Menu
Menu
Menu
Menu
Background: Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia’s experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases.Methods: We conducted a historical review of Liberia’s post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia’s Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia’s Health Sector Reform. In this case study, we examine the early reconstruction of Liberia’s health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia.Results: Six key lessons emerge from this analysis: (i) the 2007 National Health Policy’s ‘one size fits all’ approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii) the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii) a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv) effective strategies for HIV/AIDS care in other settings should be validated in Liberia and adapted for use in other chronic diseases; (v) mental health disorders are extremely prevalent in Liberia and should remain a top chronic disease priority; and (vi) better information systems and data management are needed at all levels of the health system.Conclusions: The way forward for chronic diseases in Liberia will require an increased emphasis on quality over quantity, better data management to inform rational health sector planning, corrective mechanisms to more efficiently align health infrastructure and personnel with existing needs, and innovative methods to improve long-term retention in care and bridge the rural health delivery gap. © 2011 Lee et al; licensee BioMed Central Ltd.
We conducted a historical review of published and gray literature on Liberian policies affecting health systems strengthening and chronic disease prevention and treatment, including plans for poverty reduction and health and social welfare planning in the post-conflict period. Documents were primarily country level policies sourced from the Government of Liberia Ministry of Health and Social Welfare. Key documents included the Poverty Reduction Strategy, the 2007 National Health Policy, the Basic Package of Health Services, and the 2011 National Health Policy and Plan. The documents were considered reliable as they represent direct sources describing the post-conflict recovery and health system in Liberia. We reviewed published literature on Liberian health services and outcomes, as well as health systems for chronic disease management in post-conflict settings. Measurable results of the initial post-conflict policies were also reviewed to characterize their early impact. In order to describe the preceding conditions and early impact of the 2007 National Health Policy, we reviewed general economic indicators such as gross domestic product, measures of income inequality, total health spending, and out-of-pocket health spending. We selected these indicators based on the following observations: (i) general economic indicators have been associated with a variety of health outcomes including maternal mortality [23]; (ii) inequality in income distribution and other development factors such as education explain even more variation in mortality [24]; (iii) per person or percent GDP expenditure is correlated with health outcomes such as maternal mortality and child mortality [23,25]; and (iv) high out-of-pocket payments may induce poverty and lead to further negative health consequences [26]. Furthermore, we reviewed health indicators that are particularly affected by conflict including under-five and maternal mortality, overall mortality, and existing health infrastructure including workforce distribution and measures of primary care access. Given the significant interdependencies of health and socioeconomic status, the above range of indicators were necessary to provide a reasonable picture of Liberia’s challenges and progress in the post-conflict period.
N/A
