National IPC Strategy

Objectives

Liberia’s first National Infection Prevention and Control (IPC) Strategic Plan aims to provide and coordinate acceptable, accessible, appropriate and equitable quality IPC programmes, grounded in evidence-based practice and efficient use of available resources.[1][2]Its goal is to strengthen IPC programmes throughout public and private healthcare at every level, improving patient outcomes, protecting healthcare workers, reducing healthcare-associated infections and antimicrobial resistance, and strengthening preparedness for outbreaks and other public-health threats.[3][4][2]

• Establish functional national, county, hospital and facility IPC programmes with trained teams, focal persons, link persons, annual plans and dedicated budgets.[5][6][7]
• Develop and maintain Ministry-approved, evidence-based IPC guidelines adapted to Liberia’s context, reviewed at least every five years and implemented through facility standard operating procedures.[8][7][9]
• Strengthen workforce capability through standardised pre-service and in-service education, trainer development, mentoring, continuing professional development and professional IPC expertise.[10][9]
• Establish national and facility-level healthcare-associated infection surveillance to guide interventions, detect outbreaks, support feedback and benchmark performance.[11][12]
• Improve safe care environments through adequate staffing, workload and bed-occupancy management, water, sanitation and hygiene, waste management, occupational health, infrastructure, materials, equipment and decontamination services.[13][14][15]
• Integrate IPC with universal health coverage, quality improvement, patient safety, antimicrobial resistance, One Health, emergency preparedness and response, and health promotion and disease prevention.[16][2][17]

Implementation

Implementation is structured around the World Health Organization’s eight IPC core components and a four-year implementation period, using national and facility plans, a costed implementation framework, multi-modal improvement strategies and coordinated stakeholder action.[18][17][19]The Ministry of Health leads policy, stewardship, resource mobilisation and oversight through the Healthcare Quality Management Unit, while national, county and facility structures translate the strategy into service-delivery action.[20][21][5]

• Govern implementation through the National IPC Steering Committee, the Healthcare Quality Management Unit, the National IPC Programme and the IPC Technical Working Group within the One Health Platform.[17][5]
• Strengthen subnational and facility leadership by establishing county and hospital IPC committees, quality management teams, trained focal persons and hospital IPC link-person systems.[22][5][23]
• Coordinate technical and operational support with the National Public Health Institute of Liberia, World Health Organization, United States Centers for Disease Control and Prevention, UNICEF, partners, professional associations, education institutions, communities and relevant government departments.[3][4][24][25]
• Implement multi-modal IPC strategies as integrated packages comprising system change, education and training, monitoring and feedback, workplace communications and reminders, and institutional safety culture.[26][27][28]
• Train 1,954 facility IPC focal persons, deliver annual in-service IPC training across 15 counties, standardise curricula and integrate IPC modules into pre-service education.[9][12]
• Develop a national healthcare-associated infection surveillance plan, apply standard case definitions, conduct active surveillance in district hospitals, integrate indicators into the District Health Information Software 2 system, and return findings to facilities, health workers and management.[11][12][29]
• Improve facility readiness through patient-flow and ward-design standards, power and ventilation, isolation or cohorting capacity, water supply, hand-hygiene facilities, waste segregation and disposal, medical-device decontamination and sterilisation, and reliable IPC supplies.[30][15][31][32]
• Coordinate logistics and standards-setting between the National IPC Team, the Environmental Health Department, National Medical Stores and the Pharmacy Department, including alignment with the Medical Countermeasures Plan.[33]
• Mobilise government, private-sector and development-partner support for a dedicated national coordination budget and facility IPC implementation budgets; the strategy’s costing summary totals US$8,669,714.00, although financing sources and commitments are not specified.[17][5][34]
• Monitor progress through a Ministry of Health-led integrated monitoring and evaluation platform, routine audits, supervision, facility self-assessments, data analysis and feedback.[17][35][36]
• Conduct quarterly hand-hygiene observations, annual hand-hygiene self-assessments, routine facility reporting, a mid-term review in 2025 and an end evaluation to support corrective action and future planning.[17][19][35][37]

Monitoring & Evaluation

The strategy establishes a national infection prevention and control (IPC) monitoring, evaluation and surveillance approach that combines national and facility assessments, routine audits, healthcare-associated infection (HAI) surveillance, feedback, supervision and use of data for corrective action.[18][17][19]The Health Quality Management Unit is responsible for developing the monitoring and evaluation framework and routinely tracking prioritised IPC activities and performance across the Unit, health facilities and IPC stakeholders.[19][5]

• Use an integrated country-led monitoring and evaluation platform under the Ministry of Health Directorate of Performance Monitoring and Evaluation, with a plan containing core interventions, indicators, baselines and annual targets.[17]
• Conduct a mid-term review in 2025, undertake a mid-term evaluation to identify corrective action, and complete an end evaluation to document learning for the subsequent strategy.[17][19][5]
• Establish standardised national and facility-level HAI surveillance, with case definitions, active surveillance in district hospitals, routine reporting to the Ministry of Health, laboratory support and feedback to facilities, health workers, management and stakeholders.[11][12][29]
• Integrate HAI and a minimum set of IPC indicators into the District Health Information Software 2 system for routine reporting.[35][38]
• Conduct routine facility monitoring, audit and self-evaluation against national standards; analyse IPC data quarterly or annually; and use findings in national and facility decisions.[35][36][37]
• Undertake quarterly hand-hygiene observations and annual Hand Hygiene Self-Assessment Framework assessments at hospital or facility level, followed by staff feedback and quality improvement.[35][36][37]

Baseline evidence identifies substantial performance gaps. A 2022 assessment of 255 randomly selected facilities found mean compliance of 33% with minimum facility IPC requirements, trained IPC focal persons in 79 facilities or 31%, no facility IPC annual plans or dedicated IPC budgets, mean scores of 27% for facility-specific procedures and 4% for HAI surveillance.[1][39]National assessment findings also recorded 0% for HAI surveillance and 20% for monitoring, audit and feedback.[24][16]These findings support priorities to strengthen surveillance, facility focal-person capacity, standard operating procedures, microbiology support, audit and feedback.[39][26]

The strategy specifies several reporting channels, including monthly reporting through DHIS 2 for water and electricity indicators, quarterly reporting through the electronic Logistics Management Information System for IPC-item stock-outs, quarterly electronic Joint Integrated Supportive Supervision reports for toilets and incinerators, and annual IPC reports for cleaning equipment and decontamination.[6]It also sets a 2022 baseline of zero for listed IPC and water, sanitation and hygiene indicators.[6]However, the supplied extracts do not provide a complete indicator dictionary, all target values, reporting templates, a consolidated reporting calendar or a fully detailed accountability framework.[6][36][37]

Costing & Financing

The strategy has a costed implementation framework with a stated grand total of US$8,669,714.00, covering the principal IPC programme components.[34]The largest allocation is for IPC programmes at US$3,070,764.00, followed by IPC guidelines at US$1,450,050.00 and multi-modal strategies at US$1,225,000.00.[34]

• Allocate US$903,750.00 for workload, staffing and bed occupancy; US$639,000.00 for HAI surveillance; US$524,750.00 for monitoring and auditing; US$515,900.00 for education and training; and US$338,500.00 for the built environment, IPC supplies and equipment.[34]
• Provide dedicated budgets for the national IPC coordination office and IPC implementation in all healthcare facilities.[5][40]
• Mobilise support from government, the private sector and development partners through the costed implementation framework and stakeholder engagement.[17][19]
• Prioritise spending on workforce capacity, guidelines, training, surveillance, laboratory equipment and supplies, facility infrastructure, water, sanitation and hygiene, waste management, decontamination, monitoring and feedback.[13][41][29][32]

Documented financing constraints include the absence of dedicated national and facility IPC budgets, no budget allocation at any level in the SWOT analysis, insufficient funding for staffing and logistical support, high costs of some IPC materials, limited partner funding and foreign-currency constraints affecting procurement.[42][13][2][25]The extracts also identify fragmented and uncoordinated government, private-sector and development-partner financing.[17]

Activity-level costings cover policy consultancy, coordination, quality-improvement teams, focal-person training, guideline review and printing, HAI surveillance, monitoring, human-resource planning, water, sanitation and hygiene standards, equipment and field visits.[41][9][29][36][43][32]Apart from the consolidated US dollar total and component allocations, many activity-level amounts do not identify a currency, financing source or budget period.[41][34]Funding gaps in monetary terms, financing commitments, resource-mobilisation targets and economic assumptions are not specified.[17][34]