Countries of the World/COUNTRYS.BIN/dp/0220/02201.txt

Text File | 1991-06-25 | 8KB | 139 lines

$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.)