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Service delivery

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In any health system, good health services are those that deliver effective, safe, good-quality personal and non-personal care to those that need it, when needed, with minimum waste. Services – be they prevention, treatment or rehabilitation – may be delivered in the home, the community, the workplace or in health facilities.[1]

Although there are no universal models for good service delivery, there are some well-established requirements. Effective provision requires trained staff working with the right medicines and equipment, and with adequate financing. Success also requires an organizational environment that provides the right incentives to providers and users. The service delivery building block is concerned with how inputs and services are organized and managed, to ensure access, quality, safety and continuity of care across health conditions, across different locations and over time.

Primary care as a hub of coordination: networking within the community served and with outside partners[2]

Attention should be given to the following:

  • Demand for services. Raising demand, appropriately, requires understanding the user’s perspective, raising public knowledge and reducing barriers to care – cultural, social, financial or gender barriers.
  • Package of integrated services. This should be based on a picture of population health needs; of barriers to the equitable expansion of access to services; and available resources such as money, staff, medicines and supplies.
  • Organization of the provider network. This means considering the whole network of providers, private as well as public; the package of services (personal, non-personal); whether there is oversupply or undersupply; functioning referral systems; the responsibilities of and linkages between different levels and types of provider, including hospitals.
  • Management. Whatever the unit of management (programme, facility, district, etc.) any autonomy, which can encourage innovation, must be balanced by policy and programme consistency and accountability. Supervision and other performance incentives are also key.
  • Infrastructure and logistics. This includes buildings, their plant and equipment; utilities such as power and water supply; waste management; and transport and communication. It also involves investment decisions, with issues of specification, price and procurement and considering the implications of investment in facilities, transport or technologies for recurrent costs, staffing levels, skill needs and maintenance systems.

This section of the Service delivery profile is structured as follows:


Analytical summary

In Liberia, health service delivery is fundamentally linked to geographic distribution of the population and population density. In 2007, the Ministry of Health and Social Welfare committed to establishing a consistent package of evidenced-based, essential health services to the entire population.

Thus, the Basic Package of Health Services was developed in order to ensure equitable access to health services by increasing the overall efficiency and effectiveness of the health systems at all levels. The Basic Package of Health Services prioritized services perceived at the time as the most critically needed to improve the health status of the Liberian population within the available resources.

This Basic Package of Health Services was modified in the current health plan (2011–2021) to include additional services such as noncommunicable diseases, prison health, neglected tropical diseases and is now referred to as the Essential Package of Health Services.

Distribution of health facilities by ownership and year. Source: Ministry of Health and Social Werlfare

There has been a gradual increased in the number of health facilities since 2006. The number increased from 354 in 2006 to 551 in 2010 (see figure). This has increased physical access to health services, although distribution across counties and districts is disproportionate, with 40% of households travelling 1 hour or more to the nearest health facility, especially in rural areas. Though the number of health facility has increased, many of these facilities lack basic equipment, regular electricity and water supply.

In addition, the quality of health services is poor due to limited number of skilled staff at these facilities and frequent absence of essential drugs and medical products.

The 2007 National Health Policy approaches infrastructure from the perspective of distribution of facilities in relation to population density, utilization and geographic access. The intent was for the national level to set the distribution ceilings, based on objective planning criteria. However, the size of the facility network envisaged in the National Health Policy was not based on evidence of actual affordability and accessibility. Instead, the National Health Plan simply projected that minor or major rehabilitation of 110 existing facilities would be required, 30 facilities would need to be reconstructed and 30 new health clinics would need to be constructed in underserved areas.

Antenatal visits are globally encouraged to ensure that pregnant women are assessed regularly and prepared for labour and delivery. In addition, a mother should attend postnatal clinics to be examined by trained health worker within 42 days after delivery in order to prevent and identify postpartum complications.

In 2011, antenatal care four-visit coverage was estimated to be 42%, while only 37% (64 729) of postpartum mothers had postnatal consultations.[3]

Births attended by skilled birth attendant (HMIS, health management information system; LDHS, Liberia demographic and health survey). Source: Ministry of Health and Social Welfare

The decline of skilled attendants at birth (see figure) is attributed to:

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

However, the health sector has made progress in increasing the number of skilled attendant at birth over the past 2 years. Delivery statistics for 2011, based on reported deliveries by health facilities, show an increase of approximately 8% from 2010 to 2011.

Organization and management of health services

Package of services

Public and private health care providers

Person-centredness and characteristics of primary health care services

Shadow practices

Quality of health services

Priorities and ways forward


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

  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. Framework and standards for country health information systems, 2nd ed (pdf 1.87Mb). Geneva, World Health Organization and Health Metrics Network, 2008
  3. Annual report. Monrovia, Government of Liberia, Ministry of Health and Social Welfare, 2011