$Unique_ID{COW02201} $Pretitle{238} $Title{Liberia Chapter 2E. Health} $Subtitle{} $Author{Irving Kaplan, et al.} $Affiliation{HQ, Department of the Army} $Subject{health care facilities medical children diseases liberia monrovia personnel rural} $Date{1984} $Log{} Country: Liberia Book: Liberia, A Country Study Author: Irving Kaplan, et al. Affiliation: HQ, Department of the Army Date: 1984 Chapter 2E. Health Although expenditures on health care in the last years of the Tolbert administration and the initial postcoup years were comparatively high in relation to both gross domestic product and the government budget, the facilities and personnel available in the early and mid-1980s were not able to cope with Liberia's significant health problems. Most of the outlay for health care reached only about one-third of the population-those in and near urban areas, especially Monrovia, and in the concession areas where the rubber and mining companies provided care to workers and their families. The limited available data strongly suggest that the diseases responsible for most illness, debility, and death in the country were malaria, various forms of gastroenteritis, measles, upper respiratory infections (including pneumonia), anemia (including the sickle-cell variety), and hypertension. In addition, tetanus (including a neonatal form), tuberculosis, urinary tract infections, skin and eye infections, and meningitis appeared to be common. Infants and very young children were particularly susceptible to diarrheal diseases and measles as well as neonatal tetanus. Many of these diseases, especially those affecting the young, are preventable by immunization, improvements in environmental sanitation, provision of clean water, and adequate nutrition. The health services in place in the early 1980s stressed curative rather than preventive medicine, but the government seemed to have been persuaded that a change in emphasis was necessary and would be more effective in improving the health of the population than a continued focus on dealing with illness after it had erupted. The widespread unavailability of water that is safe for drinking and other purposes has contributed to the very high incidence of diarrheal diseases, which afflict infants and children under the age of five and, because of dehydration, may lead to death. Unsanitary water supplies have also been linked to the onset and exacerbation of skin and eye infections. Ideally, the provision of clean water in all communities would solve the problem, but the cost has been prohibitive. It is more likely that efforts will be made to educate the people of rural communities to follow modern hygienic practices. Immunization for measles, tetanus, and other diseases would have an immediate impact, but these measures, like changes in environmental sanitation, require rudimentary facilities and at least minimally trained medical personnel in the rural areas. All were in short supply in the 1980s. The role of malnutrition, particularly protein calorie deficiency, in the susceptibility of Liberians to disease has not been thoroughly investigated, but prolonged malnutrition of the kind suffered by African populations frequently afflicted by drought does not seem to occur. A 1976 study carried out on children and lactating women did indicate, however, that 60 percent or more of children under the age of six suffered from anemia. Furthermore, many infants under one year received no food other than milk; conversely, many over one year of age received no milk at all, in part a consequence of minimal intervals between pregnancies. Acute protein calorie deficiency was not pervasive but did occur. From one-fifth to one-fourth of all rural children were either underweight or suffered impaired growth. Milder forms of malnutrition were more common, and the occurrence of acute diarrhea could convert such mild forms into a more acute variety. Of the relatively small number of health facilities in the mid-1980s, many were understaffed and often lacked basic equipment and medicines. The greatest concentration of facilities, particularly of hospitals, occurred in Montserrado County, locus of Greater Monrovia (see table 4, Appendix). Even more concentrated were highly qualified professionals such as physicians and medical personnel of the kind ordinarily associated with hospitals and modern medical care, e.g., laboratory technicians (see table 5, Appendix). Where these occurred outside the Monrovia area, they were often associated with facilities provided by the companies holding concessions. The apex of the health care system in 1984 was the John F. Kennedy Medical Center near Monrovia, dedicated in 1971. As Liberia's central facility for medical treatment, it was also the major teaching hospital for health personnel, including medical and nursing students who were working for degrees at the University of Liberia, as well as paramedical personnel and technicians of various kinds. The center was allocated 45 percent of the country's total recurrent expenditure for health in the early 1980s. Considering Liberia's financial constraints, some observers have questioned whether it will be possible to continue to give the center so high a proportion of the health budget and to expand rural health care simultaneously. Shortly after the 1980 coup the government committed itself to providing modern health care to the rural areas; the expansion of facilities and staff was to take place at such a rate that 90 percent or more of the population would have access by the year 2000. The kind of care envisaged would put heavy emphasis on preventive medicine, i.e., on action and education with respect to immunization, environmental sanitation, and nutrition. Preventive medicine would be combined with curative treatment and disease management in health posts and health centers staffed by paramedicals of varying degrees of training and qualification. In principle, health centers were to be referral points for health posts. They would provide services midway between those received in health posts and those offered by hospitals. Physicians' assistants were to be in charge of health centers, presumably under the supervision of physician-nurse teams stationed at county hospitals. The hierarchy of responsibility and qualification under the developing system was not clear, however, and may well have changed to meet local contingencies. For example, some of the health centers in existence in the early 1980s were not staffed by physicians' assistants, as they were supposed to be. * * * For an overview of Liberia's social dynamics in a historical context, Martin Lowenkopf's Politics in Liberia: A Conservative Road to Development and J. Gus Liebenow's Liberia: The Evolution of Privilege are especially recommended. Liebenow's subsequent reports in the American Universities Field Staff series provide insight into social developments set in motion by the 1980 coup. Articles by Svend E. Holsoe and Frederick McEvoy deal with problems of ethnic identification. Important studies on particular ethnic groups include those by Warren L. d'Azevedo on the Gola, Beryl L. Bellman and Caroline H. Bledsoe on the Kpelle, and Lawrence B. Breitborde on the Kru. Stephen S. Hlophe views the development of class structure and other social formations from a Marxist perspective in Class, Ethnicity, and Politics in Liberia; his work is particularly valuable for its analysis of the Americo-Liberian oligarchy. Tribe and Class in Monrovia by Merran Fraenkel is a classic study of social stratification and adjustment in an urban African setting. (For further information and complete citations, see Bibliography.)