Liberia Public Health Provides Confidentiality for Patients But with Exceptions

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MONROVIA – The argument on whether or not to disclose the identities of COVID-19 patients keep going in circles in Liberia to the extent that even government functionaries like the Ministries of health and information cannot find common ground.

The Ministry of Health and the National Public Health Institute of Liberia (NPHIL) have said it would be unethical to disclose the identities of the patients as such could trigger stigmatization and also hamper contact tracing.

“The critical issue we have now is for us to do effective contact tracing and for that to happen we have to utilize some measures that are not utilized during normal times. This pandemic means war. With the capacity of our health system that we know and still building to be resilient; if we allow this virus to spread in a way that sees it progressing then the entire existence of our nation is threatened. Therefore, we have to use drastic measures,” she explained.

For the Health Minister, the critical issue for her ministry and NPHIL to handle is to conduct effective contact tracing by “utilizing some measures which are not used during normal times.”

She fears that with Liberia’s health sector’s limited resilience if the virus is to spread the way it’s progressing, the entire existence of the nation would be threatened. “Therefore, we have to use drastic measures,” she said.

However, it appears that it is the Minister of Information who is bent on using drastic measures and caring less about whatever stigmatization name-calling may bring about.

He says, “COVID-19 has no stigma why are we hiding? Watch the International news; why are we hiding ourselves. It is not the normal way to behave but we are not in regular time. World leaders who get infected come out. We don’t have the technology other countries have and we are not in normal times.”

According to him, unlike the Health Minister, he is not under any oath to conceal the names of infected persons as it is his duty to duly inform the public to enable them to take precautions.

A Matter of Public Interest

Mr. Tolbert Nyenswah, the former Director-General of NPHIL and a current Senior Research Associate, an expert with the International Health Department Bloomberg School of Public Health at the Johns Hopkins University in the United States, told FrontPageAfrica that “effective risks communication, social mobilization, community engagement including working with the media and timely information sharing are critical to outbreaks response. That’s the best way of getting ahead of the curve. It enhances contacts tracing and community sensitization”

Section 12 of the Public Health Law of Liberia speaks extensively on the urgency that must be attached to reporting diseases and also the issue of patient confidentiality. According to this section, all diseases are required to be reported 24 hours after diagnosis. And within 24 hours after diagnosis, a report shall be made to the Minister [of Health] of all cases of persons, including carriers, affected with or who show evidence of any notifiable diseases or conditions of public health importance with epidemic potential.

Section 12.3.4:  “The reports required by this section shall be in writing and shall contain the full name, age, and sex and address of the person affected and all the facts known concerning the disease or condition, including the date of the onset of the illness, any available information as to the probable place and source of infection and any other information concerning the case required by the Minister for the protection of public health. These reports shall be made on forms furnished by the Minister or shall contain all the information required by such forms. They shall be sent by the most expeditious means.”

“…A person or institution to whom such information is furnished or to whom access to such records has been given, shall not divulge any part thereof so as to disclose the identity of the person to whom such information or record relates, except insofar as such disclosure is necessary for the treatment of a case or carrier or for the protection of the health of others.”

Section 12.4, Liberia Public Health Law

Section 12.4. which speaks to confidentiality of required reports and records states:

“Reports and records required by the provisions of section 12.3 shall not be subject to inspection by persons other than authorized personnel of the Ministry of Health and Social Welfare, or by the Minister of Justice when such reports and records involve an investigation of an offense, except that the person to whom any such record relates or his legal representative, by signing a written consent may authorize the Minister to open the record to inspection. These reports and records are subject to subpoena issued by an order of the court, but shall be treated as confidential communications whose divulgence is prohibited when such privileged status is applicable under the law. However, this section shall not prevent authorized personnel of the Ministry of Health and Social Welfare from furnishing appropriate information to a physician or institution providing examination or treatment to a person suspected of or affected with a notifiable disease or condition or other reportable disease or condition, or to any person when necessary for the protection of health. A person or institution to whom such information is furnished or to whom access to such records has been given, shall not divulge any part thereof so as to disclose the identity of the person to whom such information or record relates, except insofar as such disclosure is necessary for the treatment of a case or carrier or for the protection of the health of others.”

The latter part of this section may, however, validates Min. Nagbe’s stance which seems to be corroborated by Dr. Nyenswah’s comment on the need for the involvement of the media and timely information sharing which he said are critical to outbreaks response

Massive Contact Tracing Underway

The City Mayor of Monrovia announced a massive contact tracing on Facebook, disclosing the release of 6,000 “active case finders’ in Montserrado and Margibi Counties.

He posted to Facebook:

Watch out for 6000 ‘Active Case Finders’ in various communities soon with the following TOR in an effort to continue the fight against the deadly Coronavirus 

Pandemic initially within Montserrado’s 17 districts: 

Processing data on related health situations; Doing regular temperature checks; Accessing situations that show semblance of the virus like cold, cough, severe breathing etc; 329 recruited individuals from each community are folks known within those communities and will 

continue to share health tips; Each of the 329 recruits has a contract with MCC to 

visit 50 homes daily; All samples collected will be sent to MCC Data Center at our HQ; MCC Data Analysts will then send findings to NPHIL 

for action. 

With this, we are hopeful we can have hands-on happenings within Monrovia and parts beyond how we coping as a nation and people within the hotspot.

National Response Team

Meanwhile, President George Weah has formed the Executive Committee on Coronavirus (ECOC) to be headed by Madam Mary Broh as the National Response Coordinator.

In this role, according to the Executive Mansion, Madam Broh will provide supervision toward a single set of national strategic objectives for defeating the Coronavirus disease. She will also coordinate the National COVID-19 multi-sectorial response plan, in coordination with the United Nations (UN), donor partners, Ministry of Health and National Public Health Institute of Liberia (NPHIL).

The President has also appointed Finda Bundoo as the National Compliance Manager of ECOC. Madam Bundoo is charged with the responsibility of monitoring the overall allocation and disbursement of the response logistics and resources.

In consultation with the National Response Coordinator, Madam Bundoo will ensure timely delivery and accounting for supplies directed to the fight against Coronavirus in the country.

Both appointments, which have a term of nine months, became necessary following recommendations made by the United Nations, in particular the World Health Organization, which were aimed at further enhancing the national response as cases begin to spike. It is also based on a decision from a consultative meeting held between the Special Presidential Advisory Committee on Coronavirus (SACOC) and partners. 

During the discussions, a decision was made to move away from the current system of advisory and consultative meetings to operational and community-oriented outreach. Both persons have the full support and backing of the UN. 

Madam Broh and Bundoo are required to liaise with health authorities on the Incident Management Team and heed their counsel, where necessary. The appointees will report directly to the President.

Lockdown Looms

As the number of confirmed cases continues to rise, FrontPageAfrica has gathered that the 14 Military Hospital which currently hosts confirmed and high-risk cases have only 40 beds. This means the facility would be overwhelmed should the number keep rising. 

Sources within the Executive Mansion informed FrontPageAfrica that taking the limited capability of medical facilities and availability of health care workers, President Weah is expected to announce a lockdown on Wednesday which is expected to take effect on beginning Monday. It remains uncertain how long the lockdown would go for.

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