In Liberia, JSI has been working with the national government for six years to strengthen the health care system, and I’m pleased that we have reached the point where we can support the decision of the Government of Liberia to pursue Universal Health Coverage (UHC), with the goal to ensure, in the words of H.E. President Ellen Johnson Sirleaf, “that all our people obtain quality and affordable health services.” It’s an important stage in Liberia’s development, and we are proud of our contributions that allow this nation to pursue better health care for all.
Global health strategies are increasingly focusing on preparing health systems to deliver equitable opportunities for health, which means not only curative, but promotional, preventive, and rehabilitation services, and not just accessible but appropriate, high-quality and affordable services. The international community with all its development organizations has come a long way, but not yet far enough. From the original goal of relief – still needed in too many countries – we progressed to providing services, including immunizations, family planning, and maternal health care, followed by more comprehensive health systems strengthening support. The Millennium Development Goals set global indicators to monitor progress to achieve these goals. Every day in recent years, more countries decided that, to improve the health status of their citizens, they need services and interventions that ensure a continuum of care across the life span. To find indicators to measure advances toward this goal is not an easy task but the strong commitment of the international community and national governments, as is the case in Liberia, guarantee a quick way forward.
Strengthening health systems as well as developing solid strategies for health financing are necessary, fundamental steps to achieving universal coverage, as a country needs to have these systems in place in order to provide the identified essential package of services for its entire population.
World Health Organization Director-General Margaret Chan has been a forceful proponent in the current push for health coverage expansion. “In my view,” Chan said in her May 2012 speech, accepting a second five-year appointment, “universal coverage is the single most powerful concept that public health has to offer.”
Liberia has made the decision to pursue universal health coverage through a national health insurance scheme involving new funding mechanisms. Recently, the Rebuilding Basic Health Services project team in Liberia traveled with government officials to Accra, Ghana, to learn about progress in implementing universal health insurance coverage there. We went not only to observe Ghana’s practices, but also to help Liberian officials understand the importance of universal health care and to demonstrate the link between healthy populations and economically prosperous communities. Some of the lessons learned from the study tour include:
- Payroll taxes, value-added and sales taxes appeared critical to enlarging the health financing pool to support the Liberian Health Equity Fund (LHEF–the title of the national health insurance system in Liberia);
- Sustainability of the mechanism is critical and requires ongoing focused attention;
- Donor funding is likely needed in the short term;
- Health financing can be harmonized with a proposal to incorporate performance-based financing into the purchasing mechanism to incentivize providers to seek more patients;
- It is better to start with a smaller benefit package and add on services over time;
- Though mandatory enrollment is recommended to ensure UHC, it is difficult to enforce.
The commitment of the President Sirleaf, as well as the solid and sustainable steps to enhance the health system and improve health financial mechanisms that Liberia has taken with the support of the Rebuilding Basic Health System team, are encouraging elements, but universal health coverage still is a long way down the road. The commitment of JSI and its partners to support the Government of Liberia in this journey is stronger that ever.
 The World Health Organization definition of universal health coverage touches on all of these: UHC means “ensuring that all people can use the promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”