Availability of essential health services in post-conflict Liberia

Objective: Liberia has recently emerged from 14 years of civil war, which caused near-total destruction of the health system. With assistance from donor countries, Liberia is rebuilding the health system, starting with provision of essential health services. We assessed the availability of essential health services in northern Liberia five years after the end of the war.

Methods: We fielded a population-based household survey in rural Nimba County and a health facility survey in clinics and hospitals nearest to study villages. We evaluated access to facilities providing index essential services: artemisinin combination therapy for malaria, integrated management of childhood illness, HIV counseling and testing, basic emergency obstetric care, and treatment of mental illness.

Findings: Data from 1405 individuals (98% response rate) and 43 health facilities indicates that respondents travel an average of 136 minutes to reach a health facility. All respondents could access malaria treatment at the nearest facility and 55.9% could access HIV testing. Only 26.8%, 14.5%, and 12.1% could access emergency obstetric care, integrated management of child illness, and mental health services, respectively.

Conclusion: Although there has been progress in providing basic services, rural Liberians still have limited access to life-saving health care. The reasons for the disparities in the services available to the population are technical and political. More available services (HIV testing, malaria treatment) were less complex to implement and represented diseases favored by donors. Systematic investments in the health system are required to ensure that health services respond to current and future health priorities.