Maryland County Health System: Millions Spent, No Development
Since the incumbency of the Ellen Johnson-Sirleaf Government and the initiation of its Poverty Reduction Strategy (PRS) or its successor, “the Social Economic Transformation Strategy (SETS)”, the GOL has made frantic efforts to lobby with its international partners to support the initiative. There is no doubt about it: the strategy gained more support in the areas of health and education reforms. The health pool fund, that attracted several funding for the revamping of the health delivery system of the Republic of Liberia, was established for the implementation of the initiative. Every county in the Republic of Liberia, including Maryland County, benefited.
Consequently, during the past 5 years, Maryland County has received over 7 million United States dollars of the Pool fund. The first portion of the fund for the county was administered by the British INGO called Merlin in collaboration with the County Health Team (CHT). The last portion of the fund was solely administered by County Health Team headed by Dr. Odell Kumeh as County Health Officer (CHO). But, sadly, what is appalling is that Maryland County cannot boast of substantive impact of the over $7,000,000.00.
Maryland County Health Sector Pool Fund contract and its impacts:
In March, 2010, Merlin was contracted to manage the health sector Pool Fund for Ministry of Health & Social Welfare for Maryland County Health Team for the period of 33 months, but in phases and amounts allotted in same manner:
- Phase I: March 2010- June 2011 completed first phase for 15 months
- Phase II: July 2011-June 2012 for the period of 12 months, and
- Phase III: the final phase of contract was for 6 months, July-December, 2012;
The contract objective was to supplement staff salaries, purchase drugs/medical supplies and for infrastructure development. Merlin reported that for phases 1 & 2, equivalent to 27 months, a little over $4.1 million US dollars was received, managed and spent to run the health system of Maryland County. The final phase received and spent a little over $1.3 million United States Dollars, thus bringing the total cost of pool fund received, managed and spent under the Merlin contract for Maryland Health System to the amount of a little over $5.5 million United States Dollars.
Merlin contract ended in December of 2012 and the Pool Fund Secretariat turned the pool fund over to the CHT as contract-in firm that solely administered the fund from January 2013- July 2014 (for 18 months). Before the outbreak of EBOLA intensified in Liberia, The CHT received a little over 1.5million US dollars as direct cash support for goods and services and capital expenditure. Unlike Merlin, CHT contract did not cover staff’s salaries, drugs/medical supplies and infrastructures because the Pool Fund Secretariat and GOL have taken over staff salaries payment, and inferred from contract report that Merlin had taken care of these aspects (drugs/medical supplies and infrastructure development). Under the pool fund the institutions benefited from bonuses in the amounts of US$29,962.00 for Merlin and US$12,924.00 for CHT for FY 2012-2013; Merlin had 375 staff while the CHT had 12. The CHT contract was under the direct supervision of Dr. Odell Kumeh, but interestingly what is worthy to note here is, the only available structure CHT can point to is a substandard county drugs depot constructed in J. J. Dossen Memorial Hospital Compound which, according to Merlin and the CHT, cost US$100, 000.00.
The MAJOR QUESTIONS that this brings to one’s mind are as follows: what was the intent of the contract? Who were the negotiators that bargained on behalf of Maryland yea the Republic of Liberia? Was there a functional county health board that participated in the contract discussions and also kept the implementers in check? How can we spend over seven million dollars within a space of five years and the available health facilities in the county are still in deplorable condition? These questions are yet to be answered.
According to an insider, besides the County Health Officer (CHO) neither the CHT members nor the County Health Board was able to handle copy of contract for the entire 33 months Merlin managed the funds. When Dr. Kumeh (CHO) was asked by co-workers (members of CHT) as to why she could not share the contract documents with them, she allegedly told them that her email box was hacked and as a result she had no access to the documents. So when it comes to making follow up on contract implementation, no one, except her, could do so. The CHT members also asked Merlin for the contract information but Merlin refused to provide same on grounds that it was not its duty to do so. What puzzles me here is how can one monitor and evaluate the execution of project without a blue print (contract)? What will be the indicator used to rate contract performance?
Additionally, in the midst of the administration of the pool fund, GOL provided funding for GOL own health projects. I learned there are outstanding clinics construction projects for which funds were already allotted since 4 years ago. One typical example is the Wlowien clinic that should have been constructed in Karlurway Statutory District since 2012 for the cost of a little overUS$125,000.00, but to no avail. What is sad about this project is that the CHT went in the Wlowien community, raised inhabitants’ hope and encouraged them to make their contribution in the form of local material. With enthusiasm, they went ahead and mobilized local materials that are today visible in the community. But, sadly for the Wlowien community, no clinic is visible.
Besides, the Government of the Republic of Liberia annually appropriates budgetary allotments for the county’s health delivery system in general, referral/ government hospitals and social welfare institutions every fiscal year, the county health system is a beneficiary of said fund but the Maryland County Health Facilities and the J. J. Dossen Memorial Hospital, the County referral hospital, which also caters for Grand Kru and parts of River Gee Counties referral medical cases, are eventually out of every medical supplies thus making it difficult for inhabitants to survive simple medical problems, and GOL allots a little over US$10,000.00 for Doloken Boys Institute annually to the CHT as its social welfare support but the institute still lies in ruin.
The issue of health cannot be over emphasized when it comes to Maryland County given its catchment population and distance away from major health facilities in Liberia, and the presence of major institutions within the county and its environs.
William V. S. Tubman University attracts students, staff and professors from all walks of life and the concessions-CRC/MOPP and GVL in Maryland and Grand Kru Counties respectively are already on their way to start production soon, and in the face of that, will attract more workforces.
I believe that there are lapses in other counties when it comes to health delivery services, but the Maryland County case is farfetched. For the past 4 years I have observed that there have been no functional health boards for County Health System and J. J. Dossen Memorial Hospital - this erodes the check and balance system for the health sector of Maryland County. What this method of operation suggests to me is someone somewhere, well placed in the system, is remotely running the system, deliberately avoiding the establishment of major organs and placement of rightful professionals in professional areas to cleverly dribble the check and balance system. To add to this, up to 2 Liberian medical doctors have resigned the post of medical director of J. J. Dossen Memorial Hospital under the leadership of Dr. Kumeh as CHO and no one has asked why.
Today the problem at J. J. Dossen Memorial Hospital is not with the medical director because the Nigerian medical doctor who is serving in that capacity is just a ceremonial figure when it comes to the running of the hospital. The problem is the CHO/CMO who single-handedly runs the affairs of the hospital with reckless disregard to fiscal probity. The hospital administrator has already cried foul about financial scandal amounting to US$69,000.00, spearheaded by the CHO. Dr. Bernice Dahn (CMO) and also Minister designate responded by requesting the administrator to report to head office in Monrovia for reassignment. This is the game that is being played with our lives in Maryland County yea Liberia.
JJ Dossen Memorial Hospital
Unlike other government run hospitals in Liberia, there have been frequent changes of Medical Directors at the hospital, in less than 3 years; JJ Dossen Memorial Hospital has had 2 medical directors, namely Dr. Jean K. Kaly and Dr. Ernest Kokolee. These two doctors were forced to leave due to power struggles between them and the CHO.
Each of these two Liberian borne doctors felt that by virtue of the position as head administrator of the hospital they were to control the day to day running of the hospital, while the CHO plays the supervisory role. But CHO takes up direct management of the hospital, thereby fueling the frequent rivalries between the CHO and the hospital health officers. The rivalries led to forceful dismissals of the doctors mentioned above.
These medical directors felt prey to the powerful and invisible hand in Monrovia that is remotely controlling Dr. Kumeh. Whenever Dr. Kumeh complains to Dr. Bernice Dahn, the latter always sides with Dr. Kumeh without any investigation. At presence, the CHO has brought in a Nigerian doctor and made him acting medical director having no administrative authority over the hospital. The CHO signs all documents including checks for the hospital, and this is believed to be done with the approval of Dr. Dahn.
Medical assistance to JJ Dossen hospital
The Liberians, including Marylanders, in the United States of America were able to mobilize resources to procure drugs and some medical supplies in the wake of the Ebola crisis and the supplies got to Harper since November 2014. It is open secret that the supplies are being kept in a non-medical warehouse in the custody of CHT/CHO. Amid scarcity of emergency drugs, it makes sense for the CHO to turn over the drugs to the JDossen Memorial Hospital, but this is not the case. Importance administrative structure that is lacking:
1. Hospital Management Board for J. J. Dossen Memorial Hospital, the county referral hospital, is drawn up from the communities of eminent and business people headed by a chairman elected by board members and Medical Director who normally is a Liberian Medical Doctor. The chief administrator of the hospital automatically becomes the secretary. The secretary reports to the board periodically for check and balance purposes. The administrator is a direct signatory to the Hospital’s bank accounts.
2. County Health Board is headed by the county superintendent or his/her designee as chairman and County Health Officer who normally is a Liberian Medical Doctor, by the virtue of his/her position is the secretary and reports to the board periodically for check and balance purposes; s/he is a direct signatory to the CHT’s banks accounts and alternative signatory to the referral hospital accounts.
In the absence of the above structure in the health sector there are always malpractices in administering public funds and assets. My attention has been drawn to alleged financial scandal at the J. J. Dossen Memorial Hospital reported by the hospital administrator in the amount about US$69,000.00. The administrator alleged that the act was spearheaded by the CHO. But to date, there has been no immediate investigation. J. J. Dossen Memorial Hospital lacks medical supplies; at time patients are required to pay for syringes and needles to enable nurses to administer treatment.
Despite the huge amount of money spent by the international partners and the Liberian Government, the Maryland County health System still needs help in the form of drugs, supplies, infrastructures, health administrators and financial managers. The Liberian Government and its development partners need to intervene to rescue Maryland County from the corrupt and inhumane treatment meted out against our people.