The outbreak of a new coronavirus in late 2019 was the start of the global pandemic which has now spread to nearly every country and territory in the world. Since the first diagnosis of COVID-19 in Liberia on March 16 2020, the virus has spread to at least nine counties, with increasing community transmission. As of May 15, 2020, Liberia has recorded 223 confirmed cases and 20 reported deaths. As per official reports, Liberia is experiencing a higher case fatality rate compared to its neighbours in the region, and Liberian health workers account for over 20% of total confirmed cases.
The situation is especially alarming in Liberia because of the weak health sector, unstable economic system and lack of social safety net. Among the serious challenges are a shortage of trained health professionals; inadequate financial resources; poor water, hygiene and sanitation (WASH) infrastructure; overcrowding in Monrovia’s urban poor communities; high rates of informal employment and food insecurity; and the poor health of the population. Only 36% of health facilities have access to basic hygiene services, and 3% access to basic sanitation services.1 In addition to weak health infrastructure, Liberia also has one of the lowest doctor-to-patient ratios worldwide, with only one doctor for every 15,000 people.2 This is compounded by critical gaps in the availability of drugs and medical supplies. This virus not only threatens the health and survival of Liberians, it could have a devastating impact on the health system, the economy – and on the already fragile livelihoods of the most vulnerable people.
It is with this understanding that a majority of members of the Liberian International Non-Governmental Organizations (LINGO) forum want to acknowledge the leadership of the Government of Liberia for measures taken to respond to COVID 19 and flatten the epidemic curve in Liberia. Many of the LINGO members have been active participants in the National Incident Management System (IMS) at national and county level since it was activated in March. We reaffirm our support to the IMS led by the Government of Liberia. We will work with you to strengthen the IMS, because the safety and well-being of our staff is paramount as is maximizing the impact of the response to save lives and protect livelihoods.
LINGO Members wish to make the following recommendations to the Government of Liberia, Donor Community and United Nations agencies:
1. Improve coordination in the national response. If we don’t deliver a well-coordinated, multi-sectoral response, many more lives will be lost to COVID-19 as well as other diseases and health issues in Liberia. LINGO strongly encourages government, donors, UN, the private sector and civil society actors to effectively collaborate to rapidly respond to the crisis. The IMS should:
• Decentralize the coordination of the response with increased financial and logistical support to county health teams and health structures at county and district level to fast-track county readiness and response activities.
• Recognize the role of essential humanitarian workers involved in COVID-19 response and provide access passes to a limited number of INGO and CSO staff who need to move about unhindered by Joint Security.
• To the UN Resident Coordinator – ensure that all working groups are coordinated to allow the development of a national vision for overall preparedness and response, with every organisation’s role clearly defined.
1 Joint Monitoring Program as cited in World Health Organization and the United Nations Children’s Fund, WASH in health care facilities: Global Baseline Report 2019, WHO and UNICEF, Geneva, 2019. https://www.unicef.org/media/51601/file/WASH-in-health-care-facilities-2019%20.pdf
2 Liberia Medical and Dental Council. 2016. https://www.youtube.com/watch?v=2jQ_9HXp55U
Strengthen laboratory capacity and improve the testing regimen. The WHO encourages countries to invest in and strengthen laboratory capacity as one of the most effective means of flattening the curve. Liberia must quickly adopt a mass testing strategy. This is the only way we will be able to effectively test, trace, and treat COVID-19 cases. The IMS should:
• Procure more testing kits, train laboratory staff to perform tests, increase sample collection and testing, and ensure timeliness and reliability of test results and reporting. • Ensure continued reporting on number of samples collected and tested. Otherwise there is a risk that the low numbers will be attributed to lack of new infections, and the public will be less likely to comply with IPC protocols. Greater transparency will also allow us to work together to address the challenges with testing.
3. Enhance risk communication. Messages must be clear, consistent and transparent, ensuring people have the life-saving information they need to protect themselves and others from the virus and to reduce its impact on health, social life, and the economy.
• Increase the frequency and level of detail in the IMS situation reports and maintain gender- and age-disaggregated data.
• Ensure messages are gender-sensitive and also contain specific information applicable to people with disabilities, considering their rights, barriers, and needs in this emergency.
4. Increase protection of healthcare workers. Over 20% of the current confirmed cases are health workers. Public and private health institutions have expressed widespread concerns that health workers are facing a tremendous risk because they lack Personal Protective Equipment (PPE) and hygiene materials as well as adequate training. The Government and specifically the IMS must:
• Support health facilities to improve IPC protocols and ensure the availability of PPE to protect medical staff.
5. Strengthen community and civil society engagement. During the EVD outbreak, communities were initially excluded from the response which resulted in mistrust, misinformation and fear about the outbreak and response. We are seeing this play out in the COVID-19 response. A response that is disconnected from local actors and communities will exacerbate the pandemic in Liberia. For an effective response to COVID 19, the Government and development partners must:
• Ensure a community-centred approach and engage civil society and existing community structures (especially those that engage and serve the most vulnerable groups) in all coordination mechanisms for the development, implementation and monitoring of COVID-19 national response actions.
6. Apply a human-rights based approach to the State of Emergency and lockdown. A complete lockdown without appropriate mitigation measures for vulnerable populations will have a devastating collateral impact on the poorest households, which depend on the informal economy for their livelihoods and day-to-day survival. At the same time, women and girls are likely to experience increased violence due to prolonged confinement in their homes, increased financial pressure and other stressors. There is also a risk that more Liberians will die from other diseases and health complications because they will not be able to access health services. The SOE and lockdown must be accompanied by targeted measures to ensure human rights are respected, basic needs are met, and livelihoods are preserved. The Government must therefore:
• Provide social protection programs and subsidized social services, verifying that they target and reach the poorest households and most vulnerable groups.
• Guarantee preparedness and response plans are developed with an age, gender, diversity approach, and are inclusive of and accessible to persons with disabilities.
Ensure that gender-based violence protection and response services are integrated in the multisectoral COVID-19 national response plan.
• Ensure continuity of primary health care services, with the priority on reproductive health interventions and those linked with mortal diseases (TB, malaria, HIV, undernutrition, maternal mortality) and include treatment of these in protocols, preparedness and protection strategies.
• To the Donor Community and UN – hold Government accountable for upholding human rights during the State of Emergency.
• To the UN Resident Coordinator – engage LINGO in the development and roll out of Liberia’s COVID-19 Humanitarian Response Plan.
7. Mobilize additional financial resources. While multilateral and bilateral partners including the World Bank, WHO, EU, and several governments have committed resources, the IMS pillars remain largely underfunded. Most of the in-country donors have shown commitment to the response through reprogramming of existing grants; however, without committing additional resources to address the pandemic, it will be difficult to flatten the curve and minimize the socio-economic impact in the country. Donors and development partners should:
• Allocate additional funding to COVID-19 preparedness and response and increase monitoring and verification of expenditures.
• Ensure essential services and other interventions already financed remain supported throughout the crisis.
• Prioritize financial support to counties not just based on the number of cases, but through an in-depth vulnerability analysis.
8. Strengthen accountability for financial resources. All involved stakeholders must be transparent in accounting for all emergency funds to counter the widespread belief that COVID-19 is a hoax for elites to enrich themselves. Internal control measures must be strengthened to ensure that funds are utilized for the intended purpose. All actors must:
• Develop and implement robust monitoring oversight mechanisms to ensure transparency and accountability of all COVID-19 related expenditures.
9. Plan for a stronger, more resilient Liberia post COVID-19. The pandemic is reinforcing the relevance of our missions and revealing new possibilities for systemic change. Although we’re still in the middle of the crisis, we believe now is the time to start planning for a better, more equal, and more sustainable future.
• Invest in the health system and nurture local innovation in the sector.
• Invest in water, sanitation and hygiene infrastructure, services and activities with a focus on behavioural changes, specifically handwashing and hygiene practices, greetings and physical distancing.
• Given Liberia’s high dependency on imported food, prioritizing and investing in local food production will ensure access to food for primarily vulnerable groups. Emphasis must be placed on inclusive domestic value chains to reduce disruptions on local and economic markets and to reduce dependency on agricultural imports.
Considering the dramatic impact that the pandemic could have in Liberia, the Government, with the support of all stakeholders, must act fast while the situation is still manageable. Members of the LINGO network remain committed to support the Government’s efforts to “kick the coronavirus out of Liberia”. We believe that our collective experience, technical expertise and operational support are vital.
From the majority of the LINGO members.