Providing women's preventative health education and medical clinic services in Margibi County

In response to the total breakdown of the healthcare system, we have accelerated our capacity building efforts in Kakata. We have hired and are training additional Community Health Workers to improve our reach into the communities and have constructed a new purpose-built facility. Once operational our new facility will provide the basic infrastructure to provide all comprehensive basic services, including eye and dental care. This facility will fill a major gap in health infrastructure in the community that had existed long before the Ebola crisis. With lab and ultrasound imaging services onsite we will have faster, more accurate diagnoses. We will be able to offer space for overnight, short stays during the long, 8 month rainy season for birthing or hospital aftercare. Medical outcomes will be substantially improved.

The Vision of Healthy Women, Healthy Liberia is to transform communities using community based healthcare models for medical and dental care through education and services, especially to women and children. To be successful community based healthcare programs require community leaders to understand issues that impact health and take responsible action. To promote the changes necessary to improve the health of every community member. It requires leadership and investment of time and resources by both leaders and community members. HWHL provides support and medical resources. The Ebola crisis focused discussions and solutions at a community level with immediacy and in some ways moved the process forward. Our objective now is to continue the discussion, to leverage the same sense of urgency for other critical community health issues. In 2016, we expect the number of community health workers (CHWs) to remain the same and community participation to continue at just under 15,000. The four CHWs in training in Ghana will be replaced, as when they return they will assume new roles. Community health education and home care programs will change only with the normal addition of new education topics identified during the year. In the past two years we have expanded services for young mothers pre and post natal care, infant care, child spacing, sexual and reproductive health. We would like to expand these programs further and include young fathers or young couples. Although abortion is illegal we are seeing more post abortion cases. In fact, sudden death from an infected abortion is a leading cause of female teen deaths. Child marriage is still an issue leading to a wide variety of health related issues in young girls. All of the growth in HWHL services and staff will be in the new Medical Center clinic medical and dental services, pharmacy, laboratory and ultrasound services. The clinic staff will more than double with a number of new, higher level positions. When the Medical Center opens and is fully operational, we expect the number of patient contacts to double to nearly 30,000 annually. As we prepare to open the new Medical Center hiring and training staff is the highest priority. In the next few months we will be adding a physician, dentist, nurses, lab technicians, pharmacists and supporting staff, 23 new positions have been identified to be filled as funding allows. The wage cost of this expanded staff is estimated at $5,700 per month, which reflects the costs under “normal conditions”, but the challenge is finding trained staff to fill these positions. The school closings have worsened the already critical shortage of available medical personnel with few new graduates in 2015. We believe that the advantage of having a new, modern facility will help in attracting new staff, but we may need to rely on contract labor initially. Liberia has for many years published National Therapeutic Guidelines and an Essential Medicines List, which provide guidance in care for all medical practitioners and pharmacy dispensers. For the HWHL pharmacy in addition to ample shelving and good lighting, we need a computer(s) with a battery backup power source since the solar power system may be intermittent during the long rainy season. Pharmacy software systems are available from several sources. The pharmacist we hire will have input into the software purchase after consultation with the National Pharmacy Board. A printer and Rx label printer are required, as well as counting trays and spatulas, various liquid measuring devices, vials and bottles, an ointment slab, a digital electronic scale, a glass mortar and pestle to compound pediatric doses from adult meds, storage bins, paper bags and a stapler, and small and large zip lock bags. We need to invest in a a small medical library of medical and pharmacy reference materials at a minimum a current Physician’s Desk Reference (PDR for the Docs) and Facts and Comparisons (for the pharmacists). While this sort of information is available on line, the reliability of the intermittent internet in Liberia is not adequate for day to day use in our clinic. All of our systems and data needs to be available within our clinic with a server, backed up with uninterruptable power supplies. The cash economy in Liberia makes all financial processes more complex. Essentially there are two processes for every one transaction, one to get the cash and the second to make the actual purchase or payment. Automating the cash management and inventory management processes in Liberia will substantially improve our ability to track shortages and plan and schedule donations and purchases, but will required administrative staff trained in computer skills. Our primary goal is to engage everyone in the community in improving their health, while supporting those with health issues with medical services. We would like every woman and girl to be empowered with the knowledge to manage her own health and to access care when appropriate to keep herself and her family healthy. We recruit workers from the communities in which they serve, generally they are selected by their Community Leaders or elders, who have an interest in their success. Our very long term goal is to find partner ngos, government agencies, churches or schools, and transfer successful programs, so we can focus on solving the next problem. The long term impact will be a healthier, more productive community. To our knowledge ours is the only program focused on preventative healthcare for women and girls in Liberia. We believe this clinic will be a worthy model for other new clinics to open in Liberia in the future to meet the health goals of the nation.

1. Evidence of God and Christ's community in action every day at HWHL. 2. Active participation in HWHL health programs by all community leaders and community members in every Margibi County community with open discussion, prioritization and resolution of critical community health issues. 3. Improved health and life expectancy for every person in Margibi County. 4. Young mothers/couples knowledgeable of how to care properly for their children and each other. 5. Women empowered to manage their own health.