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Analytical summary - Service delivery

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In Liberia, health service delivery is fundamentally linked to geographic distribution of the population and population density. In 2007, the Ministry of Health and Social Welfare committed to establishing a consistent package of evidenced-based, essential health services to the entire population.

Thus, the Basic Package of Health Services was developed in order to ensure equitable access to health services by increasing the overall efficiency and effectiveness of the health systems at all levels. The Basic Package of Health Services prioritized services perceived at the time as the most critically needed to improve the health status of the Liberian population within the available resources.

This Basic Package of Health Services was modified in the current health plan (2011–2021) to include additional services such as noncommunicable diseases, prison health, neglected tropical diseases and is now referred to as the Essential Package of Health Services.

Distribution of health facilities by ownership and year. Source: Ministry of Health and Social Werlfare

There has been a gradual increased in the number of health facilities since 2006. The number increased from 354 in 2006 to 551 in 2010 (see figure). This has increased physical access to health services, although distribution across counties and districts is disproportionate, with 40% of households travelling 1 hour or more to the nearest health facility, especially in rural areas. Though the number of health facility has increased, many of these facilities lack basic equipment, regular electricity and water supply.

In addition, the quality of health services is poor due to limited number of skilled staff at these facilities and frequent absence of essential drugs and medical products.

The 2007 National Health Policy approaches infrastructure from the perspective of distribution of facilities in relation to population density, utilization and geographic access. The intent was for the national level to set the distribution ceilings, based on objective planning criteria. However, the size of the facility network envisaged in the National Health Policy was not based on evidence of actual affordability and accessibility. Instead, the National Health Plan simply projected that minor or major rehabilitation of 110 existing facilities would be required, 30 facilities would need to be reconstructed and 30 new health clinics would need to be constructed in underserved areas.

Antenatal visits are globally encouraged to ensure that pregnant women are assessed regularly and prepared for labour and delivery. In addition, a mother should attend postnatal clinics to be examined by trained health worker within 42 days after delivery in order to prevent and identify postpartum complications.

In 2011, antenatal care four-visit coverage was estimated to be 42%, while only 37% (64 729) of postpartum mothers had postnatal consultations.[1]

Births attended by skilled birth attendant (HMIS, health management information system; LDHS, Liberia demographic and health survey). Source: Ministry of Health and Social Welfare

The decline of skilled attendants at birth (see figure) is attributed to:

  • migration of qualified health workers
  • destruction of health facilities
  • very low production of human resources for health as a direct result of the civil unrest during that period.

However, the health sector has made progress in increasing the number of skilled attendant at birth over the past 2 years. Delivery statistics for 2011, based on reported deliveries by health facilities, show an increase of approximately 8% from 2010 to 2011.

References

  1. Annual report. Monrovia, Government of Liberia, Ministry of Health and Social Welfare, 2011