The basic package of health services and sexual and reproductive health services in Liberia
A qualitative case study on the implications of a Basic Package of Health Services for the provision of sexual and reproductive health services in post-conflict recovery in Liberia.
Between July and October 2010, HAC’s Department of Strategy, Policy and Resource Management (SPR) and the WHO Country Office, in collaboration with the Ministry of Health and Social Welfare of Liberia (MOHSW), conducted qualitative research on the implications of a Basic Package of Health Services (BPHS) for the provision of sexual and reproductive health services (SRH). The study is part a of a larger study by the London School of Hygiene and Tropical Medicine funded by the RAISE Initiative, exploring the effect of humanitarian reform and different aid delivery approaches on SRH services in conflict-affected settings.
The health system in Liberia was devastated by the long conflict. In 2007, the re-established MoHSW developed a National Health Plan, aiming at improved health, equity and post-conflict health recovery. A BPHS was developed as an early priority. The design of basic health packages, comprising a guaranteed minimum set of primary and secondary level public health services is an approach increasingly used in supporting the recovery of health services.
Objectives of the study
The study aimed to make recommendations to inform and improve policy-making in health recovery with specific reference to the provision of SRH services. It aimed:
- to assess the availability of SRH services in health facilities in comparison to the services listed in the BPHS,
- to review opportunities and challenges for SRH service provision and
- to explore the perspectives of policy makers on the impact of the BPHS approach on availability of SRH services.
Outcomes of the preliminary analysis
A total of 60 semi-structured interviews were conducted in two counties and with relevant policy-makers and implementers. Preliminary results indicate that the BPHS is widely appreciated as a useful tool to guarantee common objectives and standards. However, it seems that now a more flexible approach is needed, adjusting services and staffing more to the needs of each individual health facility.
The BPHS may be rather ambitious, creating competing priorities at the expense of effective implementation. While many policy-makers would like to expand the scope of SRH services, staff at facilities already find it difficult to get communities to accept services that are currently included in the package, and do not see a need to expansion for the time being.
One issue impeding the implementation of the BPHS has been inadequate communication between central and facility levels on issues relating to priority setting, quality of care and the full BPHS concept as many staff appear to believe that BPHS refers mainly to the incentive scheme for health workers.
Overall, it seems that the use of a BPHS has been a good starting point for re-establishing SRH services in Liberia, though there is a need for rigorous monitoring to ensure effective implementation as well as close supervision to increase quality of care and staff motivation.
The full list of preliminary results and recommendations have been shared with the WHO country office and the MOHSW, which informed a situational analysis of the BPHS. A report with a more in-depth analysis is under development.