenges facing this West African country — Africa’s oldest republic founded by freed American and Caribbean slaves — as it emerges from successive bouts of civil war, facing a dearth in everything from electricity and basic sanitation to roads and bridges.

There were two-thirds more doctors during the 1970s than today — and more than half of those now here are foreigners.

Indeed, Monrovia is negotiating with Nigeria, Egypt and Cuba to draw more health professionals to the country.

”Human resources is our biggest challenge currently,” said Bernice Dahn, the deputy health minister.

”Over 14 years of war [1989-2003], people left the country, especially the professionals. And they are not returning the way they left so we have a serious gap.

”Filling that gap,” she added, ”will take years”.

Phebe hospital is a case in point. The institution is located in the central county of Bong, where there is only one doctor for every 100 000 residents.

”We are often overwhelmed by the work in this hospital which is the only one in Bong county and where there are only three doctors including myself,” said the hospital’s 41-year-old director Garfee Williams, who also serves as county health officer.

‘There are no incentives’
At the end of Liberia’s brutal civil war, the country tried to coax doctors to return by boosting their monthly salaries from $30 to $1 000.

But, noted Williams, ”it is almost impossible to get a Liberian doctor back from the US. At the same time, it takes too long — 10 years — to train a doctor in Liberia.”

Williams counts among the rare physicians who remained in Liberia during the war. He sought refuge at Phebe and later opted to practise there.

The shortage of nurses is equally dire. Liberia’s estimated 600 nurses are half their number prior to 1989 — and one-eighth of the 4 800 the country needs.

Liberia also needs about 1 600 midwives. It has only 400.

”The salaries for these jobs are very low and there are no incentives, in particular outside of Monrovia where it is impossible to find another job to sustain a family,” said Williams.

The average nurse earns about $165 a month; the average midwife about $140. With a total budget of just $11-million, these are salaries the health ministry under President Ellen Johnson Sirleaf — who took office three years ago with a pledge to get Liberia back on its feet — is trying to address.

Phebe hospital has floated one solution, via a school for nurses and midwives partnered by the French charity Medecins du Monde (MDM). The school offers scholarships in exchange for students’ commitment to work two years in Bong county.

”But some students don’t respect their engagement and return to their region of origin or go to Monrovia to work,” MDM’s head of mission Pierre Tripon said.

”We do feel the lack of personnel every day. The worst thing is that it prevents us from providing quality attention and care that our patients require,” Williams said.

Williams himself has to juggle his jobs as hospital director and county health officer — along with a physician’s usual duties — and fill in for colleagues who are away.

”If I have not been able to do rounds for four days because I was doing administrative duties and a child dies in paediatrics, I feel responsible,” he said. — AFP