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Implementing a Basic Package of Health Services in post-conflict Liberia: Perceptions of key stakeholders

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  • Petit, Dörte
  • Sondorp, Egbert
  • Mayhew, Susannah
  • Roura, Maria
  • Roberts, Bayard

Abstract

Recovery of the health sector in post-conflict countries is increasingly initiated through a Basic Package of Health Services (BPHS) approach. The country government and partners, including international donors, typically contract international and local NGOs to deliver the BPHS. Evidence from routine data suggests that a BPHS approach results in rapid increases in service coverage, coordination, equity, and efficiency. However, studies also show progress may then slow down, the cause of which is not immediately obvious from routine data. Qualitative research can provide insight into possible barriers in the implementation process, particularly the role of health workers delivering the BPHS services. The aim of this study was to explore perceptions of health service providers and policy makers on the implementation of the BPHS in post-conflict Liberia, using SRH services as a tracer and Lipsky's work on “street-level bureaucrats” as a theoretical framework. In July–October 2010, 63 interviews were conducted with midwives, officers-in-charge, and supervisors in two counties of Liberia, and with policy makers in Monrovia. The findings suggest health workers had a limited understanding of the BPHS and associated it with low salaries, difficult working conditions, and limited support from policy makers. Health workers responded by sub-optimal delivery of certain services (such as facility-based deliveries), parallel private services, and leaving their posts. These responses risk distorting and undermining the BPHS implementation. There were also clear differences in the perspectives of health workers and policy makers on the BPHS implementation. The findings suggest the need for greater dialogue between policy makers and health workers to improve understanding of the BPHS and recognition of the working conditions in order to help achieve the potential benefits of the BPHS in Liberia.

Suggested Citation

  • Petit, Dörte & Sondorp, Egbert & Mayhew, Susannah & Roura, Maria & Roberts, Bayard, 2013. "Implementing a Basic Package of Health Services in post-conflict Liberia: Perceptions of key stakeholders," Social Science & Medicine, Elsevier, vol. 78(C), pages 42-49.
    • Handle: RePEc:eee:socmed:v:78:y:2013:i:c:p:42-49
    DOI: 10.1016/j.socscimed.2012.11.026
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    References listed on IDEAS

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    1. Walker, Liz & Gilson, Lucy, 2004. "'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa," Social Science & Medicine, Elsevier, vol. 59(6), pages 1251-1261, September.
    2. International Monetary Fund, 2008. "Liberia: Poverty Reduction Strategy Paper," IMF Staff Country Reports 2008/219, International Monetary Fund.
    3. Hugh Waters & Gilbert Burnham & Brinnon Garrett, 2007. "Rehabilitating Health Systems in Post-Conflict Situations," WIDER Working Paper Series RP2007-06, World Institute for Development Economic Research (UNU-WIDER).
    4. Sabatier, Paul A., 1986. "Top-Down and Bottom-Up Approaches to Implementation Research: a Critical Analysis and Suggested Synthesis," Journal of Public Policy, Cambridge University Press, vol. 6(1), pages 21-48, January.
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    Cited by:

    1. Bertone, Maria Paola & Jowett, Matthew & Dale, Elina & Witter, Sophie, 2019. "Health financing in fragile and conflict-affected settings: What do we know, seven years on?," Social Science & Medicine, Elsevier, vol. 232(C), pages 209-219.
    2. Luginaah, Isaac N. & Kangmennaang, Joseph & Fallah, Mosoka & Dahn, Bernice & Kateh, Francis & Nyenswah, Tolbert, 2016. "Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context," Social Science & Medicine, Elsevier, vol. 160(C), pages 75-86.
    3. Bradbury-Jones, Caroline & Taylor, Julie & Herber, Oliver, 2014. "How theory is used and articulated in qualitative research: Development of a new typology," Social Science & Medicine, Elsevier, vol. 120(C), pages 135-141.
    4. Atinga, Roger A. & Agyepong, Irene Akua & Esena, Reuben K., 2018. "Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation," Social Science & Medicine, Elsevier, vol. 201(C), pages 27-34.
    5. Lange, Isabelle L. & Feroz, Ferozuddin & Naeem, Ahmad Jan & Saeedzai, Sayed Ataullah & Arifi, Fatima & Singh, Neha & Blanchet, Karl, 2022. "The development of Afghanistan's Integrated Package of Essential Health Services: Evidence, expertise and ethics in a priority setting process," Social Science & Medicine, Elsevier, vol. 305(C).

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