A Coordinated Public-Private Sector Response in Liberia to COVID-19
By Anna Gerrard
Special thanks to Dr. Nicole Cooper, Chair of the Healthcare Federation of Liberia, and Dr. Jabbeh-Howe, Director Grants and Subsidies Unit, Ministry of Health
In February 2020, the Healthcare Federation of Liberia (HFL) was officially launched and elected its first governing board. The HFL will provide coordination among all private health stakeholders across Liberia and act as a consolidated voice to advocate for improved quality of care and increased collaboration with the Ministry of Health. The launch of the federation followed an assessment of Liberia’s private health sector, conducted by the USAID-funded Health Policy Plus project in 2019, which identified the need for a unifying body as a vehicle to improve the private health system. The HFL’s organizational strategy was to focus on strengthening standards within—and accreditation of—private facilities, providing access to business financing and supplies of essential commodities, such as for family planning. However, on March 16, 2020, Liberia recorded its first COVID-19 case. As of April 10, Liberia has recorded 37 cases and five deaths. The most important task for the HFL in its first month of operation, therefore, became coordinating an effective private sector response to COVID-19.
A 2019 assessment of the private sector in Liberia revealed that the private health sector accounts for 80 percent of facilities in Montserrado county, where a third of the total population lives.
Training Private Healthcare Providers on COVID-19
One of the significant differences between the outbreak of Ebola in Liberia in 2014 and the COVID-19 outbreak has been the speed of the private health sector response. The recent unification of the private health sector has enabled a centralized response effort, which has saved crucial time. In mid-March, the HFL began working alongside the Ministry of Health and the National Public Health Institute of Liberia under the newly established Private Sector Engagement Committee against COVID-19 to launch and scale up training for private sector providers to address COVID-19. With support from Orange Liberia and Health Policy Plus, two training centers were set up for private healthcare workers to access rapid training (via tablets) on infection prevention and control, case management, and emergency response protocols. Social distancing measures have been enacted, reminiscent of the same policies enacted to slow down the spread of Ebola. For those providers with internet access, the training is freely accessible online. It is hoped that much of the private sector is trained by the end of April, either remotely or in-person. The training materials are also being shared with public sector trainers and providers to widely spread the information.
The World Health Organization recently called for a “whole system” response to COVID-19, providing guidance to governments on how to mobilize the resources and expertise of the private sector.
Private Sector Resilience
The role of the private health sector in responding to health crises in Liberia is not without precedence. During the Ebola outbreak in 2014–2015, many of the public facilities closed, yet the private sector largely continued to provide services. GERLIB, a maternal and child health-focused private clinic, opened an Ebola isolation ward at its 48-bed facility in Paynesville, a large suburb of Monrovia, having trained its staff and provided them with protective equipment. A study on labor and delivery in Monrovia highlighted the shift from the public to the private sector during Ebola (referred to as the “substitution effect”). When public facilities closed, those healthcare workers continued to work in private facilities, thereby maintaining or increasing private sector supply.
Mobilizing Established Systems
How fast Ebola spread highlighted the substantial gaps in the Liberian public health system following years of civil war. To address these gaps, a dedicated incident management system was developed to enable reports of any case of febrile illness or death across the country and a national rapid response team was established to strengthen national and sub-national capacity to respond. Health workers, including private sector providers, were trained in infection prevention and control and were provided with personal protective equipment. County health teams supplied the private sector with essential commodities and monitored health data. These same systems have aided the preparedness of the Liberian system and the development of the strategic plan for the COVID-19 response, yet gaps remain. The Ministry of Health’s strategic plan for COVID-19 highlights the opportunity to integrate the private sector into the planned sentinel surveillance sites for severe acute respiratory infections; the ongoing need for the private sector to increase its participation in surveillance systems; and the potential for increased surge capacity provided by the private sector. How and when these areas are to be addressed is crucial—HFL’s actions will be an important factor in how fast and adequate the private health sector response is.
Chasing Another Epidemic in Liberia
In January 2020, two months before a COVID-19 case was detected in Liberia, the incident management system began monitoring global trends in COVID-19 and preparing Liberia’s response. The system’s Incident Commander, Dr. Mosoka Fallah, worked alongside other agencies on establishing the intense screening and quarantining of travelers from high-risk countries and began preliminary preparations to test for and respond to any potential cases that would arise. Public health messaging was launched to educate the public and businesses quickly resumed those measures in place during Ebola: hand washing at all public and commercial entrances and a culture of no social touching.
One grave gap remains as the number of cases increase in Liberia: access to personal protective equipment (PPE). In 2016, the World Health Organization stated that emergency stockpiles of PPE were placed in all African countries to aid with rapid response when supplies are needed. As of April 6, 2020, no new supplies of PPE have been made available to public or private facilities. The HFL, which is working closely with the Ministry of Health, awaits news of supplies being made available to private healthcare workers. Other challenges remain. How involved will the private sector be in the operationalization of the COVID-19 response strategy and the formation of the sentinel surveillance system? Will private health data be captured and utilized effectively? The HFL remains committed to strengthening and scaling private sector COVID-19 efforts where needed. The early response by the private health sector offers more than a glimmer of hope that it is a committed partner in supporting the COVID-19 response effort in Liberia.