Why Southeastern Liberia?

Southeastern Liberia, one of the poorest regions of one of Africa’s poorest nations, has been severely affected by decades of poverty and war.  The region has been historically neglected, in part because of its remote location and treacherous roads.  Traveling through deep forests on mud highways, it can take up to 12 hours to reach the region from Liberia’s seaside capital, Monrovia.  Grand Gedeh and River Gee, two counties in the region where Tiyatien currently focuses its attention, are home to nearly 200,000 farming and hunting communities.  Nearly 90% of the people here were displaced during Liberia’s civil war, 80% live on less than $1 per day and unemployment rates are as high as 85%.

The historical neglect of the southeast is reflected in severe health inequalities.  Rural Liberians living in the deep forests of the southeast can expect to live a mere 42 years, often eroded and embattled by harsh living conditions. These same conditions kill nearly a quarter of Liberia’s children before they turn five. Death during childbirth is also rampant, signaled by the shocking statistic that about one in twenty women can expect to die in childbirth. Interrupted disease control efforts have also bred one of West Africa’s largest HIV epidemic.

HIV prevalence in the southeast is the highest in Liberia, with prevalence estimates as high as 13% according to the most recent Ministry of Health antenatal survey.  Infant, child and maternal mortality rates are among the five highest in the world.  The recent DHS 2007 Survey confirms that compared to women in any other region, women in the southeast have less knowledge of contraceptive methods, received fewer prenatal care interventions and fewer had their births attended by a skilled provider. Compared to children in any other region, children in the southeast has less complete vaccination coverage, experienced higher rates of malnutrition and had less access to clinical care, including antibiotics or anti-malarial medicines for fever.

These challenges are compounded by severe gaps in human resources and physical infrastructure. Liberia has less than 50 physicians -- one of the worst human resource crises in the world -- and only two work in River Gee and Grand Gedeh.  Zwedru's Tubman Memorial Hospital, a small district-sized facility jointly operated by the Ministry of Health, Merlin and Tiyatien Health, is the only public health center providing comprehensive health and HIV services, including antiretroviral treatment, to over five districts across the two counties.