After Ebola: Ensuring Better Water and Sanitation for Health in Liberia

A health worker in Liberia washes his hands.Photo credit: Cindy Shiner/MSH

Following a 13-year civil war, Liberia's health system was decimated. Clinics had been looted and destroyed, many health workers had left the country, and the Ministry of Health barely existed. Although conditions have improved considerably over the past decade, much work remains to be able to deliver consistent, quality services to Liberia's four million people and to be able to meet the Sustainable Development Goals. 

This need was most stark during the 2014 –2015 Ebola epidemic, which exposed the health system’s fragility. 

Ebola claimed the lives of nearly 5,000 Liberians, including more than 150 health workers.

Through the US Agency for International Development (USAID) Collaborative Support for Health (CSH) program, MSH is assisting the Health Ministry to strengthen Liberia's health system. MSH's support includes working with the Ministry of Public Works to improve management of its infrastructure, including wells in rural areas.

The Liberian government and its partners emphasized the need for handwashing stations for all health facilities during the Ebola epidemic to help stem the spread of the virus. An effective water supply is critical not only during outbreaks, but also for day-to-day health service delivery.

Many health facilities in Liberia lack consistent access to water to help prevent spread of disease. Handwashing, having clean toilets, or being able to sterilize and sanitize tools and work areas are not problems unique to Liberia. Nearly half of health care facilities in at least 22 other African countries lack access to an improved water source, according to a 2015 World Health Organization report.

Diarrheal diseases, largely linked to poor hygiene, are leading causes of childhood morbidity and mortality in Liberia. 

Clean water can be hard to come by in Liberia. More than half of the country's wells dry up or break down within five years, according to MSH Collaborative Support for Health partner the Development Innovations Group. Acquiring spare parts to repair a well or getting someone who can perform the job can be problematic.

When communities do have a consistent clean water supply, they are protective of it. The village of Salala, for example, limits the amount of water that a nearby clinic can use.

With improvements underway by the CSH program to better manage Liberia’s water points, more health facilities will have improved access. MSH partner Development Innovations Group is working with the Ministry of Public Works to improve its capacity to manage the water sector. The ministry is building its expertise and is working on ways to better coordinate the nongovernmental organizations working in the sector. To properly manage water points, it’s essential to first know where they are, which are no longer functioning, and which are under construction.

In the meantime, as devastating as the Ebola epidemic was, it did result in bringing greater attention to water, sanitation, and hygiene in Liberia. President Ellen Johnson Sirleaf has highlighted the sector as a priority of her administration. And Liberians, in general, have a greater understanding about the importance of handwashing to prevent disease.

 Photos by Cindy Shiner/MSH