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Analytical summary - Social determinants

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According to the National population and housing census, 2008 Liberia’s population is estimated at 3 476 608 persons, with an annual growth rate of 2.1%. The overall sex ratio (males per 100 females) in the population is 100.2, which means an almost even distribution of the population between males (1 739 945) and females (1 736 663). Average household size is around 5.1 persons. There are indications of increasing urbanization, which is a challenging environmental health issue.[1]

In 2008, the national population density was 93 persons per square mile, ranging from as high as 1540 for Montserrado to as low 22 for Gbarpolu. There were 17 major ethnic affiliations. Most Liberians (86%) identified themselves as Christian, while Muslims made up 12.2% and “Other” made up 2.2%. Nationally, 47% of the population lives in urban areas.[1]

Girl drinking water, Liberia

The proportion of houses with improved sources of water is gradually increasing, signifying progress towards Millennium Development Goal 7. The Liberia demographic and health survey, 2007[2] and Liberia malaria indicator survey, 2009[3] show an improvement from 67% to 75% of households with access to improved sources of water.

The Liberia malaria indicator survey 2009 also found that 43% of households have access to an improved sanitary facility, while significant rural/urban disparities exist. Improved sanitation is available to 63% of urban households but only 27% of rural households.[3]

Progress toward achieving the goal of universal primary education is gradually increasing but is unlikely to be attained. In Liberia, there is free and compulsory primary education supported by significant grants.

Significant percentages of Liberians have little or no education, with females being less educated than males. A total of 42% of women and 18% of men have never attended school. While 19% of men have completed secondary school or higher, only 8% of women have accomplished the same. For both women and men, urban residents are better educated than rural residents. These low rates have an implication not only for achieving the Millennium Development Goals but also on health outcomes.[2]

The Ministry of Health and Social Welfare rapid assessment 2006 identified 354 functioning health facilities in Liberia, which include 306 public and 48 private (mostly faith-based) facilities.[4]

In 2010, the number of functioning health facilities equalled the National Health Plan target of 550 (378 public and 172 private). However, the dramatic increase in functional facilities cannot be fully attributed to improved services. Access to health care is a major determinant of health.

The National population and housing census, 2008 reported that 40% of all households travel 1 hour or more to the nearest health facility. This figure represents over two thirds of households in rural areas.[1]

According to the Core Welfare Indicator Questionnaire 2007, 63.8% of Liberians live below the poverty line. In absolute terms, the proportion of population living below poverty line – those living on less than US$ 1 a day – is 1.7 million, with 48% (1.3 million people) living in extreme poverty. The level of poverty in rural area (67.7%) is higher than that in urban areas (55%).

Poverty is on the decline but not at an appreciable rate to reach Millennium Development Goal targets by 2015. With pervasive poverty within the population, access to quality health care, food security and basic social services is a challenge. At present, women represent more than 54% of the informal sector.

The Liberia national health accounts, 2007–2008 estimated a total health and social welfare expenditure of US$ 103 496 421, or over US$ 29 per person in Liberia. Donors and out-of-pocket financing accounted for most of the expenditure (47% and 35%, respectively).[5]

According to the national health accounts, Government spending was 15% and has remained stable as a percentage of the national budget (between 7% and 8 %) over 4 years, although it more than doubled in absolute terms from US$ 10 913 584 in fiscal year 2006 to $ 25 767 030 in 2009.[5]

References

  1. 1.0 1.1 1.2 National population and housing census, 2008: preliminary results. Monrovia, Liberia Institute of Statistics and Geo-Information Services (LISGIS), 2008
  2. 2.0 2.1 Liberia demographic and health survey, 2007 (pdf 2.5Mb). Monrovia, Liberia Institute of Statistics and Geo-Information Services, Ministry of Health and Social Welfare National AIDS Control Program and Macro International, 2008
  3. 3.0 3.1 Liberia malaria indicator survey, 2009 (pdf 1.04Mb). Monrovia, Ministry of Health and Social Welfare, National Malaria Control Program and Liberia Institute of Statistics and Geo-Information Services, and ICF Macro, Calverton, Maryland, 2009
  4. Ministry of Health and Social Welfare rapid assessment, 2006. Monrovia, Government of Liberia, Ministry of Health and Social Welfare, 2006
  5. 5.0 5.1 Liberia national health accounts, 2007/08. Monrovia, Government of Liberia, Ministry of Health and Social Welfare, 2009