The Challenge

The Government of Liberia is in the process of decentralizing its health system. USAID, a major partner of the Liberia Government in the health sector, asked Social impact to assess the managerial, administrative and clinical readiness of County Health Teams (CHTs) to take on the delegated authorities that were anticipated.

SI’s Solution

SI’s team improved upon an existing assessment questionnaire to determine CHTs’ adequacies in the eight domains of Finance, Human Resources, Leadership and Management, Monitoring and Evaluation, Supply Chain, Service Delivery, Community Health, and Operations. Each of Liberia’s 15 counties were assessed on their ability to carry out essential functions of the country’s health system. Across each of the eight domains, the CHTs were assigned a rating of functional, foundational, limited or absent capacity. The team scaled the assessment to 25 surveys with over 900 questions. These new questionnaires also enhanced SI’s ability to record outcomes by providing detailed sub-questions that moved beyond measuring outputs alone.

In accordance to USAID’s Journey to Self-Reliance approach, the team met on numerous occasions with the Liberian government to ensure buy-in from all departments within the Ministry of Health (MOH). SI gathered several rounds of feedback on the surveys and made adjustments according to local expertise. Developing the surveys in collaboration with the Liberian government facilitated an improved relationship between key donor partners and the government. It also ensured a greater degree of commitment from the government to continually sustain the activities.

Over 8 weeks in mid-2019, 21 trained specialists conducted data collection for the CHT assessment.

Results

The findings revealed that the CHTs were most capable in the domain of finance, and on average, most limited in service delivery. While results within each of the 15 CHTs varied, common weaknesses were a lack of documentation of existing systems, and inadequate funding.

The results from the CHT assessment created several tangible impacts on the health sector in Liberia. SI’s assessment provided data that allowed the MOH to identify areas of weakness in health service implementation. This was later used to synergize donor projects with government programs in the­­­ sector. Most importantly, the assessment prepared Liberia and USAID for a future country-wide Heath Systems Strengthening project. SI’s assessment established baseline data on the CHTs’ capacities. Due to the comprehensive nature of the surveys developed, these capacities can be tracked to examine change over time. The findings of the CHT assessment can additionally inform future funding allocation decisions based on these existing capabilities. The efforts of SI’s team with the CHT assessment established a foundation for strengthening the Liberia CHT network with the goal of ultimately improving health outcomes of the Liberian people.