With early detection, we have been able to put people with diabetes in care - Dr Dorfelson Jayguhwoiyan

Liberia, home to 5.4 million people, is still recovering from two civil wars, an Ebola outbreak, and an ongoing malaria health crisis, a situation that has not made it easy to prioritise non-communicable diseases (NCDs) in national healthcare.

WDF has been engaged in Liberia since 2009, supporting projects that have catalysed the country's first nationwide NCD programme, integrating routine diabetes care services in 26 health facilities. The project was implemented by the Ministry of Health's NCDI Unit and Ganta United Methodist Hospital.

Our colleagues visited various hospitals under the programme to assess the results and hear about its impact from the people involved in the programme. 

One of them is Dr Dorfelson Jayguhwoiyan, county NCD focal person for Lofa County, with four hospitals under supervision. ‘It is my responsibility to monitor the clinic’s focal persons at each of these health facilities’, he explains. ‘It is also my responsibility to review their reporting in the federal ledgers as they have been trained. I do mentorship and coaching, and data analysis with them.' 

These activities ensure coordination and communication at a more central level. ‘We also have data officers who enter the information on the national server so that the Ministry can access how many cases were diagnosed, how many tests were done, and how many persons have this condition.

At the community level, the 45-year-old supervisor has seen several positive outcomes. Before it started, the health system had been facing challenges with diabetes detection and management. 

Diabetes screening and diagnosis used to only occur when a patient visited a clinician with other medical issues or symptoms. Based on medical history, the clinician would then order a test for diabetes screening. ‘By then, that person would be in the late stage of the disease’. 

‘With the programme, with early detection, we have been able to see increasing cases’, Dr Dorfelson adds.

‘We have been able to put people with diabetes in care. This has been a great change.’ 

When most of the patients in Liberia cannot afford the costs of blood sugar tests as they live in low-income settings, access to free routine services becomes life-changing. 

‘When you must tell a patient to come every week for routine testing, it becomes a financial burden. Many of them said, "if God says I will live, I will. If God says I will die, I will". But since the programme, our people have been able to get free screening and medication.'

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As the project came to an end, Dr Dorfelson hopes to see more partnerships breaking the systemic barriers to accessing NCD prevention and care. 

‘It has made a tremendous improvement for our people, because until the programme we never had an NCDI department in the country. There was no budget allocated for it. And as clinicians we know the consequences of diabetes not being managed – now, almost all pregnant women visiting the clinics for the first time are screened.

The supervisor has seen meaningful changes in terms of stronger patient-provider interaction and diabetes self-management, therefore improved health outcomes, and less social stigma.

‘Our patients get routinely tested, and our focal persons in the hospitals are now able to monitor patients even by phone. Whenever the patient’s condition changes, they can detect it early and advise on what to do – including diet. Most people do not know what to eat and what to avoid when they have diabetes or hypertension. Through education, health providers can help patients even without medication.’

The program has also established a self-support group where members coordinate and do social activities together for their well-being. The group also collectively contributes to a fund that can be utilised in case of critical conditions or to purchase necessary medicines.

‘For most of them with this condition, nobody comes around. They become stigmatised and depressed. But in a self-support group, you have diabetes, I have diabetes. You are not the only one with the problem. When I visit the communities, I encourage and assure them that they are not the only ones carrying this burden and that they don’t need to take it upon themselves as a burden. 

With advice and medication, people can live normal lives'. 

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Since 2009, WDF has supported several projects in Liberia aiming for improved diabetes and related NCD prevention and care: WDF09-0483, WDF15-1273, and WDF17-1488. These projects have progressively led to the launch of the first nationwide NCD response, WDF20-1743, completed in 2024.