Written by Bal Rham Bhui, M&E Director, Dr Theo Lippeveld, DCOP, Rebuilding Basic Health Services (RBHS), and Hannah Merchant, Program Officer from JSI Research & Training Institute, Inc
A country ravaged by 14 years of civil war, Liberia has imminent needs spanning every sector. Both the international community and the Government of Liberia (GoL) have identified strengthening health systems as a key priority. The civil war reduced the available health workforce and impacted the country’s ability to provide essential health services. Although the GoL made significant progress in development, access to medical care remained a challenge. Lack of knowledge about the level of services available to the community hampered the GoL’s ability to improve access to services.
In order to address this knowledge gap and strengthen health services, JSI’s Rebuilding Basic Health Services (RBHS) project employed geographic information system (GIS) technology in close collaboration with the Liberia Ministry of Health and Social Welfare (MOHSW) and the Liberia Institute of Statistics and Geo-Information Services. By documenting population data and health center locations through GIS in a process referred to as resource mapping, the MOHSW was able to visually and comprehensively determine which communities were served by existing health centers. Communities within five kilometers of a health center were defined as having access, and those located farther were defined as not being served by the existing health system. Using this information, RBHS helped the MOHSW develop a guideline for designing a catchment area for each health facility.
The knowledge gained through resource mapping led to the development of new community health services delivery system. The GoL created an organized cadre of community health workers and mobile clinics and dispatched them to communities lacking physical access, expanding the reach of the formalized medical system. Furthermore, resource mapping provided a clearer picture of the true reach of the existing health system and subsequently contributed to the development of the Liberian National Health Policy 2011-2021.
The National Health Policy emphasizes the importance of meeting the health needs of all Liberian citizens. Due to the success of the initial resource mapping exercise, the GOL, in partnership with RBHS, is employing GIS to identify gaps in the delivery of community health services by examining the location and distribution of community health volunteers, their catchment areas, and mobile clinic sites. RBHS is also adopting resource mapping processes to designate guidelines for community health volunteers’ catchment areas. This activity includes comprehensive training and supervision of community health volunteers and institutionalizing their reach through formalized policies. Finally, as RBHS works toward building local ownership and capacity, MOHSW staff has been trained in GIS software.
The RBHS’s partnership with the GoL has helped moving the country closer toward its goal of universal access to healthcare. In addition, the Government has gained stronger capacity to manage its own needs, particularly in terms of a stronger health workforce. Other Government Ministries have started to seek assistance in using GIS to answer their questions related to geographical access of services.
RBHS is funded by USAID and implemented by JSI Research & Training Institute, Inc., and aims to increase access to health services across the country while building institutional capacity within the decentralized health system.