The civil war destroyed Liberia’s health system. With hospitals and clinics burned to the ground and severe shortage of human resources, the country faced an urgent need to rebuild the health system. Today, despite the impressive gains, Liberia continues to face challenges in improving maternal and child health, as well as other health-related Millennium Development Goal (MDG) outcomes.


Improving the quality of care at hospitals is a key next step in rebuilding Liberia’s health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level.

Progress made through PBC in Liberia in the post-conflict period is a reason for optimism. Keys to success are strong leadership, good communication among partners, flexible and responsive management. This article highlights the overall design of schemes and lessons learned.

In 2008 the Ministry of Health and Social Welfare (MOHSW) of Liberia decided that performance based contracting would be implemented to improve health sector performance and enhance critical health outcomes. Acknowledging the significance of awareness raising and stakeholder engagement, the MOHSW applied and was awarded a World Bank Seed Grant for Results-Based Financing (RBF) to conduct several workshops.

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