EBOLA: No Health, No Sustainable Development and Progress in Liberia

It is not an exaggeration to say that our country, Liberia is now in crisis – from the high levels of insecurity to the daily tales of the Ebola epidemic, fraud and corruption in government to health workers on strike at a major state-run Ebola treatment center (JFK) in Liberia over pay and poor working conditions last week. All these are symptoms of the fundamental affliction facing our society – poor governance and culture of impunity. Last week, the US Centers for Disease Control and Prevention (CDC) and Word Health Organization (WHO) reported 1378 suspects and confirmed Ebola Virus Disease (EVD) cases in Liberia, including 322 laboratory-confirmed and 1089 deaths in Liberia from Ebola. The Doctors without Borders also known as Medicins Sans Frontiers (MSF), recently called for United Nations intervention -- military medical expertise-- to effectively combat the scourge in West Africa. Médecins Sans Frontières has described the outbreak in Liberia as “catastrophic.” The UN's Food and Agriculture Organization have warned that Ebola outbreak is putting food harvests in West Africa “at serious risk.” CDC Director Tom Frieden also warned that time is running out to contain West Africa’s Ebola outbreak, yet President Ellen Johnson Sirleaf thinks outsourcing the fight of Ebola to internationally acclaimed health organizations is unacceptable despite Liberia been the only Ebola-affected nation in the region with rising cases in the capital, Monrovia. Our nation has conceived several development plans from Independence until the 2000s. The overthrown of the Tolbert-True Whig Party administration marked the death of multi-year development plans. Since then, we had toyed with perspective plans and rolling plans under Samuel Doe, Vision 2024 under Charles Taylor, and the so-called Agenda for Transformation, what is now Vision 2030. No sectors suffered more than education and health care from our abandonment of development planning in our government strategies. Ebola brought a response, but the people of Liberia face a very fundamental health crisis. All over the place you find a population that suffers from malnutrition and has severely deficient immune systems. Measles, AIDS, Hepatitis, Tuberculosis and Malaria are ever present. And it is symptomatic of Madam Ellen Johnson Sirleaf led government failures to grow our educational and health system through creative planning, sensible spending prioritization and focused implementation. The Challenges of Liberia Health sector bring to bear the popular philosophical postulation: “a person that fails to plan, plans to fail.” The first casualty of non-planning was the relegation of preventive, mostly primary health care, the abolition of sanitary inspection and increasing focus on procurement-driven curative, secondary and tertiary health care. Dr. Walter T. Gwenigale tenure as health minister has brought back some needed focus on primary health care, with the publication of a National Health Policy and Plan in 2007. The health policy was refined, revised and updated under Minister Gwenigale and was globally acclaimed as a near-perfect blueprint for the provision of standard healthcare in a growing nation. The policy had all that was needed to make our health sector functional and world class. Unfortunately, it has been characterized by weak implementation and diversion of funds to recurrent spending. The condition is further worsened by inadequate facilities and low remuneration of public sector health care workers. Also, inconsistent implementation of the structuring led to the situation where people abandoned the Jackson Doe Hospitals and other rural health facilities in order to come to Monrovia for treatment. The condition is further worsened by inadequate facilities and low remuneration of public sector health care workers. These resulted in the mushrooming of private hospitals and clinics with only a fraction well-equipped, but could only be afforded by an opulent and sometimes foolish few. So in spite of all these efforts, the sector challenges remain and the story of Representative Albert Toe, Dr Samuel Brisbane, Dr. Samuel Muhumuza Mutoro of Uganda, etc., above remains the best metaphor for the dysfunctional state of our health care delivery system. Although "health” as a sector does not feature prominently in the measurement of GDP of a country, health expenditures account for between 4% (Turkey, Nigeria), 8% (UK) and 15% (USA) of the GDP of most countries, and the sector is a major employer of the labor - from doctors to pharmacists to laboratory technologists to nurses and midwives, and now includes HMOs and insurance companies! Quality and affordable healthcare is critical to sustainable development and progress because it is human capital that drives the other factors of production. Health infrastructure (hospitals, laboratories, pharmaceuticals, health insurance organizations and other Ancillaries) is essential for the efficient functioning of a health care system and consequently, a productive and prosperous nation. Our health sector is bedeviled by a myriad of challenges that resulted from lack of planning - policy disconnections, inadequate capital spending, poor pay, outdated technologies, poor infrastructure, sharp disparities in the availability of medical facilities across the country, coupled with the severe political and economic stresses of the past years. The net effect is inadequate medical supplies, drugs, equipment, and personnel. Similarly, poor sanitation and water supply in our rapidly growing cities have increased the threat of curable, avoidable and other infectious diseases, while health care facilities are generally unable to keep pace with urban population growth. One needs not visit hospitals without doctors or drugs, or evaluate the poor quality of health personnel, nor undertake a computation of the lost production to poor health to underscore the fact that our national development aspirations will remain just that – aspirations - if we do not embark on a concerted improvement of our human capital, especially revamped education and improved health care. So what are the facts on the ground? According to the 2013 United Nation Development index (HDI), Liberia population is 4.2 million. Liberia’s population is projected to double by 2040. 2.2 million of Liberia’s population lives in urban areas. The urban growth rate is estimated at 5.6% per annual which indicates that most Liberians now reside in urban centers according to the United Nations World Urbanization prospects 2013 report. It has a very young age profile with about 43% of Liberia’s population under the age of 15. In 2012, Liberia’s expenditure on health was $102 per capita, representing about 15.5% of GDP. Donors finance 50% of total health expenditures and households 33.3%. Also about 80% of the health services are provided by NGOs. A research by McKinsey has shown that from 1900 to 1973, less than 4 per cent of the decline in mortality in developed countries resulted from medical care, with over 90 per cent being due to public health measures like to improve sanitation and provision of clean water! This strongly suggests that focus on public health measures and primary health care should be the priority of governments that wish to improve the health of their populations. It is when preventive healthcare fails that a visit to a medical professional becomes necessary. At the moment, our healthcare facilities are grossly inadequate and can only serve 4-8% of their potential patient load. Huge sums of money in foreign exchange are spent by Madam Sirleaf, her cronies and the selective few that seek medical services abroad in places like USA, Ghana, and Europe, etc. While spending so much to keep foreign medical professionals employed, are we healthier? According to the United Nations Population Fund (UNPF) in 2013, the maternal mortality rate per 100,000 births in Liberia is 770. What this means is that out of every 100,000 women who go to give birth, 770 die. So more and more of our pregnant mothers are dying during labor. The under-5 mortality rate, per 1,000 births is 75. These are mostly caused by inadequate access to quality care in rural and remote areas and shortage of midwives. As a result, the country is not on track to meet its health MDGstargets (5 and 6). The 2013 Demographic and Health Survey (DHS) found that 56% of births were delivered in a health facility. 73% of births of urban mothers were attended to by a skilled provider and 66% were delivered in a health facility, compared with 50% and % percent, respectively, of births to rural women. Among urban women, those residing in Monrovia were more likely than those living in other urban areas to be attended to by a skilled provider (84% compared with 62%) and to deliver in the health facility (76% compared with 56 percent). This imbalance in access to specialist care between urban and rural areas has been evident in all DHS surveys in Liberia since 1986, but the gap has not narrowed over time. And as usual, the disparities between the Monrovia and rural Liberia are wide, indicating the President and cronies in Monrovia have a lot more to do, and must wake up and invest more to prevent the avoidable deaths of mothers, infants and many children under the age five. The problems of the Liberia health sector are numerous and require collective effort from every one of us, and creative planning, focused management and sensible application of resources on the part of the government of Liberia as well as the private sector. Liberia population is expected to double by 2040 to 8 Million plus. Liberia should recall that life expectancy in our country is still 62 years, one of the lowest in the world. In Egypt, it is 71; Britain, Sweden and Japan have 78.5, 80.5 and 81.3 years respectively. Given the huge revenue Liberia has earned from foreign direct investments and oil exploration, this is unacceptable! We can do, and must do better. The key factors in measuring health status are: access to clean water, safe air, adequate food and the society’s willingness to practice healthy lifestyles. There are issues to be worried about: from the report of UNDP MidPoint Assessment of the Millennium Development Goals (MDGs) in Liberia 2008, only 25% of Liberian had access to basic sanitation. Over 1,000 children die every year from diarrhea caused by unsafe water and poor sanitation in Liberia. At the same time, 60% of Liberians cannot access sustainable safe drinking water supply, according to the World Bank Water and Sanitation Program (WSP). The WHO estimates that every dollar invested in improved water and sanitation produces economic benefit that ranges from $3 to $34, depending on the country and technologies applied. Unfortunately, we are not in any way near the attainment of such beneficial status. In the 2013/14 budget, only US$ 3.7 million was allocated to the Liberia Water and Sewer Corporation. The prolonged neglect of water, sanitation and health, education in our schools is also impacting negatively on our health system. One factor responsible for the worsening state of health care in Liberia is the shortage of skilled medical personnel. Liberia population is estimated at 4 million, and the nation has less than 60 doctors left in the entire country, according to the Dr. Roseda Marshall chairs the school of pediatrics at the country's only medical school, the University of Liberia's A.M Dogliotti College of Medicine. Our situation is further compounded by the lopsided doctor-to-population distribution. Statistics from the health sector of Liberia presents a grim picture that indicates that the country’s doctor-to-patients ratio is 1 Doctor to 30,000 or more patients. In comparison, South Africa has 393 nurses and 74 doctors per 100,000 people - about twice better off than we are, while the United States has 901 nurses and 247 doctors per 100,000. Cuba a developing country with a better health care system than the USA has a ratio of 1 doctor to 125 people! Also within the country, huge inequalities exist between regions, with South Eastern Liberia lagging behind. Disparities also exist between urban and rural areas as well with 90% of doctors working in the urban areas where only about 29% of the populations reside. Many of our qualified doctors and nurses have migrated abroad due to our senseless armed conflicts while others migrated abroad to avoid poor pay, non-existent or archaic diagnostic tools and deplorable working conditions. Liberia doctors have migrated to North America, Europe, and even other African countries. We must ask: why do our young and talented medical professionals leave Liberia after we have invested vast resources in their training? Regrettably, many that have stayed back in the country remain here only because they are unable to secure other opportunities elsewhere. We have come to expect a health sector perennially dogged by labor crises. The activities of quacks in the health care sector and counterfeit drugs cannot be discounted. Infectious but treatable diseases are also major threats to our country. According to the WHO 2014 updated report on Liberia, malaria account for 33%of in-patient deaths. Acute Respiratory infections continue to be the second leading cause of morbidity, after malaria. Further projection by WHO revealed deaths from infectious diseases, maternal, prenatal conditions and nutritional deficiencies will also increase by 6% in 2015 worldwide. Alarmingly, and If not checked, all these have adverse effects - economic and social impact on our families, communities and the entire country. The health industry is very dynamic: patients' needs, innovative processes, regulated environment and demographic factors constantly changing. A responsible government must therefore be proactive in figuring out how to address expanding population and outbreak of new diseases by developing and sustaining a health care service mechanism that is both effective and efficient. According to the United Nations Population Fund (UNPF) in 2013, the population of Liberia nearly tripled in 60 years (911,000 in 1950 to over 4.1 million in 2012). If this growth rate continues, our population would hit nearly 8 million plus in 2040. The message is clear: if we cannot adequately care for our population now, and plan for the future today, what becomes of our health care system when our population reaches nearly 8 million plus in 2040; in just a few years’ time? Medical research and collaboration in Liberia is limited principally or not in existence due to the funding level (in the national expenditure) for both research and collaboration. Liberia must fund its universities; medical research and other health institutions enable them to exchange information on research about tracking, treating, preventing, and curing diseases and enhance domestic manufacturing of medicines. We lag behind the global trend of intensive investments in all facets of medical sciences, life sciences and biotechnology and must redress this urgently. What do we do in light of all these issues and challenges identified? The First thing to do is to recognize that preventive healthcare rests on improvement in enlightenment as well as provision of water supply and sanitation facilities. For too long, water, sanitation and hygiene education in our communities and schools have been given less priority. Well-structured water, sanitation and hygiene education would make a huge difference to our health system. Improvements in sanitation and hygiene behaviors combined with a safe water supply could significantly prevent diarrhea, cholera, dysentery and other contagious infections. Second is to ensure the existence of basic laboratories and diagnostic tools in each facility. And then rapidly employ and train otherwise unemployed graduates of biochemical sciences to be physician's assistants after 12 months of education and internship, and deploying them to a community clinic, health clinic, health center, county hospitals, and tertiary to handle patient with some of the commonest ailments like malaria, typhoid, and the diarrhea which take up to lots of doctor's time in the BPHS. Doctors will then properly spend their time on more serious ailments. Thirdly, to rescue the Liberia health sector, our Primary Healthcare System has to be functional, properly managed and funded. The most anticipated National Health Insurance Scheme (NHIS) needs to be implemented! NHIS should be strengthened and its activities expanded to cover every Liberian. Given that good governance and health are intertwined, facilities should be provided to keep our environments healthy. Our political leaders should lead by example and exhibit confidence in our health system by patronizing the health facilities available in Liberia instead of travelling abroad for even basic checkups. It will be nice if the President Sirleaf, Ministers and members of the National Legislature, Justices of the Supreme Court (and their families) openly declare that they will never go abroad for medical checkups, treatment and the like, and will go to government-owned facilities only! Then the rapid improvements will begin. Finally, more effective spending for preventive, primary and secondary care. Can more funding lead to better health? Not necessarily. We would need more health care worker regardless of any level of spending to get better outcomes. However, spending generates some impacts. According to WHO, every $100 per capita spent on health creates a 1.1-year increase in Health-Adjusted Life Expectancy (HALE). The Liberia health industry is potentially big, possibly bigger than the successful telecoms sector. True, telecom services are necessities, but everybody needs health care to survive and grow, and even make phone calls! Ultimately, we must accept the maxim that ‘health is wealth’ and take appropriate steps to improve the sector. At the moment, it is creating a huge hole in our political and economic development aspirations. If Liberians are not healthy, we cannot build a wealthy country. And the examples of h

EBOLA: President Sirleaf, Liberia's 'Guide,' Leads Nation Into Chaos

The Ebola virus outbreak has refocused attention on Liberia, a country that has lurched from one crisis to another since independence in 1847. Many Liberians are openly angry at the government of President Ellen Johnson Sirleaf, who has ruled unchallenged for most of the post conflict recovery. The Ebola epidemic in Liberia is without no doubt the result of widespread social and environmental degradation brought about by the demagogues in government, which are clinging to the old order of corruption, nepotism, incompetency, etc. Corruption, nepotism, patronage, etc. may not have spawned the Ebola virus, but they formidable fertile ground for it to spread in Liberia. Liberia is a weak state, not because of natural disasters, but because President Ellen Johnson Sirleaf and her cronies continue to plunder a national wealth stemming from offshore oil exploration and other natural resources. Despite over US$ 16 billions foreign direct investment base, ordinary people are living in abject poverty. Corruption has eaten deep into Liberian society and government, and even quarantine measures announced to keep the Ebola virus from Liberian people are being undermined by bribery. Public workers are owed several months' salary, and bribery has become a way of life. Ebola brought a response, but the people of Liberia face a very fundamental health crisis. All over the place you find a population that suffers from malnutrition and has severely deficient immune systems. Measle, AIDS, Hepatitis, Tuberculosis and Malaria are ever present. The Ebola virus epidemic is stretching the nation's decrepit medical services, already hard-pressed to cope with the scourge of diseases in Liberia. The desperate poverty makes the country ripe for public health emergencies. Clean running water is scarce. Medication and basic supplies like gloves and needles required for good sanitation are generally in short supply at hospitals. These conditions provide fertile breeding grounds for illnesses like the Ebola virus. The government of Liberia led by president Sirleaf fell far short of taking preventive and proactive steps to protect its citizens, until the virus had spread across the country, causing hundreds of deaths. This tragedy could have been prevented. When even though the Ebola virus was first reported in Guinea, Liberia, now has over 329 reported clinical cases of Ebola, including 100 laboratory confirmations and 156 fatal cases, according to the World Heath Organization (WHO). The questions that the Liberian public would like the Sirleaf’s administration to answer are; how did we get to this stage? Why is it that, when the virus entered the northern border district of Foya, Lofa county, did the government not act until it had spread across the country? Why did the government not provide adequate equipment and resources, promptly, and in time for front line staff that had put their lives at risk, to save others in Lofa? These are the fundamental issues that have tested the government’s readiness and ability to manage the Ebola crisis. I listened to president Sirleaf’s broadcast to the nation announcing her prescriptive plan of action aimed at combating the virus, but in my opinion, her prescriptive plan has come too late for Dr. Samuel Brisbane, Chief Medical Doctor at Liberia’s leading hospital, the John F. Kennedy Medical Center, Dr. Samuel Muhumuza Mutoro of Uganda, Patrick Sawyer and the hundreds of patients who have contracted the virus, including the dead. Whilst We welcome the president’s commitment in her broadcast, Dr Brisbane or Patrick Sawyer did not have to die before her government acknowledged the Ebola virus was a threat to national security. It is not hard to support my assertion that the government was too slow to a point of being negligent. When the Ebola virus first surfaced in Guinea, officials in the Sirleaf’s administration were in denial of the existence of Ebola. For example, one time presidential candidate and senate pro tempo Senator Cletus Wotorson (UP, Grand Kru) said the Ebola noise made by health authorities was much ado about and intended to extort money from international donors. When cases of Ebola virus were being reported in Lofa County President Sirleaf flew to Brussel to attend a summit in the name of global duty. Patrick Sawyer died in Nigeria while on official government assignment even though facts pointed to Sawyer’s Sister died from the Ebola virus and Sawyer was the person assisting to care for her, but yet he was allowed to board a flight to Nigeria as part of official government representative to a conference in Nigeria. In contrast to the initial inaction of the Sirleaf administration, let me further highlight how other governments sprung into action on the first reporting of Ebola in Guinea. Ivory Coast closed her borders immediately. Ivorian had also closed its main entry points to Guinea which means they are better prepared to screen suspected entrants, whilst at the same time contain the virus by contact tracing and quarantining. Gambia also follow the same step. In addition to the Gambia closing her borders, the government there instituted screening and support for health workers. Nigeria, on the first incident of the virus which killed Patrick Sawyer there, government officials reacted robustly to protect their citizens. Airports and border officers have been put on alert. Unlike the Liberia, these countries foresee the Ebola virus spread could lead not only to the Ebola epidemic but Ebola pandemic. A major airline in West Africa, Arik Air, Nigeria's largest airline, suspended its flight to Liberia, demonstrating that economic consideration is secondary to the containment and prevention of Ebola virus. The United States Centers for Disease Control and Prevention (CDC) had issued a level 3 warning to US residents to avoid nonessential travel to Liberia, Guinea, and Sierra Leone because of an unprecedented outbreak of Ebola. The agency has advised stateside health care providers to watch patients who have traveled to West Africa recently for symptoms of the virus. This means, it is possible that anyone coming through the US ports from the affected countries could be subjected to extra interrogation and screening to check the state of their health and contact details in the US. The Ebola virus is a war! We must put politics aside and unite in fighting the virus. Ebola does not discriminate. But we will not be a party to government mishandling and misinformation that could put our citizen’s lives in fear and danger. The tragic death of Dr Brisbane, Sawyers and others should have been avoided, but government must now take this opportunity to provide adequate resources, equipment, and improve on working conditions for all health service professionals throughout Liberia. They are on the front line of this war on Ebola; they are the nation’s heroes. God bless Liberia.

The Curse of Leadership in Liberia: A Review of the Legislature in Post Conflict Liberia

For any society to prosper, it needs to have a government to run its affairs. The government helps to sustain the social contract that binds every member of the state. Thus, the price that is paid for a state to be prosperous is for it to have an established government that enforces the social contract. Members of an ordered society, called a state, must pay taxes sufficient to carry out the functions assigned to the state. In post conflict Liberia, costs associated with the running of government have increased dramatically over the years such that an increasingly reduced proportion of public revenue is available to support and implement the primary functions of government. Consequently, the discharge of beneficial government functions has been hampered. It’s no news. The curse of leadership plagues Africa, and Liberia is chief amongst its beneficiaries. In the past year, I made a clear determination to steer clear talking about government without being able to do anything. However, I am forced to write in clear terms in this article about the attempt by members of the House of Representative to seek additional US$73 million in the 2014/2015 national budget to be divided among the country’s 73 districts in the name of spurring direct district impact projects in spite of the Social Development Funds and the County Development Funds mere with corruptions. Last year, we were served to another national comedy when Montserrado County District #16 Representative Edward Forh was caught on recording reportedly suggesting to the County's former Superintendent Grace Kpaan how the remaining county Development Fund of 2012 should be shared by saying "You eat, I eat and the Minister eats some.” One of the unintended consequences of the Legislature unilateral pending action brings to the front-burner questions about the size of government, the excessive cost of governance, and the fraud and corruption in Liberia. An examination of the operational style of the successive Liberian legislature since 2006 would reveal an array of demagogue politicians who always pretend to mean well in the kind of policies they have pursued in the running of government, but a perusal of their factual performance records would disclose only deliberate and systematic pillage of our commonwealth, reckless misappropriation of scarce resources and brazen disregard for the needs of the people. These pretentious politicians, who always claim to have people-oriented and focused leadership qualities, are, in fact, the least endowed with the virtues of transparency, probity and accountability in the running of government business. The end result of all these debauchery is the emergence of a powerful privileged class which has suddenly supplanted the yearnings and aspirations of teeming Liberians with its bloated appetite for opulent and ostentatious lifestyles. Meanwhile, in spite of our bloated and behemoth government bureaucracies, the pre-occupation of our lawmakers has ceased from being service to the Liberian people, to maintaining and protecting themselves and their numerous cronies. While corruption and cronyism continue to fester in government circles, the people continue to wallow in inexplicable squalor and denial. Liberian, generally observed and agreed that Liberia is a nation blessed beyond belief but, as at today, a nation in abject poverty, confused leadership, and obscurity. Many articles, opinions, suggestions, etc. have been written about Liberia in the recent past. More of these critical but constructive viewpoints have been adjudged by the very objective minded as poignant, relevant and indeed requisite for all those leaders who wish Liberia well. It is depressing, that several years of democratic huge investment in Liberia has yielded no fruitful gain, rather, a downturn in development and growth. The National legislature is neck-deep in corruption; is made up unserious elements and people by self-centered individuals. Our lawmakers are not justifying their monthly pays, vis-a-vis the number of days and hours they sit in a week and the number of times they go on vacation every legislative calendar. Why our lawmakers playing on the sensibility of the people by still asking for additional US$73? Is Liberia under a curse of Leadership? Is leadership Liberia’s greatest challenge? Is it corruption? What will we do about it? Will there be an end? Are we at a tipping point? Is there hope? Is there a way out? I would love you to take a little glimpse of the present crop of leaders who govern our affairs, starting with the lawmakers and others in subsequent articles. These are the leaders we have employed during the past elections, and some appointed, to serve our interests. Most of these leaders collect huge funds from the Liberian government and not only spend them lavishly but steal others. The Lawmakers Budget in Post Conflict Liberia FY 2006-2007: US$9,456,230 FY 2007-2008: US$15, 615,456 FY 2008-2009: US$17,964,000 FY 2009-2010: US$19,145,624 FY 2010-2011: US$22,846,709 FY 2011-2012: US$29,722,670 FY2012-2013: US$35,166,002 FY 2013-2014: US$38,776,146 Office of the Speaker of the House FY 2009-2010: US$605,412 FY 2010-2011: US$619,952 FY 2011-2012: US$631,167 FY 2012-2013: US$855,487 FY 2013-2014: US$816, 357 Office of the President Pro Tempore FY 2009-2010: US$634,900 FY 2010-2011: US$517,904 FY 2011-2012: US$911,227 FY 2012-2013: US$906,979 FY 2013-2014: US$846,654 If these so called “representatives and senators” earn this much, do you expect them to defend the hapless & helpless majority against a cruel government or its policies? You know why! It’s why they ignored all the waste in the budget, but instead jerked up their own budget every fiscal year. Our lawmakers are poking underage girls, stealing public funds through budgetary allocation and generally had been an inefficient nuisance since 2006. As indicated above, our lawmaker’s allocated to themselves US $ 39 million for the FY 2013-2014 and now asking for additional US$73 million in the pending 2014/2015 budget amidst the pervading abject poverty across the land. This is part of the reason why 83.2% percent of the nation’s budget is allocated to re-current expenditure while capital expenditure stands at meager 16.7%. This means that based on the government’s expenditure plan it will spend less on capital investment projects because we are using US $ 39 million, a huge chunk of the nation’s resources to service less than 103 legislators and their staff in a country of over 4 million people and yet they are seeking additional US$73 million. Where is the opposition in the legislature? CDC, LP, NDC? Birds of a feather flock together! This is it. Liberia has never worked, and may never work if we don’t rise and confront this system. The combined salaries and incentives of the House of Representative members and Senators in the Fiscal year of 2012-2013 was US $ 35 million plus and in FY 2013-2014: US $ 38 million plus. For sitting to say “aye” and “nay”. What do these leaders contribute to earn so much? What are we paying them for? In the same country where millions are starving, where millions are impoverished; where unemployment is high and poverty continue to increase! Obviously, we can’t go on like this. It will take a fight. The slavery our children will be subjected to will know no bounds. We are enslaved by our very own, our blood, our kinsmen! They ridicule us with their plunder, getting audacious with every unchecked loot they take from the system. Once we can ensure frugality at the legislative, they will exert pressure on other sectors. We have allowed those meant to keep a check on the system become loose. Insanity! I can never entrust a primary school to any of these looters, they will ruin it! We are close to a tipping point, a point where we are being reminded daily of why we should save our nation from their destructive hands. We are at a point where we must make strategic efforts to sacrifice now so we can gain tomorrow, for Liberia amongst other issues, is not yet a country. Not yet! How did we end up putting these guys at the helm of national affairs? How did we put those who keep pushing up waste and spending more? Most of these lawmakers are personal failures in their own system, hence the Need to amass wealth by all means possible. The wastes from Liberian legislature, when put together, will build schools, equip hospitals, et al. Is this why we were told to “sacrifice a little”? What do we do? We must demand a cut down of these wasteful salaries, allowances and incentives accruing to the national legislature, at least 50% cut. Protest against the US$73 million request! We Must Occupy Liberia, this time strategically and ready for each and every move of the government. To achieve this, our ideology and strategy must be full proof, must be near-perfect! The enlightened man must get to the ordinary man. We need the middle class because we have to occupy again or we die in this slavery. The ‘ordinary man’ keeps quiet, hardly knows; the ‘enlightened’ hardly engage them or ‘walk the talk’. This must change. When we enlighten and empower the common man, he would need no coercion when the elastic limit is reached! The streets, the grassroots; that’s where the power lies! Leadership failure. Leadership curse. Leadership collapse. This is Liberia, at present, the land of the living dead. We need a re-awakening!

Why Liberia Must Renegotiate, Revoke, or Cancel Disadvantageous – The Case of LB Oil BLOCK 13

I have a fine example of how corruption works in Liberia and how international businesses are in cahoots with the corruption. My example is the recent Production Sharing Contract (PSC) between the government of Liberia, and two oil exploration companies, U.S. petroleum giant, Exxon Mobil, and Canadian Oversea Petroleum Limited (COPL). A secret agreement was negotiated and signed between the government of Liberia and the oil exploration companies in New York, but very little was known about the contents of these negotiations, and actual terms of the agreements, due to opaque processes, and reasons of confidentiality often invoked in relation to the contracts. Fortunately, for the anti-corruption community, the agreement was leaked and analyzed on the internet. There is no doubt why it, like almost all agreements of this kind of, was kept secret from the Liberian people and signed in faraway New York. It is remarkably disadvantageous to the country of Liberia and its people. Liberian negotiators failed to understand that oil exploration is a long term investment, and contracts must establish how rents will be divided between governments and companies as well as how costs and risks will be shared. Unfortunately, the agreement awarded Exxon Mobil a whopping 80% of the oil shares discovered from Liberia’s block 13, while their Canadian neighbors, the Canadian Oversea Petroleum Limited (COPL) received 20%. According to Front Page Africa news, “the deal was approved by President Ellen Johnson Sirleaf who recently signed the appropriate paperwork related to the PSC that it could be sent to the Legislature for a ratification vote. The terms of the PSC will take effect once ratification has occurred and the PSC is enacted into law.” For their part the National Legislature (“You EAT; I EAT House”) ratified the deal within a week with speculations mounting that some US$2.5 million were spent to push the document during the ratification proceedings. How was the lopsided PSC made? How could Liberians negotiators give away so much to the oil exploration companies? Why the National legislature failed to critical analyze the agreement? The Environmental Protection Agency (EPA), despite the agency role in the formulation of the oil sector policy, was left out of the negotiation process of oil block 13, why? Why critical issue such as environmental pollution was not discussed and that certain environmental experts were not allowed to speak on the issue of pollution and the environment during the process leading to the ratification of block 13? Did the Liberian negotiators known that Exxon Mobil Corp. was found liable in a long-running lawsuit over groundwater contamination caused by the gasoline additive MTBE, and ordered the oil giant to pay $236 million to the state of New Hampshire to clean it up before awarding Exxon Mobile 80% of the oil block? Are our policymakers unaware that our national economy is not benefiting from these numerous concession agreements between the government of Liberia and foreign firms and to do so, it is important to have good policy in place and be more transparent by encouraging citizen and civil society participation in these concession negotiations? The contract includes the provision of only 5% Citizen Participation shares in LB-13 and 10% royalty on oil produced from wells drilled under water depths of 0 – 1500 meters without Liberian government putting in any capital. Isn’t this against the law? The latest deal falls short of our country’s current laws, which call for royalties of no less than 10 percent and a free stake for the state of 20 percent. This was an unknown provision before the agreement was exposed and to date no one in government has explained the methodology with regard to the 5% Citizen Participation Shares in LB-13. Is it only on paper? I hate to sound pessimistic, but I would presume its shares would remain in the hands of the two international oil exploration companies, Madam Sirleaf, her Son, Robert Sirleaf and bunch of their sycophants. Moreover, the agreement includes a signing bonus of USD$ 50 Million and upon ratification and printing into handbills. Where has this $50 Million dollars gone? No one knows, but please don’t tell me it went to repay Liberian debt. It definitely did not go into the accounts of the government of Liberia. Clearly these are bribes paid to the Liberian negotiators for giving away potentially billions of dollars. $50 million is insignificant compared to the huge revenues that these companies stand to reap should they discover huge oil deposits off our shores. These companies are not NAIVE; they know for sure that they will find good quantities of high quality oil in these blocks. They are going to reap so much and give Liberia so little. Considering the 10% royalties stipulated in this agreement, Liberia stands to get ten cents for every dollar earned, $10 for every $100 earned, and so forth. 50 USD million may sound a lot but I am afraid it is pea nut for a post conflict country that is so desperately needs of reconstruction, roads, schools and hospitals. For example, our annual disbursements for education and infrastructure are not stipulated in specific amounts in these agreements; this means that it could be a $75,000 , $150,000, or $200,000, etc. per year, even if these companies are reaping millions or billions per annum – government will have no control over how much these companies give in these regards. So we are selling our resource for “a penny to a dollar”. It is amazing how little money was needed to bride Liberians to negotiate this terrible agreement. This is a great betrayal of the Liberian people’s trust. So our oil is 100% Canadian and American property? The President says she wants what’s best for the nation, but how then can She and Her sycophants agreed to deal like such (Exxon Mobil a whopping 80% and the Canadian Oversea Petroleum Limited (COPL) received 20%)? What have these companies done for the Liberian people to take legal ownership of our most precious resource? Why? This agreement is very unbelievable, to say the least. I do not understand how any country will give 100% of its oil ownership away. It is only fair to say that Madam Sirleaf and her Sycophants are incapable of securing a profitable deal for our people judging from the numerous concession agreements signed between the government of Liberia and foreign firms. Another concern of mine pertaining to the LB block 13 agreement is that the agreement was signed when the prices of oil continue to sky rocket per day and the agreements has no provision if the price of oil continues to climb up when oil exportation start in Liberia. Right now oil is around $94 per barrel and if the price would reach $100 per barrels, then the oil exploration companies would reap the amount of the increase which would equal almost millions or billions of dollars per year when oil drilling in Liberia start. These types of contracts normally have a windfall tax to cover this eventuality. Unfortunately, those that negotiated the agreement were unaware of this possibility due to the lack of in-depth inquisition or should I say greed. Liberia under a Harvard trained Economist leadership continue to signed bad contracts that give a disproportionate share of the resources’ value to private foreign companies. Moreover, Liberia under Madam Sirleaf stewardship had not pursued sustainable growth strategies despites billions of debt cancellation from the International Financial Institutions (IFIS) as well as foreign aid in the tune of billions of dollars. The present regime failed to recognize that if we do not reinvest Liberia resource wealth into productive investments above ground, Liberia is actually becoming poorer. Our leader including member of the national legislature continue to use their access to financial resources from extractive industries to advance their own personal agendas, instead of using them in the best interest of the nation as a whole. Natural resources are public resource and the negotiations between Liberia and foreign companies should be transparent, accessible and easily understandable by citizens, unfortunately, this is not the case in Liberia. Communities are not given the opportunity to review contracts, and find out how much revenue has been generated and what development projects the revenues has being spent on. Sadly, the Darling of the West (Madam Sirleaf), and her Sycophants had re-introduce the failed policies of plantation economy which afford investors to loot Liberia’s resources while She and Her surrogates ripped the benefits at the expense of ordinary Liberians, but there is a simple answer after the Madam exit the national stage: renegotiate; if that is impossible, impose a windfall-profit tax. All over the world, countries have been renegotiating or imposing windfall-profit tax if renegotiation is impossible. According to Former World Bank Chief Economist and a Nobel laureate in economics; and University Professor at Columbia University, Joseph E. Stiglitz, “natural-resource foreign companies will push back, emphasizing the sanctity of contracts, and threaten to leave. But the outcome is typically otherwise. A fair renegotiation can be the basis of a better long-term relationship.” I tend agreed with Professor Stiglitz argument and Botswana is a prime example. Botswana’s renegotiations of such contracts laid the foundations of its remarkable growth for the last four decades which led to immense reduction of poverty. Moreover, it is not only developing countries, such as Ghana. Botswana, Bolivia and Venezuela, that renegotiate bad contracts; developed countries such as Israel and Australia have done so as well. Even the United States has imposed a windfall-profits tax. South Africa, home to the greatest mineral wealth in the world, estimated to be worth $2.5 trillion, is considering imposing a swinging 50% windfall tax on mining “super profits” and a 50% capital-gains tax on the sale of prospecting rights. Those are among the proposals put forward by an independent panel of experts, set up by the ruling African National Congress (ANC) to study the possibility of greater state intervention in the mining sector. Ghana, Africa’s second-biggest gold producer, recently announced a review and possible renegotiation of all mining contracts to ensure that mining profits are “maximized… [for] the good of the country”. It plans to raise taxes on mining companies, from 25% to 35%, and a windfall tax of 10% on “super profits” in addition to existing royalties on output metal, to 6%. Guinea, home to the world’s largest bauxite reserves as well as one of the world’s biggest iron-ore deposits, is helping itself to a 15% stake in all mining projects and an option to buy a further 20%. In Guinea, mining companies are legally obliged to pay a tax to the owners of the land on which they mine. They are also required to support local development projects. Namibia has decided to transfer all new mining and exploration to a state-owned company. Algeria has become the latest African country to consider slapping windfall profit taxes on foreign oil companies. According to report, Algerian government says the tax will be applied in months when the price of Brent crude averages above $30 a barrel and will vary from 5% to 50%, depending on the company’s total production. As we speak Brent Crude Oil is averaging $107 per barrel. The same can be said of Ivory Coast’s government which recently adopted a 19% tax on gold profits, seeking to capitalize on current high gold prices to help fund reconstruction following a decade-long political crisis. The new 19% windfall tax would yield some 40 billion CFA francs ($79.1 million) in additional income to the state annually. Zambia, for example, had hoped to impose windfall profit taxes on copper mining to finance an infrastructure fund. A few principles emerge from the experience of the past from other developing countries, including ensuring a truly competitive award of concessions, reducing opportunities for opportunistic renegotiations, promoting transparency and full disclosure of contract information, creating opportunities for participation as well as involving civil society in the negotiation and implementation process. The World Bank Institute has documented more than 1,000 experiences of negotiation and renegotiation of contracts throughout the world and Liberia can learn from those experiences (Please see:). Although mainly focusing on infrastructure concessions, most of the lessons learnt from the review of these documents can be applied to the other sector such as oil. Aside from the direct negative effects of potential misappropriated rents, contract renegotiation imposes substantial additional costs when handling renegotiation petitions and cases. The report emphasizes the crucial importance of designing an optimal concession contract that carefully limits the opportunities for “opportunistic” renegotiations. Weaknesses in the original concession design can result from hurried processes, vested interests (as evidence in Liberia) and limited resources of governments in the concession design. The report stresses: “the importance of granting negotiation/renegotiation in the strongest possible legal grounding; the potential impact of financial advisors and investment banks in influencing the concession transaction that should be taken into account; the need to strengthen institutions and credibility of regulatory frameworks prior to the negotiation/renegotiation process to ensure appropriate regulatory oversight and enforcement; the growing awareness of the need to establish a separate, autonomous and effective body or regulatory institution that oversees the allocation, renegotiation and implementation of concession contracts. (This institution should be granted adequate resources and capacity, including well trained and compensated staff); the need to ensure that all processes, procedures and decisions are made in the most transparent and participatory manner.” Most of the concession agreements between foreign firms and the government of Liberian were negotiated from 2006 and still on going. Madam Sirleaf and her surrogates enticed investors by granting incentives such as extensive tax and royalty exemptions. They are building a highly centralized state through kleptocracy and amassing large personal fortune through economic exploitation and corruption. Madam Sirleaf regime is notorious for corruption, nepotism, and the embezzlement of millions of dollars. Consequently, our country earned very little from such contracts. That is why it is necessary to renegotiate some of them. The challenge of negotiation/renegotiation is to ensure open, efficient and transparent access to Liberian natural resources. We should use our best endeavors to re- negotiate fair deals with multinationals in Liberia; ALSO reviewing our disadvantageous concession agreements is important for more than earning greater revenues. Governments should respond to pressures from civil society groups and communities to ensure that contracts address environmental protection, adequate compensation to affected communities as well but I don’t see this happening under this failed regime. Only in Liberia do they worship killers and crooks masquerading as politicians. In civilized countries they remain behind bars. Liberian society is sickening. Instant gratification and greed is what this is about. Most Liberians by crook or hook wants their share of the national pie and their behavior is a frightening show of disrespect for our undeveloped country. They are self-serving greedy mindless thieves with no inkling about morals and principles. What these crooks don’t realized is the government of Liberia don’t rely heavily on income tax for revenue, our country’s revenue is derived from profits accruing mainly from carried interests and corporate taxes and royalties based on certain percentage fixed rate on volume and value of our natural resources and the low interests, royalties, corporate taxes and ground rents been awarded to foreign companies on the numerous concession agreements signed by the present regime limit the potential of Liberia, and the Sirleaf Government’s inability to renegotiate better rates on royalties and higher percentage of state shares in particular, account for Liberia reliance on foreign aid to supplement its gimmick budget. Today, probably more than 90% of our GDP is generated from natural resources proceeds. Poor management of our natural resources results to No Economic Growth and No Growth, No Reduction in Poverty. It is that Simple. This is why after Madam Sirleaf and her surrogates exit the stage, the new regime should start a new beginning by the imposition of wind fall profit tax on profit on all natural resources concession agreement in Liberia if renegotiation is impossible!! A tax levied by governments against certain industries when economic conditions allow those industries to experience above-average profits is highly needed in Liberia. Windfall taxes are “primarily levied on the companies in the targeted industry that have benefited the most from the economic windfall, most often commodity-based businesses.” The benefits of a windfall tax include proceeds being directly used by governments to bolster funding. Equally important, the money gained through natural resources must be used to promote development. Stiglitz argues that “ real development requires exploring all possible linkages: training local workers, developing small and medium-size enterprises to provide inputs for mining operations and oil and gas companies, domestic processing, and integrating the natural resources into the country’s economic structure.” Our government position should show its seriousness about mobilizing resources which can help improve schools, build roads, improve mother to child health, etc. Foreign investors are welcome in Liberia, and should be seen to pay a fair share for using (renting) these resources which belonging to Liberia . Therefore, so long as the sharing is fair, there should be no problem. Oil exploration is exhaustible, unless we use it prudently now when commodity prices are good, we’ll regret later. And so, while the going is promising, we must make sufficient revenue from it and we can diversify to other areas in our economy. Liberians are sitting on huge natural resources and we ought to find a way of rewarding ourselves something from that ownership. It is up to Liberians to know what it is entitled to and claim it accordingly. If they don’t, they will have nobody to blame. Information and economic methodologies exist which Liberia can use for bargaining. If Ghana, Ivory Coast, Guinea, Algeria, and others African countries can do it, I am sure Liberia can do it as well. It’s time we get the right remittances from our natural resources. Therefore, it is no longer wise to allow investors to invade Liberia, and let them exploit its resources at will. We must do something about the exploitation of our natural resources by the selected few at the expense of the majority. Poverty in Liberia cannot possible be eliminated unless the poor themselves say we insist on justice with regard to equal distribution of wealth not CHARITY. One example of that justice is to end privatization of natural resources or obtain the right remittances from our natural resources. Shine your eyes my people!!

Liberia’s Outrageous Recurrent Expenditure

The 2nd quarter of the fiscal year has practically ended, the beginning of quarter 3rd had started, yet Liberia and Liberians are yet to know how a portion of the projected US$582 Million budget are being spent and how much more is going to be borrowed in our name to provide for services that we can neither see, nor feel. Appearing before the National Legislature, the Minister of Finance predicted a budgetary shortfall of around US$74. 5 million at the beginning of quarter three of the Fiscal Year (FY) 2013/2014. With series of budget shortfalls, the United States of America (USA), through its Ambassador accredited near Monrovia, Debora Malac, urging the Government of Liberia to discontinue the spending of money it does not have. Ambassador Malac said the Liberian Government is facing a serious budget shortfall, which has impacted its ability to execute “ambitious activities” it has planned to benefit the country and its people. The US Ambassador noted that “It is hard, when you are impatient to make things happen when the money is not there. Sometime it is good to take a step back to figure out what is possible with the funding that is available, and then look and hope for other ways to look for funding.” International Monetary Fund (IMF) asserted that“Addressing significant shortcomings that have emerged in the budget process and expenditure controls will be critical in the coming months.” Liberians, no doubts, are no longer strangers to the news of poor budget implementation, though it still remains a thorn in the flesh. The citizens are also no longer surprised that there are duplications and assessed fictitious items that facilitate easy access to public funds. Even the issue of late submission of the budget proposal, possible wrangling, claims and counter claims over votes for various sectors, Ministries, Departments and Agencies (MDAs) are the business as usual. Minister Amara Konneh and his team raised the hope of the Liberian people by adopting the Medium Term Expenditure Framework (MTEF) after MTEF the legislative approval as required by the Public Finance Management Act of 2009. The reasons mostAfrican countries are participating in the MTEF, it provides the basis for annual budget planning and consist of a macroeconomic framework that indicates fiscal targets, estimates, revenues and expenditure, including government financial obligations in the medium term. The documents also set out the underlying assumptions for these projections, provide an evaluation and analysis of the previous budget and present an overview of consolidated debt and potential fiscal risks. MTEF also produce a number of important outcomes, including the macroeconomic outlook; fiscal balance; and other key indicators. The importance of sensible and prudent budgetary allocations cannot be overemphasized because the budget itself is an expression of public policy. It is the vehicle through which the various programs and agendas of a government come to life. It is the major economic policy instrument which indicates a government’s priority, and is also a tool to correct anomalies and inequities within the society. An efficient budgetary system is critical to economic growth and developing sustainable fiscal policies. On the flip side, a poorly designed budget where attention to details are neglected and figures just altered from existing templates can only exacerbate social and economic problems within the country. The effect of faulty budget choices will inevitably be felt mostly by the ordinary citizens who are at the mercy of dysfunctional government policies and facilities. Sadly, in the Liberia context, budgeting is still based on guess work as evidenced in series of budgetary shortfalls. In a nutshell, Minister Konneh explanation to the National Legislature for the numerous budget shortfalls were poor revenue collections. I tend to partially agree with Minister Konneh, Revenue generation is the nucleus and the path of modern development, but what Minister Amara failed to educate or inform the legislature and the Liberian people is the country’s outrageous spending spree in running the government and the urgency needed in curtailing such wasteful spending. The volume of public expenditure has been on arising in Liberia if not almost all countries of the world, because of the continuous expansion in the activities of the state and other public bodies on several fronts. Public expenditures are the expenses which government incurs for the maintenance of thegovernment and the society in general. Generally, public expenditure in Liberia can be categorized into two componentparts, namely Capital expenditure and Recurrent expenditure. Recurrent Expenditure is the Spending by the Ministries, Departments and Agencies (MDA) of Government on Salaries, Pensions & Overheads Salaries Capital Expenditure is used to provide infrastructure such as roads, water and power; fund educational services such as schools, colleges and universities; and provide healthcare facilities and services among others. During FY2005/06 – FY2012/13, public spending increased by nearly three times supported by a steady increase in revenue. Spending rose from 9 percent of GDP in FY2005/06 to 33 percent ofGDP in 2012/13. This was driven by rising personnel costs, goods and services, and transfers. Capitalexpenditure has risen from a very low level of 0.5 percent to reach 7.8 percent of GDP in FY2012/13. In the 2013/14 budget, 83.2% of the nation's budget was allocated for recurrent expenditure while capital expenditure stands at meager 16.7%. We are very worried that over 83.2% of the budget is actually going for recurrent expenditure and less than 16.7% on capital expenditure. No country develops under such provisions because what grows a country or builds the economy is the amount of investments you are making on infrastructure and other structural issues that you required to strengthen your economy.It is a shame within the 8 years since Madam Sirleaf came to the presidency and with over $2.716 billion collected in total revenue collected in revenue, the ordinary people haven’t felt the impact economically. So how did we get to such a high cost of running the government? It was the two sets of increases that were done on the public sector salaries that actually catapulted recurrent expenditure to where it is today. It is not sustainable! You cannot give what you do not have as Ambassador Malac had said. We must re-examine public sector salaries, including that of political office holders across all levels of government. We must stop the stealing going on in government, plug the leakages and hold our so called civil servants accountable. There are people who say civil servants are underpaid but if you look at it, it is in terms of giving what you really do not have. At the onset of the global recession, there were countries that actually reduced wages of their civil servants because they could see that their revenue profile could no longer support the continued payment of these wages. But what did Liberia do? Not only did we literally double the minimum wage, we actually established all sorts of new institutions and escalated our expenditures through the roof. There is nothing that the Minister of Finance or the government can do to reduce recurrent expenditure and avoid shortfalls without really facing the real issues, without engaging the people. We must face the issues! Liberia must face the issues! We cannot run away from it forever. Our recurrent expenditure is outrageous! It might seem convenient now because the government doesn't want to incur the wrath of the civil service but in the long run, this country will suffer for it. A budget document that provides only 16.7% for capital expenditure is a trip in self delusional and the propagation of falsehood. The weight of recurrent expenditure cannot be supported by the capital budget. This is symptomatic of a rent economy whose long term growth is not sustainable. The ratio of recurrent to capital expenditure does not present our present leadership has willing to change the status quo. There must be the political will to restructure this equation if, as a nation, we are mindful of the need to ensure a bright and prosperous future for our citizens, particularly our teeming youths, the majority of whom are presently in the labor market. Although the Minister of Finance stated that the budget is for job creation, the amount available to pursue such an objective seems rather lean and laughable, that is why I am not surprised of the numerous shortfalls. The major trouble with the Liberian budget is the overbearing interest of those charged with the responsibility of preparing the document and appropriating its contents for the benefit of the Liberian people. Rather than see themselves as stewards, they now believe they are the primary and ultimate beneficiaries of the budgeting process. Thus, the fight between the Executive and the Legislature has been at the expense of the common man whose interest the budget has failed to truly cater for, as it should. At the presentation of the appropriation bill, Minister Konneh and his team said that it was scripted to create employment and development oriented, however, the discordant tones trial policy documents, pointed to the lack of synchronization of recurrent and capital expenditures in fiscal plans to tackle development. Still, there have been rising concerns over what makes up the nation’s recurrent expenditure, how real and necessary, they are in the economic management of the country. For instance, the rationale for the yearly budget of the National Assembly, which had been pegged at US$189 Million over the years, with no upward nor downward, but yet requesting US$73 million for so called“direct district development.” Corruption is also a factor in this equation. The figures in the recent years have become mind-boggling, leading to serious distortions in our national priorities. In a country where there is a huge infrastructure deficit, spending huge sums on recurrent items is detrimental to economic progress. The biggest constraint to productivity in the economy today is the quality of infrastructure. Improvements in this area can only be achieved if there is a significant investment. The situation is even greater concern because the full implementation of even the meager allocation is often not guaranteed (Shortfalls). For the ordinary Liberia, the budget is gradually losing its relevance. Most of the time, there has been a great variance between what is budgeted and what is actually implemented or spent, thus rendering the entire process a mere formality designed to just make the people feel good that something is being done about their affairs. In the 2012/13 budget, for instance, the level of implementation was less than projected. Granted, Liberia’s economy has been growing, but there is a greater argument that it is in figures. That is typical of the government spending.The real effect of such a growth in government spending has not been proportionately felt by the populace, resulting to the paradox of “growth without development.” So, despite the burgeoning increase in expenditure, unemployment has remained high as the development indices have remained poor. But is capital expenditure really implemented?. Obviously, much of the spending through the country’s budgets go to service the establishment — MDAs, and at the end, very little is actually spent in a way that benefits the ordinary man. An assessment of the performance of the 2013/24 budget so far showed various reasons for the failure of the budget implementation, while its impact has remained unimpressive. The MTEF projections and policy objectives over the years, had shown the nation has not moved from the old practice of heavy recurrent and light capital projection and subsequent poor implementation of the budget in the years past. The pattern is that recurrent expenditure is fully drawn down, while the capital expenditure bears the brunt of all kinds of delays, bottlenecks, inefficiencies and outright economic sabotage. The figures speak for themselves. US $4854.7 Million was released for capital expenditure in the 2012/2013 while only US$68 Million for capital expenditure.The implication from the trend in 2012/2013 is that capital budget implementation continues to be relegated as in previous years. The 2013/14 implementations may end up being as usual. Assessing MTEF, on which the 2012/2013 and 2013/14 budget bill were based, listed fundamental gaps in the document, which could raise excuse for failure in the future. They further queried the absence of indicators of the growth drivers in the document. To them, it was not all about recurrent expenditure, but the entire system on which those assumptions were made and possibility of getting positive results from faulty background. The framework fell short of the requirements expected of it on the projections and forecasts of economic growth, inflation rate, interest rate and credit policy, which should galvanize the private sector to create wealth and jobs to improve the economy. The monetary component wasn’t considered in the MTEF and must be considered to support growth and employment generation. Where is the projected sectoral contribution to the Liberia, economic growth in 2013/14? Does it mean we have no sectoral targets? This current MTEF has no foundation per se and is therefore inclined to serve the interest of some few, the creditors and the business as usual community and not the social welfare of a wider society. There have been various figures bandied around on the GOL budget implementation performance. The figures from the MDAs are at variance with what is coming from the Finance Ministry. But what is clear in all of these is that capital budget implementation has not been satisfactory. This has been a recurring trend in budget performance over the years. Whereas recurrent spending often achieve close to 100 per cent, the story for capital expenditure is quite different. Yet the critical problem of infrastructure deficit can only be addressed by scaling up capital budget performance. Recurrent spending is estimated at 83 percent. By the time allowance is made for debt servicing, total recurrent spending will be getting close to 90 per cent. However, bureaucratic bottlenecks; capacity issues in the MDAs; weak institutional capacity to capture all revenue due to the GOL Account; corruption and wrong expenditure priorities, as factors aiding poor budget performance in the country. Economic growth and development is mainlyenhanced by the expansion of infrastructural facilities, the improvement of educationand health service, the encouragement of foreign local investments, low cost housing,environmental restoration, and the strengthening of the agricultural sector. The approach consists of stimulating the economy by addressing the nations forecast needs.Dealing with these issues will result in a great amount of money spent by thegovernment and certainly lead to increased public expenditure. The size and structure of public expenditure will determine the pattern and form. If government spending is used to finance investment in roads, education, health,agriculture and other areas (Capital Expenditure), these investments will have direct social and beneficial economic effects on the country. Furthermore, by providing new opportunities andexpanding the capabilities of the masses, government capital spending plays an importantrole in ensuring sustainable economic growth.

US$78M Infused into Liberian Economy, But Where are the Jobs, Madam President?

oday, Liberia has about 1.13 million people who are willing and able to work, but the majority of them have no gainful employment. So every day, millions of our unemployed brothers and sisters – including those entering the workforce for the first time and others who lost their jobs due to the incompetent management of our economy anxiously scan the pages of newspapers and websites for job advertisements; less than five percent of applicants will be successful, but at least 100 of thousands more unemployed people will join them in the new year of 2014. Why are unemployment and inflation rates rising while productivity continues to decline? Why have our vast resources not created massive employment opportunities for Liberian? The most despairing aspect is the fact that the worst affected are Liberian between the ages of 21 and 40 years - the future leaders of our country. In 1962, our population was about 1 million, a large percentage of which was employed. The employment to population ratio grew until the early 1980s when it started to decline. Presently, Liberia’s total population is nearly 4 million. Out of this total, 1.13 million is the labor force of the country, and only 195,000 people are in paid employment. According to ILO 70% of Liberia’s population are under the age of 30. The effects of unemployment on the person and the country can be catastrophic. At current rates, even if government policies, enabling environment and direct efforts manage to create one hundred thousand new jobs a year, it would take 40 years to close the existing job gap. Except that by that time, at least millions more Liberians would have joined the workforce. According to the Labor Force Survey carried out in 2010, the labor force participation rate was 62.8 per cent, the employment-to-population ratio was 60.5 per cent and the unemployment rate was only 3.7 per cent. The labor force participation rate in urban areas at 54.9 per cent is lower than the corresponding rate in rural areas (71.2 per cent). The male labor force participation rate is higher than the female rate (66.1 and 59.9 per cent, respectively), but the unemployment rate of women is higher than that of men (4.1and 3.4 per cent, respectively). The vulnerable employment rate – the share of own account workers and contributing family workers in total employment – is high at 77.9 percent, as is the share of workers engaged in the informal economy (68.0 per cent). Perhaps, today’s figures are too scary for government to release, but unemployment is too critical for government to play political ostrich with. The average years of studies and Return on Investment (ROI) for a university degree in Liberia are both 5 years, yet it takes an average Liberian graduate an average of another five years to find what can be considered a stable job. Many others, especially those without political ‘godfathers’ remain for longer periods without jobs no matter how qualified they may be. Not only have large numbers of Liberian graduates are unemployed or underemployed; many are unable to apply the skills learnt in school. There are also large segments of the employed population who are simply wasting away, doing things they really have no business doing – just to remain alive. Another worrying issue is our national productivity output gap. Unemployment causes substantial economic losses. We should be producing goods and services for at least another 3 plus million people, but because unemployed people do not earn money, that gap remains unfilled. And there seems to be no hope in the immediate future. All government’s promises of 'creating jobs' have remained unfulfilled. Anyone familiar with data on unemployment will know that all the supposed falls in the unemployment rate are statistical manipulations because they do not reflect any actual job gains. The jobless rates in Liberia have not fallen! Liberia Institute for Statistics and Geo-Information Services (LISGIS) announced that the official unemployment rate of Liberia has declined from 85% to 3.7%; one wonder what kind of country is ours in which leaders are far away from reality. The Statistics House wanted the international partners to believe that things are getting better in Liberia, when by any stretch of the imagination huge majorities of the people are living in poverty. College graduates are walking the streets and cannot find jobs, not to mention high school graduates. Proof of the desperation was demonstrated by the “Vacation Job” scheme started by the President Madame Ellen Johnson Sirleaf. The scheme was intended to offer ten thousand vacation jobs, but over twenty five thousand applied. As a result of the excess, the management of the scheme was in crisis and the end result was the cancellation of the entire process by the President. The millions of people with no jobs represent a serious impediment to Liberia’s economic development. Apart from the immense waste of the country's human resources, it generates losses in terms of lower output which results in poorer incomes and increased poverty. It also causes social decay and inhibits national cohesion. In fact, unemployment in Liberia is a national security threat. So what should the government do to create jobs? In virtually every economy, it is small businesses and entrepreneurial ventures that account for nearly 70 per cent of new jobs, not the government and not the large companies. It is therefore sensible to remove the obstacles to doing business and sustaining small and medium enterprises. These obstacles include infrastructure constraints, especially electricity, a dysfunctional and corrupt public service that frustrates businessmen, and lack of affordable, long term finance for any venture other than trading! Liberia was ranked 144 out of 175 countries in the IFC Ease of Doing Business Index in 2013, far below Ghana (62); Botswana (65) and Sierra Leone (137). In the World Economic Forum (WEF) Global Competitiveness Index 2012–2013: Africa and selected comparator economies, Liberia ranked 111 out of 131, while South Africa moved up four places in the same period, and is now in the top 50. In terms of competitiveness within Sub-Saharan Africa, in 2013, Ghana, Zambia, Botswana, Namibia, Kenya, The Gambia, Rwanda, and Gabon are ranked well ahead of us. The WEF's observation about Liberia’s dismal position has Madam Sirleaf's work cut out for her. We need to improve protection of property rights, fight corruption, attack undue influence and government inefficiencies. Liberia was ranked low in terms of security, infrastructure, health and quality primary education. One of the much-touted actions of government of recent was the provision of USD 78 million in order to infuse the economy. The Finance Minister justified the government action by the stating the “urgent need to pay vendors and civil servant salaries, especially during the festive seasons to give more purchasing powers to the people, which will ensure revenue for the government in return.” Raw cash does not create jobs, but the entrenchment of consistently and right policies, frameworks and regulatory environments do. Why should government borrow just to pay public sector wages, while spending on capital projects that would create direct jobs and the environment for indirect jobs, remain critically underfunded? Employment and unemployment are indicators, not predictive factors for economic success. In most places in the world, job growth leads to economic growth and vice versa. So we cannot claim that our economy is growing when it is not creating jobs. Government needs to raise capital expenditures substantially – by building more schools, roads, bridges, water systems, electricity networks and other projects that facilitate job creation. Worrying about deficits but doing nothing about business opportunities amounts to doing nothing about the economy. The creation of an environment in which innovation and entrepreneurship (meritocracy) flourish – thereby creating jobs and stimulating economic growth is the responsibility of government: only a naive leadership would abdicate the responsibility of providing jobs for men and women who are willing and able to work. It has come to a point where government must tie every dollar of public expenditure to job creation: If several companies are bidding for a public contract, apart from lower costs and competence, one of the criteria should be the number of jobs each firm would generate. Government must consider awarding the contracts to the firm that promises to create the most jobs – and follow up to ensure that the jobs are actually created. If this strategy is adopted by the Liberian government in the award of contracts, more jobs would be created weekly and this would have multiplier effects on the economy as well. At the moment, many sectors capable of creating jobs for Liberians remain untapped. Tourism alone can create millions of jobs, but which tourist will visit a country that is as unsafe as Liberia? Agriculture – potentially the largest employer of labor has been left largely at subsistence. Yet, this is a sector that can earn more foreign exchange for Liberia than Iron Ore or rubber. Education – where thousands of vacancies also exist or can be created is chronically underfunded, and the informal sector – which is three to four times the size of the formal economy, has been left to its own devices because formalization channels are difficult to reach – so an important source of tax revenues remains ignored. There is an urgent need to reform the various agencies involved in creating employment and alleviating poverty. Youth, Employment, Skills (Yes), Technical, Vocational Education and Training (TVET) as it currently stands can only create what amounts to a drop in an ocean; The Division of Micro, Small and Medium Enterprise (MSMME) must help nurture small and medium businesses in Liberia because MSMME is key to job creation and the Bank of Industry must step up to save the real sector from imminent collapse. In short, all these agencies must come together – urgently - to review the job creation master plan for Liberia. We need to create a minimum of 3 million jobs every year to begin to tackle the unemployment situation in the country. It is easy to say we should give President Sirleaf more time, forgetting that she has led this country for nearly 7 years. The question on the lips of Liberian is: Madam President, where are the jobs you promised? Happy 2014 to all Liberians!

African Leaders' Children Succession, Is Liberia Next? by Seltue Karweaye

Robert Sirleaf on Wednesday announced his Montserrado county senatorial bid, breathing new life into President Sirleaf succession plan. Robert Sirleaf is the son of Ellen Johnson Sirleaf, current President of Liberia. Robert Sirleaf speedy ascent to the top—he only came to Liberia when his mother became the President of Liberia—feed into the narrative that proximity to power through kinship is a useful ingredient for the growing list of succession plans by African leaders. He had served in top governmental positions, including Senior Advisor to President Sirleaf and Chairman of the Board of Directors of the National Oil Company of Liberia. ( President Sirleaf also awarded her other sons governmental positions. Fumba Sirleaf is head of the National Security Agency while Charles is deputy governor of the Central Bank). Robert is highly qualified. According to the report, Robert is a financial expert, educated in the US and who has spent an inordinate time abroad, adding to the little-noticed trend that nearly all African leaders who are beneficiaries of dynastic or patronage politics have been educated abroad. President Sirleaf, who is the darling of the West, was educated at Harvard University. Kenyan President Uhuru Kenya, the son of Kenya’s founding father Jomo Kenyetta, in March 2013 edged out rival Raila Odinga in a closely-contest election. Kenyatta studied political science at Amherst college in the United States before returning to Kenya. It is not only in monarchies that the Head of State’s children succeed to power; it is also, alas, not unknown in republics. It has already happened in Sri Lanka, Azerbaijan, Syria. Togo, Gabon, the Democratic Republic of Congo. It sometimes happens that elections are announced to decide the succession, but it is known in advance who will emerge from them as the victor. Democratic Republic of Congo President Joseph Kabila studied at the National Defense University. He was awarded the rank of major-general and appointed Deputy Chief of Staff of the Armed Forces of the Democratic Republic of Congo in 1998. He was later, in 2000, appointed Chief of Staff of the land forces, a position he held until the elder Kabila’s was assassinated in January 2001. As chief of staff, he was one of the main military leaders in charge of government troops and when his father was assassinated, he succeeded his father. Gabon President Ali Bongo Ondimba, the son of Omar Bongo, who headed the country for 41 years, was educated in France from the age of nine, where he graduated from Sorbonne with a PhD in law. In preparing his son for the succession, Omar Bongo appointed him to governmental positions, including Minister of Foreign Affairs and Cooperation, Minister of State for National Defense. Ali Bongo was elected to parliament in 2001 and 2006 respectively. Through a bogus election, he succeeded his father immediately after his death. Another graduate of the famous Sorbonne in Paris is Faure Essozimna Gnassingbe, current President of Togo. Of the many children of former Togo President Gnassingbe Eyadema, Faure beat out his other siblings to succeed his father in February 2005. Through his father’s influence, he was elected to the National Assembly of Togo in the October 2002 parliamentary election. His father amended the constitution in December 2002, lowering the minimum age for the president from 45 years to 35 years, which was intended to benefit Faure. In 2003, he was appointed as Minister of Equipment, Mines, Posts, and Telecommunications, serving in that position until becoming president in February 2005. His appointment to the government in July 2003 came after he had already been appearing with his father at official functions and contributed to speculation that he was intended as his father’s successor. Even those seen as being prepped for presidency seem to have read the script of succession. Muhooozi Kaineraguba, the first born son of Uganda President Yoweri Museveni, is a graduate of the Royal Military Academy Sandhurst, which trains all British Army Officers, before adding stints in the military colleges in Egypt, the United States and South Africa. He is the Commander of the Special Forces Group, responsible for providing security to the President of Uganda and has been heavily linked to succeed his father who has been in power since 1986. Fiddled with the Constitution for succession Speculation has remained rife in Burkina Faso that Francois Compaore, the younger brother of Blaise Compaore is being groomed to take over next year, should the veteran failed to amend the two-term presidential limit. The younger Compaore studied economics in the Ivory Coast and the United States and has been the president’s powerful economic advisor since 1989. Ex-Senegal President Abdoulaye Wade’s positioning of his son Karim as successor contributed to his ouster in 2012 elections, following a failed bid by Wade to fiddle the constitution. Karim was referred to caustically as “Minister of Heaven and Earth” for holding several ministerial positions under his father (at one point, he reportedly controlled nearly half of the state budget). He graduated from the University of Paris with a master’s degree. Ex-Egyptian leader Hosni Mubarak was widely seen as preparing his younger son, Gamal to succeed him before the 2011 revolution. Gamal studied at the American University in Cairo, which offers an American-style curriculum and which has been the stop for many of Egypt’s and the Arab world’s foremost intellectuals and leaders.Saif al-Islam Gaddafi was mentioned strongly as possible successor to his father, Muammar Gaddafi and was said to be the de facto prime minister. He earned his PhD from the London School of Economics By promoting the political and business interests of their families, most African presidents can complicate their own successions. Handing power from father to son has not been accepted by the population, while the president is living, but has happened when a sitting president dies in office, as in Togo,Gabon and Democratic Republic of Congo as stated above. But the stakes are deadly serious for the would-be dynasties. In Equatorial Guinea, President Teodoro Obiang Nguema Mbasogo’s grip on power ensures the dominance of his children and relatives in the political, military and business elite in Malabo. His son Teodoro Nguema Obiang Mangue (‘Teodorín’) is vice-president for defense and security; Gabriel Mbega Obiang Lima, a son from another mother, is oil minister; and his brother-in-law Candido Nsue Okomo runs the state- owned oil company GE Petrol. President Obiang gave Teodorín a more powerful post and a claimed diplomatic immunity in a situation in May 2012 as France and the US were pursuing charges against the president’s son for money laundering. Although it’s clear that most of the veteran presidents in sub-Sharan Africa who are contemplating political successions are scheming to prolong their grip on power by installing their children or relative. It is equally clear they will face a better organized and equipped opposition well able to exploit information technology and social media. Not only is popular resistance growing to the tired formula of dynastic politics still being planned in states such as Equatorial Guinea, Uganda and Liberia, but people resent the chaos and repression that go along with such systems. Up to now, it has been the cause for the popular lamentation that power has almost always been in the hands of profiteers who are not concerned with serving the national interest; their concern is rather to take up their privileged positions. Not only in Liberia, not only in Africa in general, but throughout the world too, this state of affairs must come to an end. The political turmoil left in the wake of Ben Ali’s, Muammar Gaddafi and Mubarak’s dynastic ambitions could provide a stark reality check for Teodoro Obiang Nguema Mbasogo, Yoweri Museveni and Ellen Johnson Sirleaf. We are watching.

EBOLA: No Health, No Sustainable Development and Progress in Liberia

It is not an exaggeration to say that our country, Liberia is now in crisis – from the high levels of insecurity to the daily tales of the Ebola epidemic, fraud and corruption in government to health workers on strike at a major state-run Ebola treatment center (JFK) in Liberia over pay and poor working conditions last week. All these are symptoms of the fundamental affliction facing our society – poor governance and culture of impunity. Last week, the US Centers for Disease Control and Prevention (CDC) and Word Health Organization (WHO) reported 1378 suspects and confirmed Ebola Virus Disease (EVD) cases in Liberia, including 322 laboratory-confirmed and 1089 deaths in Liberia from Ebola. The Doctors without Borders also known as Medicins Sans Frontiers (MSF), recently called for United Nations intervention -- military medical expertise-- to effectively combat the scourge in West Africa. Médecins Sans Frontières has described the outbreak in Liberia as “catastrophic.” The UN's Food and Agriculture Organization have warned that Ebola outbreak is putting food harvests in West Africa “at serious risk.” CDC Director Tom Frieden also warned that time is running out to contain West Africa’s Ebola outbreak, yet President Ellen Johnson Sirleaf thinks outsourcing the fight of Ebola to internationally acclaimed health organizations is unacceptable despite Liberia been the only Ebola-affected nation in the region with rising cases in the capital, Monrovia. Our nation has conceived several development plans from Independence until the 2000s. The overthrown of the Tolbert-True Whig Party administration marked the death of multi-year development plans. Since then, we had toyed with perspective plans and rolling plans under Samuel Doe, Vision 2024 under Charles Taylor, and the so-called Agenda for Transformation, what is now Vision 2030. No sectors suffered more than education and health care from our abandonment of development planning in our government strategies. Ebola brought a response, but the people of Liberia face a very fundamental health crisis. All over the place you find a population that suffers from malnutrition and has severely deficient immune systems. Measles, AIDS, Hepatitis, Tuberculosis and Malaria are ever present. And it is symptomatic of Madam Ellen Johnson Sirleaf led government failures to grow our educational and health system through creative planning, sensible spending prioritization and focused implementation. The Challenges of Liberia Health sector bring to bear the popular philosophical postulation: “a person that fails to plan, plans to fail.” The first casualty of non-planning was the relegation of preventive, mostly primary health care, the abolition of sanitary inspection and increasing focus on procurement-driven curative, secondary and tertiary health care. Dr. Walter T. Gwenigale tenure as health minister has brought back some needed focus on primary health care, with the publication of a National Health Policy and Plan in 2007. The health policy was refined, revised and updated under Minister Gwenigale and was globally acclaimed as a near-perfect blueprint for the provision of standard healthcare in a growing nation. The policy had all that was needed to make our health sector functional and world class. Unfortunately, it has been characterized by weak implementation and diversion of funds to recurrent spending. The condition is further worsened by inadequate facilities and low remuneration of public sector health care workers. Also, inconsistent implementation of the structuring led to the situation where people abandoned the Jackson Doe Hospitals and other rural health facilities in order to come to Monrovia for treatment. The condition is further worsened by inadequate facilities and low remuneration of public sector health care workers. These resulted in the mushrooming of private hospitals and clinics with only a fraction well-equipped, but could only be afforded by an opulent and sometimes foolish few. So in spite of all these efforts, the sector challenges remain and the story of Representative Albert Toe, Dr Samuel Brisbane, Dr. Samuel Muhumuza Mutoro of Uganda, etc., above remains the best metaphor for the dysfunctional state of our health care delivery system. Although "health” as a sector does not feature prominently in the measurement of GDP of a country, health expenditures account for between 4% (Turkey, Nigeria), 8% (UK) and 15% (USA) of the GDP of most countries, and the sector is a major employer of the labor - from doctors to pharmacists to laboratory technologists to nurses and midwives, and now includes HMOs and insurance companies! Quality and affordable healthcare is critical to sustainable development and progress because it is human capital that drives the other factors of production. Health infrastructure (hospitals, laboratories, pharmaceuticals, health insurance organizations and other Ancillaries) is essential for the efficient functioning of a health care system and consequently, a productive and prosperous nation. Our health sector is bedeviled by a myriad of challenges that resulted from lack of planning - policy disconnections, inadequate capital spending, poor pay, outdated technologies, poor infrastructure, sharp disparities in the availability of medical facilities across the country, coupled with the severe political and economic stresses of the past years. The net effect is inadequate medical supplies, drugs, equipment, and personnel. Similarly, poor sanitation and water supply in our rapidly growing cities have increased the threat of curable, avoidable and other infectious diseases, while health care facilities are generally unable to keep pace with urban population growth. One needs not visit hospitals without doctors or drugs, or evaluate the poor quality of health personnel, nor undertake a computation of the lost production to poor health to underscore the fact that our national development aspirations will remain just that – aspirations - if we do not embark on a concerted improvement of our human capital, especially revamped education and improved health care. So what are the facts on the ground? According to the 2013 United Nation Development index (HDI), Liberia population is 4.2 million. Liberia’s population is projected to double by 2040. 2.2 million of Liberia’s population lives in urban areas. The urban growth rate is estimated at 5.6% per annual which indicates that most Liberians now reside in urban centers according to the United Nations World Urbanization prospects 2013 report. It has a very young age profile with about 43% of Liberia’s population under the age of 15. In 2012, Liberia’s expenditure on health was $102 per capita, representing about 15.5% of GDP. Donors finance 50% of total health expenditures and households 33.3%. Also about 80% of the health services are provided by NGOs. A research by McKinsey has shown that from 1900 to 1973, less than 4 per cent of the decline in mortality in developed countries resulted from medical care, with over 90 per cent being due to public health measures like to improve sanitation and provision of clean water! This strongly suggests that focus on public health measures and primary health care should be the priority of governments that wish to improve the health of their populations. It is when preventive healthcare fails that a visit to a medical professional becomes necessary. At the moment, our healthcare facilities are grossly inadequate and can only serve 4-8% of their potential patient load. Huge sums of money in foreign exchange are spent by Madam Sirleaf, her cronies and the selective few that seek medical services abroad in places like USA, Ghana, and Europe, etc. While spending so much to keep foreign medical professionals employed, are we healthier? According to the United Nations Population Fund (UNPF) in 2013, the maternal mortality rate per 100,000 births in Liberia is 770. What this means is that out of every 100,000 women who go to give birth, 770 die. So more and more of our pregnant mothers are dying during labor. The under-5 mortality rate, per 1,000 births is 75. These are mostly caused by inadequate access to quality care in rural and remote areas and shortage of midwives. As a result, the country is not on track to meet its health MDGstargets (5 and 6). The 2013 Demographic and Health Survey (DHS) found that 56% of births were delivered in a health facility. 73% of births of urban mothers were attended to by a skilled provider and 66% were delivered in a health facility, compared with 50% and % percent, respectively, of births to rural women. Among urban women, those residing in Monrovia were more likely than those living in other urban areas to be attended to by a skilled provider (84% compared with 62%) and to deliver in the health facility (76% compared with 56 percent). This imbalance in access to specialist care between urban and rural areas has been evident in all DHS surveys in Liberia since 1986, but the gap has not narrowed over time. And as usual, the disparities between the Monrovia and rural Liberia are wide, indicating the President and cronies in Monrovia have a lot more to do, and must wake up and invest more to prevent the avoidable deaths of mothers, infants and many children under the age five. The problems of the Liberia health sector are numerous and require collective effort from every one of us, and creative planning, focused management and sensible application of resources on the part of the government of Liberia as well as the private sector. Liberia population is expected to double by 2040 to 8 Million plus. Liberia should recall that life expectancy in our country is still 62 years, one of the lowest in the world. In Egypt, it is 71; Britain, Sweden and Japan have 78.5, 80.5 and 81.3 years respectively. Given the huge revenue Liberia has earned from foreign direct investments and oil exploration, this is unacceptable! We can do, and must do better. The key factors in measuring health status are: access to clean water, safe air, adequate food and the society’s willingness to practice healthy lifestyles. There are issues to be worried about: from the report of UNDP MidPoint Assessment of the Millennium Development Goals (MDGs) in Liberia 2008, only 25% of Liberian had access to basic sanitation. Over 1,000 children die every year from diarrhea caused by unsafe water and poor sanitation in Liberia. At the same time, 60% of Liberians cannot access sustainable safe drinking water supply, according to the World Bank Water and Sanitation Program (WSP). The WHO estimates that every dollar invested in improved water and sanitation produces economic benefit that ranges from $3 to $34, depending on the country and technologies applied. Unfortunately, we are not in any way near the attainment of such beneficial status. In the 2013/14 budget, only US$ 3.7 million was allocated to the Liberia Water and Sewer Corporation. The prolonged neglect of water, sanitation and health, education in our schools is also impacting negatively on our health system. One factor responsible for the worsening state of health care in Liberia is the shortage of skilled medical personnel. Liberia population is estimated at 4 million, and the nation has less than 60 doctors left in the entire country, according to the Dr. Roseda Marshall chairs the school of pediatrics at the country's only medical school, the University of Liberia's A.M Dogliotti College of Medicine. Our situation is further compounded by the lopsided doctor-to-population distribution. Statistics from the health sector of Liberia presents a grim picture that indicates that the country’s doctor-to-patients ratio is 1 Doctor to 30,000 or more patients. In comparison, South Africa has 393 nurses and 74 doctors per 100,000 people - about twice better off than we are, while the United States has 901 nurses and 247 doctors per 100,000. Cuba a developing country with a better health care system than the USA has a ratio of 1 doctor to 125 people! Also within the country, huge inequalities exist between regions, with South Eastern Liberia lagging behind. Disparities also exist between urban and rural areas as well with 90% of doctors working in the urban areas where only about 29% of the populations reside. Many of our qualified doctors and nurses have migrated abroad due to our senseless armed conflicts while others migrated abroad to avoid poor pay, non-existent or archaic diagnostic tools and deplorable working conditions. Liberia doctors have migrated to North America, Europe, and even other African countries. We must ask: why do our young and talented medical professionals leave Liberia after we have invested vast resources in their training? Regrettably, many that have stayed back in the country remain here only because they are unable to secure other opportunities elsewhere. We have come to expect a health sector perennially dogged by labor crises. The activities of quacks in the health care sector and counterfeit drugs cannot be discounted. Infectious but treatable diseases are also major threats to our country. According to the WHO 2014 updated report on Liberia, malaria account for 33%of in-patient deaths. Acute Respiratory infections continue to be the second leading cause of morbidity, after malaria. Further projection by WHO revealed deaths from infectious diseases, maternal, prenatal conditions and nutritional deficiencies will also increase by 6% in 2015 worldwide. Alarmingly, and If not checked, all these have adverse effects - economic and social impact on our families, communities and the entire country. The health industry is very dynamic: patients' needs, innovative processes, regulated environment and demographic factors constantly changing. A responsible government must therefore be proactive in figuring out how to address expanding population and outbreak of new diseases by developing and sustaining a health care service mechanism that is both effective and efficient. According to the United Nations Population Fund (UNPF) in 2013, the population of Liberia nearly tripled in 60 years (911,000 in 1950 to over 4.1 million in 2012). If this growth rate continues, our population would hit nearly 8 million plus in 2040. The message is clear: if we cannot adequately care for our population now, and plan for the future today, what becomes of our health care system when our population reaches nearly 8 million plus in 2040; in just a few years’ time? Medical research and collaboration in Liberia is limited principally or not in existence due to the funding level (in the national expenditure) for both research and collaboration. Liberia must fund its universities; medical research and other health institutions enable them to exchange information on research about tracking, treating, preventing, and curing diseases and enhance domestic manufacturing of medicines. We lag behind the global trend of intensive investments in all facets of medical sciences, life sciences and biotechnology and must redress this urgently. What do we do in light of all these issues and challenges identified? The First thing to do is to recognize that preventive healthcare rests on improvement in enlightenment as well as provision of water supply and sanitation facilities. For too long, water, sanitation and hygiene education in our communities and schools have been given less priority. Well-structured water, sanitation and hygiene education would make a huge difference to our health system. Improvements in sanitation and hygiene behaviors combined with a safe water supply could significantly prevent diarrhea, cholera, dysentery and other contagious infections. Second is to ensure the existence of basic laboratories and diagnostic tools in each facility. And then rapidly employ and train otherwise unemployed graduates of biochemical sciences to be physician's assistants after 12 months of education and internship, and deploying them to a community clinic, health clinic, health center, county hospitals, and tertiary to handle patient with some of the commonest ailments like malaria, typhoid, and the diarrhea which take up to lots of doctor's time in the BPHS. Doctors will then properly spend their time on more serious ailments. Thirdly, to rescue the Liberia health sector, our Primary Healthcare System has to be functional, properly managed and funded. The most anticipated National Health Insurance Scheme (NHIS) needs to be implemented! NHIS should be strengthened and its activities expanded to cover every Liberian. Given that good governance and health are intertwined, facilities should be provided to keep our environments healthy. Our political leaders should lead by example and exhibit confidence in our health system by patronizing the health facilities available in Liberia instead of travelling abroad for even basic checkups. It will be nice if the President Sirleaf, Ministers and members of the National Legislature, Justices of the Supreme Court (and their families) openly declare that they will never go abroad for medical checkups, treatment and the like, and will go to government-owned facilities only! Then the rapid improvements will begin. Finally, more effective spending for preventive, primary and secondary care. Can more funding lead to better health? Not necessarily. We would need more health care worker regardless of any level of spending to get better outcomes. However, spending generates some impacts. According to WHO, every $100 per capita spent on health creates a 1.1-year increase in Health-Adjusted Life Expectancy (HALE). The Liberia health industry is potentially big, possibly bigger than the successful telecoms sector. True, telecom services are necessities, but everybody needs health care to survive and grow, and even make phone calls! Ultimately, we must accept the maxim that ‘health is wealth’ and take appropriate steps to improve the sector. At the moment, it is creating a huge hole in our political and economic development aspirations. If Liberians are not healthy, we cannot build a wealthy country. And the examples of healthy living and confidence in our sector must begin from the political leadership. The ball is firmly in their court.