Liberia’s health system has been deeply affected by its history, particularly the 14-year civil conflict (1989–2003), which decimated health infrastructure and disrupted essential services. Post-war reconstruction relied heavily on international aid. The Basic Package of Health Services was implemented in 2008, aimed at expanding access to essential services, particularly for maternal and child health.
The 2014–2016 Ebola outbreak further crippled the health system, leading to an exodus of health care workers and a halt in service delivery. Liberia has faced persistent challenges in restoring and expanding its health care services. Government spending on health remains low, with out-of-pocket (OOP) expenditures and donor contributions playing a significant role in health financing.
Barriers to sustainable health financing
Liberia faces several significant barriers that hinder sustainable health financing.
- Limited domestic revenue: The government allocated approximately 3.7% of the overall government budget to the health sector in 2021,[1] which is well below the 15% target the Abuja Declaration set. As a low-income country, Liberia grapples with broader economic challenges that limit fiscal space for health financing.
- Historically high dependence on donor funding: A significant share of health financing in Liberia is provided by international donors – 17.6% – the government makes additional, smaller contributions. This reliance creates vulnerabilities, particularly as global funding dynamics shift and donor priorities change. As of 2021, OOP expenditure made up 24.7% of current health expenditure.[1]
Reforms for universal health coverage
In pursuit of advancing universal health coverage, Liberia has undertaken various reforms. The design of the revised Essential Package of Health Services provides a core set of high-priority interventions, including 78 publicly financed interventions intended to be accessible free at the point of use. Furthermore, the government conducted a fiscal space analysis to explore avenues to expand its health budget. Liberia has implemented performance-based financing schemes aimed at improving maternal and child health service delivery efficiency and equity. Finally, the ministry of health started planning for a national health insurance system in 2014, envisaged to become the Liberia Health Equity Fund.
References
[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)
