264975 Rebuilding basic health services in Liberia: Improving access and quality of health care in a post–conflict environment

Monday, October 29, 2012 : 12:50 PM - 1:10 PM

Bernice T. Dahn, MD, MPH , Deputy Health Minister/ Chief Medical Officer for Republic of Liberia, Ministry of Health and Social Welfare, Monrovia, Liberia
Rose Macauley, MD, MPH , Rebuilding Basic Health Services (RBHS), JSI Research and Training Institute, Monrovia, Liberia
Theo Lippeveld, MD, MPH , International Division, JSI, Boston, MA
Catherine Gbozee , Rebuilding Basic Health Services, Rebuilding Basic Health Services, Monrovia, Liberia
Vamsi Vasireddy, MD, MPH, DrPH , Rebuilding Basic Health Services, JSI Research and Training Institute, Inc, Monrovia, Liberia
Background: After the end of the 14-year civil war which destroyed most of the health infrastructure in the country, the Government of Liberia and partners embarked on rebuilding the health care delivery system of the country. In 2007 a Basic Package of Health Services (BPHS) was developed in order to ensure equitable access by Liberian citizens to the health services. For implementation, the Ministry of Health (MOH) was supported by the “Rebuilding Basic Health Services Project” (RBHS), a USAID-funded five year project.

Strategy: While the initial focus was on facility renovation, provision of basic equipment and supplies, as well as minimum staffing to deliver the BPHS, RBHS also provided support to the MOH to establish a process of continuous Quality Assurance (QA). In June 2010, a baseline assessment of the quality of clinical care provided in 103 RBHS-supported health facilities showed that only 39% of standards across ten clinical content areas were met. Results were fed back to the facilities and each facility developed a quality improvement plan.

Results: Accreditation surveys undertaken by MOH showed that most RBHS-supported facilities now provide the full BPHS with an average score of 88%. Quality of care and adherence to clinical standards is steadily improving but still below desired standards. A second QA assessment undertaken in July 2011 showed substantial improvement in some clinical content areas, with an average score of 45%.

Implications: When rebuilding health systems in post-conflict areas, priority should be given to ensuring access of the population to quality health services.

Learning Areas:
Administration, management, leadership
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
1. Identify challenges to providing quality health care in Liberia 2. Describe strategies to promote quality assurance in service delivery 3. Explain lessons learned in providing quality health care in a post-conflict setting 4. Discuss potential implications of RBHS model in similar post-conflict countries

Keywords: International Health, Quality Assurance

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As a deputy health minister I oversee various service delivery programs, the major one being RBHS - the project being discussed in the presentation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.