Embracing the Challenge of Good Data Collection in Post-Conflict Liberia

The Lofa County Survey

(Photo: left) Survey team member Priya Marwah mapping out logistics with Dr. Geetor Saydee and Dr. Basia Tomczyk, Photo: UNFPA, 18 July 2008

LOFA, Liberia — Dr. Geetor Saydee’s legs were tired, his brow drenched in sweat. He’d been walking for several hours through the dusty streets of Lofa, a county in Liberia’s northern region, to assess the status of the public healthcare system in the wake of the country’s 14-year civil war. But he trudged on, knowing how much was at stake.

Lofa was a focal point during the war, a place where ritual murder, systematic rape and torture were commonplace. Though the war ended in 2003, clean water and sanitation are still scarce and nearly all basic services, including health facilities, were destroyed and remain in shambles. The country’s Human Development Report recently concluded that as a result of the conflict, only 5 per cent of the country’s health facilities are still standing. In 2003, fewer than 20 government doctors (out of 400 who were trained before the war) remained in the country.

Difficult conditions

(Photo: left) Difficult conditions, Driving on rugged roads into Lofa County, Photo: UNFPA

“The biggest challenges were bad roads and inaccessible areas. We spent a lot of time walking. If the villages were too far to reach by foot, we’d have to turn around and find another option. After this survey was conducted, I realized that in order to gather good and genuine data, one has to surpass many challenges,” Priya Marwah of UNFPA’s Humanitarian Response Unit recalls.

Shocking results

The results of the survey were shocking: 96 per cent had lost shelter due to the war, 90.8 per cent had lost their livelihoods, and 72.8 per cent had lost a family member. More than half of all women in Lofa County were victims of at least one incident of sexual violence during the 1999-2003 conflict.

While 90 per cent of these women were physically abused at least once, almost half of the women reported more than four instances in which they were required to have sex for favours. The data also revealed that 61.5 per cent of women experienced violence at the hands of an intimate partner at some point in their lives.

A community effort

"Local NGOs know the culture, which helps them address sensitive reproductive health issues." --Meriwether Beatty

At the beginning of the survey process, the 14-member survey team travelled across rutted roads and thick forests to reach the Lofa districts of Voinjama, Foya, Zorzor and Salayea to explain to village leaders the purpose and procedures of the survey, and to obtain their permission to conduct it. Making sure the communities knew what was going on and trusted the process was critical to the survey’s success.

“The local population was very helpful and cooperative throughout the entire process. They provided accommodation for the survey team and directions to the next selected towns and villages. The local population also assisted in the education and sensitization of the survey,” said Basia Tomczyk, a CDC epidemiologist.

Forgotten and vulnerable

Ironically, access to reproductive health care often declines after a ceasefire because, once peace is forged, humanitarian agencies often stop providing emergency assistance. Yet in post-conflict settings, broken-down infrastructures and a lack of resources often mean that displaced populations are left to try to reconstruct their communities without the necessary supplies and equipment.

Conclusion

It had been nearly ten years since a population-based survey had been produced in Liberia. The lack of information meant that calculating sample frames was difficult since some of the villages and roads listed no longer existed. These obstacles are not uncommon when collecting important data in countries transitioning from the emergency phase of a conflict.

The participants of the survey included some 907 women of reproductive age living in 36 locales, which included both urban and rural areas. They were interviewed by women, many of them locally recruited, who had been trained by the CDC on the survey methodologies and who also spoke the local dialect. Survey team members filled out a questionnaire form for each participant, since many of them did not know how to write. Participants were asked about maternal health practices, knowledge and use of contraception, experiences with sexual violence during and after the recent conflict, and knowledge, attitudes and behaviours related to HIV.

“It was important to evaluate the reproductive health situations of the women here. What we found was that they have a very low social and economic status, which makes them vulnerable to a variety of things,” said Dr. Saydee, a national consultant for UNFPA, the United Nations Population Fund. Early pregnancy, sexual violence and HIV transmission are among the issues he cited.

In fact, the data he and others collected suggested that “the single most important intervention needed is improved access to and availability of reproductive health services.”