Building Sustainable Capacity for Performance-Based Financing in Liberia’s Health System


The Liberian health system suffered serious setbacks during the 14-year civil war (1989-2003), when trained health workers fled the country, training institutions closed, and health facilities were demolished. Since the end of the conflict, domestic and international efforts and invest- ments have helped produce steady gains. None- theless, Liberia's maternal mortality ratio remains one of the highest worldwide, at 770 deaths per 100,000 live births.1 The infant mortality rate is 54 deaths per 1,000 live births, and the under-five mortality rate stands at 94 deaths per 1,000 live births (Liberia DHS 2013).

In January 2011, the average accreditation score of government health facilities (clinics, health centers, and hospitals) for delivering the Basic Package of Health Services (BPHS) was 84 percent, up from 38 percent in 2008; these scores rate a facility's readiness to deliver care. However, the quality of care, which measures implementation of clinical standards, was only 38 percent in 2013.