Outcomes after 20 years of outcry for primary healthcare in Ceyah

Jul 8, 2016

When someone is bathing your back, you bathe your stomach

Philip Gbezon, Town Chief, Ceyah.

85 kilometres away from Buchanan City, Grand Bassa County, Liberia, Ceyah’s population is around 5,000. Yet, unbelievably, before 2015 Ceyah had no primary healthcare facilities.[1] Indeed, the closest available clinic was in Goblee, 30 kilometres away. As most community members use motorbikes or scooters as their primary mode of transport, travelling on poor quality and poorly networked roads for medical aid further risked the welfare of the infirm, including the elderly, pregnant women and children.

Finally, and after 20 years of requests by citizens, the wait for Ceyah’s first primary medical facility is over, thanks to local volunteers. These citizens, with support from Integrity Action partner IREDD (the Institute for Research and Democratic Development IREDD), used their training in Community Integrity Building (CIB) to address the situation. IREDD is an NGO committed to empowering communities to monitor infrastructure projects and hold authorities accountable to improve service delivery for Liberian citizens. Using Integrity Action’s CIB approach enabled IREDD to train local residents as community monitors. IREDD’s training equips monitors with skills to analyse project documents, conduct site visits to compare the actual project to the documents, take photos of the project, conduct beneficiary surveys, verify findings, and engage with stakeholders such as contractors and local government to fix problems.

IRRED was responsible for monitoring the construction of Ceyah’s health centre, which began in June 2015. During the process, the monitors discovered two serious problems. First, the site supervisor revealed that labourers had been stealing materials from a warehouse that was being used by the project’s contractor, in order to sell them. Not only did this delay implementation by more than three months. The project was also subject to a ‘fixed-price’ contract, which meant that extra funds could not be provided until construction had finished. The losses in materials, therefore, gravely threatened the project’s chances of completion. If the original budget had been allowed to be drained completely, there would have been no means of replacing the resources needed to build the clinic

The second problem was that the project’s contractor had, contrary to agreed specifications, only made provisions for a staircase to enter the clinic. Without IREDD’s intervention, the clinic would have denied access to those who could not climb stairs, whether because of injury or disability.

Upon becoming aware, in June 2015, of the disappearance of the warehouse materials, IREDD’s monitors reported the issue to Chairman of the local Development Committee, Alex Smith: an official responsible for development projects in the region. Alex conveyed the problem to Ceyah’s Town Chief, Phillip Gbezon. A week later, IREDD staff held a town meeting involving leading figures among the community’s elderly, youth and women. Participants scorned at the finding. They quickly instituted a community-led task force, which, alongside IREDD’s monitors, aimed to identify a safer structure nearby in which to relocate the building materials.

The alliance achieved its aim within a fortnight. Following this, Mr Gbezon requested Mr Smith to enlist a group of youths to guard the new warehouse until the building’s completion. These guards kept inventories of items taken to and from the warehouse, copies of which they also supplied to the site supervisor. The site supervisor and youth team-leader signed all records to avoid confusion and dispute. No further thefts were reported as a result.

IREDD’s monitors adopted a similarly cooperative strategy for overcoming the second problem. They quickly alerted local leaders, with whom they were already in close contact, to the lack of step-free access to the building. As a result, Mr Gbezon invited the contractor to a meeting on 19 September 2015, who promised to address the concern. True to his word, the contractor revised his plans to satisfy the requirement for a ramp next to the staircase.

Training in CIB gave local residents the skills and confidence to engage with key stakeholders and identify problems that were undermining the Ceyah health centre. Today, Ceyah has seen the beginnings of basic, reachable healthcare. Following Integrity Action’s guidance, IRRED’s monitors stuck to their commitment to collaboration – a commitment which, ultimately, proved necessary to address the problems encountered. The project typifies a lesson echoed by Mr Gbezon’s words above: in order to build roads, schools and clinics, one must, first and foremost, build relationships.

Institute for Research & Democratic Development (IREDD) have been an Integrity Action partner since 2010. During this time they have trained 80 people as community monitors. In 2015, IREDD successfully engaged with key stakeholders to resolve 31% of identified problems in 7 projects monitored.


[1] Primary health care centers give local citizens the opportunity to make an initial approach to a practitioner for medical advice or treatment.