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.
The majority of the country's hospitals remain in generally poor physical condition; are staffed with insufficient numbers of productive, responsive, and qualified staff in key areas of competence; have long waiting times; and lack equipment and drugs.
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.
Saidu Kay Sesay (far right) vaccinating children at the Princess Christian maternity Hospital on March 10, 2015 in Freetown Sierra Leone. Photo © Dominic Chavez/World Bank
This document outlines the protocol for the impact evaluation of the hospital improvement program, which aims to understand how facilities met quality targets, give an estimate of the impact of the project and investigate the mechanism for success, as well as provide general lessons about the quality of health care in low-income countries. In particular, the impact evaluation focuses on the changes in human resources within the hospitals and understanding better how PBF is functioning within hospitals, through the collection and analysis of data on competence, capacity, and performance.