A Policy Analysis of the Primary Health Care Approach in Liberia
Abstract
:1. Introduction
Overview of Liberia’s Health System
2. Materials and Methods
3. Results
3.1. Primary Health Care Policy
3.2. Policy Analysis using the Walt and Gilson Policy Triangle
3.2.1. The Context
3.2.2. The Actors
3.2.3. The Content
3.2.4. The Gaps
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Policy Document | Year |
---|---|
National Drug Policy, | 2001 |
National Health Policy and Plan | 2007–2011 |
Basic Package of Health and Social Services, | 2008 |
National Sexual and Reproductive Health Policy, | 2010 |
Liberia National Community Health Services Policy | 2011 |
Essential Package of Health Services | 2011 |
National Health and Social Welfare Policy and Plan | 2011–2021 |
National Human Resources Policy and Plan for Health and Social Welfare | 2011–2021 |
National Health and Social Welfare Financing Policy and Plan, | 2011–2021 |
Investment Plan for Building a Resilient Health System in Liberia, | 2015–2021 |
National Policy and Strategic Plan on Health Promotion | 2016–2021 |
Policy Document | Status | Level of Adoption | Explanation of the Document |
---|---|---|---|
National Drug Policy, 2001 [26] | Current | National/subnational | Guides the utilization of available resources in the development of pharmaceutical services to meet Liberia’s requirements in the prevention, diagnosis, and treatment of diseases by using efficacious, high quality, safe and cost-effective pharmaceutical products |
National Health Policy and Plan, 2007–2011 [27] | Outdated | National/subnational | Outlines the objectives, strategies, and resources to reform the health sector to effectively deliver quality health and social welfare services to the people of Liberia. Guided by the principles of PHC, Decentralization, Community Empowerment and Partnerships for Health. |
National Nutrition policy, 2008 [28] | Current | National/subnational | Complements the NHSWPP and the Food Security and Nutrition strategy in supporting public actions to improve nutrition. |
Liberia National Community Health Services Policy, 2011 [29] | Current | National/subnational | Defines the vision and overall goals for national community health services, specifying the framework of implementation that integrates the community, clinics, and health centers with the County and National health system, through trained community health volunteers. |
National Sexual and Reproductive Health Policy, 2010 [30] | Current | National/subnational | Guides the delivery of comprehensive Sexual and Reproductive Health (SRH) services across the country and defines the vision of SRH through principles of equity and universal coverage. |
National Health and Social Welfare Policy and Plan, 2011–2021 [7] | Current | National/subnational | Outlines the objectives, strategies, and resources to reform the health sector to effectively deliver quality health and social welfare services to the people of Liberia. Guided by the principles of PHC, Decentralization, Community Empowerment and Partnerships for Health. |
National Human Resources Policy and Plan for Health and Social Welfare 2011–2021 [31] | Current | National/subnational | Defines the vision for addressing the human resources problems in the health sector to ensure that everyone at every tier receives equitable and affordable access to motivated, productive, fairly paid, qualified health and social welfare workers. |
National Health and Social Welfare Financing Policy and Plan, 2011–2021 [32] | Current | National/subnational | Ensures that services provided are affordable to the population while preventing catastrophic household health and social welfare expenditures. It is based on the PHC principles of equity, quality, efficiency, decentralization, sustainability, and partnerships. |
National Policy and Strategic Plan on Health Promotion 2016–2021 [33] | Current | National/subnational | Guides activities directed at the adoption and maintenance of healthy behaviors and practices among individuals, families and communities through information, education, advocacy, mobilization, and empowerment. |
Mental Health Policy and Strategic Plan for Liberia, 2016–2021 [34] | Current | National/subnational | Defines the vision for mental health care that emphasizes community-based services, training of PHC providers in the recognition, prevention, and treatment of mental illnesses. |
Complementary documents | |||
Basic Package of Health and Social Services, 2008 [35] | Current | National/subnational | Describes sets of standardized packages of services to be implemented at every level in the healthcare system. |
Essential Package of Health Services, 2011 [8] | Current | National/subnational | Expands on the services provided in the BPHS and describes a standardized package of services to be implemented at every level in the health system. |
Investment Plan for Building a Resilient Health System in Liberia, 2015 to 2021 [13] | Current | National/subnational | Complements the NHSWPP and outlines emergency response services and strategies, investment in system strengthening and capacity building. |
Categories | Context Factors | Description/Determinants of the Factors |
---|---|---|
Structural | The Socio-Economic | Marginal economic growth |
Deepening poverty | ||
Post-conflict | ||
Inequity in economic development between rural and urban settings | ||
Democratic election/legitimate government | ||
Demography | Relatively young population | |
Population growth | ||
A growing number of refugees from neighboring countries | ||
Morbidity and Mortality | High maternal mortality ratio | |
The high infant mortality rate | ||
High under 5 mortality rates | ||
High burden of communicable diseases (e.g., Malaria, TB, HIV) and high prevalence of mental health disorders | ||
Nutrition | High prevalence of malnutrition | |
Water and sanitation | Low access to improved sources of water | |
Significant disparities of access to sanitation between urban and rural settings | ||
Increasing sanitation problems in populated, urban areas | ||
Access to health care and social welfare | Insufficient health facilities | |
A growing number of target groups (e.g., Children, adolescents, prisoners, substance abusers, elderly, victims of disasters) | ||
Fragmentation in service delivery | ||
Resources | Insufficient human resources for health | |
High Out-of-pocket and donor funding, low government expenditure for health | ||
Frequent stock-outs of drugs at health facilities, unregulated drug management system | ||
Decentralization | Dysfunctional or non-existent management system | |
Global | International Agenda | Millennium Development Goals |
Cultural | Stigmatization | Attitude towards mental health |
Policy | Year | Stakeholders | Role | Local Health Care Providers * | Community Representation |
---|---|---|---|---|---|
National Drug Policy | 2001 | International
| Financial support | NA | |
Local
| Technical support | A.M. Dogliotti College of Medicine, School of Pharmacy, Pharmacy Board, Liberia Bar Association | |||
National Health Policy and Plan | 2007–2011 | International
| Steering committee | NA | NA |
Local
| |||||
| Financial Support | ||||
International
| Technical Assistance | ||||
Local
| |||||
National Nutrition Policy | 2008 | International
| Financial and/or technical support | NA | NA |
Local
| |||||
Basic Package of Health and Social Services | 2008 | International
| Technical support and/or otherwise unspecified | Mother Pattern College of Health Sciences and Laboratory Technicians Association | NA |
Local
| |||||
National Sexual and Reproductive Health Policy | 2010 | International
| Technical Assistance | Unspecified health institutions and professional bodies | NA |
Local
| |||||
Liberia National Community Health Services Policy | 2011 | International
| Technical Assistance | NA | NA |
Local
| |||||
Essential Package of Health Services | 2011 | International
| Technical support | NA | NA |
Local
| |||||
National Health and Social Welfare Policy and Plan | 2011–2021 | International
| Unspecified | NA | Unspecified community, civil society, and religious groups |
Local
| |||||
National Health and Social Welfare Financing Policy and Plan | 2011–2021 | International
| Unspecified | NA | Unspecified community and civil society representatives involved |
Local
| |||||
National Human Resources Policy and Plan for Health and Social Welfare | 2011–2021 | International
| Unspecified | NA | NA |
Local
| |||||
Investment Plan for Building a Resilient Health System in Liberia | 2015–2021 | International
| Technical assistance and support | NA | NA |
Local
| |||||
National Policy and Strategic Plan on Health Promotion | 2016–2021 | International
| Financial and/or Technical Support | NA | Liberia Crusaders for Peace (LCP) Inter-Faith-Religious Council |
Local
| |||||
Mental Health Policy and Strategic Plan for Liberia | 2016–2021 | International
| Financial and/or Technical support | Mental Health Clinicians, Accreditation bodies | NA |
Local
|
Policy Document | PHC Content Focus | Service Provision Plans and Clear Guidelines |
---|---|---|
National Drug Policy, 2001 | Focuses on:
| No specific reference to PHC |
National Nutrition Policy, 2008 | Focuses on:
| No specific reference to PHC |
Basic Package of Health and Social Services, 2008 | Focuses on:
| Addresses six national priority health areas focused on a PHC approach:
|
National Sexual and Reproductive Health Policy, 2010 | The focus on:
| No specific reference to PHC |
Liberia National Community Health Services Policy, 2011 | The document reflects the community health component of the NHP of 2011–2021 which focuses on a PHC approach:
| There is the availability of clear service provision plans and strategies, grounded on a PHC approach. |
Essential Package of Health Services, 2011 | Focuses on: strengthening PHC and decentralization, by the provision of basic services universally without user fees | See above at National Health policy service provision |
National Health and Social Welfare Policy and Plan, 2011–2021 | Emphasizes PHC as the foundation and model for service delivery by focusing on:
| The PHC approach is implicitly mentioned in the accompanied Health Plan, to be affected by the Essential Package of Health Services (EPHS) through eleven service delivery areas:
|
National Human Resources Policy and Plan for Health and Social Welfare 2011–2021 | Focuses on:
| No specific reference to PHC |
National Health and Social Welfare Financing Policy and Plan, 2011–2021 | Focuses on:
| No specific reference to PHC |
Investment Plan for Building a Resilient Health System in Liberia, 2015–2021 | Focuses on health system strengthening and 3 key objectives areas:
| No specific reference to PHC |
National Policy and Strategic Plan on Health Promotion 2016–2021 | Focuses on:
| No specific reference to PHC |
Mental Health Policy and Strategic Plan for Liberia, 2016–2021 | Focuses on:
| No specific reference to PHC |
Policy Document | Process | Stakeholders Involved | Monitoring and Evaluation |
---|---|---|---|
National Drug Policy, 2001 | Consultative | Internal and external stakeholders including non-health sector actors | Yes |
Participatory | |||
National Nutrition Policy, 2008 | No Relevant Data | Internal and external stakeholders | Yes |
Basic Package of Health and Social Services, 2008 | Prioritization Process | Internal and external stakeholders | Yes |
National Sexual and Reproductive Health Policy, 2010 | Participatory | Internal and external stakeholders | Yes |
Liberia National Community Health Services Policy, 2011 | No Relevant Data | Several internal and external stakeholders | Yes |
Essential Package of Health Services, 2011 | No Relevant Data | Internal and external stakeholders | No relevant data |
National Health and Social Welfare Policy and Plan, 2011–2021 | Participatory | Representatives from communities, civil society groups, district, the county as well as other internal and external stakeholders | Yes |
Consultative | |||
Situational Analysis | |||
National Human Resources Policy and Plan for Health and Social Welfare 2011–2021 | Consultative | Internal and external stakeholders | Yes |
Participatory | |||
Situational Analysis | |||
National Health and Social Welfare Financing Policy and Plan, 2011–2021 | Participatory | Internal and external stakeholders | Yes |
Evidence-Based (Literature Review) | |||
Consultative | |||
Investment Plan for Building a Resilient Health System in Liberia, 2015 to 2021 | Consultative | Internal and external stakeholders | Yes |
National Policy and Strategic Plan on Health Promotion 2016–2021 | Participatory | Internal and external stakeholders | Yes |
Mental Health Policy and Strategic Plan for Liberia, 2016–2021 | Consultative | Internal and external stakeholders | Yes |
Primary Health Care Elements | Policy * | Gap | Level of Gap Existence |
---|---|---|---|
Education and Health Communication |
|
| Policy and Implementation |
Promotion of food supply and proper nutrition |
|
| Implementation |
An adequate supply of safe water and basic sanitation |
|
| Implementation |
Maternal and child health, including family planning |
|
| Policy and Implementation |
Immunization against the major infectious diseases |
|
| Implementation |
Prevention and control of locally endemic diseases |
|
| Implementation |
Appropriate treatment of common diseases and injuries |
|
| Implementation |
Provision of essential drugs |
|
| Policy and Implementation |
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Dadzie, J.E.; Kanagasabai, U. A Policy Analysis of the Primary Health Care Approach in Liberia. Hygiene 2022, 2, 44-62. https://doi.org/10.3390/hygiene2010004
Dadzie JE, Kanagasabai U. A Policy Analysis of the Primary Health Care Approach in Liberia. Hygiene. 2022; 2(1):44-62. https://doi.org/10.3390/hygiene2010004
Chicago/Turabian StyleDadzie, Jeffrey E., and Udhayashankar Kanagasabai. 2022. "A Policy Analysis of the Primary Health Care Approach in Liberia" Hygiene 2, no. 1: 44-62. https://doi.org/10.3390/hygiene2010004