Rebuilding and strengthening Liberia’s health systems, investing in households with young children, and revitalizing the private sector must be made priorities for Liberia, according to experts gathered at CGD for an event on what the international community can do to help the country’s people and economy recover from the toll of Ebola.
In his keynote remarks, US Senator Jeff Flake (R-AZ) recalled the Senate Foreign Relations Committee hearing on the response to Ebola, noting witnesses called for a first-rate health system to ensure similar outbreaks are prevented moving forward. Flake agreed with the witnesses, but said a model where Liberia is reliant on aid partners is not a sustainable one; instead, he argued for a model managed by Liberians themselves. The way to achieve this, he suggested, is by rebuilding the private sector. “We need to ensure that with whatever aid we provide, that we involve private sector partners, those who can continue and sustain this activity after these projects are completed. And we want to make sure—and I will make sure—that our aid is geared in that way,” said Flake.
Watch: Senator Flake’s remarks, including his comments on the severely slow response to the Ebola outbreak by the WHO.
Liberia’s Minister of Public Works Gyude Moore began his remarks, stating, “We cannot wait for zero patients.… The economic recovery has to begin now.” He then outlined two major recovery plans Liberia intends to roll out. The first is the Ministry of Health’s $270 million plan to rebuild Liberia’s health system. Over the next 10 years, with the help of Last Mile Health and Partners in Health, Liberia is hoping to build new health centers across the country and train 25,000 community health workers and 8,000 nurses, as well as doctors and specialists. The second is the Ministry of Public Works’ “Roads to Health” plan. As Moore noted, infrastructure—primarily roads—will be necessary if the new health centers and newly trained staff are to be effective. Given it rains 80 percent of the year in Liberia, causing flooding, paved roads are a necessity. “Roads to Health” is intended to provide these much needed roads.
Minister Moore also agreed with Senator Flake that Liberia’s economic recovery will have to be centered on the private sector if it is to be sustainable. Liberia’s economy, Moore explained, is reliant on investments in agriculture and mining. However, mining companies have not been as productive since Ebola spread across the country. To ensure the private sector remains viable, Moore suggested Liberia offer tax incentives to these companies. Aid to Liberia, such as the $5 million from USAID last year, could offset revenue lost through a tax break by compensating for what the government would typically spend that revenue on (e.g., teacher and health worker salaries). In other words, a tax break would allow the private sector to thrive without weakening support for health and schooling.
Watch: Minister Moore’s remarks.
In addition, on the issue of accountability, Minister Moore made clear that the money going into Liberia to fight Ebola is not necessarily going to the government, but to WHO, Médecins Sans Frontières, the World Food Programme, and other non-governmental institutions. To avoid becoming a ‘republic of NGO’s’ like Haiti did after the 2010 earthquake, Liberia’s Ministry of Finance has requested all organizations responding to Ebola provide an account of the money they received and how it was spent.
Following keynotes by Senator Flake and Minister Moore, CGD’s director of global health policy Amanda Glassman led a panel discussion with Francisco Ferreira, chief economist, Africa region, at the World Bank, Jeremy Konyndyk, director of the Office of US Foreign Disaster Assistance at USAID, Mead Over, CGD senior fellow, and Minister Moore. The panel reiterated many of Flake and Moore’s sentiments, and offered several solutions to help the economies the Ebola-affected countries recover. Suggestions included the following:
Cash transfer programs to help households with young children rebuild and protect human capital. These could provide assistance to households, especially those that have lost their family breadwinner.
Address both formal and informal sector firms in an effort to reactivate the private sector. Small informal firms and entrepreneurs make up most of the economic activity in Liberia. Any effort that focuses on a formal sector-only response will limit impact on livelihoods.
A “whole of government” response by the United States, because no single part of the US government has the capability to support the fight against and recovery from Ebola in West Africa.
Build health systems that are not only stronger but with different capabilities such as improved prevention and disease surveillance.
Regional strengthening via an African Center for Disease Control and Prevention, through which Liberia, Sierra Leone, and Guinea can share data and work together to get to zero patients
Couple Ebola response with rebuilding the health system, through such ways as maintaining community care centers near hospitals. These CCC’s should be used as a first line of surveillance and defense by isolating patients presenting symptoms of Ebola until a diagnosis is determined.
Encourage transparency of money flowing into Liberia and other Ebola-affected countries. USAID’s Fixed Amount Reimbursement Agreement (FARA), a results-based agreement, is one good model to help ensure aid is spent as the donor intended.
Watch: The panel discussion, including comments about the impact of aversion behavior, procurement rules at the World Bank, and the role of USAID’s Disaster Assistance response Team (DART).
Watch the full event, including CGD president Nancy Birdsall’s introductory remarks and two Q&A sessions here.