The Clinton Health Access Initiative, Inc. (CHAI) is a global health organization committed to saving lives and reducing the burden of disease in low-and middle-income countries, while strengthening the capabilities of governments and the private sector in those countries to create and sustain high quality health systems that can succeed without our assistance. For more information, please visit: http://www.clintonhealthaccess.org
Globally, CHAI is working with a number of governments to scale-up necessary health workforce and infrastructure to meet the demands for primary, secondary and tertiary level care. CHAI is currently working on workforce and infrastructure scale up in Ethiopia, Liberia, Malawi and Zambia and Zimbabwe.
In 2006, CHAI was the first international NGO to help Liberia’s government rebuild after a decade-long Civil War in Liberia had killed an estimated 270,000 people, decimated the nations’ health infrastructure and hindered the country’s ability to deliver vital health and social services. The partnership between Liberia’s Ministry of Health (MOH) and CHAI evolved from being HIV specific to addressing key healthcare challenges ranging from supply chain management, health workforce, and health financing, across various vertical programs including HIV, Maternal and Neonatal Health and Malaria. In 2014 and 2015 CHAI played a significant role assisting the Ministry of Health respond to the West Africa Ebola Outbreak. Since then, CHAI Liberia has focused its efforts on health systems strengthening with national health workforce scale-up and infrastructure planning.
New Redemption Hospital
In Liberia, Redemption Hospital was built in 1982 in New Kru Town, Monrovia, growing out of the site of a public market. The facility was continually expanded over the years, eventually becoming the highest volume public hospital in Liberia. While Redemption is intended as a tertiary-level hospital, it is not able to provide services at that standard due in large part to infrastructural constraints. Redemption also serves an important role as a clinical training site for medical students and resident physicians.
Redemption Hospital currently offers a number of vital services relevant to maternity and pediatric care that include interventions in Family Planning (excluding cervical and breast cancer screening and treatment of infertile couples); Safe Abortion Care; Pregnancy Care; Childbirth Care; Postpartum Care of the Mother; Care of the Newborn (excluding treatment of malformations); and Care during Infancy and Childhood.
Redemption Hospital was at the epicenter of the Ebola outbreak in Liberia having received both the first and last patients in the country’s epidemic. In late August 2014, the inpatient hospital was closed in order to focus exclusively on Ebola patients. Destitute individuals who had contracted Ebola and all those with nowhere else to go came to the doorstep of Redemption to seek care.
The impact of the 2014-2015 outbreak on the health and mortality of the surrounding community and of Liberia at-large is estimated to be devastating. A 2015 World Bank report estimates that national maternal mortality will rise by 111% to 1,347 per 100,000 live births—the second highest recorded in the world.1
As the 2014-2015 Ebola outbreak subsided, the Government of Liberia, Ministry of Health (MOH) leadership, health professional training institutions, and development partners drafted the National Investment Plan for Building a Resilient Health System 2015-2021. As a key component this plan, the Government of Liberia has planned to relocate and rebuild Redemption Hospital on a new site in Caldwell, a fast-growing township on the outskirts of Monrovia. The new hospital will be a center of excellence for high quality specialized care and training, building
Construction for the hospital is being broken into two phases. Funding for the first phase has been secured Phase I comprises of a 155-inpatient bed pediatric and women’s and maternal hospital. Phase I aims to increase pediatrics and maternity care and will serve as a national center of excellence. Construction for the project commenced on July 20, 2018. The second phase of the hospital will be a 159-inpatient bed general hospital that will include additional specialized services. Funds for the hospital’s second phase will be mobilized over time as Phase I is constructed and launched.
CHAI’s Role To-Date
The Clinton Health Access Initiative (CHAI) has been working in Liberia since 2006 with an initial focus on expanding HIV services and strengthening the health system. As part of these early efforts, CHAI established the Infrastructure Unit at the MOH and recruited MASS Design Group, an award winning non-profit architectural firm, to work in Liberia. From 2009 to 2013, the MOH hired MASS Design to conduct a national assessment of health care infrastructure (including Redemption Hospital), assist in the development of a 10-year policy and plan, and develop comprehensive architectural and engineering standards and guidelines for all scales of facilities, including clinics, health centers, and hospitals throughout Liberia.
As Ebola subsided, CHAI pivoted its activities to supporting the MOH align partners and funding against the National Investment Plan for Building a Resilient Health System 2015-2021. CHAI helped the Government negotiate with the World Bank to repurpose funds left over from the Ebola emergency response to be programmed towards an innovative Health Workforce Program (HWP) with the goal of creating a fit-for-purpose, motivated, and highly skilled workforce including an expanded pediatrics and obstetrics and gynecology workforce. As part of these advocacy efforts, CHAI developed a functional plan and other requested documentation in order to unlock $14 million of World Bank funds towards the building of New Redemption Hospital.
The MOH has shown leadership and commitment to the rebuilding of Redemption Hospital by mobilizing $1+ million of its own money for MASS Design to conduct pre-design research, produce construction-ready architectural and landscape site plans, and additional design and engineering work for the new hospital. The World Bank has joined as not only the primary financer of this project, but has also provided technical assistance to ensure all plans are aligned to the Bank’s rigorous infrastructure requirements.
Next steps and opportunity
CHAI is serving in a facilitator role to ensure that planning for the hospital is linked to the broader referral system and health professional education plans to ensure a teaching hospital is built that will become functional as part of a broader network. CHAI plans to continue to assist the government align partners and donors to the hospital project to ensure that a 1) equipment is mobilized 2) a comprehensive staffing and training plan is developed and executed and 3) annual operations (functions and costing) plan are developed and implemented in order to ensure the new hospital becomes function. CHAI will provide technical assistance and coordination support to the New Redemption Hospital Advisory Committee to lead these planning efforts as well as the MOH’s Department of Administration to ensure important policies are integrated into planning and construction of New Redemption Hospital.
Lessons learned from these deliverables and project will inform similar work in other countries such as Ethiopia and Malawi.