Final - Annual Report Liberia 2018 A4 Web

ANNUALREPORT2018
WHO LIBERIA
2018 Annual Report
Cover photo WHO / File photo
Editorial Team Jeremy S Sesay, Jr.

Julius Monday Rude
Vachel H Lake
Victoria Katawera N
and respective Cluster and Technical Team Leads of
WHO Liberia Country Office
Publication management, Allan Batte

data visualization and infographics
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2018 Annual Report
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WHO LIBERIA
2018 Annual Report
CONTENTS
Acronyms ......................................................................................................................................................................................................................................................................................................... 8
Preface ............................................................................................................................................................................................................................................................................................................. 13
Executive Summary ......................................................................................................................................................................................................................................................................... 14
Introduction ............................................................................................................................................................................................................................................................................................... 18
Liberia demographic and health indicators ........................................................................................................................................................................ 18
Chapter 1: Health Systems and Services ............................................................................................................................................................................................................ 20
Chapter 2: Health Emergencies ....................................................................................................................................................................................................................................... 28

2.1. Integrated Disease Surveillance and Response (IDSR) ........................................................................................................................... 29
2.2. Emergency Preparedness and Response ................................................................................................................................................................. 32
2.3. Water, Hygiene and Sanitation and Environmental Health: ................................................................................................................ 33
2.4: Infection Prevention and Control (IPC) ........................................................................................................................................................................ 34
2.5. Antimicrobial Resistance (AMR) ......................................................................................................................................................................................... 35
2.6. Laboratory ..................................................................................................................................................................................................................................................... 38
Chapter 3: Disease Prevention and Control .................................................................................................................................................................................................... 44

3.1 Communicable Diseases ............................................................................................................................................................................................................... 45
3.1.1. HIV/AIDS .................................................................................................................................................................................................................................................... 45
3.1.2. Tuberculosis control and services in Liberia: .................................................................................................................................................. 46
3.1.3. Viral Hepatitis: ..................................................................................................................................................................................................................................... 48
3.1.4. Malaria: ........................................................................................................................................................................................................................................................ 49
3.2. Neglected Tropical Diseases (NTDs) .............................................................................................................................................................................. 50
3.3 Non-Communicable Diseases (NCDs) ............................................................................................................................................................................ 52
3.3.1 Mental Health and Substance Abuse: .......................................................................................................................................................... 53
Chapter 4: Family and Reproductive Health .................................................................................................................................................................................................... 56

4.1. Reproductive Maternal Neonatal Child and Adolescents Health ................................................................................................. 57
4.2. Expanded Program on Immunization (EPI) ............................................................................................................................................................ 61
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4.2.1: Routine Immunization ................................................................................................................................................................................................................ 61
4.3 Polio Eradication ...................................................................................................................................................................................................................................... 63
4.4 Accelerated Measles control ..................................................................................................................................................................................................... 65
Chapter 5: Health Information, Promotion and Communication .......................................................................................................................................... 68

5.1 Health Promotion and Disease Prevention: ............................................................................................................................................................. 69
Chapter 6: WHO Field Offices .............................................................................................................................................................................................................................................. 72
Chapter 7: Country Support Unit .................................................................................................................................................................................................................................... 78

7.1 Administration, operations and Finance ..................................................................................................................................................................... 79
7.2 Transparency, Accountability and Risk management ................................................................................................................................. 79
7.3. Security ............................................................................................................................................................................................................................................................. 79
7.4 Human Resource .................................................................................................................................................................................................................................... 80
Chapter 8: Key Challenges ...................................................................................................................................................................................................................................................... 82
Chapter 9: Lessons Learnt .................................................................................................................................................................................................................................................. 86
Chapter 10: Recommendations and Key Actions ................................................................................................................................................................................... 88
Chapter 11: Priorities for 2019 ...................................................................................................................................................................................................................................... 92
Chapter 12: Conclusions ....................................................................................................................................................................................................................................................... 94
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ACRONYMS
ACCEL Academic Consortium Combating Ebola in Liberia

ACT Artemisinin-based Combination Therapy
AEFI Adverse Events Following Immunization
AFP Acute Flaccid Paralysis
AFRO Regional Office for Africa
AIDS Acquired Immunodeficiency Syndrome
ANC Antenatal Care
AMR Antimicrobial Resistance
ART Antiretroviral Therapy
AVADAR Auto - Visual AFP Detection and Reporting
AVW African Vaccination Week
CDC US Centers for Disease Prevention and Control
CD4 Cluster of Differentiation 4
CHAI Clinton Health Access Initiative
DHIS District Health Information System
DPT Diphtheria Pertussis Tetanus
DQIP Data Quality Improvement Plan
DR-TB Drug Resistant Tuberculosis
EPI Expanded Program on Immunization
EPR Epidemic Preparedness and Response
ePMDS+ Electronic Performance Management and Development System
EVD Ebola Virus Disease
GAVI Global Alliance for Vaccines and Immunization
JEE Joint External Evaluation
HIV Human Immunodeficiency Virus
IHR International Health Regulations
IDSR Integrated Disease Surveillance and Response
IM Independent Monitoring
IPC Infection Prevention and Control
IPT Intermittent Presumptive Treatment
IOM International Organization for Migration
ISS Integrated Supportive Supervision
gCHVs general Community Health Volunteers
GDP Gross Domestic Product
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
GLAAS Global Assessment and Analysis for Sanitation and Drinking Water
GLRA German Leprosy and Tuberculosis Relief Association
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GSM Global Management System
KPI Key Performance Indicators
LDHS Liberia Demographic and Health Survey
LISGIS Liberia Institute of Statistics and Geo-Information Services
LLIN Long Lasting Insecticide-Treated Nets
LQAS Lots Quality Assurance Sampling
MCV Measles Containing Vaccine
MNDSR Maternal Newborn Death Surveillance and Response
MIS Malaria Indicator Survey
MDR-TB Multi-Drug Resistant Tuberculosis
mhGAP Mental Health Gap Action Program
MoH Ministry of Health
MOV Missed Opportunities for Vaccination
NAC National AIDS Commission
NCD Non-Communicable Diseases
NCC National Certification Committee
NLTCP National Leprosy and Tuberculosis Control Program
NPEC National Polio Eradication Committee
NTD Neglected Tropical Diseases
NRL National Reference Laboratory
OFDA Office of Foreign Disaster Assistance
PIE Post Implementation Evaluation
PIH Partners in Health
PLHIV People Living with HIV
RRTs Rapid Response Teams
SARA Service Availability and Readiness Assessment
SDGs Sustainable Development Goals
TB Tuberculosis
TTMs Trained Traditional Midwives
UN United Nations
UNDSS United Nations Department of Safety and Security
UNDP United Nations Development Program
UNFPA United Nations Population Fund
UNICEF United Nations Children Fund
USAID United States Agency for International Development
VPD Vaccine Preventable Diseases
WASH Water, Sanitation and Hygiene
WHO World Health Organization
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2018 Annual Report
WHO / R. Kollie
The 2018 WHO activities implemented were in line with the National
Investment Plan and National annual Health Plan with focus on the
priority health system actions that need to be accomplished for the
overall attainment of the health goals of Liberians.
- Dr. Mesfin G. Zbelo -
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PREFACE
PREFACE
The 2018 Annual Report highlights the WHO In a special way, we thank the Ministry of Health,
country office’s (WCO) core roles and responsibilities in National Public Health Institute of Liberia, One Health
leading, managing, implementing and coordinating WHO platform, 15 county health teams, 93 district health
strategic and operational functions with intent to realize teams and health workers in all the 857 health facilities,
health outcomes in line with national priorities, regional for their trust and cooperation with WHO Liberia team.
and global commitments, WHO’s General Program We are exceptionally grateful to the people we serve, the
of Work (GPW) and Sustainable Development Goals residents of Liberia, for allowing us to serve them.
(SDGs).
Special appreciation to the former WHO
The report represents our collective effort arising Representative, Dr. Alex Gasasira, for his leadership
from the experience of the lessons learnt in previous and guidance to the WCO, MoH, NPHIL and partners
biennium with a focus on building a resilient health care that supported achieving the government of Liberia
system. The 2018 WHO activities implemented were health goals; and to WHO AFRO regional office and WHO
in line with the National Investment Plan and National headquarters for the technical and financial support that
annual Health Plan with focus on the priority health enabled us to deliver on our mandate to the government
system actions that need to be accomplished for the of Liberia.
overall attainment of the health goals of Liberians.
Finally, I want to thank all the development
We acknowledge the valuable inputs provided partners and donors for the financial support to WCO-
by the WCO cluster team leads, program managers/ Liberia that enabled us to achieve our 2018 objectives.
technical staff, Administrative staff, support staff and
WHO county field team staff for their hard work in 2018.
Dr. Mesfin G. Zbelo

WHO Representative, Acting
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2018 Annual Report
EXECUTIVE SUMMARY
The 2018 WCO- Summary of the notable achievements are described below:
Liberia annual report highlights 1. Health system strengthening: The 3rd Generation
progress, challenges, lessons Country Cooperation Strategy completed and approved ,
learnt in the implementation 2018 SARA conducted with report available for planning
of the programme of technical and review, 15 counties’ operational plans validated and
cooperation with Government funded, National Health Review Conference completed
during the first half of the and recommendations being followed, the WHO 13th
2018-2019 biennium. It General Programme of Work disseminated to Government
further details the achievements and partners and aligned with the National Health Policy,
gained during the implementation Investment Plan, and Pro Poor Agenda for Prosperity and
of the different categories Development (PAPD).
of work, consistent with the 2. WHO Health Emergencies: 99 disease outbreaks and
Transformation Agenda of public health events investigated and responded to within
the African Region, focusing 48 hours, 777 (100%) health facilities and catchment
on efforts to improve efficiency, communities with capacity to implement IDSR achieving
compliance and accountability 98% completeness and 92% timeliness, 52 Early
in operations, technical areas of Warning Epidemiological weekly bulletins produced and
work and strategic partnerships disseminated, IHR country self-assessment completed
to enhance WHO contribution and report disseminated, Annual surveillance review
to the provision of quality and operational plan completed, National Action Plan
healthcare services for the people for Health security developed and launched, National
of Liberia. Infection Prevention and Control Guidelines produced and
disseminated, Antimicrobial Resistance National Action
Plan produced and disseminated, 84.6 diseases outbreaks
requiring laboratory confirmation confirmed within 48
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EXECUTIVE SUMMARY
WHO Photo
hours of alert, AMR laboratory surveillance 4. Disease Prevention and Control: Twenty-one
decentralized to five (5) additional hospital (21) additional ART centers established; seven
laboratories in 4 counties (geographical coverage (7) Gene-Xpert diagnostic sites established; 10%
increased to 47%), 1771 patients received increase in ownership of LLINs at household
advanced laboratory diagnostics, National blood level; 2.7 million LLINs distributed nationwide;
safety policy developed, and in country capacity 82.5% and 86% average therapeutic coverage
built for water quality testing and chlorination, achieved for Schistosomiasis and STH, and
the use of the WASH- FIT in additional 40 health Onchocerciasis MMA, respectively; 632 health
facilities and Water Safety Plan for Grand Bassa workers and 10,263 community health workers
County developed and implemented. trained in NTDs; Liberia Non-Communicable
3. Family and Reproductive Health: Four Diseases and Injuries Commission report
demonstration sites for maternal and newborn validated and disseminated; 19 NCDs identified as
quality of care standards supported, revision priority NCDs by the Liberia Non-Communicable
and utilization of the national score cards with Diseases and Injuries Commission; National
13 priority indicators for RMNCAH, the first ever Cancer control policy developed; five thematic
National Family Planning Conference held and areas prioritized in the national cancer control
recommendations made, 14 mid-level health policy.
professionals providing advanced emergency 5. Health Information and Promotion: Hosted
obstetric and newborn care in 7 major hospitals 96 interactive Radio spots to provide key
under two task sharing programs and National health messages and information to the public,
Multi Sectoral Strategy and Standards for commemoration of 7 world health days , updated
Adolescent Health disseminated; 186,800 stakeholders database with additional 1,000
children received Penta-3 representing 97% members and uploaded 13 communication
coverage and 157,344 children received measles products on WCO website.
containing vaccine with the coverage of 90%.
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2018 Annual Report
These achievements
were attained through strategic
partnerships at national and
international levels, multi-sectoral
collaboration, community
engagement, active monitoring and
review of the biennium plan and
resource mobilization. The notable
challenges include inadequate
health workforce compounded
by staff attrition especially at
service delivery level and stock
out of essential drugs and medical
supplies.
The report proposes

innovations to mitigate the key
challenges during the second half
of the biennium and WCO readiness
for implementation of GPW 13.
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BACKGROUND
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2018 Annual Report
INTRODUCTION
Liberia demographic and health indicators and 41% pregnant mothers have varying degrees of
anemia (DHIS2 Annual Data, 2018).
Liberia is located in West Africa, bordering Sierra

The 2018 WHO Country Office (WCO)
Leone to the west, Guinea to the north, Ivory Coast to the
annual report is an organizational requirement
east and the Atlantic Ocean to the south. The country
prepared to highlight the major achievements made,
covers an area of 111,369 square kilometers. Liberia is
challenges encountered, lessons learnt and proposes
a low-income country with a GDP per capita of US$ 495
recommendations for enhancing performance of the
in 2013 which declined due to the Ebola Virus disease
WCO in the next half of the biennium, 2019. This report
(EVD) crisis in 2014-2015.
focuses on the progress in the implementation of the
technical programs of cooperation with the government
The country is divided into 15 political
of Liberia and the WCO annual work plans of each cluster
subdivisions called counties and five regions. These
that are aligned with the National Health Plan and Policy,
counties are further subdivided into 93 health districts.
the Investment Plan and the National Pro –Poor Agenda
The country’s estimated total Population is 4.2 million
for Development and Prosperity.
people, life expectancy – 59.1 year (2010 UNDP),under
Five Mortality 94/1,000 live births, infant Mortality
At the beginning of 2018, Liberia experienced
rate 22/1000 live births, maternal Mortality Rate
a major political transition with the election of a new
1072/100,000, neonatal mortality rate 38/1000 (LDHS,
government characterized by some challenge in
2013), HIV prevalence rate among adults aged 15-49
leadership positions. The slow process in the formulating
is 1.9 % (LDHS 2013), TB incidence is 308 per 100,000
of the new government, and the replacement of some
population (2017 WHO Country Profile Report), 97.9% of
core staff of ministry of health (MoH) affected the
children under 1 year receive DPT3/Penta-3 vaccination
ongoing and planned activities implementation of the
70.2% of pregnant mothers are receiving IPT 2, 55%
first two quarters 2018 program of work.
of pregnant mothers are attending four antenatal care
(ANC) visits 35% under 5 years have chronic malnutrition
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During this reporting period, the World
Health Organization (WHO) played a pivotal and
leading role in supporting the government in
the implementation of the National Health Plan
and Policy and the Investment Plan for building
a resilient health system in Liberia. Overall,
WHO collaborated and cooperated with the
MoH, relevant sectors, development partners,
INTRODUCTION
the donor community, international and local
non- governmental institutions in addressing
the health needs of the country as a means of
ensuring continued recovery and sustainable
development of the health sector. Priority areas
of focus were: Health System Strengthening,
Health Emergencies, Disease Prevention and
Control, Family Reproductive Health as well as
Health and Well-being.
It is pertinent to note that WHO in

consonance with her mandate will continue
to collaborate with the MoH and development
It is pertinent to note that WHO in consonance

with her mandate will continue to collaborate with
the MoH and development partners to sustain the
momentum in the building of a resilient health
system, supporting the implementation of the
National Health Policy and Plan and Investment
Plan.
partners to sustain the momentum in the

building of a resilient health system, supporting
the implementation of the National Health Policy
and Plan and Investment Plan, building technical
and institutional capacities during the hierarchy
of the needs for resilience and to ensure access
to essential quality and equity of health service
delivery, addressing health emergencies through
timely preparation, prevention, detection and
response to health emergencies and promoting
healthier Liberian population through addressing
the determinants and risk factors to health.
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2018 Annual Report
1 HEALTH SYSTEMS AND SERVICES (HSS)
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The WHO, as the co-chair of the highest health sector steering body, the Health
Steering Core Coordination Committee (HSCCC), supported health sector joint
leadership mechanisms and structures, as such, the HSCCC’s capacity to facilitate
and enhance regular communication and dialogue between MoH and stakeholders
was enhanced, to ensure better alignment to national health priorities.
HEALTH SYSTEMS AND SERVICES

The strategic objectives and priorities of the HSS
cluster in 2018 were:
1. Support the development and implementation
of robust national health policies, strategies
and operational plans to enhance coverage of
essential health services, financial protection
and equitable distribution of health.
2. Improve technical and institutional capacities,
knowledge and information for health systems
and services adaptation and related policy
dialogue
3. Ensure that international and national
stakeholders are increasingly aligned around
NHPSP and adhere to the effective development
cooperation principles.
Operational plans for Integrated Disease

Surveillance and Response (IDSR) aligned with the
International Health Regulations (IHR) were developed,
as such, MoH and the 15 County Health Teams (CHTs)
in Liberia are better enabled to create evidence-based, Figure. 1.1: Joint annual health sector performance review report:
2018.
integrated and need-based bottom-up health care
plans in order to improve equity, quality, efficiency and
resilience of health services to the general population.
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2018 Annual Report
Fig1.2: Health sector annual operational plan:2017/18. Fig 1.3: Health facility survey, 2018: Service Availability and
Readiness Assessment, Data Quality Reviews and Quality of
care assessments.
The Ministry of health, with the technical and financial

support from the World Health Organization, and in
collaboration with partners conducted an integrated
health facility survey, quality of care assessment
and data quality review in all the 15 counties (Figure
1.2). The evaluation generated reports of the data
quality and trends of health services delivery. Findings
were disseminated to all actors in the health sector
and informed the active policy dialogue among all
stakeholders. Assessment findings reported the
adaptation of the National Healthcare Quality Strategy
(NHQS) for Liberia.
In a view to integrate and align disease-specific

program plans, the MoH and stakeholders, through the
technical and financial support of the WHO, conducted
quarterly joint monitoring of implementation, and joint
annual performance reviews of the health system (figures
1.3). Recommendations guided next improvement plans
of the various investment and programme specific
action plans.
The WHO also guided technical experts from

the ministry in the process of developing the national
consolidated operational plans along with the 15
counties operational plans.
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MoH Photo
Figure 1.4: 2018 Health sector joint annual review conference, Liberia.
Approximately 24 Health managers

from the central Ministry of Health, 36
district health managers and health facility
managers are better capacitated and
better equipped on the application of the
workload indicator staffing need (WISN)
tool to optimize health workforce planning
and management.
WHO / P. Glee The WHO country office in

collaboration with AFRO took stock of
Figure 1.5: Sub - National Joint Semi-Annual Program Implementation
Review, 2018, Liberia. health workforce distribution and skill
Figure 1.6: WHO supported the first-ever national application of mix analysis, which informed planning
WISN technique for health workforce planning and management in and projection of priority health workforce
Liberia.
needs for Liberia.
Using the WHO standard national

health accounts (NHA) guide and tools,
MoH institutionalized the health sector
health accounts and was able to conduct
resource mapping. WHO collaborated with
relevant stakeholders in generating up to
date evidence on health care financing
options, including ways for generating
domestic resources; supported health
financing policy development and dialogue,
and provided technical assistance to
National Health Accounts in the production
of national health expenditure analysis.
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2018 Annual Report
Figure 1.7: Regular Joint Partners’ Coordination Meeting, 2018, Liberia.
A report on analysis of the National health accounts 1. Implementation of the recommendations of

for the health sector and an annual resource mapping Joint Financial Management Assessment
report were produced and disseminated. (JFMA) as per the priorities of the country
compact.
The national health care regulatory body, the 2. Assessment and design of the Joint Program
Liberian medical and dental council (LMDC), and the Coordination Units (JPCU) as per the
quality management unit of MoH, through technical recommendation of the health sector compact,
and financial support from the WHO, updated hospital
standards and guides. The LMDC reoriented a total of Additionally, mechanisms for coordination of
25 clinicians and laboratory experts from 25 hospitals health sector donors and implementing partners as well
as stakeholders’ Coordination to the National Public
on the application of the new standards and guides. A
Health Emergency Response, along with the IHR and
total of 20 hospital standards and guides, and infection
One Health Approach, are in place.
prevention and control (IPC) guidelines were developed
and endorsed by all stakeholders.
In order to tackle maternal and neonatal mortality
and disability at the primary referral level in Liberia, the
The WHO, as the co-chair of the highest
WHO technically and financially collaborated with the
health sector steering body, the Health Steering Core
MoH, UNFPA and, Maternal and Child health Advocacy
Coordination Committee (HSCCC), supported health
International (MCAI), through an innovative task-sharing
sector joint leadership mechanisms and structures, as
project in advanced obstetric care and neonatal care.
such, the HSCCC’s capacity to facilitate and enhance Regulation and licensing was provided by the LMDC and
regular communication and dialogue between MoH and the Liberian Board for Nursing and Midwifery (LBNM).
stakeholders was enhanced, to ensure better alignment
to national health priorities. This is resulted in a quarterly The task-sharing project produced two qualified
publication of HSCCC meeting recommendations and midwives as obstetric clinicians, is currently training nine
follow up actions. The following reports were developed: interns who have completed 2 of the 3 years of training,
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Figure 1.8: A successful collaborative initiative for realization of UHC in Liberia.
Partnerships between MoH, WHO, UNFPA and MCAI

started an innovative task sharing project in advanced
obstetric care followed by advanced neonatal care regulation
and licensing by the LMDC and LBNM.

and from 1st February 2018 took on 10 new
trainee obstetric clinicians and four neonatal
care clinicians. The WHO funded an additional
5 trainees in advanced neonatal care. Into the
three years of the initiative, a total of 1,654
Caesarean sections have been undertaken by the
first 11 trainee obstetric clinicians. As evidenced
by the number of neonates that received nasal
CPAP for life-threatening breathing difficulties,
there is improved neonatal care.
The WHO health services and systems

strengthening worked with following key
stakeholders in the health sector: UNICEF,
UNFPA, UN Women, World Bank, USAID, Irish
Aid, DFID, EU, France, Sweden, and MCAI.
Figures 1.9 and 10: Task sharing project products. Trainees,

trainers and administrator CH Rennie Hospital.
Dr. Johnson Medical Director at CH Rennie Hospital, with

recently delivered baby (by caesarean section) and the baby’s
10 year old mother. Children as mothers are common in
Liberia.
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2018 Annual Report
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Health managers from the central Ministry of Health
are better capacitated and better equipped on the
application of the workload indicator staffing need
(WISN) tool.
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district health managers and health facility managers
are better capacitated and better equipped on the
application of the workload indicator staffing need
(WISN) tool.
The WHO funded an additional 5

trainees in advanced neonatal care. The LMDC reoriented a total of
25
clinicians and
Into the three years of the initiative, laboratory experts
a total of from 25
1,654
hospitals
on the application of
the new standards and
guides. A total of20
Caesarean sections have been hospital standards and
undertaken by the first 11 trainee guides, and infection
obstetric clinicians. prevention and control
(IPC) guidelines were
developed and endorsed
by all stakeholders.
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WHO Photo
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2018 Annual Report
2 WHO HEALTH EMERGENCIES (WHE)
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The WHO and partners continue to support Liberia in strengthening the
national disease surveillance system using the Integrated Disease
Surveillance and Response [IDSR] strategic framework to
implement and the International Health Regulations
[IHR (2005)] core requirements.
WHO HEALTH EMERGENCIES

In order to keep the Liberian population safe from 2.1 Integrated Disease Surveillance and
health emergencies while simultaneously addressing Response (IDSR)
the underlying causes of their vulnerability; WHO Liberia
Health Emergencies Cluster (WHE) is part of a broader The WHO and partners continue to support
change in the national and sub-national efforts for Liberia in strengthening the national disease surveillance
prevention, preparedness and response to public health system using the Integrated Disease Surveillance and
emergencies in the country. Response [IDSR] strategic framework to implement and
the International Health Regulations [IHR (2005)] core
requirements.
The cluster brings together expertise and
resources of risk assessment and surveillance of priority
WHO supported the investigation and response
diseases, conditions and events using the Integrated
to 99 disease outbreaks and other public health events
Disease Surveillance and Response (IDSR) approach,
in 2018 from 14 out of 15 counties; 86.6% of the
disaster and Epidemics preparedness and response
outbreaks were investigated and responded to within
(EPR) and IHR to build resilient health systems; data
48 hours. The outbreaks and other public health events
management for decision making, Infection Prevention
recorded include; measles (49), Shigellosis (28), Lassa
and Control (IPC) of infectious hazards, Laboratory,
Antimicrobial Resistance (AMR) stewardship, Water, fever (13), Rabies in animals (3), Pertussis (2), Yellow
Sanitation and Hygiene (WASH), Health Emergency fever (1), Meningococcal disease (1), Scabies (1) Flood
Information and expanding partnerships involved in (1) and (1) chemical spill) as compared to 39 during
outbreaks and humanitarian crises. 2017 in 11 counties. Sixty percent (60%) of the events
had investigation reports, 7,465 priority diseases alerts
were reported verified and investigated with in 48hrs
compared to 4,729 reported in 2017 and 52 early
warning epidemiological bulletins were produced and
shared with all stakeholders).
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2018 Annual Report
Figure 2.1: A - Copy of weekly IDSR bulletins; B - WHO field epidemiologist conducting supervision.
The integrated disease surveillance and WHO supported MoH and NPHIL in building
response (IDSR) performance Indicators for 2018 resilience of surveillance officers and frontline health
indicate 98% case notification within 24hrs as compared workers through capacity building in IDSR and outputs
to 80% in 2017, 98% case documentation (case base included: Forty five (45) senior medical officers and
forms and line list) in 2018 as compared to 60% in 2017, health facility IDSR focal persons in Integrated Disease
completeness and timeliness of IDSR reports were 96% Surveillance and Response (IDSR) with emphasis on
and 92% during 2018, 46% community case detection Lassa fever detection and case management, 332
and notification was registered compared to 21% during frontline health workers and surveillance officers
2017 partly due to funding secured from AFRO to trained in IDSR, 15 County surveillance officers refresher
support community based surveillance activities. training on outbreak investigation and reporting, 350
health workers trained on AFP/VPDs active case search,
Figure 2.2: Monitoring IDSR key performance indicators: 2016 - 2018.
Comparison of Selected IDSR Performance Indicators from 2016 to 2018, Liberia
Week 40, 2016 (baseline) Week 52, 2017 Week 52, 2018 % of change (baseline vs. 2018)
120 450%
100 100 100 100 400%

98 98
100 96 96
92 National
90 Target [80%] 350%
80 81 83
300%
80
Performance Score [%]
390%
250%
% of Change
233%
60 200%
49
150%
40
158% 100%
19 24 50%
20
-4% -6% 4% 0%
0 -50%
Notification within Suspected cases with Completeness Timeliness Suspected cases with Cases detected in
24 hours case-based form/ lab sample collected the community
line list
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Figure 2.3: A - WHO field epidemiologist support IDSR specimen’s collection in the field; B - WHO co-facilitates the overview of IDSR in Nimba County during the training
51 health workers trained in Influenza surveillance,

150 health facility focal persons trained in eIDSR

(e-Surveillance), 55 staff from NPHIL, MoH, MIA and
Immigration sector trained in Port Health Management
as Trainers in partnership with NPHIL and IOM and 450
community Health volunteers trained in community-
based surveillance.
Piloted the revised AFRO 3rd IDSR technical

guidelines and training modules with 45 participants
(NPHIL, MoH and partners) and supported FETP
mentorship for CSOs and DSOs (CDC, AFENET, NPHIL),
developed 9 post EVD epidemic IHR core capacities
manuscripts, weekly epidemiological bulletins and
printed and distributed 1,000 job aids and 3000 reporting
tools to community health workers (CHVs and CHAs) in
Figure 2.4: eIDSR pilot evaluation report. border counties to aid alert notification and referral from
communities to health facilities.
WHO supported the implementation and

evaluation of eIDSR (e-surveillance) pilot with
appreciable recommendations for roll-out, in
collaboration with eHealth Africa, US-CDC, and UNICEF.
The pilot was conducted in two counties, Margibi and
Grand Cape Mount, and included 74 health facilities, and
137 health workers were trained on the eIDSR for real-
time reporting. The eIDSR pilot evaluation report was
developed and disseminated.
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NPHIL Photo
Figure 2.5: A - Copy of the National Action Plan for Health Security; B - Review of the National Public Health Institute of Liberia IHR/NAPHS implementation
performance, 2018.
2.2 Emergency Preparedness and Response e. Orientation of 25 staff at Redemption hospital

isolation unit on LF case management protocol.
The lessons learned from responding to the
2014-16 Ebola outbreaks enabled the MoH with support To strengthen the “country health emergency
from WHO and partners to develop an Investment plan preparedness” WHO in collaboration with NPHIL and
for Building a Resilient Health System 2015- 2021 where MoH contributed to:
strengthening Epidemic preparedness, surveillance and a. Launch of the National Action Plan for Health
response is a strategic investment area. WHO Health Security graced by the Vice President of Liberia
Emergencies (WHE) Program focused on building b. Validation of the National Disaster Management
country capacity to prevent, detect and respond to Agency (NDMA) Multi-hazard Contingency plan
emergencies through building all hazard emergency c. Conducted Liberia IHR Self-Assessment and
preparedness, mitigation and response capacities; submitted to WHO IHR committee: score of 48
developing prevention and control of infectious disease % (compared to 46% from IHR JEE 2016)
strategies and having an efficient detection, risk d. Conduct of VRAM workshop with 30 participants,
assessment and response mechanisms. and 10 hazards with health implications for
Liberia identified
Under “Prevention of high-threat infectious e. Conduct of full scale simulation exercises in
hazards”, WHO in collaboration with NPHIL and MoH, Margibi and Montserrado counties; with 100
contributed to; participants
a. Development and dissemination of the Lassa f. Conduct of 3 days Global emergency operations
fever (LF) case management protocol to all 15 center simulation exercise, involving 40
County health teams and 42 hospitals countries, 30 participants from Liberia (NPHIL,
b. Development and dissemination of Standard MoH, MoA, EPA, NRL and partners CDC, JIZ,
Operating Procedures and Public Health ACCEL, Africa CDC)
Emergency Contingency Plan for Seaports, g. Meningitis After Action Review (AAR) in Lofa
Airports and Ground Crossing in Liberia, with county with 36 participants
simulation exercise conducted h. Lassa fever after action review in Montserrado
c. Development of VHF Standard Operating county.
Procedures Manual
d. Conduct of Medical Countermeasures workshop,
with 40 participants
32
With WHO AFRO regional office contingency
funding, supported response to floods disaster which
affected 62,000 persons in six counties by supporting
rescue efforts of people affected with floods, surveillance
activities for communicable diseases, providing case
management of floods victims and IPC supplies. Eight
UN agencies including WHO through the UN Disaster
Management Working Group mobilized approximately $
USD 900,000 for the response.
2.3 Water, Hygiene and Sanitation and

Environmental Health
The WHO and partners supported the Liberia
Water and Sewer Corporation (LWSC) and line ministries
and agencies to conduct system approach water
Figure 2.7: Water Safety Plan for Buchanan water treatment plant.
quality risk based assessment from water catchment
to consumers for water safety plan development at
national and sub-national levels, which contributes At least nine Environmental Health Technicians

to supply of quality drinking water for all, while at the and 15 water quality technicians benefited capacity
same reducing the burden of disease associated with building training in two counties (Grand Bassa and
consuming unsafe drinking water. Montserrado Counties) for water quality monitoring
including chlorination and its residual monitoring.
Additionally, WHO supported the sub-national
capacity building for safe management of health care Over 35 additional health care facilities and
waste at the health facility level through staff mentorship 230 service providers in 2 counties ware mentored to
and technical support thus contributing to patient safety implement the Water, Sanitation and Hygiene Facility
and improved environmental health. A water safety plan Improvement Tool (WASH FIT).
(WSP) for the Buchanan water treatment plant was
developed, validated and implemented. Furthermore, Global Assessment and Analysis of Sanitation
the WSP risk assessments were conducted in Grand and Drinking-Water (GLAAS) 2018-2019 Cycle were
Cape Mount County, for the ongoing WSP development technically supported and achieved. Liberia signed up
process for these Counties. for publication in the 2018- 2019 GLAAS Survey Report.
Figure 2.6: A - Water Safety Treatment and Distribution Plant; B - Mentorship for water quality, chlorination and chlorine residual monitoring.
NPHIL Photo LWSC Photo
33
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2018 Annual Report
2.4 Infection Prevention and Control (IPC) hospital IPC focal persons as well as WHO county field
officers and regulatory bodies’ personnel trained during
WHO, in collaboration with other partners, a training-of-trainers orientation workshop. Additionally,
supported MoH, in the development of the National IPC 250 healthcare workers were trained on the IPC
Guidelines based on the 2016 WHO Guidelines on Core Guidelines, from Liberia Government Hospital- Grand
Components of IPC Programs at the National and Acute Bassa County, J.J. Dossen Memorial Hospital and John
Health Care Facility level. Sixty-seven (67) County and F. Kennedy Memorial Hospital respectively.
Figure 2.8: A - IPC Guidelines Orientation Workshop; B - National IPC Guidelines.
Based on the 2016 WHO Guidelines on Core core components. The core components are also
Components of Infection Prevention and Control (IPC) reflected in the newly published National IPC Guidelines
Programs at the National and Acute Health Care Facility for Liberia 2018. In July 2018, baseline assessments
Level, the WHO Global IPC unit developed the Infection were conducted in 32 of 38 (84%) of hospitals in Liberia.
Prevention and Control Assessment tool (IPCAT2) Health facilities (IPCAF) overall score was 451/800
(56%). There were also gaps identified in the eight core
for national programs and an infection Prevention
components with variability across the hospitals; HAI
and Control Framework (IPCAF) for acute healthcare
surveillance, IPC programs and guidelines had the most
facilities. These tools are developed using the six (6)
gaps.
Figure 2.9: IPCAT and IPCAF National and health facility level baseline results disaggregated by component.
100
83
80 72.4 72.4
68 72.2 63.1
61 62 56
60
47 47
40 35.2
20
20
0
Multimodial
IPC Education
& Training
HAI Infection
Surveillance
Strategies
Monitoring / Audits
bed occupancy
/ Feedback
Workload, staffing,
Built Environment
IPC Programme
IPC Guidelines
Average
National Level Health Facility Level
34
The national level (IPCAT2) score was 47.0%; WHO support to MoH and County health teams
gaps identified within all the six core components improved national hand hygiene self-assessment
assessed - HAI surveillance was at 0%, followed by IPC (HHSAF) compliance: HHSAF compliance from
education and training at 20% and IPC guidelines at 50% baseline to 67% reassessment by fostering the
47%. Remarkable achievements have been made with the development of action plans for 22 referral hospitals
implementation of the multi-modal strategy at 83% due across the 15 counties in Liberia.
to previous implementation of WHO tools, followed by the
national IPC program set up at 68%. (See Figure 25).
National hand hygiene self-assessment framework compliance (%) per county:

Baseline and Reassessment (n=15)
100%
90%
80% 76%
72% 72% 73% 72%
69% 70%
70% 67% 67%
Percentage
61% 64%
59%
60% 59% 57% 58% 59% 57% 59% 56% 55% 58%
55%
50% 51% 50%
50%
45% 43% 43%
40% 35% 37% 36%
30%
30%
Baseline

20%
10% Reassessment
0%
Montserrado
Gbarpolu
Bomi
GCM
Grand Gedeh
River Gee
Maryland
Grand Kru
Sinoe
Lofa
Bong
Margibi
Grrand Bassa
Rivercess
Nimba
Average
County
Figure 2.10: County and National HHSAF Hand Hygiene Level (%) results.
2.5. Antimicrobial Resistance (AMR) among the public and other key stakeholders, however,
predisposes the country to widespread AMR. As such,
Antimicrobial resistance (AMR), the ability of a combating AMR has been prioritized in the Liberia Pro-
microorganisms (like bacteria, viruses, fungi and some Poor Agenda for Development and Prosperity 2018–
parasites) to stop an antimicrobial (such as antibiotics, 2022.
antivirals, antifungal, and antimalarial) from working As a part of national efforts to mitigate
against it (WHO, 2015), is a global public health threat the prevailing AMR situation, WHO supported the
that, unless urgently addressed, will lead to 10 million Government of Liberia both technically and financially
deaths and a decrease of GDP between 1 – 3.5% per to organize multi-sectoral technical working group
annum, by 2050. WHO aims to reduce the percentage of meetings (TWG), and workshops on AMR, which led to
blood-stream infections due to drug-resistant organisms the development, validation and launch of the National
by 10%. Action Plan on Prevention and Containment of AMR;
and improved awareness and understanding on AMR
There is paucity of data on the prevalence of amongst 74 key stakeholders (47 males; 27 females)
AMR in Liberia. The widespread malpractice in the use from the relevant government line ministries and
of antimicrobials, including; limited control on selling of agencies. In addition, the Surgical Site Infection (SSI)
antimicrobial medicines, purchase of counterfeit drugs surveillance pilot protocol was developed to guide the
from “drug peddlers,” unrestrained use of antibiotics piloting on SSI and roll out of the national AMR which
in the agriculture industry, among others, as well as will commence in 2019.
limited knowledge on AMR and its contributing factors
35
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2018 Annual Report
Figure 2.11: AMR National Action Plan AMR validation workshop using One Health approach, Monrovia, June 2018.
Figures 2.12: Annual World One Health Day and Antibiotic Awareness Week commemoration with Vice President, Madam Jewel Howard Taylor (middle),
line ministries and agencies, Monrovia, 2018.
WHO Photo
WHO, in collaboration with FAO and United banners, posters, flyers; with integrated human, animal
States Agency for International Development (USAID), and environmental components on AMR, to the 15
supported the National One Health Platform in counties and other relevant sectors, policy makers, and
observance of important global events, including World international partners (including USAID, US-CDC, FAO,
Antibiotic Awareness Week and the International One etc). This resulted in raised awareness, and improved
Health Day 2018, to promote awareness and improve knowledge and understanding of AMR amongst 99 key
understanding of AMR. stakeholders (54 males; 45 females) to prevent further
emergence and spread of AMR in the human, animal and
Activities included adaptation and dissemination environment during one health and antibiotic awareness
of antibiotic awareness campaign materials like celebration.
36
NPHIL Photo
Figure 2.13: WHO, FAO and OIE
supported IHR-PVS National
Bridging Workshop to promote
One Health approach in Liberia,
November 26- 28, 2018.

WHO provided financial, technical, operational strengthen collaboration and coordination amongst
and logistical support in conducting the IHR-Performance sectors and agencies was developed.
of Veterinary Service (PVS) National Bridging
Workshop. The aim of the workshop was to: strengthen WHO, in collaboration with ACCEL rolled out
coordination amongst various sectors (Human, Animal/ laboratory AMR surveillance at 5 additional hospital
Livestock and Environment); mainstream gender in the laboratories. This was achieved through: routine technical
One Health approach; increase awareness and improve support and guidance to testing facilities; provision
understanding of One Health, zoonotic diseases and of testing guidelines as well as standard operating
AMR. Participants included 87 stakeholders (60 procedures; training of 35 personnel in bacteriology
males; 27 females) from national, county and district testing at the 5 new testing sites and refresher training
levels, including representatives from the media, for personnel at 3 existing testing sites. As a result, AMR
health, agriculture, environmental sectors as well as laboratory surveillance was decentralized to include 5
international partners (Riders for Health, FAO/ECTAD, additional hospital laboratories in 4 counties, increasing
and PREDICT) in collaboration with WHO Regional Office country coverage from 3 counties to 7 counties (from
for Africa, OIE and FAO. 20% to 47%). This enabled screening of 115 fecal
pathogens (isolated from specimens from 57 females,
A report highlighting priority areas for 58 males) AMR thus allowing for profiling of drug
interventions was produced and disseminated among resistance patterns for Liberia and informing patient
key stakeholders at the national and sub-national levels. management, change in medication, and ultimately
In addition, a national consolidated joint-road map to contributing to efforts to combat AMR.
37
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2018 Annual Report
2.6 Laboratory
The laboratory system of Liberia comprises

of public health laboratories including the National
Reference laboratory (NRL), and two regional
public health laboratories in Bong and Nimba; and
approximately 270 clinical laboratories in 36% of the Pathogen Isolation from fecal
healthcare facilities (hospitals, health centers and Specimen, 2018
clinics), arranged in a tiered system.
70
60
The NRL is led by a team of laboratory leads at
No. of Specimens
50
the National Public Health Institute of Liberia (NPHIL) 40
while clinical laboratories are directly supervised 30

20
by County Diagnostic Officers (CDO). The National
10
Diagnostic unit offers support to the CDOs, coordinates 0
distribution of laboratory commodities, and conducts
Enterbacter sp.
E. coli
Salmonella typhi
Shigella dysenteriae
Shigella flexneri
Salmonella para typhi A
Monganelli marganri
Shigella sp
Proteus mirabilis
regular supportive supervision and assessment to
peripheral laboratories, to ensure quality care is provided
to patients.
Pathogen Isolated
Since 2014, WHO intensified its support to
strengthen the laboratory system in Liberia. Major
support included training; mentorship; technical
guidance; provision of reagents and equipment; and,
development of plans, policies, strategies, guidelines
and standard operating procedures
Through WHO continued guidance and

support, Liberia sustained and decentralized IDSR
diagnostic capacity for eight priority diseases through
Drug susceptibility pattern for selected
isolated enteric pathogens
continued efforts in provision of technical support
and guidance; training of 35 personnel in laboratory 120
diagnostic procedures; daily mentorship and monitoring 100

80
Frequency
of laboratory indicators to ensure continued quality 60

testing; provision of reagents worth 3000 tests for 40
measles, rubella, yellow fever, rotavirus, and meningitis 20
0
(culture); provision of specimen collection materials for
Ampicilin
Nalidixic Acid
Ciprofloxacin
Chloramphenicol
Cotrimoxazole
over 5600 specimens including 200 specimen collection

kits for meningitis; and coordination of international
specimen referral for polio and yellow fever confirmatory
Antimicrobial agent
testing. Of the 13 disease outbreaks requiring laboratory
confirmation reported in 2018, 84.6% (11/13) were Resistant Intermediate Susceptible
confirmed within 48 hours of alert, which informed
adequate and prompt response to disease outbreaks,
appropriate patient management, and contributed to
timely containment of outbreaks, improved patient
outcome, and contributed to improved quality of life.
This was achieved in collaboration US-CDC and ACCEL.
38
IDSR Public Health Diseases Tested in 2018
1200
No. of Tests Conducted
1000
800
600
400
200
0
Accute Bloody Diarrhoea
Bacterial Meningitis
Acute Watery Diarrhoea
EVD
Lassa Fever
Measles
Polio
Rubella
Yellow Fever
IDSR Priority Disease Condition
WHO, in collaboration with partners, supported and continued mentorship. This increased the country

MoH to improve access to tuberculosis (TB) and HIV coverage to a total of 17 GeneXpert testing sites in 10
(Viral Load, and Early Infant Diagnosis - EID) diagnostics counties (from 60% to 67% count coverage with respect
and timeliness through the establishment of four to counties).
additional GeneXpert testing sites, training of personnel,
Comparison of Viral Load Test for 2017 & 2018

No. of Tests Conducted
3500
3000
2500
2000
1500
1000
500
0
Q1 Q2 Q3 Q4 TOTAL
# of Tests per Quarter
2017 2018
Figure 2.14: A - Map showing distribution of Gene exert machines in the country as of December 2018; B - Comparison of HIV viral-load testing in 2017
and 2018.
Sustained advanced clinical diagnostics procurement and installation of laboratory equipment;

(haematology, chemistry, X-ray) in 8 county hospitals, more than 340 clinical and lab equipment; establishment
in 7 counties, enabling appropriate care to patients and of chemistry testing at 5 additional hospital laboratories.
contributing to improved quality of care and ultimately Approximately 1771 patients from 7 counties benefited
improving access to universal health coverage. This from advanced laboratory diagnostic services. This
was achieved through; providing weekly mentorship to was achieved through collaboration with WB, IsDB,
94 personnel at 8 facilities in the 7 counties; monthly and GFATM as donors; and UNOPS as an implementing
monitoring of laboratory performance and service partner for equipment procurement and installation.
utilization; provision of technical oversight over
39
WHO LIBERIA
2018 Annual Report
WHO / P. Glee
Figure 2.15: Liberia Commemorates World Blood Donor Day (14 June 2018). Theme: Be There for Someone Else. Give Blood. Share Life.
WHO / P. Glee
40
Figure 2.16: Training of Laboratory technicians on AFB Microscopy ZN and FM method.
WHO, in collaboration with ACCEL and

GFATM, provided technical support to the National
Blood Safety Program (NBSP) to develop national
blood safety policy and guiding documents for
Liberia. In addition, through WHO technical support,
the World Blood Donor day was commemorated
during which regular voluntary blood donors were
honored.
WHO provided technical and financial

support to MoH to implement quality assurance
schemes for measles and rubella, GeneXpert and
Acid-Fast Bacilli (AFB) microscopy testing at the
National Reference Laboratory, 14 pre-existing
GeneXpert testing sites, and 80 (out of 94) clinical
laboratories, respectively. TB EQA was provided
with support from the TB supra-national reference
laboratory in Uganda. Liberia scored 98% in the
measles and rubella proficiency testing, 100% in
the TB panel testing, and 23% (14/80) pass rate
for the AFB EQA.
41
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2018 Annual Report
WATER, HYGIENE AND INTEGRATED DISEASE

SANITATION (WASH); AND SURVEILLANCE AND
ENVIRONMENTAL HEALTH RESPONSE (IDSR)
Over 35 Trained 45 senior

medical officers and
health facility IDSR
35
focal persons in
Integrated Disease
Surveillance.
350 health workers trained on

additional health care AFP/VPDs active case search, 51
facilities and 230 service health workers trained in Influenza
providers in 2 counties ware surveillance, 150 health facility
mentored to implement the focal persons trained in eIDSR
Water, Sanitation and Hygiene (e-Surveillance).
Facility Improvement Tool
(WASH FIT).
ANTIMICROBIAL RESISTANCE (AMR)
60
WHO provided financial, technical,
operational and logistical
support in conducting the IHR- males
Performance of Veterinary
27
Service (PVS) National Bridging
Workshop. Participants included
87 stakeholders. females
42
LABORATORY
Provided technical
oversight over Of the 13 disease outbreaks
procurement and requiring laboratory
installation of confirmation reported in 2018,
340 84.6%

major clinical and (11/13) were confirmed
laboratory equipment. within 48 hours of alert.
Established chemistry
testing at 5 additional
hospital laboratories.
Approximately 1771
patients from 7
counties benefited from
advanced laboratory Liberia scored
98%
diagnostic services.
in the measles and rubella

proficiency testing, 100%
in the TB panel testing, and
23% (14/80) pass rate for
the AFB EQA.
43
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2018 Annual Report
3 DISEASE PREVENTION AND CONTROL
44
National Response to HIV and AIDS is one of the major priorities of the
MoH of Liberia. The key MoH partners for these programs are
Global Fund and USAID.
3.1 Communicable Diseases prevalence of HIV 2.7% in each county) under

differentiated programming. The Liberia National HIV/
DISEASE PREVENTION AND CONTROL

3.1.1 HIV/AIDS AIDS Integrated Treatment Guidelines were revised to
The national HIV prevalence in 2018 was 2.1% adopt the Test and Treat Strategy, as well as scale up
in the general population. HIV is higher in adolescent HIV services by increasing the number of HIV Testing
girls and young women (2.9% - 4.0%) and key population centers from 371 in 2017 to 520 in 2018. In addition, the
(MSM 19.8%, FWS 9.8%). The HIV service coverage has integrated PMTCT and ART centers increased from 419
increased from 20% in 2016 to 61% in 2018. National in 2017 to 430 in 2018 where Test and Treat strategy
Response to HIV and AIDS is one of the major priorities is implemented, with scale up of viral load monitoring
of the MoH of Liberia. The key MoH partners for these of clients on ART and early infant diagnosis (EID) of
programs are Global Fund and USAID. WHO and other exposed neonates. The number of clients on ART
UN Agencies, including UNAIDS, UNFPA, UNICEF, and UN increased from 12,116 (84% female) in 2017 to 13,110
Women provide Technical and financial support the MoH (74% female) in 2018.
to achieve its goals. WHO Country Office Liberia has
aligned its strategic objectives to the national priorities In terms of progress on the 90-90-90 targets for
and in harmonization with the WHO General Program of 2020, Liberia was at 67-53-53 by end of 2018. In terms
Work, the Sustainable Development Goals and the AFRO of Testing and Treatment Cascade, the country progress
Transformation Agenda. Technical and financial support update was 67% for testing, 35% for PLHIV on treatment
has been provided to the National Program to adopt and and 18% for viral suppression. HIV diagnostics capacity
implement WHO recommendations and guidance in the was increased through rapid molecular testing of HIV
National Strategic Plans for HIV and AIDS. viral load/EID. Through WHO, the NACP received an
emergency supply of 1,034 pieces of Viral Load (VL)
WHO supported the National AIDS Control cartridges and 60 pieces of EID cartridges supplied by
Program (NACP) to Scale up HIV services, particularly Cepheid, the manufacturer.
in Montserrado, Margibi, and Bassa Counties (high
45
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2018 Annual Report
3.1.2 Tuberculosis control and services in Liberia With an estimated population of 4.8 million
Tuberculosis (TB) is still a major public health people and an estimated incidence rate of 308/100,000
problem in Liberia as the country is among the ten population, the mortality rate of 73/100 000 and MDR/
countries with high estimated TB incidence rate. The RR-TB incidence rate of 8.3/100 0002, the country is
high TB prevalence in Liberia is further complicated estimated to notify 15,584 all forms of TB cases and 390
by inadequate funding, increase in prevalence of MDR/RR-TB cases in 2018 of which only 8,335 (53%) and
drug resistance, TB/HIV and other socioeconomic 65 (17%) were notified. TB funding support for Liberia is
determinants such as inadequate housing and poor- mainly from the GFATM grant and partly WHO, aside the
quality health care services. government of Liberia; however, only 24% of this funding
is domestic, and the remaining 76% is international. The
46
WHO Photo
TB statistics for Liberia emphasize the need to increase Delamanid)) was also adopted. Green Light Committee
control efforts and support for TB and TB/HIV in Liberia. assessment of Programmatic Management of MDR-TB
and recommendations provided for improvement.
WHO supported the mobilization of Global Fund
resources for TB control for the period 2018-2020. In Through WHO support, in collaboration with
addition, WHO Supported the National TB Program in the Global Drug Facility (GDF) for quantification and
adopting and implementing the End TB Strategy and monitoring of supplies, Quan-TB was introduced in
WHO guidelines on TB Control, particularly MDR-TB. Liberia. Capacity for TB data collection and real-time
The WHO recommended short course treatment for reporting and integration in the Health Management
MDR-TB (New treatment regimen (Bedaquilline and Information System was developed.
47
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2018 Annual Report
There was a scale up of GeneXpert testing from WHO supported the national TB Program to
10 sites in 2017 to 17 sites in 2018 covering 10 of 15 train of 78 laboratory staff from 15 GeneXpert sites on
counties. TB case detection rate increased to 35.1%, basic laboratory procedures, introduction to Laboratory
with a total of 2,928 new TB cases being detected (1,233 Quality Management System (LQMS), sample
cases by AFB microscopy method (ZN staining) and management, inventory management, TB diagnostics
1,695 cases by GeneXpert method). (AFB microscopy and TB and HIV diagnostics using the
GeneXpert technology).
A total of 94 AFB microscopy centers in 6 counties
(Montserrado, Nimba, Grand Bassa, Margibi, River Gee The TB Annex laboratory was successfully
and Grand Gedeh) were activated into conducting AFB enrolled into external quality assurance (EQA) program
microscopy test. A total of 65 laboratory Assistance and system through the Uganda Supra-National Reference
Aids were trained in AFB microscopy using ZN staining Laboratory (SRL) for all diagnostic methods performed.
method and seven five (75) Laboratory staff including In the first EQA, Liberia scored 100%.
15 CDOs trained on the new Light Emitting Diode
Fluorescence Microscopy as well as re-instated AFB Responding to Tuberculosis is one of the major
microscopy at 6 health facilities. priorities of the Ministry of Health (MoH) and key MoH
partners are: Global Fund USA, ID, WHO, UNAIDS, UNFPA,
UNICEF, and UN Women.
Trend of TB/HIV Indicators 2014 - 2018
100%
90% 36 27 28 47 42
80%
70%
56
60% 88 80 62
10
50%
15
40% 13 15
15
15
30%
20% 70
73 68 73 70
10%
0%
2014 2015 2016 2017 2018
Known HIV % TB/HIV co-infected
% Access to CPT % Access to ART
Figure 3.1: Trend of TB Treatment Coverage 2010 - 2018. Figure 3.2: Trend of TB/HIV Indicators 2014 - 2018.
3.1.3 Viral Hepatitis The government has placed high priority on Viral
The prevalence of Hepatitis B Virus and Hepatitis and is currently collaborating with several
Hepatitis C Virus in the country is currently 6.2% partners to reduce the incidence.
and 1.8%, respectively (among blood donors) in the
general population. Viral Hepatitis testing services Major efforts of WHO in supporting the
are integrated in HIV Testing Services, Blood Safety government address this disease have resulted in:
Program, Immunization and Family Health. increase in Penta 3 coverage from 98.7% in 2018
as compared to 94% 2017; increased advocacy and
48
resource mobilization; integration of Viral Hepatitis WHO provided technical support to mobilize
in Prevention of Mother to Child Transmission of HIV Global Fund grant in the amount of $36m for Malaria
(PMTCT) and HIV Testing Services (HTS); advocacy and response for the period July 2018 to June 2021. WHO
technical support to integrate birth dose HBV vaccine provided financial and technical support to conduct
in the routine immunization program; development surveys, studies, and reviews to generate strategic
and implementation of guidelines for the prevention, information for decision-making including: therapeutic
Care and Treatment of Viral Hepatitis; and, provision of Efficacy Testing of Anti-Malaria medicines used in
technical assistance to generate strategic information Liberia; Health Facility survey and Malaria treatment
to guide the development of National Strategic Plan for compliance study; mass distribution of 2.7 million Long
Viral Hepatitis. Unfortunately, Birth dose for HBV is yet Lasting Insecticide Treated Nets (LLIN) thus increasing
to be administered in the country. household ownership from 55% to 65%; and mid-Term
Review of the Malaria National Strategic Plan
3.1.4 Malaria Due to this support, total Malaria cases declined

Malaria is the major cause of morbidity and from 2.3 million in 2016 to 1.3 million in 2017; although
mortality in Liberia. The current Malaria prevalence children under five accounted for more than 30% of the
is 28%. In addressing the current malaria situation in cases. Malaria admissions remained relatively constant
the country, WHO provided both technical and financial at nearly 90,000, with children under five accounting for
support to the National Malaria Control Program to more 60% of the admissions while Malaria deaths in
adopt and implement the Malaria Global Technical children declined from 820 to 557.
Strategy and WHO recommendations and guidelines in
the National Strategic Plans for Malaria.
WHO Photo
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2018 Annual Report
3.2 Neglected Tropical Diseases (NTDs) the targets established by WHO including: to eliminate
Lymphatic filariasis as a public health problem by 2020;
NTDs are a diverse group of communicable eliminate Onchocerciasis as a public health problem by
diseases that prevail in tropical and subtropical 2025; eradication of yaws by 2020.
conditions in 149 countries, affecting more than one
billion people mainly living in poverty with inadequate WHO has provided technical, financial support,
capacity building and guidance to the NTDs program,
sanitation; and cost developing economies billions of
in collaboration with other partners including: Sight
dollars every year.
Savers, Liverpool School of Tropical Medicine (LSTM),
Accelerating Integrated Management Initiative (AIM),
Liberia has a multiple burden of NTDs with a
DAHW, AIFO, Effect-Hope (Leprosy Mission Canada),
high prevalence and co-endemicity of: Onchocerciasis,
Medical Assistance Program (MAP), Partners in Health
Lymphatic filariasis, Schistosomiasis, Soil transmitted
(PIH), Schistosomiasis Control Initiative (SCI); to fast-
helminths, Buruli Ulcer and Leprosy. Rabies and
track the program targets
Dengue have recently been confirmed in Liberia. This
multiple burden is an impediment to socio economic
WHO provided technical support, guidance,
development of already impoverished rural communities capacity building, and through a multi-medicine
identified to be at risk of these disabling diseases, and donation by Merck and GSK supported Mass Medicines
possess a great challenge to achievement of the SGDs. Administration (MMA) for Schistosomiasis and soil
transmitted helminths (STH) in 2 phases, using
The MoH through the NTDs program has praziquantel in seven targeted counties including Grand
prioritized control and elimination of NTDs in line with Bassa, Grand Cape Mount, Montserrado, River Gee,
Figure 3.3: Schistosomiasis MMA implementation map, Liberia, 2018.
50
Bong, Lofa and Nimba counties. An average of 82.5% With support from WHO, and in partnership with
(of 1,374,316 targeted people) therapeutic coverage Center for Neglected Tropical Disease (CNTD) Liverpool,
for Schistosomiasis and STH (The target per WHO Lymphatic Filariasis (LF) Pre-Transmission Assessment
guidelines is 75%). Survey (Pre-TAS) was conducted at sentinel and spot
check sites in 9 Counties (Maryland, Grand Kru, Rivergee,
Onchocerciasis MMA was conducted in six Grand Gedeh, Nimba, Lofa, Margibi, Montserrado, and
targeted counties including Bomi, Gbarpolu, Grand Grand Cape Mt). Pre-TAS report was commissioned,
Gedeh, Bong, RiverGee, and Rivercess counties. An
with 60% (9/15) counties found to have a prevalence of
average of 86% therapeutic coverage for Onchocerciasis.
LF less than 1%.
A total of 380 health workers, 6,336 Community

With technical and financial support from
Directed Distributors (CDDs) and 3,723 Town Criers
WHO, training for integrated mapping for Yaws, Buruli
were trained on MMA for Schistosomiasis and STHs in
ulcers and Leprosy was conducted. A pilot integrated
7 Counties. A total of 3,927 health personnel (252 health
mapping was conducted in Maryland County. Yaws was
professionals, and 3675 community health workers)
confirmed to be endemic in Liberia, in Maryland county
trained in NTDs ahead of MMA with emphasis on
- case management, surveillance and control strategies
control and management of public health priority NTDs
being implemented.
(Onchocerciasis, Lymphatic Filariasis, Schistosomiasis,
Soil Transmitted Helminths and the case management
With technical and financial support from
of Buruli Ulcer, Leprosy, and Hydrocele).
WHO, delineation of onchocerciasis breeding sites was
Figure 3.4: Species distribution for the Northwest and Southwest Regions.
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conducted, in collaboration with Sight Savers, in ten (10) and diabetes as the four main types. The common
counties including: Bomi, Grand Cape Mount, Gbarpolu, NCDs in Liberia include hypertension, cancers, diabetes
Montserrado, Margibi, Grand Bassa, Rivercess, Bong, Lofa and chronic obstructive pulmonary diseases. NCDIs
and Nimba; to identify possible breeding sites of black constituted an estimated 37.9% of Liberia’s total disease
flies that cause Onchocerciasis. The Onchocerciasis burden and 43.4% of all deaths, in 2016. Additionally,
delineation report was commissioned and Simulium there is a huge burden of Mental Health and Substance
yahense was identified as the most widespread species Abuse in Liberia due to the 14 years Civil Crisis and
in the Southwest and Northwest regions of Liberia. In the Ebola outbreak. Road Traffic Accidents Deaths in
addition, Onchocerciasis MMA impact assessment was Liberia reached 1,585 or 4.51% of total deaths in 2017
conducted. according to WHO report.
With technical support from WHO, the National To combat the increasing burden of NCDIs,
NTDs steering committee was established. The National the MoH established the NCD program with the aim
Onchocerciasis Elimination Expert Committee (NOEEC) of developing and implementing strategies to increase
annual meeting was held. access to NCDIs preventive, management, and control
interventions, including minimizing risk factors; in
collaboration with local and international partners.
3.3 Non-Communicable Diseases and Injuries The program, with support from partners, developed
(NCDIs) the NCDs multi-sectoral plan to prioritize and guide
interventions to combat NCDIs. Additionally, in 2017,
Non-Communicable Diseases (NCDs) the Government of Liberia through the MoH established
are diseases of long duration and generally slow the Liberia NCDI Poverty Commission, in collaboration
progression, with cardiovascular diseases (heart attacks with the Lancet Commission on Reframing Non-
and stroke), cancers, chronic respiratory diseases Communicable Diseases and Injuries for the Poorest
(chronic obstructive pulmonary disease and asthma) Billion. The Commission’s objectives were to explore
52
and quantify the burden of NCDIs and current service was conducted and a technical working group was
availability, and to propose a list of priority NCDIs and established. Palliative care service provision was piloted
interventions that could have a favorable impact on the at Redemption hospital.
health and economy of Liberia.
3.3.1 Mental Health and Substance Abuse
Some of the partners supporting prevention Liberia has a huge burden of mental health and
and control of NCDIs include: WHO; Non-Governmental substance abuse problem having been through 14 years
Organizations (NGOs) like Partners in Health, Sight of war from 1989 to 2003 and the Ebola epidemic that
Savers, Mount Sinai Hospital; Community Based killed more than 4800 people. Currently, there is one
Organization (CBOs) like The Cancer Association; mental health referral facility and one psychiatrist for
the private sector, Drug regulatory bodies and other a population of 4.5 million inhabitants in the country
Government sectors like Ministries of Education, Internal located in Monrovia the capital. There are no well-
Affairs, Justice, Youth and Sports, Commerce and established programs on substance abuse and those
Industry, Information, Culture & Tourism, among others. that exist are mainly provided by some churches and
private individuals that are very substandard.
Through technical support from WHO, multi-
sectoral consultations, collaboration other partners, WHO supported MoH to increase access to
NCDI commission report was developed, validated and quality mental health and substance abuse services
endorsed by the MoH and disseminated to stakeholders. (MHS), including the capacity building of mental
Seventeen (17) priority NCDIs were selected for Liberia, health clinicians/MHSA workforce and infrastructure
including, asthma, chronic obstructive pulmonary development. A total of 20 health workers from 6 counties
disease, cardiovascular disease, rheumatic heart were trained as National Addiction Professionals who
disease, diabetes (type 1 and 2), cervical cancer, non- also trained 35 service providers through Echo Training.
Hodgkin lymphoma, breast cancer, major depressive One Mental Health Wellness Unit was constructed at the

disorder, schizophrenia, substance abuse disorders, CH Rennie Hospital in Kakata, Margibi County.
anxiety disorders, epilepsy, sickle cell disease, vision
loss, refraction and accommodations disorders cirrhosis, WHO supported advocacy for budgetary
chronic kidney disease, and motor vehicle road injuries allocation for mental health and substance abuse in
annual national Health Budget 2018-2019 leading to
Through technical and financial support from receipt of US$1.5 million through the President Special
WHO and other partners like Mt. Sinai Hospital, the first Initiative Project (PSIP) for the establishment of a
ever five-year National Cancer Control policy for Liberia National Rehabilitation Center in Grand Bassa County
was developed and validated, following a multi-sectorial and Construction of Mental Health Wellness Units in
consultation and collaboration with other partners. each of 10 Counties.
The policy has five priorities including: breast and
cervical cancers, Childhood cancers, Prostate cancer, WHO collaborated with Carter Center and
Hepatitis B vaccination efforts to prevent liver cancer, MoH to acquire psychotropic medications from MAP
and prevention of alcohol and tobacco use; and is to be International for the treatment of more than 2,000
implemented in 3 phases within 5 years and beyond. In clients with mental disorders.
addition, the community cancer registry was established
at six health centres. WHO supported adaptation of National
Treatment Protocol for the management of Substance
With technical support and guidance from WHO, Use Disorders; mid-Term Review of the National Mental
establishment of Palliative care service provision was Health Policy and Strategic Plan; and, facility Survey
explored in Liberia following an assessment conducted for Treatment Access, Availability and Quality for the
by African Palliative Care Association (APCA) in management of People with Substance Use Disorders.
2017. A follow up mission held, training of personnel
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WHO provided technical and financial support to the MOE in the development and validation of National School
Health Policy. In addition, WHO provided logistical support for the operation of the ‘’Step Down Project”.
Figure 3.5: Substance Use Disorders Treatment Protocol Adaptation in Gbarnga, Bong County.
54
MALARIA HIV
Health Facility survey and The HIV service coverage has increased
Malaria treatment compliance from 20% in 2016 to
61
study; mass distribution of
% in 2018.
2,7 00,000
million Long Lasting Insecticide
The number of clients on ART increased
from 12,116 (84% female)
Treated Nets (LLIN) thus

increasing household ownership
from 55% to 65%. in 2017 to 13,110 (74% female) in 2018.

TB MENTAL HEALTH
WHO supported MoH to increase access to

WHO supported
quality mental health and substance abuse
the national
services (MHS), including the capacity
TB Program
building of mental health clinicians/MHSA
to train 78
workforce and infrastructure development.
laboratory
A total of 20 health workers from 6 counties
staff from 15
were trained as National
GeneXpert
Addiction Professionals
sites on basic laboratory
who also trained 35
procedures, and introduction to
service providers
Laboratory Quality Management
through Echo Training.
System (LQMS).
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4 FAMILY AND REPRODUCTIVE HEALTH
56
The FRH cluster is one of the six clusters within the WCO. The major
programs of the cluster include child and adolescent health and nutrition
as a block; immunization and vaccine development as another block and
reproductive and women’s health as a third block.
Its goal is to promote the continuum of care were placed on ensuring the wellbeing and the enabling
spanning from pregnancy and childbirth, to childhood, environment to promote the desired health outcomes.
adolescence and beyond. The vision is to support
Liberia as a country to end preventable maternal and In an effort to support Liberia’s health and
child deaths and control vaccine preventable diseases, overall development agenda, WHO HQ, AFRO and WCO
improve nutrition, sexual and reproductive health, technically and financially supported the Ministry of
gender, equity and human rights and promote healthy Health (FHD), in planning, and successfully conducting
ageing. The mission is to promote health through the life the first ever National Family Planning Conference
cycle. which promoted family planning in a way that
FAMILY AND REPRODUCTIVE HEALTH

increased awareness and support for family planning
interventions. The successful hosting of the conference
4.1 Reproductive Maternal Neonatal Child created maximum advocacy on family planning and
and Adolescents Health increased access to family planning interventions, with
political commitment and uptake of family planning
WCO FRH cluster worked closely with other commodities at operational levels. A resolution on family
clusters within the WCO as well as with the Ministry planning was accepted and passed nationally. This led
of Health, specifically the Family Health Division,
to increased access to family planning counseling and
Community Health Services Division, EPI Division, HMIS,
services.
Nutrition Division, the Global Fund programs and other
relevant programs of the MoH. Other partners included
Through the availability of skilled HR in the use
the UN agencies, Non-Governmental Organizations,
of ICT equipment and data management tools, RMNCAH
health training institutions, among others. The collected
data analyzed resulting to the revised functional
efforts were towards ensuring the survival of mothers,
RMNCAH national scorecard; the scorecard depicts the
their babies, women of childbearing age, children under
status of core RMNCAH-N indicators being monitored
five, adolescents, youth and the populace as a whole in
terms of reproductive health care services. Emphases for targeted interventions and policy decisions. This
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WHO / P. Glee
Figure 4.1: A - WCO donating an ambulance to the MoH geared towards enhancing referral pathway;
B- National Family Planning Conference, Liberia, 2018
58
supported generation, dissemination and utilization of and being utilized at the four health facilities serving as
strategic RMNCAH Information, as well as monitoring MNH QOC demonstrating sites in the country.
RMNCAH indicators for policy making and evidence-
based decisions. Task-sharing: a possible solution to accelerating
the reduction of the high burden of deaths among
Integrating WHO standards for improving pregnant women and neonates in Liberia: approximately
QOC of maternal and newborn care in health facilities nine additional obstetric clinicians trained for emergency
and MoH existing QOC structures, WCO technically obstetric care services and four trained as neonatal
and financially supported the MNH QOC standards in clinicians to manage and care for the sick newborn
the Liberia Government Hospital in Bomi County, and including the depressed baby. This has contributed to
its ongoing implementation in four additional health increased access to emergency obstetric and neonatal
facilities. A checklist for monitoring quality of maternal services in 6 counties covering seven major hospitals.
and newborn care in health care facilities was developed
Figure 4.2: A - Preterm newborn infant receiving Oxygen treatment;

B - Training of mid-level health professionals as obstetric Clinicians.
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The Programme also provided technical related interventions targeting reduction of teenage
support to the finalization and validation of the pregnancy, unsafe abortion and STIs. The National
National Adolescent Empowerment Strategy; the Adolescent Empowerment Strategy was developed and
strategy details key interventions for addressing validated, contributing to harmonization of services for
adolescents and young people’s specific health and adolescents and youth.
development needs through sexuality education; health
Data in pictures showing status of national core indicators for 2017/2018
124000 123276
122000
120000 118913
118000
116009 115521
116000
114000
112000
110000
2017 2018
Total Institutional Deliveries

Total pregnant women receiving at least four ANC visits
Figure 4.3: Institutional deliveries Vs Pregnant women receiving at least four ANC visits.
Figure 4.4: Indicates an increase in the total number of institutional deliveries conducted in 2018 as compare to total number of deliveries conducted in
2017. There was a decrease in women receiving ANC 4 in 2018 as compare to 2017.
Pregnant women covered with 2nd dose Intermittent Preventive Treatment (IPT) 2018
14000
12170 12556 12162
12000
10000
8000 7431
# of IPT
6000 4960
4000 3121 3339 2947
1788 2125 1166 1131 2382 1915
2000 807
0
Bong
Bomi
Sinoe
River Cess
River Gee
Nimba
Maryland
Margibi
Lofa
Grand Kru
Grand Gedeh
Grand Cape Mount
Montserrado
Grand Bassa
Gbarpolu
County
Figure 4.5: Pregnant women covered with 2nd dose of intermittent preventive treatment (IPT) of malaria as per county for, 2018, low uptake was noted in
Bong 17%, Nimba 18%, Montserrado 17, Lofa 11% counties respectively.
60
4.2 Expanded Program on Immunization (EPI)
During the review period, the goal of WHO on the in the country so as to attain and surpass pre-EVD
program of immunization was continual restoration and outbreak coverage levels and contribute to the reduction
strengthening of immunization services to ensure they of vaccine preventable diseases.
are accessible, acceptable to all targeted beneficiaries
4.2.1 Routine Immunization
Figure 4.6: Cumulative routine immunization coverage from January- December 2018
120.0%
104.4%
95.5% 97.3% 97.2%
100.0% 90.6%
84.0%
79.0%
80.0%
62.5%
60.0%
40.0%
20.0%
0.0%
Fully BCG Measles OPV 3 Penta 1 Penta 3 Yellow TT2+

immunized Fever
The National Immunization Policy was revised WHO supported MoH personnel in the use of
and updated with technical and financial support from electronic integrated supportive supervision checklists
WHO along with other partners; Ministry of Health; EPI, (ISS) at county level during supportive supervision. A
Policy, M&E, Legal Departments, WHO, UNICEF, JSI and total of 1,612 ISS checklists have been completed from
LMH. Jan - December, 2018 during the visits. Data analyzed
and feedback provided to county teams to inform action
WHO provided technical support to the Ministry plans for continued program improvement.
of Health to conduct the 4 quarterly review meetings

that meeting together all 15 child survival focal persons,
CHOs, and key immunization partners. Review meeting
reports were produced, with key recommendations.
Figure 4.7: HFs where ISS was conducted and number of ISS visits per county.
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WHO supported the 8th African Vaccination Week vaccinators within the seven (7) days of activities. A total
celebrated from 24 to 30 April 2018 with the theme of 1, 264 children under 11 months were fully immunized
“Vaccines work, Do your part!”. In Liberia, the following during the AVW.
strategies were used to reach all the children regardless
of their locations: WHO supported MoH on GAVI Joint Appraisal
• Outreach vaccination for hard to reach and (JA) review in August 2018. Recommendations were
underserved communities. given based on Identified gaps and limitations.
• Involvement of students, teachers and civil
society organizations during the AVW. Missed Opportunities for Vaccination (MOV)
• Forty-one (41) health facilities were involved in assessment was conducted in Liberia six counties
the AVW. (Bomi, Grand Bassa, Nimba, Grand Gedeh, Maryland and
Montserrado) and improvement plans developed. The
A total of 195 hard-to-reach, underserved MOV technical report, as well as SOPs and Guidelines to
and reporting outbreak communities were visited by conduct MOV were developed.
62
WHO provided technical and financial support the
MoH for the development of Data Quality Improvement
Plan (DQIP). WHO facilitated (coordination, technical and
financial support) the development of the DQIP involved
desk review of relevant data quality assessments and
develop improvement plans from the findings and
recommendations.
Technical and financial support was provided to

MoH to develop the first Liberia Guidelines, SOPs, Adverse
Events Following immunization (AEFI) reporting tools
and TORs for AEFI committees on AEFI surveillance and
response during a workshop attended by 60 participants
from NPHIL, LMRH, WHO, UNICEF, JSI.
WHO provided technical support to MoH for

the submission of HPV and MCV2 vaccine introduction
applications which was accepted and approved by Gavi
IRC in 2018 for introduction into routine immunization
schedule as MCV2 in July 2019 and HPV in October
2019, respectively. Additionally, the inactivated Polio
Vaccine (IPV) Post Introduction Evaluation (PIE) was
conducted covering 6 counties and 25 health facilities.
WHO together with MoH, NPHIL, CDC, and NIH

developed a Protocol addendum on SEA and logistic
hubs for EVD vaccine deployment, updated protocol and
developed budget proposal for VSV deployment during
an outbreak and simulations exercises. PIE Guidelines
and SOPs were adapted, IPV PIE technical report was
produced, and, HPV and MCV2 introduction application
was approved.
WHO Photo

4.3 Polio Eradication
WHO supported mentorship of regional Conducted quarterly National Polio Committee

vaccine store and data managers in 3 vaccine hubs on Meetings including NTF, NPEC and NCC members
monitoring of remote temperature monitoring device, during which annual polio updates were developed
beyond wireless, completion of stock requisition/ and submitted, final classification for AFP cases were
conducted.
receipt voucher; County child survival focal persons
and cold chain officers from 15 counties trained on cold Provided technical, financial and logistic support
chain and vaccine management, including forecasting for Integrated Oral Polio Campaign conducted from
and ordering of vaccination supplies. In addition, an 4 – 7 May 2018 and from October 26 - 29, 2018 with
assessment of regional vaccine store immunization administrative coverage of 98% and 97% respectively for
round 1 and 2 which was evaluated with Independent
supply chain system with focus on vaccine stock
monitoring (IM) and Lots Quality Assurance Sampling
management (E6), distribution (7) and information (LQAS) survey. Supported pre-implementation,
systems and supportive management functions (E9) implementation and post implementation activities for
was conducted in 15 counties. the campaigns.
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2018 Annual Report
100% 100% 100%

100% 97% 98% 99% 97% 98%
96%
98% 96%
99% 98% 96% 98% 99% 97%
94% 93% 94%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Sinoe
Bomi
Bong
Gbarpolu
Grand Bassa
Grand Cape Mount
Grand Gedeh
Grand Kru
Margibi
Maryland
Nimba
Lofa
Montserrado
River Gee
River Cess
Liberia
R2 R2 Target
Figure 4.8: Administrative coverage of round 1 and 2 polio campaign 2018.
Number of <5 Conclusions Conclusions Conclusions Conclusions Conclusions Conclusions

County
Children, LQAS LQAS Feb/2017 LQAS Mar/2017 LQAS Nov/2017 LQAS Dec/2017 LQAS May/2018 LQAS Oct/2018
Bomi 60 Accepted Accepted Rejected NA Accepted NA
Bong 60 Accepted Accepted Accepted NA Accepted NA
Gbarpolu 60 Accepted Accepted Accepted NA Accepted NA
Grand Bassa 60 Accepted Accepted Accepted NA Accepted NA
Grand Cape Mount 60 Accepted Accepted Accepted Rejected Accepted NA
Grand Gedeh 60 Accepted Rejected Accepted Accepted Accepted Accepted
Grand Kru 60 Rejected Accepted Accepted NA Accepted NA
Lofa 60 Rejected Accepted Accepted Rejected Rejected Accepted
Margibi 60 Accepted Rejected Rejected Accepted Rejected NA
Maryland 60 Rejected Rejected Rejected Rejected Rejected NA
Montserrado 60 Accepted Rejected Accepted Accepted Rejected Rejected
Nimba 60 Rejected Accepted Accepted Rejected Accepted Accepted
Rivercess 60 Rejected Accepted Accepted Accepted Accepted NA
River Gee 60 Accepted Accepted Rejected NA Rejected NA
Sinoe 60 Rejected Rejected Rejected NA Accepted NA
>=90%
Legend [LQAS Coverage Band] 80%-<90% NA No Campaign
<80%
Figure 4.9: LQAS results of all campaigns conducted in 2017 and 2018.
64
All the 15 WHO county coordinators were trained on AFP Commonwealth and St Paul districts). A total of 290
and other VPD surveillance to enable them to sustain informants, 93 health workers and 14 surveillance
the gains made in AFP surveillance and maintain a officers are engaged in AVADAR and provided with
certification standard of AFP surveillance at the county mobile phones to report AFP alerts and for investigation.
and districts levels.
WHO conducted Rapid AFP surveillance 4.4 Accelerated Measles control

assessment and active case search in March and August
2018 covering all 15 counties, 50 districts and 99 health Conducted nationwide measles Campaign
facilities across Liberia. A training report was produced. (including IM and RCS) in all 15 counties and a nation-
Findings from the assessment were used to inform wide measles follow-up campaign administrative
improvement plans at national and sub-national levels coverage of 97% and 94% respectively along with
for active surveillance activities for AFP and VPDs. This partners such as UNICEF, CDC, USAID, JSI, LMH, LIP
has resulted in improved AFP surveillance indicators. etc. which was followed by Post Measles campaign
coverage survey to evaluate the coverage achieved by
AVADAR implementation is ongoing (funded by the campaign. Whereas the number of measles cases
BMGF and in partnership with Novel-t) in 4 districts of recorded in 2018 were much higher than 2017, a similar
Montserrado county (Careysburg, Central Monrovia, downward trend was noticed from Epi week 21 to 52.
Figure 4.10: Trends in numbers of suspected measles cases reported by Epi week as of week 52, 2017-2018, Liberia.
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2018 Annual Report
A total of 195 hard-to-reach, under-served and

reporting outbreak communities were visited by
vaccinators within the seven (7) days of activities.
66
WHO / P. Glee
A total of
1,264
children under 11 months were fully immunized during the AVW.
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2018 Annual Report
5 HEALTH INFORMATION, PROMOTION

AND COMMUNICATION
68
WHO in 2018 joined the rest of the world in commemoration of health days
(World Malaria Day, World Diabetes Day, African Vaccination Week, Blood
Donor Day, World AIDs Day, and World TB Day) with activities focused
on enabling the public increase control and improve their health stimulating
recommitment for support and calling for action.
5.1 Health Promotion and Disease Prevention
Health Promotion being a cross cutting and activities focused on enabling the public increase control
multi-disciplinary strategy, the WCO Health Promotion and improve their health stimulating recommitment for
unit collaborated with the various clusters in addressing support and calling for action.
the health promotion and communication needs of
the all the clusters. WHO in 2018 provided extensive WHO supported the development of a wide
support for key health promotion activities relating to range of health promotion materials, both print and
immunization campaigns, maternal and child health electronic, covering a range of issues, including Cholera,
priorities, preventing and treating communicable and Buruli ulcer, Yaws and IDSR priority diseases.
non-communicable diseases, as well as the importance
of antenatal care and institutional deliveries. In all WHO supported the MoH with the requisite
of WHO’s health promotion activities community technical and financial assistance to review and update
engagement and social mobilization strategies were messages on Health Promotion, Lassa fever and
focused at highlighting the important role played by measles and meningitis.
traditional and religious leaders, the media, youth
HEALTH INFORMATION, PROMOTION AND COMMUNICATION
clubs, sports organizations, women’s networks, service WHO in 2018 supported the Ministry of
organizations such as Lions and Rotary clubs, and the Health Communication Unit to partner with Liberia
private sector. Broadcasting System-ELBC and the Fabric FM radio
station to keep the public informed and updated about
WHO in 2018 joined the rest of the world in key health programs being undertaken through a total of
commemoration of health days (World Malaria Day, 96 interactive radio talk show programs.
World Diabetes Day, African Vaccination Week, Blood
Donor Day, World AIDS Day, and World TB Day) with
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Figure 5.1: Social mobilization activity during nationwide measles campaign.
Figure 5.2: Commemoration of World WHO Photo

Diabetes Day in Monrovia, Liberia.
In collaboration with the US-Center for Disease Control (CDC) in training 72 health promotion officers from the 15
counties on Risk Communication and health reporting.
Five (5) media briefings were organized in collaboration with the Economic Community of West African State
radio on key priority health events.
13 web articles on key national health events were developed, shared with AFRO and published on WCO website.
70
HEALTH INFORMATION, PROMOTION AND COMMUNICATION
WHO P. Glee
WHO Photo
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6 WHO FIELD OFFICES
72
One of WHO Liberia comparative advantages is presence of field offices in all the
15 counties of the country and the cordial working relationship with County and
district health teams across the country in the provision of basic health Services
under the Essential Package of Health Services as aligned to the day to day
realities in the health sector.
The WHO Field Epidemiologists (technical staff) During the period under review, WHO field teams
offer technical, logistical and financial support to the supported the Ministry of Health’s county offices (County
County Health Teams (CHT), District Health Teams health teams) in the implementation of health programs
(DHT), health facilities and communities with funding based on the national health investment plan 2015 to
support from the US-CDC, GAVI and WHO AFRO region. 2021 results of which include; 73% (570/777) health
facilities surveillance focal persons mentored by WHO
The fundamental technical support include; Field Epidemiologists and District Surveillance officers
strengthening the surveillance system through IDSR (DSOs) on IDSR priority diseases and events using ODK-
strategy, Community based disease surveillance, ISS check list improving timeliness and completeness of
Expended Program on Immunization (EPI), Infection surveillance reports to 96 and 94 respectively for 2018
Prevention and Control (IPC), Epidemics Preparedness and 7,465 priority diseases alerts reported, verification
and Response (EPR) Family Reproductive Health, and investigated with in 48hrs compared to 4,729
Maternal Neonatal and Peri-natal Death Surveillance reported in 2017.
(MNPDRS), Neglected Tropical Diseases (NTDs),Non-
Communicable Diseases (NCDs), WASH, Laboratory, WHO County Teams also supported the Training
AMR stewardship, Mental Health, data Management, and Mentorship of 1150 Health workers on AFP/VPD
TB/HIV/Hepatitis/Malaria control programs, risk active case search in 15 counties that led to national
communication and health promotion as well as health Non-AFP Polio Rate of 3.7, a 90.3% of AFP cases with
system strengthening. stool specimen collected within 14 days and 27% of non-
polio entero viruses (NPENT).
WHO FIELD OFFICES
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2018 Annual Report
Figure 6.1: WHO country office and field offices location while on the left is on job supportive supervision for community health workers by WHO field team
members.
AFP surveillance indicators by County, as of Week 52, Liberia
# of # of # of cases % of cases
Total <15 years Non-Polio # of % of
expected reported within 14 within 14
Population Population AFP Rate NPENTs NPENT
AFP cases AFP cases days of stool days stool
Bomi 103,550 46,598 1 2 4.3 2 100.0% 0 0%

Bong 410,514 184,731 4 6 3.2 5 83.3% 2 33%
Gbarpolu 102,650 46,193 1 1 2.2 1 100.0% 1 100%
Grand Bassa 272,905 122,807 2 4 3.3 3 75.0% 1 25%
Grand Cape Mount 156,429 70,393 1 3 4.3 3 100.0% 1 33%
Grand Gedeh 154,192 69,386 1 3 4.3 3 100.0% 1 33%
Grand Kru 71,291 32,081 1 3 9.4 3 100.0% 0 0%
Lofa 340,818 153,368 3 7 4.6 7 100.0% 2 29%
Margibi 258,415 116,287 2 3 2.6 3 100.0% 2 67%
Maryland 167,340 75,303 2 4 5.3 3 75.0% 0 0%
Montserrado 1,376,553 619,449 12 24 3.9 22 91.7% 5 22%
Nimba 568,754 255,939 5 7 2.7 7 100.0% 3 43%
Rivercess 82,217 36,998 1 2 5.4 1 50.0% 1 50%
River Gee 88,028 39,613 1 1 2.5 1 100.0% 0 0%
Sinoe 126,042 56,719 1 2 3.5 1 50.0% 0 0%
Liberia 4,279,698 1,925,864 39 72 3.7 66 90.3% 19 27%
% of cases within NPENT
Legend NPAFP rate >=2 >=80% >=10%
14 days stool rate
<2 <80% <10%
Figure 6.2: AFP surveillance indicators by County, as of Week 52, Liberia.
74
WHO field teams in collaborated with NPHIL, The WHO field teams supported mentorship of
MoH and partners (US-CDC, IOM, PACS, JIZ) and conduct 516 midwives on monitoring MCH progress using the
simulation exercises in Grand cape mount, Lofa, Margibi, MCH chart which has contributed to noticeable increase
Bong, Nimba, Grand Bassa and Montserrado counties in ANC visits and health facility skilled deliveries.
and lessons learnt used to strengthen the country’s Additionally, WHO supported maternal child health
readiness and preparedness capacity to prevent, (MCH)conferences held in 8 counties where county
detect, respond and control public health threats and specific MCH and MNPDSR performance was reviewed
development of contingency plans for Ebola, Lassa fever and lessons learnt being used to strengthen MNPDSR
and Cholera policy including maternal, perinatal and neonatal death
reviews aimed at reducing the maternal, perinatal and
Additionally WHO field teams In collaboration neonatal mortality rates in Liberia.
with the County health teams, US-CDC, ACCEL offered
on job training and mentorship for 1,325 HCWs in WHO vehicles in the field also facilitated joint
the application of standard universal precautions in field movements with CHTs and partners like out breaks
healthcare facilities in Grand Bassa, Rivercess and Lofa investigation and response, Integrated Joint Supportive
counties, increased the production and availability of Supervision (IJSS), bundle vaccines and medical
alcohol –based hand rub (ABHR) for use in all hospitals supplies distribution which strengthened partner’s
in Lofa and Bong counties and training 16 pharmacists collaboration and team work in field. Additionally, WHO
for scale up the production which led to Improved supported the CHTs with emergency medical supplies,
Hospital’s hand hygiene and waste management IDSR specimen collection kits, IEC materials for priority
compliance >80% as compared to < 60% in 2017 and disease and NTDs drugs which enabled the county
overall 84% IPC standards compliance (for 11 indicators) health teams extend health service to more vulnerable
an improvement of 47% from baseline. populations in Liberia.
Figure 6.3: Emergency supplies and IEC procured for county health teams to respond to disease outbreaks and NTDs.
WHO FIELD OFFICES
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2018 Annual Report
WHO County Teams also supported The WHO field teams supported mentorship of
the Training and Mentorship of
516
1,150 midwives on monitoring MCH progress using the
MCH chart which has contributed to noticeable
increase in ANC visits and health facility skilled
Health workers on AFP/VPD active deliveries.
case search in 15 counties that led to
national Non-AFP Polio Rate of 3.7.
Additionally WHO field teams In collaboration with the County health

teams, US-CDC, ACCEL offered on job training and mentorship for
1,325
HCWs in the application of standard universal
precautions in healthcare facilities in Grand
Bassa, Rivercess and Lofa counties.
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WHO Photo
WHO Photo
WHO FIELD OFFICES
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7 COUNTRY SUPPORT UNIT
78
The WCO relocated from Mamba Point –UN drive building to Pan African
Plaza-One UN building where all UN agencies are located in the same building
which has enhanced the collaboration among the UN agencies under One UN
platform coordinated by the UN resident coordinator for Liberia.
7.1 Administration, operations and Finance 7.2 Transparency, Accountability and Risk
management
The Finance and Operations team at WHO Liberia
plays a critical role in ensuring a supportive environment Transparency, accountability and risk
that enables staff to deliver on all their responsibilities management are priorities of the WHO Reform
and commitments. The Finance and Operations Team Agenda; in 2018 WHO country office-Liberia enhanced
in 2018 ensured proper implementation of financial transparency and accountability for all financial
procedures, systems and internal controls according transactions thus reducing financial risks to the
to Global Management System (GSM) instructions and Organization and its donors. Mechanisms are in place to
WHO rules. In addition, the Finance and Operations team ensure that reporting and accountability requirements
handled disbursement of funds for program activities, are met on a timely basis. The Country office follows
tracked expenditures and facilitated the timely payment procurement procedures in conformity with the UN
and transfer of funds to the Ministry of Health for polio standards. The procurement Key Performance Indicator
campaigns and program activities. Administrative and (KPI) of carrying out evaluations of current suppliers’
financial support was provided to the WHO teams in performance was maintained in 2018 in accordance
all 15 counties. The E-Imprest system was carefully with WHO procurement rules and guidelines.
managed; end-month closure reports were prepared and
submitted to the WHO Regional Office for Africa on a
monthly basis within the allocated deadlines. 7.3 Security
COUNTRY SUPPORT UNIT
The WCO relocated from Mamba Point –UN drive The Security Unit also worked closely with
building to Pan African Plaza-One UN building where all UNDSS to ensure that accurate records were maintained
UN agencies are located in the same building which has with details related to the location of accommodation
enhanced the collaboration among the UN agencies of WHO international personnel and ensured that the
under One UN platform coordinated by the UN resident Minimum Operating Residential Security Standards
coordinator for Liberia. (MORSS) were being met.
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2018 Annual Report
The WHO Liberia security KPI was met. All

UNDSS security advisories relating to demonstrations,
hazardous road conditions, or locations to be avoided
were disseminated among WHO national and
international personnel.
7.4 Human Resource
The WHO Country Office in 2016 benefitted

from the appointment of a Human Resources Officer,
who in support of the WHO Regional Office for
Africa’s Transformation Agenda has enhanced the
office’s efficiency, transparency and accountability.
Throughout the year the Human Resources team
played an instrumental role in facilitating WHO Liberia’s
transition from an emergency to recovery mode. This
included timely staffing of the relevant areas most
specifically Health Systems Strengthening, exploring
cost-effective types of contracts for United Nations
Volunteers, effective segregation of roles for members
of the administrative teams working at national level in
Monrovia and in the 15 field offices across the country,
advising on managing redundancy and separations
in accordance with the rules and regulations, and
establishing a roster for the 84 WHO drivers.
With respect to performance evaluation,

compliance with the Enhanced Electronic Performance
Management and Development system (ePMDS+) by
WHO Liberia personnel has steadily increased.
The WHO Liberia Human Resources (HR) team

throughout 2018 provided consistently high levels of
support for the 105 Personnel based at the national
office in Monrovia and at the 15 county offices.
WHO Photo
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COUNTRY SUPPORT UNIT
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8 KEY CHALLENGES
82
Despite the numerous gains made during 2018, key challenges were
experienced during the course of the operational period.
These challenges ranged from health system Majority of vaccinators not on GOL payroll and
challenges, both in terms of planning and service affects motivation to implement activities, while delay
provision, including limited technical and institutional or non-payment of incentives/ operational support to
capacity along the various hierarchy of the health system surveillance officers adversely affecting VPD and IDSR
and service delivery systems, in terms of inadequate surveillance activities while delayed disbursement of
number and limited skill mix and mal-distribution of funds from MoH national level to county levels and
health workers; management and leadership issues, liquidation of expenditures from county to national level
inadequate supply chain systems and lack of quality affecting timely program implementation.
information systems with low culture of information use
for decision making, planning and monitoring of health Unacceptably high burdens of maternal and
service delivery. There is limited fiscal space, alignment newborn deaths in Liberia: MMR of 1072/100,000 and
and harmonization of domestic and development NMR of 26/1000 (LDHS 2013) and inadequate resources
partners’ resources along the priorities set in the to address the causes of death and recommendations
national health policy and strategic plan as well as the of MNDSR reviews on top of the high staff turnover
investment plan for recovery and development of a due to low motivation. Additionally the Low capacity
resilient health system for Liberia. of health care facilities for data quality management,
KEY CHALLENGES
analysis and use at the point of collection for informed

Bad road conditions during the prolong rainy decision making and improvement of the quality of care
season that impede effective service delivery and the lack for maternal, newborn and under five years survival, IPC,
of integrated health sector progress and performance and disease outbreaks early warning, preparedness and
monitoring and review mechanism between programs response.
and the national health system are critical challenges
faced the during the implementation of its work plan.
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2018 Annual Report
The inadequate funding to

sustain WHO technical staff salaries
and programs implementation affected
catalysis of programs implemented by
MoH and the heavy reliance on WHO and
a few development partners to support
health programs implementation amidst
reducing funding remains a challenge.
The frequent stock out of basic medical
supplies, IPC supplies, on and off stock out
laboratory test kits and supplies for priority
diseases and lack of adequate dedicated
staff for the isolation units hindered the
full implementation of the IHR.
Access to safe and quality drinking

water in rural and urban Liberia is a
challenge. Robust rural and urban water
safety planning for an adequate and
safe supply of drinking water remains an
alternative, while at the same time setting
the context to combat the uncertainties
arising from changes in the climate
and environment. Some challenges
experienced by the team during this period
of response are from both the WHO and
that of partners.
Inadequate funding to support the

full implementation of IHR core capacities
across the 15 counties and the heavy
reliance on partners for funding of MoH/
NPHIL activities.
Health Promotion unit being

significant in promoting good Health was
constrained in implementing all of the
planned core activities for the reporting
period. This being due to among other
things, the shortage and unavailability of
budgetary support.
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WHO Photo
KEY CHALLENGES
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9 LESSONS LEARNT
86
Sustained partnership coordination mechanism added value for setting the agenda
for appropriate reforming of the health sector policies and strategies along the
continuous recovery and for development of a sustained and resilient health system
considering context, actors and process.
The utilization of the Health Services The use of electronic mobile data collection
Coordinating Committee, one health platform for platform (electronic IDSR, ODK for ISS, eSurv, LQAS,
sustained harmonization and alignment of stakeholders’ Measles Coverage Survey) enhanced real time
programs along a strong cooperation of the WHO with supervision, feedback and accountability of WHO
the MoH and all relevant stakeholders in the country personnel during field activities.
led to synergies in health programs implementation.
WHO’s strong engagement and cooperation with the
government and partners provided the basis for priority
health sector investment for building technical and LESSONS LEARNT
institutional capacities at all levels of the health system.
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10 RECOMMENDATIONS AND KEY ACTIONS
88
Liberia has the drive and capacity to introduce new vaccines into the routine
immunization program, however strong monitoring systems should be in-place
immediately after introduction to ensure guidelines and SOP are followed.
The IDSR system in Liberia is not yet sustainable Health partners should align and harmonize
by GOL and will require further partner support. As such, their individual plans and resources along the national
contingency measures should be in place to support the policies and plans as stipulated in the IHP+ for joint
RECOMMENDATIONS AND KEY ACTIONS

system when the surveillance officers refuse to work results while the MoH should ensure stewardship for
once operational support or incentives are delayed. implementation and accountability for results.
Strong data quality improvement systems and Innovations for increasing skilled birth
in-depth analysis to inform evidence-based decision attendants such as the task sharing programs for
making for program improvement at all levels. obstetrics and neonatal care do have notable results
and can lead to the desired pregnancy outcomes of live
Enhance WHO’s constitutional role for health healthy mother and infant.
development considering Liberia’s health sector reform
and keep momentum in supporting the technical
and institutional capacity building for health system
strengthening along the national health policy and the
investment plan.
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2018 Annual Report
WHO / P. Glee
WHO / P. Glee
90
RECOMMENDATIONS AND KEY ACTIONS
WHO Photo
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11 PRIORITIES FOR 2019
92
Major core priorities for the WHO Country Office (WCO) in 2019 include
conducting high quality polio national immunization days (NIDs) campaigns that
are integrated with high impact interventions such as nutritional supplementation
and deworming in addition to instruction of 2 new vaccines (HPV and MCV2) in
the routine EPI schedule.
PRIORITIES FOR 2019

WHO will support the implementation of WHO will support MoH, LIGGIS, NPHIL and
community health services operational plan and partners conduct of National Demographic Health
community engagement strengthening activities. Survey (DHS), DHS-Ebola and Hepatitis sero-survey,
Lassa fever risk assessment survey in 7 counties, Liberia
WHO will provide support to disseminate IDSR implementation status research and prevalence of
National cancer strategy, treatment guidelines and unintentional injuries and develop multi-sectoral action
finalize palliative care pilot at redemption hospital, plan to address the findings.
scale up to other facilities, roll out IPC, National Water
Quality Standards and Guidelines, Health facilities Also key is support in the establishment of multi-
WASH guidelines and update and roll out Liberia disciplinary rapid response committees at health facility
IDSR technical guidelines in line with AFRO-IDSR 3rd level to strengthen resilience in early disease outbreaks
Edition technical guidelines; Support MoH develop, detection, response and prevention during their first
implement and sustain a standardized and harmonized generation of cases; Scale up operationalization of the
performance monitoring, evaluation and reviews of adopted maternal newborn quality of care standards
programs and national health Plans, including, DASH in six additional focused counties: Grand Cape Mount,
BOARDS and policy briefs; Provide technical support Gbarpolu, Rivercess, Grand Kru, Maryland and River Gee
to the MoH; develop and operationalize a standardized Counties and supportive supervision and mentorship in
and integrated health information system, including, HF IDSR, data quality improvement, IPC, WASH, AMR, TB/
surveys and reviews, RDQA etc., HIV/Hepatitis services, MNH QOC health facilities for
monthly MNH QOC analysis and feedback.
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12 CONCLUSIONS
94
CONCLUSIONS
WHO is committed to continue supporting the
Government of Liberia through the Ministry of Health and
partners to strengthen the health care service delivery
as well as capacity for disaster risk management and
responding to possible emerging and re-emerging public
health emergencies including new health threats.
During the period under review, the country office

made progress in building and strengthening local staff
capacity as the number of international staff is gradually
being reduced. This is aimed at enhancing continuity and
sustainability in the execution of the country programs. The
Lessons learnt during the implementation of the 2018 work
plan, will be used to strengthen the 2019 country office plan.
95
WHO Liberia Country Office
1st Floor, One UN House,
(Pan African Plaza),
P. O. Box 316, 1000
Monrovia, Liberia
Website: http://www.afro.who.int/countries/liberia
E-mail: wholiberia@who.int

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ANNUALREPORT2018

Cover photo WHO / File photo

Editorial Team Jeremy S Sesay, Jr.

Publication management, Allan Batte

Chapter 1: Health Systems and Services ............................................................................................................................................................................................................ 20

Chapter 2: Health Emergencies ....................................................................................................................................................................................................................................... 28

Chapter 3: Disease Prevention and Control .................................................................................................................................................................................................... 44

Chapter 4: Family and Reproductive Health .................................................................................................................................................................................................... 56

Chapter 5: Health Information, Promotion and Communication .......................................................................................................................................... 68

Chapter 6: WHO Field Offices .............................................................................................................................................................................................................................................. 72

Chapter 7: Country Support Unit .................................................................................................................................................................................................................................... 78

Chapter 8: Key Challenges ...................................................................................................................................................................................................................................................... 82

Chapter 9: Lessons Learnt .................................................................................................................................................................................................................................................. 86

Chapter 10: Recommendations and Key Actions ................................................................................................................................................................................... 88

Chapter 11: Priorities for 2019 ...................................................................................................................................................................................................................................... 92

Chapter 12: Conclusions ....................................................................................................................................................................................................................................................... 94

ACCEL Academic Consortium Combating Ebola in Liberia

- Dr. Mesfin G. Zbelo -

Dr. Mesfin G. Zbelo

The report proposes

Liberia is located in West Africa, bordering Sierra

It is pertinent to note that WHO in

It is pertinent to note that WHO in consonance

partners to sustain the momentum in the

1 HEALTH SYSTEMS AND SERVICES (HSS)

HEALTH SYSTEMS AND SERVICES

Operational plans for Integrated Disease

The Ministry of health, with the technical and financial

In a view to integrate and align disease-specific

The WHO also guided technical experts from

Approximately 24 Health managers

WHO / P. Glee The WHO country office in

Using the WHO standard national

Figure 1.7: Regular Joint Partners’ Coordination Meeting, 2018, Liberia.

A report on analysis of the National health accounts 1. Implementation of the recommendations of

Partnerships between MoH, WHO, UNFPA and MCAI

HEALTH SYSTEMS AND SERVICES

The WHO health services and systems

Figures 1.9 and 10: Task sharing project products. Trainees,

Dr. Johnson Medical Director at CH Rennie Hospital, with

The WHO funded an additional 5

2 WHO HEALTH EMERGENCIES (WHE)

WHO HEALTH EMERGENCIES

Figure 2.2: Monitoring IDSR key performance indicators: 2016 - 2018.

Comparison of Selected IDSR Performance Indicators from 2016 to 2018, Liberia

100 100 100 100 400%

51 health workers trained in Influenza surveillance,

WHO HEALTH EMERGENCIES

Piloted the revised AFRO 3rd IDSR technical

WHO supported the implementation and

2.2 Emergency Preparedness and Response e. Orientation of 25 staff at Redemption hospital

2.3 Water, Hygiene and Sanitation and

WHO HEALTH EMERGENCIES

NPHIL Photo LWSC Photo

Figure 2.8: A - IPC Guidelines Orientation Workshop; B - National IPC Guidelines.

National Level Health Facility Level

National hand hygiene self-assessment framework compliance (%) per county:

WHO HEALTH EMERGENCIES

WHO HEALTH EMERGENCIES