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

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.