Liberia: A Government Assessment Shows Liberia Is 69 Percent Ready for Ebola. Frontline Health Workers Say the Missing 31 Percent Matters

Dr. Sia Wata Camanor, National Public Health Institute of Liberia’s acting director general, spoke at the Ministry of Information press briefing this month, where she released the findings of the Institute’s Ebola preparedness assessment.

Summary:

• A nationwide Ebola preparedness assessment found Liberia 69 percent ready overall, while logistics scored only 47 percent, leaving major gaps in equipment, supplies, isolation facilities and training.

• Frontline health workers say those logistics gaps can mean the difference between safely isolating a suspected patient and exposing staff, other patients and communities.

• Health authorities say they are tightening procedures at major points of entry, but the next steps, funding and timetable for closing the gaps remain unclear.

---

***By Augusta S. Lafalay, senior reporter with New Narratives ***

---

Liberia has stronger disease surveillance and laboratory systems than it did during the 2014 Ebola crisis, but the country is still only 69 percent prepared to respond to another outbreak, according to a nationwide Ebola preparedness assessment by the National Public Health Institute of Liberia. The weakest area was logistics, which scored just 47 percent.

At a September press conference to release the findings of the assessment, Dr. Sia Wata Camanor, acting Public Health Institute director general, said the country was in the “medium” preparedness range. “We don’t have the tools. We don’t have the materials,” she said. Though the risk remains low, she warned against complacency.

Health experts welcomed the government’s transparency, but they said that the number is more than a technical score. It points to shortages and weaknesses in the things health workers would need first if a suspected Ebola patient arrived at a clinic or hospital: personal protective equipment, functioning isolation space, transport, laboratory supplies, ambulances, trained staff, and a system able to move those resources quickly.

“When we say there is a lack of logistics, it can sound like we are simply talking about supplies. But for a health worker, it is much bigger than that,” said Lela Dolo, executive director of Help a Mother and Newborn in Liberia and a medical student training to become a doctor. “Do I have the personal protective equipment I need? Can a suspected patient be safely isolated and referred? Can a specimen be transported quickly? Is there an ambulance or vehicle available? Can the response team reach the community?”

The question is foremost in the minds of the country’s healthcare workers who bore the brunt of the disease in 2014. If an Ebola case reaches the country, gaps could put frontline workers at risk, slow the response and increase the chance that an infection spreads beyond a health facility and into communities.

The National Public Health Institute of Liberia’s assessment, conducted across all 15 counties, examined surveillance, points of entry, emergency operations centers, laboratories, isolation facilities, county health teams and rapid response structures. Health authorities have said surveillance officers and rapid response teams are operating nationwide, while laboratory testing and specimen transport have improved. But officials also identified the need to replenish protective equipment, maintain isolation facilities, run more simulation exercises and continue training newly deployed health workers.

For Liberia, the warning carries a painful history. During the 2014-2015 epidemic, 378 health care workers in Liberia had confirmed Ebola and 192 died, according to a U.S. Centers for Disease Control and Prevention review. Weak infection-prevention systems left health facilities vulnerable, with many lacking triage and isolation protocols, protective gear, or running water early in the crisis.

The toll weakened a health system that was already short of skilled workers. The infected health workers represented about 12 percent of Liberia’s confirmed Ebola cases, even though health workers made up only a small share of the population. Early in the epidemic, many facilities closed after transmission occurred among staff. Health workers who did not feel protected, walked away.

Dolo said the Liberian health system has learned from the last epidemic and has stronger surveillance and response systems. Her concern is whether those systems are backed by the practical resources needed when an emergency begins.

“You can train health workers to recognize Ebola and follow the right protocols, but knowledge alone cannot protect them,” she said. “They also need the tools and systems to safely do what they have been trained to do.”

Joseph Somwarbi, a pharmacologist and former head of the Legislature’s health committee, said logistics failures can quickly become safety failures. He said all parts of the chain must work together.

A shortage in one part of that chain can put frontline staff in a dangerous position. If protective gear is insufficient health workers may have to delay care or risk exposure. If laboratory agents or specimen transport are unavailable, confirmation can take longer. If supplies are concentrated in Monrovia, rural facilities can lose valuable time waiting for materials to arrive.

“Delay in procurement, delay in transportation means no access,” Somwarbi said. “No access means not available. Not available means you’re not prepared.”

Those weaknesses become especially serious in an Ebola outbreak, he said, because the first response begins before laboratory confirmation. A patient with symptoms and a relevant exposure history must be identified, separated from other patients, reported to surveillance teams, safely assessed and tested, while health workers use infection-prevention measures. Contacts may then need to be identified and monitored.

“When the system is not prepared, even 24 hours is too much of a time for disease to spread,” Somwarbi said.

The threat of Ebola remains constant. The latest outbreak in the Democratic Republic of the Congo (the country’s 17th outbreak) has reached 7,890 confirmed cases and 3,799 deaths, according to the World Health Organization, making it the second largest outbreak after the 2014 outbreak in West Africa. Experts said cuts to international aid, especially by the United States, have dramatically reduced the capacity to contain the virus. That same outcome would likely play out in Liberia, which relied heavily on U.S. help to stamp out the 2014 outbreak, were the virus to reach the country.

Liberia has responded to the DRC’s outbreak by increasing screening and surveillance at airports, seaports and land crossings. Travelers are required to cooperate with screening and reporting procedures. Procedures, health experts said, are in place to make clear who screens travelers, what happens when someone meets a suspected-case definition, how referral and transport should work, and how information moves from border health staff to surveillance and response teams.

But the country has struggled with capacities at points of entry. A 2024 peer-reviewed evaluation of eight designated Liberian points of entry found gaps in areas including quarantine, communication, water, electricity, transport, and trained personnel.

Experts said the importance of clear procedures was underlined in May, when health authorities monitored 16 travelers arriving from countries of concern. None developed Ebola symptoms during the required 21-day follow-up, according to the Institute. But a WhatsApp voice message circulated claiming suspected Ebola patients had been taken to John F. Kennedy Medical Center, sparking fear and mistrust in the community.

Experts said the incident highlighted a basic communication challenge: officials needed to clearly communicate to the people what they were doing to increase trust. Dr. Camanor’s press conference and transparency about the assessment were a sign the government has learned from the May experience.

From here, Camanor said the assessment findings would be shared with the Ministry of Health, World Health Organization and other partners, and that the National Public Health Institute planned to take the findings to the Ministry of Finance, Cabinet and Legislature to seek support for closing the gaps.

In May, Dr. Louise Kpoto, the health minister, told lawmakers that the Ebola preparedness budget was $US4.2 million.

FrontPage Africa/New Narratives contacted Dr. Kpoto and National Public Health Institute leadership by telephone and email seeking answers on what the government will do next, whether any of the $US4.2 million has been approved or released, a timetable for addressing the gaps, and how progress will be measured. Neither responded by the publication deadline.

Somwarbi said a follow-up assessment would be one way to show whether new spending improves preparedness. That would allow the public and health workers to compare the current weaknesses with what has been fixed, rather than relying only on promises or budget figures.

For Dolo, the practical test is simpler. “If the first suspected Ebola patient walks into a health facility tomorrow, does the health worker who meets that patient have everything they need to recognize the risk, protect themselves, protect other patients and activate the response system immediately?” she asked. “If the answer is not yet a confident yes, then there is still work to do.”

This story was a collaboration with New Narratives****** as part of the Investigating Liberia project. Funding was provided by the Swedish International Development Cooperation Agency. The funder had no say in the story’s content.******