Publish latest health data (LR0048)

Milestone Activity With a Verifiable Deliverable Deadline: Responsible agency 1. Collaborate with government ministries and agencies to acquire latest health census data including healthcare facilities Begins June 2020 and ongoing until July 2021 iLab-Liberia 2. Clean, analyze, visualize and map all healthcare facilities, COVID-19 facilities, Cases. Develop both digital and printed maps, create infographics, and covert data to various open data formats to be reused. Begins July 2020 and ongoing untilAugust 2021iLab-Liberia 3. Create an online repository to house all products, share printed maps with County Health Teams, shared digital contents with all stakeholders and the general public through emails, newsletters, social media, blogpost and in person. Begins August 2020 and ongoing until August 2021 iLab-Liberia

Action Plan Review

Commitment 12: Monitoring and Next Steps II

● 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 12. MONITORING AND NEXT STEPS

● 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

Desk review indicates that civil society organization iLab, with information from National Public Health Institute of Liberia and MoH, put out COVID-19 data visualization for the period March–August 2020. Visualization covered COVID-19 rapid-response functional healthcare facilities, cases per county, cases per month, and cases per gender. [88] ILab also prepared an Excel spreadsheet with detailed information on the rapid-response healthcare facilities across all counties. [89] There was no evidence on how this data is being used by government, CSOs, citizens, or other actors. There is also no evidence of this information being disseminated through emails, newsletters, social media, blog posts, or in-person meetings. There is no evidence that there were printed maps or that the visualized data was converted to various data formats to be reused.

The OGP Facebook page reported that with funding from the Government of Liberia, the OGP Liberia Secretariat conducted a survey to monitor and track the impact on citizens of the government COVID‑19 response. Enumerators were trained across five locations in Montserrado. These districts were selected based on Ministry of Health information. [90] The report indicates that government officials were unwilling to release information for public consumption. Most respondents had received government information on COVID-19 through diverse platforms. However, more funding for this was required, and the report recommended that committees set up by government during emergencies should work with statutory public institutions in execution of their mandate. [91]