Train health professionals and open health data (LR0042)

• Effective, Efficient, and Equitable: How Open Government Can Deliver on Vaccines (March 15, 2021)

6.1 Improve health care service delivery- through training and use of technology; 6.2 Open data on medical supply chain management and aid, including on emergency procurements during disease outbreak; 6.3. Improve engagement with health officials at the national, district and county levels. The following milestones will be reached to fulfill the commitment: 1. Train health care professionals as 1.1 Community Health Service Supervisors 1.2 Community Health Assistants 2. Draft guidelines in consultation with the public, CSOs, healthcare professionals and providers, and other relevant stakeholders to improve public healthcare service delivery processes; 3. Disclose medical drugs supply chain management decisions and updates, including on emergency procurements such as the ongoing COVID-19 pandemic; 4. Engagement with health officials at national, district and county levels for better service delivery: 4.1 Activate and orient county health board members in all 8 counties with public health facilities; 4.2 Ensure boards within these 8 counties are functional (and meet once every two months) and make minutes of the meetings available on the Ministry of Health website; 4.3 Develop resource allocation formulae to guide the distribution/ budgetary allocation to facilities and counties based on clearly defined parameters; 4.4 Track implementation of the MOH national operational plan at facility, district and county levels through the Verification of Implementation (VOI) developed by the MOH M&E Unit. The commitment will increase access to healthcare services by recruiting and training healthcare professionals. It will create guidelines, track supply chains, and involve county health boards in oversight of processes. It will increase public awareness by opening up information on supplies, budgets and facilities- more information on current spending can enable better decision-making through citizens' input, which may lead to a more efficient system that can serve more people, more equitably. This will increase transparency and accountability by tracking resource allocation. Milestone Activity With a Verifiable Deliverable Deadline: Responsible agency 1. Train healthcare professionals 1.1 Recruit, train and deploy 100 qualified health professionals as Community Health Service Supervisors in 8 counties where National Community Health Assistant Program gaps exist. Begins January 2021 and ongoing until December 2022 Ministry of Health (MoH) 1.2 Recruit, train and deploy 989 qualified community members as Community Health Assistants (CHA) in five counties where CHA gaps exist. Begins January 2021 and ongoing until December 2022 MoH 2. At least 2 consultations per year with public health officials, including at the county level, to understand their needs and feed into the health care budget Begins January 2021 and ongoing until December 2022 MoH 3. Track health resources (budget, medical supplies), distribution- including for COVID-19 Begins January 2021 and ongoing MoH pandemic recovery and response- and publish quarterly reports on an online portal. until December 2022 4. Engagement with health officials at national, district and county levels for better service delivery 4.1 Activate and orient county health board members in all 8 counties with public health facilities. Begins January 2021 and ongoing until December 2022 MoH 4.2 Ensure boards within these 8 counties are functional (and meet once every two months) and make minutes of the meetings available on the Ministry of Health website Begins January 2021 and ongoing until December 2022 MoH 4.3 Develop resource allocation formulae to guide the distribution/ budgetary allocation to facilities and counties based on clearly defined parameters. Begins January 2021 and ongoing until December 2022 MoH with MoFDP 4.4 Track implementation of the MOH national operational plan at facility, district and county levels through the Verification of Implementation (VOI) developed by the MOH M&E Unit Begins January 2021 and ongoing until December 2022 MoH

Action Plan Review

Commitment 6: Improve and Open Healthcare Delivery

● Verifiable: Yes

● Does it have an open government lens? Yes

● This commitment has been clustered as: Open Healthcare Delivery (Commitments 6 and 12 of the action plan)

● Potential for results: Substantial

Commitments 6 and 12: Improve and Open Healthcare Delivery (Ministry of Health, iLab Liberia)

For a complete description see commitments 6 and 12 in https://www.opengovpartnership.org/documents/liberia-action-plan-2020-2022/

Context and objectives

This cluster represents a new policy area in Liberia’s OGP action plans. Commitment 6 is a direct result of citizen input during co-creation and aims to increase citizen involvement and understanding of health service delivery. [56] Open government activities include government and civil society collaboration to develop guidelines for health services, an increased medical supply chain, and emergency procurement transparency. County health boards would bring together local administrative officials, key citizens, health practitioners, and civil society organizations. [57] The commitment aims to address challenges facing Liberia’s healthcare system, such as lack of adequate health services and facilities, low accountability in health supply chains, lack of public information on health services, and low citizen participation in the management of healthcare delivery.

In Commitment 12, iLab Liberia commits to collect, analyze, visualize, and share healthcare data. These reforms are relevant to the OGP values of transparency and civic participation.

A 2021 Afrobarometer survey found that while most Liberians approve of the government’s COVID-19 response, 78 percent believe that relief is not being distributed fairly. Very few citizens trust the government’s COVID-19 statistics, and 81 percent believe that “some” or “a lot” of COVID-19 resources were lost or stolen due to government corruption. ^[58] Ensuring an open and accountable response to COVID-19 is vital to saving lives and restoring citizen confidence in the government.

Potential for results: Substantial

The Ebola outbreak exposed the cracks in Liberia’s fragile healthcare system. Government resistance to transparency and to partnering with civil society severely weakened the response. ^[59] The corruption, endemic throughout the Liberian government, also led to the siphoning off resources intended to address the emergency. Resultantly, citizens’ trust in the government decreased, along with their willingness to follow government health guidelines. ^[60] Similarly, the COVID-19 pandemic has placed a significant strain on Liberia’s healthcare system, as well as the relationship between Liberians and their government.

This commitment’s open government opportunities lie in the Ministry of Health’s aim to disclose health service data (milestone 3) and increase collaboration among local administrative officials, key citizens, health practitioners, and civil society organizations through county health boards (milestone 4). Like many countries, Liberia has received large aid packages to shore up the healthcare system’s COVID-19 response. ^[61] Ongoing and comprehensive government disclosure of health funding and supply distribution would enable civil society and the media to track the government’s pandemic response.

Such external scrutiny can complement government efforts to uncover inefficiencies and discrepancies along the supply chain. This, in turn, promises to strengthen Liberian and international partners’ confidence in Liberia’s healthcare delivery. Such efforts are vital, as 78 percent of Liberians believe that relief is not being distributed fairly. ^[62]

For substantial results, the Ministry of Health should go beyond passive release of healthcare data to actively collaborate with civil society to monitor the distribution of vital health goods. Therefore, county health boards serve as the crux of this commitment, as they can contribute to, verify, and act on information released by the Ministry of Health. Milestones 1 and 2—to increase the number of health workers and improve communication—are undoubtably important during a pandemic. However, these activities are not related to open government and therefore are not the focus of this analysis.

At the time of writing, iLab Liberia had already collected health census data, created graphs and maps (available online), ^[63] and released downloadable open data. ^[64] Prior to iLab Liberia’s efforts, the latest health facility data for Liberia was from 2017. ^[65] The data is thorough and well presented. The next step involves ensuring that the data is used by the government, civil society, and the public to make informed decisions. Moreover, collaborative implementation of this cluster by iLab Liberia and the Ministry of Health could be a creative and effective path to furthering these reforms.

Opportunities, challenges and recommendations during implementation

In 2014, Sierra Leone adapted OGP commitments to publish Ebola outbreak and international assistance data. Sierra Leone’s Development Assistance Data now houses COVID-19 aid information. At the local level, Elgeyo Marakwet, Kenya, and Kigoma-Ujiji, Tanzania, have both committed to medicine supply chain transparency. ^[66] These examples provide useful roadmaps but also indicate the difficulty of sustaining reforms over time.

The Ministry of Health should develop a continuity plan and make sure reforms are sufficiently institutionalized so that they continue after the COVID-19 emergency has passed. Additionally, the government should partner closely with civil society that can carry forward reforms when changes in government leadership occur. ^[67] Developing these institutions with an aim for long-term use would make Liberia’s healthcare system more resilient in future crises. Specific recommendations for implementation of this commitment include the following:

County Health Boards

• The Ministry of Health should empower county health boards with sufficient authority to actively monitor and raise recommendations and concerns around healthcare supply chains and delivery.
• The Ministry of Health should ensure that the perspectives of vulnerable sectors of the population are represented on county health boards.
• The Ministry of Health could consider how to expand citizen participation nationally, as the commitment aims to institute boards in eight out of 15 counties.
• The Ministry of Health should publish county health boards’ mandate, membership, meeting minutes, and communications in a timely manner.

Healthcare Transparency

• The Ministry of Health should publish the resource allocation formula that guides supply and budget distribution to counties and the Ministry of Health monitoring and evaluation unit’s findings.
• Given that iLab Liberia has experience visualizing and publishing health data, the Ministry of Health could collaborate with that organization to ensure data is in accessible formats that meet the needs of county health boards, the media, and civil society at large.

Results Report

Commitment 6. IMPROVED AND OPEN HEALTHCARE DELIVERY

● Verifiable: Yes

● Does it have an open government lens? Yes

● This commitment has been clustered as: Open Healthcare Delivery (Commitments 6 and 12 of the action plan)

● Potential for results: Substantial

● Completion: Limited

● Did it open government? Marginal

This commitment focused on improving healthcare service delivery through training and use of technology; opening data on medical supply chain management and aid, including on emergency procurements during disease outbreak; and improving public participation in healthcare management at the national, district, and county levels. [75]

Analysis of this commitment focused on milestones 3 and 4, which had the strongest connection to open government. The Ministry of Health (MoH) has made initial progress toward milestone 4 to operationalize County Health Boards (CHBs) in eight counties. A focal point for the commitment, Dr. Justine Korvoyan from the MoH, stated that there has been progress in tracking health resources and in setting up functional CHBs in five counties: Margibi, Grand Cape Mount, Grand Bassa, Grand Gedeh, and River Cess. According to MoH documents, the boards aim to include representatives from local government ministries; traditional councils; nongovernment and faith-based organizations; youth, labor, and women leaders; and non-voting county health officials. The boards’ mandate includes decision-making and oversight of healthcare delivery at the county level. In 2020 and 2021, board members received training in their role and functions. The MoH has also developed and shared reporting templates as part of the training. [76] As the existing boards have not yet begun to execute their mandate, this commitment is evaluated to have made only marginal progress at the time of assessment. However, this reform could build toward notable open government results should the boards be instituted across counties and become operational.

The IRM researcher did not find evidence that the MoH has implemented milestone 3 to publish quarterly reports on health resources, particularly those related to COVID-19. Korvoyan reported that the MoH has employed supply chain experts and established a system to track flow of medical drugs from the source to the facilities. [77] He noted that procurement for COVID‑19 supplies is ongoing. However, the IRM did not receive evidence on transparency efforts related to health procurement. The IRM researcher did not receive a response to a request for information on the progress on the remaining milestones.