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Universal coverage

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Since the restoration of peace and stability, the Ministry of Health and Social Welfare in Liberia has made significant strides in reforming the health sector and improving access to quality health care.

The Ministry is guided in its efforts by the National Health Policy, which outlines the Government of Liberia's plans to rebuild the health system in order to ensure the delivery of quality health services.

Since 2006, the Government has targeted health sector reconstruction and investment and aims to achieve:

  • greater equity of access to health services
  • enhanced resource utilization and productivity
  • closer ties with local communities and partners.

This section of the Universal coverage profile is structured as follows:


Analytical summary

Physical access to primary health care has improved dramatically across Liberia, from one health facility serving an average of 8000 population in 2006 to one health facility per 5500 population in 2009. In several counties, namely Bomi, Grand Cape Mount, Grand Kru, River Cess and Sinoe, this ratio is below one per 4000 population. The national average ratio of facilities to served population is already lower than the norm established by the Basic Package of Health Services.

In light of the registered expansion of physical access to health care facilities (see figure), the inadequate coverage of immunization services is a matter of concern. It improved from 39% of fully immunized children in 2007 to 52% in 2010, but remains low. Most south-eastern counties present a lower than average coverage.

Access to a health care facility

The high out-of-pocket expenditure (35%) on health care in Liberia[1] has contributed to the suboptimal service uptake and may exclude the poorest from direct access to health care. The Liberian population is too poor to afford such a large out-of-pocket burden and this impacts health-seeking behaviour and health outcomes.

The National census of health and social welfare workers in Liberia, 2009[2] reported a total of almost 8553 health workers, of whom 5461 had technical skills. This total corresponds to roughly twice the number considered as active in 2006. In quantitative terms, a workforce of this size, if properly managed, would be more than sufficient to staff the existing health care network. However, the skill mix is another issue, with university- and mid-level cadres being extremely scarce.

There is major geographic variation in skilled staffing levels in Liberia, with the largest shortages in rural areas. The number of nurses and certified midwives per 1000 population varies from 0.9 nurses in Bomi to 0.3 in Nimba. There is a 25% difference in staffing levels between districts that have a county capital and districts that do not have a county capital.[2]

The number of nurses and certified midwives per clinic or per health centre also varies considerably across counties, with the more remote counties in the south-east tending to have the lowest staffing levels.[2]

Leprosy continues to be a public health problem in Liberia. All counties have pockets of leprosy cases with five counties being highly endemic: Grand Gedeh, Grand Kru, Maryland, Nimba and River Gee. The treatment coverage is low, with only 23 (16.7%) of the 137 districts and 24 (4.5%) of the 551 health facilities, both public and private, providing leprosy treatment. Two specialized hospitals serve as referral sites for reactions and complications: Ganta Rehabilitation Centre in Nimba county and the TB Annex Hospital in Monrovia.

Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

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

  1. National health accounts, 2007–2008. Monrovia, Government of Liberia, Ministry of Health and Social Welfare, 2009
  2. 2.0 2.1 2.2 National census of health and social welfare workers in Liberia, 2009. Monrovia, Government of Liberia, Ministry of Health and Social Welfare and Liberia Institute for Geo-Information Services, 2010