Objective:
To assess the availability of essential
health services in northern
Liberia in 2008; five years after the end of the civil
war.
Methods We carried out a
population-based
household survey in rural Nimba county and a
health facility survey in clinics and
hospitals nearest to study villages. We evaluated access to facilities that provide index essential services artemisinin combination
therapy for
malaria;
integrated management of childhood illness;
human immunodeficiency virus (
HIV) counselling and testing; basic
emergency obstetric care and
treatment of
mental illness. Findings Data were obtained from 1405 individuals (98response rate) selected with a three-stage
population- representative sampling
method; and from 43 of Nimba county's 49
health facilities selected because of proximity to the study villages.
Respondents travelled an average of 136 minutes to reach a
health facility. All
respondents could access
malaria treatment at the nearest facility and 55.9could access
HIV testing. Only 26.8; 14.5; and 12.1could access
emergency obstetric care; integrated management of
child illness and
mental health services; respectively. Conclusion Although there has been progress in providing basic services; rural Liberians still have limited access to
life-saving
health care. The reasons for the disparities in the services available to the
population are technical and political. More frequently available services (
HIV testing;
malaria treatment) were less complex to implement and represented
diseases favoured by bilateral and multilateral
health sector
donors. Systematic
investments in the
health system are required to ensure that
health services respond to current and
future health priorities