Towards a future free from female genital schistosomiasis in Liberia

The Ministry of Health (MoH) in Liberia is the first country to develop a National Strategy for female genital schistosomiasis (FGS), leading the way in protecting women and girls from this hidden reproductive health issue.

In Buchanan City, the Minister of Health of Liberia, Dr Louise M. Kpoto, addressed a room filled with policymakers, partners, clinicians and four women who had lived through the consequences of FGS and experienced the value of effective diagnosis and treatment.  

Dr Kpoto said, “We often overlook it. We haven’t been taught about it. We must think—when we are examining a woman, is this FGS?”. 

Over three days, women with lived experience and working groups shared insights, debated together and helped shape a path forward through integrated policy development and collaboration.

Why FGS matters 

FGS is estimated to affect as many as 56 million women and girls, mostly in sub-Saharan Africa, and millions more are at risk. Despite being a manifestation of a neglected tropical disease (NTD), FGS is also a neglected sexual and reproductive health rights (SRHR) issue. 

It is caused by the parasitic worm Schistosoma haematobium, which enters the body through contact with contaminated freshwater. When the parasite’s eggs become lodged in the genital tract, they can cause serious complications, including chronic inflammation, lesions, pelvic pain, abnormal vaginal bleeding, and infertility. Growing evidence also shows that FGS may increase vulnerability to transmission of HIV and HPV, the virus linked to cervical cancer. 

The symptoms of FGS often mimic those of sexually transmitted infections (STIs), which means women and girls can be misdiagnosed, inappropriately treated and stigmatised. The burden of this disease goes far beyond the physical; it impacts mental health and relationships and puts those affected at risk of gender-based violence. 

FGS is found in areas where access to safe sanitation facilities and clean water sources is limited. Addressing this condition is not just a health priority, it is also a matter of equity, ensuring that no woman or girl is left behind in efforts to achieve universal health coverage and gender equality. 

FGS in Liberia 

In Liberia, the risk of FGS remains high, where access to clean water and adequate sanitation is still a challenge in many communities. 

Data collected across Liberia between 2012 and 2015 indicates a high burden of schistosomiasis (as shown in the map), particularly in rural and riverine communities.  

Schistosoma haematobium is found across the country. However, currently routine services for FGS are not available, and the majority of health workers have not been trained to manage the condition, leaving women and girls at risk. This is exacerbated by the lack of available guidance, training curriculum, and resources for FGS globally.  

In 2021, during a six-month pilot study conducted in Bong and Nimba county, 258 women and girls were found to have FGS in six primary health facilities. For all of them, patient care was provided within routine service delivery as part of an integration pilot.

The Liberian Ministry of Health’s response 

The Liberian MoH is actively responding to these challenges by spearheading the development of a National FGS Strategy. It is the first country to develop a national strategy, pioneering this important work to protect the health of women and girls.  

To make sure this strategy is as strong and effective as possible, the NTD programme, in collaboration with partners Effect Hope and Unlimit Health, organised a three-day workshop in April. This gathering brought together experts and stakeholders from different sectors, including cervical cancer, maternal health, mental health and gender equality, all working to produce a first draft of the strategy.  

The workshop was an excellent example of cross-sectoral collaboration in action, with different health programmes highlighting key entry-points for FGS integration, what resources and processes could be unified, and where there were gaps.  

Not only were the different health services examined, but all elements of the health system were considered. This was guided by the World Health Organization’s (WHO) health system building blocks (as seen in the diagram), to ensure a holistic and sustainable approach. 

“Liberia is ready to scale up FGS activities to the fifteen counties through awareness, screening, diagnosis, treatment and prevention of women and girls living in schistosomiasis-endemic area in Liberia.”

Dr Anthony Bettee

Mr Anthony K. Bettee
National Coordinator, Schistosomiasis & Soil-Transmitted Helminthiasis
Neglected Tropical Diseases Program

The National FGS Strategy of Liberia will guide future planning, implementation and evaluation of comprehensive and person-centred FGS services. These will include everything from awareness raising, health education, training, prevention services, screening, diagnosis and management. One of the key goals is integration. FGS services will be integrated into all existing relevant services in Liberia, including those for cervical cancer, HIV/AIDS and sexual and reproductive health alongside critical health system functions including the Health Management Information System, Human Resources, Community Health and Health Promotion. That means more accessible, coordinated care at every level of the health system. To make sure this works effectively and sustainably, implementors will incorporate all key elements, such as reporting, referral pathways and supply chain management.  

Looking to the future 

Bringing this strategy to life will require strong advocacy, funding, and intentional coordination across sectors. Following the workshop, the MoH will gather further input from national and international stakeholders, including Effect Hope and Unlimit Health, to help shape the next steps.  

A clear process is already in place within the Ministry to develop and validate key strategic documents. This phase is expected to be completed within a few months. 

Once the National FGS Strategy is finalised, the NTD Programme is ready to take forward the strategy. The plan is to identify the critical tools and national mechanisms that will enable the translation of the integrated policy into practice and pilot key activities. The Programme will then scale up efforts, ensuring that all women and girls at risk of FGS have access to the care and services they need.