Table 4 Key barriers of IDSR (2004–2014)
Issues | Brief Description |
|---|---|
1. Disabling political, economic, and social environment | • 14 years (1989–2003) of large-scale armed conflict in Liberia caused massive destruction to the country’s infrastructure, systems, and social cohesion. The economic, social, and political environments were weakened. • The loss of human, social, and economic resources challenged the country after the conflict ended. • Insufficient economic activities impeded access to financial resources and thus affected re-establishment of the health and disease surveillance systems. |
2. Unequipped human resources | • County surveillance officers were high school graduates who had carried out surveillance for acute flaccid paralysis (AFP). • Lack of salaries for surveillance workers. • 35% of the health facilities had only one county surveillance officer to collect, report, collate, and analyze surveillance data and information. • Lack of a field epidemiology training program and data management skills. |
3. Donor-dependent financial support | • The entire surveillance system was donor dependent and driven. • Inadequacy of budgetary allocation in the MOH budget for surveillance activities. • Transportation reimbursement and daily sustenance allowance for surveillance officers was only provided by WHO’s country office. WHO also provided for surveillance workers. |
4. De-prioritization of training and supervision | • Inadequate budgetary support from the national government for training, field investigation, and supervision of surveillance activities. |
5. Vertical program reporting, lack of integrated surveillance system | • Only vaccine preventable diseases such as yellow fever, measles, polio, etc., were responded to because these were the only diseases reported to WHO through the expanded program on immunization for which DSA was provided to the surveillance officers. |
6. Inadequate laboratory capacity | • Lack of testing capacity for priority notifiable diseases including yellow fever, Lassa fever, Ebola, and others. All AFP and Lassa fever samples were sent out of the country for testing. • No national reference laboratory |
7. Weak surveillance structures in practice | • Lack of well-established surveillance structures from communities, districts, and counties to the national. • Symbolically there were structures, but they were not capacitated. • Non-existent incident management system teams. • No capacity for rapid response teams. • Non-existent emergency operations centers at the communities, districts, counties, and national levels. |
8. Lacking active surveillance and reporting mechanisms | • Active surveillance was nonexistent. The surveillance system was reactive rather than being a proactive surveillance system to detect diseases of epidemic potential. • Reports were submitted through desk phones; surveillance officers made reports through a very high frequency (VHF) radio. Each county had a desk officer that collected the information and reported it to Monrovia. • No computer system, no data clerks. |
9. Lack of logistics and equipment | • Insufficient vehicles and motorcycles. There was only 1 motorbike per county. • Lack of communication equipment. • No GSM network at the time. • No computers. • Surveillance system was handicapped for lack of logistical support. 15 gallons of gasoline were provided by WHO only when reports were delivered. |