Sister Aid Liberia policy brief on the passage of the Draft Public Health Law of Liberia

Title: RESURFACING THE REVISED PUBLIC HEALTH BILL AT THE SENATE

(Date: February 24, 2024)

Authors: Cllr. Tomik L J Vobah

                General Counsel

                Ministry of Health

                Dr. Peter S, Coleman

                Former Chairman, Senate Committee

                Former Minister of Health

                Madam Miatta Garmai Darwolor

                Executive Director

                Sister Aid Liberia

               Patricia Z. Gaye

               Program Manager

               Sister Aid Liberia

Introduction, Background, Context

The Public Health Law of Liberia (Title 33) was first enacted as “The Public Health and Safety Law” before 1950. In 1956, it was amended and re-enacted as Title 31 of the Liberian Code of Laws. Twenty years later, the Law was revised and re-enacted in 1976 as the “Public Health Laws, (Title 33, and Liberian Code of Laws Revised).” All crucial aspects of Liberia’s public health systems are stressed with high-pressure points, including legal, leadership, and regulatory challenges. In light of several legal and health challenges that Liberia experienced, especially the outbreak of the Ebola Virus Disease between 2014 and 2015, the Ministry of Health decided to review and revise the Public Health Law to make it fully compatible with contemporary health practices. Already, the Revised Bill had endured exhausting procedures and processes. Yet, it is still docked at the Committee on Health.

In February 2020, His Excellency Dr. George M. Weah submitted the Revised Public Health Bill to the Legislature. The Bill was sent to the Health and Judiciary Committees on Apr11 1, 2020, for review, deliberations, and recommendations. The Plenary of the House of Representatives passed the Revised Public Health Bill on July 21, 2022, on the recommendation of the Joint Committee on Health and Judiciary at the House of Representatives.  After its passage, the Bill was forwarded to the Liberia Senate for concurrence. The Senate received the Bill as sent; however, the Joint Senate Committee on Health and Judiciary. The Senate has not taken concurrence votes on the Bill mainly because of strong opposition to the reproductive health chapter. The urgent need for the passage of the Revised Bill into Law cannot be overemphasized.

When passed into Law, the Revised Public Health Law will play a crucial role in addressing the many public health challenges in Liberia. The Revised Public Health Law covers several crucial needs; some of them are nuisances and mental health. Drug peddling, nutrition, and non-communicable diseases.  Others are leprosy, the referral systems in the hospital, clinical trials, HIV/AIDS, sexual reproductive health, discrimination in providing healthcare services, and regulation of marketing of products for infants and young children.

Sister AID Liberia seeks to address these core issues through the following intervention the passage of the draft   instrument has been delayed based on the below-listed issues

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WHY THE SENATE HOUSE HAS NOT ENGROSSED BILL #23, DRAFT PUBLIC HEALTH BILL?  KEY FINDINGS:  

Since the submission of the Public Health Bill by former the President in February 2020, the passage of the draft   instrument has been delayed based on the below-listed issues Identified by SALI during her engagement through Dialogues, technical retreat sessions, and bilateral meetings held with different stakeholders: The Issues Include:

1. dismal motivation and limited information about the law among key stakeholders and the public;
2. Limited consultation with all stakeholders and the situation of harmonization of overlapping issues in the law like the ( administrative component among the health workers and  sexual and reproductive health sessions that highlighted Abortion) that has for too long been downplayed due to elections, traditional and religious interference, and lack of widespread awareness

• Scanty understanding of the Bill among the newly elected senators. SALI observed that only a couple of senators may have read the Bill. The Public Health Bill is a three hundred twenty-six-page document broken down into nine parts and fifty-four chapters. Besides the drafters and the editors, no one has read through all the pages of the Bill. Though some senators have read through the abortion provisions of the Public Health Bill and those enshrined in the Penal Code, their interpretation of those provisions is sometimes inadequate.

• Pushbacks from the religious and the Traditional County. The religious community—led by the catholic bishop and the Islamic leader and traditional Leaders—has been forceful in the law-making process, strongly objecting to the passage of the Bill. Though the Constitution of Liberia (1986) forbids the direct involvement of religion in the political governance of the Republic of Liberia, the Senators have consistently invited the religious Traditional communities to hear their view—which is usually objection to the Bill.

• Inadequate awareness and sensitization on the Bill among the general population. The Ministry of Health and its supporting partners have not done a wider comprehensive awareness and community sensitization on the Bill. With support from the UNFPA, the Ministry of Health visited a few communities in Monrovia and a few other counties for community engagement on the law. The Ministry also made a few radio appearances. Advocates for the passage of the Bill will have to carry out more such activities to

• Lack of awareness opportunities for community people to understand the law.

There has been a low level of awareness among local community dwellers in rural areas. 

SALI has observed that some Liberian women and girls who are affected most by illegal abortions are generally not involved in the abortion bill debate. The Senate has three women and twenty-eight men currently; the 54^th legislature has two women.   

• Key actors in the health sector provide mixed messages to the senators on the law.

The Public Health Bill was written by a team of professionals assembled from institutions playing roles in the health sector. The Liberia Medical and Dental Council and the pharmacy board actively participated in drafting the Public Health Bill. However, these three institutions have opposed the passage of the Bill at two public hearings called by the Senate. That must change for the Bill to be passed. 

SALI Progress

Notwithstanding, SALI has made some level of progress in addressing some of the key problems. SALI has increased Stakeholder engagement through different bilateral meetings that led to sensitive participation and engagement from key stakeholders such as a)the Senate Committee on Health chair(Senator Dabah Varpileh) who has started supporting SALI advocacy at the level of the Senate b) the Senate Pro-tempore of the Liberian Nyonblee Karnga-Lawrence, the journalists, health practitioners,  traditional leaders and the SRHR Champions in the discussions surrounding the draft public health law: For Example, the Senate Chair-Person committed to reawakening the draft Public Health Instrument discussion and coordination among different senate committees’ chairs and members of the senate to push the passage of the Law. The National Traditional Council of Liberia Head, Chief Zanzan Karwa has started working with SALI to speed up the passage of the draft law. They developed a press release that is yet to be published. The release called the attention of the House of Senate to speedily pass the draft Public Health.

SALI alsoprovided better understanding, increased awareness, and collaboration among stakeholders regarding the importance and potential impact of the proposed public health law. Some stakeholders self-proclaimed that the strategic technical Retreat event increased their level of understanding and collaboration. They jointly developed an action plan to engage the Senate, including key messages and strategies for Advocacy. SALI works along with stakeholders headed by Cllr. Tomik L J Vobah and Dr. Peter S, Coleman to develop this policy brief. That tool will be used to facilitate the engagement with the Senate on the speedy passage of the draft public health bill. The Advocacy roadmap will also be used to engage with traditional and religious leaders at rural community levels. In addition, The Senate committee chairperson at the start has little knowledge of the law. However, she admitted that the conversation she had about the laws with SALI Staff gave her advanced knowledge which she has used to engage other committee members for their support—the same with the members of the traditional council.

About the overlapping issues in the Law, SALI along with stakeholders identified two potential challenges and barriers to passing the draft bill during the retreat session. The administrative component among the health workers was highlighted, but the stakeholders agreed to urgently address the sexual and reproductive health session that has for too long been downplayed due to elections, traditional and religious interference, and lack of widespread awareness. The participants brought forth different advocacy methods to address the abortion component of the law. Some of these include: a) To Change the nomenclature of abortion to modify it with words like Pregnancy Resolutions b) To create awareness and sensitization in the public beginning at community levels, through the community health approach by using Influencers, engaging key stakeholders like Senators and policymakers. Community leaders. Media and key public c) Do jingoes and promos in the various dialects to Engage with religious groups, traditional groups, families, and schools on the components of  Sexual and Reproductive health, and d) To summarize key chapters of the proposed public health law and share it with stakeholders. SALI looks forward to the implementation of those action plans during the second phase of this intervention.

SALI enhanced the capacity of 25 Media practitioners to take advocacy action: The trained Media actors organized and launched the first SRHR Media network to promote advocacy messages around the draft law and unified voice through radio presentation and article publication. The Media network also designed a media engagement tool to fact-check the growing stigma around abortion and localize advocacy messages in simple Liberian English.

POLICY RECOMMENDATIONS

1. Advocates for the passage of the Bill must ensure that Senators fully understand the difference between the Public Health Bill and the abortion provisions of the Penal Code. This could be done through one-on-one sitting with individual Senators or a seminar with a group of senators, especially the new senate
2. Engage the religious community with the facts about illegal abortion and make the discourse a science-based debate as opposed to a religious debate.
3. Increase community awareness to obtain support from the general population particularly the youth (the youths constitute the majority of the population)
4. Advocacy for the passage of the law should focus on the safety of women and girls (Not Right to a Woman’s Body Autonomy) relative to the parallel relationship between illegal abortion and maternal mortality.
5. Engage more women at the community level to get their involvement in the advocacy—ensure that opinion leaders in the women’s community speak to the law.
6. Obtain the Full support of the Liberia Medical Dental Council, Liberia Medical Dental Association, and the Pharmacy Board to ensure sector players speak to the Bill with one voice.
7. Ensure that all advocates for the passage of the bill understand the Bill and what it seeks to cure.

Conclusion

The Public Health Bill has been lingering in the Senate for some time now; the Senate is reluctant to take the required concurrence vote because of a variety of reasons such as opposition from the religious community and inadequate understanding of the Bill by newly elected senators as described earlier. Accordingly, the advocacy has to be a concerted effort of all the institutions advocating for the draft public health law to be passed. Particularly women and health practitioners must speak in support of the Bill. Community support will allay the fear of senators who may be afraid of adverse political backlash for passing draft law. Lastly, we therefore request the Senate’s Committee on Health and Judiciary to urgently facilitate the speedy attainment of the Senate’s concurrence. Meanwhile, we solicit support from the president of Liberia, His Excellency Amb. Joseph N. Boakai as well as the involvement of all public and private actors to join us engage the Liberian Senate to pass the Revised Public Health Bill into Law. 

Signed: Titus B. Pakalah APHRC Project