Dear Dr. Kpoto,
Ardent greetings, and congratulations on your appointment by President Joseph Nyumah Boakai, and subsequent confirmation by the honourable Liberian Senate as Minister of Health of our beloved country.
As a concern student of Public Health, my attention has been keen on the health components of President Boakai’s “ARREST Agenda” with key focus on the deliverables of pillar 2 and letter “S” of the Priority Investment areas for next six (6) years (2024-2029), coupled with other promises made by the His Excellency the President during his first Annual State of the Nation Address on January 29 of this year.
Madam Minister, per my observation, your nomination by the President brought relief to a lot of stakeholders, including students, healthcare providers, and CSOs. Many see you as a symbol of hope and as the perfect rescuer of our overly challenged healthcare system, and with such level of optimism in your abilities to adequately deliver the much needed leadership we desire, I religiously followed your confirmation hearing on February 5, 2024. Your deliberation was succinct and I must commend your commitment to overhaul our health sector by providing transformational leadership, and your dedication to uphold the values of transparency, integrity and accountability.
In light of your esteemed position and the pressing challenges facing our healthcare system, I wish to humbly provide some recommendations based on my observations and studies:
Health Information System (HIS):
Our reliance on outdated paper-based medical records and inability to adjust to the reality of the 21st century extends from the national referral hospital (JFK) to Zekepa Health Center in Zekepa Nimba county and Zingbor Community Clinic in Todee, Montserrado county. Despite adopting the DHIS2 (District Health Information System 2) in 2011 as the official reporting software integrated under the Health Management Information System, over 99% of all medical reports, including event-specific reports, surveillance reports of national health indicators, remain paper-based. Therefore, the need to strengthen the HIS by transitioning referral hospitals to digitized Electronic Medical Records and enhancing disease surveillance cannot be overemphasized. Modernizing from paper records to comprehensive EMR systems at facilities like JFK would improve care coordination, reduce errors, and enable better data collection for policy decisions.
Supplies of Medication and other medical Supplies
The procurement and supplies of essential medication and equipment remains a major challenge affecting the delivery of health services at all levels of our healthcare care system. This challenge continues to impede the smooth operations of agencies such as the Central Medicines Store (CMS). For example, since the 1 truck which was donated by a partner got damaged in early 2021, the CMS lacks the logistics to scale up the supply of medication throughout the country. Another key issue and errors on the part of MoH past leadership was scrapping NDS/CMS of its AUTONOMY in 2015, and outsourcing the distribution of medical supplies to INGOs, thereby reducing the entity’s role to only warehousing management (storage). This in my opinion makes CMS nothing more than a “toothless bulldog”.
Madam Minister, with the aforementioned, I would like to suggest the following;
· That your leadership should kindly work with relevant stakeholders to RESTORE the semi-autonomous status of the Central Medicine Store and provide the much needed technical and logistical support to enable the institution to carry out its statutory mandate of Procuring, Storing and Distributing Drugs and Medical Supplies throughout the country.
· Review the agreement/contracts where available that relinquished CMS of its statutory mandate and outsourcing the power to distribute medical supplies to the World Food Program.
· Build regional depositories or storage facilities to end the existential supply chain “wahala” especially in far to reach counties like Grand Kru and Gbarpolu. This can be done by dividing the country into four clusters.
§ Cluster 1: Montserrado County, Grand Bassa, Margibi
§ Cluster 2 (Wester): Bomi, Grand Cape Mount, and Gbarpolu
§ Cluster 3 (North-Central region): Bong, Nimba, Lofa, Grand Gedeh
§ Cluster 4 (South-eastern region): Rivercess, Sinoe, Rivergee, Grand Kru, and Maryland
Mental Health
The struggle for Mental health in Liberia has been more of words rather than deeds. While there has been minimal improvement, mental health continues to suffer mammoth setbacks at all levels of our society. From daily increase in mental disorders due to substance use/addiction among young people, and other factors including Epilepsy, Post-traumatic stress disorder, etc. to confronting stigma from family members and community dwellers; from limited budgetary support to sustain the sector and address the growing demands highly trained mental health professionals, to running debilitated and overcrowded national referral facility called E.S. Grant psychiatric hospital (the former home of the late Dr. E.S. Grant). This hospital can only cater for about 80 in-patients and is in dire need of renovation and repair, psychotropic drugs and a full cadre of specialty care, clinical supervision and quality assurance (Mental Health Policy 2016-2021).
Madam Minister, while renovation and repair will help solve some of the bread and butter issues, I strongly believe that it is the right time to rewrite history, by reconstructing the Catherine Mills Rehabilitation Center, a state-of-the-art facility in its early days (pre-civil war era), expand the capacity of the E.S. Grant and provide advanced training mental health clinicians.
Key Policies Issues
Madam Minister, during the past administration, we noticed long-lasting delays in the development of health policies including the “National Health Policy (developed but not published)”, and the “Liberia Rights Charter” developed in the 2020 but not published. I therefore urge your honorable office to fast track the publication of these essential public documents, and the development of the Mental Health Policy and Strategic Plan for Liberia (past policy expired in 2021).
Finally, Madam Minister, I admonish you to establish a Youth Advisory Panel, to advise your office on matters related to youth and adolescent health, including sexual and reproductive health for vulnerable women and girls.
In closing, I thank you sincerely for the opportunity to share my views and recommendations on strengthening our healthcare system and improving health outcomes for all Liberians. This is a pivotal moment for healthcare reform in our country, and your leadership gives us immense hope.
Please accept my best wishes as you embark on this important endeavour, and I look forward to seeing the positive impacts of your time in office.
Best regards,
Elijah S. Tingban
Public Health Student