Sorry it's been a while since posting-- there's more and more kinds of work here than I anticipated...
So, where are you again? Liberia, West Africa. Oh. So, where are you again? Well, read on. I've tried to put it into sections, as well as a section specifically on JFK Hospital, where I am now, and a few key numbers after that. A lot of the below information comes from the 2006 and 2008 UN Country information, but from what I can tell, not much has changed...
Oh, and some media on Liberia: movies- Liberia: America's Stepchild, Sliding Liberia (we met Alfred, who's featured in the movie) books- Through the Liberia Storm and Liberia: the Path to War (both written by a Nigerian MD who's here with us now), also Blue Clay People, and This Child will be blessed (I think, the autobiography of Liberia's president, Ellen Johnson Sirleaf, who is the first female head of state in Africa)
COUNTRY OVERVIEW
Liberia is situated in West Africa, bordering the Gulf of Guinea, Côte d'Ivoire, Guinea and Sierra Leone. Lying just north of the equator, the country has a tropical climate and is one of the wettest in the world, with an average annual rainfall of more than 5,000 mm in Monrovia. Liberia’s population is currently estimated at 3.4 million with an annual growth rate of 4.9 percent.1 Average life expectancy is 39 years2 and an estimated 50 per cent of the population are below the age of 203. 95 per cent of Liberians belong to one of 16 indigenous tribes.4 The
remaining population consists of Americo-Liberians and so-called Congo people, descendants of immigrants from the United States and Caribbean. An estimated 40 per cent of the population hold indigenous beliefs, 40 per
cent are Christian and 20 per cent Muslim. 5 Liberia is rich in natural resources, including iron ore, timber, diamonds, gold and potential for hydropower. Despite this natural wealth, it is among the poorest countries in the world measured in terms of per capita income. Liberia is not currently rated on the Human Development Index (HDI) given the lack of data. However, its HDI rating in 1999 was 0.276, down from 0.311 in 1996, placing it second from the bottom on the list of countries.6 The economy of Liberia reflects the toll of the war. Per capita GDP stands at US$ 163, a dramatic drop from the 1980 level of US$ 1,269. Foreign debt exceeds US$ 3.7 billion (650 per cent of GDP). Unemployment is estimated at 85 per cent, with nearly half the population existing on less than US$ 0.50 per day. Some 86 per cent of the poor live in rural areas7. Liberia’s economy is dominated by agriculture, which accounted for 52 per cent of GDP in 20058 - or a commanding 77 per cent including forestry.9 Only 12 per cent of GDP is generated from the industrial sector.
1 CIA World Fact Book, June 2006
2 37 year for males and 41 years for females
3 UN Liberia Human Development Report DRAFT 2006
4 Kpelle, Bassa, Gio, Kru, Grebo, Mano, Krahn, Gola,
Gbandi, Loma, Kissi, Vai, Dei, Bella, Mandingo and Mende
5 CIA, June 2006
6 MDGR, 2004
7 ibid.
8 IMF 2006
9 CIA, June 2006
ECONOMICS
With the end of the war and restoration of security, the economy has begun to improve; increased activity in urban areas has contributed to an estimated GDP growth rate of 5.3 per cent in 2005, double that of the preceding year. However, current growth is neither equitable nor based on sound management of national
resources. Issues of sustainability will emerge unless conditions become conducive to private investment and public expenditure is directed towards reconstruction and job-creation.
Food security requires that ‘all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.’17 For the vast majority of Liberians, this is not the situation today. At least 810,000 are receiving food assistance through
resettlement, school feeding, food for work and institutional feeding programmes. The agricultural sector is fundamental in an economy based on natural resources. Liberia’s conflict largely destroyed an agricultural sector
already weakened by previous government policies subsidizing food imports at the expense of local producers. Widespread displacement of the population also adversely impacted agricultural production and the food security
situation. Today, approximately 95 per cent of urban food needs have to be met through imports, including rice and other staples.
HEALTH:
Conflict led to the forced movement of health workers and professionals into IDP camps and as refugees to neighbouring countries. Health facilities were looted and vandalized and medical supplies became
unavailable. As most parts of the country were inaccessible and national security was given the highest priority by the government, funding stopped and health services collapsed. The problem of skilled health staff cannot be
overemphasized. Liberia today has only 26 medical doctors in clinical practice. Insufficient skilled personnel, poor referral systems and inadequate health facilities are of great concern as are the lack of essential drugs and supplies, including reproductive health (RH) commodities. The decline in health services came with increased health problems arising from the conflict, including hunger, disease and the spread of HIV/AIDS. As levels of poverty and hunger rose, many young girls resorted to prostitution as a means of survival. This led to a range of health problems including sexually transmitted infections. Regional conflict, and the movement of fighters across borders, coupled with the use of sexual violence as a strategy of combat, further exacerbated the HIV/AIDS situation. The vast majority of Liberia’s public health care continues to be externally supported. The
national budget for health has in real terms declined considerably since 1990 and resources committed to the sector are insufficient to provide a basic level and quality of service.
Priority health issues: Within the range of health problems facing Liberia the United Nations identifies the following priority areas:
1. Maternal Health: Despite an absence of reliable data on the current maternal health situation, figures from the 1999/2000 Demographic and Health Survey showed Liberia to have one of the highest maternal mortality
rates (MMR) in the world, estimated at 578 per 100,000 live births – more than twice the 1986 estimate of 260.23
Access to maternal health care services, especially basic and comprehensive emergency obstetric, antenatal, and postnatal care and RH services including family planning, and information and counselling remain grossly
inadequate - especially in rural areas. The Liberia Safe Motherhood Needs Assessment puts institutional deliveries at 11 per cent. The referral system is close to non-existent. Unwanted pregnancies resulting in complications and unsafe abortions are common. Maternal nutrition is also poor. All of these are responsible for high maternal mortality and it is highly unlikely that Liberia will meet related MDG targets by 2015
given the current conditions.
2. Child Mortality and Health: Data on newborn morbidity and mortality are not available and programmes for newborn care are lacking. Available data indicate that infant mortality rates remain high, estimated at 157 per 1,000 live births.24 Liberia is unlikely to meet the MDG target to reduce child mortality.
3. Malaria: Malaria accounts for up to 10 per cent of all deaths in Liberia. Malaria cases increased from 35 per cent of clinic visitors in 1997 to 50 per cent in 2000. Strategies for controlling malaria prior to the conflict mainly involved prevention through bed-netting and insecticide application, with a limited amount of
prophylaxis distributed for pregnant women. New strategies are required and much work remains if Liberia is to meet the target of halting and beginning to reverse the incidence of malaria by 2015.25
4. HIV/AIDS: National prevalence of HIV/AIDS in Liberia is not known but some estimates put the infection rate as having doubled from 4.2 per cent in 1994 to 8.2 per cent in 2001.26 Prevalence rates among women are higher than men, with the infection rate among pregnant women aged 15 to 24 rising from 4.2 per cent in
1994 to 12.9 per cent in 200027. Though antiretroviral (ARV) treatment guidelines have been designed under the Global Fund Programme, healthcare providers lack the necessary expertise and apparatus for managing HIV/AIDS cases. Prevention of HIV/AIDS requires the joint effort of the entire society and is therefore discussed at greater length as a cross-cutting imperative.
5. Nutrition: Nutritional status deteriorated significantly as a result of the years of conflict in Liberia. In 2002, 46 per cent of the population were estimated to be undernourished.28 Malnutrition is pervasive among children under five years of age. Children also suffer from anaemia and vitamin A deficiency. Micronutrient deficiencies were also prevalent, with 86 per cent of children aged 6-23 months anaemic and 53 per cent deficient in vitamin A - exacerbating the condition of those suffering from malaria, diarrhoea and acute respiratory infections.
Numerous other diseases also affect Liberia’s population. It is estimated that 29 per cent of children 0 to 59 months of age suffer from acute respiratory infections such as pneumonia. Diarrhoea accounted for up to five percent of inpatient and out-patient consultations in 2004.29 Tuberculosis rates are estimated at four per
1,000. Certain diseases such as schistsosomiasis impose huge costs on the agricultural economy.
Mental health problems are prevalent and there are no programmes to adequately address adolescent health issues.
John F. Kennedy Medical Center:
JFK Medical Center, located in the central Sinkor District of Monrovia, is the academic teaching hospital of Liberia and is affiliated with the University of Liberia A.M. Dogliotti College of Medicine. From 1989-2003, Liberia suffered from continuous armed conflict. Prior to that period, the hospital served as the center for clinical training for adult, pediatric, surgical, nursing, and allied health services. However, the conflict greatly damaged JFK Medical Center’s capacity to provide care and training, and even led to the hospital’s periodic closure. Fortunately, with a return to peace, and thanks to the commitment of its staff and leadership, JFK Medical Center is rebuilding. Efforts are under way throughout the hospital to restore its previous health services and resident training programs.
ECONOMIC INDICATORS
GDP at current market prices (US$ million) (2005) 574.5
GDP at 1992 constant prices (US$ million) (2006) 433.2
Unemployment rate (%) 80
Private sector employment (2006) 74,774
Public sector employment (2006) 58,500
Informal sector employment (2006) 470,000
GDP per capita (in 2005 US$ prices) 163
GDP growth rate (2006 estimate %) 7.8
Inflation rate (est average 2006 %) 4
External debt (US$ billion) 3.7
Domestic debt (US$ million) 700
National budget 2006/07 (US$ million) 129.9
Average lending rate (%) 16.4
Net remittances (inflow minus transfers of money, US$ million) 54.2
Imports (US$ million) 443.8
Exports (US$ million) 180.8
Total trade value (US$ million) 624.6
Trade deficit (net trade value, US$ million) 263
SOCIO-DEMOGRAPHIC INDICATORS
Population size (projection in millions) 3.6
Population growth rate (%) 4.6
Life expectancy at birth (years) 47.7
Illiteracy rate (%) 70
Infant mortality rate (per 1,000 live births) 157
Under five mortality rate (per 1,000 live births) 235
Maternal mortality rate (per 100,000 live births) 578
% population below poverty line (living on less than US$1 per day) 76.2
HIV/AIDS prevalence rate (%) 5.2
Human Development Index 0.319
Total geographic area (km sq) 111,370
Total land area (km sq) 96,320
Coastline (km) 579
POLITICAL INDICATORS
Government Republican
Presidency Executive
Legislature Bi-cameral
Senators (30)
Male 25
Female 5
Representatives (64)
Male 56
Female 8
Executive (Cabinet Ministers)
Male 15
Female 5
Proposed size of the National Army of Liberia (AFL) 2,000
Proposed size of the National Police and security forces 6,000
Sources:
1. Human Development Report 2006/Interim Poverty Reduction Strategy Paper (iPRSP)
2. Second Review of Performance under the Staff-Monitored Programme, IMF
3. LISGIS, Liberia National Population Panel 2007
(Population estimate of 3.6 matches with the target developed by NEC for local elections in 2007).
4. Bureau of the Budget/Ministry of Finance
5. The President’s 2006 Annual Message, 29 January 2007
6. Annual Report 2006, Central Bank of Liberia
7. WHO Report 2006
6
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