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Introduction to the Special Collection: HRSA’s PEPFAR-Supported Resilient and Responsive Health Systems Initiative in Liberia

Liberia was declared free of Ebola in September 2015. In the aftermath of the Ebola epidemic, the Government of Liberia moved rapidly to “develop a resilient health workforce through focused investments that would (1) address Liberia’s severe shortage of skilled health workforce, (2) achieve a more rational geographical distribution of clinical workers, (3) improve the management of public-sector health facilities, (4) enhance infrastructure and equipment in the country’s teaching hospitals, and (5) expand community-­‐level access to health care. To achieve these objectives, the Government of Liberia developed a 7-­‐year Health Workforce Program (2015-­‐ 2021)”¹ and discussed support for the Program with international partners.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), was among the international partners that answered Liberia’s call. PEPFAR made a $10 million investment in Liberia’s health system over five years, with the request that prevention and treatment of HIV be emphasized. The U.S. Health Resources and Services Administration, through its partner Brigham and Women’s Hospital, administered the project. The following were key program elements:

Improve pre-service training for future care providers

Physicians

- Strengthen and seek accreditation of the Internal Medicine residency program.

Nursing and midwifery

- Revise, update and disseminate national training curricula for nurses and midwives. - Support classroom mentorship and pedagogical support for key nursing and midwifery training institutions, including Liberia’s only rural public university. - Support a new Master’s-level midwifery program.

Health Managers

- Create an executive education-style course for hospital administrators, department supervisors and program managers.

Conduct in-service training for current care providers

- Deliver a broad range of workshops to train physicians, nurses and midwives on essential concepts and skills, emphasizing HIV prevention and treatement. - Create Liberia’s first accredited Continuing Professional Development course for nurses and midwives, building a national system to support future courses. - Provide continuous, inter-professional bedside mentorship to ensure that core concepts are applied to patient care.

Strengthen direct service delivery in clinics, including HIV clinics

- Implement quality improvement projects at the two largest HIV clinics in Liberia, including introduction of Non-Communicable Diseases screening, strengthening of viral load systems, and launching an electronic health records strategy. - Launch HIV index testing services and support for key populations in Maryland County.

This collaboration between the Government of Liberia, the U.S. Government, implementing partners, and other global and regional collaborators including Stellenbosch University, produced multiple positive impacts and established a new trajectory for Liberia’s clinical training programs.

The papers presented in this Special Collection present examples of this work. They include descriptions of educational programs, document the strengthening of Liberia’s health workforce that resulted from these interventions, and demonstrate improvements in health.

On behalf of the people of Liberia, I am pleased to see the progress in strengthening the health workforce in Liberia that has resulted from these national and global partnerships. We would like to acknowledge Annals of Global Health for publishing this Special Collection reflecting this important work in Liberia.

Bernice T. Dahn, M.D., MPH Vice President for Health Sciences, University of Liberia Former Minister of Health for the Republic of Liberia

Reference

¹Liberia Health Workforce Program (fy2015-2021), Health Work Force Program Strategy, January 2016