HEALTH AND SANITATION
Poor health contributes significantly to poverty in Liberia, and health systems are in a state of disrepair in the aftermath of the conflict. Life expectancy at birth is just 45 years. There are only 51 Liberian physicians and 297 nurse midwives (excluding trained traditional midwives) to cover public health needs according to PRS-I and is expected increase by now. Out of the 325 health facilities available before the war, about 95 percent were partially or wholly destroyed. A survey undertaken in 2006 indicated that only 10 percent of communities reported having a health facility within the community, and more than 50 percent of PPA respondents claim to have no health facility in their community. Liberians’ major concerns about the health sector revolve around their lack of financial and physical access to healthcare, as well as quality of healthcare delivery. In general, healthcare is more accessible and of better quality in urban areas than rural areas. Based that health care is important in a country, BIRD-Liberia is focusing on improving health care and provide support that increase livelihood across Liberia.
According to PRS, several key health indicators have begun to improve since the end of the conflict, but remain poor. In particular, infant and under-five mortality rates have fallen sharply since 1999/2000. The infant mortality rate fell from 117 to 72 deaths per 1,000 live births, while under-five mortality fell from 194 to 111 deaths per 1,000 births. These declines can be attributed primarily to the end of the conflict, the restoration of basic services in some areas and increased immunization.
Also, maternal mortality remains high and appears to have increased in recent years from 578 (Year 2000) to 994 (Year 2007) deaths per 100,000 live births. The main health factors contributing to the high level of maternal mortality include the acute shortage of skilled labor, inadequate emergency obstetric care, inefficient referral systems, and poor nutritional status of pregnant women, high fertility rates and extremely high numbers of teenage pregnancies. Moreover, less than half of births are attended to by health professionals.
Although the total fertility rate in Liberia has decreased over the past two decades, fertility remains high at 5.2 children per woman and fertility in rural areas is significantly higher than in urban areas (6.2 children per woman as compared to 3.8). In Lofa County, one of those most affected by conflict, a reproductive health survey revealed a teenage pregnancy rate of over 68 percent among 15 to 19 year olds. This is a very high rate, especially in a country in which 51 percent of the population is below 25 years of age. HIV prevalence is estimated at 1.5 per cent. The rate was found to be higher for women (1.8 percent) than for men (1.2 percent). Paradoxically, the HIV prevalence rate was recorded to be higher among persons with some level of education (2.1 percent for persons with secondary or higher levels of education and 1.3 percent for persons with only a primary level of education) than for persons with no form of education (1.0 percent). The likely explanation is that persons with some form of education are mostly based in urban areas, where the prevalence rate is higher. Although the HIV prevalence rate is higher for persons between the ages of 25 to 39 years, about 0.9 percent of young people 15 to 19 years old and 1.4 percent of persons 20 to 24 years old were found to be HIV positive, according to Liberia PRS report.
Children and youth constitute 65 percent of Liberia’s population. At present, around 17 percent of child deaths are attributable to malaria and another 20 percent to preventable environmental diseases such as diarrhea and cholera. Almost 40 percent of Liberian children are growth-stunted from poor nutrition, about one-third of under-fives are severely underweight; recent estimates indicate that one in five deaths in children under-five is attributable to malnutrition. Less than half of all births are delivered by a health professional, which contributes to an unacceptably high (and apparently rising) maternal mortality rate, according to the PRS report.
According to the PPA survey, a majority of people understand how HIV and AIDS spreads, and cite condoms or monogamy as prevention mechanisms. As a means of handling the many health problems, BIRD-Liberia will engaged in awareness to expand access to basic health care of acceptable quality and establish the building blocks of an equitable, effective, efficient, responsible and sustainable health care delivery system as etched in the Poverty Reduction Strategy.
WATER SANITATION & SAFETY
Although the civil war in Liberia ended in 2003, a decade ago, the country is still recovering from a situation in which institutions were decimated and the population was extremely poor. To date livelihoods, youth unemployment, female vulnerability and food insecurity remain critical problems. The poverty reduction strategy II (PRS II) indicates that 64% of Liberians live below absolute poverty line of which 48% are extremely poor.
According to the 2018 census, the total population is 3.5 million but density varies: the counties Montserrado, Nimba, and Bong comprise 55% of the population. This includes the capital of Monrovia which has a population of about 1 million. The five smallest counties, Grand Kru, Rivercess, River Gee, Bomi and Gbarpolu contain 10.5% of the population, a drop from 12% in 1984, showing an increase of people moving to more populated areas.
Poor sanitation and hygiene, and use of unsafe water, causes ill health and contributes to an estimated 88% of deaths from diarrheal disease worldwide. Malaria remains the leading cause of morbidity and mortality in Liberia, followed by diarrhea and acute respiratory disease.
According to the Joint Monitoring Program (JMP), based on 2011 data, access to improved sanitation is just 18% nationally, with 7% in rural areas and 30 % in urban areas, and the open defecation rate is 44%. Twelve percent of the population uses unimproved (often traditional) latrines and 26% of the population share toilets with their community members. The most affected places are rural areas, peri-urban slums and informal settlement. BIRD-Liberia during the Ebola crisis in 2014 got engaged and carried on awareness and best behavior practices to curtail the sanitation problem faced by the country.
With the help of partners, BIRD-Liberia will achieve the following under water, sanitation and hygiene:
1. To increase access to human waste collection and disposal facilities from 15% to 40%
2. To increase access to safe drinking water from 45% to 90% by 2022.
3. To conduct awareness and sustainability of 90% of water and sanitation facilities in the country.
4. Create awareness on open defecation in and around Liberia.
The significance of water, sanitation and hygiene and its critical role in determining the health status is well acknowledged in the Sustainable Development Goal (SDG).The sixth SDG emphasizes on achieving universal and equitable access to safe and affordable drinking water, as well as to achieve access to adequate and equitable sanitation and hygiene, for all and end open defecation. The strategy document emphasizes on increasing awareness and understanding of adverse health impacts of poor drinking water supplies, lack of adequate sanitation facilities, and poor hygiene. BIRD-Liberia as an institution is charged to conduct massive awareness in achieving these.
Importance of Water, Sanitation & Hygiene to Reaching Liberia’s Vision 2030
Economic and scientific studies have shown that water, sanitation and hygiene does not only improve the quality of life but also bring tangible health, environmental and economic benefits and contribute to poverty reduction. With the current poor access to water, sanitation and good hygiene practices in Liberia, it should be noted that Liberia is losing a notable proportion of its GDP and that not financing WASH will contribute to preventing Liberia from reaching its vision of becoming a middle income country by 2030 (WASH Sector strategy 2011).