Rebuilding Basic Health Services in Liberia with Performance-Based Financing: A Conversation with Floride Niyuhire

MSH contributes to health systems strengthening in Liberia through Rebuilding Basic Health Services (RBHS), a USAID-supported project, led by the JSI Research & Training Institute, Inc. We spoke recently with Floride Niyuhire, MD, MPH, a Performance-Based Financing Advisor for RBHS.

Liberia experienced civil war throughout the 1990s, finally ending in 2003. How did civil war affect the health system?

There was total collapse. Infrastructure was destroyed; health facilities were physically destroyed or in need of major repair. There was a severe shortage of qualified health workers. When RBHS came on in 2008, Liberia was just shifting from emergency mode to development mode. The goal was to help strengthen delivery of quality services, human resources for health, infrastructure, and the systems that support them.

What has been MSH’s role in rebuilding the health system?

MSH is one of four implementing partners on RBHS. We support costing of health services, quality assurance and quality improvement, implementation of performance-based financing (PBF), and building capacity of staff at the Ministry of Health and Social Welfare. We’re currently supporting the Ministry with development of clinical standards and rollout of PBF. 

How does performance-based financing contribute to rebuilding the health system?

It’s brought a culture of results to the Ministry. Under PBF, there’s a mechanism for setting performance targets at the central, county, and health facility level. Performance targets are set along with county implementing partners and we hold them accountable for results. They can either earn or lose a bonus based on whether they meet the targets. We’ve seen a renewed interest in achieving results and a gradual improvement of service delivery indicators in facilities implementing PBF. 

What achievements are you most proud of, so far?

I’m most proud of our work with the PBF unit in the Ministry. There are five people in the unit trained on PBF processes and around 35 colleagues who can help to verify results at the county level. That’s a function that was nonexistent before. We spent countless hours mentoring and coaching; now they truly own the PBF intervention and conduct most activities independently.  

What will be the lasting impact of this work?

There is still a lot to be done, and many challenges, but we have strengthened capacity. The PBF work started in the right place, at the central level. Now there’s a critical mass in the Ministry to reach out to counties and strengthen services there. I think the results-driven culture can be replicated at the county level. That will have a lasting impact.