Which Doctor?

Kruk, Margaret E; Rockers, Peter C.; Varpilah, S. Tornorlah; Macauley, Rose

doi:10.1097/mlr.0b013e31820f0dd4

Cited by 32 publications

(18 citation statements)

References 18 publications

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“…The NHP envisaged an assessment of rehabilitation and construction needs based on utilization, population, geographic access, cost, and other socioeconomic factors, but this long-term assessment had not been carried out. By including rapid targets for renovation or construction of health facilities in the NHP and PRS in the absence of a thorough needs assessment, a significant amount of capacity and resources were committed to targets that were not based on evidence or patient preference [33,43,44]. By 2010, many clinics fell outside catchment criteria established by the MoHSW; over 50% of government clinics were serving catchment populations smaller (40%) or larger (11%) than the established criteria [45].…”

Section: Progress and Challengesmentioning

confidence: 99%

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

et al. 2011

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BackgroundGlobally, 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.MethodsWe 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.ResultsSix 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.ConclusionsThe 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.

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Section: Progress and Challengesmentioning

confidence: 99%

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

et al. 2011

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“…According to the country’s first national clinic accreditation process, 80 % of government clinics were estimated to meet the minimum standards for delivery of the BPHS by 2010 [19–21]. The government therefore upgraded the BPHS to the Essential Package of Health Services (EPHS) in 2011, an expanded initiative that introduced a more comprehensive program for indicators (such as child health) that required increased attention [21].…”

Section: Introductionmentioning

confidence: 99%

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

Kentoffio

Kraemer

Göen³

et al. 2016

BMC Health Serv Res

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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.

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“…In order to improve population health, new health services have to be used. Our previous work on health care utilization in Liberia suggests that rural Liberians disproportionately use informal or traditional sources of care compared with modern health care (Kruk et al 2010). Data from Demographic and Health Surveys show the low utilization of basic health care, particularly in rural areas, where only 25.5 percent of rural women delivered with a health professional and 32.5 percent of 2-year-olds had all required immunizations.…”

mentioning

confidence: 98%

Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

Kruk

Rockers

Varpilah

et al. 2011

Health Services Research

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OBJECTIVE. To quantify the influence of health system attributes, particularly quality of care, on preferences for health clinics in Liberia, a country with a high burden of disease that is rebuilding its health system after 14 years of civil war. DATA SOURCES/STUDY SETTING. Informed by focus group discussions, a discrete choice experiment (DCE) was designed to assess preferences for structure and process of care at health clinics. The DCE was fielded in rural, northern Liberia as part of a 2008 population-based survey on health care utilization. DATA COLLECTION. The survey response rate was 98 percent with DCE data available for 1,431 respondents. Mixed logit models were used to estimate the influence of six attributes on choice of hypothetical clinics for a future illness. PRINCIPAL FINDINGS. Participants' choice of clinic was most influenced by provision of a thorough physical exam and consistent availability of medicines. Respectful treatment and government (versus NGO) management marginally increased utility, whereas waiting time was not significant. CONCLUSIONS. Liberians value technical quality of care over convenience, courtesy, and public management in selecting clinics for curative care. This suggests that investments in improved competence of providers and availability of medicines may increase population utilization of essential services as well as promote better clinical outcomes.

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Which Doctor?

Cited by 32 publications

References 18 publications

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

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

Population Preferences for Health Care in Liberia: Insights for Rebuilding a Health System

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