National IPC Strategy

Objectives

Liberia’s National Infection Prevention and Control (IPC) Strategy seeks to provide accessible, appropriate, equitable and evidence-based IPC programmes across public and private healthcare, reduce healthcare-associated infections (HAIs), protect patients and health workers, and strengthen preparedness for outbreaks and other public-health threats.[1][2]It positions IPC as a foundation for safe, effective, quality healthcare, universal health coverage, antimicrobial resistance reduction, water, sanitation and hygiene (WASH), occupational health, and the One Health approach.[3][4]

• Strengthen national and facility-level IPC programmes, governance structures, policy, focal-person capacity and dedicated implementation arrangements.[5][6][7]
• Standardise national IPC guidelines, facility standard operating procedures, emergency and surge-capacity plans, and periodic guideline review.[8][7]
• Build workforce competence through harmonised curricula, pre-service and in-service education, certification, mentorship, simulation and multimodal training.[9][10]
• Establish national and facility HAI surveillance, including case definitions, routine reporting, feedback, outbreak detection and integration with antimicrobial-resistance planning.[11][12]
• Improve monitoring, audit, feedback and use of IPC indicators to identify implementation gaps and support quality improvement.[13][14]
• Strengthen safe infrastructure, WASH, waste management, decontamination, isolation capacity, ventilation, equipment availability, staffing, workload and bed-occupancy conditions.[15][16][17]

The strategy is organised around the World Health Organization’s eight core components of IPC programmes, with particular emphasis on gaps in the national IPC programme, education and training, HAI surveillance, and the built environment, materials and equipment.[5]Baseline evidence indicates substantial weaknesses: a 2022 assessment recorded 0% for national HAI surveillance and 20% for monitoring, audit and feedback, while a facility assessment found mean compliance of 33% with minimum IPC programme requirements and a 4% mean HAI-surveillance score.[18][19]

Its intended framework is described principally as the 2022-2027 National IPC Strategy, although some extracts refer to a four-year strategy period of 2023-2027 and a 2022-2026 monitoring and evaluation period.[1][6]

Implementation

Implementation is intended to use a tiered, integrated delivery model spanning national, county or district, hospital and other facility levels, combining system change, training, monitoring and feedback, workplace reminders, and a safety culture rather than treating these as separate interventions.[20][21]National leadership sits with the Ministry of Health Healthcare Quality Management Unit, supported by a National IPC Coordinator or Focal Person, the National IPC Steering Committee and an IPC Technical Working Group.[18][5][6]

• Coordinate national planning and technical oversight through an IPC coordination office, Steering Committee, Technical Working Group and IPC representation in the One Health Platform.[6][21]
• Establish and support county, hospital and facility IPC committees, multidisciplinary teams, trained focal persons and IPC link persons, including in public hospitals.[2][22][23]
• Engage the National Public Health Institute of Liberia, World Health Organization, United States Centers for Disease Control and Prevention, UNICEF, Last Mile Health, Jhpiego, Partners in Health, United States Agency for International Development, Expertise France and other government and development partners.[1][18]
• Integrate IPC activities with environmental health, WASH, antimicrobial resistance, quality improvement, patient safety, emergency preparedness, procurement and logistics systems.[11][24][16]
• Equip facilities with functional water, sanitation, hand-hygiene, waste-management, isolation, ventilation, cleaning, decontamination and sterilisation arrangements, alongside essential IPC commodities.[15][16][25]

Operational delivery includes reviewing, printing and distributing Ministry-approved guidelines; training and mentoring facility staff and focal persons; conducting active HAI surveillance in district hospitals; integrating HAI and other IPC indicators into District Health Information Software 2; and providing regular feedback to health workers, managers and stakeholders.[8][12][26]Multimodal interventions are to support hand hygiene, surgical-site infection prevention and other IPC priorities across public and private facilities.[10]

Monitoring is to operate through a country-led Ministry of Health platform, with a plan containing priority interventions, core indicators, baselines and annual targets.[6]Proposed mechanisms include routine audits, facility self- and peer-assessment, quarterly hand-hygiene observation, annual hand-hygiene self-assessment, supervisory visits and reporting through District Health Information Software 2.[13][27]A mid-term review was planned for 2025, followed by an end evaluation to inform the subsequent strategy.[6]

The monitoring matrix includes quarterly tracking of national and subnational Steering Committee meetings, targeting four meetings annually from 2023 to 2027 after a baseline of zero in 2022.[28]It also tracks hospitals with costed annual IPC operational plans and government IPC expenditure as a share of total government health expenditure.[28]

Financing is intended to shift from fragmented government, private-sector and partner contributions towards a costed implementation framework and dedicated IPC budgets nationally and at facility level.[6][29]The costing summary reports a total annual requirement of USD 8,669,714, including USD 3,070,764 for IPC programmes, USD 1,450,050 for guidelines, USD 1,225,000 for multimodal strategies and USD 639,000 for HAI surveillance.[30]The source does not specify confirmed funding sources, allocations, funding gaps or economic assumptions for the full strategy.[31][30]

Monitoring & Evaluation

The strategy establishes a national monitoring, evaluation, surveillance and feedback architecture for infection prevention and control (IPC), centred on routine facility assessment, healthcare-associated infection (HAI) surveillance, reporting through the District Health Information Software 2 (DHIS2), and use of findings for quality improvement and accountability.[6][12][13]

• Assess national and facility IPC capacity using the Infection Control Assessment Tool for Minimum Requirements and the Infection Prevention and Control Assessment Framework (IPCAF), including the revised IPCAF-MR tool.[18][5]
• Use the 2022 baseline of 33% mean compliance with minimum facility IPC requirements across 255 assessed facilities to prioritise implementation; HAI surveillance scored 4%, while trained IPC focal persons were present in 79 facilities, or 31%.[19]
• Establish a standardised national and facility-level HAI surveillance system with case definitions, active surveillance in high-risk areas and district hospitals, routine reporting to the Ministry of Health, and feedback to health workers, facility management and stakeholders.[11][12][26]
• Integrate HAI and other core IPC indicators into DHIS2 and health-management information tools, while using routine data for decision-making, benchmarking, reporting and advocacy for IPC financing.[12][27][32]
• Implement a national monitoring and evaluation plan containing priority interventions, core indicators, baselines and annual targets, under a country-led platform managed by the Ministry of Health Directorate of Performance Monitoring and Evaluation.[6]
• Conduct routine audits, facility self-assessments and peer evaluations, quarterly hand-hygiene observations, annual hand-hygiene self-assessments, and regular feedback linked to quality improvement.[13][27][33]
• Undertake a mid-term review in 2025 and an end evaluation to document learning and inform the subsequent IPC strategy.[6]

The monitoring matrix includes specific measures for programme functionality, implementation fidelity, operational planning and budget allocation. It sets a 2022 baseline of zero for planned national and subnational IPC Steering Committee meetings, with annual targets of four meetings from 2023 to 2027.[28]It also tracks hospitals with costed annual IPC operational plans, with a 2022 baseline of zero and listed targets of 23 hospitals and 35 health centres.[28]

Important gaps remain: earlier assessments found no established national or facility HAI surveillance systems, limited microbiology support, weak monitoring and audit feedback, and no comprehensive national IPC monitoring and evaluation system.[19][20][34]The strategy assigns oversight roles to the Health Quality Management Unit, IPC Technical Working Group, IPC Steering Committee, facility focal persons and monitoring bodies, but several extracts do not specify complete indicator definitions, reporting templates, sanctions or formal accountability procedures.[6][8][13]

Costing & Financing

The strategy identifies substantial financing and resource gaps in IPC, while providing a costed annual requirement of USD 8,669,714.00 across the eight IPC core components.[30]It envisages dedicated budgets at national and facility levels, a costed implementation framework, and coordinated resource mobilisation from government, private-sector and development-partner sources.[6][29]

• Allocate dedicated IPC budgets to national and facility programmes, as the source reports that no dedicated national or facility IPC budget had been available and that no assessed facility had an annual IPC plan or dedicated budget.[2][19]
• Address fragmented financing from government, private-sector and development-partner contributions through a costed implementation framework and stakeholder advocacy.[6]
• Use National COVID-19 response-budget allocations, National Medical Stores orders and partner donations to support IPC materials and equipment, while establishing a designated budget for reliable supplies.[2]
• Prioritise financing for staffing, training, surveillance, monitoring and evaluation, water, sanitation and hygiene, waste management, infrastructure, laboratory capacity, supplies and equipment.[35][36][5]
• Track government IPC expenditure as a share of total government health expenditure, with a baseline of 0 in 2022 and target sequence of 20%, 30%, 40% and 50%.[28]

The annual costing summary allocates USD 3,070,764.00 to IPC programmes, USD 1,450,050.00 to guidelines, USD 515,900.00 to education and training, USD 639,000.00 to HAI surveillance, USD 1,225,000.00 to multimodal strategies, USD 524,750.00 to monitoring and auditing, USD 903,750.00 to workload, staffing and bed occupancy, and USD 338,500.00 to the built environment, supplies and equipment.[30]Activity-level costs are also provided for surveillance, audits, laboratory inputs, communications, decontamination and field visits, although many entries do not identify a currency or period.[32][37][14][33][31]

World Health Organization support for strategy development and planning included technical, logistical and financial assistance, but the associated amount and period are not specified.[1][38]Several extracts identify insufficient allocations, high or unavailable prices for IPC materials, inadequate maintenance resources, limited funding for periodic surveillance and no workload-based staff-recruitment budget mechanism.[35][36][39]Except where the costing matrix specifies USD, the source does not provide currencies, financing timetables, quantified funding gaps or economic assumptions.[30]