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Health system outcomes

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Health systems have multiple goals.[1] The world health report 2000[2]defined overall health system outcomes or goals as improving health and health equity in ways that are:

  • responsive
  • financially fair
  • make the best, or most efficient, use of available resources.

There are also important intermediate goals: the route from inputs to health outcomes is through achieving greater access to, and coverage for, effective health interventions without compromising efforts to ensure provider quality and safety.

The health systems access framework[3]

Countries try to protect the health of their citizens. They may be more or less successful, and more or less committed, but the tendency is one of trying to make progress, in three dimensions:

  • First, countries try to broaden the range of benefits (programmes, interventions, goods, services) to which their citizens are entitled.
  • Second, they extend access to these health goods and services to wider population groups and ultimately to all citizens: the notion of universal access to these benefits.
  • Finally, they try to provide citizens with social protection against untoward financial and social consequences of taking up health care. Of particular interest is protection against catastrophic expenditure and poverty.

In health policy and public health literature, the shorthand for these entitlements of universal access to a specified package of health benefits and social protection is universal coverage.

This section of the Health system outcomes profile is structured as follows:


Analytical summary

Immunization coverage in Liberia shows an overall gradual increase from 2010. Three doses of pentavalent vaccine (Penta-3) coverage increased from 73% in 2010 to 78% in 2011, while polio third dose coverage increased from 72% to 77% during the same period (see figure).[2]

Immunization coverage by antigens, 2010-2011[2]

The Comprehensive food security and nutrition survey 2010 found that 42% of Liberian children aged under 5 years are stunted, increasing their risk of dying from normal childhood illness and of developing chronic illnesses later in life. Rural areas have more cases of stunting than urban areas. Montserrado county has the lowest prevalence at 31%, while nine other counties exceed 40%.[3]

The National Nutritional Policy was developed in 2009 to improve the nutritional status of the population, especially children. The National Food Security and Nutrition Strategy is multisectoral and oriented toward communities, households and individuals to reduce the high levels of food insecurity and malnutrition.

Malaria prevalence rate[1][4] LMIS, Liberia malaria indicator survey

Malaria is the leading cause of morbidity and mortality, accounting for 38% of outpatient attendance and 42% of inpatient deaths, respectively. The major achievements in malaria control include:

  • 47% of households have at least one insecticide treated bednet (up from 18%);
  • 45% of women now receive two or more intermittent preventative treatments during their most recent pregnancy (up from 4.5 %);
  • 17% of children aged under 5 years now receive prompt and effective treatment for malaria within 24 hours of onset of fever (up from 5%).

Overall, malaria prevalence has reduced (see figure) and access to prompt and effective treatment has expanded.

There has been a decline in the presence of skilled birth attendants at birth. The Liberia demographic and health survey 2007 figure was 46%, reflecting a 45% decline in 21 years.[5] The decline of skilled attendants at birth is attributed to:

  • migration of qualified health workers;
  • destruction of health facilities and very low production of human resources for health as a direct result of the civil unrest during that period.

The tuberculosis case detection rate increased from 61% in 2008 to 80% in 2011. However, the current figure is still above the WHO recommended target of 70%. Sustaining and increasing access to treatment is a great challenge. The tuberculosis treatment success rate has shown a remarkable improvement of 19% (from 67% in 2008 to 86% in 2011).[2]

General overview and systemic outcomes

Priorities and ways forward


Endnotes: References, sources, methods, abbreviations, etc.

  1. 1.0 1.1 Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
  2. 2.0 2.1 2.2 2.3 The world health report 2000. Health systems: improving performance (pdf 1.65Mb). Geneva, World Health Organization, 2000
  3. 3.0 3.1 The world medicines situation (pdf 1.03Mb). Geneva, World Health Organization, 2004
  4. Liberia malaria indicator survey, 2009 (pdf 1.04Mb). Monrovia, Government of Liberia, Ministry of Health and Social Welfare and Liberia Institute of Statistics and Geo-Information Services; and ICF Macro, Calverton, Maryland, 2009
  5. Liberia demographic and health survey 2007 (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