Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization

Abstract

BackgroundDespite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.MethodsWe assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.ResultsMost child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).ConclusionsOur data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.

Maternal health care service utilization in post-war Liberia: analysis of nationally representative cross-sectional household surveys

“…In our findings, initial percentage of maternal care utilization was low, but with a steady increase in skilled care for women between 2007 and 2016. This is in line with the reports of a previous study [8, 24].…”

“…These indicators place Liberia among the sub-Saharan African countries with highest maternal and neonatal mortality rates. Like other post-war countries, health care system in Liberia faces a multitude of supply side barriers such as inadequate infrastructure, lack of skilled health personnel, and medical equipment [8]. Low utilization of contraceptive methods and high teenage pregnancies are prominent contributors to maternal death, as approximately 60% of neonatal deaths occur among adolescent women compared to about 6% for those above 19 years, which indicates the need to delay child birth through access to improved sexual and reproductive health care services [9].…”

Pediatric Mortality in a Rural Tertiary Care Center in Liberia

“…Additionally, the higher mortality rate in Nigeria may reflect more acutely ill patients presenting due to the presence of a pediatric intensive care unit, which was not available in our setting, or a better prehospital transport system, which allowed these patients to reach the hospital faster. Access to health care in Liberia is still an issue in rural settings, which affects health outcomes of the population [ 10 ].…”

Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

“…According to the 2012 Liberian Demographic and Health Survey, Konobo had worse maternal and child health outcomes than other rural Liberian districts. 8 …”