The Liberia Health Systems Strengthening Project (HSSP) aims to strengthen the institutional capacity needed to improve maternal health, child health, and infectious disease related health outcomes at target facilities. The project utilizes an innovative approach involving systematic and coordinated improvements in the quality of services delivered at target facilities (through performance-based incentives), and an expansion of health worker skills (through the provision of specialized training, and decentralization of specialist availability). Specifically, the project will:

  • (a) focus on improving the quality of care standards (in both diagnosis and treatment) for services with proven effectiveness;
  • (b) increase the availability of qualified graduate physicians (pediatricians, obstetricians, general surgeons, and internal medicine specialists, with cross-cutting focus on anesthesiology);
  • (c) enhance the clinical capabilities and competencies of mid-level cadres - nurses, midwives, and physician assistants- in emergency obstetrics, surgery, pediatrics, and internal medicine;  
  • (d) improve provider-accountability mechanisms related to both the achievement of results, and health-worker performance at selected facilities.

These improvements should provide a thrust towards improved outcomes.

The project includes an impact evaluation that will attempt to estimate the causal impact of project interventions on key health (and related) outcomes. Specifically, the impact evaluation takes the project as a given, and therefore is designed without control over either the selection of the six targeted hospitals, or the timing or structure of the interventions. The impact evaluation is based on a combination of two strategies:

  • A simple before and after comparison of outcomes in all six hospitals
  • A series of small augmented interventions at each hospital with randomized treatment groups and timing. In the end we will be able to make important but not statistically rigorous statements about the project itself and statistically rigorous statements about how some of the components of the program interact with the existing human resources for health (HRH) conditions in Liberia.

Findings are also expected to significantly advance our understanding of the interaction between HRH and incentives within hospitals in low resource settings.


The quantitative and qualitative baseline reports are available and the endline survey is scheduled for the end of 2018.