How do you rebuild a health system after decades of instability?

Nazaradden Ibrahim, September 2023

Liberia’s government is making progress in rebuilding the country’s health system. And a key part of this is launching the National Eye Health Policy (2022-2032) to ensure that eye health is considered a priority.

Over the past decades, civil war and political unrest both contributed to weakening Liberia’s health system, with Ebola having further devastating effects. But as the country progressed towards full economic recovery after the Ebola epidemic, the COVID-19 pandemic further shrunk the economy and negatively impacted the already weak health system.

At this time, the health system was entirely dependent on donor support and these crises majorly affected the ability of these stakeholders to deliver health services. These included eye care, the training and equitable distribution of health care workers and procurement and distribution of equipment, medication and consumables.

But today, as Liberia rebuilds, work supported and driven by different stakeholders is beginning to improve the country’s health care system. At Sightsavers, we’ve been supporting eye health programmes in Liberia for more than 20 years and working to strengthen the health system alongside the Ministry of Health.

Nowah wears optometry glasses during an eye test at her school in Liberia.

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Vision technician Ruth Zeo points to an eye chart during an eye screening
A Sightsavers-supported programme in Liberia is testing students for vision problems at school. © Sightsavers/Carielle Doe

Sustainability is at the forefront of our minds when we design and implement our work. By working with government institutions, we ensure they have ownership and can carry the work forward in the long-term.

However, many external stakeholder organisations began their work independently and were not working cohesively with each other and the government because there wasn’t a national strategic document to drive the delivery of eye health services in the country. This resulted in the delivery of standalone eye health programmes that are not sustainable and worked outside the health system.

Therefore, a policy direction was desperately needed. In 2021, we began supporting the Ministry of Health to develop the National Eye Health Policy. The introduction of this policy means that any stakeholder working in Liberia will have clear directions to work under. The policy also outlines the key areas that we must address and prioritise.

Facial gets her eyes tested at school in Liberia.
Students who have their eyes tested at school can receive glasses or be referred for treatment if they need it. © Sightsavers/John Healey

Priorities of the National Eye Health Policy

1. Working towards universal health coverage

The first priority of the policy is access. Historically, eye health facilities were mainly in Monrovia, Liberia’s capital city, which meant they were unreachable to many people and communities. Over time, access increased with organisations supporting some facilities across the country. But these only lasted while the organisations were actively working in Liberia. And there were many remote and hard to reach areas in the country where there were no eye health services at all.

In the policy, we want to work towards universal health coverage. We want to focus on access and ensuring that services are closer to people and communities and that no one is left behind.

2. Increasing in-country human resources for eye health

The second priority is human resource as compared to other countries in the region, Liberia was far behind. Therefore, a policy direction outlining training was included. This involves:

  • Establishing centres that train mid-level staff
  • Ensuring there is an equitable distribution of health care workers across the country
  • Introducing approaches to motivate and encourage health care workers to work in the hardest to reach areas of the country

The work already done has led to great improvements. For example, the health system now employs cataract surgeons based in the country.

3. Creating a resilient infrastructure

The policy also provided a strategic direction on the need for the right infrastructure to be in place and for appropriate equipment is available to provide good quality services. These are needed alongside data systems that can monitor the performance of the eye health services. These systems will also help us to understand if services are impacting the prevalence of visual impairment and provide the evidence needed to design future programmes, use for advocacy and mobilise resources.

4. Aligning to global goals and policies

We have also made sure that the policy considered key global principles. For example, the equity and inclusion of marginalised groups, people with disabilities, people from a low socio-economic backgrounds and other marginalised groups. There are also policy statements on eye health facilities being climate and environment-friendly to reduce the impact of eye health services on climate and the environment.

A school student has her eyes tested while wearing optical glasses: an eye health worker's hand is changing the lenses in the glasses.

Screening children for vision problems

The School Health Integrated Programming (SHIP) project screens schoolchildren for health problems and provides spectacles and treatment where needed.

More about SHIP

The ultimate goal

Through the Ministry of Health and the National Eye Health programme, the government of Liberia was the main driver that led the policy development process. Extensive consultations were held through the technical working group to ensure the buy-in of all stakeholders. This would ensure a coordinated approach in the implementation of the policy document.

Using the policy, stakeholders and development partners can work on different aspects and activities concurrently. And before we know it, the entire country has a resilient health system that furthers the attainment of universal health coverage – this is the ultimate goal!

Irish Aid logo.Sightsavers’ eye health work in Liberia is funded by Irish Aid. About Sightsavers and Irish Aid


Nazaradden Ibrahim is Sightsavers’ global technical lead for eye health in West Africa.


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