Monrovia, 27 July 2023: The World Health Organization (WHO) and partners continue to support Liberia's Ministry of Health (MoH) to revolutionize the country's emergency health system and enhance the quality-of-service delivery. This collaboration is driven by a shared vision of providing quality essential health services to all, with a specific focus of ensuring timely access to acute care for time-sensitive conditions and appropriate referral care.

Liberia, like many countries, faces challenges in its capacity to provide emergency and critical care services. The MoH Health Information System (HIS) report of 2021 revealed a startling statistic: out of 48,588 hospital admissions, only 257 individuals (0.5%) had access to facility-based emergency or critical care. Recognizing the urgent need for improvement, Liberia conducted an Emergency Care Systems Assessment (ECSA) in 2022, leading to the development of a maiden costed comprehensive plan with 40 key priorities to strengthen the emergency care system.

To address these priorities and improve emergency care, Liberia adopted a phase approach in the implementation of the Emergency Care Toolkit (ECT) between December 2022 and May 2023. The ECT is designed to enhance the capacity of the MoH and its stakeholders, empowering them to lead and transform emergency care in the country. WHO has provided crucial institutional support, including training for providers and Training-of-Trainers (TOT) sessions. The support package also included assessment of Hospital Emergency Units in 10 pilot referral hospitals across six counties: Montserrado, Grand Bassa, Bomi, Margibi, Bong, and Nimba. Additionally, a national-level ECT workshop was conducted, involving decision-makers, partners, and stakeholders. WHO played a pivotal role by providing financial, material, and technical support to the process. Part of the material support included the provision of electronic gadgets, didactic material and manikins to facilitate the assessments and training workshops. Moreover, WHO facilitated the reorganization of emergency rooms in key healthcare facilities in Liberia, such as John Fitzgerald Kennedy (JFK) Memorial Hospital, Redemption Hospital and the 14 Military Hospital, which will collectively serve over 2 million Liberians, representing about 38% of the country’s population.

Dr. Jerry Brown, the Chief Executive Officer (CEO) of JFK hospital, expressed pride in the country's progress in emergency care. He reflected on the initial stages when they relied on facilitators from other countries to implement the Emergency Care Toolkit (ECT) training program but can now conduct the training independently,

“I remember several months back when we sent the first team to Ghana for training in Basic Emergency Care(BEC) with an aim of them roll out the training in Liberia- upon return, we still had to rely on facilitators from other countries to first work along with them. But now, I am happy we are able to do it all by ourselves. This is why I want us to give ourselves a big hand of applause”, exclaims Dr Brown.

The impact of the initiatives is already evident. The Basic Emergency Care (BEC) training resulted in the certification of 71 BEC providers in all 15 counties in Liberia, 15 provisional facilitators, 1 registered facilitator and 4 Master trainers. Additionally, 53 national and sub-national stakeholders, including clinicians, managers, and policymakers, have benefited from the ECT and Interagency Integrated Triage Tool (IITT) programs. Among the notable success highlights are the reorganization of emergency rooms in ten referral hospitals and development of tool and indicators to monitor ECT implementation. Additionally, countless individuals have experienced improved emergency care, including proper patient triage and more effective treatment.

The WHO country office focal point highlighted the importance of the ECT in reducing patient morbidity and mortality more importantly in resource-limited settings like Liberia.

“The interventions under the ECT are simple and practical to implement, requiring minimal financial resources. There is a lot the medical directors and clinicians can do to improve emergency care in Liberia with the knowledge, skills and competencies they have acquired from the workshop.”, explained Dr. Ocan Charles.

Moving forward, WHO and the MoH will establish a national Technical Working Group (TWG) to steer the implementation of the national roadmap for emergency care.  The TWG will continue to provide support for the implementation and monitoring of priority interventions outlined in the ECT. Additionally, WHO will assist the MoH in analyzing and disseminating findings from the Hospital Emergency Unit Assessment Tool (HEAT) assessment conducted in 10 referral hospitals.

As Liberia strengthens its emergency care health system, it moves closer to achieving Universal Health Coverage and ensuring equitable access to quality essential health services for all citizens.