1980 impact study - jfkmc

8/9/2019 1980 Impact Study - JFKMC

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The Jqhn F. Kennedy Medienl C e n t e r -rises four separate and disL.irrctt i tut ians (until nid-1973 it included f i ve ) , -I. John F. Kennedy Hemrial E o s p i t e l , a 300-bad general medical andm i c a 1 teaching hospitiml and out-patient'clhicr2 . Maternity Hospital, a 200-bed and 100 basbet obstetrics andgynecology hospital; '3 , Ribm National Institute of Medical A r t s , . a pammd~- ' c a l .trainingf a c i l i t y ;4, Catherine ,Mills Rehubifitation mspita l , a 60-bed acute pslrchiatdc:

The entire concept of a Xational Meiiical C a t e r orighatsd in the dd-19508under the adr;.dnistratior,of the l a t e President W i l l i a m V.S. Tub-. Theo f f i c i a l beginning of tile Center cm be stated as October 1959 when theGovernment oi Liberia =tered ihto en agreeiaqentw i t h a private arckitectua$engineering f lm f o r purposes of constructing a new 200-bed hospital babWnrovia. In F e h r a ~ r y1961 the E i m w a s instructed by the a to contactcertain members of the medfeal profes~ion n Sw5tzerlmd regarding the desfgof a Medical College to be integrates with the proposed hosgftal,Later in 1961, President Wman paid an o f f i c ia l visit to the tlnited S t a t e sand net with the l a t e Presid-t John F. Kemedy, Che of the results of t h i svisit bas a joint comamiCruey t h e United States and the Republic of Liberistating the-United State's interes t in helping to finance the constmctiozzof a ~ a t i o n a l Iedical C e n t e r , to support the country's national public healtprogr-. This C e n t e r would not only provide hospital care fox the citirensof Liberia but am16 serve as a focal poin t fo r health services and paramedial training and constitute a refexral center for all of Liberia's hospitalsan5 c l in i c s ,Zie role ar.d cozps i t i on of the Nedical Center has undergone canthued refinment over the y e a r s . Such change is n a t u a l in m y evolving health programcan be expected to continue. 'Fhe primary role, however, that of serving 8tbthe nucleas and hub fo r G natioraal health deUvery -ram, has never beenlost sight of and continues to be its f o r m s t function.'ihe new 3FK Memcrial Hospital, when it was conceived, was sorely needed. Thold Government Eiospita lla builc?ing and e q t i i g m e n t were grossly inadequate,Built in 1917 by the Ger-s as e telegrrpQ cable off i ce , the b u i l d h i desigwas ill suited for case af the s i c k , a ~ dt had h e n allowed t~ deterioratebeyon3 the p i n t where i t s xeclmatfcm w u l d hzve been possible, even if itha6 been desirable, Basic equipment was broken or non-existent, general


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1sa nit ati on was poor, and there was nothing to encourage or permit an accefl-able Level of medical care. PO; example, there was no functioning X-raymachine, the ~aundxywas d ~ n e y hmc,8 as the aquip~entwas out of order,soiled curtains hmg in c3ouruays ax16 windam, bedsprings s a 2 ~ e d nll mattres-ses were stained a?c? n poor condition, post-oprative patients had ts becarried d m na.xrOFI winding staircase, steps were broken, anQi W e nf l - q were uneven. Tkc state of th is , the only ~ o v e k teneral hospikalin Bbnmvia, reinforces the notion that t h e - d em hospital provided was taata h m r y but a necessity, Even in its state of repair, the old Gwernmenthospital vfth 200 beds had an occupancy rate of 93 peremt. --.

The basic goal of rJSAIDts participation wit5 GQL; in this project was to as-s ist the Government of m e r i a to improve the cpality of l i f e of theLiberian populace by providing improved n'atioaai public health and f d l yplanning services. The pcrpose was to strengthen and improve the effective-ness o f he National Medical Center as the key im t i t u t i on which would S a mas the hub of the mplan or a nation-wide health delivery system. USAXD'sassistunce mu16 be Limited to only three of *e forrr institutional wmpmeritsof the NMC, namely the JFK Mexwsia3. Hospital, the ~aternity io sp i ta l nd theTubman National Institute of Ledfcal-s, Basic zssmptions for achievementof the project9 p'xpose were: (1) GClL wuuld give the Ministry of ~ e a l t h uf-f i c i e n t authority to implement a National Health Care Delivery System ushgthe NHC as a key element; (2) a Charter woilld estab l i sh the C e n t e r znd f>g a@de tq project plan Fmplenentation; (3) there m u l d be cpntinuity of quali-fied staff to imp lemt the plans; and (4 ) there w u l 6 be continued and.fn-creasing GOL f inanciai ccrctrrlitznent in pmportiua to its incre~sed ole anddecreasing US inputs over time.fie i n i t i a l input was a US cepital loen for $5,8 mil l ion ard a concurrent $1.&nillion ccmtribution by GClL wh i c h endxed the c m s t m C t of the'hoqdta& -Thfs was supplenterited d t h a ser ies sf te+cMcalassistence g r & i & ~ ~ ~%..nearly $10 millien over the period 1951 tkooqh 1978 to finance t e ch&cf s , .participant training, snd cormuodfties ta help staff, equip =d operate thehospi-1. .In 1965 construct5on of the JE'K Memoria?- Hospital 1.~29oeficialXy be-. PJune 1970 construction was completed and frm, Jtr?e 1970 to July i913 hospiequipment was h s t z l l e d and the building readied for occupancy. The buildingwas dedicated in J m e 1971 and its .first patient was admitted on July 27 , 1971,

early 1972 the C e n t e r was e s t d l i s h e d as an autonormus agency of Wvemmenta d prated by a Board of'Trustees, direct ly responsible to the President-ofLiberia, From the time the National Fk-3icalCsn6cer becase fu l ly operational in1971 and un t i l USAID act iv i t i es phased mt in 1978, C4L ha5 ccrnmitted $34.4s t i l l ion to its deve1op;aent and o p e r a t i ~ n ,exclusive of capital loan servicingand amortization.III. IMPACTA. Generalx t is perhaps useful to quote the for& Chief P&dical Officer of Lib


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~ 6 sevelopsent of the g a t i o a ~ d c a ~enter b s lose ly p z , ~ a~ l e l e dhedevdbgment of the overall Health Program of the cotnnklp &rhg *e 1970s-During this period. -ia has -gad to pull hf~r sc l f t f squalorof one of the least advanced health situations ir the world, anb.ioto whatik at least an acceptable s t anda rd of h d t h -c,

-While we still have a lo- way to go, snd while re could do mch mre. -menwithin OW l imited resources, it caruret be d d e 6 thzt we have ccae f e a rin the health sector duriag this decade than in i - jy c c X ~ ~ & l eeriod oftime in our his taq ,To establish a.perspectfve, m e might wraside;: t k a situation as it existedjust at the inaucpraticn of the l a t i ona l Pladical Center in 1971, and can-pare that w i t h oar psftfozr, go* ht.019#, Ebdpite t4e ~8~ of chrozdshortages and shortfalls in both m i m p v e r and fiiab, a story of stea6y pro-gress em e q e s . In a few &stances, the s v e s s haz eevz~ e s z u?2tswg.This has been L period riheo the national buagst Car h d k h serrrices ir.czeesedfrom 54.9 millien in L972 to a projected $25 miL15-03 f o r 1980. of thesem t s , operation of the Y&ical Center co-3d $2.4 r ; i l l i ~ n n 1972. sndw i l l have consumed $10.8 million in 1979/1930. Ir.i971. meze w c e fever th30 native L ibe r i a q ~ a l f f i e d s pl.ysic2cr.c anE deslti-. ~ c h g So 1980.there are nearly 100 Liberrfan 50crC:~s n remrc. AZ even -re *resoivestatistic is t h e fact -at +he ~edical ellege 2f tae tF*versFty of LFberiawill have graduate6 61 doctars shce it first cl-sss of f o ~ z~ 2.973.The John F. Kermedy Wdical Center hzs mccessii~ely ;-iveri i n * c firste i gh t y e a r s of its existence f r a a a Service Ec:piCal % I-%dc& Center, toteachfng hospital. cxxplex. D e s i t e P W ~ diE5irqzlt iee, khe Ce s k s r ~ E S f i l l e dthese expanding robs d* some d g r a e of efficimcp z s z it cmxtimes toplay a cmcidl role io the Health zaxe D e l i . v e q Systez for k5e ~ s t i o a . ~The 3PK Hospital n=aaes a W l y in-patie~t rz6 of =ore 330 m d out-patient locd of 450. Even thc~ugzthe ho5p5ks2. is zk s~ pex cf 31. Liberiahealth care deEvezy sy*en, a d ~ e s rez.5 g z t i e z t z 5 all svez Execountry, the pcpda t i o l 05 Mrrrovia bertefLts ~ : - ~ ~ i o n a t e L yarc a te to itslocation. It also treats.~atie~ts-x . ~ ~ 5 q h h r k g


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p r i v a t e companies send their workers for treatment to JFK whereas they area b l e t o pay t o send them tg p r i v a t e clinics and h o s p i t a l s . It a l s o servesas the o f f i c i a l morgue for t h e city o f Monrovia by d e f a u l t since theMonrovia City Corporation has n o t seen fit to construct i t s own, T h i s hascreated critical space problems.Salaries o f professional- t a f f generally are -considered to be too low. Since60L is unable to raise salaries it is condoning the pract fcemat doctorsoperate their own private clinics i n t o m and t h a t nurses moon7 i g h t on otherjobs. This results i n hi9her than desirzble absenteeism and patient com-plaints tibout inte&tnab?e wai t in g times and inabi 1ity to see doctors.Finally, the fact that JFK i s the central drug suppf ie r for the wholegovernmental medical structure in the country, drugs a t the hospital i t s e l fare often i n short supply as inventory, reordering and drug security are m i s -managed.Yet, the overall p o s i t i v e impact o f th e JFK Medical Center and i t s con t r i -butian to raising the qua1 i t y and quant i ty o f msdical care, a re indisputable.Since only one t h i r d o f a l l Liberians have access t o any form o f medicalcare, much mcre needs i~ be dose. However, the pyramfda'l system of healthcare delivery w i t h JFK a t the t o p i s conceptualiy correct :

County Heal th PostsV i ? a g e Meal t h Workers

B . Economic ImpactI n 1979 the csnb'ned insts tutSons which consti tuts the Nat io f ia l Medf cal Center,

r ?r )employed 1 OLL persons, i n c l u d i n g 75 doctors (ha!: o f t h en Liberians) and 526nurses, w i t h an annual p2yrol7 o f 5 5 . 5 millfan; i t purchased o t he r servicesand materials acd supplies worth $4 r n f l i i o ~ er annun, h a l f o f i t from local- - - - - --.-- - - 2 2: L..L~-.. - + ~ 3 i e deYelcpZentu expenbitaresbuppt S E E 3 c t ~ u I ~ L I u u c u i . 2 1 , auu r tu i*$i n excess o f $1 million, t h e bu l k o f i t for property acquisftion in Monrovia.The Ministry o f Planning and Eccnomic A f f a i r s estfzates t h a t each dollar spentin th e Kanrov ia metrspolftan area has a ruitip?fer e f f e c t of 4 . Therefore,w i t h a n ~ ~ a locat payments o f $8 mill on , we itre ta ! king about an annual econom-i c impact o f abaut $32 million as a resuit o f JFK's existence and cperztion.

iFurther direct bene f i t s are derfvzd f r om t h e TWiYi and the 9oglictti HedicalSchool , which annually graduates over a hundred .prafessional h e a l t h techniciansand mdical doc to r s , f o r j obs both in tile p u b i f c and p r i v a t e medical doctorsa t an average annual s t a r t k g sa la ry o f $3,090 per person. The c uz ~a f t i v e


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employment e f f e c t therefore i s quite substantiel. Xncirect benef i ts ofincreased producttvi ty because o f a h e a l t h i e r population, are d i f f i c u l t tomeasure q u a n t i t a t i v e l y .On the nega t ive s ide , the ' annual cost o f o$erating the National Medical Centi s enormous and a t more than 40 percent o f t h e t c t a i health budget , i t "presents a sericus d r a i n .an nat iona l pub! i c finance, since incomes from patfees are i n s i g n i f i c a n t .C . Social ImpactThe JFK Memorial Hospita ' i services an annual average i n p a t i e n t component o302 persons per. day, or 110,230 p a t i e n t dsys, and has an annual number o f cupatient v i s i t s o f close t o 169,030. Its in-patient occupancy rate i s 103.3percent.The Haternity Hospftal in I979 served 20,378 i n - p a t f e ~ t s or close t o 70,000in-patient days and recorded 56,372 ou t - pe t i en t s hav iog receSved tzratment.Its i n - p a t i e n t occupancy r a t e i s 3 7 , 5 percent.-he Tuhan Hational Institute o f Red!cal A r t s ir: i s 7 9 hzd ati enrollment o f 2

.Labevt ha l f o f ~ h win the E:ursbg and Midxifery "rogrsm, and graduated 93trained a n d certified medics; t e c h n f c i a ~ s nd heai%h service personnel f o rglacenent a! 1 over Liberia.Even though the 3FK.5edical Center a l one cannot claisl f u i responsib i l ity f othe improvenent over time o f basic heelti: indicztors, i t has certainly mademajor contribution tomrd t h e i r fnprovemnnt:

MosIcdica or -950 S 970- !?*dentLife expectancy zt- b i r t b 40 47 4I n f a n t mortal i y ra2e 2 69 155 14ChSid x o r t a f i t y r a t e -f3 29- - ,.,... 7 - cnn 2Fopu! s t i a n per ph.ysic i an . i d *tui' 8 t *dl-u 10,05Pcpulation per nurse 5,7f 0 4,5% 3,15CruGe death rate (per 1,009) 25 25 1S ince th e Nationel Fed i c a l Center is 2 referrai institutfon of t h e last resi t has 5 predictebly h i g h d e a t h rats. A t JFK Wemriaf Hospital cut e 6,54in-patients ar f n i t t o d i n 1679 , 1,285 d i e d (20 percent!. Comparable figures athe Haternity Hosp i ta ! l n d i c a t r t h a t out o f 22,378 pstieilts adqf tted, 269 (1percent)died . T h i s has earned th e JF K 1marial Hospital :he u n j u s t i f i e d an2 i f 'unfriendly epithet ''J.:st Pc: k 2 , I ,,, . ~ n f s r t i l n b t e l y h i s perce ived unfavo

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makes F ec p ie r e l u c t a n t tf seek modieel a t t e n t i o f i there ,I fcheap a sd f a s i i p accessiD1e.isome s o c i a l drawiacks such as overcro~ding,the non-central i o ca i i o r , which requires up-cg r e a t distances to g e t treatment, and certain precsegmnts o f the general public about the hospi ta l.rate, i t has had considerable pcsitive social it i : s t i c a l i n d i c a t i o n . Ssms key inf tn ,an;s noted t h a t JFK serves t.f a " ." i l age squa!=e8', in t h a t there i s 8s iniesssnt coming andcan usually f i n d scse zacjuosiniances to cha t w i t h arms th e many persoin ha i l s and w a i t$nq rooms. S o w people just seem to go there for pugregariousness. Others c l e the " we l f a re ' asp ec t s opoor, desti tute and hungry are accomncdated and g i v ec a r e , E pood peal o r 2 used shirt . The transferseem to have Seen larsely successfu? i n t h a t technic ianhandle arid r r a i n t a in epu ipment snd a ph;~ij.scczi p l s n t ~ X i c h

i/ A rando;.! szmpie of 103 n:ar"t sellers and shapers a t-i i*v-, acil' L ~ 3 s" iriarkct i 5onr~s:ia t=+eq!jented y 7 ~ + f - $ n9s; res2s:ses ts t h f l ~ e s t i a n : " ~ fcv s i c 4


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than i n many other hosp f ta l s in West A f r i c a t h a t are completely staffed andoperated by 1ocal nati na1 s.The outreach function of 3FK Medical Center has a l s o beesocial development in t h a t i t benef i ts s t a f f and pa t i e n tMonrwfa; especially the support (unspeciff d) which JFKCounty Rural Health project , was singled out by one i n f othjs outreach function.. .O. Policy Impact

Knot-rledgeable s'nfomants have indicated t h a t the National Mindeed becoine the "hub" o f the t?ber ian hez t th services del

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C, CulturalKariy qualified cSserver\s have sta ted that the 9FK Mmarlargely an Amer ican t ra l~sp lar : t n t o A f r i c a r ; sc . c+e ty , Tlay o u t , a1 though correctconform t~ A f r j c a ~cui t u rby' some to be t o o sopktsticated, which has 1ed t o occasionalmaintenonce problem. InLiberian p a t i e n t s in t h e ifor th e ~ o b e r n estern-typteam t h ~ t uch coments, zgenerai y ref 1e c ti g ma3GYV . CONCLUSIONV t t h i n less t h a n a decadestandard o f medf cal c z r e it h e base f o r Fu r t h e r upgraof services. Especialiy,ca r e de7 i v e r y , 1thcug h recThe people profittSng f r onsaved and th e impsrved h a 'nre h a r d t3 r e a s w e . Its ecommThere a r e f u r t h e r needs i n r e i c c a t i n ~conponents, t h e renovatfond r e ~s hospi a 7 . Hotever,h p a c t on h e t ? t h care 7'n Lly. The creatior: o f 3 F K Medical Center wa

rthe years i t hzs grow. f r ~m ~ o v e m m ~ n towhich provides s e r v i c e s ,delfvery s y s t a i n Liber ia .


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- - .In C Q Q S ~ % & ~ % Q &%tB-.s%C1?%fst2cZ~irfrozP the BS l%. u t d f h s L * a ' i r * t i ~ a O i f f c e r % f - ~ m ;f-" k e y ~ ~ i n f u ~ t "r o i i e b --&&. &-somey 2ethe I X f 8 biiwet'isvaZZtkbl6- f o i %@actbtuia&s--c&&stP-f s 'bder'--We'Pithis8 sMdie;s &Po c=arr%eres l ired that sDae B ibs wtitzla fesii l t; -rsrt e. blview but oi.iaailli&FZQaad ~v&%IabFlfty;Thes q 2 e s ' of b s p 2 t a l rtesrds atid- Zni;erviews-wZ.th aof potential-patients;_of 3?E w e r e cersfed ant tn a"key izPfumantsW n';ewie#a,- - ----=S pX'C3,ject -- a ' b % Z lQZle -- W 2 9 C!h2%fS&8 WSBt e e t our- approacfiaaa m e t b d ~ l o g y ad %a fIel6-tesn a r c . Interriexr were azrmged-#it3 24 hey23 were caopesativt, &t5ough ese wes cxceasiveLibcrfan interviewer w h felt she was 3s- 3dFeBSbR,The rcsultr; o f the questioU&&r~ ere %&lml8t5din Appendix- Bo. 2. Xost of tDe respor.rfgats rated"greatly Beneficial" ( 52 percant), r e l e 35 perten"better t h a average %eneloitw ad 13 percesi. r t t e dhad 'werage berefifR,TRa use of'liberian professionill wrvey r e s e e h eresulttd. in Zese rastra+rst in r e s p ~ z d i w n the pBfewees who hqp~ar - t l y di d net as@ the h&L1far staac"tellirrg BID &at. they t m L3wan t s tc hear. " Theare therefore garh-r =M trutkfxl psovlde g mtlma ff we ourselves ha& xm&srk&errYle S-S"rtemievs.me exercise h a o tnly- ~2'ielded nterest-?g i n r p r c t date andpercegt fo~son the project p ? r P ~ e It has also l e d to a c-ompltterertsio~ srtd resria-i;cstionor ~ z eunZeg s . i ; r w e ~ i - i ,Besides ha* been an interest- sta&y, it k&s rrsnlted in avelaable learning experience r ~ riSXIE Liberia m- ceXlas for tteccatraetor, the f i r s t prtvste T,iberim-o~~:ednb ~taife'edaa3Wg;e- -1-t reeersscb gnd cona;uXtiag l im .


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1. Of the 24 key M o ~ t sontacted, 23 or 9 5 percent, b&%ca*ddhy#re f.lrilisr dth tha jpint GC a m I D project to ascablish a mei%brlc a t e r in Mmmda,'


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C, The Potation of the beneficiaries was i d a C j f i e G ky 91 ptzrca% ofth. raspondents ar L J L ' " c p ~ g ~ tiberfs, wi+& egzin in e c h a u l e S q ~ n t%atpeople i r r the Mbnrsvia . benefit -re hcezrss of e&siersceeae,A randan sample of 50 at -pat ient ar6 5 0 in-prkiant c a + S r ~v e a l s nat thammdhe~U&ngmajority come in0& fropl the Mmmvia

autatferitsr e f e r r a l s / ou t - ~ f -m = 8 p ~ ~ a r t tcentral 3kmrovis = 32 percurtHmmvia s*&uxhs e: 54 p c - toutlying mcttropo'lftur areas I 6 percent

referrals/aut-of-W m2 1 2 pXc=tc~+c.raLEunrovfa = 30 pim~atHmrsvia s-bs .i; 50 percentwatlybz m-plitdt: sm&s P E prcezt

- Rowever, &Us ay e m ~ d e r s ~ ~ ~%e referrals &rzd c--t:t-of-f~%mup ofpatients. The Assfstsnt Director of Stat i s t i cs ir, the meiral E e c o ~ sDq at ;?K confirms %\at a66reesas sigg#.i& by patients may GOt jeentirely 'acctir~te. ecaue szmf perso.'zj: ftamt-uf-h2m!. sTa l l y aversLatives fivhg in a r 2lmxa~iasea (PWm~r'ia'Bpffiktim 23 =re *an80 percent* migrant'f ar.6 patierits a y be giving their zelatfves* addressein 3~Bmv;istrather t h & ~heir mm Poc~fdons5.n C'he h t e r i o r .

D. In attempt to ~aage la pp~faiercopdm as to where the 56eafar the J X Medicel C a t e r origisar;eb, 65 pe3rcst ident i f i ed t h % G o v e ? w e r ;of XiEierfa es L la origir~ater f +he idea, 22 wrcai, t k 3 ~ 5 k t %e ~ ~ 1 ~ c e -was a joint oae betrsan ajL. k-ld U S A D , k&iZe 13 percent dl2 naC- 331- whereidea ozigbated ,* - -e -k@ ei~*&ez& - r )s t zeESujae hi--r e - "=-I -- . Q , e~+Z---- -+P-red "yssnf 9 perze?+ a5ssersd "zo" =d 4 prcczzt --e pat s-=a or 6ia

not most.F. fn respanse tEr t:ie q~es+kiaz 5y t5ie L7 G a ~ ~ r r i - i n t .n'r - iBec? assistahelp create JFK, 83 parcent reepandd ~5th var ie ty -if perraied reaso*ile 27 percezzt co';ct>dpsot a-iswez the p f s ~ - ; i o n . Si-9 scrn;s cf CTCremcms

were:- maybe it m a becaiise +&ey were askei5 azr?Wey were f e a r f ~ l ihat ifthey d id m t assist we w i l d go sme pbace d s e Cf cr pissiaCtzmco);


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- .based on the C O ~ ~ Y ~ ~ Beed;


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- not enough engineers a d &&?ltects were consulted; m a y aspects wer'left out (of the ~rigiaal esign) wh i c h deLayed consti?xtior' , ;- ideclsims were] mostly po l i t i c a l ; this c m be, seen frm the des ignand locatio,a.of cp! structwe. ( ~ tas) a stat= cf symbol. to the wof the great USA: -

. the design was i l l - s ' a i t ed for Liberia: Liberian doctors were not corsulted. They just p l a t e d their p181z.s 02 as, The site was badlychosen h c ~ u s e t is ~ O O lose to t%e ocear,; t3e salt rains a l l theequipment ;- no, beca~se f they had consclted the nurses, we coul6 have made sosuggestions as to +&e design of the buf Cfng. Bcth in the in-patienand out-patients erens, c e e a i n t h i n g are ~ s s i z g :- no, because of its locatisn; it should not have been hilt on th ebeach; instead (it h ~ u l Z ave been hilt) iz ax ere5 where the porw e ccrccentrateci;- international dozsrs m2k:rce mcst @f Lie 3ecFsions witho'at adeq?~atet,yconsul t i rq local authorit ies; =d S e g g a r s cay no t be c3d0sess -- OU

h=ds were t ietl ;- not eqoush inpzt f m, biieriarss wko were kzowieegeeble. L136~t.theheal th sector at t h e tine;- no; they m u l l go to i%eWesieent ( -WI?~] discuss thirrgs w i t 3

h in and then info,= the -2, I would c r i t i c i z e Z S h I D tiieir ctractors vezy .seri.ousfy; tfiey xade czrrieC cut decisions w i t b uconsulting the Ward;

- most of the _pecpie felt t h a t 25% cieciw of Sic buildL?g %as ra t theresult of sdeq~a te or,stlltafriein ~ 5 t h le TLiberizq ~ e d 5 c a I tacf,7 . to a l t e rna t i ve projests to 3W. bein? cslrsteered ~t that tire, 63- -- --~ c a tf t's.,e rcsgandents did nett ~ . ? O W&3ut t5is; L3 ,w~c~zI ' ;ere stire tno al ternat ive hea l th sector pro jects were considered; while 4 p r c - tinc3icete6 *at alternat ive gro2ecta were fcCseZ coasidered.8. Eighty-seven percent of those ictes?ric.%.eS clzimd to WAY the SF)=project was c h o s e , k+PLe 13 p r c e n t did ;!ot :i;~r.owthe zeasozs for it. Zinothe reasons for t h e choice of the project are the f ~ i ~ k m i n g :

- the old f a c i l i t i e s (a Zcmer ~C+za-i?r teXegap?i of f i c e ) ha6 became inedeqiiate, A larger hospitzl structWe =cl zeedica'r center wasneeded;

- abe r i~eedeZ t k i s fsc i l ik-c zznd Y z i s pzsject was w re i m p o r t a t thothers, a t h e d s s !Prcsidenr! F ~L ~ I z ~ ~ Iax15 not hsve asked for 52;


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I . .- there was a need for a hosp i t s l t 2 cepe + iCc the healL5 needs ~f thegrowing r n e t r a p o L i 4 ~popt?ls t ic~ , There was a nee3 for t- refarralcenter for small hos3itaX.s an6 c l i s i c s , Tnere was E n e d to &CCC?Wm a t e the M i c a 1 (md m s e s trziri ing) S C ~ W ~ S ;- it was polit ical; ta show that t h e 'iiS GoT~emzz i tsave Likeria SX andthey hilt the f i-mt&caL centex &nLiberia. .

9 . There was coasiderable disagreement over the choice o f the l o c a t i o ~ l dsiting of the hospital, Tnirty-five percent felt it s:rlo118have been p l a cdelsewhere in rbnroviar away fron; "the c ama i v e effects of t%e salt sea-airend closer to pp l a t i o n concatrations (it is locate6 in the suburb ofSinkor); 30 percerzl tirouqht it shaulcl have bees p'iaced sblenhere elsealtogether, since rur~l ealth needs ure greater? another 3C)percent thoughtit was placed is the right locatior,t a l e 5 percent did not know.10. As fur *e prcject acfiieving its ob$ertlves, 93 percat respcrided pos-i t ive ly ; 5 percent thought it was partly stlcceesr'cl, while 5 jprcerjt d5d nctthirJc t?e project succe&ed in schievin.3 its ob-jsctives. Irrtervievee!~ ereasked to list reasons--or scirccess or lack of success, 'i'~13.a westionsppzrently f e i l e d to e l i c i t the expected rss_p.nse, W a t l s e intervitwees cm-tinuaLLy c i t e i e x m ~ X e e 3 ick i22.uetrate its saccess tat)lex +&en l i s t fngmasms for it, Reshsoas given f o x lack of success were: bp.zzger/inadetpatepl~urning,training p r o S f e s s (too my people trahied Zar certain functionsand tcm few trsine? fo r othess! , p e r n a ~ p rtfPlzatien of retum&p-cipmts, while the contractor (inaim BeaiCih Strr ics , P w k ) cazr;e in forsome cziticisa as F-11.11. When the key in50~rmntswere zskd to e on what shozld haye beer! dodifferently-to &fe Eke project more sr;ccessEttfr- cmly 3.3 percent responrded,It was thought that pEa i i b g f ~ rF;e project ha2 beer? f a ' l e ; tSe &ifz.rwa~fsshould have mticipat& f u b e patient Leads. LTadditLon, vSkD &ouZLt 'navasat a tern, of evelueetozs to see what tke , ~ t f ~ i _ ~ z s t sze doing on t ! e 5cbafter they had returned frm trzt5aing Lz c-rder t = s Lriit,iate =re feedback &fd=s*.ize that p r t i c i p a t s were eq3ioyed in w r k fsr wkfckr *ey were trair;e&,As it apms t 1y C m e d out, some were a& ~ z s 6 i p e d tFzz~;I~TTc;~T~,t wassLdte6 bb\~t "hay did r-,at hsVe ' $ t $ d t c i 3 ~--- %-,..&&.-&t?- t 2 5 2 r i k b e k ~~~~O t l e x s k\euc+t Eia-L Gm. sshorztrd kaxys rcxtr~cted he mzcezen t of 3FK to aprivate f im, %-ti;mphaasds on etffic8eficj -~fts ctperations, "Fx-mdhg of JEX'op-r&t i~asi.L\r;t regar2 f c r rff cizzcy "%2s t? &sEl Locete n e d a c l mat?ay,which tv~f.6ave been wed k t t e r in other =eas," %%is ~-tic..;?22r=n t e r r imi l lustrated t i i s lack of efficiency by observir,: %ha% *ere ese P?= stw.dardsw d no perfon=ce evaluztio~s t JFZ: aq6 zs 2 result "eveqone 6-s what he/she feels Like dcing ."If. Frnen to r;Lte t>e Lzmr t~ace f- d i e prs? ck ingzts czs a scale f mI {L=) to 5 $~igh,), in terv ie?ees ccraezts w5err &ey rz ted ~ r i o u s ~ u t sowwere:- f a c i l i t i e s and ecpigs-t -re t c ~ophist icate2;

- .- tec'mzcrafis: sane y+e=fr5;~-.nczrcaLoz 02 t h e i r ~ Z esves , l i k e the(eaTetion bqz na.e;e cspplied) &-> .-;ho?zght t k a t the b h c k F- could notd o a thihgi


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/ A2BP33IX Ti@Pzg'e 5 02- lu+.stical s u e ~ r t : nost rf ?t %-,s rig? i n cur best intnrrstifram the Indim reservations.


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/

j&rn?zQfr: P:G,F2g-e 7 c x2

- - -11 children ud Eesfrt~tes ecelve f r ae ~ & C i l a I " are;- giving Jm ubomy ma illving it mzzas. its- t o . 5 ~ es=cZZe2m

bureaucratic r & . t a p e ~- Government d - y ~ )z~~yt:& o i m p e henltli care ds l i v eq ; +c t i e --

area. and hcvir.,g JFK (to r* heaLth persamet: has mnde thedifference:

n- w e s b e q a n w olicy to trskn p h y s i c i ~ ssista3tsn (rurhealth workers) at J E W

' L- a nw p>licg ~ s se- izip'Zemted regarCi7g c csf ie in l era l orstan6hjc? of health pers~n'lelqi&L'L'ity pr,"omiiGce.

17. mk& to raxk the ~ve iaZ . l enefit of Z p x pra jec t ~ r - ibera x w l e or. a scale f m (lat) t~ 5 (hi~hj, 3 p r c c z t rated it 3, 35 prate6 it 4 m8. 57 part-t rated it 5 .3.8-19. s i ~ o e ~ ~ tevelcpzkextAmcrjec:t b a ~ e rZntwde6 side af f ec t s bot- ew s i t i v e ngq~tivc. espx;n&e-?ts $=re zsked to m.want en t ? % sasmatm l L , Sixty-~ae erceqt tkio~cS-t t ha5 in5rtemd& s i d e =ff e ts ; 9 p e ~ tawaght it not, k u l e 33 grcml . e;izegttive aide effects. 14percent l ist& a&$ egative ps i t i y e , &.ile 5 ~ r ~ e c e n t=th;;&side effects O ~ I ~ .SO= of t ,hs negative .ic%-effscte s i r e considerec?m be:

- it a negative e z f e d 9~ 5 % ~ ~ ~ a r i z 3 because oi L%@inef cihic2-. XfLl is l o s i ~ ~- & ~ " ~ - d & lu t s f azz servicesredere3 .it must &vr r . 2 ~ w egat ivs sile a:'rects bsc i . ;=~~ ~ n z 3 ~ eerecoieplainiog, ep~w.cjsZP$ "iho e q ~ k * m 3 t ;

-;----&b...rweye n3st n%&ee,tr&nes ~ p i eefg=& to go ~;LG%:;: h.-ie-i ----*,-5esire, 2% e rn s of fun&inc:, these r-e in&Zeqcii.te for c S&~Zsedical c-u. such as the ,TI% c : o - z ~L%~ i- pcy ~ c ~ ~ e ~2 6ncesqG&vesfa ,cwrs - e r e Iov i z l Z i a i l y &ld=s

C~ctozs eft tc pzzctlce e i z ~ ~ 2 ~ z r e :- ~ ~ ~ ~ I ~ c e3 6e cm r - t r.73st.s of ~ z i n i l g he Canker (an. .3zqk.h);elese (%) e%sxsqir+w r e not fsrtendsd an2 nct :oreseer&;

-r.-"-=- other hosp i t a l r a d l l r . l c a ~ E e re5ents [M jrh; when th- cget %reat& l o c a l l y ; sE.;;es grr& i-;oras:LPe a? Z X ?(at presen


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/

APPENDIX No. 2Page 8 of U)

P o s i t i v e s i d e effects w e r e consjZ=d to Eg;- exchange of p e r s q w (medical doctors, fnterns, residents) prith. other .hospitalsand other countriG;- the MeCical Supplies Depot (central s.2ppl:f facility for msdical-

supplies fo r all government hospFtais an4 c l ~ i c s ) as a posit iveoff s h k o f the project; in addition, t3e physician assistants("barefoot doctorsn) t r a k i n g program at mIHA -- not orginallyplameed -- benefits rural health centers;- benefit of J P K to rursl health prograr tfie outreach function of JPlC;it also benefitted the Lofa C~m, tyRaal Zealth project;- it was not planned as a teachins ibspital; however, JPK is s e r v i n gW i t purpose now an6 is serving it well.

20. In response to the q ~e s t io n s tc who is generally r e ~ a d e d sreppensfile for t h e prcject , in carryinc it oot, the di~tzi 'euticnwas asfollows:'JSAXD only = 15 percentGOL only f: 26 _percatGSL & U S S R - 52 ?&centGOL, USAIP & Others 5 percent

,;,would be a , ~ r o p r L a ~lsewh1. When asked whether ox not a sk . l lar p o j - - +in Liberia, 20 percent responded negetfvely k i i l e 74 percent gave a posf-eresponse. Z~wever, he general &ift of the resFEnse wes that a duplicrtiona large medical center elsew5ere ir. Li>e r i a w&s n c t needed (one respondentnoted 'at "--ria can only affcrd one J F X n ) , Sat that smaller versicns ofJET wid be appropriate u~cormtry nd t t a t needed t~ .e done additioaaly Fn the health sector to p t medical services b5t in . i~ he roach of all'Liberims.

b22. Respondents were asked if t h s y ~ o u 3 . 2 kmqe the &deaL% sf s a l - l l r rproject today. ?%is qttestion t.as generally misinterpreted because +he me-g- of the word "design" was thought to be ph:~sical lay-cut arcbitectuee.did correctly ir-terprst t k qca:tior. as to the "project dewa 3eZVing, responded that they would prefer to jave it done Z i f f e r ~ t l y the JPK

project was behs designed W a l ~ :,- cofisultation and planxirig, espe-l:ially or: the technical. level shouldimprovd, it is greferable to pfve 5-ia Ge mney and cbolfa of

m a r k e t s to obtain hupglies and equipmer i t , ra tbr than haviog it tie6to US suppliers soz~t5.zes ir,suit&iIe @Perit;

........... . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . ... . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Page cf -f l a ~ ~ & i e Z~ o - z ! - hbaZ&*e icroCr'r'exenLLa2 x.aK%e:a %hasBe-cpaentgJ, i a t%: - E t s i ; ~ qx$z",c&-agk, GS&Jr) -m'is,&-aPnndled phssed 2~-v.tat- be %WEe-&zLr:~%~.rt~egtm fweer ogt -6-.nee&& "tic'be -kcjed); ~ z ~ ~ e zh M d.+- . %'abe 3.n tDe hbsrds ~f t;Y~%,r Z , , UEZJC sk2.aa1.8c w eA*&x' qef r-+ M m e d d pdre'-&n&i-w-'Stifid up"eh@@mJeeZ;p1gcgg &$$&&gd e' d&y&"k,rreb=-'

-+&itk; ;oz&z -$* ie- s;o %>&$ +I--. ~ ~ i re~~ be$.&an t g ' cog&L&sz&Foc; & s Q p r ~ 3i h t e &a a l ~ l=.b;rrrtkudLZy decf %a6, - - . . -

kqsrove *&a pler-.%ng Lqce; beteer ec~%s246rs,%foaf el-tema%ives;ar 'fiEg mdsm Fu3,sgf "idS, c. ~ a b e rf sml'L,ecmp?yt (coaessziou- ype) hos@t&r;

tse+ th&24, Seyan%y cer~e3$ =-fC.3 ~ B P ~ f e ~ ~ ~ tg,,,,T r-,,on consti$stas ~ i , ~~3~~ ezr_kIt~: c . Y q ~ , ;z pe?ccs% Y~FS~&&=&- - Lit F2yt-F ~ r ~ ~ ~ ~ ~ e ,;&L~q '! < % ~ - u u ~ ~-:-amC - -%a .?+ s-2 S u I B +-.:t-:-il-k.%*a7% 2-Z Ei Y L & ~ Z ?- -&seI+dd.t;f% be- ~ I r f cs ep+s$ -;&2*;tsz-hc;c.k-;.s~ ca%ss&e=sf st-- r r & umee l r m s e Z$C Latter g p ~ t y Z . : X & L ~ ~ Q ,r&rpi3.L-e 3% incge f@sxew& &2m>v-r4


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1980 impact study - jfkmc

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