Prior to the Ebola Viral Disease outbreak in 2014, the government of Liberia had gradually charted a path toward achieving the fourth Millennium Development Goal (MDG 4)—reducing under-five mortality by two-thirds three years ahead of the 2015 deadline. Conversely, performance with regard to the fifth MDG remained poor, with the maternal mortality ratio ranking among the highest in the world; this has been exacerbated by high rates of teenage pregnancies and low rates of contraceptive prevalence (DHS, 2013). In 2014, the Ebola Viral Disease outbreak eroded RMNCAH progress and further widened preexisting gaps: service utilization plummeted, service quality deteriorated—in part because of significant losses in human resources for health—and economic, as well as urban-rural disparities, deepened.
Liberia’s country platform is composed of two technical working groups overseen by a health sector coordination committee: the first technical working group focuses on RMNCAH and the second concentrates on health financing. The country also recently joined the International Health Partnership (IHP+) to strengthen coordination in the country.
Under the strong leadership of the Ministry of Health, the RMNCAH Investment Case is being developed in close collaboration with development partners—including the Clinton Health Access Initiative, Jhpiego, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the World Bank, and the World Health Organization (WHO).
Prioritizing integrated RMNCAH approaches and building on ongoing performance-based financing activities, the Liberian Investment Case seeks to improve the delivery of Emergency Obstetric and Neonatal Care services and enhance the delivery of RMNCAH services at community level. In parallel, it proposes to particularly target adolescents with a specific focus on family planning and on strengthening the health system, including human resources for health, primary and secondary health facility infrastructure, and drug and commodity supply chain management. In addition, the Liberian Investment Case emphasizes emergency preparedness, surveillance and response, especially focusing on maternal and neonatal deaths surveillance and response (MNDSR). It also plans to adopt a crosscutting approach to strengthen the Civil Registration and Vital Statistics system as well as reinforce RMNCAH leadership, governance, and management at all levels. To further increase RMNCAH coverage and improve equity, the Investment Case identifies different scenarios, which will be implemented based on available resources, prioritizing counties with the worst RMNCAH indicators as a first step.
Many development partners—such as Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. Agency for International Development (USAID) and the World Bank, with resources from both the International Development Association (IDA) and the GFF Trust Fund, are aligning their financing in support of the Investment Case. Conversely, United Nations organizations, the private sector, as well as civil society—represented by the RMNCAH Goodwill Ambassador—are providing technical support alongside Last Mile Health, Partners in Health and BRAC. They will also play a key role in implementation.
Health Financing Strategy
The health financing strategy prioritizes the development of a Liberia Health Equity Fund (LHEF) to create a sustainable health financing system that guarantees equal access to quality health care and ensures financial protection for all Liberians. It intends to protect vulnerable and poor Liberians from catastrophic health costs through risk pooling and sustainable resources mobilization. The Ministry of Health is also keen to roll out a resource allocation formula to improve the allocative efficiency of health resources. At the same time, the government of Liberia seeks to improve the efficiency and effectiveness of donor funds through IHP+ participation and enhance resource mapping, as well as strengthen joint monitoring and evaluation and joint fiduciary assessments. Further strengthening the sector-wide approach represents another priority in health financing—with an intent to increase the amount of external financing that is “on-budget.”